Every expectant mother wants to have the best care for herself and her baby, but this may mean different things to different people. You may plan to go to the closest hospital, or one you were impressed with for a different service -- but it's worth looking into all of your options to find the best hospital for you. No two birth settings are the same, and hospitals that are great for hip and knee replacements may be lacking in maternity care. Doing your research up front is an important part of making the right decision for you and your family.
1. What are my options?
Approximately 98.8 percent of births in the U.S. take place in hospitals, so it's not surprising that many women don't know they have other options. Your birth setting will determine whether your delivery is performed by a midwife or OB/GYN, so consider which you would be more comfortable with. If you want a trained physician as your caregiver, a hospital is likely your best option. Midwives do practice in some hospitals, but mainly in birth centers and private homes. Ask yourself whether you would prefer the comfort and privacy of your own home, the focus and control of a birth center or the resources and expertise of a full hospital staff. In addition to finding the best birth setting for you, ask these questions of your pregnancy provider to determine if they are a good fit.
Some expectant mothers choose to have a doula in addition to a midwife or physician, since doulas do not assist in the physical delivery of a baby. There are a number of types of doulas, but the most common -- the labor doula -- is usually hired to support the mother, baby and partner through the birthing process. This includes mental and emotional support and non-labor-related needs such as massage, homeopathic assistance, sleep coaching and housework. Doula services may be partially covered by insurance, but check with your carrier for more details.
2. What kind of experience do I want?
Some birth centers are located within hospitals, but they have separate requirements and standards for independence. Notably, the childbearing woman is the chief decision-maker about the circumstances of her delivery. Birth centers are centered on continuous, supportive care, and interventions are used only when medically necessary.
Hospitals, on the other hand, tend to leave the decisions up to their own well-trained experts. If you would rather have a hospital's technology and an OB/GYN on your side, you'll want to check out local delivery rooms.
If you prefer a home birth, you will be without the immediate safety net of physicians and most available medical interventions. Home births are more common among women who are 35 or older and those who have given birth before. Many women who choose to give birth at home also have a backup plan to go to a hospital should any serious complications arise.
3. Is the hospital in or out of my insurance network?
Though the Affordable Care Act considers maternity care to be an essential benefit, meaning it must be covered by your insurance, what exactly counts as being "covered" can vary depending on where you live. The cost of having a baby varies widely between hospitals and states, and depends on a number of factors. For some lower-tier insurance plans with high deductibles, you could rack up thousands of dollars in medical bills, even for an in-network provider -- but only up to an out-of-pocket maximum of $6,350. Out-of-network services, however, may not count toward your out-of-pocket maximum, which could mean that you are saddled with the entire bill -- a bill that could run to tens of thousands of dollars.
Your insurance company is required to provide a directory listing to aid in your decision, and a summary of benefits that clearly shows what's covered. If you have Medicaid, birth centers are covered, but if you have a commercial provider and want to use this option, coverage varies. In either case, you'll want to check who and what your insurance covers.
4. What are the rates of natural deliveries, C-sections and complications?
If a natural birth is important to you, you will want to compare rates of cesarean section between the providers you are considering. C-section rates can differ vastly between hospitals and will likely factor into your decision, especially if you are considered low-risk and want to avoid an unnecessary procedure. While the national rate of C-sections is 32.8 percent, only about 6 percent of women who deliver in birth centers have C-sections. Consider taking a tour of the facility as you get closer to your decision and confirming the latest rates -- but also do your own research to compare rates online.
In 2012, the Centers for Disease Control and Prevention reported that childbirth complication rates had been on the rise for the past decade. This sparked new programs designed to improve safety and prevent injury, but you will want to research local hospital data as you narrow your choices. Hospitals aren't likely to advertise this information, so you may have to ask up front. Your caregiver can help you to understand the complication rates between low- and high-risk pregnancies, since you will want the information most relevant to you.