When I found out I was pregnant with my first child, my husband and I immediately toured local hospitals to pick one for the delivery. We quickly discovered that our grandmother's maternity ward was a thing of the past. Gone is the whitewash and the pneumonia smell. They've abolished those waiting rooms where exiled dads pace in a cloud of cigar smoke. Today's hospitals offer "family birthing suites" with soothing wallpaper, aromatherapy, soft lighting, comfy tubs, pull-out beds for Dad and catered meals.
While all this makes for good advertising, it does not necessarily make for good birthing. Unfortunately, what I didn't know then was that not all hospitals are safe: Roughly a quarter of patients admitted to a hospital will be subject to some form of medical error. But fear not -- you and your baby have much better odds of a good outcome at some hospitals than at others. So from one mother to another, here are seven questions you should ask -- and I wish I had asked -- when shopping around for a hospitals to give birth in.
1. What is the hospital's infection rate? Ask what precautions are taken and what the infection rate is. If the hospital can't tell you, take that as a red flag. Find out what its Hospital Safety Score is and check around for a sink with soap and towels at the entryway or a hand gel dispenser. Doctors should not be wearing ties -- they can touch patients and aren't washed often enough. Stethoscopes should be disinfected every time they are used. The rooms should look clean.
2. What is the hospital's policy on what patients can and cannot do? Studies have determined you have the best odds if you can have a partner with you at all times, freedom to walk around if you wish, choice of labor positions and your baby with you as much as you wish. Don't assume you'll get this. For instance, some hospitals routinely hook you up to an IV when you are admitted, which is usually medically unnecessary and restricts your movement. Some hospitals confine you to certain birth positions, which can prolong or even complicate labor.
3. Will the hospital resort to surgery too quickly? Women's bodies are designed for giving birth. Sometimes things don't go well, however, and medical science developed procedures to help out. But do a third of women need to endure major abdominal surgery in order to give birth as nature intended? That's what we are see in the U.S. rate of C-sections at 32 percent. However, the rate varies greatly by hospital, which suggests the culture and policies of a hospital have more to do with the decision for surgery than medical need: Some hospitals do C-sections on 50 percent or more of their births, while others only 15 percent. Some hospitals require you to have a C-section if you've had one before, while others safely let you deliver naturally. Another surgical intervention that should only rarely be used is called episiotomy, an incision that expands the birth canal during delivery. Studies show it is usually of no benefit and can be harmful. Even if your doctor or midwife avoids surgery, the hospital must have the same philosophy, because you can't always know who will be on call when your baby chooses to be born.
4. Does the hospital prevent unsafe scheduling of deliveries? Many neonatal intensive care units are filled with babies suffering on respirators and stuck with needles who never should have been there in the first place. This can happen when a hospital permits doctors to schedule deliveries before 40 weeks of pregnancy -- and medical authorities are unanimous on the need for 40 weeks. Even if you would never agree to needlessly put your baby at risk by scheduling your delivery early, it's wise to consider whether hospitals would put any baby at risk.
5. Is the hospital's neonatal intensive care unit (NICU) qualified and safe? If your baby is born early and weighs less than 1,500 grams, the baby's chance of survival will depend on having a great NICU immediately available, preferably on site at the hospital you deliver at. Choose a backup hospital if your chosen facility doesn't have a qualified NICU. Also, ask for the NICU infection rate, which is much higher in some hospitals than others, and will too easily kill or disable the vulnerable newborns that need intensive care.
6. Will my baby's first hours of life be safe and healthy? Ask if the hospital has a lactation consultant and encourages breastfeeding, but make sure there are options for women who will not choose to breastfeed -- women's personal choices should always be respected in the hospital. The hospital should also do appropriate screenings on the baby, including for signs of jaundice. Jaundice can lead to disability and even death if not detected early, and it's more a problem with babies of color because it is more difficult to detect the signs early enough. Also, make sure you have an option, but not the requirement, to room with your baby.
7. Will I have peace and quiet? It's called "labor" for a reason -- giving birth is hard work and a test of human fortitude and endurance similar to running a marathon. Women need rest and recovery, which will in turn benefit them and their babies in their first days of togetherness. Yet some hospital units sound like Grand Central Station, and orderlies, aids and clinicians run in and out of patient rooms every minute of the hour -- hardly a place for rest. Look for hospitals that respect quiet, with strict guidelines about disruption of patients and families.
There's surprisingly little information comparing hospitals for women to use in selecting one. But here are the three best places to start. First, check out your state health department. Some states require hospitals to report Cesarean rates and infection rates, as well as other maternity measures by hospital. Next, my nonprofit has free information at www.leapfroggroup.org. Search your hospital for infection rates in the intensive care unit (ICU), presence of a qualified NICU under the measure "high-risk deliveries," and rates of episiotomies and early elective deliveries (click further into the measure called "maternity care"). Unfortunately, not all hospitals voluntarily report to Leapfrog, so you may not find all the hospitals you are interested in. If not, it's worth asking them to report to Leapfrog.
Finally, for information on childbirth, neonatal health and the pros and cons of the many options and adventures ahead for pregnant women, visit www.ChildbirthConnection.org. The site does not have individual hospital ratings, but in my view this nonprofit resource is the best, most comprehensive resource available to pregnant women on all aspects of pregnancy and childbirth.