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Health costs associated with pregnancy, childbirth, and postpartum care

By Matthew Rae Twitter ,  Cynthia Cox Twitter , and  Hanna Dingel

July 13, 2022

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Pregnancy is one of the most common reasons for a hospitalization among non-elderly people. In addition to the cost of the birth itself, pregnancy care also involves costs associated with prenatal visits and often includes care to treat psychological and medical conditions associated with pregnancy, birth, and the post-partum period.

To examine the health costs associated with pregnancy, childbirth, and post-partum care, we examined a subset of claims from the IBM MarketScan Encounter Database from 2018 through 2020 for enrollees in large employer private health plans. We look at health spending (both the amount paid by insurers and that paid out-of-pocket by enrollees) for female enrollees of reproductive age who give birth, compared to those who do not give birth, holding age constant.

We find that health costs associated with pregnancy, childbirth, and post-partum care average a total of $18,865 and the average out-of-pocket payments total $2,854 for women enrolled in large group plans. We also examine how pregnancy, childbirth, and post-partum health spending among large group enrollees varies by the type of delivery, finding these costs for pregnancies resulting in a vaginal delivery average $14,768 ($2,655 of which is paid out-of-pocket) and those resulting in cesarean section (C-section) average $26,280 ($3,214 of which is paid out-of-pocket).

How we measure the cost of pregnancy, birth, and post-partum care

Some previous analyses of the cost of pregnancy and childbirth have looked at the cost of specific services , such as vaginal and cesarean delivery, or services with a pregnancy diagnosis code . However, looking only at specific claims can miss other care associated with pregnancy and birth, such as psychological care, physical therapy, or treatment of other conditions that arise because of pregnancy but are not necessarily billed as a pregnancy related expense.

In this analysis, we take a different approach. Using a regression model controlling for age, we look at the average difference in health spending for women of reproductive age who give birth compared to those of the same age who do not give birth. The benefit of this approach is that it allows us not only to look at the cost of the delivery, but also at all health costs associated with pregnancy, childbirth, and postpartum care.

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We limit the analysis to people who give birth in a hospital (either a live birth or stillborn) and do not include pregnancies that end in abortion or miscarriage. This analysis only includes the cost of the pregnancy, delivery, and post-partum recovery for the woman, and not any subsequent health spending for care of the infant.

How much does pregnancy, childbirth, and post-partum care cost?

We estimate that pregnant women of reproductive age (ages 15 to 49) enrolled in large group health plans incur an average of $18,865 more in health care costs than women who do not give birth. This additional health spending associated with pregnancy, delivery, and post-partum care includes both the amount paid by insurance (an average of $16,011) and that paid out-of-pocket by the enrollee (an average of $2,854). There is significant variation around these averages, and costs vary significantly by the type of delivery.

Women who give birth incur nearly $19,000 in additional health costs and pay almost $3,000 more out-of-pocket than those who do not give birth

How much pregnancy-related health spending is for hospitalizations and outpatient care.

While pregnant women typically have frequent outpatient office visits prior to giving birth, most pregnancy-related health spending is for the delivery. Women in large group plans with a pregnancy incur an average of $19,906 more in inpatient and outpatient costs than women of the same age who do not give birth. But prescription drug spending averages $1,040 less for women who give birth than for those who do not. Pregnant women are less likely to use prescription drugs than women of the same age who are not pregnant. Birth control pills ( oral contraceptives ) are one of the most used types of prescription drugs for women of reproductive age and some other prescription drugs are unsafe to take during pregnancy. However, these data only include spending on retail prescription drugs and therefore likely miss most out-of-pocket spending on prenatal vitamins or over-the-counter drugs that pregnant women may use.  

When looking at out-of-pocket costs over the course of a pregnancy, we find that pregnant women enrolled in large group health plans spend an average of $2,924 more on inpatient and outpatient care than women who are not pregnant spend out-of-pocket, while pregnant women spend an average of $70 less out-of-pocket on prescription drugs. In total, out-of-pocket costs are $2,854 higher for pregnant women than for those of the same age who do not give birth.

These out-of-pocket costs only include amounts paid for cost-sharing (deductibles, coinsurance, and copayments) under the health plan. Therefore, out-of-pocket spending on fertility care is generally missed because these services are not often covered by insurance. Similarly, we do not include any balance bills sent by out-of-network providers directly to patients. We previously estimated that 10% of in-network admissions for maternity care included an out-of-network charge putting patients at risk for surprise medical bills. However, as of January 2022, the No Surprises Act prohibits surprise billing by out-of-network providers when a patient was admitted at an in-network hospital.

How do pregnancy and childbirth costs vary by type of delivery?

Health costs associated with pregnancy, childbirth, and post-partum care vary significantly based on whether the baby is born by cesarean section or vaginal delivery. Over the course of their pregnancy, delivery, and post-partum period, large group enrollees who give birth via cesarean section incur an average of $26,280 more in healthcare costs than those who do not give birth. By contrast, this amount for women with a vaginal delivery averages $14,768.

Pregnancies resulting in C-sections are associated with higher health spending and out-of-pocket costs than those resulting in vaginal deliveries

The higher costs associated with pregnancies that result in cesarean section are not only because of the higher cost of the delivery, but also include higher costs before and after the birth, which may be associated with greater service intensity for care of complications or underlying health conditions that can lead to cesarean section and recovery from the surgery.

Average out-of-pocket costs associated with pregnancy, childbirth, and post-partum care are also higher for women who deliver via cesarean section ($3,214) than for those with vaginal deliveries ($2,655). However, while the average total cost of a pregnancy resulting in a cesarean section ($26,280) is 77% higher than a pregnancy resulting in a vaginal delivery ($14,768), average out-of-pocket costs are 21% higher for women who give birth by cesarean section ($3,214) than those with a vaginal delivery ($2,655). This is largely because enrollees with an inpatient admission often hit their plans’ deductible or out-of-pocket maximum, so higher-cost hospitalizations do not always lead to higher out-of-pocket costs for the admission.

What are the implications of high out-of-pocket costs for pregnancy and childbirth?

The frequency and intensity of services associated with pregnancy and childbirth can lead to considerable out-of-pocket expenses for new parents, particularly those covered by private insurance.

On average, over the course of their pregnancies, pregnant women enrolled in large employer health plans incur $2,854 more in out-of-pocket costs than similar women who are not pregnant. These costs are more than many families can afford. Roughly one third of multi-person households and half of single-person households would not have the liquid assets needed to cover typical out-of-pocket costs associated with pregnancy and childbirth in private health plans. About half of people who give birth in a given year are covered by private insurance, and the remainder are mostly covered by Medicaid, which generally has little or no out-of-pocket liability.  

Medical care for the infant can result in even more out-of-pocket costs for families with private insurance coverage. And these out-of-pocket health costs arrive just as these parents begin taking on additional costs of caring for a child. Many new parents also experience income losses due to a lack of paid parental leave, which can leave many new parents vulnerable to incurring medical debt .

Limitations

This analysis has some limitations, including that we do not control for health status before the pregnancy. It is possible women who give birth are somewhat healthier on average going into their pregnancies than women of the same age who do not give birth. Conversely, it is also possible that health conditions present before pregnancy may be incidentally discovered during pregnancy. Although we do not control for health status, health status and spending are strongly correlated with age, for which we do control.

We are only including health spending that happens through the health plan, so do not include care that is paid fully out-of-pocket, which would include most fertility treatments (as this care is often not covered by insurance).

We describe our findings as applying to pregnant women, though some of the births included were for female enrollees under the age of 18. The MarketScan sex variable is binary and our analysis is limited to the classification on the health record.

This analysis uses claims from the IBM Health Analytics MarketScan Commercial Claims and Encounters Database, which contains claims information provided by a sample of large employer plans. MarketScan allows for enrollees to be tracked for their duration at one contributing employer, and we used a subset of claims for enrollees covered in each of three years, 2018 through 2020. All dollar values are reported in 2020 nominal dollars. To make MarketScan data more representative of large group plans, weights were applied to match counts in the Current Population Survey for enrollees at firms of a thousand or more workers by sex, age and state. Weights were trimmed at eight times the interquartile range.

We further limited the sample to female enrollees between ages 15 and 49 who were continuously enrolled during the 2018-2020 period, to avoid including costs for women who changed coverage during the pregnancy. In total, this analysis used claims for almost 2,267,200 female enrollees, which represents about 15% of the estimated 14,800,000 women of reproductive age enrolled in large group market plans (plans offered by employers with one thousand or more workers) in 2018.

IBM assigns a DRG to each admission using the Centers for Medicare & Medicaid Services (CMS) Grouper. This method selects a DRG for the admission based on the diagnosis and procedures a patient received during the stay. We identify women as having a pregnancy if, between August 2018 and September 2020, they had an admission that was designated as a delivery (783-788, 796-798 and 805-807). We then modeled spending for these enrollees between January 2018 and December 2020, controlling for age and whether they had multiple pregnancy related admissions over that period. This method does not include the cost of pregnancy for enrollees who do not give birth (i.e., those pregnancies ending in a miscarriage or abortion).  

Claims data available in MarketScan allows an analysis of liabilities incurred by enrollees with some limitations. First, these data reflect cost sharing incurred under the benefit plan and do not include balance-billing payments that beneficiaries may make to health care providers for out-of-network services or out-of-pocket payments for non-covered services, meaning that we may understate the costs associated with pregnancy. Secondly, claims data show the retail cost for prescription drugs and do not include information about the value of rebates that may be received by payers. Third, when showing how spending is divided across types of care (i.e., health services and prescriptions), we combine spending on inpatient and outpatient care because global billing is commonly used for maternity services. In claims data, inpatient costs will therefore sometimes include all services for routine prenatal care, delivery services, and postpartum care since the global maternity claim is typically billed the day of delivery. Lastly, sex is defined as reported on the claim, and we are unable to identify the gender identity of the enrollee.

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How Much Does It Cost to Have a Baby? Expenses from Pregnancy to Delivery

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Having a baby is expensive — sometimes alarmingly so. Costs related to pregnancy, childbirth and postpartum care average nearly $19,000 for individuals covered by large group insurance plans, according to a July 2022 study by Peterson Center on Healthcare and KFF, a health policy nonprofit. Insurance covers most of the costs, with the average woman paying about $2,850 out of pocket.

Differences between actual prices as well as insurance coverage can span tens of thousands of dollars. Navigating the costs of nine months of pregnancy — and then the cost of raising a baby — can seem overwhelming, but knowing what to expect can help. Read this guide to understand your coverage as well as which expenses to expect and when.

Beware of major differences in cost and coverage

Any guide to medical bills and your share of the cost should come with several disclaimers.

Prices vary from city to city and even hospital to hospital. Researchers at the University of California, San Francisco found in 2014 that in the Golden State, the cost of an uncomplicated vaginal birth varied widely — from $3,296 to $37,227, depending on the hospital. Cesarean sections ranged from $8,312 to almost $71,000.

If you have health insurance , coverage differences are similarly dramatic. The Affordable Care Act requires most health plans to cover maternal and newborn care. But because ACA requirements remain broad, insurance coverage isn’t uniform.

Price and out-of-pocket cost estimates are handy but are estimates. The only way to know for certain what you’ll pay is to contact your medical providers and health insurance company. The more work you’re willing to do on the front end, the less likely you’ll get surprise bills.

Get a handle on your insurance

If you’re unsure how your health insurance works, now's the time to research your benefits. You could take an entire course in understanding your policy and still likely have questions. Consider this a cram session. Your top two study areas include:

Learning about out-of-pocket costs: copays, coinsurance and deductibles .

Making sure your doctors are in your provider network, if possible.

Contact your health insurance company — with policy number in hand — and ask the key questions below. Make sure to write down whom you talked to and the date.

Are prenatal care, labor and delivery covered benefits under my policy?

Do I need a referral from my primary care doctor to see an OB-GYN or other specialists?

Will I need pre-authorization for any prenatal care?

What prenatal tests are covered (ultrasounds, amniocentesis, genetic testing, etc.)?

What common prenatal, labor and delivery needs are not covered by my policy?

Which hospitals in my area are in my insurance policy’s network?

What do I need to do to ensure that my newborn is covered from the moment of delivery?

How long of a hospital stay is covered after delivery?

Does my policy cover a private room or suite, or will I have to share a room?

If you’re interested in nontraditional deliveries, like a home birth with a midwife, ask about coverage for these.

Throughout your pregnancy and into your baby’s well-child visits, err on the side of caution. If you are unsure about your coverage and want to be doubly safe, call your insurance company to get confirmation in advance.

Watch out: Depending on your medical providers’ billing practices and your due date, you could have to pay two deductibles if your prenatal care happens in one calendar year and your baby is delivered in the next.

Some providers package their charges to insurance companies in what’s called “global billing,” which can include all prenatal and delivery charges. Ask your OB-GYN whether they plan to use global billing so you’ll know where you stand.

» MORE: How do insurance deductibles work?

Uninsured? Seek help

If you don’t have health insurance, you’re looking at tens of thousands of dollars in care over the next nine months.

Despite requiring health insurance companies to offer well-woman and maternity care, the Affordable Care Act doesn’t consider pregnancy a “qualifying event.” You will have to wait until your child is born to sign up for a new plan under the ACA.

But ACA insurance plans aren’t your only option. If you meet income requirements, you could be eligible for Medicaid , which covers many maternity care costs.

If you’re forced to pay cash for maternity care, these steps can help:

Comparison and price shop for prenatal visits, tests and your labor and delivery.

Explain to your doctor and all medical providers that you are a cash-paying customer. They often offer discounts for uninsured peoples.

Negotiate lower balances and payment plans on your medical bills.

Ask the hospital about “charity care” programs that may be available.

Consider a maternity package, increasingly offered by hospitals as a way for new parents to get all of their maternity and childbirth expenses covered under one price.

Prepare for how much it costs to have a baby

For all medical care from pregnancy to birth to recovery, the Peterson and KFF study places the total at $18,865. This is an average based on insurance benefits claims data from 2018 through 2020. The data included enrollees in large employer private health plans. Researchers compared health spending between female enrollees who gave birth and those who didn’t.

The type of delivery can have a big impact on the total cost. Pregnancies that resulted in a vaginal delivery averaged $14,768, compared with $26,280 for those involving a cesarean section.

Insurance pays most of that. The study reported out-of-pocket expenses of $2,655, on average, for vaginal delivery. The average balance for a C-section was $3,214.

» MORE: How to handle your medical bills

Averages can help you prepare. But unless you pay upfront for a maternity package, there’s no single, knowable price tag on pregnancy and childbirth. Labor and delivery might loom in your mind as the most expensive part of the experience, but a routine pregnancy requires several standard appointments and tests. Special concerns about your health or your baby’s could mean more doctor visits and interventions, all potentially coming at an additional cost.

It’s important to note that the cost breakdown below begins with a positive pregnancy test. If you hope to become pregnant after going through in vitro fertilization or some other fertility treatment, this guide can help you prepare for one phase of your journey to parenthood. You also may want to learn more about IVF costs .

Similarly, if you're looking to adopt a newborn, medical care for your baby’s birth mother may be a significant part of your expenses. NerdWallet can help you prepare for the other costs of adopting a child as well.

First trimester

If you have an uncomplicated pregnancy, you’ll see your doctor for monthly checkups during the first trimester. Typically, these are subject to a copay.

These visits will involve checking your weight, blood pressure, fundal height measurement and fetal heart rate as soon as it’s audible. Additional lab work and tests will come throughout and could cost extra.

Prenatal vitamins: Your doctor may prescribe these, or you can find them over the counter at most drugstores. Under a prescription, they’ll be subject to your copay. Bought over the counter, a bottle containing a one-month supply will cost about $10 to $30.

Lab work: Blood will be drawn for a series of lab tests including screening for common birth defects, your blood type, Rh status, hemoglobin measurements, and immunity and exposure to certain kinds of infections. If you have insurance, it’s likely that much of this will be covered, though it could be subject to your deductible. Costs vary widely.

Early ultrasound: If everything appears healthy, your doctor may not recommend an ultrasound this soon. However, a first-trimester transvaginal ultrasound may be necessary to establish the location of the fetus, how far along you are, viability of the pregnancy and number of fetuses. For people without insurance, the average cost of an early ultrasound is $1,423, according to 2022 data from FAIR Health, a national, independent nonprofit that uses health care claims data to provide cost estimates to consumers. For those with insurance coverage, the average amount billed to the insurer is lower — $586 — because of agreements between the provider and the insurance company. The amount an insured person pays out of pocket depends on their plan’s cost-sharing rules.

Cell-free fetal DNA testing: After 10 weeks of pregnancy, your baby’s blood can be screened for genetic conditions. This testing is typically performed only for at-risk pregnancies, and costs can run upward of $4,000 for people without insurance, according to FAIR Health.

Chorionic villus sampling, or CVS: This test looks for many of the same genetic abnormalities as a cell-free fetal DNA test does but analyzes the tissue surrounding the baby, similar to an amniocentesis. The test looks for Down syndrome, cystic fibrosis, sickle cell anemia and other genetic abnormalities. Most insurance plans will cover CVS in high-risk pregnancies, though you could be responsible for out-of-pocket costs if it's subject to your deductible.

A medical bill often includes multiple charges for a single procedure. One charge covers the work of professionals who performed the procedure or interpreted test results. Another charge comes from the facility where the procedure was performed, covering the use of equipment and supplies. For this article, cost estimates combine these charges, which were each provided by FAIR Health.

Second trimester

Through the end of your second trimester (week 28), you’ll continue with monthly prenatal visits. In addition, you’ll likely need:

Glucose screening: Used to test for gestational diabetes, this bloodwork is typically done around weeks 24 to 28. If you’re not insured, you could pay about $240, according to FAIR Health.

Maternal blood screening: This blood test looks for four substances that could be evidence of possible birth defects. Costs vary widely by location and coverage.

Amniocentesis: An amniocentesis is the analysis of amniotic fluid surrounding your baby. It looks for genetic conditions like Down syndrome and is usually covered by insurance when medically necessary. The average cost to someone without insurance is $1,933, according to FAIR Health.

Ultrasound: The main ultrasound during a pregnancy occurs around 18 to 22 weeks, according to the American Congress of Obstetricians and Gynecologists. Your doctor will look for things such as the overall health and position of your baby and placenta, and your ovaries and cervix. It’s at this ultrasound that your doctor will be able to determine your baby’s sex — if the little one is willing to reveal that. This ultrasound is usually covered by insurance.

Third trimester

By your third trimester, basically every lab test that needs to be done has been done. Your monthly checkups will likely be every two weeks from weeks 28 to 36 and then weekly until the baby’s birth.

Birthing classes: These classes help you prepare for labor and delivery and are often covered by health insurance. If you’re a new parent, you might also be interested in classes that introduce you to breastfeeding or newborn care. Without insurance coverage, these classes can cost $50 to $200 each.

The largest expense you can expect during this last phase of pregnancy is the cost of labor and delivery.

Labor and delivery

Your itemized bill for labor and delivery will be immense, in ink and paper, if not cost. Hospitals in the U.S. often bill per service, and each hospitalization represents a series of small services and related fees.

It’s common to be billed for each doctor who attends to you and for each pill and IV fluid pouch as well as the use of your room, among many other things. Because these prices vary from hospital to hospital, the total cost of childbirth can be difficult to estimate.

On average, someone covered by insurance would see their insurer billed $6,230 for a vaginal delivery or $5,252 for delivery via cesarean section, according to FAIR Health. The cost to the person varies, depending on cost-sharing rules in their insurance plan.

For expectant parents without insurance, the average cost of giving birth ranges from about $10,000 for vaginal delivery to about $12,000 for a C-section.

If you have to be induced, need an unexpected C-section, receive an epidural or get a snack, the charges climb. Doulas, midwives and birthing tubs are typically considered optional and thus additional, too.

If you’re insured, determining how much you’ll pay will include knowing what’s covered and how much your share of the bill will be, including deductibles and coinsurance.

To try to lower childbirth charges:

Call the hospital’s billing office to get an estimate of total charges, and apply that to what you know about your policy specifics.

If possible, set aside enough money to cover any remaining deductible for the year, plus your coinsurance share of the expected charges and some cushion for unexpected denials and charges.

If you have access to a health savings account or flexible spending account through your employer, you can set aside these anticipated expenses using pretax dollars.

Consider a maternity package: It offers all the normally itemized features of a delivery for a flat fee. Many of these packages come with payment options and discounts for those paying cash, with some costing about $3,000 to $8,000.

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How Much Your Pregnancy Will Really Cost You

We wish we could give you a firm number, but  prenatal health care and delivery costs vary radically. How much you’ll pay will depend on factors like where you live, whether you have any complications and whether you have a vaginal birth or a c-section. But here are some ballpark figures: Prenatal care and delivery costs can range from about $9,000 to over $250,000 (quite a range, huh?). But before you freak out, know that we’re talking without insurance. With health insurance, the bulk of these expenses could be covered — but that’s not always true.

I have health insurance. What should I expect to pay for prenatal care and delivery?

Policies that cover maternity costs Good news: If you have insurance provided by your employer and the company employs at least 15 people full-time, your insurance must provide maternity services.

The percentage of prenatal and maternity costs that will be covered depends on your insurance carrier and which plan you have, but typically, employee plans cover between 25 percent and 90 percent of costs. Keep in mind that this is after the deductible has been met and that there may be a separate deductible for each family member, so you’ll likely be paying a bit more than that out of pocket. In other words, if each family member (including your newborn baby) has a $2,000 deductible, you’d have to pay the first $4,000 of expenses for both your and baby’s medical care, plus whatever else your plan doesn’t pay for.

If you have a plan through the Affordable Care Act, it will cover pregnancy and childbirth — yes, even if you were pregnant before you got the coverage.

Policies that don’t If you have an individual insurance policy, which isn’t provided through your employer, odds are it won’t cover maternity costs. Several states mandate that plans cover prenatal and delivery costs, but most states don’t require that they do. In 2010, just 12 percent of individual policies offered maternity coverage. Often, it’s possible to buy a rider to cover maternity expenses, but the cost for that can be high (up to $1,100 a month), and sometimes there’s a waiting period of one or two years before the benefit can be used.

How can I make sure my health insurance provider pays for as much as possible?

To avoid paying extra or for something you shouldn’t have to, it’s important that you thoroughly understand your insurance carrier’s maternity coverage policy. If you have insurance through your employer, your human resources department should be able to help you understand your coverage. Most carriers also have a pregnancy hotline you can call to find out all the details. Follow these tips to ensure maximum coverage and minimum sticker shock:

Go in-network. Choose an OB and hospital or birthing center that’s “in-network” to avoid out-of-pocket costs.

Understand your insurance plan. Find out the deductible, copay and out-of-pocket maximums to estimate what your costs will be.

Don’t stay too long at the hospital. Check the length of hospital stay that is covered and only stay that long, if possible.

Notify your carrier of baby’s birth asap. Many plans require that a new baby be added to a family’s insurance policy within 30 days of birth. If not, your baby’s expenses may not be covered. Some even expect you to call them when you get to the hospital to deliver, and if you don’t, they may refuse to cover the cost of your delivery and your baby’s hospital care.

How can I get health insurance if my (or my partner’s) employer doesn’t provide it?

Individual health insurance may be an option, but look closely at your choices, since the plans usually don’t cover maternity costs and sometimes legally treat pregnancy as a preexisting condition (which means it might not be well-covered). You may qualify for a federal or state health insurance program. A few that are available:

Medicaid This federally funded program provides medical assistance to low-income families and individuals. Kathleen Stoll, deputy executive director of Families USA , recommends that women explore this option even if they don’t think that they’ll qualify. “Income eligibility levels are higher for pregnant women, so don’t assume that you’re not eligible,” she says.

State health insurance programs These are offered in several states. Qualifications vary from state to state.

Healthcare.gov It facilitates federally funded health centers that provide basic medical care, including prenatal care on a sliding scale fee basis. And, as we mentioned above, it covers pregnancy costs.

COBRA This program offers continuation of health coverage to individuals and families who lose their health benefits because of job loss or other qualifying circumstances.

For help finding out more about private insurance options, check out the Plan Finder .

What are some ways to reduce my prenatal and delivery costs?

Shop around. “Unlike in an emergency medical situation, you can be a smart shopper. You can do some shopping ahead of time because you have lead time,” says Stoll. Look for a hospital that offers good rates for delivery and postnatal care (yes, you can ask), and see if it’s considered in-network for your plan.

Consider other settings. If you anticipate an uncomplicated birth, consider using a birthing center instead of a hospital. The costs will range from about $3,000 to $4,000, which is about half of what a hospital birth would cost. Just know that the birthing center may not be considered in-network, so you could end up paying more out of pocket than you would at an in-network hospital. For a home birth, usually all costs are 100 percent out of pocket, but they’re usually much less costly.

Negotiate with your hospital. Find out if the financing department of the hospital where you’ll deliver offers discounts for uninsured patients or if it will work with you to set up a payment plan.

Take generic medications. “Work with your OB to explore if there are generic alternatives to drugs prescribed during prenatal or postnatal care. You may also be able to take over-the-counter prenatal vitamins instead of prescription ones,” says Stoll.

Plus, more from The Bump:

How Much Having a Baby Is Going to Cost

51 Ways to Save Up for Baby

Top 5 Things Moms-to-Be Hate About Going to the OB

Best Things Moms Brought to the Hospital

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Prenatal care: 1st trimester visits

Pregnancy and prenatal care go hand in hand. During the first trimester, prenatal care includes blood tests, a physical exam, conversations about lifestyle and more.

Prenatal care is an important part of a healthy pregnancy. Whether you choose a family physician, obstetrician, midwife or group prenatal care, here's what to expect during the first few prenatal appointments.

The 1st visit

When you find out you're pregnant, make your first prenatal appointment. Set aside time for the first visit to go over your medical history and talk about any risk factors for pregnancy problems that you may have.

Medical history

Your health care provider might ask about:

• Your menstrual cycle, gynecological history and any past pregnancies
• Your personal and family medical history
• Exposure to anything that could be toxic
• Medications you take, including prescription and over-the-counter medications, vitamins or supplements
• Your lifestyle, including your use of tobacco, alcohol, caffeine and recreational drugs
• Travel to areas where malaria, tuberculosis, Zika virus, mpox — also called monkeypox — or other infectious diseases are common

Share information about sensitive issues, such as domestic abuse or past drug use, too. This will help your health care provider take the best care of you — and your baby.

Your due date is not a prediction of when you will have your baby. It's simply the date that you will be 40 weeks pregnant. Few people give birth on their due dates. Still, establishing your due date — or estimated date of delivery — is important. It allows your health care provider to monitor your baby's growth and the progress of your pregnancy. Your due date also helps with scheduling tests and procedures, so they are done at the right time.

To estimate your due date, your health care provider will use the date your last period started, add seven days and count back three months. The due date will be about 40 weeks from the first day of your last period. Your health care provider can use a fetal ultrasound to help confirm the date. Typically, if the due date calculated with your last period and the due date calculated with an early ultrasound differ by more than seven days, the ultrasound is used to set the due date.

Physical exam

To find out how much weight you need to gain for a healthy pregnancy, your health care provider will measure your weight and height and calculate your body mass index.

Your health care provider might do a physical exam, including a breast exam and a pelvic exam. You might need a Pap test, depending on how long it's been since your last Pap test. Depending on your situation, you may need exams of your heart, lungs and thyroid.

At your first prenatal visit, blood tests might be done to:

• Check your blood type. This includes your Rh status. Rh factor is an inherited trait that refers to a protein found on the surface of red blood cells. Your pregnancy might need special care if you're Rh negative and your baby's father is Rh positive.
• Measure your hemoglobin. Hemoglobin is an iron-rich protein found in red blood cells that allows the cells to carry oxygen from your lungs to other parts of your body. Hemoglobin also carries carbon dioxide from other parts of your body to your lungs so that it can be exhaled. Low hemoglobin or a low level of red blood cells is a sign of anemia. Anemia can make you feel very tired, and it may affect your pregnancy.
• Check immunity to certain infections. This typically includes rubella and chickenpox (varicella) — unless proof of vaccination or natural immunity is documented in your medical history.
• Detect exposure to other infections. Your health care provider will suggest blood tests to detect infections such as hepatitis B, syphilis, gonorrhea, chlamydia and HIV , the virus that causes AIDS . A urine sample might also be tested for signs of a bladder or urinary tract infection.

Tests for fetal concerns

Prenatal tests can provide valuable information about your baby's health. Your health care provider will typically offer a variety of prenatal genetic screening tests. They may include ultrasound or blood tests to check for certain fetal genetic problems, such as Down syndrome.

Lifestyle issues

Your health care provider might discuss the importance of nutrition and prenatal vitamins. Ask about exercise, sex, dental care, vaccinations and travel during pregnancy, as well as other lifestyle issues. You might also talk about your work environment and the use of medications during pregnancy. If you smoke, ask your health care provider for suggestions to help you quit.

Discomforts of pregnancy

You might notice changes in your body early in your pregnancy. Your breasts might be tender and swollen. Nausea with or without vomiting (morning sickness) is also common. Talk to your health care provider if your morning sickness is severe.

Other 1st trimester visits

Your next prenatal visits — often scheduled about every four weeks during the first trimester — might be shorter than the first. Near the end of the first trimester — by about 12 to 14 weeks of pregnancy — you might be able to hear your baby's heartbeat with a small device, called a Doppler, that bounces sound waves off your baby's heart. Your health care provider may offer a first trimester ultrasound, too.

Your prenatal appointments are an ideal time to discuss questions you have. During your first visit, find out how to reach your health care team between appointments in case concerns come up. Knowing help is available can offer peace of mind.

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• Lockwood CJ, et al. Prenatal care: Initial assessment. https://www.uptodate.com/contents/search. Accessed July 9, 2018.
• Prenatal care and tests. Office on Women's Health. https://www.womenshealth.gov/pregnancy/youre-pregnant-now-what/prenatal-care-and-tests. Accessed July 9, 2018.
• Cunningham FG, et al., eds. Prenatal care. In: Williams Obstetrics. 25th ed. New York, N.Y.: McGraw-Hill Education; 2018. https://www.accessmedicine.mhmedical.com. Accessed July 9, 2018.
• Lockwood CJ, et al. Prenatal care: Second and third trimesters. https://www.uptodate.com/contents/search. Accessed July 9, 2018.
• WHO recommendations on antenatal care for a positive pregnancy experience. World Health Organization. http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/anc-positive-pregnancy-experience/en/. Accessed July 9, 2018.
• Bastian LA, et al. Clinical manifestations and early diagnosis of pregnancy. https://www.uptodate.com/contents/search. Accessed July 9, 2018.

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Health Costs Associated with Pregnancy, Childbirth, and Postpartum Care

Matthew Rae , Cynthia Cox , and Hanna Dingel Published: Jul 13, 2022

Pregnancy is one of the most common reasons for a hospitalization among non-elderly people. In addition to the cost of the birth itself, pregnancy care also involves costs associated with prenatal visits and often includes care to treat psychological and medical conditions associated with pregnancy, birth, and the post-partum period.

This analysis examines the health costs associated with pregnancy, childbirth, and post-partum care using a subset of claims from the IBM MarketScan Encounter Database from 2018 through 2020 for enrollees in large employer private health plans. It finds that health costs associated with pregnancy, childbirth, and post-partum care average a total of $18,865 and the average out-of-pocket payments total $2,854. The analysis also examine how pregnancy, childbirth, and post-partum health spending among large group enrollees varies by the type of delivery.

The analysis can be found on the Peterson-KFF Health System Tracker , an information hub dedicated to monitoring and assessing the performance of the U.S. health system.

• Health Costs
• Women's Health Policy
• Private Insurance
• Peterson-KFF
• Cost Sharing
• Reproductive Health

news release

• Women who Give Birth Incur Nearly $19,000 in Additional Health Costs, Including $2,854 More that They Pay Out of Pocket

Also of Interest

• KFF COVID-19 Vaccine Monitor: Pregnancy Misinformation – May 2022
• Medicaid Postpartum Coverage Extension Tracker
• Employer Coverage of Travel Costs for Out-of-State Abortion

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Prenatal care checkups

Prenatal care is medical care you get during pregnancy. at each prenatal care visit, your health care provider checks on you and your growing baby., call your provider to schedule your first prenatal care checkup as soon as you know you’re pregnant., getting early and regular prenatal care can help you have a healthy pregnancy and a full-term baby., go to all your prenatal care checkups, even if you’re feeling fine..

What is prenatal care and why is it important?

Prenatal care is medical care you get during pregnancy. At each visit, your health care provider checks on you and your growing baby. Call your provider and go for your first prenatal care checkup as soon as you know you’re pregnant. And go to all your prenatal care checkups, even if you’re feeling fine.

Getting early and regular prenatal care can help you have a healthy pregnancy and a full-term baby. Full term means your baby is born between 39 weeks (1 week before your due date) and 40 weeks, 6 days (1 week after your due date). Being born full term gives your baby the right amount of time he needs in the womb to grow and develop.

Don’t be afraid to talk to your provider about personal things. Your provider needs to know all about you so she can give you and your baby the best care. She asks lots of questions about you, your partner and your families. Your medical information and anything you tell her are confidential. This means she can’t share them with anyone without your permission. So don’t be afraid to tell her about things that may be uncomfortable or embarrassing, like if your partner hurts or scares you or if you smoke , drink alcohol , use street drugs or abuse prescription drugs .

Who can you go to for prenatal care?

You can get prenatal care from different kinds of providers:

• An obstetrician/gynecologist (also called OB/GYN) is a doctor who has education and training to take care of pregnant women and deliver babies. The American College of Obstetricians and Gynecologists  can help you find an OB in your area. 
• A family practice doctor (also called a family physician) is a doctor who can take care of every member of your family. This doctor can take care of you before, during and after pregnancy. The American Board of Family Medicine can help you find a family practice doctor in your area. 
• A maternal-fetal medicine (also called MFM) specialist is an OB with education and training to take care of women who have high-risk pregnancies. If you have health conditions that may cause problems during pregnancy, your provider may want you to see a MFM specialist. The Society for Maternal-Fetal Medicine can help you find a specialist in your area.
• A certified nurse-midwife (also called CNM) is a nurse with education and training to take care of women of all ages, including pregnant women. The American College of Nurse-Midwives  can help you find a CNM in your area.
• A family nurse practitioner (also called FNP) or a women’s health nurse practitioner (also called WHNP). A FNP is a nurse with education and training to take care of every member of your family. A WHNP is a nurse with education and training to take care of women of all ages, including pregnant women. The American Association of Nurse Practitioners can help you find these kinds of nurse practitioners in your area.   

Think about these things to help you choose a provider:

• Is the provider licensed and board certified to take care of you during pregnancy, labor and birth? Licensed means the provider can legally practice medicine in a state. To have a license, a provider has to have a certain amount of education and training and pass certain tests to make sure he can safely take care of patients. Board certified means that a provider has had extra training in a certain area (called a specialty).
• Is the provider covered by your health insurance ? 
• Have you heard good things about the provider? Is she recommended by your friends or family? How does your partner feel about her as your prenatal care provider?  
• Would you rather see a man or a woman provider? How old to you want the provider to be? Does he explain things clearly? 
• Is the office easy to get to? Do the office hours fit into your schedule? Is the office staff friendly and helpful? 
• Who takes care of phone calls during office hours? Who handles them after hours or in an emergency? Do you have to pay if your provider spends time with you on the phone? 
• Is the provider in group practice? If yes, will you always see your provider at prenatal care checkups? Or will you see other providers in the practice? Who will deliver your baby if your provider’s not available when you go into labor? 
• What hospital or birthing center does the provider use? What do you know about it? Is it easy for you to get to?  

How often do you go for prenatal care checkups?

Most pregnant women can follow a schedule like this:

• Weeks 4 to 28 of pregnancy. Go for one checkup every 4 weeks (once a month).
• Weeks 28 to 36 of pregnancy. Go for one checkup every 2 weeks (twice a month).
• Weeks 36 to 41 of pregnancy. Go for one checkup every week (once a week).

If you have complications during pregnancy, your provider may want to see you more often.

Your partner or support person (a friend or someone from your family) is welcome at your prenatal checkups.

How can you get ready for your first prenatal care checkup?

Be ready to talk with your provider about:

• The first day of your last menstrual period (also called LMP). Your provider can use this to help find out your baby’s due date .
• Health conditions you have, like depression , diabetes , high blood pressure , and not being at a healthy weight . Conditions like these can cause problems during pregnancy. Tell your provider about your family health history . This is a record of any health conditions and treatments that you, your partner and everyone in your families have had. Use the March of Dimes Family Health History Form and share it with your provider. If you have a record of your vaccinations , take it to your checkup.  A vaccination is a shot that contains a vaccine that helps protect you from certain harmful infections. 
• Medicines you take, including prescription medicine , over-the-counter medicine, supplements and herbal products . Some medicines can hurt your baby if you take them during pregnancy, so you may need to stop taking it or switch to another medicine. Don’t stop or start taking any medicine without talking to your provider first. And tell your provider if you’re allergic to any medicine. You may be allergic to a medicine if it makes you sneeze, itch, get a rash or have trouble breathing when you take it.
• Your pregnancy history. Tell your provider if you’ve been pregnant before or if you’ve had trouble getting pregnant. Tell her if you’ve had any pregnancy complications or if you’ve had a preterm baby (a baby born before 37 weeks of pregnancy), a miscarriage or stillbirth . Miscarriage is when a baby dies in the womb before 20 weeks of pregnancy. Stillbirth is when a baby dies in the womb after 20 weeks of pregnancy.
• Smoking, drinking alcohol, using street drugs and abusing prescription drugs. All of these can hurt your baby. Alcohol includes beer, wine and liquor. Street drugs are illegal to use, like heroin and cocaine. Abusing prescription drugs means you use them differently than your provider tells you to. This means you take more than your provider says you can take, you take it with alcohol or other drugs or you use someone else’s prescription drugs.
• Stress you feel. Stress is worry, strain or pressure that you feel in response to things that happen in your life. Talk to your provide about ways to deal with and reduce your stress. High levels of stress can cause complications during pregnancy.
• Your safety at home and work. Tell your provider about chemicals you use at home or work and about what kind of job you have. If you’re worried about abuse during pregnancy and ask about ways you can stay healthy and safe at home and work.

What happens at your first prenatal care checkup?

Your first checkup is usually the longest because your provider asks you lots of questions about your health. At your first prenatal care checkup, your provider:

• Gives you a physical exam and checks your overall health. Your provider checks your weight and height to figure out how much weight you should gain during pregnancy.
• Checks your blood, blood pressure and urine. Blood tests can tell your provider if you have certain infections, like syphilis , hepatitis B and HIV. Your provider also uses a blood test to find out your blood type and Rh factor and to check for anemia. Anemia is when you don't have enough healthy red blood cells to carry oxygen to the rest of your body. Rh factor is a protein that most people have on their red blood cells. If you don’t have it and your baby does, it can cause Rh disease in your baby. Treatment during pregnancy can prevent Rh disease. Blood pressure and urine tests can help your provider diagnose a serious condition called preeclampsia . This is a kind of high blood pressure that can happen during pregnancy. Having too much protein in your urine may be a sign of preeclampsia. Urine tests also can tell your provider if you have a kidney or bladder infection or other conditions, like diabetes.  
• Gives you a pelvic exam and a Pap smear. Your provider checks the pelvic organs (pelvis and womb) to make sure they’re healthy. For the Pap smear, your provider collects cells from your cervix to check for cancer and for infections, like chlamydia and gonorrhea. The cervix is the opening to the uterus (womb) that sits at the top of the vagina.
• May give you vaccinations, like a flu shot. It’s safe to get a flu shot any time during pregnancy. But some vaccinations are best at certain times and some aren’t recommended during pregnancy. Talk to your provider about what’s best and safe for you and your baby.
• Tells you your due date. Your provider usually uses your LMP to figure out your due date. But you may get an early ultrasound to confirm that you’re pregnant and help your provider figure out your baby’s age. An ultrasound uses sound waves and a computer screen to show a picture of your baby inside the womb.
• Prescribes a prenatal vitamin. This is a multivitamin made for pregnant women. Your prenatal vitamin should have 600 micrograms of folic acid in it. Folic acid is a vitamin that every cell in your body needs for healthy growth and development. If you take it before pregnancy and during early pregnancy, it can help protect your baby from birth defects of the brain and spine called neural tube defects (also called NTDs), and birth defects of the mouth called cleft lip and palate .
• Talks to you about prenatal tests. These are medical tests you get during pregnancy. They help your provider find out how you and your baby are doing. You may want to have certain tests only if you have certain problems or if you’re at high risk of having a baby with a genetic or chromosomal condition , like Down syndrome . If your provider thinks you’re at risk for having a baby with one of these conditions, he may recommend that you see a genetic counselor . This person has training to help you understand about genes, birth defects and other medical conditions that run in families, and how they can affect your health and your baby’s health.

What happens at later prenatal care checkups?

Later prenatal care checkups usually are shorter than the first one. At your checkups, tell your provider how you’re feeling. There’s a lot going on inside your body during pregnancy. Your provider can help you understand what’s happening and help you feel better if you’re not feeling well. Between visits, write down questions you have and ask them at your next checkup.

At later prenatal care checkups, your health care provider:

• Checks your weight and blood pressure. You also may get urine and blood tests.
• Checks your baby’s heartbeat. This happens after about 10 to 12 weeks of pregnancy. You can listen, too!
• Measures your belly to check your baby’s growth. Your provider starts doing this at about 20 weeks of pregnancy. Later in pregnancy, she also feels your belly to check your baby’s position in the womb.
• Gives you certain prenatal tests to check you and your baby. For example, most women get an ultrasound at 18 to 20 weeks of pregnancy. You may be able to tell if your baby’s a boy or a girl from this ultrasound, so be sure to tell your provider if you don’t want to know! Later in pregnancy, your provider may use ultrasound to check the amount of amniotic fluid around your baby in the womb. Between 24 and 28 weeks, you get a glucose screening test to see if you may have gestational diabetes . This is a kind of diabetes that some women get during pregnancy. And at 35 to 37 weeks, you get a test to check for group B strep . This is an infection you can pass to your baby.
• Asks you about your baby’s movement in the womb. If it’s your first pregnancy, you may feel your baby move by about 20 weeks. If you’ve been pregnant before, you may feel your baby move sooner. Your provider may ask you to do kick counts to keep track of how often your baby moves.
• Gives you a Tdap vaccination at 27 to 36 weeks of pregnancy. This vaccination protects both you and your baby against pertussis (also called whooping cough). Pertussis spreads easily and is dangerous for a baby.
• Does a pelvic exam . Your provider may check for changes in your cervix as you get close to your due date.

How can you get free or low-cost prenatal care?

If you don't have health insurance or can't afford prenatal care, find out about free or low-cost prenatal care services in your community:

• Call (800) 311-BABY [(800) 311-2229]. For information in Spanish, call (800) 504-7081.
• Visit healthcare.gov to find a community health center near you. Community health centers can provide low-cost prenatal care.

Last reviewed: June, 2017

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Prenatal care and tests

Medical checkups and screening tests help keep you and your baby healthy during pregnancy. This is called prenatal care. It also involves education and counseling about how to handle different aspects of your pregnancy. During your visits, your doctor may discuss many issues, such as healthy eating and physical activity, screening tests you might need, and what to expect during labor and delivery.

Choosing a prenatal care provider

You will see your prenatal care provider many times before you have your baby. So you want to be sure that the person you choose has a good reputation, and listens to and respects you. You will want to find out if the doctor or midwife can deliver your baby in the place you want to give birth , such as a specific hospital or birthing center. Your provider also should be willing and able to give you the information and support you need to make an informed choice about whether to breastfeed or bottle-feed.

Health care providers that care for women during pregnancy include:

• Obstetricians (OB) are medical doctors who specialize in the care of pregnant women and in delivering babies. OBs also have special training in surgery so they are also able to do a cesarean delivery . Women who have health problems or are at risk for pregnancy complications should see an obstetrician. Women with the highest risk pregnancies might need special care from a maternal-fetal medicine specialist .
• Family practice doctors are medical doctors who provide care for the whole family through all stages of life. This includes care during pregnancy and delivery, and following birth. Most family practice doctors cannot perform cesarean deliveries.
• A certified nurse-midwife (CNM) and certified professional midwife (CPM) are trained to provide pregnancy and postpartum care. Midwives can be a good option for healthy women at low risk for problems during pregnancy, labor, or delivery. A CNM is educated in both nursing and midwifery. Most CNMs practice in hospitals and birth centers. A CPM is required to have experience delivering babies in home settings because most CPMs practice in homes and birthing centers. All midwives should have a back-up plan with an obstetrician in case of a problem or emergency.

Ask your primary care doctor, friends, and family members for provider recommendations. When making your choice, think about:

• Personality and bedside manner
• The provider's gender and age
• Office location and hours
• Whether you always will be seen by the same provider during office checkups and delivery
• Who covers for the provider when she or he is not available
• Where you want to deliver
• How the provider handles phone consultations and after-hour calls

What is a doula?

A doula (DOO-luh) is a professional labor coach, who gives physical and emotional support to women during labor and delivery. They offer advice on breathing, relaxation, movement, and positioning. Doulas also give emotional support and comfort to women and their partners during labor and birth. Doulas and midwives often work together during a woman's labor. A recent study showed that continuous doula support during labor was linked to shorter labors and much lower use of:

• Pain medicines
• Oxytocin (ok-see-TOHS-uhn) (medicine to help labor progress)
• Cesarean delivery

Check with your health insurance company to find out if they will cover the cost of a doula. When choosing a doula, find out if she is certified by Doulas of North America (DONA) or another professional group.

Places to deliver your baby

Many women have strong views about where and how they'd like to deliver their babies. In general, women can choose to deliver at a hospital, birth center, or at home. You will need to contact your health insurance provider to find out what options are available. Also, find out if the doctor or midwife you are considering can deliver your baby in the place you want to give birth.

Hospitals are a good choice for women with health problems, pregnancy complications, or those who are at risk for problems during labor and delivery. Hospitals offer the most advanced medical equipment and highly trained doctors for pregnant women and their babies. In a hospital, doctors can do a cesarean delivery if you or your baby is in danger during labor. Women can get epidurals or many other pain relief options. Also, more and more hospitals now offer on-site birth centers, which aim to offer a style of care similar to standalone birth centers.

Questions to ask when choosing a hospital:

• Is it close to your home?
• Is a doctor who can give pain relief, such as an epidural, at the hospital 24-hours a day?
• Do you like the feel of the labor and delivery rooms?
• Are private rooms available?
• How many support people can you invite into the room with you?
• Does it have a neonatal intensive care unit (NICU) in case of serious problems with the baby?
• Can the baby stay in the room with you?
• Does the hospital have the staff and set-up to support successful breastfeeding?
• Does it have an on-site birth center?

Birth or birthing centers give women a "homey" environment in which to labor and give birth. They try to make labor and delivery a natural and personal process by doing away with most high-tech equipment and routine procedures. So, you will not automatically be hooked up to an IV. Likewise, you won't have an electronic fetal monitor around your belly the whole time. Instead, the midwife or nurse will check in on your baby from time to time with a handheld machine. Once the baby is born, all exams and care will occur in your room. Usually certified nurse-midwives, not obstetricians, deliver babies at birth centers. Healthy women who are at low risk for problems during pregnancy, labor, and delivery may choose to deliver at a birth center.

Women can not receive epidurals at a birth center, although some pain medicines may be available. If a cesarean delivery becomes necessary, women must be moved to a hospital for the procedure. After delivery, babies with problems can receive basic emergency care while being moved to a hospital.

Many birthing centers have showers or tubs in their rooms for laboring women. They also tend to have comforts of home like large beds and rocking chairs. In general, birth centers allow more people in the delivery room than do hospitals.

Birth centers can be inside of hospitals, a part of a hospital or completely separate facilities. If you want to deliver at a birth center, make sure it meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers. Accredited birth centers must have doctors who can work at a nearby hospital in case of problems with the mom or baby. Also, make sure the birth center has the staff and set-up to support successful breastfeeding.

Homebirth is an option for healthy pregnant women with no risk factors for complications during pregnancy, labor or delivery. It is also important women have a strong after-care support system at home. Some certified nurse midwives and doctors will deliver babies at home. Many health insurance companies do not cover the cost of care for homebirths. So check with your plan if you'd like to deliver at home.

Homebirths are common in many countries in Europe. But in the United States, planned homebirths are not supported by the American Congress of Obstetricians and Gynecologists (ACOG). ACOG states that hospitals are the safest place to deliver a baby. In case of an emergency, says ACOG, a hospital's equipment and highly trained doctors can provide the best care for a woman and her baby.

If you are thinking about a homebirth, you need to weigh the pros and cons. The main advantage is that you will be able to experience labor and delivery in the privacy and comfort of your own home. Since there will be no routine medical procedures, you will have control of your experience.

The main disadvantage of a homebirth is that in case of a problem, you and the baby will not have immediate hospital/medical care. It will have to wait until you are transferred to the hospital. Plus, women who deliver at home have no options for pain relief.

To ensure your safety and that of your baby, you must have a highly trained and experienced midwife along with a fail-safe back-up plan. You will need fast, reliable transportation to a hospital. If you live far away from a hospital, homebirth may not be the best choice. Your midwife must be experienced and have the necessary skills and supplies to start emergency care for you and your baby if need be. Your midwife should also have access to a doctor 24 hours a day.

Prenatal checkups

During pregnancy, regular checkups are very important. This consistent care can help keep you and your baby healthy, spot problems if they occur, and prevent problems during delivery. Typically, routine checkups occur:

• Once each month for weeks four through 28
• Twice a month for weeks 28 through 36
• Weekly for weeks 36 to birth

Women with high-risk pregnancies need to see their doctors more often.

At your first visit your doctor will perform a full physical exam, take your blood for lab tests, and calculate your due date. Your doctor might also do a breast exam, a pelvic exam to check your uterus (womb), and a cervical exam, including a Pap test. During this first visit, your doctor will ask you lots of questions about your lifestyle, relationships, and health habits. It's important to be honest with your doctor.

After the first visit, most prenatal visits will include:

• Checking your blood pressure and weight
• Checking the baby's heart rate
• Measuring your abdomen to check your baby's growth

You also will have some routine tests throughout your pregnancy, such as tests to look for anemia , tests to measure risk of gestational diabetes , and tests to look for harmful infections.

Become a partner with your doctor to manage your care. Keep all of your appointments — every one is important! Ask questions and read to educate yourself about this exciting time.

Monitor your baby's activity

After 28 weeks, keep track of your baby's movement. This will help you to notice if your baby is moving less than normal, which could be a sign that your baby is in distress and needs a doctor's care. An easy way to do this is the "count-to-10" approach. Count your baby's movements in the evening — the time of day when the fetus tends to be most active. Lie down if you have trouble feeling your baby move. Most women count 10 movements within about 20 minutes. But it is rare for a woman to count less than 10 movements within two hours at times when the baby is active. Count your baby's movements every day so you know what is normal for you. Call your doctor if you count less than 10 movements within two hours or if you notice your baby is moving less than normal. If your baby is not moving at all, call your doctor right away.

Prenatal tests

Tests are used during pregnancy to check your and your baby's health. At your fist prenatal visit, your doctor will use tests to check for a number of things, such as:

• Your blood type and Rh factor
• Infections, such as toxoplasmosis and sexually transmitted infections (STIs), including hepatitis B , syphilis , chlamydia , and HIV
• Signs that you are immune to rubella (German measles) and chicken pox

Throughout your pregnancy, your doctor or midwife may suggest a number of other tests, too. Some tests are suggested for all women, such as screenings for gestational diabetes, Down syndrome, and HIV. Other tests might be offered based on your:

• Personal or family health history
• Ethnic background
• Results of routine tests

Some tests are screening tests. They detect risks for or signs of possible health problems in you or your baby. Based on screening test results, your doctor might suggest diagnostic tests. Diagnostic tests confirm or rule out health problems in you or your baby.

Understanding prenatal tests and test results

If your doctor suggests certain prenatal tests, don't be afraid to ask lots of questions. Learning about the test, why your doctor is suggesting it for you, and what the test results could mean can help you cope with any worries or fears you might have. Keep in mind that screening tests do not diagnose problems. They evaluate risk. So if a screening test comes back abnormal, this doesn't mean there is a problem with your baby. More information is needed. Your doctor can explain what test results mean and possible next steps.

Avoid keepsake ultrasounds

You might think a keepsake ultrasound is a must-have for your scrapbook. But, doctors advise against ultrasound when there is no medical need to do so. Some companies sell "keepsake" ultrasound videos and images. Although ultrasound is considered safe for medical purposes, exposure to ultrasound energy for a keepsake video or image may put a mother and her unborn baby at risk. Don't take that chance.

High-risk pregnancy

Pregnancies with a greater chance of complications are called "high-risk." But this doesn't mean there will be problems. The following factors may increase the risk of problems during pregnancy:

• Very young age or older than 35
• Overweight or underweight
• Problems in previous pregnancy
• Health conditions you have before you become pregnant, such as high blood pressure , diabetes , autoimmune disorders , cancer , and HIV
• Pregnancy with twins or other multiples

Health problems also may develop during a pregnancy that make it high-risk, such as gestational diabetes or preeclampsia . See Pregnancy complications to learn more.

Women with high-risk pregnancies need prenatal care more often and sometimes from a specially trained doctor. A maternal-fetal medicine specialist is a medical doctor that cares for high-risk pregnancies.

If your pregnancy is considered high risk, you might worry about your unborn baby's health and have trouble enjoying your pregnancy. Share your concerns with your doctor. Your doctor can explain your risks and the chances of a real problem. Also, be sure to follow your doctor's advice. For example, if your doctor tells you to take it easy, then ask your partner, family members, and friends to help you out in the months ahead. You will feel better knowing that you are doing all you can to care for your unborn baby.

Paying for prenatal care

Pregnancy can be stressful if you are worried about affording health care for you and your unborn baby. For many women, the extra expenses of prenatal care and preparing for the new baby are overwhelming. The good news is that women in every state can get help to pay for medical care during their pregnancies. Every state in the United States has a program to help. Programs give medical care, information, advice, and other services important for a healthy pregnancy.

Learn more about programs available in your state.

You may also find help through these places:

• Local hospital or social service agencies – Ask to speak with a social worker on staff. She or he will be able to tell you where to go for help.
• Community clinics – Some areas have free clinics or clinics that provide free care to women in need.
• Women, Infants and Children (WIC) Program – This government program is available in every state. It provides help with food, nutritional counseling, and access to health services for women, infants, and children.
• Places of worship

More information on prenatal care and tests

Read more from womenshealth.gov.

• Pregnancy and Medicines Fact Sheet - This fact sheet provides information on the safety of using medicines while pregnant.

Explore other publications and websites

• Chorionic Villus Sampling (CVS) (Copyright © March of Dimes) - Chorionic villus sampling (CVS) is a prenatal test that can diagnose or rule out certain birth defects. The test is generally performed between 10 and 12 weeks after a woman's last menstrual period. This fact sheet provides information about this test, and how the test sample is taken.
• Folic Acid (Copyright © March of Dimes) - This fact sheet stresses the importance of getting higher amounts of folic acid during pregnancy in order to prevent neural tube defects in unborn children.
• Folic Acid: Questions and Answers - The purpose of this question and answer sheet is to educate women of childbearing age on the importance of consuming folic acid every day to reduce the risk of spina bifida.
• For Women With Diabetes: Your Guide to Pregnancy - This booklet discusses pregnancy in women with diabetes. If you have type 1 or type 2 diabetes and you are pregnant or hoping to get pregnant soon, you can learn what to do to have a healthy baby. You can also learn how to take care of yourself and your diabetes before, during, and after your pregnancy.
• Genetics Home Reference - This website provides information on specific genetic conditions and the genes or chromosomes responsible for these conditions.
• Guidelines for Vaccinating Pregnant Women - This publication provides information on routine and other vaccines and whether they are recommended for use during pregnancy.
• How Your Baby Grows (Copyright © March of Dimes) - This site provides information on the development of your baby and the changes in your body during each month of pregnancy. In addition, for each month, it provides information on when to go for prenatal care appointments and general tips to take care of yourself and your baby.
• Pregnancy Registries - Pregnancy registries help women make informed and educated decisions about using medicines during pregnancy. If you are pregnant and currently taking medicine — or have been exposed to a medicine during your pregnancy — you may be able to participate and help in the collection of this information. This website provides a list of pregnancy registries that are enrolling pregnant women.
• Pregnancy, Breastfeeding, and Bone Health - This publication provides information on pregnancy-associated osteoporosis, lactation and bone loss, and what you can do to keep your bones healthy during pregnancy.
• Prenatal Care: First-Trimester Visits (Copyright © Mayo Foundation) - This fact sheet explains what to expect during routine exams with your doctor. In addition, if you have a condition that makes your pregnancy high-risk, special tests may be performed on a regular basis to check the baby's health.
• Ten Tips for a Healthy Pregnancy (Copyright © Lamaze International) - This easy-to-read fact sheet provides 10 simple recommendations to help mothers have a healthy pregnancy.
• Ultrasound (Copyright © March of Dimes) - This fact sheet discusses the use of an ultrasound in prenatal care at each trimester.

Connect with other organizations

• American Academy of Family Physicians
• American Association of Birth Centers
• American College of Obstetricians and Gynecologists
• Center for Research on Reproduction and Women's Health, University of Pennsylvania Medical Center
• Dona International
• March of Dimes
• Maternal and Child Health Bureau, HRSA, HHS
• National Association for Down Syndrome
• National Center on Birth Defects and Developmental Disabilities, CDC
• Public Information and Communications Branch, NICHD, NIH, HHS
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How Much Does Prenatal Care Cost?

While pregnant, it is very important for a woman to take care of herself and the baby by getting regular check-ups.  These check-ups, which start monthly, then turn to bi-monthly and eventually weekly, will help the doctor determine if everything is progressing normally with your pregnancy.

How much does prenatal care cost?

On average, the total prenatal visits will cost anywhere from $1,700 to $3,000 for the entire nine months during the pregnancy.   This is without insurance and doesn’t include the baby delivery.

According to Revolution Health , the average prenatal care cost of a prenatal visit is $133.  Throughout most pregnancies, the mother will see the doctor about 14 times.  Therefore, the total average cost is $1,862.

WebMD.com states that the average person pays around $2,000 for prenatal care.

Plan on spending anywhere from $95 to as much as $200 per visit without any sort of insurance.

Depending on the type of insurance you have, you will only have to pay a percentage of this.  Most insurance companies cover anywhere from 85%-90% of costs.  Basically, you will probably have to pay about $15 per visit out of pocket.

Prenatal care overview

At the first prenatal visit, the doctor will calculate your due date and give you information regarding not only your pregnancy but about your newborn baby.  The doctor will discuss with you things like diet and exercise, vitamins to take, birthing options, etc.  Most visits after this will simply consist of taking your weight, a urine analysis, listening to the heartbeat, and an opportunity to ask any questions you may have.

During the first appointment, the doctor will be able to determine a due date, perform an exam and will more than likely perform a pap test.  The government also requires that all women get tested for HIV.

During the subsequent appointments, the doctor will ask about how you’re feeling and if you have any concerns.  The goal of each appointment is to see how the pregnancy is proceeding and to provide you with information along the way.  Each appointment will often include checking your weight, blood pressure and taking urine samples.   As the baby grows, the OB/GYN will check the position of the baby, along with the heartbeat.

At around 20 weeks, an ultrasound will be scheduled in order to better assess the health of the baby and to find out the sex of the baby if the mother so desires.

Most appointments will include a urine sample to screen the sugar, a weight recording, the baby’s heartbeat (if applicable), the OB/GYN will check the position and your blood pressure will be checked.

You should expect to see the doctor about 12 to 15 times.

Prenatal screenings

Most of the screenings will be done throughout the pregnancy; however, some may be optional and will only be recommended if your doctor recommends it.

• Bacteriuria urinary tract
• Rh incompatibility
• Hepatitis B
• Gestational diabetes

What are the extra costs?

If there are any complications resulting in extra testing, the total cost will increase.

If you would like additional ultrasounds, such as a 4d ultrasound, this will more than likely not be covered by insurance because it is not a necessity.  A 4d ultrasound can cost anywhere from $100 to $300 depending on what features are included in the experience.

Most doctors suggest that pregnant women take some sort of multi-vitamin.  This is usually covered by insurance except for a small copay.

The baby delivery will be considered an additional cost outside of the care.

Complications during a pregnancy can sometimes lead to extensive tests or prolonged hospital stays.  If this is the case, the cost can greatly vary depending on what has been done.

Tips to know:

During the first appointment, be sure to bring items such as your medical records, a list of medications you’re currently on, questions you may have (write these down) and a friend or husband to help support you during this process.

Before the process even begins, it’s essential to know what’s going to be covered under your health insurance policy.  Since many health insurance policies are different, one policy may cover one procedure, while another may deny it.

Consult with the hospital before the labor begins.  If paying out of pocket, the hospital will be more than happy to give a discount to those that are paying up front with cash.

If purchasing prenatal vitamins on your own, talk with your OB/GYN.  Many OB/GYNs are more than happy to give out samples for free throughout the duration of the pregnancy.  This is a great way to avoid paying the full retail price.

While a hospital delivery can be rather expensive, consider other alternatives that are cheaper such as a doula and/or midwife.  An insurance company may not cover a procedure such as this one, but many soon-to-be moms prefer this route because of the home-based setting.   See: “ How much does a doula cost? ”

How can I save money?

Planning pregnancy ahead of time can help save confusion with the insurance company.  If you sign up for health insurance when you are already pregnant, some companies consider it a “pre-existing condition” and it will not be covered.   Keep in mind that if you sign up with a group insurance plan, they will have to cover you by law.

If you have no insurance, many doctors offices and hospitals will give discounts if you pay in cash.  These discounts are not openly offered, however;  you must inquire and bargain with them.

Uninsured women who meet certain financial guidelines will find that there are many programs that can help with the cost of the care.

Most OB/GYNs are more than happy to provide you with prenatal vitamins for free.  If you can’t afford the vitamins, let them know.

Prenatal care low-income options:

Local Health Department

Your local health department should be able to provide you with some programs that they run at a lower cost or even for free.  To connect with a local health department in your area, call 1-800-311-BABY.

Medical Schools

Many bigger medical schools will run clinics for the public.  Working with medical students that are supervised, you can get care at a fraction of the cost.

Planned Parenthood

Like the health department, planned parenthood can provide care based on your salary.

This is a program sponsored by the government for those who meet certain income guidelines.  If accepted to this program, you will get a list of doctors that you can see for care.

How to choose a prenatal care provider:

Similar to a midwife, a doula is more like a coach.  They will help with physical and emotional support during the labor.  A doula will often work with a midwife during the labor process.  If using a doula, make sure that you check with your insurance company to see if you’re covered.

A certified midwife is great for women who are considered to be at low-risk.  Educated in nursing, a midwife can practice at hospitals and a birthing center.  Many prefer to deliver babies in the patient’s home.

Family Practice

Family doctors can provide care during a pregnancy but it may not be as detailed as an OB.  They can do just about everything, except for cesarean deliveries.

Obstetricians

Medical doctors who specialize in delivering babies.  They will also have special training with surgeries such as a cesarean section.  Women who think that they are at the highest risk during a pregnancy should consider this specialty.

How can I compare prices?

Because we are talking about the health of you and your baby, you should choose a doctor and hospital according to their credentials and your comfort level, not according to price.

When choosing a provider, research their reputation, their bedside manner, office location, where you deliver and how they handle off-hour calls.

Advertising Disclosure: This content may include referral links. Please read our disclosure policy for more info.

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Pregnant and Uninsured

Fact-checking standards, latest update:, read this next.

What to Expect When You're Expecting , 5th edition, Heidi Murkoff. WhatToExpect.com, How Much Does Pregnancy Cost? December 2020. Health Care Cost Institute, Understanding Variation in Spending on Childbirth Among the Commercially Insured , May 2020. Healthcare.gov, Health Coverage if You’re Pregnant, Plan to Get Pregnant, or Recently Gave Birth, 2021. Department of Labor Employee Benefits Security Administration, FAQs on COBRA Continuation Health Coverage , November 2015. Kaiser Family Foundation, Medicaid/CHIP Eligibility Limits , 2019.

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The cost of prenatal care without health insurance may seem overwhelming — but, if you’re an expectant mother, you always have options. Learn more about what to do to lower your costs of prenatal care without insurance here.

• When to Start
• Due Date Calculator
• Prenatal Care Costs

Prenatal Care Without Insurance: 5 Steps You Should Take

Many times, the women who face unplanned pregnancies are in less-than-ideal situations . They may still be in school, working to advance their career, barely affording their day-to-day costs, or simply not ready to become a parent. For some women, an unplanned pregnancy can be dire if they do not have health insurance. Pregnancy can be a scary and complicated medical condition, and going into this nine-month journey without access to medical care is incredibly stressful.

If you’re in this position, you are probably feeling incredibly overwhelmed at the prospect of obtaining prenatal care without insurance. You want the best for yourself and your unborn baby, but a future of insurmountable medical bills can make you wonder what the best step is moving forward.

If you are worried about your upcoming prenatal care cost without insurance, always remember that you have options . If you have no insurance, prenatal care isn’t off the table; you will just have to take a few extra steps to obtain the affordable medical care you need.

What to Do If You are Facing Prenatal Care Cost Without Insurance

Almost half of pregnancies in the United States are unplanned. Therefore, a great percentage of these women find themselves uninsured and worried about how they will afford their upcoming prenatal care costs. About 11 percent of American women in 2011 were uninsured and, because women are more likely to lose their dependent status on insurance, that coverage is more at-risk than a man’s insurance is.

All this to say: You are not alone if you are wondering how much prenatal care without insurance is in your situation. You have nothing to be ashamed of if you discover you are pregnant while uninsured, but the next steps you take can make all the difference in the world for the remainder of your pregnancy.

Step 1: Understand the true costs of prenatal care without insurance.

If you find yourself pregnant and uninsured , you may be wary of the extra steps and responsibility involved in getting insurance at this already-stressful time in your life. However, do not underestimate the importance of insurance during your pregnancy.

Women often ask, “How much for prenatal care without insurance should I expect to pay?” Every woman’s pregnancy is different, but the average cost of prenatal care without insurance for a typical pregnancy is about $2,000 , according to the Kaiser Family Foundation. That doesn’t include the costs of childbirth and delivery, postpartum recovery and the rest of your costs of raising a child — all substantial aspects of your pregnancy costs.

The costs of prenatal care without insurance can be prohibitive to even the best prepared. If you are not sure you can afford the overall costs of pregnancy and parenthood, you can always choose to terminate your pregnancy (an average cost in the hundreds to thousands of dollars ) or place your child for adoption ( which is always free to you ). Keep in mind that, should you choose adoption, the costs of your prenatal care will always be covered by your adoption professional, as well as other living expenses during your pregnancy.

Step 2: Apply for Medicaid, if eligible.

If you decide to continue your pregnancy with the goal of raising your child, obtaining some kind of insurance will be incredibly helpful in the months to come. Fortunately, there is a government-sponsored Medicaid prenatal care program that can cover your prenatal services, if you are eligible.

Different states have different rules regarding Medicaid eligibility but, if you are living on a low income, it’s likely that you will be eligible for Medicaid prenatal care coverage. Contact your local Medicaid office today for more information about the program and your eligibility.

Step 3: Research the Affordable Care Act’s prenatal care policies.

Since 2013, insurance companies are required to cover maternity care and childbirth, not treat it as a pre-existing condition. Expectant mothers can obtain health coverage even after their pregnancy begins. The ACA prenatal care policy reaffirms that maternity care and childbirth are covered by Medicaid and Children’s Health Insurance Program (CHIP).

You can learn more about applying for these insurance programs at any time on HealthCare.gov .

Step 4: Consider purchasing a prenatal care insurance plan.

Many group and private insurance policies offer you the chance to enroll in their programs at certain times during the year. Talk with your employer to see if there are any employer-provided plans available to you, or search through the HealthCare.gov Marketplace for more options. You may also consider alternative short-terms plans ( such as AmeriPlan ) that provide discounts on your healthcare services.

Step 5: Search for low-cost, affordable prenatal care clinics and services.

In addition to purchasing prenatal care insurance plans, there are a few steps you can take to reduce what your no-insurance prenatal care costs you.

First, you should search for low-cost family planning clinics and community healthcare clinics around you ( such as Planned Parenthood ). These professionals typically charge less than larger, private healthcare providers. You should also take the time to shop around for providers; ask them about their healthcare costs, especially if you are paying for your prenatal care without insurance. Find out if they offer payment plans or reduced-cost programs for low-income expectant mothers. Simple steps such as choosing generic prescriptions over brand-name can also play a huge role in reducing your cost of prenatal care without health insurance.

Prenatal care without insurance isn’t impossible to find; you just need to know where to look and what to look for. We know an unexpected pregnancy can be stressful, so take the time to find the professional who is right for you and your budget to start your pregnancy out on the right note.

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Their first baby came with medical debt. These Illinois parents won't have another.

Medical debt is as much a hallmark of having children as long nights and dirty diapers. The Crivilare family, Andrew, Heather and Rita, 2, are pictured at their kitchen table in Jacksonville, Ill. Neeta Satam for KFF Health News hide caption

Medical debt is as much a hallmark of having children as long nights and dirty diapers. The Crivilare family, Andrew, Heather and Rita, 2, are pictured at their kitchen table in Jacksonville, Ill.

JACKSONVILLE, Ill. — Heather Crivilare was a month from her due date when she was rushed to an operating room for an emergency cesarean section.

The first-time mother, a high school teacher in rural Illinois, had developed high blood pressure, a sometimes life-threatening condition in pregnancy that prompted doctors to hospitalize her. Then Crivilare's blood pressure spiked, and the baby's heart rate dropped. "It was terrifying," Crivilare said.

She gave birth to a healthy daughter. What followed, though, was another ordeal: thousands of dollars in medical debt that sent Crivilare and her husband scrambling for nearly a year to keep collectors at bay.

The Crivilares would eventually get on nine payment plans as they juggled close to $5,000 in bills.

"It really felt like a full-time job some days," Crivilare recalled. "Getting the baby down to sleep and then getting on the phone. I'd set up one payment plan, and then a new bill would come that afternoon. And I'd have to set up another one."

Crivilare's pregnancy may have been more dramatic than most. But for millions of new parents, medical debt is now as much a hallmark of having children as long nights and dirty diapers.

About 12% of the 100 million U.S. adults with health care debt attribute at least some of it to pregnancy or childbirth, according to a KFF poll .

These people are more likely to report they've had to take on extra work, change their living situation, or make other sacrifices.

Heather Crivilare says she wishes there were a grace period for medical debt after the birth of a child, as there is for student loan debt after graduation. Neeta Satam for KFF Health News hide caption

Heather Crivilare says she wishes there were a grace period for medical debt after the birth of a child, as there is for student loan debt after graduation.

Overall, women between 18 and 35 who have had a baby in the past year and a half are twice as likely to have medical debt as women of the same age who haven't given birth recently, other KFF research conducted for this project found.

"You feel bad for the patient because you know that they want the best for their pregnancy," said Eilean Attwood, a Rhode Island OB-GYN who said she routinely sees pregnant women anxious about going into debt.

"So often, they may be coming to the office or the hospital with preexisting debt from school, from other financial pressures of starting adult life," Attwood said. "They are having to make real choices, and what those real choices may entail can include the choice to not get certain services or medications or what may be needed for the care of themselves or their fetus."

Best-laid plans

Crivilare and her husband, Andrew, also a teacher, anticipated some of the costs.

The young couple settled in Jacksonville, in part because the farming community less than two hours north of St. Louis was the kind of place two public school teachers could afford a house. They saved aggressively. They bought life insurance.

And before Crivilare got pregnant in 2021, they enrolled in the most robust health insurance plan they could, paying higher premiums to minimize their deductible and out-of-pocket costs.

Then, two months before their baby was due, Crivilare learned she had developed preeclampsia. Her pregnancy would no longer be routine. Crivilare was put on blood pressure medication, and doctors at the local hospital recommended bed rest at a larger medical center in Springfield, about 35 miles away.

"I remember thinking when they insisted that I ride an ambulance from Jacksonville to Springfield ... 'I'm never going to financially recover from this,'" she said. "'But I want my baby to be OK.'"

For weeks, Crivilare remained in the hospital alone as covid protocols limited visitors. Meanwhile, doctors steadily upped her medications while monitoring the fetus. It was, she said, "the scariest month of my life."

Fear turned to relief after her daughter, Rita, was born. The baby was small and had to spend nearly two weeks in the neonatal intensive care unit. But there were no complications. "We were incredibly lucky," Crivilare said.

When she and Rita finally came home, a stack of medical bills awaited. One was already past due.

Crivilare rushed to set up payment plans with the hospitals in Jacksonville and Springfield, as well as the anesthesiologist, the surgeon, and the labs. Some providers demanded hundreds of dollars a month. Some settled for monthly payments of $20 or $25. Some pushed Crivilare to apply for new credit cards to pay the bills.

"It was a blur of just being on the phone constantly with all the different people collecting money," she recalled. "That was a nightmare."

Big bills, big consequences

The Crivilares' bills weren't unusual. Parents with private health coverage now face on average more than $3,000 in medical bills related to a pregnancy and childbirth that aren't covered by insurance, researchers at the University of Michigan found.

Out-of-pocket costs are even higher for families with a newborn who needs to stay in a neonatal ICU, averaging $5,000. And for 1 in 11 of these families, medical bills related to pregnancy and childbirth exceed $10,000, the researchers found.

"This forces very difficult trade-offs for families," said Michelle Moniz, a University of Michigan OB-GYN who worked on the study. "Even though they have insurance, they still have these very high bills."

Nationwide polls suggest millions of these families end up in debt, with sometimes devastating consequences.

About three-quarters of U.S. adults with debt related to pregnancy or childbirth have cut spending on food, clothing, or other essentials, KFF polling found.

About half have put off buying a home or delayed their own or their children's education.

These burdens have spurred calls to limit what families must pay out-of-pocket for medical care related to pregnancy and childbirth.

In Massachusetts, state Sen. Cindy Friedman has proposed legislation to exempt all these bills from copays, deductibles, and other cost sharing. This would parallel federal rules that require health plans to cover recommended preventive services like annual physicals without cost sharing for patients. "We want ... healthy children, and that starts with healthy mothers," Friedman said. Massachusetts health insurers have warned the proposal will raise costs, but an independent state analysis estimated the bill would add only $1.24 to monthly insurance premiums.

Tough lessons

For her part, Crivilare said she wishes new parents could catch their breath before paying down medical debt.

"No one is in the right frame of mind to deal with that when they have a new baby," she said, noting that college graduates get such a break. "When I graduated with my college degree, it was like: 'Hey, new adult, it's going to take you six months to kind of figure out your life, so we'll give you this six-month grace period before your student loans kick in and you can get a job.'"

Rita is now 2. The family scraped by on their payment plans, retiring the medical debt within a year, with help from Crivilare's side job selling resources for teachers online.

The Crivilares paid off the medical debt for Rita's birth, but they are shouldering some more since Rita needed surgery for recurrent ear infections. Neeta Satam for KFF Health News hide caption

The Crivilares paid off the medical debt for Rita's birth, but they are shouldering some more since Rita needed surgery for recurrent ear infections.

But they are now back in debt, after Rita's recurrent ear infections required surgery last year, leaving the family with thousands of dollars in new medical bills.

Crivilare said the stress has made her think twice about seeing a doctor, even for Rita. And, she added, she and her husband have decided their family is complete.

"It's not for us to have another child," she said. "I just hope that we can put some of these big bills behind us and give [Rita] the life that we want to give her."

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

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