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

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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They say there's no use in crying over it, but for pumping mamas, spilled milk is a major upset.

When you're working so hard to make sure your baby has breast milk, you don't want to lose a drop, and Chrissy Teigen knows this all too well.

The mom of two posted a video to social media Wednesday showing her efforts to rescue breastmilk from a tabletop. She used various utensils and a syringe to try to get the milk back in the bottle.

"I spilled my breastmilk and this is how important it is in this house," she says while suctioning up milk with what appears to be a baster.

In a follow-up video Teigen continues to try to rescue the spilled milk.

"We're trying," she says as she suctions up a drop or two. "I got some."

Teigen is currently breastfeeding baby Miles, her son with husband John Legend, and has been very public about the fact that she pumps a lot as a working mom.

She's also been open about the fact that milk supply has always been an issue for her, not just with Miles but with Luna, too.

"I actually loved [pumping] because I'm a collector of things, and so when I found out I could pump I [did it] so much because I knew the more you pumped, the more milk you'd make," she told POPSUGAR back in March. "So I loved collecting my breast milk and seeing how much I could get, even if it was very, very little."

Like a lot of moms, Teigen did struggle emotionally when a pump session wouldn't get her the ounces she wanted.

"I wasn't producing a lot of milk, and it was frustrating. When you're frustrated, [it can also make you] not produce that much."

Research backs her up. Stress has been linked to lower milk production. Because of that, she's trying to stay positive this time around, but captioned her video post "EVERY DROP COUNTS IN THIS HOUSE" because, well, they do.


So many mothers can relate. Have you ever tried to save your breastmilk?

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Former Bachelorette and mom of two Ali Fedotowsky is on a roll when it comes to starting conversations about why we mamas should love our bodies (and we love her for it).

Earlier this week Fedotowsky posted a series of photos showing her postpartum belly, loose skin and all. It was a vulnerable post, but a really valuable one in a world where images of celebrity postpartum bodies often don't reflect the ones we see in the mirror.

"I know it's important to be open and honest about my postpartum body in hopes that it helps even one person out there who is struggling with their own body image," Fedotowsky captioned the photos.

It seems like that post is helping, because, as Fedotowsky noted in her next Instagram post, her honest belly pics were met with an outpouring of love and support.

"I had no idea how many women needed to see that post," she wrote, noting that the reaction to those photos inspired her to write a blog post featuring her favorite breastfeeding-friendly clothing, because she's celebrating and loving her postpartum body for what it did and continues to do for her baby, not just what it looks like.

"Yes, I may have extra fat and loose skin around my belly, but that same body nourishes and comforts my child. Just another reason to love every inch of my body and how it has changed."

Fedotowsky gave birth in May, so she's only a couple months postpartum and it's not surprising that she's still carrying a little extra weight. Research indicates that about 20% of moms are carrying about 11 pounds extra 6 to 18 months after giving birth. And while weight loss is often cited as a reason for women to breastfeed, studies show that breastfeeding doesn't lead to substantial weight loss for everyone, and in fact only has a small effect on postpartum weight loss typically.

So moms like Fedotowsky should absolutely love the bodies that are feeding their babies, and we love how Fedotowsky is encouraging that.

Pregnancy changes our bodies. But they are still so beautiful.

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Nicole Hughes lost her 3-year-old son, Levi, on June 10, 2018. As she points out in an emotional essay she wrote for Scary Mommy, drowning is the leading cause of death in children ages 1 to 4 and the second leading cause in ages 1 to 14.

And it can happen in less than a minute. In the majority of child drownings, the child wasn't expected to be swimming at the time. That was the case for Hughes, who doesn't know what prompted Levi to venture outside to the pool, alone, as she was cleaning up after dinner. It happened so fast.

"I was the one who found him, face down, in the deep end. Just moments before this horrific discovery, I split a brownie with him. I still had the other half of the brownie in my mouth when I jumped into the pool to grab my son. Mere moments, seconds," Hughes writes.

Her pain is unimaginable, but in the days and weeks after Levi's death, Hughes began to ask a very important question: "Why did I not know that drowning is the leading cause of death?"

In every photo she has of Levi on that last day of the family's beach vacation he is wearing a lifejacket, and Hughes says the family took water safety very seriously. But she wonders how, as a mother on her third journey through parenting a preschooler, she had never heard that 69% of kids who drown were not meant to be swimming when they did?

"But why did I not know about the dangers of drowning during NON-SWIMMING times? How did I not know it took less than one minute?" she writes.

Now, Hughes is on a mission. She's created a non-profit called Levi's Legacy to ensure other parents know what she didn't: That a child can drown when we think they're inside eating a brownie, and that it happens so fast.

"I don't want this role of water-safety advocate. I want 30 seconds back on June 10. But I am determined to share these facts I so desperately wish I had known," she writes.

Hughes is asking the American Academy of Pediatrics to step up efforts to educate parents about drowning prevention, and feels that current resources on the AAP website fail to address the issue with the urgency it deserves.

Way back in the mid-90s the AAP noted that "although drowning is the second leading cause of death by unintentional injury in the pediatric population (aged 0 to 19 years), most pediatricians do not routinely provide information to their patients, or to their patients' parents, on drowning prevention," and suggested that if "the prevention of drowning is made a priority in pediatric practice, many more children's lives will be saved."

Hughes agrees, but says the AAP hasn't been doing enough.

So Hughes and other mothers are working to help spread the message they wish they had heard. Morgan Beck Miller, wife of Olympian Bode Miller, also lost a child to drowning recently. Her 19-month-old daughter, Emeline, drowned in a backyard pool the same day Hughes' son did.

On Instagram, Miller encouraged her followers to read Hughes' essay and learn more about drowning prevention. "It's been 37 days since I've held my baby girl. I pray to God no other parent feels this pain. My heart is with you @nicolehughes8 as we walk this journey together," she wrote.

"Drowning is the NUMBER ONE cause of death in children ages 1-4. We talk about vaccinations, car seats, organic foods, screen time, etc at length...but not the number one risk your children's' lives face...a silent killer. It takes SECONDS. Please share and help us spread awareness. It's the first step to preventing these types of tragedies."

Water safety tips:

  • Assign a supervisor: The Mayo Clinic recommends that when kids are using a pool, parents turns as the "designated watcher", so that one adult is always focused on the kids. Hughes' organization, Levi's Legacy, has created "water guardian" tags that adults can wear to show that they are the one watching responsible for pool supervision at that moment. The CDC says "supervisors of preschool children should provide 'touch supervision' be close enough to reach the child at all times."
  • Install barriers: Many pool drownings are the result of a child getting into a pool when they were not expected to be near it. That's why the CDC recommends "self-closing and self-latching gates that open outward with latches that are out of reach of children," and "additional barriers such as automatic door locks and alarms to prevent access or alert you if someone enters the pool area."
    • Fences that provide a complete barrier around all sides of a pool may prevent 7 out of 10 drownings of children under 5, notes Parachute, a charity dedicated to injury prevention.
    • If you're renting a beach house or booking an Airbnb with a pool, look for one with these features.
  • Keep toys away from the pool: The CDC suggests that as soon as pool time is over, parents put away any toys, floats or other fun objects that may be in or around the pool. Removing the toys removes an element of temptation for children.
  • Take swimming lessons: According to the AAP, "children over age one may be at a lower risk of drowning if they have had some formal swimming instruction. However, there is no evidence that swimming lessons or water survival skills courses can prevent drowning in babies younger than one year of age."
  • Take a CPR course: When seconds count, you want to be ready to do everything possible to save a child.

These two mothers have been through a loss that most parents cannot even fathom, and if they get their way, none of us will have to.

[Update: July 18, 2018: Added additional safety tips.]

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If you've ever experienced a surge of guilt after saying yes to your child's request for iPad time, you may find some comfort in mom of three Katherine Heigl's approach to screen time.

She recently told People her daughters, 6-year-old Adalaide and 9-year-old Naleigh are (like most kids) big fans of iPads, but Heigl isn't beating herself up over it.

"It's okay. It's not the end of civilization as we know it, I promise," she told People.

While Heigl admits that she may need to curtail the girls' tech use a bit, "so much of that use is reading," she explains. "They're reading, they're playing educational games. I don't allow them to scroll through YouTube videos and stuff; I put some limits on that."

Recently, Heigl was hanging out in her living room with her daughters, her husband Josh Kelley and her teen niece, Madison. Everybody had a digital device in their hand, and for a moment, Heigl felt that screen time guilt.

"And then I went, 'Oh, wait a minute — Naleigh and Madison are playing Words With Friends against each other, so essentially they're playing Scrabble, just without the board on the table. Adalaide is coloring on her iPad, Josh is reading the news and I'm reading a book," she said.

"We're all doing things that we would be doing to entertain ourselves, we're just doing them differently than we did them 20 years ago."

Screen time (both ours and the next generation's) gets such a bad rap in some parenting circles, but Heigl makes a very good point: Not all screen time is equal. Using a coloring app on the iPad isn't the same as zoning out in front of egg unwrapping YouTube videos, and reading a book on our phone is a different experience than scrolling (and scrolling and scrolling) through Instagram.

Matthew Johnson, the Director of Education for MediaSmarts, a not-for-profit charitable organization for digital and media literacy, previously told Motherly that while any screen time isn't really developmentally appropriate for toddlers, by the time kids are in elementary school, it's not so black and white, and parents should consider what kids are doing during screen time rather than just how much they get.

"Specifically, instead of counting hours you might consider a creative use of screens—doing an animation project or doing school research—as being counted differently than using it in a passive way."

It sounds like Heigl is finding the middle ground when it comes to her kids' screen time. She doesn't allow phones and iPads at the dinner table, or in her kids' rooms. "I don't allow them in the bedrooms, like, 'Charge them at night where I can see them,'" she says.

Thrive Global founder Arianna Huffington previously told Motherly that keeping phones out of the bedrooms and off the dinner table is an important part of teaching kids good "phone hygiene" and that, "Phones, like all technology, should augment our humanity, not consume it."

Heigl's family enjoys plenty of device-free outings together, so using a coloring app or letting the kids play Words with Friends isn't the end of the world in her world.

Sometimes, mama just wants a few minutes to sit and read her book (even if that book is on a phone), and allowing some limited iPad use allows her to do that.

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