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
September 1, 2014 -- Updated 1221 GMT (2021 HKT)
Carlos Moreno says atheists, a sizable fraction of Americans, deserve representation in Congress.
August 31, 2014 -- Updated 1625 GMT (0025 HKT)
Julian Zelizer says Democrats and unions have a long history of mutual support that's on the decline. But in a time of income inequality they need each other more than ever
August 31, 2014 -- Updated 0423 GMT (1223 HKT)
William McRaven
Peter Bergen says Admiral William McRaven leaves the military with a legacy of strategic thinking about special operations
August 29, 2014 -- Updated 1611 GMT (0011 HKT)
Leon Aron says the U.S. and Europe can help get Russia out of Ukraine by helping Ukraine win its just war, sharing defense technologies and intelligence
August 29, 2014 -- Updated 1724 GMT (0124 HKT)
Timothy Stanley the report on widespread child abuse in a British town reveals an institutional betrayal by police, social services and politicians. Negligent officials must face justice
August 30, 2014 -- Updated 0106 GMT (0906 HKT)
Peter Bergen and David Sterman say a new video of an American suicide bomber shows how Turkey's militant networks are key to jihadists' movement into Syria and Iraq. Turkey must stem the flow
September 1, 2014 -- Updated 1554 GMT (2354 HKT)
Whitney Barkley says many for-profit colleges deceive students, charge exorbitant tuitions and make false promises
August 29, 2014 -- Updated 1434 GMT (2234 HKT)
Mark O'Mara says the time has come to decide whether we really want police empowered to shoot those they believe are 'fleeing felons'
August 28, 2014 -- Updated 1432 GMT (2232 HKT)
Bill Frelick says a tool of rights workers is 'naming and shaming,' ensuring accountability for human rights crimes in conflicts. But what if wrongdoers know no shame?
August 29, 2014 -- Updated 0243 GMT (1043 HKT)
Jay Parini says, no, a little girl shouldn't fire an Uzi, but none of should have easy access to guns: The Second Amendment was not written to give us such a 'right,' no matter what the NRA says
August 30, 2014 -- Updated 1722 GMT (0122 HKT)
Terra Ziporyn Snider says many adolescents suffer chronic sleep deprivation, which can indeed lead to safety problems. Would starting school an hour later be so wrong?
August 29, 2014 -- Updated 1330 GMT (2130 HKT)
Peggy Drexler says after all the celebrity divorces, it's tempting to ask the question. But there are still considerable benefits to getting hitched
August 29, 2014 -- Updated 1849 GMT (0249 HKT)
The death of Douglas McAuthur McCain, the first American killed fighting for ISIS, highlights the pull of Syria's war for Western jihadists, writes Peter Bergen.
August 26, 2014 -- Updated 2242 GMT (0642 HKT)
Former ambassador to Syria Robert Ford says the West should be helping moderates in the Syrian armed opposition end the al-Assad regime and form a government to focus on driving ISIS out
August 27, 2014 -- Updated 1321 GMT (2121 HKT)
Ruben Navarrette says a great country does not deport thousands of vulnerable, unaccompanied minors who fled in fear for their lives
August 27, 2014 -- Updated 1319 GMT (2119 HKT)
Robert McIntyre says Congress is the culprit for letting Burger King pay lower taxes after merging with Tim Hortons.
August 26, 2014 -- Updated 2335 GMT (0735 HKT)
Wesley Clark says the U.S. can offer support to its Islamic friends in the region most threatened by ISIS, but it can't fight their war
August 26, 2014 -- Updated 2053 GMT (0453 HKT)
America's painful struggle with racism has often brought great satisfaction to the country's rivals, critics, and foes. The killing of Michael Brown and its tumultuous aftermath has been a bonanza.
August 26, 2014 -- Updated 1919 GMT (0319 HKT)
Rick Martin says the death of Robin Williams brought back memories of his own battle facing down depression as a young man
August 26, 2014 -- Updated 1558 GMT (2358 HKT)
David Perry asks: What's the best way for police officers to handle people with psychiatric disabilities?
August 25, 2014 -- Updated 1950 GMT (0350 HKT)
Julian Zelizer says it's not crazy to think Mitt Romney would be able to end up at the top of the GOP ticket in 2016
August 25, 2014 -- Updated 2052 GMT (0452 HKT)
Roxanne Jones and her girlfriends would cheer from the sidelines for the boys playing Little League. But they really wanted to play. Now Mo'ne Davis shows the world that girls really can throw.
August 25, 2014 -- Updated 2104 GMT (0504 HKT)
Kimberly Norwood is a black mom who lives in an affluent neighborhood not far from Ferguson, but she has the same fears for her children as people in that troubled town do
August 22, 2014 -- Updated 2145 GMT (0545 HKT)
It apparently has worked for France, say Peter Bergen and Emily Schneider, but carries uncomfortable risks. When it comes to kidnappings, nations face grim options.
ADVERTISEMENT