Tessa Quinn
Choosing a hospital to give birth in is an important decision that can greatly influence how comfortable your birthing process will be. While many factors can influence your decision, such as insurance coverage, location, and accessibility, it is also crucial to consider your specific needs and preferences. This may include the availability of pain management options, such as nitrous oxide or epidurals, the presence of a neonatal intensive care unit (NICU), and the hospital's policies on electronic fetal monitoring and support people during labour and delivery. It is also worth researching each facility's maternal and fetal outcomes, including C-section rates, early elective delivery rates, and episiotomy rates. By carefully considering these factors, you can make an informed decision about which hospital will provide you with the safest and most positive birthing experience.
| Characteristics | Values |
|---|---|
| Travel distance from home | In general, the distance between your home and the hospital has no effect on birth outcomes, but it shouldn't be so far that you're worrying about traffic when you go into labor. |
| Insurance coverage | Choose a hospital with doctors who take your insurance, as what gets covered in and out of network can vary. |
| Facilities for high-risk pregnancies | If you have a high-risk pregnancy, consider whether the hospital has a blood bank, an ICU, or an NICU. |
| Cesarean section rates | Ask for the NTSV C-section rate, which refers to first-time mothers with a single full-term baby in a headfirst position. |
| Early elective delivery rates | Hospitals must report early elective deliveries (performing C-sections or inducing labor before 39 weeks without medical necessity). A high rate is a red flag. |
| Amenities | Amenities that make a difference include pain services, neonatal intensive care units, and clinical excellence status. |
| Alternative pain management | Not all facilities offer alternatives like water therapy and nitrous oxide. |
| Group prenatal care | Group prenatal care programs allow expectant mothers to receive prenatal education and social support with their peers. |
| Maternal and fetal outcomes | Research each facility's maternal and fetal outcomes, including C-section, early elective delivery, and episiotomy rates. |
| Anesthesiologist availability | Ask whether there is an anesthesiologist on duty in the birthing unit or if they are on call. |
| Nurse-to-patient ratio | "One nurse per two women during early labor and one nurse per woman in the pushing stage of labor is ideal," says Angela Washer, APRN-CNP. |
| Teaching hospital status | Ask whether medical students or residents will attend your birth, and if you can opt out if you are uncomfortable with this. |
| Electronic fetal monitoring policy | Ask about the hospital's policy on the use of electronic fetal monitoring and the required length of time. |
| Neonatologists on staff | Neonatologists can help if there are any complications. |
| Labor, delivery, and recovery in one suite | Some women prefer to stay in one room for their entire stay. |
| Birthing tools | Ask whether birthing tools like balls, bars, or chairs are available. |
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What You'll Learn
Location and accessibility
When choosing a hospital for pregnancy, location and accessibility are key factors to consider. While the distance between your home and the hospital generally has no effect on birth outcomes, you wouldn't want the hospital to be so far away that you're worried about traffic when you're in labour. As Sarah Little, a maternal-fetal medicine specialist, says, "birth is mostly local. Most people are choosing hospitals nearby."
It's important to consider whether the hospital is within a reasonable driving distance and whether it's the closest hospital to your home. You should also check whether the hospital is in your insurance network and whether your doctor has admitting privileges there. If you have a specific doctor or midwife in mind, choosing them will likely determine which hospital you give birth at.
If you have a high-risk pregnancy or a planned C-section, it's recommended that you plan a hospital birth. Hospitals provide a safety net in case you need additional care, and you'll have access to emergency services and specialists such as neonatologists and lactation consultants. They also offer the most options for pain management, including nitrous oxide, IV pain medication, and epidurals.
If you're considering a birthing centre, be sure to research the staff's credentials. While rare, problems during labour and delivery can arise, so you'll want to ensure you can get the best care possible. Birthing centres are usually located near a hospital and are run by certified nurse-midwives or doctors.
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Insurance coverage
When it comes to insurance coverage, there are a few key things to keep in mind when choosing a hospital while pregnant. Firstly, it is important to understand that pregnancy is considered a pre-existing condition, and as per the Affordable Care Act (ACA), insurance companies cannot deny you coverage or charge you more due to a pre-existing condition. This means that you can be pregnant when signing up for health insurance, and they cannot increase your premium based on your health condition.
Secondly, you should review your health plan's summary of benefits to understand what services are covered and what your costs will be. Each plan has a summary that outlines the expected costs of pregnancy care, making it easy to compare costs and services across different plans. Pay close attention to specific services you require, such as labour and delivery services in your chosen setting, whether that be a birthing centre, at home, or in a hospital. Additionally, consider whether you require a private room during delivery, as this may impact your costs.
It is also important to note that your insurance plan will likely only cover preventive services in full and at no cost if you use in-network providers. This includes obstetricians, hospitals, and paediatricians that participate in your plan. Using out-of-network providers may result in higher out-of-pocket costs. Therefore, it is recommended to contact the doctor's offices directly to confirm whether they are in your insurance network.
Furthermore, consider supplemental maternity insurance, which pays you directly instead of a healthcare provider. This type of insurance usually needs to be purchased before becoming pregnant and can provide additional coverage beyond a normal health insurance policy. Short-term disability insurance can replace a mother's income during maternity leave, while hospital indemnity insurance pays a fixed amount per day during a hospital stay.
Lastly, remember that your financial situation will play a role in choosing the right insurance plan. If you have significant savings, you may opt for a high-deductible plan, resulting in lower monthly rates but higher healthcare costs. On the other hand, if you have a lower income, you may qualify for Medicaid or the Children's Health Insurance Program (CHIP), which offer free or low-cost coverage to millions of Americans, including pregnant women.
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Facilities for high-risk pregnancies
When choosing a hospital for a high-risk pregnancy, it is important to consider the facilities available to accommodate a worst-case scenario. While most pregnancies end with a healthy baby, high-risk pregnancies require close monitoring to reduce the chance of complications.
Firstly, consider the location and accessibility of the hospital. While the distance between your home and the hospital generally has no effect on birth outcomes, you don't want the hospital to be so far away that you're worrying about traffic when the baby is on the way. It may be advisable to choose the nearest maternity hospital, especially if your pregnancy is high-risk.
Secondly, research the hospital's amenities and clinical excellence status. Ask about pain services, such as epidurals, nitrous oxide, oral medications, and alternative pain management options like water therapy. Inquire about the availability of a Neonatal Intensive Care Unit (NICU), an Intensive Care Unit (ICU), and a blood bank. Check if the hospital has perinatologists or neonatologists on staff, and if they offer group prenatal care programs.
Thirdly, inquire about the hospital's policies and procedures. Ask about their C-section, early elective delivery, and episiotomy rates, especially for low-risk pregnancies. Find out if they have an anesthesiologist on duty in the birthing unit or if they are on call. Understand the nurse-to-patient ratio, and whether medical students or residents will attend your birth.
Lastly, consider choosing a hospital where your doctor has admitting privileges, as this will determine where you can go if you want that doctor to assist in your delivery. You may also want to ensure the hospital provides a comforting and supportive environment, with designated areas for natural childbirth, in-house lactation specialists, and accommodation for your spouse to spend the night.
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Pain management options
When choosing a hospital for pregnancy, it is important to consider your pain management options. It is recommended that you discuss your pain relief options with your obstetrician-gynecologist (ob-gyn) during one of your prenatal care visits. You can also take a childbirth education class to learn more about your options.
There are several pain management options available to women during pregnancy and childbirth. These can be pharmacological or non-pharmacological. Pharmacological treatments include opioids, which are drugs that decrease the ability to feel pain. While opioids are commonly prescribed, they have been associated with an increased risk of death from overdose. Other pharmacological treatments include systemic analgesia, which provides pain relief over the entire body without causing loss of consciousness, and regional analgesia, which relieves pain in a specific region of the body. Regional anesthesia, which blocks sensation in a specific region of the body, is also an option. This includes epidural anesthesia, which involves placing a needle in the lower back to allow a catheter to be passed through to the epidural space, providing a continuous infusion of local anesthetic and narcotic medication.
Non-pharmacological treatments include acupuncture, behavioural and relaxation exercises, and water therapy. Nitrous oxide, or laughing gas, is another option. It is inhaled through a hand-held mask and helps to dull the pain and reduce anxiety. It can be used once or continuously during labor. Local anesthesia is also used to prevent pain in a small area of the body, such as when an episiotomy needs to be performed or when tissues need to be repaired after childbirth.
It is important to consider the potential side effects and risks of each pain management option. For example, local anesthesia can rarely cause an allergic reaction or nerve or heart problems if the dose is too high. Nitrous oxide may cause dizziness or nausea, but these sensations are usually temporary. It is also important to consider any medical conditions that may affect your pain relief options, such as heart disease, blood disorders, liver disease, or previous spinal surgery.
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Healthcare provider
When choosing a healthcare provider for pregnancy and childbirth, there are several options to consider. An obstetrician, often referred to as an OB-GYN, is a doctor who specialises in birth and women's medical and surgical care. A maternal-fetal specialist is an OB-GYN with additional training to handle more complicated pregnancies and births, and they are also known as perinatologists. A gynecologist is also an OB-GYN, but they usually focus on gynecology, including cancer screenings and treating health issues like urinary tract infections and fertility concerns.
Midwives are another option. They are registered nurses with a master's degree in nursing, and they provide comprehensive maternity care from prenatal visits through labour, delivery, and post-birth. Birthing centres are often run by certified nurse-midwives or doctors, and they usually offer natural, holistic approaches to childbirth. However, in the event of complications, hospitals provide a safety net with access to advanced technology and emergency services.
When choosing a healthcare provider, it is essential to consider your specific needs and preferences. Research the hospital's policies and approach to birth to ensure they align with your birth plan. Ask about pain relief options, the nurse-to-patient ratio, the availability of an anesthesiologist, and whether medical students or residents will attend your birth. If you have a high-risk pregnancy or prefer a specific doctor, you may want to opt for a hospital birth.
It is also worth noting that your insurance provider may influence your choice of healthcare provider and hospital. Your insurance coverage may dictate the doctors and hospitals available to you, so consider staying "in-network" to reduce out-of-pocket expenses.
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Frequently asked questions
The first step is to narrow down facilities based on location and accessibility. Then, consider the following:
- Insurance coverage: Find out which hospitals are covered by your insurance plan.
- Doctor's admitting privileges: Your doctor must have admitting privileges to the hospital.
- Amenities: Consider amenities that are important to you, such as pain services, neonatal intensive care units (NICU), and group prenatal care.
- Maternal and fetal outcomes: Research the hospital's rates of C-sections, early elective deliveries, and episiotomies.
- Birthing options: Decide if you prefer a hospital, birthing center, or home birth.
When choosing a hospital for pregnancy, consider amenities such as pain services, neonatal intensive care units (NICU), and group prenatal care. Pain services may include epidurals, nitrous oxide, oral medications, guided meditation, aromatherapy, and tools like peanut balls. NICUs are important if you have a high-risk pregnancy or prefer alternative pain management options like water therapy. Group prenatal care programs provide prenatal education, social support, and physical checkups.
Here are some important questions to ask:
- What are the hospital's policies on continuous electronic fetal monitoring, routine IVs, and pain relief options?
- How many support people are allowed in the labor and birth room?
- What are the nurse-to-patient ratios?
- Is the hospital a teaching hospital, and can I limit student attendance if I'm uncomfortable?
- Does the hospital have perinatologists or neonatologists on staff?
