How to choose a Maternity Hospital
Why Shop for a Maternity Hospital?
Naturally, it matters who your doctor is. However, your OB might not even deliver your baby, depending on their on-call schedule. Someone you've never met before may be the other physician in the practice or even an ob-gyn who just so happens to be working at the maternity hospital the night you go into labor.
Apart from the medical professional handling your delivery, the environment you choose can have a big impact on how comfortable the entire experience is for you. After all, you'll be attended to by hospital staff most of the time, even if your OB is able to rush in at the last minute to deliver the baby. A cozy and encouraging setting make labor and delivery—as well as the healing process, which is physically tiring as well—much more enjoyable.
More significantly, current data indicates that rates of cesarean sections differ significantly between states, cities, and even individual hospitals within a state. Furthermore, whether or not you give delivery vaginally may depend on the maternity hospital you select.
Your doctor must be admitted to the hospital with admitting privileges in order to deliver your child there; otherwise, they are unable to deliver babies at any hospital of your choosing. Therefore, it is sense to make sure that the maternity facility that feels suitable to you is affiliated with your present ob-gyn. If that's not the case, you might want to hunt for a new OB who practices in a hospital that does.
How to Draw Up a List of Maternity Hospital Contenders
The best time to start shopping is always now. Individuals may begin considering prior to becoming pregnant. Naturally, most women won't begin actively searching until they receive a positive pregnancy test result, and that's okay too. Finding a healthcare provider, you want to stay with as early in your pregnancy as possible makes sense, even if you can change doctors at any time. This implies that you must also choose your preferred maternity hospital as soon as feasible.
What to Look for on the Maternity Hospital Tour
Location and Accessibility
The first step in selecting a maternity hospital is to make a list of facilities and sort them according to accessibility and location.
Consider the following inquiries for yourself:
- Which amenities are located in the same geographic area as me?
- Is the risk of my pregnancy so great that I should only think about receiving care at the closest maternity hospital?
- Does my birth attendant work at more than one maternity hospital, or only one?
- Which hospitals are in network and accept my health plan?
Hospital Facilities and Amenities
It's crucial to keep in mind that not all hospital amenities are the same, even though many hospitals may appear ideal on the internet.
- Pain services like epidurals, nitrous oxide (laughing gas), oral drugs, guided meditation, aromatherapy, and instruments like peanut balls are examples of amenities that are beneficial.
- Availability of the neonatal intensive care unit (NICU).
- status for clinical excellence.
The following are some luxuries that aren't worth the money and could be very expensive:
- cuisine cooked by a personal chef.
- satellite radio station XM.
- either pedicures or manicures.
- Concierge services to assist with extra duties, such as setting up presents or newborn photos.
Medical Staff and Expertise
Your maternity care provider and the location of your baby's birth are closely related.
The decision is typically made by the patient once they have found a doctor or midwife with whom they click.
Selecting the caregiver for your needs is just as crucial as deciding on the location of your care.
You want a group of medical experts that will listen to you and then provide you with solutions that are suitable for your particular situation. That supplier frequently offers a variety of hospitals where they are affiliated.
You should talk about the following with your maternity hospital and care team:
- Does the facility employ perinatologists, or physicians with specialized training in high-risk pregnancies, or maternal-fetal medicine specialists? According to Gaither, these doctors only handle abnormalities or other high-risk problems related to pregnancy and delivery. You will feel more at ease knowing that specialized care is available on-site if you are at high risk because of gestational diabetes, preeclampsia, or any other recognized condition.
- Does the hospital provide different experiences for labor and delivery? Midwives are accessible through alternative birth techniques, which also include giving birth in water and in different postures, like on hands and knees. They might also contain non-pharmacological painkillers like nitrous oxide and water treatment. If these are services, you're interested in using, you should check with the hospital as not all hospitals provide them.
- Do they provide prenatal care in groups? Pregnant women who are in comparable stages of pregnancy might benefit from one-on-one physical checkups, prenatal education, and peer support through group prenatal care programs like Centering Pregnancy.
Maternity Services and Procedures
You should look into the rates of cesarean sections, early elective deliveries, and episiotomies at each maternity hospital before selecting one.
You should be able to gather this data because statewide websites and specific maternity facilities are increasingly providing public data on these measures. Ask your OB-GYN for more details about the hospitals in your area if you are unable to locate it. These parameters are also used by U.S. News to rate maternity hospitals.
C-section rate
Examining a hospital's C-section rate and contrasting it with other local hospitals is crucial.
Consult your physician or use the Cesarean Delivery Rate by State online tool from the Centers for Disease Control and Prevention to determine the quality of a hospital.
This is the significance of the C-section rate:
- Compared to vaginal deliveries, C-sections are more risky surgeries. These hazards may include hemorrhaging in the mother or breathing problems in the infant.
- Compared to vaginal deliveries, C-sections necessitate a few weeks more healing time for the mother.
- Research indicates that C-section rates are determined by a facility rather than by certain doctors. Your chances of requiring a C-section may be affected by the maternity hospital you select. These odds can be affected by certain hospital policies and how prepared the institution is to handle higher-risk vaginal deliveries.
Recall that teaching hospitals, or high-risk academic centers, frequently have higher rates of C-sections due to the increased number of multiple births and high-risk deliveries they see. Ask for the nulliparous, term, singleton, and vertex C-section rate (NTSV C-section rate) to have a better understanding of the C-section rate for low-risk pregnancies. A first-time mother who is carrying a single full-term baby and planning to deliver the infant headfirst is described by these terms. To put it another way, they don't have as many risk factors that are usually connected to C-section deliveries.
Early elective delivery rate
Early elective delivery is defined as performing C-sections or initiating labor before 39 weeks of gestation without a medical necessity. These early elective deliveries must be reported by hospitals. Regarding the caliber of maternity hospitals, a high percentage of early elective deliveries is regarded as a warning sign.
We are aware that babies who are "just because" born before 39 weeks of pregnancy do not fare as well as those who are left to give birth when their mothers naturally go into labor.
She notes that this could be due to the mother and child not being prepared for a natural birth and the possibility that inducing labor won't be properly received.
But sometimes complications, such early water breakage or elevated maternal blood pressure, make early deliveries unavoidable.
"Having a delivery is the safest course of action when a mother or infant is experiencing a problem. This is often the case. However, there are rather rigid standards for defining such items. A hospital that recognizes the value of physiologic labor and its safety will refrain from doing those early elective deliveries.
Episiotomy rate
A surgical incision made to the vagina after childbirth to help prevent vaginal tears is called an episiotomy. Episiotomy should not be used routinely unless it is necessary in certain clinical circumstances, such as fetal distress.
Episiotomies were once a common procedure, but they are now extremely uncommon.
NICU and emergency capabilities
If your pregnancy is deemed high risk or if it seems probable that your baby will require some time in neonatal critical care following delivery, you may wonder:
- Is there a pediatrician and anesthesiologist on staff at the hospital all the time?
- Is it possible to get a transfusion whenever you need one? How accessible is the blood bank?
- Is there a neonatal intensive care unit at your hospital? What level is the NICU, if any? There are different hospital NICU levels: I, II, III, and IV. Your baby could need to be transferred to a higher acuity facility if they require more advanced NICU treatments, such as being on a ventilator, and the hospital only offers a level I or II NICU. Gaither advises parents to be particularly conscious of the NICU services their preferred hospital provides if they are aware that their unborn child has a prenatal diagnosis and will have a medical problem at birth.
- Are there private rooms in the NICU? According to Cormano, "new hospitals are starting to provide individual rooms for these babies instead of the NICU being one big space so that parents can room in, even once (parents) are discharged from the hospital." This choice is still not very frequent, though.
- How often can I see my baby in the NICU? Certain facilities could have set hours for visitors. On the other hand, certain maternity hospitals might provide parents with technological choices such as round-the-clock, real-time video access to their critically ill newborns.
- What resources are available, and how do hospitals address emergencies during childbirth? Inquire as to where your infant is sent if they get suddenly sick and the hospital does not have a NICU. How is the infant moved around?
Postpartum care for you and your baby
Don't undervalue the assistance you'll require following childbirth while deciding which maternity hospital to use.
It might be necessary for you to inquire:
- Is there a special care nursery at this hospital? For babies who don't exactly require NICU-level care but may require more attention than a standard postpartum ward might provide, this is a type of step-down care. Infants born late or with low blood sugar or jaundice may fall under this category.
- What support services does a maternity hospital provide for breastfeeding mothers? Breastfeeding is shown to be optimal for babies, but it’s definitely a learning experience for new mothers. Ask about international board-certified lactation consultants on staff.
- Is this facility baby-friendly? This means that the hospital will have staff trained to troubleshoot difficulties with breastfeeding, allow babies to room in with mothers instead of be sequestered in a newborn nursery and they won't give baby formula samples on behalf of formula manufacturers, which can discourage breastfeeding.
What to ask for on the Maternity Hospital Tour
When selecting a maternity facility, the birthing experience is a major consideration. You should enquire the following concerning labor and delivery from your maternity care team:
Can I tour a maternity hospital virtually before making a decision?
It helps to have a feel for a birthing setting before deciding on one. Numerous establishments provide both online and in-person tours. Look into whether they have private birthing rooms or suites if you need a little extra room, though it's not usually necessary.
What pain control options do you offer, including and beyond epidurals?
When thinking about your pain management options, be sure you have access to an anesthesiologist who can administer your epidural fast. Asking about additional pain management alternatives is crucial, though.
In addition to being able to move around or use a peanut ball to find a better position, you might want to know about additional choices that are available for pain control and support during delivery, such as nitrous oxide.
Will my birth plan and preferences be considered?
You may have certain preferences regarding things like wearing your own maternity gown, having access to birthing baths, being able to move around throughout labor, and delaying the cutting of the cord. Find out from the maternity hospital what guidelines or protocols they have in place for these typical birth plan choices. Find out from the hospital how many caregivers you are permitted to have with you and whether a delivery doula is considered one of them.
Will I have induced labor? What goes into that decision?
Instead of waiting for labor to start naturally, different drugs or other techniques are utilized to induce contractions. Labor induction may be safer or necessary depending on the mother's medical state or certain pregnancy issues.
Does your facility offer VBAC/TOLAC?
Find out if the facility accepts VBAC if that's what interests you.
A hospital has to be prepared to act fast when attempting a VBAC since there is a danger of uterine rupture—a condition where the scar from the C-section tears apart.
For the average patient doing a labor trial, the risk is less than 1%. However, that might be a very harmful result. An emergency C-section is necessary, where personnel can react in a matter of seconds.
Do you offer gentle C-sections?
Feeling more connected during childbirth may be an option for women who require C-sections. Gentle C-sections, also called family-centered C-sections, are a type of cesarean delivery that incorporates breastfeeding and immediate skin-to-skin contact, a calm environment, and clear surgical drapes to allow the mother to see the baby in order to promote early interaction and bonding between the mother and newborn.
It can help the cesarean birth feel less like an operation and more like a vaginal birth.
Look Hospital Reviews and Patient Experiences
To choose a maternity hospital wisely, expectant parents should have access to all the tools and assistance necessary for a successful pregnancy, delivery, and postpartum experience.
For many of the patients we see, one of the most crucial questions is: Do they make it easy for me? Do they manage to get me the care at a time that works well for me? Do they respect and acknowledge the past I bring with me, as well as the baggage at times?
By posing queries such as these, you can determine whether a facility is capable of fulfilling your specific needs:
- Does the hospital provide supplementary resources, such as community health workers and maternal health navigators, who can follow up with families during their hospital stay and assist them with community resources?
- Do you run a program whereby you provide cribs or car seats to those in need?
- For my appointments, do you have any transportation choices like Lyft or Uber rides, or bus or subway tokens?
- If I need it, could you put me in touch with food programs?
As previously noted, you can locate top-notch maternity care in your area by browsing the U.S. News Maternity Care ratings. These rankings emphasize important aspects of care for pregnancies that are not difficult. For information on how to care for a high-risk newborn during a challenging or high-risk pregnancy, view the rankings of the Best Hospitals for Neonatology.
Why Shop for a Maternity Hospital?
Naturally, it matters who your doctor is. However, your OB might not even deliver your baby, depending on their on-call schedule. Someone you've never met before may be the other physician in the practice or even an ob-gyn who just so happens to be working at the maternity hospital the night you go into labor.
Apart from the medical professional handling your delivery, the environment you choose can have a big impact on how comfortable the entire experience is for you. After all, you'll be attended to by hospital staff most of the time, even if your OB is able to rush in at the last minute to deliver the baby. A cozy and encouraging setting make labor and delivery—as well as the healing process, which is physically tiring as well—much more enjoyable.
More significantly, current data indicates that rates of cesarean sections differ significantly between states, cities, and even individual hospitals within a state. Furthermore, whether or not you give delivery vaginally may depend on the maternity hospital you select.
Your doctor must be admitted to the hospital with admitting privileges in order to deliver your child there; otherwise, they are unable to deliver babies at any hospital of your choosing. Therefore, it is sense to make sure that the maternity facility that feels suitable to you is affiliated with your present ob-gyn. If that's not the case, you might want to hunt for a new OB who practices in a hospital that does.
How to Draw Up a List of Maternity Hospital Contenders
The best time to start shopping is always now. Individuals may begin considering prior to becoming pregnant. Naturally, most women won't begin actively searching until they receive a positive pregnancy test result, and that's okay too. Finding a healthcare provider, you want to stay with as early in your pregnancy as possible makes sense, even if you can change doctors at any time. This implies that you must also choose your preferred maternity hospital as soon as feasible.
What to Look for on the Maternity Hospital Tour
Location and Accessibility
The first step in selecting a maternity hospital is to make a list of facilities and sort them according to accessibility and location.
Consider the following inquiries for yourself:
- Which amenities are located in the same geographic area as me?
- Is the risk of my pregnancy so great that I should only think about receiving care at the closest maternity hospital?
- Does my birth attendant work at more than one maternity hospital, or only one?
- Which hospitals are in network and accept my health plan?
Hospital Facilities and Amenities
It's crucial to keep in mind that not all hospital amenities are the same, even though many hospitals may appear ideal on the internet.
- Pain services like epidurals, nitrous oxide (laughing gas), oral drugs, guided meditation, aromatherapy, and instruments like peanut balls are examples of amenities that are beneficial.
- Availability of the neonatal intensive care unit (NICU).
- status for clinical excellence.
The following are some luxuries that aren't worth the money and could be very expensive:
- cuisine cooked by a personal chef.
- satellite radio station XM.
- either pedicures or manicures.
- Concierge services to assist with extra duties, such as setting up presents or newborn photos.
Medical Staff and Expertise
Your maternity care provider and the location of your baby's birth are closely related.
The decision is typically made by the patient once they have found a doctor or midwife with whom they click.
Selecting the caregiver for your needs is just as crucial as deciding on the location of your care.
You want a group of medical experts that will listen to you and then provide you with solutions that are suitable for your particular situation. That supplier frequently offers a variety of hospitals where they are affiliated.
You should talk about the following with your maternity hospital and care team:
- Does the facility employ perinatologists, or physicians with specialized training in high-risk pregnancies, or maternal-fetal medicine specialists? According to Gaither, these doctors only handle abnormalities or other high-risk problems related to pregnancy and delivery. You will feel more at ease knowing that specialized care is available on-site if you are at high risk because of gestational diabetes, preeclampsia, or any other recognized condition.
- Does the hospital provide different experiences for labor and delivery? Midwives are accessible through alternative birth techniques, which also include giving birth in water and in different postures, like on hands and knees. They might also contain non-pharmacological painkillers like nitrous oxide and water treatment. If these are services, you're interested in using, you should check with the hospital as not all hospitals provide them.
- Do they provide prenatal care in groups? Pregnant women who are in comparable stages of pregnancy might benefit from one-on-one physical checkups, prenatal education, and peer support through group prenatal care programs like Centering Pregnancy.
Maternity Services and Procedures
You should look into the rates of cesarean sections, early elective deliveries, and episiotomies at each maternity hospital before selecting one.
You should be able to gather this data because statewide websites and specific maternity facilities are increasingly providing public data on these measures. Ask your OB-GYN for more details about the hospitals in your area if you are unable to locate it. These parameters are also used by U.S. News to rate maternity hospitals.
C-section rate
Examining a hospital's C-section rate and contrasting it with other local hospitals is crucial.
Consult your physician or use the Cesarean Delivery Rate by State online tool from the Centers for Disease Control and Prevention to determine the quality of a hospital.
This is the significance of the C-section rate:
- Compared to vaginal deliveries, C-sections are more risky surgeries. These hazards may include hemorrhaging in the mother or breathing problems in the infant.
- Compared to vaginal deliveries, C-sections necessitate a few weeks more healing time for the mother.
- Research indicates that C-section rates are determined by a facility rather than by certain doctors. Your chances of requiring a C-section may be affected by the maternity hospital you select. These odds can be affected by certain hospital policies and how prepared the institution is to handle higher-risk vaginal deliveries.
Recall that teaching hospitals, or high-risk academic centers, frequently have higher rates of C-sections due to the increased number of multiple births and high-risk deliveries they see. Ask for the nulliparous, term, singleton, and vertex C-section rate (NTSV C-section rate) to have a better understanding of the C-section rate for low-risk pregnancies. A first-time mother who is carrying a single full-term baby and planning to deliver the infant headfirst is described by these terms. To put it another way, they don't have as many risk factors that are usually connected to C-section deliveries.
Early elective delivery rate
Early elective delivery is defined as performing C-sections or initiating labor before 39 weeks of gestation without a medical necessity. These early elective deliveries must be reported by hospitals. Regarding the caliber of maternity hospitals, a high percentage of early elective deliveries is regarded as a warning sign.
We are aware that babies who are "just because" born before 39 weeks of pregnancy do not fare as well as those who are left to give birth when their mothers naturally go into labor.
She notes that this could be due to the mother and child not being prepared for a natural birth and the possibility that inducing labor won't be properly received.
But sometimes complications, such early water breakage or elevated maternal blood pressure, make early deliveries unavoidable.
"Having a delivery is the safest course of action when a mother or infant is experiencing a problem. This is often the case. However, there are rather rigid standards for defining such items. A hospital that recognizes the value of physiologic labor and its safety will refrain from doing those early elective deliveries.
Episiotomy rate
A surgical incision made to the vagina after childbirth to help prevent vaginal tears is called an episiotomy. Episiotomy should not be used routinely unless it is necessary in certain clinical circumstances, such as fetal distress.
Episiotomies were once a common procedure, but they are now extremely uncommon.
NICU and emergency capabilities
If your pregnancy is deemed high risk or if it seems probable that your baby will require some time in neonatal critical care following delivery, you may wonder:
- Is there a pediatrician and anesthesiologist on staff at the hospital all the time?
- Is it possible to get a transfusion whenever you need one? How accessible is the blood bank?
- Is there a neonatal intensive care unit at your hospital? What level is the NICU, if any? There are different hospital NICU levels: I, II, III, and IV. Your baby could need to be transferred to a higher acuity facility if they require more advanced NICU treatments, such as being on a ventilator, and the hospital only offers a level I or II NICU. Gaither advises parents to be particularly conscious of the NICU services their preferred hospital provides if they are aware that their unborn child has a prenatal diagnosis and will have a medical problem at birth.
- Are there private rooms in the NICU? According to Cormano, "new hospitals are starting to provide individual rooms for these babies instead of the NICU being one big space so that parents can room in, even once (parents) are discharged from the hospital." This choice is still not very frequent, though.
- How often can I see my baby in the NICU? Certain facilities could have set hours for visitors. On the other hand, certain maternity hospitals might provide parents with technological choices such as round-the-clock, real-time video access to their critically ill newborns.
- What resources are available, and how do hospitals address emergencies during childbirth? Inquire as to where your infant is sent if they get suddenly sick and the hospital does not have a NICU. How is the infant moved around?
Postpartum care for you and your baby
Don't undervalue the assistance you'll require following childbirth while deciding which maternity hospital to use.
It might be necessary for you to inquire:
- Is there a special care nursery at this hospital? For babies who don't exactly require NICU-level care but may require more attention than a standard postpartum ward might provide, this is a type of step-down care. Infants born late or with low blood sugar or jaundice may fall under this category.
- What support services does a maternity hospital provide for breastfeeding mothers? Breastfeeding is shown to be optimal for babies, but it’s definitely a learning experience for new mothers. Ask about international board-certified lactation consultants on staff.
- Is this facility baby-friendly? This means that the hospital will have staff trained to troubleshoot difficulties with breastfeeding, allow babies to room in with mothers instead of be sequestered in a newborn nursery and they won't give baby formula samples on behalf of formula manufacturers, which can discourage breastfeeding.
What to ask for on the Maternity Hospital Tour
When selecting a maternity facility, the birthing experience is a major consideration. You should enquire the following concerning labor and delivery from your maternity care team:
Can I tour a maternity hospital virtually before making a decision?
It helps to have a feel for a birthing setting before deciding on one. Numerous establishments provide both online and in-person tours. Look into whether they have private birthing rooms or suites if you need a little extra room, though it's not usually necessary.
What pain control options do you offer, including and beyond epidurals?
When thinking about your pain management options, be sure you have access to an anesthesiologist who can administer your epidural fast. Asking about additional pain management alternatives is crucial, though.
In addition to being able to move around or use a peanut ball to find a better position, you might want to know about additional choices that are available for pain control and support during delivery, such as nitrous oxide.
Will my birth plan and preferences be considered?
You may have certain preferences regarding things like wearing your own maternity gown, having access to birthing baths, being able to move around throughout labor, and delaying the cutting of the cord. Find out from the maternity hospital what guidelines or protocols they have in place for these typical birth plan choices. Find out from the hospital how many caregivers you are permitted to have with you and whether a delivery doula is considered one of them.
Will I have induced labor? What goes into that decision?
Instead of waiting for labor to start naturally, different drugs or other techniques are utilized to induce contractions. Labor induction may be safer or necessary depending on the mother's medical state or certain pregnancy issues.
Does your facility offer VBAC/TOLAC?
Find out if the facility accepts VBAC if that's what interests you.
A hospital has to be prepared to act fast when attempting a VBAC since there is a danger of uterine rupture—a condition where the scar from the C-section tears apart.
For the average patient doing a labor trial, the risk is less than 1%. However, that might be a very harmful result. An emergency C-section is necessary, where personnel can react in a matter of seconds.
Do you offer gentle C-sections?
Feeling more connected during childbirth may be an option for women who require C-sections. Gentle C-sections, also called family-centered C-sections, are a type of cesarean delivery that incorporates breastfeeding and immediate skin-to-skin contact, a calm environment, and clear surgical drapes to allow the mother to see the baby in order to promote early interaction and bonding between the mother and newborn.
It can help the cesarean birth feel less like an operation and more like a vaginal birth.
Look Hospital Reviews and Patient Experiences
To choose a maternity hospital wisely, expectant parents should have access to all the tools and assistance necessary for a successful pregnancy, delivery, and postpartum experience.
For many of the patients we see, one of the most crucial questions is: Do they make it easy for me? Do they manage to get me the care at a time that works well for me? Do they respect and acknowledge the past I bring with me, as well as the baggage at times?
By posing queries such as these, you can determine whether a facility is capable of fulfilling your specific needs:
- Does the hospital provide supplementary resources, such as community health workers and maternal health navigators, who can follow up with families during their hospital stay and assist them with community resources?
- Do you run a program whereby you provide cribs or car seats to those in need?
- For my appointments, do you have any transportation choices like Lyft or Uber rides, or bus or subway tokens?
- If I need it, could you put me in touch with food programs?
As previously noted, you can locate top-notch maternity care in your area by browsing the U.S. News Maternity Care ratings. These rankings emphasize important aspects of care for pregnancies that are not difficult. For information on how to care for a high-risk newborn during a challenging or high-risk pregnancy, view the rankings of the Best Hospitals for Neonatology.
