• Costs for complicated births range from $20,000 to $400,000 per baby, compared to about $6,400 for a "normal" uncomplicated delivery (Laman and King, 1994).
• Some complicated pregnancies require that the newborn be delivered by cesarean section. Cesarean delivery costs an average of $11,450 in comparison to $7,090 for an uncomplicated vaginal delivery (Mushinski, 1998).
• Among the 20 states with at least 150 uncomplicated cesarean births (83% of total births), average total charges ranged from $14,470 in New York to lows of $8,820 in Ohio and $8,870 in Tennessee in 1996. Total charges differed by as much as 64% among the study states (Mushinski, 1998).
• Vaginal births after a previous cesarean (VBAC) in the United States costs an average of $7,730 (Mushinski, 1998).

An overview of costs for two leading contributors to infant mortality and morbidity (birth defects and prematurity/low birthweight) in the United States are described below:


Birth Defects

• Birth defects can result in high costs in human suffering, medical costs, non-medical costs for special education, rehabilitation, and other services.
• The estimated lifetime costs for 18 of the most clinically significant birth defects in the United States were $8 billion in 1992 (Waitzman et al., 1994).
• The lifetime costs of specific birth defects ranged from $75,000 to $503,000 per new case. Conditions with the highest costs per case include those with h9igh levels of long-term activity limitations: cerebral palsy ($503,000), Down syndrome ($451,000), and spina bifida ($294,000).

Low Birthweight/Prematurity

• Babies born too small can require increased hospital and provider resource, including time in a neonatal intensive care unit (NICU) at a cost ranging from $1,000 to $2,500 per day (Krebs, 1993). A severely ill newborn may spend several weeks or months in a NICU depending on the complexity of the health problem.
• The median treatment cost of delivery for very low birthweight infants (<1500 grams) is almost $50,000, ranging from $32,000 for infants weighing 1251-1500 grams to almost $90,000 for infants 501-750 grams. This is more than $1,000 per day, with a median length of stay of 49 days (Rogowski, 1999).
• Low birthweight accounts for 10 percent of all health care costs for children (Lewitt et al., 1995).
• Health care, education, and child care for the 3.5 to 4 million infants and children from birth to 15 years born low birthweight cost between $5.5 and $6 billion more than they would have if those children had been born at a normal birthweight.

References

• Krebs G. Maternity medical case management: a study of employer attitudes. Presentation before the National Managed Health Care Congress; Dec. 9, 1993.
• Laman J, King M. Promoting health babies. NCSL Legisbrief, National Conference of State Legislators; Feb. 1994.
• Lewitt EM, Baker LS, Corman H, Shiono PH. The direct cost of low birthweight. In: The Future of Children. Vol. 5, no. 1. Los Altos, CA: The David and Lucile Packard Foundation, 1995; 35-56.
• Mushinski M. Average charges for uncomplicated vaginal, cesarean, and VBAC deliveries: Regional variations, United States, 1996. Statistical Bulletin, MetLife, (July-Septmeber 1998).
• Nicholson WK, Frick KD, Powe NR. Economic burden of hospitalizations for preterm labor in the United States. Obstetrics and Gynecology 2000; 96: 95-101.
• Rogowski J. Measuring the cost of neonatal and perinatal care. Pediatrics 1999; 103 (1 Suppl E): 329-35.
• Waitzman NJ, Romano PS, Scheffler RM. Estimates of the economic costs of birth defects. Inquire 1994; 31:188-203.