Skip to main content

Cost of U.S. childbirth outrageous

By Eugene Declercq, Special to CNN
July 9, 2013 -- Updated 1301 GMT (2101 HKT)
STORY HIGHLIGHTS
  • Eugene Declercq: U.S. maternity care costs are the highest in the world
  • Declercq: Partly, the problem is that Americans are obsessed with newer technologies
  • He says more tests, reliance on big hospitals do not improve health of mothers and babies
  • Declercq: Look to midwife-led birthing centers as a safe and cost effective alternative

Editor's note: Eugene Declercq is professor and assistant dean at the Boston University School of Public Health. He is founder of Birth by the Numbers, a website that provides information on childbirth practices and outcomes in the U.S. and abroad.

(CNN) -- Across the U.S., many families know firsthand how high maternity care costs are. As noted in The Times recently, giving birth in the U.S. is more expensive than any other country in the world. Total costs average $18,329 for a vaginal delivery and $27,866 for a C-section, with the bulk of the bill going to insurers. However, families with insurance still have to pay about $3400 out of pocket.

What's ironic is we can't even claim that the extra expense pays off in healthier mothers and babies. According to a study by the Institute of Medicine, the U.S. ranks at or near the bottom on virtually all maternity care outcomes.

Eugene Declercq
Eugene Declercq

So who's to blame for these high costs?

Partly, mothers themselves. Americans are obsessed with the notions that "newer is better" and "more technology is always a plus." When it comes to medical technology, the U.S. public becomes Oliver Twist, continually asking, "Please, sir, I want some more."

I was part of a team that recently conducted a pair of national surveys of mothers. Among the many questions, we asked if mothers agreed with the statement, "Newer maternity tests and treatments are generally improvements over older ones." An overwhelming majority of mothers (74%) agreed while only 10% disagreed.

Likewise, when given the statement, "Maternity tests and treatments that work the best usually cost more than those that don't work as well," mothers were twice as likely to agree than disagree. Mothers were also far more likely to agree that women get too few tests during pregnancy rather than too many.

"Newer equals improvement" and "More is better than less" have long been effective marketing themes in American culture. But the problem is that in the case of medical technology, the results don't consistently bear that out.

Yahoo extends maternity leave
Man shows off 'pregnant' belly in photo

While other countries have set up elaborate systems to assess new medical interventions for their cost effectiveness compared to existing practices before approving them, until recently that has not been a priority in U.S. medical care. The result is that public infatuation with newer technologies merges smoothly with the medical industry's desire to profit from providing more services.

A prime example of this problem is the failure to take advantage of midwife-led birthing centers. These have been found in the U.S. and overseas to be a safe and cost effective alternative to universal reliance on large hospitals. Freestanding birthing centers (as opposed to hospitals which refer to their maternity ward as a "birthing center") are usually directed by midwives and are affiliated with hospitals that serve as a referral site for transfers. The cost savings stem from less reliance on expensive medications and technologies, a shorter stay (mothers typically return home within 24 hours) and lower personnel costs.

While the numbers of birthing centers have increased in the last decade, less than 1 in 300 U.S. births occur in a center. How come?

Consider who loses money if birthing centers become popular: Large hospitals, pharmaceutical companies, obstetricians and anesthesiologists -- all powerful groups who believe deeply that the use of their products and services is not only a source of income, but the safest option for mothers and babies.

The result is that an array of regulatory (restrictive state licensing laws) and financial barriers (denial of insurance coverage) combined with informal constraints (hospital refusal to provide backup) limit their use.

Freestanding birthing centers aren't for everyone. They are meant to serve women with lower risk pregnancies and there's about a 1 in 8 chance a woman would need to be transferred to a hospital during labor. Nonetheless, it is of concern that so many women who are interested in it are denied an option that can provide a safe and far less expensive experience for mothers and babies.

Medical technology has done wonders for our lives, especially in select, high-risk cases. But rising maternity care costs reflects the downside of our societal obsession with newer, bigger and shinier technology.

The U.S. needs to seriously rethink how we approach maternity care. The first question that needs to be addressed is: Do more tests and reliance on the biggest, most expensive hospital settings actually improve the health of mothers and babies? When they do, great. But when they don't, we need to overcome the financial, institutional and cultural barriers to use reasonable options like birthing centers.

Follow us on Twitter @CNNOpinion.

Join us on Facebook/CNNOpinion.

The opinions expressed in this commentary are solely those of Eugene Declercq.

ADVERTISEMENT
Part of complete coverage on
April 18, 2014 -- Updated 2047 GMT (0447 HKT)
Jim Bell says NASA's latest discovery support the notion that habitable worlds are probably common in the galaxy.
April 18, 2014 -- Updated 1817 GMT (0217 HKT)
Jay Parini says even the Gospels skip the actual Resurrection and are sketchy on the appearances that followed.
April 18, 2014 -- Updated 1752 GMT (0152 HKT)
Graham Allison says if an unchecked and emboldened Russia foments conflict in a nation like Latvia, a NATO member, the West would have to defend it.
April 18, 2014 -- Updated 1311 GMT (2111 HKT)
John Sutter: Bad news, guys -- the pangolin we adopted is missing.
April 18, 2014 -- Updated 1252 GMT (2052 HKT)
Ben Wildavsky says we need a better way to determine whether colleges are turning out graduates with superior education and abilities.
April 18, 2014 -- Updated 1026 GMT (1826 HKT)
Charles Maclin, program manager working on the search and recovery of Malaysia Flight 370, explains how it works.
April 18, 2014 -- Updated 1250 GMT (2050 HKT)
Jill Koyama says Michael Bloomberg is right to tackle gun violence, but we need to go beyond piecemeal state legislation.
April 17, 2014 -- Updated 1845 GMT (0245 HKT)
Michael Bloomberg and Shannon Watts say Americans are ready for sensible gun laws, but politicians are cowed by the NRA. Everytown for Gun Safety will prove the NRA is not that powerful.
April 17, 2014 -- Updated 1328 GMT (2128 HKT)
Ruben Navarrette says Steve Israel is right: Some Republicans encourage anti-Latino prejudice. But that kind of bias is not limited to the GOP.
April 16, 2014 -- Updated 2323 GMT (0723 HKT)
Peggy Drexler counts the ways Phyllis Schlafly's argument that lower pay for women helps them nab a husband is ridiculous.
April 16, 2014 -- Updated 1642 GMT (0042 HKT)
Rick McGahey says Rep. Paul Ryan is signaling his presidential ambitions by appealing to hard core Republican values
April 16, 2014 -- Updated 1539 GMT (2339 HKT)
Paul Saffo says current Google Glasses are doomed to become eBay collectibles, but they are only the leading edge of a surge in wearable tech that will change our lives
April 15, 2014 -- Updated 1849 GMT (0249 HKT)
Kathleen Blee says the KKK and white power or neo-Nazi groups give haters the purpose and urgency to use violence.
April 16, 2014 -- Updated 1156 GMT (1956 HKT)
Sen. Sheldon Whitehouse and Rep. Henry Waxman say read deep, and you'll see the federal Keystone pipeline report spells out the pipeline is bad news
April 16, 2014 -- Updated 1153 GMT (1953 HKT)
Frida Ghitis says President Obama needs to stop making empty threats against Russia and consider other options
ADVERTISEMENT