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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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When you become a mama, your definition of a smooth morning undergoes a complete evolution. Now, you consider it a win if your real alarm wakes you up and you get to drink coffee while it's still warm. The not-so-smooth mornings? Well, let's face it, that's a rough way to start the day.

When the wake-up call comes early and the coffee has been forgotten in the microwave, it may seem absolutely impossible to carve out any time for yourself. But a centered, confident mama is a happier mama, and there are some simple ways to sneak self-care into your morning to ensure you're putting your best face forward.

Specializing in quick, easy and (we must say) beautiful morning makeup routines, Woosh Beauty understands busy mornings, and has created an 'everything-in-one' makeup palette that is our new secret weapon for feeling like we made the effort to center ourselves, too.

Inspired by Woosh Beauty, here are five ways we've given our morning beauty routines a self-care makeover.

1. Make time (and space) for calm

As moms, time is priceless and that's especially true in the morning. Even if you're racing against the clock, it's worth it (trust us) to hit the pause button for just five minutes before tackling all the to-dos on your list.

With The Fold Out Face from Woosh Beauty, you have all the makeup you need (coverage and color) in one compact, portable palette. That means no scrambling to find your concealer. No opening, closing, then reopening and closing eyeshadows and powders.

Most importantly, no need to set up shop in front of your vanity/bathroom mirror/designated makeup space while keeping one eye on a constantly moving child. The Fold Out Face goes wherever you go and gives you everything you need in the flip of one flap—so you really can focus on yourself.

2. Create rituals that boost confidence

Even if you're going on your third day with the same yoga pants (they're so comfy!), it's important to make time in the morning to do something that will put a confident pep in your step.

While makeup has likely been part of your routine for years, motherhood can take a toll on your skin in new ways—which is why having 13 full-sized cosmetics, made from luxurious high-performing mineral-based formulas, allows you to erase the appearance of under-eye circles, perfect any imperfections and give yourself an effortless glow—all in less than five minutes.

So even if you don't have time to meticulously apply makeup, you can look and feel like you did. 😉

3. Allow our minds to drift 

For most of us, mornings mean going from zero to 60 in about five seconds flat. Before fully immersing yourself in the obligations of the day, it's nice to have just a few minutes to allow your mind to drift away from the to-do list. Woosh Beauty makes having mindspace while checking off "put on makeup" possible by numbering the order in which the cosmetics in The Fold Out Face should be applied.

4. Savor little luxuries

Before you go spend the morning driving kids around to the tune of nursery rhymes and eat a lunch of PB&J crusts, it can make a world of difference to your outlook to lavish in something that is all yours.

We love that Woosh Beauty makes that simple with The Essential Brush Set, a luxe collection of double-ended brushes that are numbered to correspond with the steps in the Fold Out Face, and come in a soft storage bag to keep them away from kids who may mistake them as paint brushes.

5. Be kinder to ourselves

Sometimes, a healthy self-voice for the rest of the day starts with rituals that remind us we're doing good for our bodies, too. By using Woosh Beauty products in your morning beauty routine, which are free of parabens, sulfates, gluten and fragrance—not to mention they are animal cruelty-free—you aren't just applying makeup, you're applying products and using tools that you can feel good about.

In the morning, a seemingly little thing like taking a few minutes for self-care is really a big thing that will continue to pay off with a beautiful outlook throughout the day—and with The Fold-Out Face from Woosh Beauty, it pays off with a beautiful look throughout the day, too.

Motherly readers can receive a 20% discount site wide using the code MOTHERLY at checkout.


This article was sponsored by Woosh Beauty. Thank you for supporting the brands that support Motherly and mamas.

As if new mamas don't have a steep enough learning curve already, one event takes most of us off-guard: that first postpartum period. After what was probably a hiatus of a year or longer, the return of your menstrual cycle isn't just back to business as usual. In most cases, it's initially less predictable and stronger than when Aunt Flo used to come calling.

The good news? By preparing yourself for what is to come, they don't have to be so intimidating — especially if you also stock your drawer with THINX underwear, made specifically to absorb menstrual flow. Every pair of THINX undies is created with their signature 4-layer technology that is super-absorbent, moisture-wicking, odor-fighting, and leak-resistant. Translation? You never have to worry about leaks or stains, even when your period is a surprise.

Here's the DL on those first postpartum periods:

1. When your period will return varies from woman to woman

The biggest factor that affects your period's return is whether or not you are breastfeeding. "If a woman is not breastfeeding, then the first menses usually returns at six weeks postpartum to three months postpartum," says Elizabeth Sauter, MD, Fellow of The American Congress of Obstetricians and Gynecologists.

Among exclusively breastfeeding mamas, Sauter says it can be harder to predict when menstruation will return in full force: It's rare for your period to return until at least six months postpartum (at which point you've probably introduced some solid food to baby's diet), but it may not return at all until you are done breastfeeding a year or more postpartum.

Before you get back to it, whenever that is, it can help to add some new undies from THINX, to your dresser drawer. We especially love the chic and practical Hi-Waist undies for postpartum—or any—bodies.

2. Your first postpartum period will probably be heavier than ever

Whenever your period does return, it will likely be in full force as it's not only the shedding of your uterine lining, but also the shedding of any clots or blood from the delivery process. (And you thought you got past that during the initial round of postpartum bleeding!)

While this can be a less-than-pleasant experience, Sauter says that many women eventually enjoy less painful and intense periods as they get farther away from baby's birth.

Because you are probably already getting up enough during the night, waking up to change a pad or tampon probably isn't high on your list of things you want to do. We love (like, love) that the most absorbent THINX undies can hold up to two tampons' worth of blood.

3. Your menstrual cycle may not be as easy to track

Again, whether or not you are exclusively breastfeeding has an impact on how reliable your period will likely be for the first year or so. As Sauter explains, mothers who had regular periods before pregnancy and do no breastfeed often fall back into that rhythm within a few months of baby's arrival.

For breastfeeding mamas, even once your period returns, it may not come back in exactly 28 days (or whatever frequency you were used to). However, for some women, this is a silver-lining.

"Many mothers who had irregular menses prepregnancy in fact start more regular menses postpartum," says Sauter, adding the disclaimer this isn't always the case, especially for women with polycystic ovarian syndrome.


Like everything motherhood, soon enough you will be right in the normal routine of life with a period again — only now, with period-proof underwear by THINX, you'll find it's easier than ever to take on your period with confidence.

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

2018 will go down in history as the year that gave us a royal wedding, a second Chrissy Teiegn cookbook and saw Serena Williams prove that new mamas can do anything. It's also the year that a bunch of adorable celebrity babies came into the world.

Here's to all the celebrity babies born this year!

Elizabeth Smart and Matthew Gilmour welcomed baby Olivia

Back in June author and activist Elizabeth Smart announced she and husband Matthew Gilmour were expecting their third child, and in November baby Olivia arrived.

She was born in hospital and Smart shared a sweet post-birth selfie with her Instagram followers.

"So happy to welcome Olivia to our family!" she wrote.

We are so happy for her.

Jessica Chastain and Gian Luca Passi de Preposulo welcomed a baby girl

After actress Jessica Chastain was spotted out in October carrying a baby in a car seat, media outlets began to speculate about whether she and husband Gian Luca Passi de Preposulo had become parents, and it turns out the rumors are true. On November 19, E! News reported Chastain's daughter was born in the spring, via surrogate.

Chastain has not spoken publicly about her daughter or posted any baby photos on her Instagram, which is absolutely her choice. If she ever does decide to talk about the early days of her daughter's life, we will be all ears!

Until then, congratulations to Jessica and Gian!

Kate Upton and Justin Verlander welcomed daughter Genevieve

What a sweet little face! On November 10 Kate Upton and Justin Verlander introduced the world to their daughter, Genevieve Upton Verlander who was born on November 7.

On his Instagram account proud dad Verlander added notes "You stole my ❤️ the first second I met you!!!"

Looks like Genevieve's parents are very much in love with their baby girl.

Gabrielle Union and Dwyane Wade welcomed (a surprising) baby girl 

Gabrielle Union and Dwayne Wade shocked the world in November by announcing the birth of the daughter fans didn't know they were expecting!

"We are sleepless and delirious but so excited to share that our miracle baby arrived last night via surrogate and 11/7 will forever be etched in our hearts as the most loveliest of all the lovely days. Welcome to the party sweet girl!" Union, who has previously written about her struggles with infertility, wrote on Instagram.

Diane Kruger and Norman Reedus welcomed their first baby together

Diana Kruger and her partner, Walking Dead star Norman Reedus, are the latest celebrity parents to welcome a new baby, but unlike a lot of celebrity couples they did not do an Instagram baby announcement.

The family is keeping things low key, but People reports it has confirmed the baby's arrival.

Whether or not a family chooses to publicize their child's image and name is totally up to the parents, whether they are famous or not. Kruger and Reedus may choose to keep their baby out of the spotlight and that's totally cool. Big announcements aren't for everyone.

 Hilary Duff and Matthew Koma welcomed daughter Banks Violet Bair

Hilary Duff shared some big news in October, dropping an adorable birth announcement on Instagram and letting the world know that she had a home birth for daughter Banks Violet Bair. What a unique name!

Pippa Middleton and James Matthews welcomed a baby boy 

Little Prince Louis now has a close cousin! The Duchess of Cambridge's sister, Pippa Middleton, and her husband James Matthews welcomed a baby boy on October 16, one day after her sister's sister-in-law, Meghan Markle, announced her pregnancy.

Kate Hudson and Danny Fujikawa welcomed baby Rani Rose 

Kate Hudson is now a #girlmom.

The actress (who is also mom to sons, 7-year-old son Bingham and 14-year-old son Ryder) and her partner Danny Fujikawa announced the birth of their daughter one day after she was born on October 2. The birth announcement came via a series of Instagram slides, captioned with simply, "She's here".

"We have decided to name our daughter Rani (pronounced Ronnie) after her grandfather, Ron Fujikawa. Ron was the most special man who we all miss dearly. To name her after him is an honor," Hudson wrote.

"Everyone is doing well and happy as can be. Our family thanks you for all the love and blessings that have been sent our way and we send ours right back."

Jillian Harris and Justin Pasutto welcome baby Annie 

On October 1 Jillian Harris and Justin Pasutto announced they just welcomed their second child (and first girl), baby Annie. According to the Instagram post introducing Annie, Harris and Pasutto were enjoying a date night when Annie started making her entrance into the world, interrupting mom and dad's round of golf.

 Kim Kardashian +  Kanye West welcomed Chicago Noel West

Celebrity power couple Kim Kardashian and Kanye West welcomed their third child, baby Chicago via a gestational surrogate on January 15, 2018. Chicago came into the world weighing 7 pounds, 6 ounces and was instantly loved by the whole Kardashian family, including her siblings, North and Saint.

"We're so in love," Kardashian said in a statement released shortly after Chicago's birth.

"We are incredibly grateful to our surrogate who made our dreams come true with the greatest gift one could give," the proud mama explained.

[Updated: November 20, 2018.]

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It's a scene many moms are familiar with: Baby's pacifier drops to the floor so you take it to the sink, wipe it on your pants, or even pop it in your own mouth before giving it back to baby.

Perhaps that last option grosses you out, but cleaning a baby's pacifier with your own saliva may not be such a bad idea. According to a new study, the bacteria in a mother's mouth may actually help prevent allergies in young children.

New U.S. research being presented at the American College of Allergy, Asthma and Immunology (ACAAI), suggests that children of mothers who suck on their pacifiers to clean them have lower allergic responses than children whose mothers clean the soothers either by sterilization or hand washing.

Popping your child's dropped pacifier in your own mouth doesn't really clean it, but it can expose your child to whatever's in your mouth, and research suggests that exposure can strengthen immune systems.

"We found the children of mothers who sucked on the pacifier had lower IgE [immunoglubin E] levels," says Dr. Eliane Abou-Jaoude, the study's lead author and a fellow at the Henry Ford Health System in Detroit.

The body produces the antibody, IgE, when the immune system overreacts to an allergen, which can then cause an allergic reaction. Higher IgE levels indicate a higher risk of having allergies and asthma, according to Abou-Jaoude.

The researchers interviewed 128 mothers of infants over the course of 18 months for the study. Of the 128 mothers participating in the research, 58% reported that their child currently used a pacifier. Within that group, 4% of respondents reported cleaning their child's pacifier by sterilizing it, while 72% said they hand washed it, and 12% reported they sucked on it.

Only nine babies in the study had mothers who reported they sucked their children's binkies clean. But compared with the other children, those nine showed significantly lower levels of IgE, starting at around 10 months old. No fathers were included in the research.

The study has yet to be peer-reviewed and officially published, and its small sample size and short length of 18 months make it difficult to draw too many conclusions about long-term health outcomes, the researchers note. Other factors in addition to mom's saliva could have developed the children's immune systems.

"What's very, very important to realize is that this was not a cause and effect study, Abo-Jaoude tells CNN, noting that more research is needed to examine the possible correlation. "This is not telling you, if you suck on your child's pacifier, they will not develop allergies."

Still, the study does suggest few risks to cleaning a baby's pacifier with your own mouth, and the findings contribute to a growing body of research that indicates early exposure of microbes in babies may prevent allergies in children.

"The idea is that the microbes you're exposed to in infancy can affect your immune system's development later in life," Abou-Jaoude says.

A 2014 study conducted by scientists at the John Hopkins Children's Center showed a link between early exposure to bacteria and a lower likelihood of developing allergies and asthma. Infants in the study who were exposed to pet and rodent dander, as well as a wide variety of household bacteria, in the first year of life appeared less likely to suffer from allergies, wheezing and asthma.

The study also found the earlier the exposure the better — children who encountered such substances before their first birthday seemed to benefit rather than suffer from that exposure, while the same benefits were not seen if the child's first encounter with these substances occurred after age one.

The study, published in the Journal of Allergy and Clinical Immunology, suggests that early exposure to bacteria and certain allergens may have a protective effect by shaping children's immune systems — findings that are consistent with the so-called hygiene hypothesis, which states that children who grow up in very sterile environments may develop hypersensitive immune systems that make them prone to allergies.

Additional 2017 research from an Urban Environment and Childhood Asthma (URECA) study showed a lower risk of asthma at age seven for children in homes with higher levels of cat, mouse and cockroach allergens in the first three years of life. Previous research has also shown that children who grow up on farms, and thus have regular exposure to the microorganisms present in farm soil, also have lower allergy and asthma rates.

Despite the body of research, no one can say for certain whether pet dander or sucking on binkies will ensure your child an asthma and allergy-free future, but early exposure to household bacteria may help more than hurt.

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When Gabrielle Union surprised the world with a birth announcement this month after a long struggle with infertility, we were thrilled.

In an Instagram post announcing the birth of her child, Union shared how she and her husband Dwyane Wade welcomed their new baby girl thanks to a surrogate, but there was one detail missing: The baby girl's name!

This week, proud dad Wade (who is currently on paternity leave from the NBA) showed off his baby girl's name, as it is tattooed on his shoulders.

Kaavia James Union Wade is clearly very loved, and we love the story behind her unique name.

When a fan asked Union about the name on Instagram she explained how her daughter's middle name, James, is a family throwback.

"We wanted my family represented in her name," Union wrote. "My godfather is my uncle James Glass. She is named after him.. and then Union...thats... ya know...me."

The origins and meaning of the name Kaavia aren't clear, but a user suggestion on Names.org indicates the name may be Sanskrit in origin and could mean "work of art."

We don't know how accurate that name meaning is, but we do know that Kaavia is going to grow up with lots of love, and her traditionally male middle name is a good fit in a house full of boys. This little girl has four big brothers—Wade's sons 4-year-old Xavier, 11-year-old Zion, 16-year-old Zaire as well as Wade's 17-year-old nephew Dahveon, who has lived with Wade and Union for years.

Little Kaavia has a lot of people who love her, and we just love her name.

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Just weeks after announcing her pregnancy and letting the world know that's she's determined to keep working while she's expecting, Amy Schumer dropped some bad news Thursday.

She posted a photo of herself in a hospital bed with her little dog Tati, and spelled out the details of her health issues in the caption. "I have hyperemesis and it blows," Schumer wrote, noting that she's had to cancel upcoming shows in Texas due to the condition.

Poor Amy. Hyperemesis gravidarum (also known as HG) is a rare but serious pregnancy complication, and it's really tough.

Kate Middleton, Ayesha Curry and Motherly co-founder Elizabeth Tenety are among those who, like Schumer, have suffered from this form of severe morning sickness that can be totally debilitating.

As she previously wrote for Motherly, Tenety remembers becoming desperately ill, being confined to her apartment (mostly her bed) and never being far from a trash can, "I lost 10% of my body weight. I became severely dehydrated. I couldn't work. I couldn't even get out of bed. I could barely talk on the phone to tell my doctor how sick I was—begging them to please give me something, anything—to help."

Thankfully, she found relief through a prescription for Zofran, an anti-nausea drug.


It looks like Schumer is getting the medical help she obviously needs. In her Instagram post she wrote, "the doctors and nurses taking great care of me and Tati."

She seems to be getting IV fluids (she's probably super dehydrated) and hopefully her team can find a way to get her some relief with Zofran or another form of therapy.

Schumer says she feels very lucky to be pregnant, but HG can make a mama feel downright unlucky. As Schumer notes in her post, most mamas feel better in their second trimester, but HG can make it feel even worse than the first. "I've been even more ill this trimester," she says.

We're glad to see Schumer is getting help, and totally understand why she would have to cancel her shows. Any mama who has been through HG will tell you, that wouldn't be a show you'd want front row seats for anyway.

Get well soon, Amy!

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