If you’re in the early stages of pregnancy or considering getting pregnant, chances are you’re already starting to consider where you want to deliver your baby.
You’re sifting through search results online long before you’re packing your hospital bag, but it’s hard to tell what you’ll need. The photos look charming, but which facility is going to respect your labor choices? They have excellent patient reviews on their front page, but which one is the safest?
Here are some tips on how to narrow down your search and, ultimately, how to choose a maternity hospital that suits your needs.
[READ: Exercising During Pregnancy]
Location and Accessibility
When choosing a maternity hospital, the first step is to narrow down facilities based on location and accessibility.
Here are some questions to ask yourself:
— Which facilities are in my immediate geographical location?
— Is my pregnancy high risk enough that I should only consider care at the nearest maternity hospital?
— Does my birth provider have privileges at multiple maternity hospitals or only one?
— Which hospitals accept my insurance plan and are in network?
[READ What Is Advanced Maternal Age?]
Hospital Facilities and Amenities
While many hospitals may look picture perfect online, it’s important to remember that not all hospital amenities are created equal.
According to Dr. Kecia Gaither, a double board-certified OB-GYN and maternal-fetal medicine provider, amenities that make a difference include:
— Pain services, such as epidurals, nitrous oxide (laughing gas), oral medications, guided meditation, aromatherapy and tools, like peanut balls.
— Neonatal intensive care unit (NICU) availability.
— Clinical excellence status.
Some amenities that aren’t worth it and may come with large price tags include:
— Private chef-prepared food.
— XM satellite radio.
— Manicures and/or pedicures.
— Concierge services to help with ancillary tasks, like arranging newborn photography or gifts.
[READ: 7 Things to Know About Home Pregnancy Testing.]
Medical Staff and Expertise
Where you deliver your baby is closely tied to your maternity care provider.
“People are usually going to make that decision based on their first finding a physician or midwife they feel that they connect with,” explains Dr. Jennifer Frink, an OB-GYN and medical director of Ascension Maternal Health Service Line and Ascension Michigan Women’s Health Service Line in Kalamazoo, Michigan.
Deciding who will be providing your care is as important as where you’re getting your care.
“You want to have a team of professionals that, once they listen to those things, are going to give you some options that are medically appropriate for you,” Frink adds. “Oftentimes, that provider will have different hospitals where they practice as options.”
Items to address about your maternity hospital and care team include:
— Does the facility have maternal-fetal medicine specialists or perinatologists (doctors who are specially trained in high-risk pregnancies)? These specialists deal exclusively with anomalies or other high-risk issues in pregnancy and delivery, Gaither says. If you are at high risk due to gestational diabetes, preeclampsia or any other known issue, you’ll have peace of mind knowing specialty care is on-site.
— Does the hospital offer alternative labor and delivery experiences? Alternative birth practices include access to midwives, water birth and delivering in various birth positions, such as hands and knees. They may also include alternative pain management options, such as water therapy and nitrous oxide. Not all facilities offer these alternatives, so you’ll want to check with the hospital if these are services you’re interested in using.
— Do they have group prenatal care? Group prenatal care programs, such as CenteringPregnancy, allow expectant mothers at similar stages of their pregnancy to receive prenatal education and social support with their peers, along with one-on-one physical checkups. Emerging research, like a study in the January 2019 Journal of Women’s Health, suggests that group prenatal care is associated with a lower risk of having a preterm birth or having a baby with low birth weight.
Maternity Services and Procedures
When choosing a maternity hospital, you’ll want to research each facility’s maternal and fetal outcomes, including cesarean section, early elective delivery and episiotomy rates.
Because public data on these metrics are increasingly available from individual maternity hospitals and statewide websites, you should be able to collect this information. However, if you can’t find it, ask your OB-GYN for more information about the hospitals in your area. U.S. News also provides ratings on maternity hospitals based on these metrics.
C-section rate
It’s important to look at a hospital’s C-section rate and compare it with other facilities in the region.
To gauge hospital quality, ask your doctor or use the Centers for Disease Control and Prevention’s Cesarean Delivery Rate by State online tool.
Here is why the C-section rate matters:
— C-sections are a major surgery and have more risks than a vaginal delivery. These risks can include maternal bleeding or respiratory difficulty for newborns.
— C-sections require longer maternal recovery time by at least a few weeks compared with vaginal deliveries.
— Data shows that a facility, not just individual physicians, drives C-section rates. The maternity hospital you choose may impact the odds of you needing a C-section. Individual facility protocols, as well as how well-equipped the hospital is to manage higher-risk vaginal deliveries, can influence these chances.
— If you’ve had a previous C-section, your provider should still discuss the risks and benefits of attempting to deliver vaginally with a subsequent pregnancy, known as a trial of labor after cesarean, or TOLAC. When it results in a successful delivery, it’s called a vaginal birth after cesarean, or VBAC.
Keep in mind that high-risk academic centers, also known as teaching hospitals, often have a higher C-section rate because they have more high-risk deliveries and multiple births. To get a better idea of the C-section rate for low-risk pregnancies, ask for the NTSV C-section rate, which stands for nulliparous, term, singleton and vertex pregnancies. These terms describe a first-time mother who is only pregnant with one full-term baby in a headfirst position for delivery. In other words, they have fewer risk factors that would typically be associated with a C-section delivery.
Early elective delivery rate
Performing C-sections or inducing labor before 39 weeks of gestation without medical necessity is known as early elective delivery. Hospitals must report these early elective deliveries. A high rate of early elective deliveries is considered a red flag in terms of maternity hospital quality.
“We know that babies that are born before 39 weeks ‘just because’ don’t do as well as babies that are allowed to deliver when their moms go into labor naturally,” Frink says.
She explains that this is because the mother and baby may not be ready to naturally deliver and inducing labor may not be well tolerated.
However, early deliveries aren’t always avoidable, especially if there are complications, like water breaking early or high maternal blood pressure.
“There are plenty of times when there is something going on with the mom or baby, and the safest thing in that setting is to have a delivery,” Frink says. “But there are pretty strict criteria for what those things are. A hospital that stays away from those early elective deliveries values the importance and the safety of physiologic labor.”
Episiotomy rate
An episiotomy is a surgical cut made to the vagina during childbirth to help prevent vaginal tearing. Routine use of episiotomy is not recommended, except when indicated in certain clinical situations, like fetal distress.
“Episiotomies have become something that used to be done routinely and now are very rarely needed,” says Dr. Holly Loudon, chair of obstetrics, gynecology and reproductive science at Mount Sinai West and Mount Sinai Morningside in New York City.
Birthing Experience
The birthing experience is crucial when factoring in how to choose a maternity hospital. Questions to ask your maternity care team about labor and delivery include:
Can I tour a maternity hospital virtually before making a decision?
Before you choose a birthing setting, it’s helpful to get a feel for it first. Many facilities offer both virtual and in-person tours. Although not always necessary, check to see if they have private birthing rooms or suites for some additional space.
What pain control options do you offer, including and beyond epidurals?
When considering your pain management options, be sure to check that an anesthesiologist is readily available to get your epidural quickly. However, it’s also important to ask what other pain management options are offered.
“You may want to know what other options are available for pain control and support during labor, such as nitrous oxide, as well as being able to walk around or use a peanut ball to find a better position,” Loudon says.
Will my birth plan and preferences be considered?
Issues like whether you want to walk around during labor, have access to birthing tubs, wear your own maternity gown or delayed cord clamping may be important to you. Ask the maternity hospital what policies or procedures they have in place for these common birth plan preferences. Ask the hospital how many support people are allowed to be with you, and if a birth doula counts as one of them.
Will I have induced labor? What goes into that decision?
With induced labor, various medications or other methods are used to stimulate contractions instead of waiting for labor to begin on its own. Certain pregnancy complications or medical conditions of the mother may make labor induction necessary or safer.
Does your facility offer VBAC/TOLAC?
If you’re interested in VBAC, ask if the facility allows it.
Because trying to have a VBAC comes with the risk of the C-section scar on the uterus opening, known as uterine rupture, a hospital must be equipped to respond quickly.
“The risk is less than 1% for an average patient undergoing a trial of labor,” says Dr. Julia Cormano, an associate professor of obstetrics, gynecology and reproductive sciences with UC San Diego Health System. “But it can be a very dangerous outcome. It requires an emergency C-section … where people can respond within seconds.”
Do you offer gentle C-sections?
Women who need C-sections may have the option to feel more connected during childbirth. Gentle C-sections, also referred to as family-centered C-sections, is a method of cesarean delivery that aims to foster early interaction and bonding between the mother and newborn by incorporating practices such as immediate skin-to-skin contact and breastfeeding, a calm environment and clear surgical drapes to see the baby.
“It can make the cesarean birth more like a vaginal birth experience and less like an operation,” Loudon says.
Postnatal Support
Don’t end your maternity hospital search after finding a facility that caters to your labor and delivery preferences. Postnatal care is crucial and shouldn’t be overshadowed by labor care, because complications can arise even after a successful labor and delivery. Here are some considerations for choosing a maternity hospital with proper postnatal support.
NICU and emergency capabilities
If it’s likely that your baby will spend some time in neonatal intensive care after delivery or your pregnancy is considered high risk, you might ask:
— Is there an anesthesiologist and pediatrician in the hospital 24/7?
— What is the blood bank’s availability — are transfusions possible around the clock?
— Does your hospital have a neonatal intensive care unit? If so, what level is the NICU? Hospital NICU levels vary — level I, II, III or IV. If your baby requires more advanced NICU treatments, like needing to be on a ventilator and the hospital only has a level I or II NICU, your baby may need to be transferred to a higher acuity hospital. Gaither says if you are aware your baby has a prenatal diagnosis and will be born with a medical condition, then you should be especially cognizant of the NICU services your hospital of choice offers.
— Does the NICU have private rooms? “Increasingly, in new hospitals, rather than the NICU being one giant space, there are individual rooms for these babies so that parents can room in, even once (parents) are discharged from the hospital,” Cormano says. However, this option is still fairly uncommon.
— How often can I see my baby in the NICU? Some facilities may have specific visiting hours. In contrast, other maternity hospitals may offer tech options for parents like real-time, 24/7 video access to their newborns in intensive care.
— How does a hospital handle emergencies during childbirth, and what resources are available? Ask if your baby unexpectedly is in need of NICU care, and the hospital does not have a NICU, where does the baby get transferred to? How does the baby get transferred?
Postpartum care for you and your baby
When considering how to choose a maternity hospital, don’t discount the support you’ll need after labor and delivery.
You may need to ask:
— Does this hospital have a special care nursery? This is a form of step-down care for babies that don’t quite need NICU level of support, but they might need more attention than what a typical postpartum ward could offer. This could include late preterm infants or those with issues with jaundice or low blood sugar.
— 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.
Hospital Reviews and Patient Experiences
Expectant parents should have all the resources and support that they need for a healthy prenatal, delivery and postpartum course in order to properly know how to choose a maternity hospital.
“One of the most important things for a lot of the patients that we serve is: Do they make it easy for me?” Frink says. “Do they find a way to get me the care and that’s convenient for me? Do they acknowledge and respect the history, and sometimes the baggage, I bring in?”
Asking questions like these will help you understand if a facility can meet your individual requirements:
— Does the hospital offer additional resources, like maternal health navigators and community health workers who can help families with available community resources and follow families through their hospital stay?
— Do you have a program that gives car seats or cribs to people in need?
— Do you have transportation options like Lyft or Uber rides, or bus or subway tokens, for my appointments?
— Can you connect me with food programs if needed?
As mentioned, you can look through the U.S. News Maternity Care ratings to find high-performing maternity care near you. These ratings highlight key factors of care for uncomplicated pregnancies. If your pregnancy is complicated or high risk and requires more intensive care, see the Best Hospitals for Neonatology rankings for the care of a high-risk newborn.
More from U.S. News
What Are the Early Signs of Pregnancy?
Pregnancy and Body Image in a Post-Roe World
A Patient’s Guide to Pregnancy Insomnia
How to Choose a Maternity Hospital originally appeared on usnews.com
Update 11/09/23: This story was previously published at an earlier date and has been updated with new information.
