There was a lot of effort, planning, and training that goes into making sure that there aren't any complications. Not to mention the fact that even routine procedures can have unexpected complications that have to be planned for and addressed. I think that $38k for a surgical procedure with post-operative care for the mother and child isn't necessarily that outrageous. Just imagine the people, training, facilities, etc...

EDIT: Now that I'm thinking about it -- was the $38k bill with or without insurance? Meaning, was this their out of pocket costs with insurance? If so, that does seem rather unreasonable. If that was the billed rate for the insurance company and your friend's out of pocket costs were lower, that would make more sense.

I wonder how much of this is due to the repeal of the individual mandate, which Wikipedia says takes effect this year.