This article originally appeared on Health.com.
When Reddit user halfthrottle looked at the hospital statement for the recent cesarean-section delivery of his son, he found an unexpected charge: $39.35 for “skin to skin,” a term used to describe when a baby is placed on a mother’s chest after birth.
Halfthrottle shared an image of the itemized bill in a post titled, “I had to pay $39.35 to hold my baby after he was born.” A nurse let him hold his son to his wife’s neck and chest, he explained on Reddit; the nurse even borrowed his camera to take a few pictures.
“During the c-section, a nurse asked my wife if she would like to do skin to skin after the baby was born,” halfthrottle wrote. “Which of course anyone would say yes too. We just noticed it in the bill today and had a laugh.” He also wrote that the couple’s birth experience was very positive, and that everyone involved was great.
Other Redditors were less understanding. Many seemed outraged that hospitals would charge for such a “service,” citing price-gouging and hospital overbilling practices. Some—particularly Redditors from other countries—expressed shock and dismay at the cost of having a baby in general. (The statement’s total charges exceeded $13,000, although insurance and a “contractual allowance adjustment” seemed to cover most of it.)
But back to this skin-to-skin thing: What exactly is it, and is the extra charge justified?
For starters, it’s more than just a photo op. Research shows that placing a newborn on a mother’s chest immediately after birth, also known as kangaroo care, can have benefits for both mom and baby.
According to a 2013 scientific review, there is evidence that the practice can help stabilize a baby’s breathing, temperature, and glucose levels; decrease stress; and facilitate bonding between mother and child. Skin-to-skin contact is endorsed by several non-profit health groups, including the World Health Organization and the American Academy of Pediatrics.
One Redditor, who identified herself as a labor and delivery nurse, described it in this way: “If [parents] ask what ’skin to skin’ means, I would say, ‘We will bring down your gown, unwrap the baby, and put the naked baby right on your chest. And cover you both with a blanket. This is good for bonding and transitioning. Your body keeps the baby warm. Your heart beat and your scent help soothe the baby. It is also beneficial for breastfeeding.’”
Health also spoke with Elicia Jacob, a doctor of nursing practice and administrative director of nursing at the University of Alabama Birmingham. Jacob says that at UAB Hospital, skin-to-skin contact is encouraged immediately after birth, and that patients are not charged extra for it. (Jacob was not involved in the Reddit thread and cannot speak for other hospitals’ delivery processes or billing practices. The name and location of the hospital in the original post is unknown.)
“In the operating room, it’s something we’ve practiced in the last three years or so,” she says. Incorporating skin-to-skin contact into daily practice was part of UAB’s journey toward becoming a Baby-Friendly birth facility, she says—a distinction the hospital was awarded in 2015. According to Baby Friendly USA, these facilities offer an optimal level of care for breastfeeding mothers and their babies.
At UAB, Jacob explains, the practice is done after every delivery, assuming both mom and baby are in stable condition. If a mother isn’t able to, skin-to-skin can also be performed with dads. “Either way, the thermogenetics and instant contact with a parent provides the baby with better outcomes,” she says. (If your baby’s not able to get skin-to-skin contact right away for whatever reason, though, it’s not something to feel guilty about.)
How long a baby remains in this position will depend on the hospital and the specifics of each delivery, but it can range from a few minutes to an hour. “It does take a little more time, but it’s really what’s best for the mom and what’s best for the baby,” Jacob says.
At UAB, Jacob explains, every delivery involves a care team that includes a nurse specifically for the mother and a nurse specifically for the baby. This may not be the case at all hospitals, though.
On Reddit, the labor and delivery nurse volunteered a possible reason for the charge on the statement in question: After deliveries at her hospital, an additional nurse is called in to supervise and help the parents with skin-to-skin contact while the rest of the team tends to the mother’s incision and vital signs.
“An active operating room isn’t set up for skin to skin contact during surgery,” she wrote. The mother is still under anesthesia and has an open abdominal cavity, she adds, and “someone needs to be there to make sure that the baby doesn’t slide off of her chest on to the floor.”
Jacob says that any parents-to-be who are worried about what they might be charged for in the delivery room should ask their hospital about common practices. “It’s true that you don’t always know what’s going to happen during your time there, but I don’t see why the billing office can’t provide you with the basics,” she says. “If you’re concerned, it’s worth asking ahead of time what’s included and what’s extra.”
As to whether that skin-to-skin time is worth a $40 charge, Jacob says that’s a choice that every family should make for themselves. “Do your research, read up about why it’s recommended, and decide yourself what you find valuable,” she says.