Bundles of joy are also bundles of expense

Having a baby is a major expense, and from insurance to nappies, careful planning is essential to avoiding an unwanted surprise.

United Arab Emirates - Abu Dhabi - March 4th, 2010:  Alice Miller lies in her crib in her home in Abu Dhabi.  (Galen Clarke/The National) for personal finance

Less than an hour after giving birth to her third child, Jane Miller is rolled into her room at Abu Dhabi's Al Corniche Hospital. Exhausted and in a post-anaesthetic haze, she has to endure the labour-induced screams of the woman sharing her room. Mrs Miller, 39, didn't pay a fil for her Caesarean delivery, or the examinations and tests she received during her pregnancy. And Alice, her newborn daughter, will now spend two days in ICU under observation because of complications, all at no cost to the family.

Fortunately, Mrs Miller has premium health cover through her husband's employer. But what her insurance didn't pay for is the cost of a private room - a benefit that would have been a priceless commodity for Mrs Miller. She wanted nothing more than to rest. "When they finally took the woman away for the delivery, I prayed it would be a long labour," says Mrs Miller who moved to the capital three years ago from the UK, and gave birth to Alice last September.

With myriad insurance schemes, paperwork and costs to deal with - including supplies, nursery care and the possibility of placing your career on hold - having a baby in the UAE can be complicated and costly. And it's a process many parents will go through this year in the Emirates. Al Corniche Hospital in Abu Dhabi, for example, delivers about 10,000 babies a year. A normal delivery costs between Dh7,000 and Dh9,000, and a Caesarean section can cost up to Dh15,000.

Prenatal check-ups average around Dh275 per visit, and most medical professionals recommend that mothers-to-be see their doctor month during pregnancy. Add to this the cost of ultrasounds, blood tests and procedures to test for genetic defects such as Down syndrome, and having a baby can easily cost more than Dh30,000. There is good news. Patients covered by Daman who present their insurance cards upon registering for their initial prenatal consultation don't have to worry about fees related to child birth, because the company covers all costs and pays the hospital directly.

But the process, unfortunately, is rarely this efficient, making it essential that you fully understand your insurance plan's details. Mrs Miller, for example, was unaware that a private room was not covered by her Daman policy; she would have had to pay Dh1,000 a night extra for that luxury. Meanwhile, if you are insured by most other companies, hospitals will expect full payment upfront; you must then file a claim with your insurance company for reimbursement.

Not having the advantage of direct billing was a factor in Sam Turner's decision to have her baby at Al Noor Hospital, a private institution in Abu Dhabi.

Mrs Turner, 38, a mother of four, moved to the UAE from St Albans in the UK three years ago when Rob, her husband, was offered a job leading a facilities management company. The birth of her fourth child, Zahra, now three months old, was paid for through a combination of cover from Bupa, the international insurance provider, and the Abu Dhabi National Insurance Company, which was included in her husband's salary package. "Part of the reason we chose not to go to the Corniche Hospital was financial," Mrs Turner says. "We would have had to pay the full cost and claim it back [at Al Corniche Hospital], so there was no advantage in taking that option." At Al Noor Hospital, a routine delivery package costs Dh15,000, and includes a single room with a private bathroom. The hospital charges Dh20,000 for a Caeseraen section, and offers prenatal examinations at Dh250 per consultation. Ultrasounds cost an additional Dh350. Selecting a hospital that fit with their insurance scheme was a solution for the Turners. But what about those who have no prenatal insurance at all? Kim Escourt was six months pregnant when she arrived in Dubai late last September. Born in New Zealand, Mrs Escourt, 36, was living in Dublin when her husband was offered a job in the emirate. Her daughter, Ivana, was born at Welcare Hospital in December of last year. The family's medical policy, underwritten by American Life, didn't cover birth expenses. However, Mrs Escourt was unfazed by the challenge of moving to a new city and the costs of having a baby. "We could have topped up the insurance, but after looking at several hospitals we decided just to pay for it," she says. "We ended up going to Welcare Hospital on the recommendation of someone from my husband's office." Welcare offers a standard-delivery package, and charges Dh11,000 for a single room and Dh10,250 for twin accommodation. If a Caesarean is necessary, patients pay Dh22,500 for a single room and Dh20,000 for shared quarters. "I went to the hospital every couple of weeks for tests, and then every week, which cost us many thousands of dirhams," Mrs Escourt says. "I can't remember how much, but it was unexpectedly high." Of course, while the right insurance can take the financial pain out of childbirth, the amount you pay for prenatal medical care and delivery is negligible compared to the costs of raising a child. For starters, there's the expense of setting up the nursery, not to mention food, nappies, baby monitors, childcare and a pram. Mrs Miller estimates that she spent more than Dh5,000 on baby supplies and clothes during the first six month's of Alice's life. And most of what she bought was second-hand. Buying all new items, as many mothers tend to do, would have cost at least five times that amount, and it's easy to let these early costs spiral into the many thousands of dirhams. The best approach, Mrs Miller says, is to shop around and buy a mix of new and used items. Online forums and bulletin boards, such as expatwoman.com or abudhabimums.ae, are great places to find quality second-hand items. Another popular source for new mothers is the thrift shop at Abu Dhabi's St Andrew's Church in Mushrif, and the Dubai Flea Market at Al Safa park. Mrs Miller spent her Dh5,000 on a used high chair, bouncy chair, cot and a bag of barely-used clothes bought from a friend. Her budget also included a new car seat, which cost her Dh1,000, and a mattress, which set her back Dh1,500. Mrs Escourt says she spent at least Dh5,000 on similar products, plus another Dh3,500 for a pram, which doubles as a car seat. "We will have to spend another Dh750 on a stroller attachment when Ivana gets bigger," she said. As with most products, the store from which you buy will determine the price you pay. A high chair can cost as little as Dh180 at LuLu, for example, while Mammas and Pappas charges up to Dh1,000. Food and nappies can also be very expensive. The most economical, and healthiest, food option is breast milk. If you want to breast feed and maintain some freedom, you can hire a breast pump from a clinics for about Dh25 a week, plus a Dh2,000 refundable deposit. If you want to instead use baby formula, expect to pay around Dh45 per week. When it come to nappies, the choices are disposable and washable, and the pros and cons abound. The latter are less expensive, and most people say they are better for the environment, though you do have to factor in the use of water. Mrs Escourt has gone the reusable route. She invested in Top Bots nappies, which cost her Dh2,000 for a pack of 20. They will fit Ivana until she's a toddler. In the long run, even expensive reusable nappies will be cheaper than buying disposable ones, which will cost between Dh20 and Dh50 a week for two to three years. But the cost of nappies, food and supplies pales in comparison to childcare. And the lack of care centres in the UAE that have extended hours - most close at 2pm - has prompted many mothers to give up work, perhaps the biggest cost of all. Mrs Miller, an occupational therapist, and Mrs Turner, who has a marketing background, said they were keen to return to work, but were not optimistic of finding part-time opportunities. Meanwhile, Mrs Escourt hopes to go back to work teaching English as a second language once Ivana is nine months old. "I'm starting to look at nurseries now, but it will depend on if we get a place, and also how much it costs, to see whether it's worth me going back," Mrs Escourt said. Nursery schools and summer camps can cost more than Dh40,000 a year in both Abu Dhabi and Dubai. Most facilities have a limited number of open slots and long waiting lists, along with hours that don't coincide with a normal work day. Jo Shaban, who opened the first of Abu Dhabi's two Bright Beginnings nurseries in Mushrif five years ago, said the number of babies under 12 months of age enrolled at the nursery has increased notably since the she opened. Bright Beginnings, which admits babies at 4 months of age, is unique because it closes at 4pm. Her staff care for eight babies a day, including four under six months of age. "The waiting list is about nine months long, so obviously, the more prepared the mother is, the better," Mrs Shahban said, advising parents to get their names on lists as soon as they can. Fees at Bright Beginnings average Dh1,850 a month for care until 2pm; you will pay an additional Dh45 if your child stays at the nursery until 4pm. In Dubai, nurseries tend to stay open later, but they are more expensive than their counterparts in the capital. The Emirates British Nursery opens from 7.30am, and children can take classes until 12pm, 3pm or 5.30pm. Fees depend on what time they are picked up, and average about Dh8,900 a term for the 7.30am to 3pm session. Terms last from 12 to 16 weeks. "We have 450 children coming to us, and about 90 of them are under 18 months, and some are as young as three months," said Tracy Penketh, the nursery's headmistress. "We are full, but our waiting list is not that long. A lot of working mothers use the nursery as childcare." Another option is to hire a nanny or maid, but this also comes with considerable expense. "As Alice was our third child, we decided to take the plunge and sponsor a maid," Mrs Miller said. "It cost us about Dh6,000 in one-off sponsorship fees, medical tests and health insurance. We pay for our maid to live out, which is another Dh700 a month." While it's difficult to quantify the cost of the first six months of a baby's life, parents can easily expect to pay anywhere between Dh50,000 and Dh100,000. And the expenses never end. As your child grows, there are school fees, dance classes, rugby squads and football teams. There are the new shoes every three months for growing feet, and an ever-increasing grocery bill. But in the end, Mrs Miller says, it's about much more than money. "There's no doubt having children is expensive, but you don't really think about that," Mrs Miller said. "I remember when I was finally alone in my room after the birth and Alice was upstairs in ICU. "I just wanted to hold her."

There are a multitude of insurance companies in the UAE, and they all have different levels of coverage. You should make sure you understand your policy, and don't hesitate to ask questions. Below you'll find some information about four of the leading insurers operating in the country. DAMAN  Prenatal cover Claims for prenatal checks are subject to evaluation How long policyholders must be insured before cover kicks in No waiting period in Abu Dhabi, six months elsewhere Coverage limits Up to Dh250,000, depending on plan Direct billing Yes, at Government hospitals AXA INSURANCE Prenatal cover Yes How long policyholders must be insured before cover kicks in No waiting period in Abu Dhabi, 24 months elsewhere Coverage limits Between Dh25,000 and Dh250,000, depending on plan Direct billing Yes BUPA Prenatal cover Dependent upon plan type How long policyholders must be insured before cover kicks in Nine months Coverage limits Varies depending on plan Direct billing Yes ALLIANCE INSURANCE Prental cover Yes How long policyholders must be insured before cover kicks in Cover is immediate in Abu Dhabi. In other emirates a 12-month waiting period applies Coverage limits Up to Dh250,000 in Abu Dhabi, and between Dh10,000 and Dh250,000 in other emirates, depending on the plan Direct Billing Yes, but a Dh50 ­surcharge applies