Rhondda Evans Hartman is a Registered Nurse with a BS in Nursing and an MA in Sociology. Rhondda taught classes and trained and supervised other teachers in husband-coached childbirth with the world-renowned Dr. Robert A. Bradley for twenty-five years, and frequently spoke alongside Dr. Bradley at major conferences. She is also the author of two books: Exercises for True Natural Childbirth and the newly-released Natural Childbirth Exercises. Rhondda is a proud mother of five and grandmother of nine. Her website is

The Real Cost of Childbirth 

By Rhondda Evans Hartman | RN

Birth is a normal, natural function of your female body. Knowing this is the first step towards taking power over your body during pregnancy, labor and delivery, and post-partum. When we allow someone else, even someone with good intentions, to take that power, we are no longer in charge of our bodies or our births. When we allow our birth experience to become a medical event – one controlled by doctors, hospital policies and insurance companies – we are the ones who lose.


These losses come in many unwanted forms. Many women feel physical losses – the difficult and painful healing process after a caesarean is one example. Others feel emotional losses; they grieve the loss of their ideal birth, or feel a deep loss in self-esteem believing that they “couldn’t do it,” often because someone else decided it was so. Another loss affects not only individual women, but our entire society – the increasing monetary cost of maternal care.


In The Cost of Having a Baby in the United States, a 2013 report issued by Childbirth Connection, Catalyst for Payment Reform, and the Center for Healthcare Quality and Payment Reform, these costs are made clear: improved maternity care in the US could save billions of dollars each year.


Improved? But doesn’t the US have the most advanced medical care in the world? Yes – in terms of technology. In terms of pregnancy and childbirth, a normal, natural function of your female body, not at all. As The Cost of Having a Baby report stated, “Most childbearing women are healthy, have healthy fetuses, and have reason to expect an uncomplicated birth, yet routine maternity care is technology-intensive and expensive: combined maternal and newborn care is the most common and costly type of hospital care.”


Have you ever wondered why more than one-third of babies in the US are now born via cesarean, a 50% increase in just ten years? It’s not because women have suddenly forgotten how to give birth. Here’s a hint from the study: the average total payments for maternal and newborn care with cesarean births were about 50% higher than average payments with vaginal births.


Maureen Corry, the Executive Director of Childbirth Connection, put it simply: “If the rate of c-sections were reduced from 33% to 15% (the World Health Organization recommends a c-section rate of 15% or less), national spending on maternity care would decline by more than $5 billion.”


In any medical procedure, there is a profit involved. The expensive equipment needed for rare and unusual medical emergencies in birth must be available. It also must be paid for. It follows logically that if birthing women do not use that equipment, how can buying and maintaining it be cost-effective for a hospital? It becomes financially necessary for the hospital to encourage its use. Hospitals set their own protocols. These “rules” can require that staff use expensive techniques and equipment when there is only the slightest suggestion of risk to baby or mother.


As mothers, we are terribly vulnerable during the birthing process. Would any one of us want to jeopardize the life or safety of our babies? Of course not! When a doctor declares that an intervention “must” be done, would any parent disagree?


Who is responsible for the number of cesarean births today? Ask around and you’ll hear blame put on doctors, hospitals, insurance companies, mothers… all we know for certain is that the increased cesarean rate increases the costs of childbirth dramatically, and not just childbirth via cesarean – even mothers who have normal, natural vaginal births in hospitals pay more in “facility expenses” because hospitals today need multiple operating rooms to keep up with the exploding cesarean rate. Between 2006 and 2010, the out-of-pocket expenses for mothers who birthed via cesarean or vaginally both increased fourfold.


Medical costs should never be the deciding factor in how our babies are born – but it could easily happen that way if we stay uninvolved in our own births. As a mother-to-be, you have the responsibility of planning your birth. Your best defense is to choose your health care provider with great care. Find one who believes you are the primary participant in your birth. Find one who will happily explain the reason for all birth procedures, and shows flexibility when it comes to your wishes. Find one who does not think of an epidural as a “routine” birth procedure (epidurals are very common, but they are still an intervention). Find one who will listen to you and discuss a birth plan with you. If a care provider’s eyes roll when you say the words “birth plan,” walk out and keep looking for someone who will include you in your own birth experience!


All interventions carry some kind of risk. Unless interventions are truly necessary, the fewer procedures and interventions used during your birth, the better for you and your baby – and the lower the cost of birthing. It’s up to you to be informed and educate yourself enough to feel confident saying “yes” or “no” when an intervention is suggested. Sometimes interventions are necessary, but you should still be included in making the decision to go ahead. You have the power. Use it!