When Elizabeth O'Brien Brown found out she was pregnant, she knew it would be expensive. So she chose a hospital in her insurance network and even declined a few recommended procedures, like tests in the first and third trimesters that detect abnormalities.

Her portion of the $36,000 bill still came to $7,500 before insurance took over. That didn't include her prenatal care, which required weekly ultrasounds and a fetal echo-cardiogram. It also didn't account for the surgery her son would need for a skin condition soon after his birth in December 2018.

All in all, she and her husband were charged about $12,300 in the first nine months of her son's life.

"On the billing side, you're getting hounded by calls, you're a new mom and you're a wreck ... and they just don’t care. It’s a business," said Brown, a New Orleans resident who worked in hotel sales at the time.

+2 Why do Louisiana workers pay more for family health insurance? Employers are to blame, study says Louisiana workers who get health insurance through their employers pay a larger share of their family health insurance costs than workers in a…

Across the country, women are getting sticker shock for the high cost of giving birth. Aside from the costs of child care, supplies and lost wages, the doctor and hospital bills alone can put a family in debt — even if they have insurance through an employer.

A study published in the journal Health Affairs this month found that the out-of-pocket medical costs of having a child have increased 50% since 2007. The study looked at more than 650,000 working women with employer health insurance across the country.

In the U.S., the average out-of-pocket cost for maternal care before, during and after pregnancy rose from $3,000 to $4,500 between 2007 and 2015, the most recent year for which data were available. That was three times the rate of inflation over that period.

“Most Americans don’t have that amount of money in reserve,” said Dr. Michelle Moniz, lead author of the study and an OB/GYN and assistant professor at the University of Michigan in Ann Arbor. “These are the kind of dollar amounts that put people into debt. That’s not how we want families starting out.”

In Louisiana, the average amount negotiated by insurance companies for a vaginal birth without complications is around $6,000, according to a 2019 analysis by Fair Health, an independent nonprofit that compiles health care data. The insured person pays a portion of that depending on their health insurance terms. Without insurance, women pay almost $11,000, the analysis showed.

Medicaid, the insurance program for low-income residents, reimburses hospitals an average of $9,213, according to the Louisiana Department of Health.

However, it can be nearly impossible to determine how much a pregnancy typically costs with insurance or how much a hospital might charge an uninsured person. In part, that's because births can be unpredictable.

“Often delivery doesn’t go exactly as planned,” said Lisa Christian, a psychologist who studies how stress affects health at Ohio State University’s Wexner Medical Center. “It’s not uncommon to have extended recovery or for their babies to have issues.”

Maternal and newborn care constitute the biggest categories of hospital payouts for most commercial insurers and state Medicaid programs. But there's little public data on how hospitals and insurance companies determine costs. Insurance companies do not publicly share the discounted rates they negotiate on behalf of patients. Hospitals don't often name a price.

Touro Infirmary, where more babies are born than any other hospital in New Orleans, was unable to provide an average cost for giving birth at that hospital or at West Jefferson Medical Center, the two facilities where parent company LCMC Health provides maternal services.

"Patients are encouraged to contact their insurance providers in advance of delivery to understand and plan for costs, knowing that the cost will ultimately be determined by the care provided in the hospital," LCMC spokeswoman Mary Beth Haskins said in a statement.

As health insurance costs rise, some Louisiana residents are turning to faith-based plans Dawn McNemar is one of many Louisiana residents who saw the cost of her health insurance soar over the past few years.

New moms say bills from hospitals are confounding.

Jessica Warner, of Lafayette, gave birth to her third child two months ago. The last-minute C-section cost her only about $50 out-of-pocket under a policy with a $990 monthly premium, but the bill noted costs totaling $49,000. Some of them didn't make sense to her.

"The belly band was around $600 for this piece of elastic," she said, referring to the postpartum recovery support band. The same product ranges from $17 to $40 on Amazon.

Her first birth, on the other hand, cost around $3,600 at a birth center, which she paid out of pocket. That included meeting with a midwife once per month in the early stages of pregnancy and once per week as she neared delivery.

Amy Shamburger self-paid for her hospital birth in Baton Rouge after she got pregnant too close to signing up for insurance in 2006 and the company declined her coverage. She got a 25% discount for paying the hospital and doctor around $7,300 upfront for the vaginal birth, which was without complications.

"I declined anything extra," said Shamburger, who had two subsequent home births with a licensed midwife, for about $3,500. "The epidural would have cost an extra $1,500."

And while a provision in the Affordable Care Act required employer-based insurance policies to provide maternity care, deductibles have crept up. That has meant that even women with insurance are paying more.

When New Orleans resident Sarah Stickney Murphy got pregnant in 2015, she crunched the numbers. First up: the actual cost of delivery, ringing in at $2,500 before insurance kicked in.

“That’s a low cost for a birth,” said Murphy, a professional fundraiser working in education. “I had a great insurance plan.”

But the costs continued to add up in the first year. She paid around $800 for a doula. Her premium increased by 800% after she added her new child. And because her employer did not provide paid parental leave, she lost about 19% of her salary to take a few months off work after giving birth.

Still, Murphy said she felt lucky. She said friends have told her they've paid up to $10,000 just for a hospital deductible after giving birth.

“I have a good job and I make a good wage, and I’m lucky my husband is a schoolteacher and was off three months for the summer after I had to go back to work,” said Murphy, who is now pregnant with her third child. “Even with all that, it cost a lot of money.”

For Brown, the costs remain a financial burden. She and her husband are still paying off bills from her son's birth and have barely begun to chip away at the surgery bill.

When someone she knows is thinking about having kids, she said, she warns them of the unforeseen costs.

"It consumes years of your life," said the 31-year-old. "People just don’t know."