When people talk about the costs of raising a child, they often mention college, enrichment activities, and basic necessities like food and clothing. One cost that is not widely discussed, however, is the cost of birth itself. Maternity care, which includes prenatal, delivery, and postpartum services, is a significant cost for individuals and health insurance providers alike.

The high cost of birth.

The United States is the most expensive country in the world for childbirth, according to the BBC. In 2011, the average for a vaginal birth with no complications was $10,657 (with complications, $13,749) and the average for a caesarian section was $17,859 ($23,923 with complications), according to the U.S. Agency for Healthcare Research and Quality. This number is more meaningful when you compare to the Netherlands, where the average physician and hospital costs are $2,824, or to Spain where the cost is likely to be around $2,251.

Insurance payouts are also increasing. "From 2004 to 2010, the prices that insurers paid for childbirth — one of the most universal medical encounters — rose 49 percent for vaginal births and 41 percent for Caesarean sections in the United States, with average out-of-pocket costs rising fourfold, according to a recent report by Truven that was commissioned by three health care groups," according to a 2013 report from the New York Times.

However, national averages only show part of the picture. Within the United States, the actual charges for giving birth in a hospital vary significantly by state, although the services offered to women are essentially equivalent. New Jersey has some of the highest birth costs and Maryland some of the lowest, the U.S. Agency for Healthcare Research and Quality reports. In Maryland, the average cost of a vaginal birth with no complications was only $5,786 in 2011, or just slightly more than half the national average. In New Jersey, by contrast, a vaginal birth with no complications cost an incredible $19,045.

Although there are data for the cost of hospital labor and birth for 35 of the 50 states, there is no indication of what accounts for the drastic cost differentials between states. While the quality of care can vary by hospital, lower cost do not necessarily equate to lower quality care and vice versa. Maryland and New Jersey, for example, each have three nationally ranked hospitals, and others that meet national high performing standards, according to U.S. News and World Report rankings.

Insurance doesn't cover everything.

Prior to the Affordable Care Act much of these high costs were being passed directly onto families. Many individual insurance plans did not include maternity care, and parents were left to foot the bill instead. The Affordable Care Act sought to change that by establishing a list of essential health benefits that had to be included in all private and small group insurance policies beginning in 2014. One of the included benefits is pregnancy, maternity and newborn care. Maternity coverage is also provided for employees of large companies, who are required to include this benefit under the Pregnancy Discrimination Act of 1978, NPR reports. While this is not flawless (see NPR’s article on how some young women are still not covered), many more women now have at least partial coverage for their hospital and delivery expenses.

That being said, if your health insurance doesn’t cover the full amount and you’re looking to avoid outrageous hospital bills, stay away from New Jersey, California, Rhode Island, Florida, and Nevada. These states have the highest hospital labor and birth charges in the country.

For those lucky enough to give birth in Maryland, West Virginia, Utah, and Vermont (or to have health insurance that covers most or all of the costs), your hospital bills will be only a fraction of what they are elsewhere in the country, and you’ll have a little extra cash for the college fund.