Is it cheaper to give birth in a hospital or at home?
When preparing to have a child, it’s crucial to consider the financial aspects. It may not be as costly as financing an adoption, but pregnancy and childbirth bring a financial burden. And the total cost largely comes down to whether you choose a home birth or hospital birth.
As soon-to-be parents, you naturally want to make the choice that gives your baby the greatest chance to survive and thrive. However, the cost of giving birth in the United States is high, and health insurance plans are complicated.
While there are many personal and emotional reasons to choose home or hospital birth, you must also consider the financial implications.
Home Birth vs. Hospital Birth Costs
When deciding between giving birth at home or in a hospital, look at the cost of having a baby in either situation. Four primary factors are involved: pregnancy and prenatal care, labor and delivery, a hospital stay, and postpartum care.
Home Birth Cost Factors
Home birth seems like it should be less expensive than a hospital birth. But the costs can add up quickly if you go in unprepared.
Insurance Coverage for Home Births
Some states’ insurance allows coverage for home births — but not all of them. As of May 2020, only 21 states covered home birth under the Medicaid program, for example.
As you’re preparing, a couple of things are essential: asking your insurance carrier what types of birth they cover and ensuring you choose something that fits the bill. Some insurance companies may only cover a home birth with a certified nurse-midwife attending, while others may only cover a midwife if you give birth in a birthing center.
So it’s key to communicate clearly with your insurance provider. Find out what your out-of-pocket costs are for any deviations from their typical requirements.
Home Birth Prenatal Options
Home birthers typically receive a similar level of prenatal care as those having a hospital birth. However, when you decide on a home birth, you might work closely with a midwife, doula, or both. Each birth assistant has different roles and responsibilities.
- A doula is a guide who provides physical and emotional support before, during, and after childbirth. They may be doula-certified, but they are not necessarily medical professionals.
- A midwife is a trained professional who assists healthy individuals in childbirth and provides prenatal and postnatal care. Training varies, but certified nurse-midwives have completed a training program, making them the safest (and most expensive) option.
Doula and midwife fees vary greatly based on geographic location and services provided. It’s usually more expensive in cities and higher-cost-of-living areas.
For example, in a large city in the Dallas-Fort Worth, Texas, metro area, you can find doula packages ranging from $1,600 to $2,500. But in a significantly smaller city like Abilene, Texas, they’re less than $1,000. But going to an even higher cost-of-living area like New York City may mean a minimum of $2,000.
Typically, the doula fee includes a specific number of prenatal visits, prenatal support and information, assistance during labor and delivery, and at least one postpartum visit. Typically not included are prenatal vitamins, any required lab work, or any type of hospital visit.
Midwives are generally more expensive. Because of the wide variance in things like certification status, it’s hard to put a solid number on midwife costs. But expect to pay on the high end of doula costs at a minimum. But some midwives may charge $5,000 or more.
Note that the fees for doulas and midwives may not include necessary medical exams like regular OB-GYN visits and ultrasounds. And those cost just as much as they would for a hospital birth if they’re not included as part of your package (some midwives and doulas work with OB-GYNs).
You also need prenatal vitamins, which are relatively inexpensive. For example, many prenatal vitamins range from about $0.08 to $0.48 apiece at Walmart. Over nine months of pregnancy, that’s only between about $20 and $130. Fortunately, you don’t need a prescription, so there’s no added cost for a doctor’s visit.
Home Birth Labor & Delivery Costs
Fortunately, if you’re electing for a home birth, you’re skipping one of the most significant expenses associated with childbirth: the hospital stay. That’s a major benefit many expectant parents appreciate about the home-birth option. Ideally, you’d incur zero hospital costs.
And doula and midwife packages typically include labor and delivery.
A midwife will usually provide equipment like IVs, sterile gloves, gauze pads, a thermometer, and waterproof bed covers. You may want to ask your midwife just to be sure, though. Doulas may provide some of this equipment, but they’re not authorized to insert IVs unless they’re also medical professionals.
You may also have to purchase special equipment if your doula or midwife doesn’t provide them. Costs vary, depending on the types of supplies you need.
Even if your midwife or doula doesn’t provide them, simple items like waterproof mattress covers cost under $40 on Amazon. But if you need a birthing tub, you’re looking at $100 or $200 and up at a retailer like Oasis or La Bassine. You can also look into renting one, though you may not save much money if you need to keep it for several weeks.
Fortunately, midwife and doula fees include some services hospitals may ask you to pay for, such as facilitating skin-to-skin contact. Even if it doesn’t cost much, it’s annoying to pay to hold your own baby.
If your home birth expenses come down to just a few thousand dollars paid to a midwife, that may sound like a simple decision from a financial standpoint.
But you need to consider the safety of both the mother and baby. The infant mortality rate for babies born at home is several times higher than the rate of babies born at hospitals, according to a 2010 to 2017 study featured in the American Journal of Obstetrics and Gynecology.
And just because you plan to give birth at home doesn’t mean it will turn out that way. So plan your ideal situation and have a Plan B in case complications arise. Have enough money saved for a hospital stay for both Mom and Baby. If things go smoothly, just add it to Junior’s college fund.
Postpartum Care After a Home Birth
Most doulas and midwives include some form of postpartum support and care in their packages. Your specific agreement may vary, but it’s fairly standard to offer at least one postpartum checkup. (Babies should see a pediatrician for their post-birth care.)
Those with postpartum depression or psychosis must seek mental health treatment from a source other than their doula or midwife unless they’re also qualified therapists. That treatment may include talk therapy, medication, or a combination of the two.
You may also wish to seek the advice of a lactation consultant. Most midwives and doulas are trained to help, but a board-certified lactation consultant may provide further assistance if you need it. A home visit can be around $200 or more per hour, depending on your location.
Insurance may cover some of these costs, but you can also get free online assistance at La Leche League.
The U.S. Department of Agriculture also offers WIC breastfeeding support. Online resources are freely available to anyone, though you must qualify for the Special Supplemental Nutrition Program for Women, Infants, and Children to get personalized support. Your local health department may have resources as well.
Hospital Birth Cost Factors
Hospital births are often more expensive than home births, but that may not necessarily be true. In general, insurance covers hospital births more thoroughly than home births, meaning a home birth could lead to higher out-of-pocket costs.
But a hospital birth costs considerably more than a home birth unless your insurance covers the majority. Know what your insurance pays for and what it doesn’t.
Hospital Birth Insurance Coverage
Under the Affordable Care Act (ACA), pregnancy, maternity, and newborn care are essential benefits that qualified health plans must cover. That said, if you’re a dependent on a parent’s or guardian’s policy, coverage may vary, so look into that sooner than later.
Note that its status as an essential benefit doesn’t prevent insurers from charging copays, coinsurance, or deductibles, so that doesn’t necessarily mean insurance covers the full cost.
But if you’re tempted by a home birth only for the cost savings, your insurance could drop the amount for a hospital birth to a very comparable number. So check into your coverage and do the math.
Some policies cover prenatal care at a higher level than others. Additionally, high-risk pregnancies require a greater level of care and could cost more, even with insurance. But you should likely opt for a hospital birth anyway.
Whatever type of insurance coverage you have, know how much your deductible is, the length of hospital stay covered, and what doctors and hospitals are in your network to achieve maximum coverage.
Additionally, if you require prenatal tests your insurance doesn’t cover, be mindful that you may incur those costs and can ask your doctor how much they are. For example, not all plans cover genetic testing.
Fortunately, there’s a cap on how much you can pay out of pocket on all medical care each year. On the most affordable Bronze level ACA insurance plans, the maximum individual out-of-pocket cost in 2022 is $8,700 for in-network medical services for an individual ($17,400 for a family). The max gets lower as you buy more expensive plans.
However, your pregnancy will last around nine months, meaning you could easily straddle two plan years, making the maximum overall individual out-of-pocket potential on the lowest plan $17,400. So that’s another factor to consider.
If you don’t have health coverage through an employer or your spouse, go to Healthcare.gov to see if you qualify for a special marketplace enrollment period based on a qualifying life event, such as losing your employer-sponsored health benefits or changes of state of residence.
While pregnancy is not a qualifying life event, it may give you access to programs like Medicaid or the Children’s Health Insurance Program (commonly known as CHIP). And even if you only qualify for open enrollment toward the end of your pregnancy, it can still save you significant cash.
Hospital Birth Prenatal Care Options
The Kaiser Family Foundation says prenatal care totals an average of about $2,000, including about 12 doctor’s visits at $100 to $200 each if you don’t have ACA-compliant health insurance.
Hospitals also often provide free childbirth and infant care classes, so take advantage of those opportunities, especially if you’re a first-time parent.
Your obstetrician will recommend prenatal vitamins and other preventative strategies to ensure your and the baby’s health throughout the pregnancy. The vitamins cost the same as they would for a home birth at around $21 to $130 for the whole pregnancy unless your doctor prescribes something special.
When charged separately, ultrasounds range in cost from an average of $319 in New Jersey to $2,295 in Florida, according to a 2021 survey by Hospital Pricing Specialists. The national average cash price for an ultrasound came out to $745, so research prices in your area carefully.
General office visits to your obstetrician during pregnancy run about $207 if out-of-network or uninsured and $105 if insured and in-network, according to Fair Health Consumer.
Prenatal care packages at hospitals and birthing centers typically detail how many visits and ultrasounds they include and what types of additional care they offer, which can save you money on those costs. But if you have insurance, ensure your plan covers a package before you buy it.
Hospital Birth Labor & Delivery Costs
Despite the cost, there are advantages to a hospital birth. It allows you to have an epidural, even if you initially planned against it. Epidurals will put the cost of a vaginal birth toward the upper range of any uninsured rate estimates.
At the hospital, you can choose a cesarean delivery if it becomes medically necessary (even a certified nurse-midwife cannot legally perform a C-section).
And that’s important because the type of delivery you have can also influence the cost. For example, health care cost transparency advocate Fair Health Consumer states that the national average charge for a vaginal delivery is $12,290. The national average charge for a C-section is $16,907. (That’s as of 2018.)
But those are just averages. How much it truly costs varies widely based on where you live and what services you want or need.
For example, Fair Health Consumer puts the average uninsured cost of a vaginal delivery with pre- and post-delivery care in New York City’s priciest Manhattan zip code at between $12,380 and $24,666, depending on the specific care you need. But in Boise, Idaho, it’s only $4,180 to $16,269.
Note that those numbers don’t include prenatal or newborn care, which Fair Health Consumer shows comes in at several hundred (potentially close to $1,000) dollars per day, assuming there are no complications.
The Fair Health Consumer site can give you a ballpark idea of how much you’ll pay if you search based on your specific location.
Skin-to-skin contact is another aspect of the birth experience that might incur a charge. Although it may seem silly, after a surgical birth, the mother may be unable to safely hold her baby, making it necessary to have an additional nurse on hand to assist her.
Most hospitals allow parents and babies to have skin-to-skin contact as a matter of routine, but it never hurts to ask. It’s unclear what the average cost is, but the charge that went viral was $40.
Postpartum Care After a Hospital Birth
If you’ve chosen a hospital birth, you should have plenty of help in the realm of postpartum care. Most hospital birthing packages include at least one follow-up visit soon after the baby is born. You should take the baby to a pediatrician for their follow-ups, which is an entirely separate charge.
If you experience a high-stress birth, such as having emergency surgery, you will need greater care in the following days and weeks. It may be as simple as family members assisting you after the cesarean procedure so you don’t overexert yourself. But it could be something more costly.
Even if the delivery went smoothly, your OB-GYN will screen you for potential post-birth issues, such as postpartum depression. Postpartum depression could lead to serious expenses. Insurance should cover much of the cost of treatment, but if you’re uninsured, the rates can rack up fast.
In most areas of the country, one session with a psychologist runs between $100 and $200. It’ll cost even more if you need to see a psychiatrist (a medical doctor who can diagnose and treat mental disorders and prescribe medication). Rates per session are similar to a psychologist’s, but an initial visit could be $300 to $500.
Postpartum care may also include physical therapy and pelvic rehabilitation to help restore pelvic floor muscles. The cost for these can vary by location, but expect to pay between $150 and $400 per 45- to 90-minute session.
Many mothers also seek lactation assistance. It can save money in the long run if your baby breastfeeds instead of needing formula, so the investment in a consultation (around $200 per hour) can be well worth it.
But you might get plenty of lactation help through your hospital as well. Some offer one or more free sessions initially and quite reasonable follow-up visits. For example, Baptist Health of Lexington, Kentucky, offers one free lactation consultation and follow-up visits for $25.
And you have the same free or low-cost options as you would for a home birth, including the La Leche League, WIC breastfeeding support, or your local health department.
The Verdict: Should You Choose Home Birth or Hospital Birth?
Overall, home birth costs are typically lower than those of hospital births. But the decision-making process isn’t as simple as looking at the numbers.
It doesn’t help when you consider that hospitals negotiate rates based on factors like a patient’s insurance, whether you pay in cash, or whether you’re out of network. It’s tough to know the “official” cost of childbirth.
But there are things you can consider to help you make the decision.
A Home Birth Makes Financial Sense If…
Finances shouldn’t be the only reason you choose a home birth. But they can play a significant role in your decision. A home birth makes financial sense if:
- You Need to Save Money. Home births are often cheaper. But if possible, don’t allow money to be the sole deciding factor in your birth plan. You must also consider your and your baby’s health and safety and your personal preferences.
- You Don’t Have Any Health Risk Factors. If you don’t have underlying risk factors like obesity or diabetes that could put you or your baby in danger, a home birth is less likely to result in emergency hospital expenses.
- You Have a Solid Backup Plan. Even if you don’t have risk factors, you need to prepare for an emergency hospital trip. That means setting up an emergency fund. If you don’t use it, you can spend it on the baby or set up a college fund.
- You Live Near a Hospital. Don’t plan for a home birth unless you can get to a hospital quickly if something goes wrong during delivery. Emergency care will probably be more expensive than a hospital package, especially if you have to be air-lifted.
- You Have a Trusted Midwife and Amazing Support Team. A doula or midwife with solid credentials (ideally a certified nurse-midwife) can save you money by providing similar care for less money, working with (not against) your medical team, and calling for medical intervention as early as necessary.
- Your Insurance Covers Home Births. If your insurance covers home births, crunch the numbers to determine how much it can save you. While home births are already cheaper than hospital births, insurance can make it even cheaper.
- You Don’t Have Insurance. If you’re uninsured, a home birth can save you a ton if you’re healthy. But it’s still a gamble. Complications could land you in the hospital anyway. It may be better to see if you qualify for open enrollment or wait until you do to try to become pregnant.
A Hospital Birth Makes Financial Sense If…
There are some circumstances in which a hospital birth is the best choice. In fact, medical professionals overwhelmingly recommend hospital births. Regardless of the cost, you should have your baby in a hospital or birthing center in the following situations.
- You Prefer the Greatest Level of Access to Medical Care. Opting for a hospital birth means having licensed OB-GYNs available on-site and top treatment and surgical options. Many things can impact labor and delivery, and the hospital can provide access to a C-section and pain medication as needed.
- Your Insurance Has Better Hospital Birth Coverage. Insurance can make hospital birth competitive with home birth. And you can always have a midwife or doula with you in the delivery room.
- You Have Contraindications to Home Births. If you have risk factors like diabetes or obesity, are carrying multiples, have had a prior cesarean delivery, or there are any issues with the fetus, plan a hospital birth. Home birth won’t save you money if you have to go to the hospital anyway, and it’s safer to be there from the beginning.
Both Make Financial Sense If…
Both home and hospital birth can be a high-quality childbirth experience as long as you have top-notch care. Choose the one that makes the most sense to you in these situations.
- You Have a High Income. If your household income is high enough that the cost difference between a home and hospital birth doesn’t matter, go with your preference.
- Cost Is Equal in Both Situations. Some people will find that the financial cost of using a midwife to facilitate a home birth is quite comparable to that of a hospital birth. If the cost is similar for both options, go with your personal preference.
- You Want the Best of Both Worlds. A hybrid approach in which you do much of the laboring process at home and then move to the hospital as labor progresses may lessen the amount of time spent in the hospital since early labor can be quite a long ordeal.
The choice between home birth and hospital birth isn’t purely a financial issue.
A home birth has other distinct advantages: the potential for greater freedom in choosing your birth plan, a more intimate experience, and a more comfortable environment in which to bring your baby into the world.
If you’re underinsured and worried about the costs of a hospital birth, in some situations, a home birth can be a safe alternative, especially if you’re healthy and build your emergency fund to cover unexpected hospital expenses.
On the other hand, hospital births are safer, and infant mortality is much lower. You have access to more advanced care and licensed physicians, which can bring immense peace of mind during what can be a very uncertain and emotional few days. And insurance coverage can help lower hospital costs, even if you need a C-section.
Overall, the decision is an important and personal one. Examine your insurance coverage to help you evaluate the options and choose the right birth plan for your family.