Pregnancy costs are out of control

The United States has what may well be one of the most bizarre cultures surrounding pregnancy, labour, and delivery in the world. Though having children is not on my agenda (so much so that I went to considerable lengths to rule it out as a possibility), I follow this among other health care issues out of a general interest in the health care system. It’s also explicitly of interest because it surrounds a sexist and misogynistic culture — the vast majority of pregnant people in the United States are women, and the complex culture surrounding pregnancy is rooted in that fact. So is the skyrocketing cost of pregnancy, a move that seems almost calculated to bankrupt women and their families.

Historically, labor and delivery took place at home, with varying survival rates for parents and children alike depending on the circumstances of a pregnancy and the environment of the labor and delivery room. Pregnancy started to become more medicalised in the 1930s, when there was a big push to move it to hospitals — ostensibly to make pregnancy safer, but also calculated to cut midwives out of the conversation and culture surrounding childbearing. Obstetrics was a profitable specialty for doctors who wanted to create more opportunities for themselves, and thus even low-risk pregnancies ended up in hospital delivery rooms. In fact, in some cases hospital outcomes were worse than home births, in part because hospitals weren’t necessarily the cleanest of environments, and because newborns were exposed to communicable disease.

The relationship to labour and delivery really underwent radical shifts as hospitalised births also increasingly distanced women from their own pregnancies with the use of things like ‘twilight sleep,’ which was supposed to make deliveries go smoothly and pleasantly for all involved. At the same time, a huge backlash to medicalisation led to a growing home birth movement in the 1960s and 1970s; thus a generation split between ferocious advocacy for being born at home and taking advantage of all the benefits of a hospital birth.

Today, the vast majority of children are born in hospital environments, with some parents opting for a birthing centre as a stepdown environment (and one that provides very rapid access to emergency interventions). Births do still take place at home, though, and not necessarily among crunchy hippie parents. For those children born in hospital, however, the costs are staggering. Pregnancy care can cost as much as $50,000 — and that’s for labour and delivery alone, not including prenatal care. Some of this is due to the oft-criticised number of C-sections in the US (a separate issue and one with very tangled implications I don’t care to delve into at the moment).

It’s also due to the fact that pregnancy is assigned as a ‘women’s health care thing,’ and that means absurd expenses can be tacked on — and women can find themselves holding the bag, as there are often excuses to deny full coverage. This is one of the things the Affordable Care Act was supposed to address, and in some cases, it has, but the situation for pregnant people in the United States is still rather grim. In addition to the absurd costs for pregnancy care, they’re also looking at extreme pressure to follow a set pregnancy ‘script,’ and woe betide those who engage in self advocacy and want to take an active role in develop their patient plans.

Not all patients want to labour on their backs, an extremely painful and unproductive position. Not all patients want epidurals. Not all patients want C-sections. Patients who’ve needed C-sections in the past might want to attempt a vaginal birth, and a growing number of providers flatly refuse to offer VBAC care. Many patients want to control the medications administered during labour and delivery, and they want to communicate with nurses, doctors, and other support staff; pregnant people are often treated like objects not just in society in general, but also during labour, with the people around them refusing to include them in the discussion about the status of the labour and how to proceed.

Yet, the United States has fed a very strong culture of prioritising hospital births over all others, and shaming those who choose alternatives (though it’s also worth noting that some advocates of home birth are equally aggressive about shaming people who choose or are forced to give birth in hospital environments, which is equally inappropriate). It also has a culture of telling women what to do that translates dangerously to the way pregnancies are managed, depriving people of autonomy in everything from prenatal care to being able to hold and nurse their infants after giving birth.

Pregnancy is becoming so expensive that, costs of actually raising a child aside, it’s a serious economic barrier to having children. And it shouldn’t be. I reject the argument that people who can’t afford the expenses of having a pregnancy that’s managed as safely and respectfully as possible shouldn’t have children. When you’re looking at costs that rival those of a full year at an Ivy League college — and all four years of education at many excellent schools — you have to challenge these kinds of attitudes and get to the deeper root of the problems with labour, delivery, and pregnancy culture in the United States.

Pregnant people are not objects, and there shouldn’t be a financial premium on pregnancy. We already live in a society where so many basics of life are restricted to the very wealthy.

Image: Shirley, Pregnant, Elvis Huang, Flickr