Though it isn’t often given much thought compared to, say, choosing a provider, choosing the location where you give birth is a very important decision. The hospital or birth center you choose can directly impact the quality of your birth experience, as well as postpartum care for you and your newborn. As you develop your birth plan and preferences, you’ll want to make sure you choose a hospital or birth center that meets all of your needs.
Questions to ask
When choosing a birth center or hospital for labor and delivery, there are several factors to consider. You, your partner, and your doula or midwife may find it helpful to address the following questions:
- If you’re seeing a doctor, which hospital are they affiliated with?
- If you’re working with a midwife, where do they have privileges?
- How close is the hospital or birth center from your home?
- How does the affiliated hospital or birth center stack up in terms of key maternal outcomes?
- C-section rates
- Episiotomy rates
- Early elective induction rates
- Rate of emergency and non-emergency transfers
- Which facilities in your region have the highest maternal satisfaction rates?
- Does your pregnancy have special needs that must be met?
- What are the birth locations’ capabilities for caring for preemies or other special-needs babies? How do their NICUs stack up?
- What are their policies around birth preferences like photography, etc.? How many visitors do they allow in the room during the delivery?
- Will they do their best to follow your birth plan?
- What are your options for pain management? Epidural? IV pain meds? Nitrous oxide? Sterile water injections?
- What are the visiting hours, and who can visit?
- Who is allowed to be in the room with you during labor and delivery?
- Do they require IV access in labor?
- Do they allow for intermittent fetal monitoring?
- How do they support physiologic birth? Do they have birth balls, birth bars, birth stools, and aromatherapy? Do they allow for ambulation in labor?
- How often do they recommend vaginal exams in labor?
- Do they support skin-to-skin contact after delivery? Is your hospital baby friendly (i.e., supports skin-to-skin and breastfeeding and trains hospital staff about the importance of early bonding to aid in successful breastfeeding)?
- Do they offer breastfeeding support after delivery?
- Which provider will be present at the birth?
With these questions in mind, you can begin to compile a shortlist of potential hospitals in your area. It may be helpful to start by choosing several hospitals or birthing centers, then narrowing them down until you find the perfect facility for your birth. You can even use our directory to see what others are saying about the hospitals in your area. Think of it as the Yelp for Moms—including birth centers, hospitals, and doulas—where you can see real reviews from moms just like you.
Remember that choosing a hospital for your birth is a decision that shouldn’t be rushed. It’s a team effort, and people like your partner and doula should be involved in the process. As you dig deeper to choose the best hospital for giving birth, consider the following factors:
Insurance coverage
First things first: Who pays for the stay? Childbirth is expensive, which makes health insurance one of the most important aspects of pregnancy for many of us. Though you’re probably familiar with thinking about which providers your plan covers, there may also be some particulars related to the facility you use.
Make sure you’re familiar with your coverage, your deductibles, and other provisions within your plan. Your health insurance provider’s website will be a great resource about coverage, including which hospitals are in your network. If you want to birth somewhere that’s not in your network, you can call that hospital’s billing department for information about out-of-pocket costs. It also might be a good idea to figure out how much of your hospital stay would be covered, in case you need to spend several nights in the maternity ward for postpartum care.
Unfortunately, health law provides no guarantees of access to birthing centers. Although delivering a baby in a birth center tends to be less expensive than more traditional hospital stays, some insurance companies have been slow to catch on to this birth preference. Some insurance carriers are more likely to cover birth centers; in a national survey of birth centers, these insurers included Aetna/US Healthcare, Blue Cross Blue Shield, TriCare, and Humana.
Elective and emergency C-section rates
Similarly, it’s important to review each potential hospital’s rates for elective births and emergency cesarean sections (C-sections). Although there is no “right” way to give birth, a C-section is a major surgery that carries risk of serious complications and prolonged recovery time compared to vaginal birth.
Many experts think that the current C-section rates are too high and that not all are medically necessary. The Leapfrog Group reports that one in three women in the United States give birth via C-section, and that 60 percent of reporting hospitals have a C-section rate that’s deemed “excessive.”
If you choose to have a vaginal birth, there may be certain emergency situations where a C-section becomes necessary, such as a breech birth. However, you can reduce the likelihood of having an unplanned cesarean by selecting a hospital with a lower rate of elective inductions and emergency C-sections. Hospitals with lower rates for these procedures are more likely to pursue other alternatives first, rather than rushing to surgery.
Per the Leapfrog Group, look for a C-section rate of 23.9 percent or lower. If your birth location has a rate that’s higher than that, you might want to ask deeper questions about why.
Episiotomy rates
Another factor to consider is the hospital’s episiotomy rate. An episiotomy is a procedure where a surgical incision is made in the perineum (the tissue between the vaginal opening and anus) during vaginal birth.
Episiotomies used to be a standard medical practice, performed based on the belief that they made vaginal birth easier and helped women heal faster. However, modern research suggests that episiotomies are often unnecessary. In fact, episiotomies have been linked to numerous complications, such as pain during sex and urinary incontinence.
Although there are cases where you can’t or shouldn’t avoid an episiotomy, researching episiotomy rates can provide a clearer picture of your chances in general. When rates are low, it generally means that episiotomies are only performed in situations where they’re actually medically necessary.
According to experts, the rate of necessary episiotomies is about 5 percent of live births or less. You can use our directory to find data about episiotomy rates; in doing so, you can make a more informed and educated decision about the hospital you choose.
By choosing a hospital for labor and delivery with a low episiotomy rate, you can reduce the likelihood that this procedure will be performed on you.
Other interventions and policies
Maternity care in U.S. hospitals tends to be intervention intensive. C-sections and episiotomies are two examples of medical interventions. They can be medically necessary and life-saving, and they can also be unnecessary, disrupting the natural physiological process of childbirth and lead birthing people to feel disempowered in their birth environment. Sometimes, they result from what’s called a cascade of interventions—essentially, the idea that having one intervention can lead to a domino effect of others, which can have the unintended consequence of increasing complications and impacting the overall experience.
Listening to Mothers III , a national survey of women’s pregnancy, birth, and postpartum experiences, reports that for women who gave birth from June 2011 to June 2012:
- 89 percent of women experienced electronic fetal monitoring (66 percent continuously)
- 62 percent received intravenous fluids
- 79 percent experienced restrictions on eating
- 67 percent of women who gave birth vaginally had an epidural in labor
- 31 percent were given Pitocin
- 20 percent had their membranes artificially ruptured
- 17 percent had an episiotomy
- 31 percent had a cesarean
So let’s revisit that list of questions above to understand how hospital policies toward how births should unfold might impact the suggestion of an intervention.
- How does the affiliated hospital or birth center stack up in terms of key maternal outcomes?
- C-section rates
- Episiotomy rates
- Early elective induction rates
- What are your options for pain management? Epidural? IV pain meds? Nitrous oxide? Sterile water injections?
- Who is allowed to be in the room with you during labor and delivery?
- Does the birthing location require IV access in labor?
- Do they allow for intermittent fetal monitoring, or only continuous?
- How do they support physiologic birth? Do they have birth balls, birth bars, birth stools, and aromatherapy?
- Do they allow for a fully ambulatory labor?
- How often do they recommend vaginal exams in labor?
Lactation consultants and other maternity services
Next, look into the hospital maternity services for each potential facility. How many maternity nurses are on staff? What about midwives and lactation consultants? Does the hospital offer prenatal care, classes, and support groups for new mothers? Is it baby friendly?
The Baby-Friendly Hospital Initiative was launched by UNICEF in 1991 to ensure that all maternity wards, whether freestanding or in a hospital, become centers of breastfeeding support. Today, there are more than 600 baby-friendly designated facilities in the United States, and getting designated requires that a facility supports skin-to-skin contact and breastfeeding and trains hospital staff about the importance of early bonding to aid in successful breastfeeding.
Most hospitals provide access to a lactation consultant, but it’s also worth asking how long you’ll have access to them and what other services they provide.
If you have a doula, they can help you understand the benefits of each of these services. They can assist with choosing a hospital for labor and delivery that includes more than basic care. Alternately, you can go online and read reviews about each potential hospital’s lactation consultants and maternity services.
Facilities for high-risk pregnancies or complications
If you have a high-risk pregnancy, it’s likely that you will be delivering in a hospital, especially if your provider has anticipated that there may be complications with your labor and delivery. This can include medical conditions affecting the mother, birth defects that have been detected, or being pregnant with multiples.
If you don’t have a high-risk pregnancy, birth can still unfold in unexpected ways. For this reason, we recommend researching the episiotomy rates and C-section rates at the hospital of your choice, so you’ll be better prepared for whatever pregnancy throws your way on the day of your delivery.
Find the perfect hospital using the Motherfigure directory
To help you choose the perfect hospital for labor and delivery, visit the Motherfigure directory. Our directory includes valuable insight about hospitals and birthing centers in your area, including information about episiotomy rates, early elective delivery rates, and C-section rates. Use our database to help you make more informed decisions about your birth plan.
Like this piece? Subscribe to our newsletter for real stories about women on their journey to motherhood.