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

As NerdWallet’s Senior Economist, Elizabeth Renter spends her time analyzing economic trends and data to help people make more informed decisions about their personal finances. Her work has been cited by The New York Times, The Washington Post, the "Today" show, CNBC and elsewhere. Prior to joining NerdWallet in 2014, she was a freelance journalist. She received a Masters of Science in Finance and Economics from West Texas A&M University, and focused her elective coursework on macroeconomics and analytics. When she’s not at work, Elizabeth enjoys college football, old houses, traveling to old cities and powerlifting. She is based in Durham, North Carolina.

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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.

On a similar note...

Health Spending

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Access & Affordability

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• Prescription Drugs

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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The Peterson Center on Healthcare and KFF are partnering to monitor how well the U.S. healthcare system is performing in terms of quality and cost.

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How much is the average prenatal care cost? Where can I go for free prenatal care? Find the answers to these questions and more here and get your pregnancy started on a healthy note.

• When to Start
• Due Date Calculator
• Preparing for Childbirth

How Much Does Prenatal Care Cost?

If you’re facing an unplanned pregnancy, the odds are that you aren’t 100 percent financially ready to raise a child.

However, if you plan to carry your pregnancy to term, you will need to accept that there are certain costs involved in doing so safely. Your prenatal care costs will just be the start of the expenses you can expect during your pregnancy and the years to come of raising your child. It’s important to understand exactly what these costs entail before you get any further in your pregnancy.

In this article, you’ll find out a little more about the average prenatal care cost for a woman in your situation. If you’re worried about the cost of prenatal care and delivery, you will also find resources for free prenatal care and affordable prenatal care to make this journey a little easier on your growing family. We know the details of pregnancy can be confusing — and that’s why we’re here to help.

Prenatal care is a necessary part of every pregnancy — not just to protect your baby’s health but to protect yours, as well. Before you get carried away buying baby supplies and other necessities for when your baby comes, you first need to be prepared for the costs of the next nine months.

You may ask: “How much does it cost for prenatal care?”

The answer to this question will depend upon several factors , including your insurance situation, the status of your pregnancy and the professionals that you choose.

According to the Kaiser Family Foundation , the average prenatal care cost for a typical pregnancy is about $2,000 . This estimate accounts for about 12 doctors’ visits at about $100 to $200 each, as well as routine blood tests, urinalysis and at least one ultrasound. You should also expect to spend money on basic prenatal vitamins (which may or may not need to be prescribed by your physician) and any additional ultrasounds or testing that your doctor recommends.

If your pregnancy requires more visits or testing than the average pregnancy does, you can expect your total cost for prenatal care to be a bit higher.

There’s one important caveat to keep in mind: When we talk about average prenatal care cost, we are only referring to the medical expenses you will incur during your pregnancy. Unfortunately, not all insurance policies will cover childbirth and delivery costs at the same rate as prenatal care costs. On average, the cost of staying at the hospital for a child delivery is $3,500 per stay . Make sure you are prepared for this financial burden when you are calculating your overall cost for prenatal care.

Is There Such a Thing as Free Prenatal Care?

For most women, free prenatal care is entirely possible. If you have insurance, your prenatal care cost is generally covered as preventative care. According to the Kaiser Family Foundation, private insurance pays on average about 87 percent of the costs for prenatal care for women.

However, depending upon your insurance policy, you may be expected to pay certain co-pays or deductibles for your prenatal care. One of the first things to do when you discover your pregnancy is to review your insurance policy and contact an insurance representative. They should be able to tell you more about which prenatal care services are covered by your policy and what kind of out-of-pocket cost of prenatal care and delivery you can expect.

Don’t have insurance? You can still purchase an insurance plan even after finding out about your unplanned pregnancy. The federal government prohibits group health insurance from treating pregnancy as a pre-existing condition. However, you will want to avoid most individual health insurance plans, as they can treat pregnancy as a pre-existing condition and refuse to cover your prenatal care costs. It’s a good idea to research insurance policies to ensure you get the coverage you need for affordable prenatal care.

If you are wondering how to get free prenatal care because you are not financially prepared for your unplanned pregnancy, you might consider adoption as one of your options. If you are looking for free prenatal care, it’s more likely that you will struggle to afford the costs of raising your child. But, if you choose to place your child for adoption, you will receive free prenatal care and other living expenses assistance from your adoption agency. Adoption will cover your pregnancy costs , and you will get the satisfaction of placing your child with a family who is 100 percent prepared for the costs of parenthood to give your child the best opportunities possible.

How to Find Affordable Prenatal Care

If you’re in a tight financial spot, you may be looking for cheap, low-cost prenatal care to work with your personal budget. Whether you have insurance or not, there are a few steps you can take to find affordable prenatal care near you:

• Apply for Medicaid: Medicaid is a government-sponsored health insurance program for low-income families. If you are pregnant, you can apply for Medicaid to receive adequate prenatal and postpartum care. You will need to contact your local Medicaid office for more information about the requirements in your state and the steps you’ll need to take to obtain coverage.
• Find a low-cost prenatal care clinic: There are many family-planning clinics that exist to help women in your situation. Consider finding your local Planned Parenthood or community health center for prenatal care that usually comes at a fraction of the cost at a larger, private obstetrician’s office.
• Shop around with your insurance: If you have insurance, your first step should be to contact your provider and find out which local clinics and physicians will accept your insurance. Your insurance can usually provide an estimate for its clients’ average prenatal care cost. Think smart about what kind of services you want and which you don’t need during your prenatal care, and search out generic prescriptions for any medications that your physician provides.

The cost for prenatal care in the United States can certainly seem overwhelming at times for expectant mothers, especially if you had no prior plans to become pregnant. But, with a little research and preparation, finding affordable prenatal care to keep yourself and your baby healthy is not as hard as it may seem.

For more information about prenatal care costs in your area and how to get free prenatal care, please contact a local family-planning clinic.

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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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Your Guide to Prenatal Appointments

Medical review policy, latest update:.

Minor copy changes.

Typical prenatal appointment schedule

Read this next, what happens during a prenatal care appointment, what tests will i receive at my prenatal appointments, what will i talk about with my practitioner at prenatal care appointments , first trimester prenatal appointments: what to expect, second trimester prenatal appointments: what to expect, third trimester prenatal appointments: what to expect, questions to ask during prenatal appointments  .

Prenatal care visits are chock-full of tests, measurements, questions and concerns, but know that throughout the process your and your baby’s wellbeing are the main focus. Keep your schedule organized so you don’t miss any appointments and jot down anything you want to discuss with your doctor and your prenatal experience should end up being both positive and rewarding.

What to Expect When You’re Expecting , 5th edition, Heidi Murkoff. American College of Obstetricians and Gynecologists,  Having a Baby After Age 35: How Aging Affects Fertility and Pregnancy , 2020. American College of Obstetricians and Gynecologists,  Routine Tests During Pregnancy , 2020. US Department of Health & Human Services, Office on Women’s Health,  Prenatal Care and Tests , January 2019. Journal of Perinatology ,  Number of Prenatal Visits and Pregnancy Outcomes in Low-risk wWomen , June 2016. Mayo Clinic,  Edema , October 2017. Mayo Clinic,  Prenatal Care: 2nd Trimester Visits , August 2020. Mayo Clinic,  Prenatal Care: 3rd Trimester Visits , August 2020. Jennifer Leighdon Wu, M.D., Women’s Health of Manhattan, New York, NY. WhatToExpect.com, Preeclampsia: Symptoms, Risk Factors and Treatment , April 2019. WhatToExpect.com, Prenatal Testing During Pregnancy , March 2019. WhatToExpect.com,  Urine Tests During Pregnancy , May 2019. WhatToExpect.com,  Fetal Heartbeat: The Development of Baby’s Circulatory System , April 2019. WhatToExpect.com,  Amniocentesis , Mary 2019. WhatToExpect.com,  Ultrasound During Pregnancy , April 2019. WhatToExpect.com,  Rh Factor Testing , June 2019. WhatToExpect.com,  Glucose Screening and Glucose Tolerance Test , April 2019. WhatToExpect.com, Nuchal Translucency Screening , April 2019. WhatToExpect.com, Group B Strep Testing During Pregnancy , August 2019. WhatToExpect.com,  The Nonstress Test During Pregnancy , April 2019. WhatToExpect.com,  Biophysical Profile (BPP) , May 2019. WhatToExpect.com,  Noninvasive Prenatal Testing , (NIPT), April 2019. WhatToExpect.com,  The Quad Screen , February 2019. WhatToExpect.com,  Chorionic Villus Sampling (CVS) , February 2019. WhatToExpect.com,  The First Prenatal Appointment , June 2019. WhatToExpect.com,  Breech Birth: What it Means for You , September 2018.

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• The average total cost for prenatal care throughout a typical pregnancy is about $2,000, according to the Kaiser Family Foundation. This figure includes about 12 doctors' visits at $100 to $200 each, as well as routine blood tests, urinalysis and at least one ultrasound -- usually done at about 20 weeks. The March of Dimes[ 2 ] offers an overview of routine prenatal tests.
• Prenatal care usually is covered by health insurance. Even if you join a group health insurance plan after you already are pregnant, prenatal care still will be covered; according to the U.S. Department of Labor[ 3 ] , the federal government prohibits group health insurance plans from treating pregnancy as a pre-existing condition, or, if they offer maternity coverage, from refusing to cover prenatal care or childbirth. However, individual health insurance plans can legally treat pregnancy as a pre-existing condition, baby delivery probably will not be covered if you join one while pregnant. If you are insured, it is very important to check with the insurance company about their requirements; some companies require you to "pre-authorize" coverage for your baby.
• For patients with insurance, out-of-pocket costs for prenatal care, which usually consist of copays or coinsurance for office visits and laboratory work, can range from less than $200 to several thousand dollars or more, if the deductible is high or the pregnancy has complications. According to the Kaiser Family Foundation, private insurance pays about 87 percent of the costs for prenatal care -- so, in that case, the out-of-pocket costs on a typical $2,000 bill would total $260 .
• The first prenatal visit usually takes place about 8 weeks after the last menstrual period, and lasts longer than subsequent visits. During the visit, the doctor or midwife will: calculate your due date based on your last period; take your medical history; perform a physical exam and possibly an ultrasound; do a Pap test and check for sexually transmitted diseases; take a urine sample to check for urinary tract infections; and draw blood for a number of laboratory tests. The U.S. government now also recommends that all pregnant women be screened for HIV at their first prenatal visit, so the doctor probably will offer a test. The doctor probably also will want to discuss diet and exercise, miscarriage precautions and other safety issues.
• BabyCenter.com offers a guide to the first prenatal visit[ 4 ] .
• On subsequent prenatal visits, the doctor or midwife will: check your weight and blood pressure; look at the baby's position and listen to its heartbeat; take urine for a urinalysis; and possibly order other tests. BabyCenter.com has a guide to second trimester prenatal visits[ 5 ] and third trimester prenatal visits[ 6 ] as well as an overview of prenatal tests[ 7 ] .
• Because mouth health affects overall health, it is recommended that patients have a dental checkup early in the pregnancy.
• All pregnant women or women trying to conceive should take a prenatal vitamin containing folic acid; the average cost is about $0.30 per day -- or about $9 per month. For more information, see CostHelper.com's article on prenatal vitamins .
• Extra ultrasounds -- doctors sometimes order one early in the pregnancy to try to determine the due date or late in the pregnancy to check the position and health of the baby -- usually cost about $200 each. For more information, see the CostHelper.com article on ultrasounds .
• Women with a chronic illness or who experience pregnancy complications will have to see a doctor more frequently. Diagnostic tests -- to check for possible problems or genetic abnormalities -- cost extra, and are most commonly recommended for patients 35 and older or those who have a family history of certain conditions or genetic abnormalities. The U.S. Department of Health & Human Services has an overview of the most commonly ordered tests, which can cost $1,000 or more extra, depending on which tests are needed.
• TheAmerican Pregnancy Association[ 8 ] offers an overview of free and discounted prenatal care options for uninsured or underinsured pregnant women.
• Some providers will negotiate a discounted package rate for prenatal care, or prenatal care combined with delivery, for a patient paying out-of-pocket.
• An obstetrician/gynecologist should be board-certified by the American College of Obstetricians and Gynecologists[ 9 ] . Or, the American College of Nurse-Midwives[ 10 ] offers a certified midwife locator. And the American Board of Family Medicine[ 11 ] offers a board-certified family physician locator. A maternal-fetal medicine specialist is an obstetrician/gynecologist who has two to three years of additional education and clinical experience with high-risk pregnancies; the Society for Maternal-Fetal Medicine[ 12 ] has an overview on this type of specialist, and a physician locator.
• Tip: When you find a prospective provider, make sure you feel comfortable with them and ask questions such as which hospital they are affiliated with; whether you always will be seen by the same provider; who covers when the provider is unavailable; and how after-hours calls and emergencies are handled. The March of Dimes[ 13 ] has a guide to choosing a prenatal care provider.
•   womenshealth.gov/publications/our-publications/fact-sheet/prenatal-care.cfm
•   www.marchofdimes.com/pregnancy/prenatalcare_routinetests.html
•   www.dol.gov/ebsa/publications/newborns.html
•   www.babycenter.com/0_your-first-prenatal-visit_9344.bc?page=1&articleId=9344
•   www.babycenter.com/second-trimester-prenatal-visits
•   www.babycenter.com/third-trimester-prenatal-visits
•   www.babycenter.com/0_prenatal-tests-an-overview_326.bc
•   americanpregnancy.org/planningandpreparing/affordablehealthcare.html
•   www.acog.org/About_ACOG/Find_an_Ob-Gyn
•   www.midwife.org/rp/find.cfm
•   /www.theabfm.org
•   /www.smfm.org/index.cfm?zone=info&nav=about
•   www.marchofdimes.com/pregnancy/prenatalcare_provider.html

Appointments at Mayo Clinic

• Pregnancy week by week

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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All Costs Considered: Pregnancy, Childbirth and Health Insurance

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Our panel of insurance experts has reviewed the content to ensure that our reporting and statistics are accurate, easy to understand and unbiased.

SmartFinancial Offers Unbiased, Fact-based Information. Our fact-checked articles are intended to educate insurance shoppers so they can make the right buying decisions. Learn More

Coronavirus may be keeping people at home, but couples are still planning families. Prenatal care and pregnancy require medical attention to ensure a safe and healthy delivery.

It's important that you know how you're going to pay for doctor visits and delivery room charges. Without health insurance an average delivery of a baby costs $10,808 , and as much as $30,000 if you factor in prenatal and postnatal care.

Even though the Affordable Care Act requires that pregnancy, labor, delivery and care of a newborn be mandatory coverages, not everyone has insurance. Also consider that over one million mothers had a c-section in 2017. C-sections are not only more costly, but they often carry risks that may prolong a hospital stay and increase an already exorbitant bill. In California, for example, a c-section without insurance cost an average of nearly $20,000.

Note that being pregnant does not mean that you are eligible for health insurance any time. The birth of a child, however, is a qualifying event which enables you to buy insurance outside the regular Open Enrollment dates for health insurance. You have a 60-day window to enroll in a new plan after the birth of a child.

More about that later. Let's get started with the basics first.

When Is Open Enrollment?

Open Enrollment period is usually from October through mid-December. Plans become effective January 1.

Find an Affordable healthcare Plan

How Much Does Pregnancy Cost?

The answer to this question depends entirely on the expectant mom. There is a big range in prices depending on your location and where and how you give birth. Without health insurance, however, a hospital birth can cost tens of thousands of dollars. In California, around $14,000 without c-Section, close to $20,000 with a c-section

Buying health insurance before or as soon as you find out you are pregnant is crucial to avoiding medical bankruptcy. Comparing health insurance plan rates is very important too, if you want to pay the least. But to do so, you must first consider how often you'll be seeing a doctor, how much in copays you'll be paying each and how many specialists you'll need to see. These factors are important because you may end up paying less in medical costs overall by paying a higher premium. Generally speaking, HMOs have the least out-of-pocket expenses. But it's important for you to speak with a trusted agent about all your options before you choose a plan.

Do All Health Insurance Plans Cover Pregnancy?

All health insurance marketplace plans and Medicaid plans cover pregnancy and childbirth. After you have the baby, you can switch plans again, even if it's outside the Open Enrollment Period. If you've already given birth and are uninsured, you can shop and compare quotes for health insurance outside the Open Enrollment Period.

Maternity care and childbirth are essential benefits that all Marketplace plans and private plans must offer. You are covered even if you were pregnant before coverage began.

Beware, however, some grandfathered private insurance plans do not cover pregnancy and childbirth. You may also not be covered if you're insured on your parents plan. If this is your situation, it's a good idea to buy health insurance separately.

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What is prenatal care and am i covered.

Prenatal care is medical care you get during pregnancy. You will likely be covered by your medical insurance. You may have a copay. A copay is a small portion of the bill, which can range from $25 to $95 depending on your plan and if you're seeing a specialist.

It's important to get prenatal care. Babies who do not receive it are three times more likely to be underweight and five times more likely to die . Complications with a pregnancy can also be detected during prenatal care. The earlier a problem is spotted, the easier it is for a doctor to solve it.

Prenatal care is just as important for experienced mothers as it is for new moms. It doesn't matter if it's your first pregnancy or your third or fourth. It's important to get the right vitamins and discuss any medications you may be taking with your doctor. Getting a flu shot is also highly advised and so is avoiding x-rays.

Also, be prepared to get some push back if you are on your parents' health insurance plan and become pregnant. Some carriers will not cover maternity costs for adult dependents of a policyholder.

Which Services Are Usually Covered for Expecting Mothers and Babies?

• Prenatal visits
• Postnatal visits
• Gestational diabetes screening (often a risk during pregnancy)
• Newborn care
• Lactation counseling
• Breast pump rental

I'm Pregnant Now, Do I Qualify for Insurance?

Unfortunately, you'll have to wait until the child is born to get insurance outside of Open Enrollment, unless you have another qualifying event, like losing a job or moving. Here's much more on qualifying events that make you eligible for a Special Enrollment Period.

I May Be Pregnant but I'm Not Sure

It's important to see a doctor as soon as you suspect that you are pregnant. The sooner you begin prenatal care, the better. Below you'll find some common symptoms of pregnancy. However, it's important that you take a test and/or see your doctor. Even if you're not pregnant, some of these symptoms may point to other serious complications.

• Missed period
• Nipple discharge
• Vision changes
• Sudden facial hair
• Pelvic pain
• Breast tenderness
• Frequent urination
• Darkening areolas
• Cervical mucus

I'm Ready to Buy Health Insurance But How Does it Work?

The plan options will be available in different tiers , which range from bronze to platinum. The more expensive it is each month, the less you pay out of pocket. Here's everything you need to know about buying health insurance.

When you're done, just enter your zip code below, and we'll find you the lowest rates.

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Fran Majidi manages content on SmartFinancial's website. She's had nearly a decade's worth of experience writing about insurance-related topics. Prior, she was an arts and entertainment editor in New York City. She has a B.A. from Barnard College and an M.F.A. in writing from The New School. She writes books under her given name, Afarin Majidi.

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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.

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Why Pregnancy Ultrasounds Are Done, Week by Week

When do you get ultrasounds during pregnancy, and why are they usually done? Here's what expectant parents should know about these important prenatal scans.

Why Do People Get Pregnancy Ultrasounds?

First trimester ultrasounds, second trimester ultrasound, third trimester ultrasound, baby ultrasounds for special situations, how many ultrasounds during pregnancy are safe, how much does an ultrasound cost.

During a pregnancy ultrasound , your health care provider or a skilled technician uses a plastic transducer to transmit high-frequency sound waves through your uterus. These sound waves send signals back to a machine that converts them into images of your baby.

Most pregnant people have only a couple of ultrasounds throughout their prenatal care, but some get them more frequently. Read on for a breakdown of the most common types of pregnancy ultrasounds, when you might get them, and what to expect during the prenatal scans.

According to the American College of Obstetricians and Gynecologists (ACOG), health care providers may use baby ultrasounds for the following reasons:

• Monitoring your baby's growth and development
• Detecting congenital anomalies
• Guiding chorionic villus sampling (CVS) or amniocentesis
• Helping predict your due date
• Determining whether you're carrying multiples
• Showing the position of your placenta
• Estimating your baby's size
• Measuring amniotic fluid
• Revealing your baby's genitals

How Many Ultrasounds Will You Get?

Uncomplicated pregnancies typically have fewer ultrasounds than high-risk pregnancies, but how many you receive over the course of your pregnancy will vary. Factors influencing the number of ultrasounds you'll receive include your preference, your provider's standard protocol, ultrasound machine access, medical history, and pregnancy complications.

GETTY IMAGES

Not everyone receives a first-trimester ultrasound during pregnancy. That said, a health care provider may sometimes use them for determining viability, dating the pregnancy, or ruling out suspected complications.

Early pregnancy (6–8 weeks)

Your first ultrasound, also known as a fetal ultrasound or sonogram, could occur as early as six to eight weeks into your pregnancy. In addition to a pregnancy test , some health care providers use ultrasounds for the following reasons.

Detecting the fetal heartbeat

The main reason to conduct an ultrasound this early on is to detect the fetal heartbeat . An abdominal ultrasound can usually detect a baby's heartbeat if you are at least 8 weeks into your pregnancy. If your pregnancy has a gestational age of less than 8 weeks (between 6 and 8 weeks), a transvaginal ultrasound (inserting the ultrasound probe into your vagina) is usually needed for accurate results.

Although the heart structures aren't yet fully developed at six weeks gestation, it's possible to see the electrical impulses of their developing heart (sometimes referred to as embryonic cardiac activity ).

Determining a due date

Evidence suggests that ultrasounds more accurately predict your due date  than using your last menstrual period, but only in the first trimester and early second trimester (until roughly 20 weeks). Early ultrasound due dates have a margin of error of roughly 1.2 weeks.

After 20 weeks of pregnancy, your estimated due date shouldn't change based on an ultrasound because it will be less accurate. And remember: It's an estimated due date; the vast majority of people don't deliver their babies the day they're due. In fact, it's thought that only around 4% of people give birth naturally on their due date.

Nuchal translucency ultrasound (10–13 Weeks)

A nuchal translucency (NT) ultrasound occurs around weeks 10 to 13 of pregnancy. According to ACOG , this ultrasound measures the space at the back of a fetus' neck. Abnormal measurements can indicate Down syndrome and other congenital disabilities of the heart, abdomen, and skeleton. In addition to an abdominal ultrasound, an NT screening includes measuring hormones and proteins with a blood test.

A nuchal translucency ultrasound is optional for everyone who is pregnant. Sometimes, people choose to have this ultrasound to alleviate concerns about their baby's health. Other times, your health care provider might recommend it if you're at risk of complications or have a family history of congenital disorders.

In addition to screening for anomalies, this pregnancy ultrasound can offer the same information as an earlier scan, including an estimated due date , your baby's " crown-rump length " (measurement from head to bottom), the number of babies in the womb, and fetal cardiac activity.

According to the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), early pregnancy ultrasounds can also determine the following:

• Determine the number of fetuses
• Determine if multiples share a placenta and amniotic sac

But not everyone will get this early scan. ISUOG does not recommend routine early pregnancy ultrasounds unless there's a clinical indication of a complication. For example, some health care providers will only conduct early ultrasounds for certain high-risk pregnancy conditions like bleeding and abdominal pain, or to rule out ectopic pregnancy , congenital disorders, or miscarriage.

The second trimester is the most common time for a routine prenatal ultrasound. The anatomy scan, a thorough scan of your baby's developing body and organs, is offered to every pregnant person.

Anatomy scan (18–22 Weeks)

According to ACOG, this detailed pregnancy ultrasound generally happens between weeks 18 and 22 in the second trimester. It's the most thorough check-up your baby will have before they're born.

During the anatomy scan, also called a level II ultrasound, the health care provider will check your baby's heart rate and look for abnormalities in their brain, heart, kidneys, and liver, says Jane Chueh, MD, director of prenatal diagnosis and therapy at Lucile Children's Hospital Stanford , in Palo Alto, California. In other cases, such as  Down syndrome , however, ultrasound can't offer a firm diagnosis. Instead, it can show markers associated with a higher risk of various conditions.

They'll also count your baby's fingers and toes, examine the placenta, and measure the amniotic fluid level. And they'll probably be able to see your baby's genitals to guess your baby's sex , although it's not a slam dunk. If you don't want to know about your baby's genitalia, be sure to inform the technician ahead of time.

Editor's Note

Even though people often look forward to this pregnancy ultrasound to learn their baby's gender, it's important to note that gender is a personal identity that exists on a spectrum, can change over the course of a person's lifetime—and most importantly—is something that a person defines for themselves. Sex is assigned at birth based on the appearance of a baby's genitalia. While sex assigned at birth often matches a person's gender (called cisgender), sometimes it does not.

Many parents-to-be don't need an ultrasound in the third trimester. But if your pregnancy is considered high-risk—or if you didn't get a screening during the first or second trimester—it may be recommended.

For example, if you have high blood pressure, bleeding, low levels of amniotic fluid, preterm contractions , or are over age 35, your doctor may perform in-office, low-resolution ultrasounds during some of your third-trimester prenatal visits for reassurance, says Dr. Chueh.

In addition, if an earlier scan found your placenta was near or covering the cervix ( called placenta previa ), you'll require additional ultrasounds to monitor its location.

Your health care provider may recommend an ultrasound during pregnancy outside of the situations mentioned above. For example, ultrasounds might be indicated if you have certain health conditions that warrant specific monitoring or if you have a procedure that uses ultrasound guidance.

Doppler ultrasound

Doppler ultrasound is a special imaging test showing blood moving through vessels. In pregnancy, a Doppler ultrasound can help determine if your baby's blood is circulating properly. According to a Cochrane review , Doppler ultrasound in high-risk pregnancies may reduce the risk of perinatal death and obstetric interventions.

Your health care provider may recommend fetal Doppler ultrasound in the following circumstances:

• You have diabetes
• You have high blood pressure
• You have heart or kidney problems
• The placenta does not develop properly
• Suspected fetal growth problems

Handheld fetal heart rate monitors also utilize Doppler technology. Health care providers commonly use these devices to monitor your baby's heartbeat during prenatal exams and labor. While these are available over the counter, the Food and Drug Administration (FDA) advises against using them at home due to lack of oversight and unnecessary ultrasound exposure.

Guiding ultrasounds

Your health care provider may also order other pregnancy tests that require ultrasounds for guidance. These might include chorionic villus sampling (CVS) or amniocentesis, which screen the baby for congenital disorders. Fetal echocardiograms, which show the baby's heart rate and detect anomalies, also use ultrasound technology.

Ultrasound is considered safe for you and your baby when used for medical purposes. Although ultrasounds require no radiation, only a trained professional who can accurately interpret the results should perform them. Your technician should have education in obstetrical ultrasound, preferably at a center accredited by the American Institute of Ultrasound in Medicine .

Some medical practices offer 3D (high quality and lifelike) and 4D (moving picture) ultrasounds, which may help doctors detect specific fetal abnormalities and congenital disorders. However, these exams are also available at fetal portrait studios in places like shopping malls.

Experts discourage these "keepsake" ultrasounds since untrained personnel may give out inaccurate information, says Michele Hakakha, MD, an OB-GYN in Beverly Hills and author of Expecting 411: The Insider's Guide to Pregnancy and Childbirth .

Plus, according to the FDA , although ultrasounds are safe in medical settings, they might heat tissues or produce bubbles (cavitation) during use if not performed correctly. Experts aren't sure about the long-term effects of heated tissues or cavitation, especially when not medically indicated. Therefore, the FDA advises that people use ultrasound scans judiciously—only when there is a medical need, based on a prescription, and performed by appropriately-trained health care providers.

Ultrasounds aren't cheap ; they can cost hundreds or thousands of dollars, depending on your location and health care provider. However, most health insurance plans will cover the cost of prenatal ultrasounds (at least partially) if they are for medical purposes. Always ask your health care provider and insurance company if you're unsure how much you will need to pay.

Ultrasound Exams , ACOG, 2021

Pregnancy Ultrasound Evaluation . StatPearls [Internet] . 2023.

Role of ultrasound in the evaluation of first-trimester pregnancies in the acute setting . Ultrasonography . 2020.

Pregnancy Dating . StatPearls Publishing. 2022.

Prenatal Genetic Screening Tests . American College of Obstetricians and Gynecologists . 2020.

ISUOG Practice Guidelines: performance of first-trimester fetal ultrasound scan . Wiley’s Obstetrics and Gynaecology. 2012

Sonography 3rd Trimester and Placenta Assessment, Protocols, and Interpretation . StatPearls [Internet] . 2023.

Fetal and umbilical Doppler ultrasound in high-risk pregnancies . Cochrane Database of Systematic Reviews 2017, Issue 6. Art . 2017.

Ultrasound Imaging . U.S. Food and Drug Administration . 2020.

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Shots - Health News

Abortion is becoming more common in primary care clinics as doctors challenge stigma.

Selena Simmons-Duffin

Elissa Nadworny

Abortion As Primary Care, I

Dr. Stephanie Arnold, who prefers bright-colored clothes instead of a white coat, meets with a patient who needs a pelvic exam. The family medicine clinic Arnold founded offers reproductive health care, including abortion, alongside all kinds of other care. “It’s a little bit of everything, which is very typical of family medicine,” she says. Elissa Nadworny/NPR hide caption

It’s a typical Tuesday at Seven Hills Family Medicine in Richmond, Va. The team — which consists of Dr. Stephanie Arnold, registered nurse Caci Young and several medical assistants — huddles to prepare for the day.

Arnold, a primary care physician, runs through the schedule. The 9 a.m. telemed appointment is for chronic condition management. At 10 a.m. there’s a diabetes follow-up. The 11 a.m. appointment is to go over lab results for potential sleep apnea, then there are appointments for knee pain and one for ADHD results review. The schedulers fit in a walk-in patient who has a suspected yeast infection.

And then, at 1 p.m., a patient who took the bus from Tennessee is scheduled for an abortion.

“It’s a little bit of everything, which is very typical of family medicine,” Arnold says. The patient from Tennessee is one of three abortion procedures Arnold will do today at this clinic, where abortion is “just in the mix,” Arnold says.

In lieu of standalone clinics offering abortions, or telehealth appointments where patients get abortion medication by mail, family doctors are offering an abortion option in a familiar setting.

This trend of primary care integrating medication or procedural abortions, usually in early pregnancy, is growing in states where abortion is legal. While there is little data on how common this is becoming, NPR heard from primary care doctors across the country who said they are expanding their practices to provide abortion care.

“There's no reason for this care to be siloed,” says Arnold, who is very public about her offerings, which include abortions up to 12 weeks of pregnancy and gender-affirming care. “I don't feel like it's any different than my management of diabetes or chronic pain or endometriosis — this is just a routine part of my day.”

More demand for training

Elizabeth Janiak of Harvard Medical School co-leads a program called ExPAND that trains primary care providers on abortion. In May, she published a paper in the journal Contraception documenting the rising demand among primary care physicians seeking abortion care training, a phenomenon she observed after Roe v. Wade was overturned.

Dr. Arnold meets with her staff at Seven Hills Family Medicine in Richmond, Va. to discuss the schedule for the day. Elissa Nadworny/NPR hide caption

Janiak estimates a very small portion of family medicine doctors in the U.S. perform abortions in their practice. She points out that even 5% of the country’s 250,000 primary care doctors is a significant number. “So we’re talking thousands and thousands of providers,” she says. Since nearly 40% of U.S. counties have no OB-GYN, Janiak says, primary care doctors can fill gaps in reproductive health care.

Michigan, Colorado, California, too

In Michigan, Dr. Allison Ruff says “when Dobbs happened, I personally felt really engaged.” She’s an associate professor at the University of Michigan and an internist, a speciality that does primary care with a focus on medically complicated adults.

Right after the decision, it was unclear whether access to abortion would be banned in Michigan. So she started reading and talking to experts about what providing abortion entailed, and what she learned surprised her.

“The medications used for abortion are safer than a lot of the medicines we use every day for other things — that was really shocking to me,” she says. “As far as riskiness goes, it's pretty small potatoes compared to some other things we learn in clinical practice every day.”

Ruff wrote a paper in November in a medical journal calling for more abortion training resources for doctors in her specialty.

“You can't just send your patient out to the abyss and say, ‘Go talk to someone else, go to Planned Parenthood and get this handled,’” Ruff says. “No, we as general internists are able to provide that spectrum of care.”

Many of the abortions provided at Seven Hills are done with medication; there's a pharmacy right in the doctor’s office. The first pill people take is mifepristone. Elissa Nadworny/NPR hide caption

In California, Dr. Sheila Attaie, a family physician in Sacramento, took advantage of that wave of interest and enthusiasm to expand access to abortion where she works.

"Everyone was emboldened after Dobbs in the blue states, and I have used that,” says Attaie, a fellow with Physicians for Reproductive Health. After advocating for years that her clinic fully integrate abortion, she says, administrators finally agreed after the Supreme Court overturned Roe v. Wade.

NPR heard similar stories from primary care doctors around the country, including in Minnesota and Pennsylvania. The doctors’ enthusiasm also came at a time when some blue states were making abortion access easier by getting rid of hurdles like waiting periods.

Integrating abortion into primary care is another way to increase access. Attaie says now, when patients find out they are pregnant, she can counsel them on all their options.

“Some folks end up scheduling for a medication abortion and some folks schedule for an initial prenatal visit — both of them happen in the same clinic at the same time, which is really great,” she says.

Normalize the care, but some keep it 'hush-hush'

But while Dr. Stephanie Arnold in Virginia advertises her abortion services on her website, talks to the press and is very public, most other primary care providers are being quiet about it.

After Attaie’s clinic integrated abortions, she says she was told by administrators that “we weren't allowed to advertise that we do it because we don't want that attention” — attention that could come with protesters or threats from people who oppose abortion. Since it’s not mentioned on the website, the main way patients discover abortion is offered is during doctor’s appointments, often when discussing birth control or sexual health.

Staff member Katie Yates preps the procedure room in Richmond. There’s one blue cushioned exam table where Dr. Arnold performs abortions, skin tag and mole removal, pelvic exams, biopsies and IUD placements. Elissa Nadworny/NPR hide caption

Attaie says she understands, but also finds the secrecy frustrating. “If we are hush-hush about all these things, how do we normalize them as health care?” she asks. “If we act in fear, how do we expect anything to be changed?”

Dr. Ben Smith, who practices family medicine in Fort Collins, Colo., can relate. And while limits on advertising may keep the number of abortions performed in his primary care clinic low — he estimates they do one to two per month — it can help free up appointments at abortion clinics nearby. That’s especially helpful in a state like Colorado, which has become a destination for people traveling from states with abortion bans.

“Every abortion that we do in primary care becomes a space for a more nationally facing organization [to] accommodate someone who is traveling from Texas, from Florida,” he says.

Pushback from anti-abortion groups

Anti-abortion rights activists oppose exactly what these physicians are trying to do: normalize abortion care. Dr. Christina Francis, an OB-GYN in Indiana who runs the American Association of Pro-life OB-GYNs, says abortion is nothing like managing a chronic condition like diabetes.

“Chemical abortion drugs end the life of my fetal patient, so that in and of itself makes it different from a diabetes drug,” she says. “But also, the complications related to a diabetes drug are not going to require an expertise that's outside of the skill set of a family medicine physician to manage.”

Francis maintains that family medicine physicians aren't qualified to provide abortion, which she opposes. “I'm not saying that family medicine physicians are not good physicians, they certainly are, but their training is not the same as OB-GYNs in these kinds of things,” she says. In her view, abortion is not part of essential health care for women. Her organization sued the federal government to try and remove abortion medication from the market, but the Supreme Court dismissed that challenge earlier this month.

Dr. Stephanie Arnold in Virginia pushes back on the idea that primary care doctors aren’t qualified to manage abortions. She points to a bulletin from the American College of OB-GYNs that says any clinician who can screen patients for eligibility can safely prescribe medication abortion, as long as they themselves can provide or refer patients for follow-up care — usually a uterine evacuation — as needed. The American Academy of Family Physicians also says it “supports access to comprehensive pregnancy and reproductive health services, including but not limited to abortion.”

“There's no reason for this care to be siloed,” says Dr. Arnold, who is very public about her offerings, which include abortions up to 12 weeks and gender affirming care. “I don't feel like it's any different than my management of diabetes or chronic pain or endometriosis.” Elissa Nadworny/NPR hide caption

Arnold says abortion has been separated from other kinds of care for political reasons, not for medical reasons. “It's just important to me to fight back against that stigma,” she says.

A history of isolation and stigma

There have long been family doctors who provided abortion and advocated for access, but it hasn’t caught on like this before, according to Mary Ziegler, a historian at the University of California, Davis who’s written extensively on the history of abortion.

Before Roe v. Wade , abortions generally happened at hospitals, she explains, but even then, not all hospitals offered them, often for religious reasons, making access across the country very uneven.

In the 1970s, abortion rights groups began focusing on the opening of freestanding abortion clinics. “On the one hand, obviously, those clinics did expand access in a lot of parts of the country. On the other hand,” Ziegler says, “they physically and symbolically isolated abortion from other health services and made them easier to stigmatize.”

Dr. Arnold meets with a patient interested in gender-affirming care in her offices in Richmond, Va. Elissa Nadworny/NPR hide caption

That isolation also made it easier for abortion clinics to be protested and lent credence to the idea that abortion was different from other forms of health care. For years, a key anti-abortion strategy was to target those clinics with regulations — known as TRAP laws, which stands for “targeted restrictions on abortion providers.” Those laws, for instance, mandate a certain width of hallways or that all doctors have admitting privileges at hospitals. TRAP laws made it hard or even impossible for clinics to operate, says Ziegler.

There have been advances that make abortion especially simple and safe, like abortion medication. But Ziegler says abortion in early pregnancy, which is when the vast majority of abortions happen, has never been medically complicated.

“What’s changed is more the willingness of primary care providers to integrate it into their practice, not their ability,” says Ziegler. “It's about the stigma changing.”

Back in Richmond, a successful patient experience

At Seven Hills Family Medicine, the staff ready the procedure room for the abortion patients. It’s the same room where mole removals, IUD placements and biopsies happen. They use the nitrous oxide, also known as laughing gas, for pain relief, and Arnold will use a hand-held SofTouch device to perform the abortions.

For the patients having procedural abortions Dr. Arnold uses what’s called a “SofTouch” device — a small, hand-held tool that creates a vacuum and allows a doctor to empty the uterus through suction. Elissa Nadworny/NPR hide caption

This is just what Arnold envisioned when she set up the practice soon after the Dobbs decision. The 37-year-old doctor, who eschews a white coat and favors brightly patterned jumpsuits, changes into scrubs before the procedures.

Liz Johnson, who was one of Arnold's primary care patients, had a medication abortion here in October 2022. Years before, she had an abortion at a specialty clinic and found it a little perfunctory. “It can feel very impersonal and fast and procedural,” she says, reflecting back on the differences between that day and her day in Arnold’s office.

She says she liked that the doctor, and staff knew her and her medical history. They checked in with her afterward to see how she was doing.

“I really appreciated the personal touch,” says Johnson, “being available and being able to text to check in.” She says the experience was so smooth she can hardly remember the details.

For Arnold, this is the way it should be.

And as a family medicine physician, this is how she wants people to understand her and her specialty. Those opposed to abortion call providers “abortionists” — that’s the word used by Supreme Court Justice Samuel Alito in the decision that overturned Roe v. Wade . Arnold says that term is used to “dehumanize” providers.

“I’m not some evil person who wants to harm people,” she says. “I am a mom and a family doctor, and I happen to provide abortion care.

“I'm a real doctor taking care of all kinds of real doctor things.”

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Emergency care for pregnant women at stake in Supreme Court case, Missouri doctor warns

Dozens of missouri doctors joined in asking the court to uphold a federal law that allows doctors to perform emergency abortions in states with bans, by: anna spoerre - june 18, 2024 9:00 am.

Jennifer Smith, an OBGYN, speaks about medical challenges without legal abortions in Missouri during a rally held by Missourians for Constitutional Freedom Friday morning (Annelise Hanshaw/Missouri Independent).

When a woman experiencing a second trimester miscarriage came into the hospital bleeding through her clothes, Dr. Jennifer Smith couldn’t immediately help her. 

Not while her fetus still had a heartbeat.

Too scared to wait for the miscarriage to progress far enough to be admitted to the hospital in Missouri, the woman and her husband drove to Illinois where she could obtain an abortion. 

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Until the situation is life-threatening to the mother, her hands are tied, said Smith, an OB-GYN in St. Louis. But at least in the worst emergency cases, Smith knows she can help thanks to a federal law called Emergency Medical Treatment and Active Labor Act ( EMTALA ).

“It’s just hard to imagine that we’re living in a time where that actually may not be true,” Smith said. 

The U.S. Supreme Court will soon decide whether a federal law mandating hospitals treat and stabilize every patient, regardless of their ability to pay, includes providing abortions where they are otherwise illegal.

In the case, the Biden administration sued Idaho to block enforcement of its abortion ban, arguing that it violated EMTALA by denying women abortions in emergency situations. Idaho bans abortions in almost all cases, with exceptions to save the life of the pregnant woman or when the pregnancy is the result of rape or incest. 

In response, Idaho argued that the federal law only requires “stabilizing treatment for the unborn children of pregnant women.” Idaho is asking the court to lift a temporary injunction blocking enforcement of its abortion ban in hospital emergency rooms.

The government is arguing that EMTALA requires hospitals to provide abortions needed to stabilize or save the life of a pregnant patient It also protects doctors from prosecution.

Without the law, hospitals and health care workers would have to wait until a mother is actually dying to proceed with a life-saving abortion, Smith said. St. Louis area hospitals still perform abortions for ectopic pregnancies, a nonviable pregnancy that if left unaddressed can be life-threatening to the mother, Smith said. But without EMTALA, she’s not so sure.

“It leaves every person involved in the care open to be prosecuted,” Smith said.

After Missouri banned abortion, the state saw 25% drop in OB-GYN residency applicants

In May, nearly 6,000 physicians across the country signed a letter on behalf of the Committee to Protect Health Care asking the Supreme Court to uphold the federal law. 

Smith was among 32 Missouri doctors to sign on.

In June 2022, Missouri became the first state to ban abortion following the Supreme Court case overturning the landmark Roe v. Wade decision. The ban was triggered under a law passed in 2019 that made it effective with the Supreme Court action.

The 2019 law states abortions will only be permitted in cases of a medical emergency when “a delay will create a serious risk of substantial and irreversible physical impairment of a major bodily function.”

H ealth care providers who perform abortions not necessary to save the woman’s life can be charged with a class B felony. If convicted, they would face up to 15 years in prison and their medical license could also be suspended or revoked. 

Because of this ban, some doctors and hospitals in Idaho recently stopped admitting pregnant patients who came into the emergency room, potentially needing abortions to save their lives. Instead, women are being transferred to other states for treatment during emergency situations. 

Since Roe was overturned, a Missouri hospital became one of the first in the nation to be cited for violating EMTALA by denying a pregnant woman emergency care. 

In August 2022, Mylissa Farmer entered a Joplin emergency room after her water broke at about 18 weeks pregnant. Even though the pregnancy was no longer viable, because the fetus had a heartbeat, and because Farmer’s condition wasn’t immediately life-threatening, she was turned away. She returned the next day, was kept overnight and then released without additional treatment.

Freeman Health in Joplin was later cited for being in violation of federal law. 

“Although her doctors advised her that her condition could rapidly deteriorate, they also advised that they could not provide her with the care that would prevent infection, hemorrhage, and potentially death because, they said, the hospital policies prohibited treatment that could be considered an abortion,” the report from the U.S. Secretary of Health and Human Services stated. “This was a violation of the EMTALA protections that were designed to protect patients like her.”

Smith said that while she and her colleagues often aren’t able to immediately help patients who experience situations like Farmer, she can at least direct them to care a short drive away in Illinois. 

Prior to the Dobbs decision that overturned Roe, Smith said if a pregnant patient experienced premature rupture of the membranes, they could deliver the baby so the family could have some memories to hold on to. 

Often parents would get copies of their child’s footprints and say their goodbyes.

Now, since they can’t act while the fetus has a heartbeat, Smith said she refers patients to abortion clinics in Illinois where they can receive a surgical abortion. But as a result, they don’t get to hold their baby, and often have to navigate anti-abortion protesters on the way. 

To Smith, it’s not worth risking the mother’s life and well-being to wait for her condition to deteriorate. 

“To delay the care of the mother based on the beating heart of the baby is so counterproductive,” she said. “ … It just takes one emergency that we don’t act on or that we delay to change the life of a whole community.”

A decision in favor of Idaho could impair care for pregnant patients with serious injuries from car accidents or gunshots, or who suffer a stroke, Smith said. In those cases,  saving the mother sometimes isn’t possible without first delivering the pregnancy, whether viable or not. 

Pregnant women can quickly lose blood in emergency situations, potentially putting the mother and child’s lives at risk, she said. 

“Unless you’re a trauma physician, it’s an amount of blood that nobody else in the hospital deals with. It’s an unbelievable amount and it can happen so fast,” she said. “If you have to wait and question your legal standing, the likelihood of saving that patient intact, saving the baby, saving her uterus, all of it, it just goes down all the time.”

The Supreme Court could rule on the EMTALA case as early as next week. Until then, doctors continue holding their breath. 

“They’re just singling out pregnancy at this point,” Smith said. “But once you start chipping away at rights, it’s really unclear where the end point is.”

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Anna Spoerre

Anna Spoerre covers reproductive health care for The Missouri Independent. A graduate of Southern Illinois University, she most recently worked at the Kansas City Star where she focused on storytelling that put people at the center of wider issues. Before that she was a courts reporter for the Des Moines Register.

Missouri Independent is part of States Newsroom , the nation’s largest state-focused nonprofit news organization.

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Guest Essay

Even Doctors Like Me Are Falling Into This Medical Bill Trap

By Danielle Ofri

Dr. Ofri is a primary care doctor in New York.

Thank goodness for urgent care centers. Last July my daughter was still limping a week after a bike injury, and we needed a quick X-ray to rule out a fracture. As a doctor, I knew we didn’t need an expensive emergency room for something this straightforward. We found an urgent care at the end of a strip mall in Chicago, and 20 minutes later we received the good news that there was only a sprain.

As the three employees closed up shop for the day, I reflected on how urgent-care centers filled a perfect niche between the overkill of an emergency room and the near impossibility of snagging an immediate orthopedic appointment.

But this is health care in America, and nothing ever closes up tidily. Two weeks later a bill arrived: The radiology charge from NorthShore University HealthSystem for the ankle and wrist X-rays was $1,168, a price that seemed way out of range for something that usually costs around $100 for each X-ray. When I examined the bill more closely, I saw that the radiology portion came not from the urgent care center but from a hospital, so we were billed for hospital-based X-rays. When I inquired about the bill, I was told that the center was hospital-affiliated and as such, is allowed to charge hospital prices.

It turns out that I’d stumbled into a lucrative corner of the health care market called hospital outpatient departments, or HOPDs. They do some of the same outpatient care — colonoscopies, X-rays, medication injections — just as doctors’ offices and clinics do. But because they are considered part of a hospital, they get to charge hospital-level prices for these outpatient procedures, even though the patients aren’t as sick as inpatients. Since these facilities don’t necessarily look like hospitals, patients can be easily deceived and end up with hefty financial surprises. I’m a doctor who works in a hospital every day, and I was fooled.

As of 2022, federal law protects patients from surprise bills if they are unknowingly treated by out-of-network doctors. But there is no federal protection for patients who are unknowingly treated in higher-priced hospital affiliates that look like normal doctors’ offices or urgent care clinics. Federal regulations are needed, at the very least, to require facilities to be upfront with their pricing scheme — and more ideally, to eliminate this price differential entirely. Otherwise patients will continue to face unexpected high bills that most can ill afford.

One study of pricing revealed that HOPDs charged an average of $1,383 for a colonoscopy, compared with the $625 average price at a doctor’s office or other non-HOPD settings. A knee M.R.I. averaged $900, compared with $600. Chemotherapy and other medications cost twice as much . Echocardiograms command up to three times as much . Much of these costs comes from tacked-on facility fees , which are rising far faster than other medical costs.

The American Hospital Association justifies these costs by arguing that patients seen in HOPDs are sicker than other outpatients . But that doesn’t typically make the procedures performed at these facilities any more complicated; an outpatient echocardiogram, for instance, is basically the same no matter who it’s for. If a patient’s illness does render a procedure more complicated, there are legitimate ways to account and bill for that.

Last December the health insurer Blue Cross Blue Shield released findings that HOPDs charged far more than doctors’ offices for certain procedures. ( Prostate biopsies , for example, cost over six times as much.) HOPDs turn out to be an attractive business plan for hospitals that are aggressively acquiring doctors’ practices . ​​When these acquisitions occur, prices often rise as patients are now seen in “hospital facilities.”

It’s difficult to quantify how many patients find themselves unknowingly getting higher-price care at HOPDs as we did. But news outlets have reported frustrations suffered by some patients receiving hospital-cost charges after a visit to walk-in care centers. There are also stories on Reddit and other platforms about new — and steep — facility fees at doctors’ offices appearing on medical bills and often not covered by insurance. One patient’s bill went up 10-fold for the same procedure after her doctor’s practice changed its classification of her appointment to a hospital-based designation. Another study of outpatient surgical procedures found an increase of more than 50 percent in facility fees over the course of six years, resulting in much higher out-of-pocket expenses for patients. Most patients find out only weeks later when the bill arrives.

There’s a movement afoot to make so-called site-neutral payments the law, meaning that Medicare would pay doctors the same price for an outpatient procedure like an endoscopy, no matter what type of outpatient setting it’s performed in. Though at least 16 states have passed laws requiring transparency about facility fees, headwinds are still stiff. Congress inserted a site-neutral payment rule into the Bipartisan Budget Act of 2015, but ferocious lobbying from the hospital industry exempted nearly all existing HOPDs. The American Hospital Association vehemently opposes any legislation that equalizes HOPD payments or eliminates facility fees .

The House recently passed the Lower Costs, More Transparency Act , which would enforce site-neutral payments for one narrow slice of health care — physician-administered medications. The Senate has yet to take up any such legislation.

I was so livid about being charged hospital rates for two simple X-rays that I filed a formal complaint with the Illinois attorney general’s office, which concluded that the billing was legal under federal law. When I asked for on-the-record comments about my contention that the charges seemed excessive and that the system felt deceptive, a representative for NorthShore University HealthSystem (now Endeavor Health) offered only a general statement that read, in part: “We understand that navigating the health care landscape, including billing, can be complex.”

It’s time for Congress to protect patients from both unfair pricing schemes and health care deception. MedPAC, the nonpartisan Medicare Payment Advisory Commission, recently recommended to Congress a basic set of site-neutral policies. It would apply site-neutral payments to a handful of low-risk procedures — some imaging, medication injections, simple office procedures — and this would apply to all HOPDs.

After six months of fighting the cost, the hospital quietly canceled our bill. I’m sure it calculated that this was the simplest way to get rid of a pesky patient — but that wasn’t what I was after. I wanted to untangle this loophole that catches patients unaware and saddles them with exorbitant bills. Congress should tune out hospital lobbying and enact these common-sense measures to protect patients.

Danielle Ofri , a primary care doctor at Bellevue Hospital, is the author of “When We Do Harm: A Doctor Confronts Medical Error.”

Source photograph by Chase D’animulls, via Getty Images.

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips . And here’s our email: [email protected] .

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How Pregnancy Affects Aging, New Model Organisms for Aging Research, HRT (The Optispan Podcast with Matt Kaeberlein)

Home » How Pregnancy Affects Aging, New Model Organisms for Aging Research, HRT (The Optispan Podcast with Matt Kaeberlein)

The Optispan Podcast with Matt Kaeberlein featured an interview with Bérénice Benayoun about her work regarding sex differences in aging and health and the importance of studying ovarian aging. “[Ovarian aging] has huge impacts on brain health and cardiovascular health,” Benayoun said. “I’m so glad there’s now work being done and more and more people taking this into account because I think that has the potential to be transformative for women’s health during aging.”

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Transposons could be new targets for aging research and treatment (medical xpress), doctors say there could be a mutation that stops us from aging (twisted sifter), ten years of fasting diets: the legacy of michael mosley (the times [uk]).

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Watch CBS News

IVF costs put the fertility treatment out of reach for many Americans: "I don't think it's fair"

By Nikki Battiste , Analisa Novak, Angelica Fusco

Updated on: June 20, 2024 / 1:19 PM EDT / CBS News

Nearly every dollar Mary Delgado had was riding on one shot at  IVF . Three years ago, while trying to conceive a second child with her long-time partner Joaquin Rodriguez, Delgado, who is now 35, learned she had severe endometriosis, a common cause of infertility.

"I was broken," Delgado said. "To be told that I'll never get pregnant again naturally. The doctor told me the only solution for you is IVF . And I knew IVF was expensive."

In the U.S., just one round of IVF — or in vitro fertilization — costs an average of $20,000, according to Fertility IQ , a platform for patient education. It generally takes three IVF cycles for a woman to have a baby, and insurance doesn't always cover it — putting it out of reach for many Americans and leaving others with a heavy financial burden.

Delgado relied on Medicaid after leaving her job to care for her 10-year-old son, who has a rare genetic disorder. She was aware that Medicaid wouldn't cover IVF, and said all that ran through her mind "was the dollar sign."

"I don't think it's fair, because they don't want the poor to reproduce," Delgado said.

In most states, Medicaid does not cover any fertility treatment costs. However, in New York, where Delgado lives, Medicaid does cover some of the medication needed for IVF. 

Delgado found a clinic four hours away that offered a discount and a payment plan. She took out a $7,000 loan from the clinic, which she had to repay over two years. She also spent approximately $3,000 on medication and another $2,000 on genetic testing. She said she spent $14,000 in total.

For Delgado and her partner, one round of IVF was money well spent. Their daughter, Emiliana, is now 14 months old, and their $7,000 IVF loan is paid off.

"She was definitely worth it. Definitely, definitely worth every single penny," Delgado said. "She came to fix my broken heart. She really did because I was so fearful I would never, ever get pregnant."

Delgado recently started a job that offers her some fertility insurance. 

The push for broader IVF coverage 

Across the country, 45% of large companies offered IVF coverage last year, up from just 27% in 2020.

Illinois Democratic Sen. Tammy Duckworth , who conceived her own two daughters with IVF, is fighting to pass legislation that would give even more Americans fertility benefits and lower costs.

"Why would we prevent Americans from being able to fulfill that dream of holding their own baby in their arms?" Duckworth said.

So far, 22 states plus Washington, D.C., have passed fertility insurance laws, according to Resolve, The National Infertility Association, which is a nonprofit organization. Fifteen of the state laws include IVF coverage requirements, and 18 cover fertility preservation, which includes saving a person's eggs or sperm from infertility caused by chemotherapy, radiation or other medical treatment, 

Dr. Asima Ahmad, co-founder of Carrot Fertility, said that even with these laws, it doesn't mean everyone in those states will have coverage. "Sometimes it's partial, sometimes it's none. There's still this large gap," said Ahmad.

Her company is trying to close the gap by helping more than 1,000 employers globally provide fertility benefits, including coverage for IVF and fertility preservation, and postpartum and menopause care. 

Ahmad believes the issue is that people often view fertility treatment as an elective procedure. "Infertility is a disease. And some people need to do fertility treatment to grow their family. There is no other way to do it," she said.

If a person works for a company that does not offer fertility benefits, Ahmad suggests they talk to their HR team directly. She said it could be a catalyst for bringing benefits to the company.

Delgado said everyone deserves a chance — "no matter who you are, no matter your race, no matter your economical status." 

Nikki Battiste is a CBS News national correspondent based in New York. She is an Emmy and Peabody-award winning journalist, and her reporting appears across all CBS News broadcasts and platforms.

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