ARTICLE

Uncovering the unpredictable costs of maternity care


Kari Carlson, MD

Updated: June 5, 2024

Pregnant person in a work meeting

Health care services for new parents and children — from labor and delivery to childhood immunizations — account for $1 out of every $5 that large employers spend on health care.1 And with most pregnant people working until late in a pregnancy and returning soon after giving birth, much of their prenatal and postpartum time is spent in the workplace.

  • 70% of pregnant people work during pregnancy.2
  • The average new mother returns to work less than 3 months after giving birth.3

High-quality maternity care not only keeps your employees at their best — it helps you get the most out of your health care investment.

70% of pregnant people work during pregnancy

Why are maternity care costs so unpredictable?

Maternity care is one of the top 5 drivers of employer health care costs.6 But on top of medical costs, there are indirect costs to consider — like unexpected time away from work and short- and long-term disability — that can come up during or after pregnancy.

 

For pregnant people with large group health plans, the average cost to have a baby in the U.S. is nearly $19,000 — including almost $3,000 in out-of-pocket costs.7 But when complications arise — such as preeclampsia or a premature birth — costs can quickly spiral into the hundreds of thousands of dollars.8 And complications are on the rise: In the past decade, the rate of high blood pressure disorders in pregnant people rose by 52%.9

“Complications during pregnancy are increasing for a variety of reasons,” says Kari Carlson, MD, a doctor of obstetrics-gynecology at Kaiser Permanente Redwood City Medical Center. “For one, people are entering pregnancy unhealthier than before, mostly due to obesity, but also due to older age. And unfortunately, we still see disparities in care for certain races/ethnicities, as well as socioeconomic factors.”

Several hidden factors can also drive up maternity care costs:

  • Babies born to people who don’t receive prenatal care are 3 times more likely to have a low birth weight — a condition that can cost more than $114,000.10
  • Cesarean sections cost 77% more than vaginal deliveries.11
  • Mood and anxiety disorders affect 1 in 7 pregnant people and if untreated can add nearly $32,000 in costs per birth.12
     

Understanding the major factors impacting cost

1. Early prenatal care
People who receive early, comprehensive, and continuous prenatal care and preventive screenings are more likely to have healthy pregnancies and less likely to have dangerous complications. Births with complications cost twice as much as uncomplicated deliveries.13


2. C-section rates
Cesarean births are abdominal surgeries — they increase recovery time, extend hospital stays, and cost significantly more than vaginal births. Since all surgeries carry risks, the least invasive option is preferred for low-risk pregnancies.

 

Taking steps to lower C-section rates is an important global health initiative. The World Health Organization’s ideal acceptable rate of cesarean births is 10% to 15%14 — but the U.S. national average for these procedures is 26.3%.15
 

Parent with their baby

3. Postpartum depression screenings and treatment

Maternity care also remains important after babies are born. Postpartum depression can begin anytime in the year after birth and affect every aspect of a new parent’s life — including their ability to be present and engaged at work. Without treatment, postpartum depression can last for months, even years. It can also have compounding effects on other health issues. People who experience major depression in the first year after giving birth are 41% more likely to be unemployed within 3 years.17

 

And the parent who gives birth isn’t the only one at risk. Up to 13% of new fathers experience depression after their child’s birth — and that number rises to 50% when the baby’s mother also has postpartum depression.18 Regular screenings should be part of every new parent’s care plan, so they can easily get connected to the support they need. Research shows depression in dads puts children at a 42% higher risk of depression themselves.19

Parent with their baby

The benefits go beyond cost savings

The more that businesses understand the unpredictable costs of maternity care — and the factors driving those costs — the more they can serve as advocates for their employees during such an important phase of life.


“Employers should look to partner with health care providers that support reproductive health at all points: planning, preconception health, prenatal care and delivery outcomes, as well as postpartum,” says Dr. Carlson.

 

When your employees receive high-quality care, your business benefits from increased engagement, lower turnover, and a healthier, happier workforce.

 

Workplace wellness for women

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Championing Women's Wellness in the Workplace

Kari Carlson, MD, is a doctor of obstetrics-gynecology at Kaiser Permanente Redwood City Medical Center. She joined Kaiser Permanente in September 2003. Dr. Carlson has an undergraduate degree in American history from Princeton University and attended medical school at the University of California, Davis. She completed her residency at Kaiser Permanente in Santa Clara.    

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Footnotes:

  • 1Purchaser Business Group on Health, “Supporting Non-Hospital Birthing Options: Employer Strategies to Improve Quality,” May 23, 2022.

  • 2Jessica Mason and Katherine Gallagher Robbins, “Issue Brief: Pregnancy Discrimination,” National Partnership for Women & Families, October 2022.

  • 3Jane Herr et al., “Gender Differences in Needing and Taking Leave,” U.S. Department of Labor, November 2020.

  • 4See note 2.

  • 5See note 1.

  • 62024 Large Employer Health Care Strategy Survey, Business Group on Health.

  • 7Matthew Rae et al., “Health Costs Associated with Pregnancy, Childbirth, and Postpartum Care,” Peterson-KFF Health System Tracker, July 13, 2022.

  • 8Andrew L. Beam et al., “Estimates of Healthcare Spending for Preterm and Low-Birthweight Infants in a Commercially Insured Population: 2008–2016,” Journal of Perinatology, February 26, 2020.

  • 9“Health, Not Age, Driving a Rise in Pregnancy Complications,” American College of Cardiology, February 24, 2023.

  • 10“Prenatal Care,” womenshealth.gov, February 22, 2021; see note 6.

  • 11See note 5.

  • 12Dara Lee Luca, PhD, et al., “Financial Toll of Untreated Perinatal Mood and Anxiety Disorders Among 2017 Births in the United States,” American Journal of Public Health, June 2020.

  • 13Christopher M. Black et al., “Costs of Severe Maternal Morbidity in U.S. Commercially Insured and Medicaid Populations: An Updated Analysis,” Women’s Health Reports, September 2021.

  • 14Cornel M. Angolile et al., “Global Increased Cesarean Section Rates and Public Health Implications: A Call to Action,” Health Science Reports, May 2023.

  • 15“Reduce Cesarean Births Among Low-Risk Women with No Prior Births — MICH-06,” Healthy People 2030, health.gov, accessed April 4, 2024.

  • 16See note 15.

  • 17Slawa Rokicki, PhD, et al., “Depression in the Postpartum Year and Life Course Economic Trajectories,” American Journal of Preventive Medicine, February 2022.

  • 18Sam Wainwright et al., “Screening Fathers for Postpartum Depression in a Maternal-Child Health Clinic: A Program Evaluation in a Midwest Urban Academic Medical Center,” BMC Pregnancy and Childbirth, September 19, 2023.

  • 19Berihun Dachew, PhD, et al., “Paternal Depression and Risk of Depression Among Offspring: A Systematic Review and Meta-Analysis,” JAMA Network Open, August 16, 2023.