Hidden Costs of Pregnancy for Women

All you read about are the joys of pregnancy - creation of a new life, that pregnancy glow, maternal bond with the baby, blah, blah, blah,. I don't want to be the downer, but I have yet to read anything that talks honestly about the financial issues women, specifically, will face due to pregnancy and childbirth. Much is written about how much you need to spend to outfit a baby and figures about how much it costs to raise a child from infancy through college, but nothing about what I call the woman's hidden costs of pregnancy - those costs that make pregnancy expensive in the unglamorous ways you had never thought about until you're actually living it.

I think about the women I know and their diverse situations - high-paying jobs, low-paying jobs, kids, no kids, thinking about kids, married, in a relationship, living with a partner or not. Some of them talk openly with me about money, not necessarily as it pertains to kids, because so few of my friends have kids yet, but about general budgeting and saving and about how they approach sharing household expenses with a partner. Most split directly down the middle, as Chris and I do, while one couple I know does a give and take - he pays the electric bill, she pays the Internet, he pays for groceries when he goes to store, and she the next time. Another couple calculated that of their combined income, he makes 60%, and she makes 40%, so that's how they split each one's share of the mortgage and other bills. But how will the couples in my social circle handle a circumstance that financially burdens one person more than the other, but is really the financial responsibility of both?

Actually being pregnant has allowed me to see how women can be impacted financially by pregnancy, in small and big ways. If you're married or in a committed relationship, having a baby sparks a new set of budgeting discussions, but the increased costs of pregnancy, and then beyond, (daycare, increased household expenses, schooling, etc.) become absorbed into the family expenditures. For women who are on their own, or are in relationships where finances have remained relatively separate, the hidden costs might be more of a burden.

1. New Wardrobe

If you've noticed patterns in my dress the past few months, it's true, I wear the same few outfits over and over again. The Bella Band gave me a few extra weeks in my pre-pregnancy pants and I was able to wear a few shirts and t-shirts with looser cuts for awhile after I started showing. But by the third trimester, the only pre-pregnancy clothes that still fit are my socks, my soccer shorts (worn so low I look ridiculous) and one skirt that has an elastic band and might have been a tad loose on my anyway when I was at my lowest weight. Everything else has been purchased since then and my old clothes are literally collecting dust and probably going out of style (that is, if I were ever in style to begin with). So I've bought as few clothes as I can get away with in an attempt to save money. And I've gotten away with fewer purchases because most of my growing has taken place during the warmer months, including September, which has been unseasonably warm for Minnesota. But although I've survived on a minimal wardrobe for now, fall will eventually be here and I'm facing having to buy yet another set of clothes to get me through the last few weeks of pregnancy and the first few weeks post partum (where, sorry, I've been informed, I'll still be wearing maternity clothes).

If I weren't pregnant, I wouldn't have gone nine months without buying any new clothes, but it is expensive (and time consuming and overwhelming) to need to replace an entire wardrobe in such a short time span. Imagine, too, if your professional requires formal attire, like a suit. My running shoes would have needed replacing by this point anyway, pregnancy-related feet woes or not, but by the third "upgrade" in intimate apparel, I was swiping the joint debit card at the register, not the one on my personal account.

2. Lost time at work/lost wages

For those who have jobs that aren't salaried, lack adequate paid time off or don't have flexible work hours, attending doctor's appointments or missing work because you're feeling ill or are experiencing complications during your pregnancy can add up to lost wages. It will depend upon what you do for work, whether you need to expend a lot of energy, be on your feet a lot or just be creative - all difficult even with mild nausea. Even if you have a desk job, the healthiest of pregnancies still require monthly and then bi-monthly doctor's appointments. Unlike the dentist, which you can schedule six months out and snag an early-morning appointment and still be to work reasonably on time, most obstetrician's offices I've encountered schedule appointments between 8 a.m. and 4 p.m., and you have little leeway to postpone an appointment by any more than a week or so to accommodate your work schedule. If you don't get paid for the hours you're not at work, or can't make up the hours, your income goes down. The writer of the memoir, Rattled! relied on freelance work to supplement her low editor's salary, but the ability to put in the extra hours was threatened by pregnancy fatigue. Her checking account dipped dangerously low as she scraped by in New York City, while her ex-boyfriend continued to live a life she could no longer afford of nights out with friends, expensive clothes and splurge purchases.


3. Health care costs

Because of all the attention paid to rising out-of-pocket costs for healthcare and the growing prevalence of high-deductible plans, I was surprised and relieved to learn that pregnancy is 100% covered (and not subject to the deductible) on my plan, just as preventative care like your annual physical is. I have never paid a co-pay at an office visit or received a bill in the mail for my prenatal care. But I've also experienced no complications. The routine care is covered, even the first and second trimester screenings, which are optional, but had I gone on medication for high blood pressure, or needed extra care related to gestational diabetes, (examples of common conditions that can pop up in pregnancy) my understanding is that I would have been responsible for some of these costs according to the terms of my health plan. Therefore, I'm waiting to see how much they charge me for those lovely wrists splints I was given (which aren't working by the way).

Then months into my pregnancy, I learned that pregnancy is covered, but that labor and delivery are considered separate from "pregnancy" and that this along with your hospital stay, are treated by your insurance company as would costs incurred if you visited your doctor for an illness, or went to the emergency room for a broken leg. Where I had previously misunderstood that I wouldn't be paying a cent for any medical costs related to pregnancy, I'm facing an undetermined bill that could be in the low thousands once the deductible and out-of-pocket maximum is factored in.

At some point during delivery the creature that's been stirring around inside of you is considered by the insurance company a separate human being in need of its own coverage. So you'll actually get two bills, one for you and one for the baby (who now has its own deductible). You instantly go from single coverage to "employee + dependent," or "employee plus spouse" to "family coverage," complete with increased monthly premiums.

My earlier rant about the costs borne by women for maternity wardrobes may seem superficial, and as for the potential for lost wages, you'll most likely have a healthy pregnancy with little time off needed from work. But unless you give birth at home without professional help, you and your new child could incur thousands of dollars in hospital costs. How will you and your partner split what insurance doesn't cover? If you've each spent years contributing to a health savings account, how much from each account will you tap into? Some people are lucky to have an employer who offers great coverage with a low monthly premium, while others don't have health insurance at all. If you're married, your options open up, but if you are not married and are about to have a baby, the question of how to make sure you and your baby are covered and how you will split those costs is a lot more complicated.

4. Maternity Leave

You will need to take time off after you've given birth, but unfortunately for those of us working in the United States, maternity leave is not paid (and not even guaranteed). It seems the common scenario is that new moms only receive a full salary during maternity leave by using up any vacation time and sick time,(so limited in the States, and again, not even guaranteed) then a partial salary by applying for disability and then when that runs out, they round out maternity leave by taking unpaid time off. Realizing that your household may go weeks without a second paycheck is a financial shocker for many couples, but if paychecks in your relationship are still seen as "her" money and "his" money, where does that leave the woman when her income is non-existent for a few weeks or months?

Full Term!

At 37 weeks as of today, my baby is now considered full term. Although I have three weeks to go based on a 40-week gestation period, the baby's organs are now theoretically mature enough to live outside the womb without complications. Ideally labor will wait another three, four, or even five weeks, to give the baby the opportunity to mature further. Regardless of my due date, if the baby were to decide to arrive today, my doctor would not try to stop labor.

Before I was pregnant, I didn't understand what an emotional milestone reaching 37 weeks is. Chris expressed his emotions by high-fiving me as I stumbled to the bathroom early this morning while he was getting ready for work and exclaimed, "37 weeks!" I've been reassured by stories of friends' kids who were born weeks before term and grew up without health complications and by a friend who's a doctor (and who's own kid was born two weeks before term) who told me when I was at 33 weeks that if our child were born that day, it'd earn itself a few days in the NICU, but that it would be fine. Regardless of my kid's chances in the few weeks leading up to now, the less drama in my pregnancy, the better.

Like the rest of my pregnancy, Chris and I can only sit and wait, but otherwise go on with our lives. If I were to develop complications or were to go too far past my due date, (where the risk of the baby growing too big or the placenta breaking down goes up) my doctor would consider inducing labor or even a c-section. But those scenarios haven't even been discussed yet. I'm enjoying the thrill of knowing the baby and I have made it, even if I'm in a bit of denial that the baby really could theoretically come any day now.

Public Service Announcement: Get Your Flu Shot

In my memories of flu shots from childhood, only the over-protective parents made their kids get them. My parents were diligent about taking my brother and me to yearly check-ups and other health care appointments, but I don't think flu shots were ever recommended by our doctors, because maybe we would have otherwise gotten them. I don't remember walk-in clinics set up smack between the greeting card section and check-out lines of the grocery stores, or recall my parents saying they were offered vaccinations through work.

As a healthy kid whose only missed days from school were due to the chicken pox in second grade, getting sick and staying home from school was a fantasy for me. By grad school, I finally understood that the real flu (and not the, I have a bad cold, I must have the "flu") can leave you bedridden for a week and since I didn't have time for that anymore, I willingly signed myself up for my first flu shot and have been getting them ever since. Because once out in the working world, I also didn't have time to miss a week of work. Now that I'm about to be a mom, I really don't have time to be sick. And since I'm pregnant, I also fall into a high-risk category, something I wouldn't have considered myself in since that label also applies to the elderly and those with chronic medical conditions. But more important than my time is protecting my baby from an illness he or she won't be able to receive an immunization for until flu season has passed.

I've done my part to protect myself against the flu, but protecting my child doesn't stop with me. Once I'd received my flu shot* from a nurse at my prenatal appointment, her eyes immediately turned to Chris, who was informed that he, too, needed to be vaccinated too in order to protect the baby. Ha! And he thought as the male counterpart in this pregnancy, he could get away without any poking or prodding. The nurse was satisfied when he said he'd be getting the shot through work in two weeks. I wonder if I can get a note from his boss.

And again, it doesn't even stop with Chris. Flu shots are recommended for anyone who will be in contact with a newborn, such as grandparents, aunts and uncles, older siblings of the newborn and any caregivers. I look at receiving a flu shot as not only protecting yourself, (against health complications, loss of school or work, or leisure activities) but also your family and community.

I'm not posting this reminder and request as a paranoid mother-to-be. I worry about enough other things, and fear of contracting the flu or the "swine flu" has barely registered with me. When pictures of Mexico City residents wearing surgical masks appeared in the paper and Chris's company issued an official statement regarding the illness on the company website, we both rolled our eyes. While I understood that swine flu is a special concern for its potential to infect larger segments of the population at a more rapid pace, it seemed like hysteria was building for an illness that we can't combat any differently than we have learned to do for the seasonal flu: wash your hands regularly, stay home if you're sick and get your flu shot every year.


* I received the vaccination to prevent seasonal influenza, and not the novel 2009 H1N1 virus, which requires a separate shot and won't be available until some time in October.

36-Week Appointment

I'm a pregnancy super trooper no more, but my doctor actually seemed delighted to hear some complaints out of me. She says it just means I'm normal.

Since about my 35th week, the soreness in my fingers has grown worse to the point where my lack of a comfortable grip on a chef's knife makes chopping vegetables, well dicey, my feet ache more often, the gas pain and pressures has me wondering whether labor won't be as bad, or whether it will be worse, and I have to wedge my feet into my clogs. I hear so many comments about how awful it is to be pregnant in the summer, but the changing to the autumn chill from sandal weather just adds more anxiety to the question of what I'm going to wear.

And the doctor said it's just going to get worse, (I suspected it would be downhill from now on) so when she offered me braces for my wrists to increase circulation while I'm sleeping, I accepted. My surprisingly quality sleep (for a pregnant woman) hasn't been interrupted the past couple of days by late-night trips to the bathroom, but instead, because any number or combination of limbs has gone numb. Then I'm awake and realize I have to go to the bathroom, again. But the process of getting out of bed, however cumbersome, at least temporarily improves blood circulation.

The good news is that despite my list of complaints, (which really are mild and totally normal for someone who is nearly full term) my body is already preparing itself for labor. Even though Chris's co-workers apparently know some intimate details, I'll spare the rest of you - I am trying to preserve some dignity in this process. But this is where it's going to get really exciting, or move agonizingly slowly. There's enough change happening to warrant appointments every week now, and eventually every couple of days. While it could be easily another five weeks until I deliver, if I went into labor now, my doctor wouldn't intervene anymore and would let nature runs its course.

Breastfeeding Basics

Chris brags that he's willingly gone to breastfeeding class twice. He's just that awesome of a husband, right?. Well, if he admitted what happened the first time around, he'd blow his own cover, and mine too.

We had arrived at the classroom, the same one our prenatal class was held in the week before, but it was empty. A very sympathetic and helpful instructor, who had arrived early to set up for another class later in the evening, made a series of phone calls for us and learned that I had the right date and time for the class, but the wrong hospital. Oy vey. Some light tears later, (Okay, so it did go through my mind, if I get the wrong hospital for a class, what will I mess up when I go into labor?) I was at least was able to snag the last two spots in the class being held two weeks later, and officially rescheduled.

Our second attempt at attendance went off without a hitch. We had the correct location, we were on time, and despite that I've listened to every Pregtastic podcast there is on breastfeeding, I still found the class informative and worthwhile. In fact, I enjoyed it much more than the the prenatal class, which glossed over ever pregnancy and labor topic possible, while this was topic specific.

While Chris admitted it was probably good that he went, we're still not in agreement that the class was absolutely necessary. He reminded me that they teach all of this in the hospital, along with diaper changing and bathing the baby (two other things Chris and I have never done). His friend and his partner didn't bother with the class, even though she knew wanted to breastfeed, and he reported that she's doing fine. However, I don't think you can lump something as personal and emotional as breastfeeding in with diapers and baths. It's true that labor and delivery nurses are trained in basic breastfeeding techniques and most hospitals have a lactation specialist or consultant who can visit you within 24 hours of birth. However, in that time, the baby will have needed to feed multiple times, I will be exhausted and I'm so emotionally committed to breastfeeding, that I want to go in as prepared as possible for my own benefit. Because a lot can go awry.

Breastfeeding, in general, is not complicated, and sure women have been doing it since the beginning of time, but the mechanics is not actually instinctual (or so I've been told). Both babies and mothers can perform a piece of the process incorrectly enough to through the rhythm out of sink. A baby can have trouble latching on correctly. Or the mom might not figure out how to hold the baby in a comfortable position and suddenly question how she'll be able to put up with nursing 8-10 times a day. Breastfeeding has been compared to dancing, where you each may know the steps, but not the style at which your partner moves. Because of formula, no baby will starve, but each unsuccessful day of breastfeeding can lead to health complications for the mom and baby, frustration, and ultimately, giving up breastfeeding.

So I signed us up for a class offered through the hospital called Breastfeeding Basics. In two and a half hours, it covered the benefits of breastfeeding, how to prepare, avoiding and solving problems, and the role of the support person.

The latter is why Chris was there. Actually, the description of the class specifically instructed you to bring your support person and I ended up with some additional authority when we met a woman in our baby class who didn't know her husband was supposed to attend the breastfeeding class with her, and she felt like a loser for being the only one there without a partner. As she recounted the story over lunch in the hospital cafeteria, I interpreted the look on her husband's face as, "Don't be me."

There are two pieces in this becoming a parent adventure Chris is naturally and obviously excused from: labor and breastfeeding. He's attended appointments and a prenatal class and kept up on the stages of pregnancy. It's his kid too, after all. Even though only I can make the decision whether to breastfeed or not, (they are my breasts, after all) I think it's important that he be just as informed. Two minds are better than one, so even though we received more information in those two and a half hours than we could actually process and remember, we've both received the same basic information and can help each other in those first few weeks after birth. I don't think I'll have the patience to explain basic breastfeeding concepts, and he'd be hearing it second-hand, anyway, instead of from the instructor with an advanced degree and 24 years experience. Meanwhile, the nurse or lactation consultant at the hospital won't have to help him play catch-up during the precious time she has to work with the baby and me. Just as I haven't spent any significant time with babies and nursing mothers, Chris had to be introduced to this foreign world of breast pumps, a new vocabulary with terms like engorgement, let down and colostrum and a lifestyle altered to accommodate round-the-clock feedings and pumping and freezing milk. The class helped us transition from breastfeeding as a theory - something we supported, something we knew other people do - to a reality with all the physical, logistical and emotional details.

One belief surrounding breastfeeding that hasn't changed after the class and all the research I've done is that it really is a personal choice. Just as I feel the pull towards doing anything less than a natural, unmedicated birth is considered an injustice to your child, I sense a shame out there among women who don't want to or can't breastfeed. The "Breast is Best" movement has done a lot to encourage women to breastfeed and support those who choose to do so. I do believe breast milk is better than formula, but formula is still good. I remind myself that I was a formula-fed baby. And I'll admit that I want to breastfeed as much for the health benefits for me as for the baby, and the idea of breastfeeding as better for bonding than bottle feeding (oft mentioned in the pro-breastfeeding literature, but one I haven't been able to buy into yet) is less motivating than the thought of the cost savings (less often mentioned). I have the time and support, and hopefully when the baby is born, the patience and lack of complications. Breastfeeding is a logical option for me now, but not for every woman.

34-Week Appointment

At my 34-week appointment right before the Labor Day Weekend I was in and out in a flash. The baby's heart beat is now in the high 130s, right where it should be, and with a measurement of 34 centimeters, I'm following the growth charts with measurements corresponding to the number of weeks I am in my pregnancy. I was chipper and full of energy and the doctor was impressed with how easily I still pop up from a reclining position on the exam table without any assistance. How are you doing? Any discomfort? "Nah, I replied. I'm doing great!"

Three days later, I noticed a mild soreness in my fingers and I couldn't comfortably make a tight fist. Now I know why pregnant women are known for dropping things. I couldn't discern any swelling, but knew it had to be the culprit. While swelling is uncomfortable to look at, and certainly isn't flattering, it never occurred to me that you feel physical side effects to it.

By that night, the baby had completed two straight hours of what felt like somersaults inside me. It was cute when it was smaller and had more room to maneuver, but each movement caused incredible discomfort as it bounced a limb off the uterine wall or took a break directly on what felt like my bladder. Certain sensations I can't put into words, (Other than, am I feeling the baby grab an intestine?) and while they are better described as discomforting rather than painful, they still caught my breath and left me unable to sit still. I finally retreated to the bedroom where I hoped gravity could relieve some discomfort by pulling the baby off my bladder.

My emotional state wasn't admittedly the greatest at this peak of discomfort, but being surrounded by 20-something guys who have never spent such an extended period of time in close contact with a pregnant woman, as was the case when we all spent the weekend together at the cabin Up North, was not providing the emotional comfort I was seeking. They all, my own husband included, barely looked up from their card game. He finally excused himself to see what I was making such a fuss about and reported back that "Kirsten's 'uncomfortable.'" I could picture their eyes rolling. Yes, accurately and succinctly put, I was "uncomfortable." But "uncomfortable" covers a wide range, and I was at the point where I couldn't articulate in what ways I was uncomfortable, because I didn't know precisely what was causing it. (Other than that because there was a baby in there.) And if I had tried to describe it, and prove to them that I had something real to complain about, I would have been accused of providing "too much information."

It's not that I wanted to be done with pregnancy at that point. Really, I had gotten used to being enormously pregnant and awkward. I just didn't want to be in discomfort anymore, and wanted to stop feeling bitter that I was left to feel like a mess while my husband was feeling none of it and couldn't wait to go back to his card game. Distraction and some extra attention were the only remedies I could think of at that point and I wasn't getting it.

Now that I'm nearing my 36th week, I'm grudgingly accepting that some of the physical side effects of pregnancy, those that I thought with good health, lots of hydration and routine exercise would be prevented, are afflicting even me. The soreness in my fingers is still there, except now I notice swelling, especially when I wake up in the morning. It was a badge of honor to still be able to fit my wedding ring on my finger, but I'm glad now that I stopped wearing it a few weeks ago as a precautionary measure. My feet swell and feel sore if I've been standing on them for too long, so I've been telling myself it's okay to actually relax and literally put my feet up. Meanwhile, my sleep is disrupted by extremities that go numb and by the time I wake up for good in the morning, my hips are usually sore, probably because I'm left with just the options of either sleeping on my left side or my right side. And now that my husband has said goodbye to summer after a final weekend at the cabin, I've finally gotten his attention back. Cuddling with him on the couch is very soothing and I feel as if I could fall asleep in his arms. But our mellow time together is interrupted far too quickly by, "Sorry, sweetie, I've got to go the bathroom."