Having a baby is expensive in the U.S., and not even a good insurance plan will pick up the full tab.

A new study by the Kaiser Family Foundation found that the average cost of childbirth in the U.S. is $18,865 under large insurance plans. Though most of that is often picked up by insurance, out-of-pocket payments clock in at an average of $2,854. That includes money spent during pregnancy, childbirth and postpartum-care periods over the course of about three years. Those costs also do not include the amount spent on heath-insurance premiums themselves, or extra bills incurred from out-of-network providers or non-medical procedures and services. 

The average cost for pre-and postnatal care, as well as the cost of delivery for someone covered by Medicare was $12,770 in 2010, according to the Guttmacher Institute.

The Kaiser study also compared the health-care costs of different deliveries. C-section births cost the most, averaging  $26,280. Just over $3,200 of that was a patient’s out-of-pocket cost. Vaginal-delivery births and associated care costs an average $14,768, with a $2,655 out-of-pocket.

Most Americans have health insurance, and the majority are covered by large group plans such as those featured in the Kaiser study. A recent report from the Congressional Research Service found that 91% of Americans have health insurance, and two-thirds have either employer-sponsored or individually-elected coverage. 

The U.S. is among the most expensive countries to give birth and has the highest maternal mortality rate of any developed nation, with an acute increase in risks for Black women. The Centers for Disease Control and Prevention places the U.S. infant mortality rate at 5.4 deaths for every 1,000 live births.

It’s more expensive to give birth in Japan—at an average of $61,810, researchers at Coyne College found—but a separate report from UNICEF found that the country also has the lowest infant mortality rate, at one in 1,111 newborns. For most countries, the cost of childbirth is under $10,000, no matter the type of procedure.

Of course, pregnancy and childbirth are just the beginning. A February 2020 report from the U.S. Department of Agriculture estimates that for children born in 2015, their family will spend $233,610 on average by the time that child is 17—and after that comes college.

This article was provided by Bloomberg News.