Haggling for Maternity Healthcare

Taking a look at the high costs of birth in America.


An article that posted in the New York Time's Well column this week talks about what women without health insurance and those with policies that exclude maternal healthcare go through when trying to afford basic obstetric care. This article hit very close to my home. As the woman at the center of this article tried to price epidurals, hot tubs and labor and delivery services she faced an array of sliding price tags that were outrageous and I flashed back to my pregnancy with daughter #2.

I was at the tail end of nursing school and seven months pregnant when my husband's employer switched insurance providers. The new insurance policy considered my pregnancy a preexisting condition they wouldn't cover. Essentially, that left me uninsured without the income to accommodate what the hospital estimated would be at least $8000 for basic OB services. When pressed, the hospital refused to break down the prices associated with a vaginal delivery claiming it was unpredictable. They had one price tag for insured patients and another, much higher price for uninsured or underinsured patients like me. That was a long time ago and prices are many times higher now.

With no way to pay that bill, I made a decision that some consider risky, but I considered the only sensible thing to do. I found a midwife (still illegal in my state at that time) with extensive experience and a great reputation. She had an office where she saw patients, a classroom where she offered a thorough prenatal education and a couple bedrooms with double beds, showers and basic delivery equipment.

For $800 this midwife agreed to provide the remainder of my prenatal care, all my delivery services, newborn care and several follow-up postpartum visits. She had an emergency plan in case something went wrong during labor that included a backup obstetrician on-call at a nearby hospital. There wouldn't, of course, be an epidural on demand in her back-office bedroom, but there'd be a compassionate midwife and trained nurses to take care of my baby and me. 800 bucks or upwards of 8000... the decision came down to cash.

When I went into labor, things moved quickly. I spent several hours laboring at home. My midwife checked in with me hourly by phone, assuring me they were ready whenever I wanted to come in. We arrived at her office, my water broke, my daughter was born and four hours later, after a bowl of Cheerios and a shower, I was back home with a healthy newborn in my arms. I had no vaginal tears, no excessive bleeding and no complications. My daughter was fine and we had an appointment for a pediatrician to evaluate her within 24 hours of birth (sooner, if we needed him). Things could not have gone smoother.

I had insurance that covered maternity care with my other children's births, but the care I received on a cash-pay basis was excellent. Many years later, when once again I was insured, but with a policy riddled with exclusionary clauses on preexisting conditions I needed some hospital-based medical care.

When the bills arrived with panic-attack inducing bottom lines, I argued with the hospital's financial department for better prices. I was not one of the uninsured, unemployed, unable to pay patients asking for financial aid. I was a working mother with some health complications who know full well that hospital-based medical care was priced on a sliding scale. I demanded the same prices they gave to insurance companies and payment arrangements that didn't mean I'd have to sell my house. After much debate, the hospital agreed and I paid my bill over time.

It's ridiculous that we make pregnant women and families jump through these hoops. Here we are celebrating our country's independence – the land of the free and the home of the brave and on too many levels that motto falls short. This is the land of the free only for those who can afford really good insurance. It's the home of the brave for those who have to face pregnancy, childbirth and other physical conditions without a high-priced policy. Seriously, America?

Jeanne Faulkner, R.N., lives in Portland, Oregon with her husband and five children. Got a question for Jeanne? E-mail it to jeanne@jeannefaulkner.com.

This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.