What to Expect: Hospital Birth Costs
News flash: Having a baby is expensive. It's the most costly health event families are likely to experience during their childbearing years. A study published in Health Affairs by the University of Michigan found that in 2015 (most recent year available), the average cost of giving birth was $4,500—even with insurance. That's including pregnancy, labor and delivery, and three months of postpartum care.
But a lot of factors can move your bottom line, says Aleksandr M. Fuks, M.D., Director of the Department of Obstetrics and Gynecology at Queens Hospital Center. Here's a break down of what to expect from hospital bills—and how to safely lower them— when you're expecting.
Type of Birth
Whether you deliver your baby vaginally or via a C-section could have a significant impact on the cost. It also depends on what state you live in. According to data collected by Fair Health, the average cost of having a vaginal delivery is between $5,000 and $11,000 in most states.
The numbers are higher for C-sections, with prices ranging from $7,500 to $14,500. You can get an estimate of what childbirth costs are in your state with or without insurance through Fair Health's free healthcare expenses tool. Vaginal deliveries account for about 7 in 10 childbirths, and C-sections for about 3 in 10, according to the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project.
A C-section is a major operation that involves anesthesia, longer hospital stays, and higher instances of morbidity and mortality, says Toni Stern, M.D., Chair of Obstetrics and Gynecology at Coney Island Hospital. All of these mean more resources used—and more dollars spent.
Complications during childbirth further increase the overall cost. For a vaginal delivery with complications requiring an operating room procedure, the cost is an average of $10,700—nearly double the average cost of a vaginal delivery without complications, according to a report by Premier on maternal and infant health trends.
Mom's and Baby's Health
Happy and healthy—that's all that matters, right? Although that wish has nothing to do with hospital costs, complications can really increase them.
Some common (and costly, but not-so-common) delivery complications include premature rupture of the amniotic sac, abnormal presentation, dangerous umbilical cord positioning, difficulty breathing, amniotic fluid embolisms, irregular blood pressure, postpartum hemorrhage, bleeding in the brain, fluid accumulation in the brain, neurological problems, intestinal problems, jaundice and anemia, according to the Mayo Foundation for Medical Education and Research.
Many of these complications are out of your hands, but you can help to make sure they are treated as quickly and easily by getting good old-fashioned prenatal care, Dr. Stern says. You want your health care team to know your and your baby's chart backward and forward, including all of your medications, allergies, health conditions and any problems experienced during pregnancy, as all of these can affect how your doc should treat you on the big day. Talk, talk, talk with your OB-GYN during your prenatal checkups and on the day. She can read your tests, but not your mind.
Be aware that certain health conditions can also increase your risk of complications and delivery costs. Premier's analysis found that women with conditions like diabetes or chronic pain had deliveries that were $1,000 to $2,200 more expensive on average compared to women with uncomplicated deliveries.
Premature birth is one of the largest game-changers in terms of medical costs, occurring in about 1 of 8 pregnancies. Average healthcare for premature/low birth weight infants is nearly 11 times more costly than that for newborns without complications, according to a Thomson Reuters study for March of Dimes.
However, knowing the symptoms and avoiding particular risk factors can lower your chance of going into premature labor. If you are pregnant or trying to become pregnant, talk to your OG-GYN about what you can do to help prevent premature delivery. If you do go into premature labor, your doctor may use medications to halt uterine contractions, according to Mayo Clinic—but those meds are going to cost you. And if they cause additional maternal complications, they are going to cost you even more.
Health Insurance Coverage
You've probably given a lot of thought to your health insurance coverage and costs. But if you don't know your maternity coverage, it's time to take another look. Health insurance is vital to obtaining maternity care services—and being able to afford them, according to the March of Dimes.
Thanks to the Affordable Care Act (ACA), pregnancy is no longer considered a pre-existing condition, and must be covered in all individual and small group insurance policies. If you apply for coverage while pregnant—individual or through your employer—health plans cannot deny you coverage. If your plan covers maternity care, you are entitled to a minimum of 48 hours of hospital stay after a vaginal delivery, and 96 hours after a C-section, according to the Department of Labor. You also don't need to be preauthorized from your insurance plan for the minimum hospital stay to be covered.
Make sure your insurance covers childbirth costs, including baby's nursery care. Depending on your birth plan, you may also want birth setting and labor support options included in your provider's plan. Pay attention to your co-pay, deductible, and what percentage is covered after your deductible is met. Once again, the details of what your plan covers varies by where you live and the type of plan you have, so be sure to carefully read the summary of benefits to fully understand your coverage.
Programs such as Woman, Infants, and Children (WIC) and Children's Health Insurance Program (CHIP) may help you find low-cost coverage if you're not eligible for Medicaid. As of 2020, about 12 percent of women between the ages of 19 and 44 are uninsured in the U.S. Here are additional health assistance resources for pregnant women from the U.S. Department of Health and Human Services.