Updated: March 30, 2021
Originally Published: July 18, 2018
It’s hard to fathom that it has already been over five months since our second child, Max, made his grand entrance. His mother, Jenna, is recovering well, which is a blessing considering the alarmingly high maternal mortality rates in the U.S. Max is thriving, albeit he has decided that sleep is overrated during the night. The truly astonishing part? I am still receiving bills related to his birth.
As someone who studies health policy, I thought I was prepared for the financial realities of pregnancy and childbirth. I have extensively analyzed the American healthcare system, but nothing could prepare me for the bewildering experience of navigating it firsthand. It’s worth noting that our delivery was straightforward, and we had health insurance.
I can only imagine the chaos and confusion that couples with fewer resources and less understanding of the healthcare landscape must face.
The New Reality of Pregnancy and Childbirth
From the moment we had our first doctor’s appointment, we were greeted by a mountain of paperwork and the promise of bills. There were the monthly, then biweekly, and finally weekly visits, each generating its own set of invoices. Living in West Virginia, where the opioid crisis has led to stricter regulations, my wife’s doctor insisted on drug screenings as a precaution.
To my surprise, Jenna’s doctor ordered an extensive array of blood tests and ultrasounds — referred to as “outpatient diagnostic services” — that added up to thousands of dollars. It’s hard to challenge these tests when all you desire is a healthy baby, and the doctor is the only one who can determine their necessity. Naturally, we wanted to ensure Max would be healthy, but the bill for genetic testing sent to our insurer was a staggering $26,755.
The experience of bringing our first son, Leo, into the world was a marathon; Jenna endured over 30 hours of labor. This time, determined to avoid a long hospital stay, she nearly gave birth in the front seat of our car. Fortunately, I managed to get her into a maternity room just in time for Max’s arrival. I joked with Jenna, “At least we can’t be charged for delivery!” Little did I know how wrong I was — every time I requested a detailed bill, new charges appeared, while others mysteriously vanished.
The Shocking Costs of Delivery
The delivery room, which we occupied for barely a minute, cost approximately $7,000. Jenna’s 48-hour stay racked up over $3,100 in room and board, while two Tylenol tablets were billed at a staggering $25. Laboratory work alone amounted to $1,200.
As for Max, his room and board were just over $1,500, with various lab charges adding another $1,400. His hearing test? $260. I tried to keep track of all the medical professionals who came and went, but the sheer volume made it a blur. The doctor who wasn’t even present during the birth billed us $4,200, and pediatricians charged $150 for each brief visit to check on Max.
As a side note, we couldn’t utilize a tax-favored flexible spending account for many of these expenses because “being pregnant” doesn’t qualify as a “life event.” “Giving birth” does count, but only for future expenses, leaving us to shoulder the costs incurred before the birth.
Bringing Baby Home
While giving birth is undeniably challenging, the real hurdles often begin once you leave the hospital. Like many American women, Jenna, who is a teacher, lacked access to paid maternity leave. This meant we relied on a single income during those critical early months, which was particularly inconvenient as we were inundated with medical bills, many of which contained errors that required endless phone calls to rectify.
Diapers and other baby necessities, of course, come with their own hefty price tag.
Once my semester ended in early May, Jenna returned to work while I took on childcare duties with Max. This brought its own set of challenges. As a professor, I wasn’t getting paid during the summer months. Furthermore, while the Affordable Care Act offers important benefits for breastfeeding, it does have limitations. Not all breast pumps are covered, and insurance companies are becoming increasingly stringent. Ironically, there’s a national push to encourage breastfeeding due to its proven benefits for mothers and babies alike. Finding an appropriate space and time to pump at work, even with decent equipment and legal protections, is no simple task. Jenna often locks her classroom and uses any spare moment she can find, which is particularly challenging during field trips or professional development.
Moving forward, we are relatively fortunate. Thanks to the Affordable Care Act, well-child visits and preventive care like immunizations will be covered by our insurance. However, in the event of a serious health issue, we could still face thousands of dollars in out-of-pocket costs.
My employer allows me to work from home during the fall semester, enabling me to care for Max. But while I may not have to teach on campus, the expectations for research and service remain unchanged. Soon, we’ll need to enroll Max in daycare, and we’ve been on multiple waiting lists since we first learned of Jenna’s pregnancy. The last time, I drove Leo 45 minutes one way to a daycare we trusted in Pennsylvania. Even if we find a good option nearby, the fees will likely surpass in-state tuition at West Virginia University, where I work.
Putting Our Experience in Perspective
Our journey is not unique. America’s most vulnerable populations are somewhat insulated from medical expenses; Medicaid generally does not require out-of-pocket payments. Those enrolled in programs like the Children’s Health Insurance Program or with cost-sharing subsidies through the Affordable Care Act face limited out-of-pocket contributions. In both scenarios, the exorbitant costs of childbirth are shifted to public funds and those of us with private insurance.
The real challenges for low-income families arise as they try to raise their children with scarce resources and dwindling governmental support. Meanwhile, the middle class finds itself increasingly squeezed by rising healthcare costs. Premiums, deductibles, and co-pays continue to soar, while the range of services and choices shrinks each year.
With ongoing Republican efforts to dismantle the Affordable Care Act, even those of us with employer-sponsored insurance may lose vital protections. Many of us are simultaneously grappling with student loan repayments, which force delays in marriage, parenthood, or homeownership. For us, this has meant cutting back on nearly everything, including family vacations and necessary purchases, and seeking out side jobs to make ends meet. Potential pay raises will likely be swallowed by rising premiums and co-pays as healthcare costs remain unchecked.
Straddling the Line Between Financial Aid and Hardship
Given these challenges, it’s no wonder that frustrations among the middle class breed resentment towards publicly funded programs. Calls for work requirements and more punitive approaches to social safety nets can be understood as a response to the situation.
The current support systems for parenthood in our country are woefully inadequate. Healthcare, parental leave, childcare, and educational support need significant improvement. As a society, we should strive to better support our families and help them thrive.
If you’re considering starting your own family, check out this home insemination kit for a closer look at your options, and for more information on pregnancy, the NICHD is an excellent resource. For those interested in fertility treatments, TFP Boston Place Fertility Clinic can provide authoritative guidance.
Summary
Having a baby in America can be an overwhelming and costly experience, even for those well-versed in the healthcare system. The financial burdens of childbirth, combined with the emotional and practical challenges of parenthood, often leave families feeling squeezed and unsupported. As the middle class grapples with rising healthcare costs and diminishing resources, there’s a pressing need for improved support systems for families to thrive.