Let’s be real here. Women make babies. Women also kick butt working. Sometimes women need to make babies while kicking butt working. So, you know, the human race can survive … no big deal. But, all too often, families are unfairly burdened by our dismal maternity support system. Bleary-eyed and bloody, new mamas emerge from childbirth facing a mountain of medical bills and no income.

For my first pregnancy, my family had coverage through the army (Tricare Prime), and we paid nothing out of pocket. For my second pregnancy, I was the sole breadwinner and worked for a private company. I was wholly unprepared for the costs coming my way. I wish someone had told me these things. I also polled a group of financially savvy physician moms and here are the most important tips we came up with.

First, the basics. Some states offer some maternity pay, including California, New Jersey, Rhode Island, and New York. The Family Medical Leave Act (FMLA) guarantees your job will be there when you get back. But most moms will not get paid on maternity leave. To supplement, most American families will need various insurances. Short-term disability insurance can be purchased as an add-on benefit (usually pays 60 percent or so of your salary, covers up to three months). Long-term disability insurance kicks in after three to six months of disability. And, of course, medical insurance will help cover medical expenses. Medical insurance has different options including health maintenance organization (HMO), preferred provider organization (PPO)and high-deductible health plan (HDHP). Then, there is life insurance to cover your survivors in case the worst happens.

Now, for the top 10 high-level tips to optimize maternity leave finances:

1. When looking for a job, pay attention to maternity benefits. It doesn’t matter if you are planning to conceive or not, be prepared and pay attention. Don’t be afraid to talk about maternity leave benefits. Don’t be afraid to negotiate. Your baby deserves a financially secure home.

2. Hold off for a year. Most employers won’t cover maternity leave within one year of new hire.

3. Timing is key. Pregnancy is considered a pre-existing condition. Short-term disability won’t cover you if you’re pregnant when you start a job. Get life and disability insurances prior to getting pregnant. Pregnancy-related conditions like gestational diabetes will increase your rates. So get them before you collect medical diagnoses.

4. Look at your medical insurance plan closely. Look at the benefits package and know your deductible and other out of pocket expenses. I was totally prepared to pay my deductible. What I didn’t realize was when my baby separated from me, he would have his own deductible. So take the deductible and double it. Speaking of deductibles, try to conceive and deliver in the same benefit year so you only pay the deductible once. Otherwise, take your deductible and triple it.

5. Look at your pay structure. When you do come back to work sleep deprived, you may find that you will not meet any bonuses that year no matter how hard you work. Productivity bonuses are usually given above a yearly relative value unit (RVU) threshold for physicians. Negotiate the RVU threshold during maternity before you sign a contract.

6. Short-term disability (STD) doesn’t pay for all of maternity leave. Usually, there is a waiting period of two weeks before it kicks in. You may also be asked to use up your paid time off prior to STD kicking in. Short-term disability pays six weeks for vaginal delivery and eight weeks for C-section. Typically, this only starts after delivery, so if you decide to go out a little early, those days may not count towards the two weeks mentioned above.

7. You may owe money. Not only will you not make bonuses, but you may also owe money to your employer after maternity leave. To my surprise, I owed my practice $1800 when I got back. For the two months that I was out, my insurance payments were not coming out of my paycheck. (Yes, this also includes the very short-term disability I was drawing on. Turns out you still owe premiums even when you are disabled). So, be prepared for this, too, and try to find out the number up front.

8. Price shop. Know what the fair price is for your delivery and who offers the best service. Unknowingly, I chose the most expensive hospital in the area to have a baby. There are awesome resources out there to get pricing information, see below. On the same note, minimize your hospital stay to keep costs low.

9. Compare hospitals and price shop at Healthcare Bluebook. Get more in-depth insurance info at Fair Health.

10. You have resources. Finally, if something seems off and your insurer is giving you the runaround, go to battle, fierce mama. Document, document, document, and then contact the National Association of Insurance Commissioners. They are there to hold insurance companies accountable.

By no means do you have to procreate. But, if you do, be wise and advocate for yourself. When you kiss those little fingers and little toes, all of these struggles will fade away into distant memory. You can do this.

“The Frugal Physician” is an internal medicine physician who blogs at the Frugal Physician.

Image credit: Shutterstock.com