Mommie Dearest: Why Is Maternity Care So Darn Expensive?

Apparently, when it comes to maternity care costs in this country, I lucked out big time. Seven years ago, when I found myself pregnant for the first time, I had just switched from my own insurance to my husband’s much better one, and had only one, $25 co-payment for the entirety of my pregnancy — including the delivery. That’s it. Twenty-five dollars got me multiple visits with my midwife and a hospital birth (albeit a short one — I was in and out of the hospital in 10 hours, my choice).

Yet, my experience is certainly not the norm when it comes to maternity care costs in this country. The New York Times recently looked into why the U.S. has the most expensive maternity care in the world … despite not necessarily being at the top when it comes to quality of care. The facts are both absolutely terrifying and downright maddening. According to the Times article, prenatal and delivery charges can cost upwards of $50,000, depending on whether the mom-to-be has insurance or needs a C-section. Even for those with insurance, there is still the possibility of a costly birth, especially if your policy does not include maternity care coverage.

My friend Nicole, a teacher from New York, is currently almost a week overdue with her second child. With her first, she was 100 percent covered for the birth and paid nothing. This time around, due to a change in carriers within her policy that took place in March, Nicole and her husband found out that they will have to pay an almost $6,000 deductible when it’s time to hit the hospital. Six thousand dollars. The extreme change in out-of-pocket expenses caught them entirely by surprise.

Unfortunately, Nicole is not alone. I have many friends who’ve experienced similar scenarios. As they’ve changed jobs or insurance companies, many are finding out that their benefits are not covering prenatal and maternity care costs like they expected. This trend seems to be more commonplace, according to the Times:

“[…] plenty of other pregnant women are getting sticker shock in the United States, where charges for delivery have about tripled since 1996, according to an analysis done for The New York Times by Truven Health Analytics. Childbirth in the United States is uniquely expensive, and maternity and newborn care constitute the single biggest category of hospital payouts for most commercial insurers and state Medicaid programs. The cumulative costs of approximately four million annual births is well over $50 billion. ”

And it would be one thing if these exorbitant costs were matched with access to high standards of quality care, but that’s simply not the case. Much of the high costs result from tests and procedures that may not be warranted, but are ordered anyway as providers receive payment incentives. These incentives — as opposed to the flat fees most birth care providers are paid in other countries — encourage more expensive care, not necessarily better care.

It was fear over the quality of care I might receive that caused some anxiety during my own pregnancy. An avid reader (and worrier), I had done the research and knew that I wanted to do everything in my power to have an intervention-free birth. I was already seeing a midwife, who spent more, quality time with me than any OBGYN I had seen in the past. While my insurance covered those visits, it did not cover the doula that my husband and I eventually hired. We paid for her out-of-pocket, but in the end, she was worth every penny. She helped navigate our delivery, stepping in at a crucial moment when my son’s heartbeat sounded too weak to the nurse. What could have easily slipped into a moment of panic for all, ended up being fine, thanks in most part to our doula. But if we had more co-pays or a high deductible to pay, I doubt we would have been able to afford our beloved doula, and who knows how my son’s birth would have ended up. And while my case might not have been severe, for many other mothers, it can be a matter of life and death.

The U.S. is struggling with a rising maternal mortality rate, clocking in at #50 world wide. That means that there are 49 other countries that are better at keeping new mothers alive — all while costing much, much less. In our consumerist culture, most people would be livid if they were paying premium prices while receiving questionable quality. That’s not to say there aren’t amazing, hardworking birth professionals out there. There are. But in the current system that demands a high entry fee, how many pregnant mothers have access to these professionals? How many are simply going along with the status quo based on lack of insurance or ability to pay these high fees?

The rest of the world seems to understand that it pays to invest in its citizens right from the start. Most countries provide either free or low-cost births, while still maintaining similar (or better!) standards of care. The U.S., however, has yet to get that message, and I can only imagine what will happen if we continue to treat childbirth like car shopping.

Avital Norman Nathman blogs for The Mamafesto.

[Photo of newborn baby via Shutterstock]