Margaret Ertter gave birth three times at the old Saint Alphonsus hospital in downtown Boise. This bill is from a premature delivery of two baby boys. One baby, David, survived. The other baby did not, according to Ertter’s grandchildren.
Margaret Ertter gave birth to her daughter, Mary, in March 1922. The bill was $92.
Ertter delivered twin boys four years later. They were born prematurely, and only one baby survived. The bill for Ertter’s 14-day hospital stay and medical care for her preemie newborns? $154.50.
Ertter’s granddaughters in Boise discovered the documents this year: a handwritten receipt from a Saint Alphonsus Hospital in downtown Boise at the time, and a handwritten note of costs nearly 100 years old.
And in between, the bill for their father’s 1923 birth: $137, which included a $1 circumcision.
The unique records show how much has changed in health care.
Even taking into account inflation — the bills would range from $1,471 to $2,371 today — childbirth in the 1920s cost a fraction of what it does now in Idaho or anywhere else in the U.S.
But medical care has changed dramatically in the past century. Health care providers spend and borrow for costly education, training and licensing. Health insurance plans now largely determine how much a family pays for a child’s birth — and how much the hospital makes. Neonatal ICUs now keep babies alive even when they’re born months too early. And prenatal care can ensure babies and mothers have the best shot at a healthy birth.
The maternal death rate in 1920 was 7.8 per 1,000 births, according to a contemporaneous record. By 2018, the maternal death rate had declined to 17.4 per 100,000 births, the U.S. Centers for Disease Control and Prevention says.
A childbirth can range in cost from thousands to hundreds of thousands of dollars at Idaho hospitals. Most people with exorbitant bills don’t pay the full amount; either their public or private health insurance covers a great deal of the cost, or they qualify for financial assistance from the hospitals. But it isn’t rare for Idahoans to pay several thousand dollars out of pocket to welcome their new family member.
Without complications, surgery or a neonatal ICU stay, the median pre-insurance charge at Saint Alphonsus Regional Medical Center in Boise is $8,427, plus $2,920 for the newborn’s medical care, according to the hospital’s price transparency list. St. Luke’s would charge (pre-insurance) an estimated $14,484 for the birth and $3,117 for the newborn. Those estimates don’t include fees for certain physicians and services, or prenatal care.
With the circumstances of Ertter’s second birth, the charges likely would be in the hundreds of thousands of dollars.
New mothers in the Treasure Valley shared their present-day birth stories with the Idaho Capital Sun, including one new mom whose experience mirrored Ertter’s — but differed in some big ways.
1920s birth: Two weeks in the hospital, a month in bed
Ertter and her husband, L. Roswell “Ross” Ertter, married in 1921 and had four children — three who survived — according to Boise resident Nancy DeWitt.
One of those children was Lawrence “Larry” Ertter, the father of DeWitt and Karen Smith, who discovered the hospital bills and shared the records and their family stories with the Sun.
DeWitt says it’s likely that they paid their hospital bills in cash, based on her father’s approach to finances.
“My dad was, ‘You pay in cash for everything,’” she said. “They were big into saving. … I assume my father got that from his father.”
One of the bills showed charges of $59.50 for 14 days in the hospital at $4.25 a day, $85 for the medical doctor, $5 for the delivery room, $3 for dressings and $2 for laboratory fees.
Smith and DeWitt said their grandmother was several years older than their grandfather when they wed. Margaret Ertter was in her early to mid-30s when the babies were born, they said.
They said family stories about the births illustrate the stark differences between present-day and 1920s maternity care.
On top of the 14-day hospital stay, Smith’s mother told her that Ertter was told to stay “in bed for a month with each child,” she said.
New mothers now are typically encouraged to get up and move as soon as they can, to prevent blood clots. They are discharged from the hospital within a few days.
Ertter developed “a lot of health problems that my mother said were related to the lying-in periods,” Smith said.
High-cost deliveries — and modern health care that likely saved lives
Courtney Pacholke, who lives in Nampa, gave birth to baby Eleanor on June 4 at the Saint Alphonsus Birkeland Maternity Center. Her water broke early, before she went into labor. She waited about 12 hours to go to the hospital — at which point she was at risk of developing an infection.
She began to spike a fever that night in the hospital, while trying to deliver the baby.
Women in the early 1900s, and before that, died of childbirth-related infections that are now prevented and treated before they become life threatening.
“I ended up going septic, hypothermic, and my baby was born with an infection,” Pacholke said. They both received treatment and recovered.
The total charges for Pacholke’s birth were $15,965, with insurance covering all but $1,809 of that, according to a hospital bill Pacholke provided to the Sun.
The charge breakdown included the hospital bed and nursing care; delivery room; recovery room; anesthesia; laboratory and pharmacy costs; a treatment room and supplies.
In addition, they were billed about $16,000 for an emergency caesarean section surgery, and about $800 for Eleanor’s care, since newborns generally become a separate patient after they’re born. Insurance covered the vast majority of those bills, Pacholke said.
They also paid about $1,700 for obstetric care, according to a bill she provided to the Sun.
Another local mother, Krista Phillips, went septic partly due to complications of her pregnancy. She needed an emergency C-section to deliver baby Noah in February. Their hospital charges were about $23,000, she said.
Due to her pregnancy complications, she was on bed rest for about half of the pregnancy.
“Thankfully, due to the circumstances and how I wasn’t able to work … they put me on Medicaid,” she said. Idaho Medicaid paid the costs for her delivery, at a significantly reduced rate.
Twins and a 14-day stay at ‘the priciest hotel’
Lauren Wong has some things in common with Margaret Ertter of the 1920s.
She lives in Boise and gave birth to twins at a downtown Boise hospital.
Wong’s sons, Aiden and Luke, were born at the St. Luke’s hospital after her water broke about seven weeks early for twins.
Doctors kept Wong in the hospital for two weeks — not for recovery, like Ertter, but to keep the boys in the womb to develop as long as possible.
They gave Wong steroid injections and other medications to try to speed up the babies’ lung and brain development and to stop her contractions.
She delivered the babies on Nov. 6 “and then I (left the hospital) Nov. 7, because I just did not want to be there any longer than I had been there already,” she said.
The twins stayed in the neonatal ICU for 26 days.
When she learned about Ertter’s two-week hospital stay and monthlong bed rest, Wong laughed in disbelief.
“The two weeks was hard enough,” she said. “I kept saying to my doctor, ‘Are you sure I can’t just do this at home?’”
The hospital charges for Wong were almost $66,000, she said. There was no C-section necessary, but the hospital care that kept her babies from arriving too early was pricey.
“I’m pretty sure it was $3,000 a night … between $3,000 and $3,500,” she said. “I remember thinking, well, that’s the priciest hotel I’ve ever stayed at.”
The charges for the NICU were $231,000 for one baby and $464,000 for the other, she said.
That brought the total charges to nearly $800,000 for Wong’s care, and to bring home two healthy baby boys.
The family paid $8,000 of that — the yearly maximum out-of-pocket costs on their health insurance plan.
Wong is grateful for the medical care they received, noting that “so much has changed, especially since the ‘20s, in what they can do” to give babies and mothers a better chance of surviving and having a healthy life.
“When we were in the NICU, I would talk to the different nurses there … some of them who had been doing the NICU nursing for a long, long time,” she said.
One nurse told her about previous patients, twins who weighed less than a pound at birth. They’d just graduated from high school or college, she said. “The fact that they kept babies alive who were that tiny … is nuts.”
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