The US is the second-most expensive country to give birth in — here's what you'll pay and tips to save

• On average, childbirth in the US costs nearly $14,000, but many factors can affect your final bill.
• Consider asking your care team for an estimate and comparing costs of hospitals and birth centers.

During your pregnancy, you might budget for plenty of new expenses — like maternity clothes, diapers, an infant car seat, and a crib. But there's one major cost you may not have considered yet: Childbirth itself.

On average, a vaginal delivery in the United States costs about $13,811 before insurance kicks in — making the US the second-most expensive country in the world to have a baby in, after Japan.

To compare, here's the average cost of a vaginal delivery in several other countries:

• Japan: $61,810
• Singapore: $8,045
• Australia: $5,312
• The UK: $4,609
• Canada: $3,195
• Russia: $950-$1,950

That said, a number of factors go into how much you actually pay, including the state where you give birth, your insurance coverage, and complications during delivery.

As you prepare to welcome your baby into the world, here are four main factors that can affect the cost of childbirth.

1. Your insurance

Here's what insurance typically covers when it comes to childbirth, according to Dr. Kim Langdon, an OB-GYN at Medzino:

• Doctor's fees
• Hospital fees
• Prescription medications
• Lab work
• Pediatric care for the baby

With insurance, the average out-of-pocket costs for childbirth can range from $1,077 to $2,473 depending on where you live.

How much your insurance provider covers largely depends on your deductible, and whether or not your doctor is in-network, according to Louise Norris, health policy analyst for Healthinsurance.org.

Medical term: A deductible is the amount you have to pay out of pocket before your insurance provider starts covering expenses. Norris says deductibles may range anywhere from $0 to $9,100 in 2023.

If you don't have insurance, Langdon and Norris both strongly recommend reaching out to your state's Medicaid office to check if you qualify for coverage. Enrollment runs year-round.

Medicaid provides coverage for families with lower incomes, older adults, pregnant people, and people with disabilities. In some states, the program covers all adults whose income falls below a certain level — and the income maximum is much higher if you're pregnant, Norris says.

Medicaid covers more than four out of 10 births, and this coverage has no out-of-pocket costs for pregnancy-related services. You can learn more about this option and apply for coverage on the Medicaid website.

Due to variations in income qualifications, however, a good first step may be calling your local office to get more personalized guidance based on your situation.

If you're not eligible for Medicaid, you can search for other low-cost health insurance programs or financial assistance via the:

• Special Supplemental Nutrition Program for Women, Infants, and Children
• Children's Health Insurance Program
• Center for Disease Control and Prevention (CDC)

2. Where you give birth

Your location can play a significant role in the cost of childbirth.

Here's the average cost of vaginal delivery in the least expensive states:

• Mississippi: $7,639
• Oklahoma: $9,111
• Kansas: $9,867

Here's the average cost of vaginal delivery in the most expensive states:

• California: $19,230
• Alaska: $19,050
• Oregon: $17,586

These differences may be due to variations in provider fees based on the cost of living in each state.

Even within the same state, the costs of childbirth can vary quite a bit from hospital to hospital. For example, in the Memphis, Tennessee metro area, the price of delivery before insurance ranges from $4,475 to $17,113.

As a general rule, childbirth also tends to cost more at hospitals located in rural areas or owned by the government or a nonprofit. This may be due to the fact that rural hospitals have a harder time staffing their delivery units.

Also, the average cost of childbirth at a freestanding birth center runs about 40% less than at a hospital. These out-of-hospital facilities are ideal for low-risk pregnancies. They have certified midwives on staff, and many people prefer their home-like atmosphere.

However, your insurance may not cover these centers, and out-of-pocket costs can vary widely. If you're considering this option, you'll want to call birth centers directly to get more information about their costs and ask about an estimate for your own delivery.

What about home births?

The average pre-insurance cost of a home birth in the US is $4,650 — which includes the fee for a certified midwife and the cost of necessary medical supplies for delivery.

It's generally much less expensive to give birth at home than in a hospital, Norris says, due to the lack of facility costs and the fact that home births often involve no medication.

However, not all insurance providers cover home births. That's why Norris recommends contacting your insurance company to find out if they have any in-network midwives.

3. Your birth plan

Many childbirth services are charged a la carte — and even small fees can add up.

Here are some things you can expect to pay for as part of your birth plan, according to Norris:

• Fees for your doctor's services
• Your hospital room — you'll pay less for a shared room and more for a private suite
• Lab tests for you and your baby
• Anesthesia
• Epidural injections and other medications used to ease pain
• Postnatal care

"Depending on the health plan, all of these services can be counted toward the deductible, or there may be individual copays that apply," Norris says.

Items that aren't medically necessary usually come with extra charges. For example, fetal DNA testing and amniocentesis — optional screenings for genetic defects — can cost up to $2,000 or more.

According to anecdotal reports, some hospitals also charge fees for skin-to-skin contact — holding your baby on your bare chest after a C-section birth — because an additional nurse must be present for safety reasons. Other reports reveal some hospitals charge higher amounts for basic supplies, like Tylenol, antibacterial ointment, or alcohol prep pads.

Note: According to some research, almost 1 in 5 insured families received surprise bills for maternal or newborn care. These surprises cost an average of $744 — but for a third of families, they exceeded $2,000.

Keep in mind that even if you have an in-network doctor and hospital, other specialists at that facility may be out-of-network. For example, you might unknowingly rack up costly fees from an out-of-network anesthesiologist.

As of January 2022, however, the No Surprises Act protects you from these unexpected charges. If you don't have health insurance, the No Surprises Act allows you to request a good faith estimate from your doctor, which will detail how much your care should cost before you receive it.

If your final bill is substantially higher than your estimate, you can dispute the charges. You can start by reporting errors on your bill to your insurer and hospital — but if you still can't resolve the issue, you may want to file a federal complaint online.

4. Potential complications

Things don't always go according to plan, and potential complications can increase the costs of childbirth by 20-25%. For example, delivering a premature baby costs four times more.

If your doctor believes vaginal delivery might put you or your baby at risk, they'll recommend a cesarean section (C-section). This is pretty common in the US — in fact, about 32% of all US deliveries happen via C-section.

But a C-section often costs around 30% more than a vaginal delivery, due to the fact that they require a major surgical procedure with anesthesia and a longer hospital stay.

Again, though, the cost difference can vary depending on where you live — for example, one 2020 study found a $1,852 cost difference between vaginal birth and C-sections in Maryland, and a $10,755 cost difference in Oregon.

According to Langdon, other potential complications that may add to your final bill total include:

• Forceps or vacuum deliveries, otherwise known as "assisted birth"
• Neonatal intensive care unit (NICU) admission for the baby
• Amniotic fluid embolism, a rare but life-threatening condition where fetal material or amniotic fluid enters the mother's bloodstream
• Heart attack
• Acute respiratory distress syndrome and pulmonary edema — conditions that involve too much fluid in the lungs
• Acute renal failure, a condition in which the kidneys suddenly can't filter waste from the blood.
• Postpartum hemorrhage, or excessive blood loss
• Preeclampsia and gestational hypertension, or high blood pressure
• Sepsis

Note: Certain health conditions may also raise your risk of complications, through no fault of your own — but this can increase the cost of childbirth. For instance, health concerns like chronic pain, obesity, or diabetes can add an average of $1,006 to the cost of vaginal delivery and $2,264 to the cost of C-section delivery.

How to minimize costs

Here are some strategies for keeping the costs of childbirth down, according to Norris and Langdon:

• Shop around to compare the costs of childbirth at different hospitals.
• Check whether your hospital offers maternity packages, which bundle itemized services for a flat fee and often include discounts.
• If you don't have a high-risk pregnancy, consider delivering your baby at a freestanding birth center.
• Keep up with prenatal care. While you can't control many childbirth complications, getting regular prenatal care can increase your chances of a healthy pregnancy and prompt treatment for any issues.
• Work with your doctor to determine which tests are absolutely necessary for your birth plan.
• Ask your doctor about the costs of any additional services or products they suggest that aren't on your estimate, so you know what to expect.
• Ask if your hospital outsources its emergency room team since this can mean this service is not in-network. The No Surprises Act doesn't offer protection from charges for out-of-network ground ambulances if you need emergency transportation to the hospital for delivery.
• Bring some of your own supplies to the hospital. Using simple items like over-the-counter pain relievers and a box of tissues can result in a significant extra charge.

Insider's takeaway

The cost of childbirth can range quite a bit based on where you give birth, your health insurance coverage, and whether or not you experience any complications during delivery.

If you have health insurance, you can keep your costs down by sticking with in-network facilities and doctors. If you don't have insurance, state-funded programs can help you find out what low-cost plans you might qualify for.

Requesting an estimate from your doctor or facility can help you plan financially for childbirth. It's also important to know your rights when it comes to surprise charges. When in doubt about whether or not your insurance company covers a particular service, always ask ahead of time.