My wife and I recently welcomed a beautiful baby girl, Matilda, into our family. Since Tillie is our second child, we were able to enjoy a much calmer pregnancy—unconsumed by horrifying birthing stories and wonderments of what life as parents would be like. This extra mental capacity gave me ample time to reflect on other aspects of childbirth and our interactions with the health care system.
In the days leading up to her arrival, I found myself wondering: How much does a birth cost? What are the major drivers of those costs? Are there any interventions that might lower costs? Not surprisingly, these weren’t pressing questions on my wife’s mind.
It turns out I had a lot to learn. Giving birth in the US is expensive—really expensive. A 2013 analysis by the Center for Healthcare Quality & Payment Reform (PDF) showed that “maternal and newborn care together represent the largest single category of hospital expenditures for most commercial health plans and state Medicaid programs.” The cost of birth is twice or three times as expensive in the US as in other developed countries, and this disparity is generally getting worse.
A main driver for the high cost of birth is the increasing rate of Cesarean delivery. According to an analysis by the Center for Improving Value in Health Care, if we were able to reduce the rate of C-sections in Colorado by just 10 percent, which is consistent with the nationally-identified Healthy People 2020 goal, we’d lower health care spending by $6.5 million per year. Other drivers of childbirth costs are expensive medical procedures like epidurals and labor inductions, which add up quickly and may be unnecessary.
One approach to reducing labor and delivery costs that has recently shown potential is the utilization of birthing support systems and advocates—more commonly known as doulas. Doulas have long been used in certain niche populations as patient advocates during birth and are starting to see more widespread use. Some states have also recognized the benefit of doulas, and have expanded Medicaid coverage to include doula services for pregnant beneficiaries. Support from a doula has been found to lower Cesarean and other intervention rates, result in fewer complications, and shorter labor hours.
When Oliver was born in 2012, our providers and insurer never talked to us about the benefits of midwives or doulas. This year, both our provider and insurer openly encouraged us to utilize a birthing support system. This signals an important shift in how we’re approaching birth. The extra expenses don't result in better outcomes for our mothers or our babies, so I’m glad to see us exploring better options that will also help with the sticker shock.