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Do you have to pay to hold your baby after birth in America?

Quick Answer

In most hospitals in America, holding your newborn baby skin-to-skin immediately after birth is free of charge and highly encouraged as part of the birthing process. However, some hospitals have incorrectly charged separate fees for this crucial bonding time, sparking outrage and prompting policy changes. While skin-to-skin contact after birth should always be free, standard newborn care and other services may be itemized on your delivery bill.

What is skin-to-skin contact?

Skin-to-skin contact, also called kangaroo care, refers to placing your naked newborn baby directly onto your bare chest immediately after delivery. This initiates crucial maternal bonding, helps the baby adapt to life outside the womb, and supports breastfeeding. Doctors overwhelmingly recommend skin-to-skin contact for at least the first hour after birth, barring any medical complications. This intimate time allows the mother and baby to bond through touch, smell, sound, and eye contact. Skin-to-skin contact helps regulate the newborn’s temperature, breathing, and blood sugar levels while soothing crying. It also stimulates breastfeeding by releasing oxytocin, a hormone that promotes milk production. Kangaroo care is especially important for premature or low birth weight babies.

Why did some hospitals charge for it?

While most hospitals provide one hour of skin-to-skin contact standard at no extra charge, a handful made headlines for charging fees ranging from $25 to $50 on delivery bills. Some branded it as “skin to skin after Cesarean” as an additional charge beyond the C-section procedure. Others listed it obscurely as “newborn assessment” or “newborn evaluation.”

After public criticism, many eliminated this fee from bills andabsorbed skin-to-skin contact as part of routine postpartum care. But the practice raised larger questions about transparency in medical billing. Like most health services, deliveries are coded with billing modifiers that assign prices to every step of care. Holding a new baby may be billed separately from nursing assistance or recovery room time.

Itemizing something as natural as holding a baby outraged many patients. But hospitals argued that integrating skin-to-skin into global billing rates meant cross-subsidizing across services, since state Medicaid programs reimburse deliveries at a flat rate.

Is skin-to-skin contact ever not free?

Most hospitals now guarantee at least one hour of uninterrupted kangaroo care immediately after birth as part of their standard care, no charge. However, extended skin-to-skin contact beyond the initial period may incur charges for continued use of the delivery room or nursing assistance. Some hospital policies include two hours of free skin-to-skin time.

Premature babies requiring neonatal intensive care may also be billed for ongoing kangaroo care during their hospital stays, as nurse monitoring is required. But in general, healthy full-term babies can enjoy unlimited skin-to-skin time with mom during the standard postpartum recovery period without added fees.

What about other newborn procedures and tests?

While skin-to-skin time is free, other newborn procedures performed after birth may appear as line items on your delivery bill:

  • Apgar score assessment – this quick test checks baby’s heart rate, breathing, skin color, muscle tone, and reflexes at 1 minute and 5 minutes after birth.
  • Footprints – hospitals often provide keepsake footprints.
  • Vitamin K shot – this injection provides important clotting factors until baby’s natural levels rise.
  • Erythromycin eye ointment – administered to protect newborns’ eyes against infection.
  • Newborn blood screening – screens for genetic, hormone, and metabolic disorders.
  • Hearing test – screens for hearing impairment.
  • Circumcision – an elective procedure to remove foreskin, typically performed after 24 hours if requested.

Your insurance may cover some or all of these standard procedures. Families can opt out of certain tests for personal reasons, but may then be billed directly. Know your delivery hospital’s exact policies on newborn care costs and insurance coverage to avoid surprise charges.

What other typical delivery and nursery costs may I see?

In addition to the delivery itself and newborn procedures, other hospital services reflected on your bill may include:

  • Labor room or surgical suite occupancy fees.
  • Medications, IV fluids, and anesthesia during labor and delivery.
  • Recovery room stay.
  • Operating room, equipment, and supply charges.
  • Fetal monitoring during labor.
  • Lactation consultant visit.
  • Nursery room occupancy and newborn care fees.
  • Circumcision.
  • Pediatrician exam.
  • Take home supplies like bassinet, swaddles, ice packs, peri bottle.

Talk to your hospital about any included amenities and what services are billed separately. Request an itemized bill and ask about discount programs or financial assistance if needed.

How are delivery and newborn charges billed?

Charges for mom’s and baby’s care may be billed together or separately:

  • Global billing: All prenatal, delivery, and postpartum care combined into one bill for mom.
  • Unbundled billing: Separate charges for prenatal visits, hospital delivery, and post-birth care.
  • Newborn billing: Nursery care, procedures, pediatrician costs billed separately under baby’s name.

Delivery methods also impact billing complexity. Vaginal birth invoices are typically simpler, while C-sections involve surgery, anesthesia, and more recovery factors. Give your insurer a head’s up on your upcoming delivery to understand coverage and cost sharing. Thoroughly review medical bills and insurance statements for errors or double charges.

Sample delivery cost breakdown

While amounts vary widely, here is an example cost estimate for an uncomplicated vaginal delivery:

Service Typical cost
Routine prenatal care $2,000
Hospital delivery charges $5,000 – $11,000
Anesthesia $1,000 – $1,500
Postpartum hospital stay $1,000 – $3,000 per day
Nursery care $1,000 – $2,000
Total (prenatal + delivery + postnatal) $10,000 – $20,000

Actual charges depend on location, hospital, insurance coverage, and any complications. Out-of-pocket costs for insured mothers average $3,000-$5,000, but may reach $10,000 or more. Uninsured mothers can expect dramatically higher bills approaching $30,000. C-section deliveries typically double the final costs.

How can I lower my delivery costs?

To reduce delivery and newborn expenses:

  • Review insurance coverage and shop birthing centers in your network.
  • Ask about cash discounts for prepayment or prompt payment.
  • Inquire about income-based financial assistance programs.
  • Consider a midwife delivery in a birth center instead of a hospital if low-risk.
  • Decline optional newborn procedures like circumcision if not needed.
  • Request an itemized bill and challenge any incorrect charges.

Maximizing insurance benefits and negotiating with hospitals can help lower your own payment portion. Above all, prioritize a safe, healthy birth experience over costs when choosing a delivery provider.


While skin-to-skin bonding time is now considered a standard component of postpartum care, new parents may still get sticker shock from other itemized delivery and nursery charges. With rising maternity costs, it is essential to understand what is covered by insurance versus individual responsibility. Do not hesitate to thoroughly examine each charge and verify billing accuracy before paying. Most importantly, all mothers should feel empowered to enjoy critical moments with their newborns without added fees.