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Giving birth means going into debt for some mothers in America, but why?

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For American parents, the reward in childbirth is, of course, the baby. Yet, the existing incentives in the healthcare industry are all backward: Costs for mothers and babies continue to climb as health outcomes worsen. And behind these statistics are real parents who often feel out of control or unprepared for the bills that follow baby's birth.


When she was expecting her second child in 2009, Jessica Pennington was already well aware of the steep costs associated with giving birth in the United States. Hoping to brace for the financial impact, Pennington and her then-husband set aside close to $2,000 to pay the bills that were sure to follow her hospital delivery—despite their private insurance coverage.

"I had no way of knowing the birth was going to be anything but normal," Pennington tells Motherly.

A 2013 report prepared by Truven Health Analytics based on 2010 data shows Pennington could have expected a bill of approximately $3,400 for a standard vaginal delivery or $5,100 for a cesarean birth.

But all did not go according to plan.

Endometriosis further weakened Pennington's uterus after her first birth and the strain of pitocin, a labor-inducing drug, caused Pennington's uterus to "split like a banana peel."

Thankfully her baby was unaffected by the traumatic delivery, but doctors had to fight to first save Pennington's life and then her reproductive system—even though she says a hysterectomy would have been her first choice if she or her husband had been consulted.

"They were using things like brand new technologies they never used before," Pennington says, adding surgeons performed a hysterectomy after exhausting their other options. "One procedure alone was $40,000 and it didn't work."

By the time she was released from the hospital, the costs for her medical care topped $140,000. After petitioning for more insurance coverage, that left Pennington and her ex with a bill of $30,000—an unfathomable amount on their full-time student, part-time employee budgets.

"My education got put on hold so that I could make any kind of money to even buy groceries," Pennington says, adding the couple was initially unable to make the minimum $150 monthly payments. "Now, looking back it doesn't seem like much, but when you're not working and trying to pay for college and trying to raise two kids and maintain a normal house and lifestyle and groceries, it was just unheard of."

Childbirth costs in the United States continue to climb, even as outcomes worsen

Although Pennington's experience was more dramatic than most, even by-the-books deliveries come with growing price tags for American families: According to the report prepared by Truven Health Analytics, out-of-pocket costs for maternal care quadrupled from between 2004 and 2010.

Upon a close inspection of bills, some medical charges may seem exorbitant—such as a single pill of acetaminophen (or Tylenol) topping $30, according to the 2016 Trends in Hospital Inpatient Drug Costs report from NORC at the University of Chicago.

Other charges may even be inexplicable. That was the case for Amy Sallie, a mother of four, who delivered her second baby on the floor of the emergency room minutes after walking into the hospital.

"Here's the fun thing, I got billed for all of the normal expenses," Sallie tells Motherly. "Labor and delivery room, all the normal stuff. And I'm just thinking like, 'I literally gave birth in your hallway. What are you talking about?'"

For parents who are trying to navigate life with a newborn, it can be hard enough to scan the intrapartum bills in detail—let alone figure out how to start debating charges or requesting more insurance coverage. To limit potential surprises, Hector De La Torre, executive director of Transamerica Center for Health Studies (TCHS), tells Motherly that expectant families should consider their health insurance options and make sure they will be in-network for care.

"A substantial subset of millennials do not feel very informed about the health insurance options available to them and find decision making about health insurance plans difficult," he says.

While costs have been rising, outcomes for mothers have been worsening: According to a 2017 report from the Centers for Disease Control and Prevention, the maternal mortality rate in the United States has steadily climbed since the mid-1980s. This gives America the distinction of having the worst rate of maternal deaths in the developed world, according to a 2016 report published in the journal The Lancet.

The current maternal healthcare system rewards complications

The current rate of cesarean births in the United States is nearly 32%, which is more than double the number that is estimated to be medically necessary by the World Health Organization. This single data point is representative of the larger trend of intervention-intensive maternity care, which is often not in the best interest of low-risk mothers—or their bank accounts.

"Birth costs are inflated by probably a lot of things that people don't need and things that can also unintentionally pose harm," says Carol Sakala, Director of Childbirth Connection Programs at the National Partnership for Women & Families, which collaborated with Truven Health Analytics on the 2013 report. "You have a greater likelihood of things like bleeding and infection and so forth when you're taking surgical steps and giving powerful drugs."

While options such as medically inducing labor or offering an epidural are often presented as "not an issue" to mothers, Sakala says these steps may be the start of "a very intervention-intensive birth for a population that is by and large low-risk and healthy."

However, the dominant healthcare structure doesn't actually offer incentives for positive outcomes.

"The essential point is that the fee for service system we have now, adding up all these different fees from all these different services, is not tied in the least to value," Sakala says. "It doesn't matter if you did something that was a good thing to do or not, it doesn't matter if you got a good outcome or not."

'We're heading in the direction' of a better option

Although it hasn't yet been reflected by healthcare costs or outcomes, Sakala says there is reason to be optimistic due to a growing movement behind "bundled" or episode-based care. Currently offered through Medicaid programs in Ohio, Tennessee and Arkansas, as well as with some Cigna plans, this payment structure controls the costs for families and encourages better outcomes from the very start of maternal care.

Unlike the current standard, this system rewards healthcare providers for positive outcomes—such as lower rates of C-sections and higher rates of breastfeeding—or, in some cases, penalizes them for negative outcomes.

"Now it gets their attention that they're not only providing services and business as usual, as we are accustomed to in the current cultural ethos of maternity care," Sakala says, "but they are paying attention to what is going to get the best outcome and trying to work together to do that."

What can expectant parents do to control costs?

For what it says about transparency in the healthcare system in general, it is actually difficult to find estimates for childbirth costs in the United States. De La Torre recommends expectant parents familiarize themselves with their insurance policies from the beginning of maternal care. And tools such as that provided by the non-profit consumer group FAIR Health can help individuals estimate childbirth costs in their own states.

Beyond that, remember you are your best advocate. One surprising finding from the Truven Health Analytics report is that uninsured women paid less on average for childbirth services than mothers with insurance. The reason behind that may be twofold—and comes with a lesson for all families: For one, uninsured women may be slower to accept unnecessary interventions, which lowers their overall costs.

They may also be more proactive about petitioning their bills, which is something all families can do. As Sakala says, "This figure told me that hospitals by and large are ready to negotiate."

Looking back on her experience, Pennington says her insurance company was also easy enough to work with—but it was the pure scope of their debt that cast a shadow over a time that should have been happier.

"To be honest, the whole first year after that was a blur," she says. "It was rough. I think we have everything paid off now, eight and a half years later, but every once and a while something will creep up from 2009 and we're like, 'Oh my gosh.'"

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While breastfeeding might seem like a simple task, there are so many pieces to the puzzle aside from your breasts and baby. From securing a good latch, boosting your milk supply and navigating pumping at work or feeding throughout the night, there's a lot that mama has to go through—and a number of products she needs.

No matter how long your nursing journey may be, it can be hard to figure out what items you really need to add to your cart. So we asked our team at Motherly to share items they simply couldn't live without while breastfeeding. You know, those ones that are a total game-changer.

Here are the best 13 products that they recommend—and you can get them all from Walmart.com:

1. Medela Nursing Sleep Bra

"This fuss-free nursing bra was perfect for all the times that I was too tired to fumble with a clasp. It's also so comfy that, I have to admit, I still keep it in rotation despite the fact that my nursing days are behind me (shh!)." —Mary S.

Price: $15.99

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2. Dr. Brown's Baby First Year Transition Bottles

"My daughter easily transitioned back and forth between breastfeeding and these bottles." —Elizabeth

Price: $24.98

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3. Multi-Use Nursing Cover

"When I was breastfeeding, it was important to me to feel like a part of things, to be around people, entertain guests, etc. Especially since so much of being a new mom can feel isolating. So having the ability to cover up but still breastfeed out in the open, instead of disappearing into a room somewhere for long stretches alone to feed, made me feel better."—Renata

Price: $11.99

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4. Lansinoh TheraPearl Breast Therapy Pack

"I suffered from extreme engorgement during the first weeks after delivery with both of my children. I wouldn't have survived had it not been for these packs that provided cold therapy for engorgement and hot therapy for clogged milk ducts." —Deena

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5. Medela Quick Clean Breast Pump Wipes

"Being a working and pumping mama, these quick clean wipes made pumping at the office so much easier, and quicker. I could give everything a quick wipe down between pumping sessions. And did not need a set of spare parts for the office." —Ashley

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6. Earth Mama Organic Nipple Butter

"This nipple butter is everything, you don't need to wash it off before baby feeds/you pump. I even put some on my lips at the hospital and it saved me from chapped lips and nips." —Conz

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7. Medela Double Electric Pump

"I had latch issues and terrible postpartum anxiety, and was always worried my son wasn't getting enough milk. So I relied heavily on my breast pump so that I could feed him bottles and know exactly how much he was drinking. This Medela pump and I were best friends for almost an entire year" —Karell

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8. Lansinoh Disposable Stay Dry Nursing Pads

"I overproduced in the first couple weeks (and my milk would come in pretty much every time my baby LOOKED at my boobs), so Lansinoh disposable nursing pads saved me from many awkward leak situations!" —Justine

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9. Haakaa Silicone Manual Breast Pump

"This has been a huge help in saving the extra milk from the letdown during breastfeeding and preventing leaks on my clothes!" —Rachel

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10. Medela Harmony Breast Pump

"Because I didn't plan to breastfeed I didn't buy a pump before birth. When I decided to try, I needed a pump so my husband ran out and bought this. It was easy to use, easy to wash and more convenient than our borrowed electric pump." —Heather

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11. Milkies Fenugreek

"I struggled with supply for my first and adding this to my regimen really helped with increasing milk." —Mary N.

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12. Lansinoh Breast Milk Storage Bags

"I exclusively pumped for a year with my first and these are hands down the best storage bags. All others always managed to crack eventually. These can hold a great amount and I haven't had a leak! And I have used over 300-400 of these!" —Carla

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13. Kiinde Twist Breastfeeding Starter Kit

"The Kiinde system made pumping and storing breastmilk so easy. It was awesome to be able pump directly into the storage bags, and then use the same bags in the bottle to feed my baby." —Diana

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This article is sponsored by Walmart. Thank you for supporting the brands that support Motherly and mamas.

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Ashley Graham is having a baby! The supermodel recently shared the exciting news on social media — and it didn't take long for her to make an important statement about pregnant bodies.

Ashley shared a beautiful photo featuring something nearly every woman on the planet has: stretch marks. The photo, which features Ashley nude and seemingly unfiltered, is kind of revolutionary—because while it's completely normal for a woman to have stretch marks (especially during pregnancy), we don't often get to see celebrities rocking this reality on magazine covers or even in social media posts.

That's probably why Ashley, who will welcome her firstborn with husband Justin Ervin, is earning so much praise for the photo, which she posted on Instagram. The images shows the model's side with the caption "same same but a little different".

One follower who is loving this real look at a pregnant body? Hillary Scott of Lady Antebellum, who writes "My Lord, THANK YOU for this."

Ashley's post touches another user in an unexpected way: "I'm such a wimp. I'm pregnant, hormonal, and going though so many body changes. This made me tear up. I really needed this today," she writes.

Another user adds: "I showed my husband this photo and he said, 'See! She's just like you' I am almost 21 weeks pregnant and I've been struggling with my changing body. I love how much you embrace it. I've always looked up to you and your confidence. ❤️ Congratulations on your babe!"

Yet another follower adds: "This is what girls need to see. We need this as a reference for real and relatable. Women young and old. Thank you!"

Of course this is social media we're talking about so a few hateful comments make their way into the mix—but Ashley's many advocates shut that down. We have to applaud this stunning mom-to-be for showing the world how pregnancy really changes your body.

Women everywhere can see themselves in this photo of a supermodel (and how often does that happen?). That's powerful stuff—and it just might make it a little bit easier for the rest of us to embrace the changes we see in our own bodies.

One follower sums it all up best, writing: "I CANNOT WAIT for you to be a mother and teach another human being that ALL bodies are beautiful. You're going to be such an amazing mother."

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Finding out that you are having multiples is always a surprise, but finding out that you're in labor with triplets when you didn't even know you were pregnant, well that's the mother of all surprises.

It happened to Dannette Glitz of South Dakota on August 10. The Associated Press reports she had no idea she was pregnant and thought the pain she was experiencing was kidney stones.

"I never felt movement, I never got morning sickness, nothing!" Glitz explains in a social media post.

"Well this was a huge shock"

When Glitz posted photos of her triplets to her Facebook page last week one of her friends was confused. "What? You really had triplets?" they asked.

Glitz (who has two older children) started getting pain in her back and sides in the days before the birth, but it felt like the kidney stones she had previously experienced so she brushed it off. Eventually, she was in so much pain all she could do was lay in bed and cry.

"It hurt to move and even breath[e]," she wrote, explaining that she decided to go to an Urgent Care clinic, "thinking I'm going to have to have surgery to break the stones up."

A pregnancy test at Urgent Care revealed Glitz was pregnant—that was the first surprise. The second surprise happened when a heart monitor revealed the possibility of twins.

'I need another blanket, there's a third'

Glitz was transferred to a regional hospital in Spearfish, South Dakota. "And in about 2 hours they confirmed twins as there was 2 heart beats," she writes.

Glitz was 34 weeks along and four centimeters dilated. She was transferred again, rushed by ambulance to the hospital in Rapid City and prepped for a C-section. When the C-section was happening she heard the doctor announce that Baby A was a boy and Baby B was a girl.

"Then [the doctor] yells 'I need another blanket, there's a third' ....I ended up having triplets, 1 boy [and] 2 girls," Glitz writes.

Glitz and her husband Austin named their surprise children Blaze, Gypsy and Nikki and each of the trio weighed about 4 pounds at birth. Because the couple's older children are school-aged, they didn't have any baby stuff at home. Friends quickly rallied, raising over $2,000 via a Facebook fundraiser to help the family with unexpected expenses.

A family of seven 

The family is getting used to their new normal and is so thankful for the community support and donations. "It's amazing in a small town how many people will come together for stuff that's not expected," Glitz told KOTA TV.

Her oldest, 10-year-old Ronnie, is pretty happy about a trio of siblings showing up suddenly.

"One time I seen a shooting star and I wished for a baby brother, and I wished for like two sisters for my little sister because she always wanted a little sister, I knew this day was always going to come," Ronnie told TV reporters.

Ronnie may not have been surprised, but everyone else in this story certainly was.

Congratulations to Danette and her family! You've got this, mama.

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Orange Is the New Black star Danielle Brooks is pregnant and frustrated. The actress took to Instagram this week to lament the lack of plus-sized options for pregnant people.

"It's so hard to find some clothes to wear today....Although I get to pregnant I still can't find no clothes. It's so hard to find some clothes when you're pregnant," she sings in a lighthearted yet serious video.

"It's so hard to find cute plus size maternity fashion while pregnant, but ima push through," she captioned the clip.

Brooks has been talking a lot this week about the issues people who wear plus size clothing face not just when trying to find clothes but in simply moving through a world that does not support them.

"I feel like the world has built these invisible bullets to bully us in telling us who we're supposed to be and what we're supposed to look like. And I've always had this desire to prove people wrong—to say that this body that I'm in is enough," she told SHAPE (she's on the new cover).

"Now that I'm about to be a mother, it means even more—to make sure that this human being I'm going to bring into the world knows that they are enough," she said.

Danielle Brooks is the body-positive hero we need right now. Now can someone make her some cute maternity clothes, please?

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Can pregnancy be contagious among friends? Science says yes, and so do some staff at a hospital in Maine where nine nurses from the Labor & Delivery Unit were all expecting at the same time, and now they are all mamas.

About 5 months ago, after one of the nurses posted a photo of 8 of the 9 mamas-to-be the sweet pic quickly went viral.

Soon local news stations picked up the story of the baby boom on the L&D unit at Maine Medical Center.



"It's really nice coming to work and seeing other people who are just as pregnant and watching their bellies pop and just talking about these experiences that we are going through together," one of the nurses, Amanda Spear, told WMTW.

"I feel like every other day we would come into work and it would be like, 'someone else is pregnant,'" Spear told NBC.

Another of the nurses, Erin Grenier, said that with every pregnancy announcement the staff got more and more excited for each other.

Nurse Brittney Verville couldn't believe the photo she posted to Facebook before resting up for the night shift got thousands of likes and shares. "When we woke up we're like, 'oh my gosh I think we're viral,'" she told NBC.

Now, the mamas are going viral again, as a picture of the babies is blowing up, even making it to CNN.

The youngest is 3 weeks old and the oldest is 3½ months. The mamas are already getting them together for playdates. The photographer who snapped the viral pic, Carly Murray, told CNN she hopes one say these kiddos understand how important the work their mamas do is.

Congrats to the nurse of the Maine Medical Center Labor and Delivery Unit! 🎉

[A version of this post was originally published March 26, 2019. It has been updated.]

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