Originally published in the Journal Inquirer June 18, 2013
by Kristen J. Tsetsi
Birth rates in the United States may be falling — 2012, Pew research says, saw a 1 percent decrease from 2011, a year when Americans had fewer babies than in any of the previous years — but the cost of having them certainly isn’t.
A patient bill issued by Blue Cross Blue Shield to a woman who gave birth at Hartford Hospital in June 1955 shows a charge of $163.30. Itemized charges were five days in the hospital at $17 per day, a $30 delivery room charge, $15 for anesthesia, $6.80 in laboratory fees, $4 for a service labeled “Rt. Spec Serv,” and $22.50 for the nursery. In today’s dollars, that would be $1,416.88, according to a Bureau of Labor Statistics formula.
The bill for a standard delivery today at Hartford Hospital comprises two major charges: the mother ($9,498) and the child ($2,802). Itemized charges include anesthesia, $144.35 (billed separately); labor and delivery, $1,728; ultrasound, $360; pharmacy, $12.20; medical supplies, $13.26; and obstetric accommodations, $1,842.
The bill’s itemized breakdown is somewhat different now from what it was in the 1950s. But then, so is the hospital delivery experience.
When a woman of the 1950s admitted herself to a hospital to have a baby, she was brought to a triage area for women in the early stages of labor, says Adam Borgida, chief of maternal fetal medicine at Hartford Hospital. There, women would occupy beds that were placed side by side and separated only by a curtain.
While monitoring the mother, Borgida says, “the nurse would listen for the baby’s heart rate with special stethoscope that attaches to the forehead so she could put her head right on the mother’s belly to listen for the heartbeat.”
When the mother was ready to deliver she would be moved to a sterile operating room where a bed outfitted with stirrups awaited her. There was no electronic monitoring of the mother, and no routine antibiotics were used, but in the room were a basin of iodine and a tray of instruments that included suturing implements and forceps.
Forceps, Borgida says, were used — and episiotomies were given — in about 75 percent of births at the time because mothers, drugged into a state called “twilight sleep,” weren’t usually able to push the baby out themselves.
“Twilight sleep” was routinely practiced on all women delivering in a hospital in order to “obtain amnesia during labour,” as explained in a 1916 article published in the Canadian Medical Association Journal. To induce twilight sleep the doctor, sometimes even without the patient’s consent, would inject into the mother a combination of morphine and scopolamine to render her semi-conscious throughout the delivery and leave her with little to no memory of the event.
Once the baby was delivered, there was no special equipment to keep it warm aside from, perhaps, a heat lamp, Borgida says. The doctor or nurses would warm it up a little bit and resuscitate it, and then walk out to the waiting room to tell the father, who was not allowed in the delivery room, whether it was a boy or a girl.
Things have changed quite a bit since the era of the twilight sleep delivery method, says Elisabeth Deckers, medical director of labor and delivery at Hartford Hospital.
“The patient has considerably more say in her care and what’s going on. Most of our patients actually come to labor and delivery armed with a birth plan, in which they’ve outlined how they want their care to proceed,” she says.
They are also the beneficiaries of significantly better technology and personal comfort. Women delivering in Hartford Hospital today are taken immediately to a private room where they both labor and deliver. The room includes a bed that can be modified for delivery, external fetal monitoring capabilities, monitoring for the mother that includes blood pressure, pulse, oxygen, and saturation, an IV pole should there be a need to administer medications, and an infant warmer.
“A lot of the electronic stuff, gas and stuff, is hidden in drawers,” Borgida says. It makes the room more comfortable, less clinical.
Even considering the technology now used to ensure the comfort and safety of mother and child throughout the delivery process, which includes two monitoring belts the mother wears (one for herself and one for the child), the estimated charge of $12,300 may still seem high when compared to the $163.60 bill just under 60 years ago.
It should be noted, however, that what a person is billed isn’t necessarily indicative of the actual cost. In the case of the 1955 hospital bill, for example, insurance covered $100 of the total costs, leaving the patient responsible for just $63.30. And insurance continues to cover a significant portion of today’s billed charges.
Depending on how the bill is being paid, the final cost to the patient can vary widely. An uninsured patient not living in poverty will receive a 44 percent self-pay discount at Hartford Hospital; uninsured, low-income patients can receive additional “charity discounts” covering up to 100 percent of the bill; and for those who are insured, their individual insurance companies make their own agreements with hospitals concerning how much and what they’ll pay, explains Hartford Healthcare Chief Financial Officer Tom Marchozzi.
“If I give you a bill that showed charges, it would be completely distorted from what ends up being paid,” he says, adding, “This is the industry, this isn’t Hartford Hospital.”
Carolina Herrera, director of research at the Health Care Cost Institute, says that while medical inflation is rising faster than regular inflation — pre-insurance, pre-discount “list prices” for labor and delivery fees rose by 7.3 percent from 2009 to 2010, she says — several factors in addition to the availability of advanced equipment and medical care (and private room perks such as television and WiFi) could be contributing to the higher costs.
“When comparing to the past,” she says, “you have to think, ‘What has changed? What are mortality rates?’”
In 1935, she says, 55.7 per 1000 babies died. Now the rate is 6.8 per 1000.
“I think that’s part of it,” she says. “We’re keeping babies in the hospital and we’re keeping them alive.”