9 Unexpected Costs of Childbirth (and How to Plan)
by Randle Browning
Psst… We also have a companion article on unexpected costs of pregnancy.
When I became pregnant with my daughter in 2019, I knew that everything involved with having a baby was going to be expensive—from the costs of pregnancy to all the things babies require, like clothes, diapers, and gear. But I had no idea how to financially plan for the costs of the actual birth. I agonized about opening every piece of mail that came from a hospital or lab for months after my baby was born.
I had reason to be concerned. According to The Atlantic, a study published in January 2020 found that in 2015 it cost an average of $4,500 to deliver a baby in the U.S. (and that doesn’t include raising your child.) You’re not alone if that sounds like an exorbitant amount of money to have on hand. And, if your pregnancy was unplanned, you may feel even less prepared for the bills that could come your way.
Though you can’t anticipate every unexpected cost of giving birth, you can budget for common expenses. And, perhaps even more importantly, you can get ready to protect yourself by learning which expenses you can push back on or negotiate down.
Here are some of the costs of childbirth you might not be expecting, with tips on how to prepare for them.
The hospital is where we expect to get dinged with huge bills, but the cost of giving birth can start adding up before you even leave the house. If you’d like to have support laboring at home before you head to the hospital (or if you’re doing a home birth and don’t plan on a hospital stay at all), you can pay a licensed doula or other professional to be at your birth.
My doula met with me a few times before birth to help me prepare, and planned to come to my apartment to help me labor at home and know when to leave for the hospital. After that, she’d accompany me and my partner to the hospital and help guide us through labor…for a hefty fee. Unfortunately, these costs were not covered by my insurance or bundled into hospital care—they were all extra.
Doulas can be expensive, but there are also affordable options. Prices vary widely based on your location and levels of demand. In New York City, for example, doulas can cost from $150 to more than $2,800, according to the New York City Department of Health and Mental Hygiene. Check with your insurance if they will cover part of the cost of a doula, and look for a doula in your budget.
Plan your finances ahead of time to prepare for the special day.
Depending on where you live, you could end up shelling out to get to the hospital. That could just mean a taxi fare, but if you are driving your own car to the hospital, you could have to pay for parking once you get there. Parking is not always free at the hospital, even for your partner or other support person. Check in advance—it might be worth it to have someone else drop you off and pick you up later, or to have a couple friends or family members take your car home and bring it back when it’s time for you to be discharged.
I was surprised to find that in the New York City hospital where I had my baby, shared rooms on the Labor & Delivery floor were the norm. While I was grateful to have access to high-quality medical care, sharing a small room with just a curtain separating my bed from the next felt like being in a college dorm room, and there was only a narrow reclining chair for my partner to sleep in through my three-night stay.
It can be a tough time to share a room and bathroom, especially if you’re recovering from a c-section, learning to breastfeed, and getting to know your baby. Some hospitals offer private rooms with extra space and amenities, but for a fee.
If you live in a city with a dense population, this could be the case at your hospital. Check in advance if your hospital charges for private rooms, research the nightly rates, and decide if you’d like to budget for that.
In the U.S., the high cost of childbirth has to do with the intricacies of insurance coverage. My plan had partial out-of-network coverage, but if yours doesn’t, you’ll want to be extra cautious. I’ve spoken to friends who reported unexpected out-of-network charges for lab work and anesthesia during their labor and recovery that they never approved. A 2019 NBC story featured two women who had their babies in the same hospital, with the same insurance, but one got hit with an out-of-network charge for her epidural because the anesthesiologist happened to be out-of-network. She was able to get her money back, but only after a lot of back-and-forth with her insurance company.
Unfortunately, this kind of thing isn’t rare. A 2020 study in JAMA looking at about 350,000 patients covered by a major insurance company found that over 20% of them were hit with unexpected out-of-network charges, even though they had elective surgeries. It suggests that despite being able to choose in-network hospitals and providers before their surgeries, they still got dinged with surprise medical bills.
The trouble is that if you’re in labor or undergoing a c-section, you can’t advocate for yourself or make decisions about your providers. But you can contest unexpected medical bills after the fact. Consult with the hospital directly about waiving or reducing the fees, and check with your insurance company about making an exception to their out-of-network policy. Be sure to get itemized bills so you can check them thoroughly.
Just like out-of-network charges, insurance deductibles can add up, especially if you’re on a high-deductible plan. Two special scenarios involving deductibles can drastically raise the cost of childbirth, so look out for these:
To prepare, make sure you know when your deductible rolls over and plan accordingly. And check with the hospital in advance about whether they bill separately for mother and baby.
If something doesn’t go as planned — like if your home birth turns into a c-section — you could end up paying for things you didn’t expect. Even if you don’t plan to give birth in a hospital, it’s smart to find out what will be covered if you end up there.
Of course, you can’t plan for all the unforeseen complications that might crop up. But, the more prepared you are to navigate your insurance coverage, and the more informed you are about how your hospital works, the better off you will be.
The hospital where my baby was born offered free information sessions about what to expect while admitted, and some hospitals host tours. These are great opportunities to ask questions and get a sense of how things work where you’ll deliver. If you are having a baby during the coronavirus pandemic, however, these likely won’t be taking place in person. Check if offerings have moved online, or see if you can find answers to your questions on the hospital website. (And read more on giving birth during the COVID-19 outbreak.)
Breastfeeding can be an affordable choice, since it means you don’t have to spend money on formula or expensive donor milk. But it still comes with some costs, especially early on.
You will likely need to purchase a breast pump, for example. My insurance covered the pump 100%, but not the cooler bag, extra bottles, and specific accessories many women need to make it work for them. Check what is covered by your provider before you go out and buy a pump. You might need to order from a specific vendor to get reimbursed.
Many people also pay up for a professional lactation consultant, who may not be covered on your insurance. Before hiring a consultant, check their prices. You can also go directly through your insurance to find someone in-network, if they are covered.
Whether you have a vaginal delivery or a cesarean section, you’ll spend the weeks and months (even years) after having your baby physically recovering. For some, this could mean postpartum physical therapy. Your insurance might cover a certain amount of sessions, but always check in advance if PT is part of your plan.
Recovering could also mean tailored exercises that are safe postpartum. I was lucky to have access to postpartum yoga and strength training classes near my apartment, but at a cost. Programs that required instructors with postpartum specializations and certifications meant higher class prices.
And if childcare is offered at your gym or studio, you’ll have to pay extra to bring the baby along too. Look for free classes in your area or online. They could be offered at community centers or baby and maternity stores, and local community-based Facebook groups can point you in the right direction.
According to the U.S. Office on Women’s Health, 1 in 9 women experience postpartum — or perinatal — depression, although some studies report the number is higher. Postpartum anxiety can also crop up. If you don’t have coverage for mental health, that could mean paying out-of-pocket for therapy or psychiatry visits, plus the costs of any medications your doctor prescribes.
Check if you can get in-network coverage through approved providers. Or, like physical postpartum recovery, see if you can find free or lower cost options in your community.
Preparing to have a baby can be exciting and also scary — even without the financial cost of giving birth, there is so much to think about and plan for. But, learning more now can help you prepare, meaning you can focus on yourself and your baby in the weeks and months after birth, rather than fretting over bills. If you are looking for professional financial advice, My Financial Counsel offers matching with fiduciary advisors who have your best interests at heart. You can take a quick and easy questionnaire here.
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