A recent study from Health Affairs found that the average out-of-pocket costs (i.e. costs incurred with comprehensive health insurance) of delivering a baby in the United States now exceeds $4,500. (Moniz, Fendrick, Kolenic, Tilea, Admon & Dalton, 2020) The average out-of-pocket cost for vaginal births in 2015 was $4,314, up from $2,910 in 2008—an increase by over 48-percentage points. Cesarean birth out-of-pocket costs have also risen to $5,161 in 2015, an almost 50-percentage-point increase since 2008 ($3,364). While these upward cost trends align with the overall rising U.S. healthcare costs, The Atlantic article, “The High Cost of Having a Baby in America,” surmises that the rising prevalence of high-deductible health plans contribute to these upfront costs. (Khazan, 2020)

This makes sense. While many Americans—through experience—know that health insurance is not a complete catch-all, high-deductible plans are even less so with coverage not kicking in until the beneficiary first meets a several-thousand dollar deductible. By design, these plans encourage Americans to be more cost-conscious of healthcare services, but the resulting upfront costs often backfire as Americans choose not purse recommended health services.

While the Affordable Care Act requires health plans to cover a sanctioned list of preventive-care services, many pre- and postnatal care services (e.g. childbirth education) are a la carte, depending on a beneficiary’s health plan. This presents a unique challenge—and opportunity—for childbirth education.

Evidence continues to show that comprehensive childbirth education reduces the need for birth interventions and increases the likelihood of a non-complicated vaginal birth. (Gluck, Pinchas‐Cohen, Hiaev, Rubinstein, Bar, & Kovo 2018) Although costs for both vaginal and cesarean deliveries both continue to increase, the difference between an uncomplicated vaginal birth ($4,314) and a cesarean birth ($5,161) is significant. Because beneficiaries feel the direct impact of out-of-pocket costs, the approximate $1,000 difference in these birth procedures (other health matters aside) may be an incentive to learn more about pre-birth measures that increase the likelihood of a vaginal birth. With this point alone, Lamaze advocacy continues to make the case to lawmakers and payers that childbirth education is a small price to pay for improved childbirth outcomes.

Taking the whole-picture view of an ideal pregnancy with regard to outcome and cost, childbirth education plays a critical role. Although out-of-pocket for many, the upfront cost of a Lamaze course may pay for itself many times over. The upcoming Lamaze white papers on the contribution childbirth education has in healthy birth outcomes and in facilitating shared decision-making will further speak to these facts.

Many of Lamaze childbirth educators and advocates will have a chance to speak to these points—and more—in June when Lamaze hosts a Congressional Hill Day as part of its 2020 Advocacy Summit. Stay tuned for more information about the Summit and getting involved as a Lamaze advocate.  

References

Gluck, O., Pinchas‐Cohen, T., Hiaev, Z., Rubinstein, H., Bar, J., & Kovo, M. (2018). The impact of childbirth education classes on delivery outcome. International Journal of Gynecology & Obstetrics.

Khazan, Olga. “The High Cost of Having a Baby in America.” The Atlantic. January 6, 2020. https://www.theatlantic.com/health/archive/2020/01/how-much-does-it-cost-have-baby-us/604519/

Moniz, M. H., Fendrick, A. M., Kolenic, G. E., Tilea, A., Admon, L. K., & Dalton, V. K. (2020). Out-Of-Pocket Spending For Maternity Care Among Women With Employer-Based Insurance, 2008–15: This study evaluates trends in cost sharing for maternity care for women with employer-based health insurance plans, before and after the Affordable Care Act. Health Affairs, 39(1), 18-23.

About Molly Giammarco, MPP

Molly Giammarco has consulted for professional healthcare associations for more than eight years. As Lamaze International’s Senior Manager for Policy & Government Relations, Molly monitors legislation regulations related to maternal and child health, as well as advises the Lamaze Advocacy + Collaboration Committee.

Molly received her undergraduate degree from Smith College in Northhampton, Massachusetts and her master's degree in public policy from the George Washington University in Washington, D.C. She currently lives in Washington, D.C.

Main Photo by AllGo - An App For Plus Size People on Unsplash

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