When we found out we were pregnant on a January morning, excitement and joy filled our home immediately. We were going to have a baby! But, I must admit that by the end of the first week knowing I was pregnant, I was feeling incredibly overwhelmed with all of the planning, preparing and decisions that we needed to make over the next 9 months. The first being choosing a care provider associated with the hospital or birthing center where we wanted to deliver. One of the most important things to consider early on is where you want to give birth. By first determining this, you can make sure you are receiving prenatal care from providers who deliver at your chosen place. I want to help your feel more prepared to explore options, know what to look for in terms of facilities, and give ideas for questions that I wish I had asked, or at least been on the lookout for during my hospital tours. It is important to explore options in your area to make sure that you will feel confident, comfortable and well-taken care of during your prenatal care, labor and delivery, and postpartum care.
Choosing where to give birth
There are many important factors that should go into deciding where you want to give birth. The first place to start is proximity. While you don’t necessarily need to choose the hospital closest to you on a map, having an idea of where different hospitals, birth centers and women’s health centers are in relation to you will help you narrow down your choices. Once you have determined realistically where and how far you are willing to travel to prenatal appointments, and ultimately for birth, you can start learning more about these places.
Next, you should begin doing some research on the internet. You can explore their websites to get an idea of what their facilities offer in terms of amenities, midwives, doctors, and pain/labor interventions and strategies. When deciding, remember that you are never locked into your choice until you have been admitted for labor and delivery. While receiving prenatal care from the providers associated with your hospital is generally preferred, if you begin to feel uncomfortable or unhappy with your care you can switch at ANY point in your pregnancy. Additionally, because complications may arise or your pregnancy risks may change, it is smart to explore a variety of birthing options so that you can make an educated switch should your personal needs change.
While I hope to provide some helpful advice in terms of your care, you should always consider your own unique needs in making your decision. Some of these include (but are not limited to): pregnancy with multiples, pre-existing conditions or complications, labor earlier than 35 weeks, or if you are considered a high-risk pregnancy for any other reason.
On the flip-side, if you are considered “low-risk” and are not expecting any complications, then this may also influence your decision to maybe choose a smaller hospital, or have less concern with a higher ‘level’ NICU (neo-natal intensive care unit) at your chosen hospital, you can see more about this below.
Be sure to investigate if the hospital or birthing center is going to be able to adequately and safely reach your needs and promote your birth wishes. For example, some hospitals and delivery teams are known for promoting VBAC (vaginal birth after C-section) and others discourage it, some hospitals specialize in births of multiples, etc. Some hospitals are quicker to suggest pain interventions while others have different philosophies. Some hospitals even offer water births should this be what you are looking for.
Usually this information can be found online, and this can be a good source of information to help you narrow down your list and decide where you want to go tour. Additionally, I found it useful to research specific hospital stats while also comparing nationwide stats on the whole for hospitals versus birth centers.
Which stats should you care about?
When you begin to do research about possible birth places the numbers that you want to most pay attention to are rates of various interventions, rates of c-sections in first births as well as repeat births, breastfeeding rates during hospital stays and upon leaving the hospital, and rates of newborns who room-in vs. stay in the nursery. At the bottom of this article you will find a list of resources for websites that will help you look up nationwide hospital statistics such as rates of C-sections by hospital, and a list of search term advice to help you find rates of other interventions and birth stats within hospitals in your specific location.
Choosing Who to Deliver With
Understanding your options when it comes to maternity care and ultimately your delivery begins with the provider that you choose. You will need to decide if you want to deliver with a Certified Nurse Midwife or Doctor.
With N, I decided that I wanted to deliver with a midwife and would absolutely make this decision again if my future pregnancies are considered low-risk. I decided this because my wishes were to deliver with minimal pain interventions (which ultimately did not happen, as you can read more about in my Birth Story), and because I was hoping to build a relationship with the women who would ultimately deliver my baby. This is not to say that I couldn’t have found these things in a doctor, but midwifery care is known for being more individualized, and therefore less ‘standardized’, have longer prenatal visits with more emphasis on discussion, and typically involves the birthing mother and her partner in any decisions necessary throughout the pregnancy and birth. Midwives are known to avoid unnecessary tests and treatments. In fact, women under the care of midwives are less likely to have a cesarean, an episiotomy and other interventions than women receiving care from doctors. (see sources). Midwives often encourage skin-to-skin care, rooming in, and provide more support towards breastfeeding.
In my personal experience, I was receiving care from a midwifery group that included five midwives, and I got to know them all very well by the time I was ready to deliver. This meant that no matter which midwife was on duty when I went to the hospital, I would be greeted with a familiar face who knew us and our birth wishes. For me, this was important. Lastly, midwives will put more emphasis on caring for the “whole” mother, and will be able to spend time talking about and working through psychological concerns and emotions surrounding pregnancy and birth.
Something that one of my midwives explained to me is that prenatal care and pregnancy in general in our country is looked at as a “medical condition” but in most other parts of the world is not viewed this way. Caring for the expecting mother emotionally and psychologically is viewed as equally important as medically in many other countries and cultures, and this is a hallmark of midwifery prenatal care. As an expectant mother you are not ill, and in low-risk pregnancies we can trust our bodies to grow and develop our babies with relatively minimal monitoring,
Delivering with a doctor is not something I can speak about from personal experience, but it can also result in a positive birth and is considered the ‘norm’ for care in the United States, approximately 9 out of 10 births are attended by a doctor. Doctors are necessary for high-risk pregnancies, and also for more specific and specialized medical or birth needs. Doctors will pay very close attention to physical concerns and often will recommend more tests and treatments. These tests will be administered more preemptively, even in a low-risk pregnancy, to make sure there are no problems. If you are someone who has high anxiety, or likes to feel in control then maybe this type of care would be beneficial to you, even if you do not have a high-risk pregnancy.
Hospital Maternity Units
Hospital deliveries account for 98% of births across the United States, and is a must for women with high-risk pregnancies. You can deliver with a doctor OR a certified nurse midwife. 92% of hospital deliveries are done by a doctor and around 7% are by midwives (see resources). The benefits of delivering in a hospital are the medical staff at your disposal should complications arise, and the options for medical interventions such as an epidural, which cannot be administered in a birth center. There is also a lower chance of needing to be moved to a different facility in the event of complications, which may occur at a birth center, and a lower chance of being separated from baby after birth should the baby suffer any complications. The exception to this would be if you need a highly specialized doctor or if the hospital that you choose to deliver in does not have a high enough level NICU to care for your newborn baby.
Hospital Nurseries and Neonatal Intensive Care Units (NICU)
Newborn nurseries are leveled from 1-4 with the following descriptions (see sources):
- Level I, Basic newborn care
- This is the nursey care provided to full-term, healthy newborns. They are also able to stabilize newborns who may need to be moved for more advanced care.
- Level II, Advanced newborn care
- Equipped to care for babies born at least 32 weeks, or newborns with some more serious conditions
- Level III, Subspecialty newborn care
- “Level 3 NICUs care for babies born at less than 32 weeks gestation as well as babies born with critical illness, at all gestational ages. These facilities offer prompt and readily available access to a full range of pediatric medical subspecialities. They also offer a full range of respiratory support and perform advanced imaging.”
- Level IV, Highest level of newborn care
- “Level 4 NICUs provided the highest level, the most acute care. These nurseries are located in a hospital that can provide surgical repair of complex congenital or acquired conditions. These facilities have a full range of pediatric medical and surgical subspecialities as well as pediatric anesthesiologists on site. Level IV NICUs also facilitate transport and provide education outreach.”
If you have a high-risk pregnancy, it will be mandatory to delivery at a hospital with a Level 3 or Level 4 NICU. If you are concerned about being separated from your baby, even with a low-risk pregnancy, then delivering at a hospital with at least a level 3 NICU will mean that the odds of being separated from baby will be extremely low. The care needed from a level 4 NICU would most likely be something you would know about prior to birth.
This was something that weighed heavily on my decision about where to give birth. I ultimately did not choose the hospital with the highest level of NICU in proximity to my home, and was fortunate that nothing went wrong. Because my pregnancy was low-risk and because of my knowledge of my own pregnancy, the benefits of a smaller, quieter hospital, which only had a level 2 nursery, outweighed the risks involved. I researched my options with my husband and we decided that given everything we knew about my pregnancy and the likelihood of us needing a level 3 or 4 NICU, we felt comfortable with our choice. However, had N suffered complications from pooping while still inside of me (see my Birth Story for more details), she would have been moved to the bigger hospital close by to receive care from a higher level NICU and we would have been separated. To be honest, I think I will still opt to deliver my future children at our smaller, local hospital, but I wanted to share my experience to help you better understand and inform your own decision.
In-Hospital Birthing Centers
Everything mentioned about birthing in a hospital is true for an in-hospital birth center as well. What is different is that an in-hospital birth center will have a more “home-like” feel. This means that it will have things like decorations, soft lighting and lamps, wallpaper or neutral colors on the walls. There may be more furniture, sofas, rocking chairs, tables etc. An in-hospital birthing center will not necessarily be less likely to provide interventions or have the lower intervention and cesarean rates associated with free-standing birth centers. I delivered at an in-hospital birthing center. The benefit for me was that I was able to receive medical interventions I would not have been afforded at a free-standing birthing center. My birth also would have likely been moved to a hospital had I started at a free-standing birth center because N pooped in utero. An in-hospital birthing center is a nice in-between because should any complications arise, you will not have to re-locate and may not need to be separated from baby.
Free-standing birth centers are less common in the United States, but their popularity is rising and more and more of these facilities are becoming available. Of the 1.2% of births that happen outside of a hospital, around 28% of these births are in a birth center. Birth centers offer an in-home feel, but offer more support and a feeling of safety that you may not feel in your own home. They almost exclusively deliver with midwives which means that care is more individualized rather than standardized, which results in fewer interventions, and relies more on the woman and natural labor practices. Drawbacks to delivering in a birth center is the need to switch to hospitalized care due to any unforeseen complications during labor, delivery, or in your newborn. There is also no access to certain pain interventions such as epidurals and nitrous oxide.
Looking for more information about pain management options, interventions and creating a birth plan in order to inform your decision about where to birth? You can find that and more in Trina’s informative 3 Part Birth Plan article.
What to look for and ask about on your tour
One of the best things you can do when making your decision is taking an in-person tour of birthing options near your home. During a tour you will get a feel for the hospital or center. Things to consider is how busy the floor seems, does it feel homey or more clinical, and which environment will make you feel most comfortable. Do the people on the floor seem positive and uplifting, busy and stressed, informed and willing to answer questions? Do you get a sense of communication and team work? This is the sign that the floor works well together and information will not slip through the cracks during shift changes or between nurses, midwives and O.B.s. Whether the floor looks shiny and fancy is not all that important, what’s really going to make for a great birth experience is the overall culture of the birthing facility. What is your general impression?
If the tour does not include this, then definitely ask to see labor rooms, delivery rooms and postpartum rooms. You want to be able to envision yourself in all aspects of your birth. When you see the labor and delivery rooms look for and ask about things like birthing balls, hydro-therapy showers, laboring tubs, labor ‘bars’, room to walk around, and a place for your partner to be. Think about the feel of the room. Ask if the lighting can be dimmed and if you will have control over the thermostat. Is there Wi-fi and plenty of outlets for music and charging? Does the room include a fridge to keep cold beverages and snacks for your partner?
When you see the postpartum room consider how your partner will fit into your recovery and learning about how to care for your new baby. Some places have postpartum rooms with double or queen-sized beds. This probably indicates more emphasis on including the partner in the post-birth care of your newborn. Some hospitals promote and emphasize having your newborn room-in and others put more emphasis on their nursery. Is there a nursing chair in the room? A bedside or easily accessible sleep space for baby? Do they have different nursing pillow options on hand to help you get the best start to breastfeeding? What are the pillows and blankets like? These are all legitimate things to consider because you want to be set up for success and know what you need to bring. You need to think about what feels important to you. Another good thing to ask is if the postpartum care room is different should you be recovering from a c-section or vaginal birth. It is important to be able to envision yourself in either space should your birth not go as planned.
Next, make sure that you ask about support staff, supplies, meals and hospital visitor policies. Find out about the lactation consultants on staff and how often they make their rounds. Will visits with the lactation consultants be covered under your postpartum stay or be billed separately to insurance (this is something to consider taking up with the insurance company). Ask what the hospital will supply. Most hospitals provide receiving blankets, diapers and wipes for baby, samples of other baby products, and petroleum jelly ointments. Hospitals will also usually provide postpartum care supplies such as postpartum pads, witch hazel pads, ice packs, and lanolin nipple creams. It is a good idea to ask so that you know what to bring and what you can expect to have access to there, although I still always recommend bringing your own preferred products, just in case.
What about food?
Another important thing to understand is the meal policy and what is covered under insurance so that you know if your partner will need to bring food. Usually the post-partum care only includes meals for the mother, but some hospitals offer a celebratory ‘dinner’ which includes a meal for both parents. You want to have an idea of when visiting hours are, policies about who can stay over in the room, policies about older siblings and outside food as well. For example, the hospital that we stayed in prohibited older siblings from staying over in the hospital, but had open visitor hours until late into the night. These are all important things to know about for planning and preparing purposes and things that may influence your ultimate decision if you are down to two choices
As I mentioned above, but is worth re-stating, you want to find out about the general philosophies and affiliations the hospital has in terms of newborn care, interventions and birth philosophies. For example, some hospitals may routinely practice skin-to-skin while others you will need to be more vocal about your wishes.
Talk to Other Mothers
I found it really helpful to talk to mothers and maternity care providers in my community about my options. If you are involved in a pre-natal yoga or fitness class, find women who are already mothers and ask them about their experiences or even ask the instructor what she knows about different facilities near you. Talk to pediatricians or pediatric nurses about the hospitals that they have worked with or what they have heard. Ask family members and friends who have given birth about their experiences in various settings. Even if the other moms in your life didn’t necessarily birth in your community they may be able to help you decide to deliver with a doctor or midwife, at a hospital or birth center, or help you decide what level of nursery care makes you feel most comfortable. Hearing the stories of other people can always help you better understand your choices. Definitely read my birth story and Trina’s birth story as a reference point too!
With this guide, you are ready to make an informed decision about the best place for your unique and special birth. You are now equipped with foundational knowledge about your provider and location options. Your next steps are to look at choices near your home, research and then visit these places. If you have any questions or need help with any step of the process, please comment below!
As you are deciding where to give birth and slowly starting to prepare for your baby’s arrival, remember that it is never too early to think about a childbirth class. I wish that I had known about the variety of online childbirth classes that exist! Part of the beauty is that you can start them at any point in your pregnancy and revisit closer to your due date. By doing classes online, you don’t have to worry about scheduling or making sure you and your partner can attend. For a class geared for couples, I recommend this Online Prenatal Class for Couples created by a labor and delivery nurse. To make sure dad is prepared check out Supporting Her, the labor class just for dads. If your goal is to have a natural childbirth, definitely learn more about hypnobirthing and take the Hypnobubs Online Hypnobirthing Class. For more information, and to read my full reviews, you can head to my article all about Online Childbirth Classes.
If you want to read more about my experience birthing at an in-hospital birth center with a midwife, which includes information about hospital pain interventions, you can read My Birth Story. For another midwife birth story and additional information read Trina’s Birth Story. You may also find it helpful to read Trina’s article about creating a birth plan before choosing where to give birth.
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Resources For You
- Hospital Compare:
- Government website with over 4,000 hospitals stats on early-elective delivery rates
- Why Not The Best:
- Allows you to compare hospitals in your area and see rates of c-sections in first births, births after c-sections, and total c-sections rates. Just choose the “inpatient quality indicators – maternity” as your category
- You can also usually find state-specific data bases, and even region-specific databases that will compare rates of c-sections, breastfeeding rates, VBACS, episiotomies and more. Try searching for:
- State Name birth data
- State Name hospital birth comparisons
- State Name hospital birth statistics
- Childbirth Connection:
- This website is full of great information about maternity care, where to give birth, providers, and more.