physician get involved in the care of your patients?
• What is the role of the physician in your practice?
• What position do most of the women you work with adopt for the second stage of labor?
• How do you make the decision to transfer the patient to a hospital or the care of a physician? How often does that happen?
FOR BOTH OB/GYNS AND MIDWIVES
• Do you have an advice line we can call when we panic about something?
• What are your rates and payment plans?
• What insurance, if any, do you take?
• What percentage of your patients had natural, unmedicated births in the past year?
• What’s your definition of “high risk”?
• If labor starts when you’re not on call, will you come in anyway?
• What and who (besides you, Dad) is allowed in the delivery room (friends, relatives, doulas, cameras, webcams, etc.)?
• Are you willing to wait until the umbilical cord has stopped pulsating before you clamp it?
• What prenatal tests do you suggest getting? Which ones do you require?
• Which tests do you usually order for women like your partner (her age, race, medical history, and risk factors)?
• How many sonograms (ultrasounds) do you routinely recommend?
• Are women free to walk, move, and take a shower throughout the early stages of labor? Can the baby be put to the breast immediately after delivery?
• Are you willing to dim the lights when the baby is born?
• How much experience have you had with twins or more? (This is a very important question if you and/or your partner have a family history of multiple births or if you suspect that your partner is carrying more than one baby.)
BILLS
Having a baby isn’t cheap. Exactly how much you have to come up with will depend on how and where your baby is born, and which of the infinite combinations of deductible, coinsurance, copays, and out-of-pocket maximums you have. According to the Agency for Healthcare Research and Quality, a part of the U.S. Department of Health and Human Services, the average charge for a vaginal delivery is just under $9,000—nearly triple what it was in 1993. And the average charge for a Cesarean is almost $16,000—2.5 times higher than in 1993. Private insurance covered an average of 80 percent of prenatal care charges and 88 percent of delivery charges. But even if you have good insurance, that 12–20 percent can still add up in a hurry. Do keep in mind, though, that what the practitioner receives will almost always be quite a bit less than the sticker price.
In the sections that follow, you’ll get an idea of how the costs for a typical—and a not-so-typical—pregnancy and childbirth experience might break down. It’s a good idea to look over your insurance policy, find out how much it will be picking up, and start figuring out now how you’re going to pay for the rest of it. Oh, and all of this is in addition to anything you might have paid for fertility diagnosis and treatment. What we’re talking about here are just the costs that come up after your partner gets pregnant. Putting together a budget can be important even if you’re adopting. In many cases, adoptive parents are in close contact with the birth mother throughout her pregnancy and delivery. You and your partner might go with her to the doctor’s appointments, see the ultrasound, hear the baby’s heartbeat, and pick up the bills—most of which won’t be reimbursed by your insurance company—for everything. If you’re doing an international adoption, you won’t have to worry about covering the birth mother’s medical expenses, but you’ll probably need to budget in the cost of several overseas trips. In addition, you’ll need to take into account the many other adoption-related expenses you’re likely to incur, including agency fees, attorney’s fees, and the home study you’ll have to go through.
Pregnancy and Childbirth
Most doctors charge a flat fee for your partner’s care during the entire pregnancy. This generally covers monthly visits during the first two trimesters, biweekly visits for the next month or so, and then weekly visits until delivery. But don’t make the mistake of thinking that that’s all you’ll pay. Bills for blood and urine tests, ultrasounds, hospital fees, and other procedures will work their way into your mailbox at least once a month. Here’s what you can expect to pay (before your insurance pays its part) for having your baby:
OB/GYN
Expect to pay $2,500–6,500 for general prenatal care and a problem-free, vaginal delivery. Add a few thousand more for a C-section. Most doctors will meet with you to discuss their rates and the services they provide. For a list of important questions to ask, see pages 20–21. In addition, be sure to discuss which insurance plans, if any, they participate in (it might actually be easier to start with the doctors your insurance covers and choose from there). You should also ask whether they’ll bill your insurance company directly or will want you to make a deposit (most will want to collect about 25 percent of the anticipated bill up front); whether you can make your payments in installments; and whether they expect their fee to be paid in full before the delivery.
MIDWIFE
The average cost of a delivery by a midwife is $2,000–4,000, but it can vary greatly depending on where you live and whether you expect her to be with you throughout labor or just the part that’s right before the birth. If you’re delivering at home, you’ll also need to add the cost of the supplies the midwife thinks you’ll need for the birth (sterile pads, bandages, and so on).
Lab and Other Expenses
• Blood: Over the course of the pregnancy, you can expect to be billed anywhere from $200 to $1,500 for various blood tests.
• Ultrasound: At least $250 each. In an ordinary pregnancy, you’ll have between none and three.
Prenatal Testing
If you and/or your practitioner decide that you’re a candidate for amniocentesis or any other prenatal diagnostic test, you can expect to pay $1,000–1,500. In most cases genetic counseling is required beforehand, and that costs an additional $400–600. If you’re having any prenatal testing done just because you’d like to find out the sex of the baby or want reassurance of its well-being (and not because you’re in a high-risk group), your insurance company may not pay for it. But if your partner is thirty-five or older, they probably will pay for testing.
At the Hospital
• If you’re paying for it yourself, a problem-free vaginal delivery and a twenty-four-hour stay in a hospital will run anywhere from $4,500 to $9,000, depending on where you live. Add $5,000–7,000 for a Cesarean.
• If you’re planning to spend the night in the hospital with your partner, add about $250 per day.
• Anesthesiologists usually charge from $1,000 to $1,500, depending on what they do and the time spent doing it.
• Although a lot of people worry about preterm delivery, there’s also the issue of late delivery. If your baby decides to stay
