The high and rising costs of childbirth pose a financial challenge to many families. One study found that 60% of pregnant and postpartum women reported having difficulty affording care, with women enrolled in commercial insurance more likely to report affordability challenges than those with public insurance. To understand the average total spending on childbirth related services, as well as to look more broadly at the distribution of total and out-of-pocket spending for people who give birth, HCCI analyzed costs associated with prenatal through postpartum care for individuals with employer-sponsored insurance (ESI) who gave birth between 2019-2021. In this brief, we include spending on all health services, including services not specifically related to pregnancy or birth, that occur 9 months prior to and 12 months following birth.

We identified more than 440,000 births in our ESI population for which we have data on the full prenatal period and 12 months post-delivery. Among those, average total spending over the course of the prenatal, delivery, and postpartum periods was $25,669, which is $1,333 higher than the total spending previously reported by HCCI for years 2018-2020. People who gave birth from 2019-2021 paid for 14% of this spending out-of-pocket on average.

Nationally, there is a large variation in the cost of childbirth. Five percent of childbirth episodes had a total spending of less than $10,000, while 25% of childbirth episodes had total spending above $30,000. This large variation also held true for out-of-pocket spending on childbirth. Nine percent of childbirth episodes had a total out-of-pocket spending of less than $500, while 26% of childbirth episodes had a total out-of-pocket spending that exceeded $5,000. You can view the percentage of births that fell above and below these thresholds by delivery type in Figure 1.

Figure 1. National Variation in Total and Out-of-Pocket Spending on Childbirth, Prenatal through Postpartum

Delivery continues to be the most expensive part of childbirth, making up about 60% of total spending

Consistent with our previous finding, the largest share of total spending—60%—was associated with the delivery itself. Just over a quarter of spending occurred in the prenatal period, on average, with the remaining 15% occurring in the 12-month postpartum period.

Figure 2 shows average per delivery total and out-of-pocket spending for the prenatal, delivery, and postpartum periods, overall and by delivery type (vaginal or c-section). The delivery type has implications for spending since c-sections are, on average, more expensive than vaginal births. We found that just under 34% of deliveries in our cohort were c-sections, which is slightly higher than the national percentage reported by the CDC (32%).

Figure 2. Average Total and Out-of-Pocket Spending by Perinatal Period

Which services accounted for the most spending in the prenatal and postpartum periods?

On average, over half of spending during the prenatal period was labs, tests, and imaging (57%), including ultrasounds, blood tests, gestational diabetes tests, and urine tests (Figure 3). Just over 12% of spending was on evaluation and management (E&M) services, including physician office visits. Administered and other drugs (including vaccines) made up about 6% of spending. The remaining spending was on other services, including female reproductive procedures, behavioral health services, emergency services, and physical or occupational therapy. Note that some of the spending on female reproductive procedures in both the prenatal and postpartum periods captures claims that were billed under a global code that covers multiple services for prenatal and postpartum care.

In the postpartum period, 19% of spending was on labs, tests and imaging. E&M services made up the next largest proportion of spending (16%), followed by vaccines and drugs (10%), female reproductive services (6%), and behavioral health services (5%). The remaining spending was on inpatient services, emergency services, and other care. The proportion of spending on E&M office visits, drugs and vaccines, behavioral health services and physical therapy increased from the prenatal to the postpartum period.

Figure 3. Share of Spending in the Prenatal and Postpartum Periods

High costs associated with childbirth remain a challenge for families

Childbirth remains the most frequent reason for a hospital admission for those with employer-sponsored insurance. The high costs associated with childbirth have real and wide-reaching implications for families. The average out-of-pocket cost of a childbirth episode, $3,605, is equivalent to about 5% of the median annual household income. This is a significant burden for many families. In addition, the wide variation in childbirth spending can make it difficult to plan and save for the costs that they may incur. Ensuring that all people who give birth receive appropriate prenatal and postpartum care is dependent, in part, on addressing the high costs that they, their families, their employers, and their insurers face.