How Much Does Having a Baby Actually Cost?

Nobody knows, more than it should, hopefully less than it might; good luck!

Before I had a baby, I had the same questions a lot of parents-to-be probably have, but two of the biggies were:

How much is this going to hurt?

and

How much is this going to cost?

The first question is subjective and unquantifiable. The answer is "probably a lot, for perhaps a long period of time, and it's different for everybody." Now that I'm on the other side of birth, the closest physical ordeal I can compare it to for me specifically is the time Josh and I tried to hike all the way to the top of Mt. Whitney in one day with minimal training. The hike took 20 hours, we didn't make it all the way to the top, and by the end, my back was spasming if I tried to carry anything at all, but after that hike we ate a bunch of Chinese food and slept for 12 hours and the next day just carried on with our lives, versus after we had a baby, after which I most definitely did not sleep for 12 hours in a row, and haven't even slept for six hours in a row by now, five months later.

The second question--How much is this going to cost?-- should be easy to quantify, despite the multiple variables that could impact the answer. But when I tried to find answers leading up to the birth of my kid, every resource was so all over the place and nonspecific that I ended my search more confused than I was when I started. It wasn't until after I gave birth that I had any numbers at all, and until I sat down to write this that I actually totalled all of the numbers.

The resources for parents-to-be who want to know how much birth costs is opaque and sometimes contradictory.

The data used in this CBS story on the average "price" to give birth across the US comes from something called Hospital Pricing Specialist, which analyzed the "price" of giving birth in all fifty states. The national average of the "price" of giving birth vaginally with no complications in the US is around $15,000 before health insurance, but that's out of a huge cost range from $8,805 (Nebraska) to $29,048 (New Jersey). I couldn't find whether the data was weighted in a way that reflected the number of births at each price point-- for example, many more children are born ever year in California where the average "price" of an uncomplicated birth is more than $26,000 than are born in, say, South Dakota, where the average "price" is just over $11,000, so it's not clear whether the $15,000 is the "price" of the average birth or the "price" averaged across all 50 states. I also couldn't find clarity on what they meant by "price," which is why I'm putting it in those snotty little quotation marks. Did "price" mean how much insurance companies were billed by hospitals? How much insurance companies actually paid hospitals? How much an uninsured person would be expected to pay?

And these numbers are total garbage when one considers how many babies in the US are born via C section-- about 1 in 3, which significantly drives up "average" (2-3 times higher than what the World Health Organization deems necessary to improve maternal health outcomes-- again, our health care system is trash!). Some of those C sections are planned, some aren't. There are also babies born outside of a traditional hospital environment-- say, a separate birth center or at home-- and while those numbers are rising, according to the most recent numbers I could find, it's still under 2% of all US births.

This article, however, has different answers to my most complicated of simple questions, stating that the average vaginal birth costs $13,024 and the average C-section costs $22,646. But wait! It's different if you have insurance. And wait! It's also different depending on how good your insurance is. And wait once more! Some insurance plans cover the baby and mother together until they both are checked out of the hospital post-birth and some plans immediately start billing the baby separately! And wait once more! It's also possible that the anesthesiologist and NICU aren't covered the same way that the rest of the hospital is. Hope this helps.

This piece from The Cut from last year has a different set of number entirely, claiming that the average cost of a vaginal birth with insurance can run from $4500 to $11,200 and the average C section birth with insurance runs from $5,100 to $15,000.

I spent hours trying to figure out how much this was going to cost-- not the imaginary scary number that the hospital tries to bill my insurance company for, how much money would be going from my bank account to the bank account of my insurance company and various health care providers in the service of getting the baby that was inside of me to the outside.

Before giving birth, I heard horror stories about birth-related sticker shock from other people who gave birth in the US. I was warned that many anesthesiologists operate independently from hospitals, and sometimes don't take any insurance at all. Cool. Very cool. Same deal with NICU's. A baby facing a post-birth medical emergency doesn't exactly get to shop around in accordance with arrangements their parents' insurance company have made.

I figured I'd be as smart as I could about all of these variables and not be one of those people who got hit with a surprise five figure bill after childbirth. But as with most American health care, there's not much choosing availalbe to patients. You get what you get and them's the breaks.

Fast forward to last November. I was in the hospital, exhausted from being awake for 24 hours and in the worst pain of my life because I had tried to Be A Hero and have an unmedicated birth, when the anesthesiologist arrived in my room to administer the epidural for which I was yelling.

"Do you take BlueCross?" I asked, between animalistic screams of pain.

He kind of laughed. "I have no idea," he said. "Somebody else handles that."

Would his answer have made a difference either way? No. I also had no other choice. He was the anesthesiologist. It was him or unbearable pain that was causing me so much obvious distress that my husband still talks about how horrible it was to witness.

I also got a confused chuckle when I had earlier casually asked my nurse if the NICU took BlueCross. Nobody who worked in caregiving roles at the hospital seemed to know how much anything they did cost for any patient in particular, because in the US an entire little economy of wasted human capital exists between the care providers and health care consumers (or, to put it non-sociopathically, "patients.")

Bills for Juniper's uncomplicated, non-C section birth with an epidural, a 2-night hospital stay for me and a one-night stay for her, and a short stint in NICU began arriving a few weeks later, while my daughter was still a purple little potato that didn't know what was going on and I was still bleeding and leaking. The bills are all in and accounted for now, and it's even been confusing to figure out how much the birth has cost.

Just to illustrate how absurdly complicated this all is, and to offer some solidarity to readers who have been through this themselves:

Between my pregnancy confirmation appointment last year and the follow-up appointment with my OB a few weeks after giving birth, my insurance company has been billed about forty times. This includes things like prenatal bloodwork and genetic screening, ultrasounds, routine prenatal visits, the birth itself, and specialist care that Juniper needed in the hospital after she was born. (She's needed some regular specialist care since and I've had follow up care as well, but for the purposes of this piece, we're totaling up my pregnancy confirmation appointment until the moment hospital staff pushed me out of the automatic doors in a wheelchair.)

It took me way too long to figure how much this actually cost for me, a person living in a major city with the best insurance possible available to a person who works as a freelancer. This is the clearest, simplest, easiest-to-understand version of the kafkaesque system patients in the US navigate every day.

Here are some screen grabs from Explanation of Benefit forms from my insurance provider. Keep in mind that the Affordable Care Act actually made health insurance coverage for pregnancy and childbirth-related costs more straightforward than they were before.

Okay, so that's easy. Right? Not really. Because while it says "Owed: $0," if you scroll over to the far right of the PDF version of this benefits, you arrive at a little nugget that explains that my "patient responsibility" is $754.33, and that my insurance paid $9,919.67. That first huge $18,000 number is just made up. Nobody paid it.

This one's a little trickier (and apparently the anesthesiologist WAS covered by my insurance). The "discount" is $2301.34, which means that what the insurance company was actually billed was $1298.66, but I was responsible for zero of those dollars, because I had met my annual out-of-pocket maximum.

Here's my bill from the OB-GYN, the doctor who actually was there for the birth and afterward reached into my body to yank my stubborn old placenta out. It's a separate bill from the hospital:

Oh, look! A different color ink. I think this has something to do with my hitting my out-of-pocket maximum, and Affordable Care Act guidelines. Ah yes, lower on the EOB is this:

Now at least I know some actual numbers around the costs associated with my care when I gave birth-- the hospital, the doctor, and the anesthesiologist. The fake number that my health care providers say things cost, all in, is $26,898.75. But my insurance company didn't actually pay that much because, again, nobody actually pays that much; my insurer paid $13,439.84, because of "discounts." The portion I had to pay was $754.33, plus what I paid in health insurance premiums for the 2021 calendar year, which for the ~Cadillac~ plan that I enrolled in anticipating that I might get pregnant, cost around $13,500 for the duration of the pregnancy and all of the prenatal care the ACA mandates be covered. Which means I basically went halfsies on my pregnancy and daughter's birth with my insurance company.

But wait, there's more. Juniper counts as a separate person from the second she's out of me, so she got her own set of bills.

She incurred $109.36 in charges simply by being born, an impressive feat.

We also got a bill from the pediatrician who barged into our room at 8 am and turned all the lights and started doing a very cringe stand up comedy routine to go along with his exam of newborn Juniper as I sat up in bed, unable to get out because I wasn't wearing pants or a bra. For that, insurance was "billed" $214, actually paid $90.12, and we owe a measley $13.

And here's another EOB for her while we were in the hospital, for what I'm assuming were the battery of tests they ran on her when they whisked her away to the NICU for 4 hours. I don't know; I was very tired:

Why is one covered 60% and one covered 100%? Something to do with "in-network" vs. "out of network"? Don't know. Just tell me who to pay.

This is what it looks like to have absolutely top-notch insurance in the US. It shouldn't be this way, for anybody anywhere.

Anyway, hope this cleared some things up.

Original Illustration by beautiful genius Tara Jacoby.