Vaginal Delivery (full care)

What it is

Obstetric care is usually billed as a package rather than visit by visit. When one practice provides the routine prenatal visits, attends a vaginal birth, and then sees the patient through the postpartum period, that entire span is billed once under this code. That is why the price attached to it looks large next to an ordinary office visit: it is nine months of appointments plus a delivery, not a day's work. The professional package covers what the obstetric practice does. What the hospital charges for the labour and delivery room, the bed, the nursery and the supplies is billed separately, as is anesthesia if an epidural is used.

Why it is done

• Vaginal birth is the default route of delivery when the pregnancy is progressing normally and there is no reason to operate
• Labour proceeds through contractions that thin and open the cervix, then a pushing stage, then delivery of the placenta
• Recovery after an uncomplicated vaginal birth is generally quicker than after abdominal surgery, and the hospital stay shorter

What to expect

Prenatal visits start monthly and become more frequent as the due date approaches. Labour and delivery are managed in hospital by the practice on call — which may not be the individual clinician seen at every prenatal visit, since obstetric groups rotate coverage. An uncomplicated vaginal birth is typically followed by a short hospital stay, then a postpartum check with the same practice some weeks later. If the plan changes to a cesarean during labour, the billing changes with it, and the delivery is no longer covered by this code.

Questions worth asking

• Exactly which visits fall inside the global package, and which ones — ultrasounds, genetic screening, non-stress tests — are billed on top?
• Is this quote the obstetrician's package only? What does the hospital's own facility charge for a vaginal delivery look like?
• Is anesthesia for an epidural billed by a separate group, and is that group in my network even if the hospital is?
• If I change practices partway through the pregnancy, how is the package split, and could I end up paying two partial packages?
• Is the newborn billed under their own account from birth?