The Cost of Birth

Recently, I was asked by a pregnant mama debating the switch from hospital to home birth if I had any advice or perspective about the steep financial burden of choosing home birth, especially living in Los Angeles, where costs for everything are higher. This topic is one I am passionate about and have previously discussed on Instagram, but I wanted to share a bit more here with the hope that it offers clarity and support if you’re navigating a similar crossroads.

In the United States, the average cost of a wedding is $30,000, with 56% of newlyweds going into debt to pay for their wedding. The average flower budget alone is $3,500! However, when it comes time to plan for birth, I often hear people say that they really want to have a home birth, yet can’t justify the out-of-pocket expense.

Look, I get it. I, too, pay an obscene amount for health insurance each month that I rarely ever use. I also recently got married, so I am in no way minimizing the sacredness of that special day and the lifelong memories it creates – flowers included. However, I do find it interesting that culturally we are willing to break the bank for a wedding but not for birth .

Both birth and weddings are one-day events (give or take), but how your wedding turns out – or how fancy your flower arrangements are – is not going to impact how happy or healthy your marriage is. On the other hand, how your birth unfolds, how supported you feel through the process, and the care you receive before, during, and after can have a massive impact on your early motherhood experience. Our births leave a lasting imprint on our physical and mental health and, of course, the health of our children. This is why I feel so passionate about a mother being in the environment that best suits her needs and prioritizing the support she desires.

In the US, 45% of women report experiencing birth trauma, which is known to contribute to an increased likelihood of postpartum depression and anxiety. Birth trauma is also correlated with higher rates of marital struggles and breastfeeding challenges. Birth may just be a one-day event, but it flows right into the postpartum period, which should be approached with just as much attention to detail as the honeymoon. In many cultures, it is believed that how we approach postpartum can make or break our lifelong health.

I asked my followers to share the cost of their births, both at home and in the hospital, and the answers varied greatly. I was not surprised to read that for most hospital births, even after insurance, the out-of-pocket costs were about the same as the cost for a home birth with a midwife. Of course, this won’t be the same for everyone based on the city you live in, who you hire, your insurance type, the interventions utilized, and if a transfer becomes necessary. Many people don’t realize that they walk away from a hospital birth paying the same out-of-pocket expense as a home birth! In many states, the average cost of home birth midwifery matches the average wedding floral budget. However, in states like California, the cost can be twice as high.

There has been a lot of talk lately in mainstream media about Free Birth; birth that is not attended by a licensed midwife or trained professional willing to intervene if necessary. The conversation around Free Birth is complex and nuanced, and a topic for another Substack article. However, I bring it up here because although the “Free” in Free Birth refers to the freedom of birthing outside of the system, more and more women are turning to Free Birth because it is Free. Some find it empowering not to have to outsource or invest in others in order to birth. I have respect for many of the conversations and beliefs surrounding Free Birth, but I know to be true that most women do, in fact, want support in their labor, and every woman should have access to the support and the quality of care she desires. No woman should be left unsupported due to fear of being mistreated by the medical system or going into debt.

Here are some actionable tips and things to consider when budgeting for birth:

- Reimagine The Registry - Instead of a baby registry to gather items (many of which you probably won’t use), use a registry like Little Honey Money, where friends and family can contribute to your birth and postpartum support fund. This is not a GoFundMe for your birth but rather shifting the narrative of what mothers truly need and inviting your village to contribute to the care every mother deserves. You can find my registry list here with some items you might not need.

- Skip the Nursery - You will have plenty of opportunities to decorate your child’s bedroom later on. If you plan to co-sleep, trust me, you won’t need a nursery, and your baby won’t care what color the walls are, what fancy furniture you choose, or how nice the diaper changing table is. My daughter is 3 years old, and we still share a bedroom (although she is now in her own bed).

- Start Budgeting Now- What expenses can you pause or skip for now to reallocate towards your pregnancy, birth, and postpartum support? Set goals to help you save for the birth you desire. What we water grows. I love following Dave Ramsey for financial inspiration. Make sure you are keeping your savings in a High-Yield Savings Account to maximize interest.

- Get Clear on Your Values and The Value: We all have priorities and preferences that shape our spending habits. When it comes to how you spend your money, it is personal and important for you to feel good about the value you get from the investment. The level of care, connection, and time you get with your midwife is far more than most OBGYNs can offer. For most, this looks like being able to text directly to ask questions and getting more hands on postpartum support. The value of my midwife was and is truly priceless to me. I never flinch when writing her a check, not because it isn’t a lot of money, but because I feel the value she gives me and my family is a 100x gain on the investment.

- Call Your Insurance Company: Find out if your insurance covers midwifery care. It’s not always easy, but worth shopping around and advocating for. It is unlikely you will receive a full reimbursement, but you might be able to fight for something. You may want to consider a free-standing birth center, as insurance companies are generally more likely to cover costs.

- Health Share - I am not very well-versed in this option, but it is one I am hearing more and more about as families seek out alternatives to health insurance.

- Explore FSA/HSA Fund Options- Most birth expenses and sometimes even self-care modalities like massage and acupuncture can be covered as healthcare expenses with FSA/HSA funds.

- Go Green- As someone who trains new doulas, I can say confidently that some of the most dedicated birth workers I know are new! Of course, there can be tremendous benefits that come with experience, but don’t rule out a newer doula or midwife if you feel an alignment and trust in her skills. Generally speaking, those with less experience will have lower rates to offer.

- Find Local Organizations- There are organizations across the country that help to provide low-income families access to midwifery care and postpartum support. Check out Birth Fund and Joy In Birthing Foundation.

- Ask About a Trade - If you have a special skill or service that you provide, you might want to ask if your midwife or doula is interested in a partial trade. This is not something your hospital will be open to, and one of the beautiful aspects of community care.

When Things Don’t Go as Planned: We all know that no matter how much we plan or prepare for a certain type of birth, we can’t always control the way things unfold. Sometimes our babies have their own plans. This is where things can get costly. If you pay for midwifery care and then have to, or choose to, transfer to the hospital at some point in your pregnancy or labor, you might be faced with double the expenses. To me, this is a risk I am willing to take, and this is why I have insurance. The home birth transfer rate is around 10%, so the risk is not huge, but something to consider. The way I see it, home birth to hospital transfer is emergency care, just like any other unforeseen circumstance in my life that would call for emergency care. Even with insurance, the expense of these events can be a hard pill to swallow financially. However, if the intervention is truly necessary, I know my gratitude for the emergency services provided would help lessen the blow.

American parents (98% of whom are currently birthing in hospitals) pay more for birth than any other country, and yet have the highest rate of maternal mortality of all high-income countries. Our taxpayer and insurance dollars are feeding a broken system, one dictated by insurance and pharmaceutical companies, and leaving many mothers disappointed in their care.

You may be wondering why home birth is such a sought-after option in the first place. You can read more in my Substack post here and my book, Growing Together.

Regardless of where you choose to give birth, I encourage you to invest the same amount of time and attention to detail as you would for your wedding day.

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