Expecting parents have a lot to consider leading up to the birth of their baby. Who should be their provider? What should go in their birth plan? Choosing where to deliver can help answer some of those questions.
Can I choose where to deliver my baby?
There are a few options for where people can deliver a baby, but not every location is ideal for each patient. Although a patient’s autonomy for deciding which setting for delivery is best, underlying medical and obstetrical conditions should always be taken into consideration.
- A hospital offers full medical support, pain management options and emergency services if needed.
- A birthing center is often a midwife-led environment and does not have as many emergency services available. However, birthing centers often work with hospitals to ensure transfer of care is available if needed.
- A home birth is an option that may be acceptable for low-risk pregnancies with an established transfer plan. Research shows that for truly low-risk patients, outcomes can be similar to those in birth centers; however risks increase if complications arise.
What to consider when picking a location for delivery
Some things to consider when picking where to deliver includes:
- Distance from home, especially for those with a history of fast labor
- Whether your doctor or midwife delivers there
- Whether the location has a NICU, which is particularly important for high-risk pregnancies
- Availability of anesthesia services if you anticipate requesting an epidural
- Cesarean section rates and induction of labor policies
- Lactation support services available
Who should plan on a hospital birth?
Stephen Thung, MD, chair of Obstetrics, Gynecology and Reproductive Science’s at Bridgeport Hospital and professor of Obstetrics, Gynecology and Reproductive Sciences at Yale School of Medicine explains that anyone with a condition that may require urgent intervention should plan on delivering their baby in a hospital. That way they can get the care they need when and if they need it. For example, this may include patients with:
- Pre-eclampsia
- Diabetes requiring medication
- Maternal cardiac or renal disease
- Multiple gestation such as twins or triplets
- Previous cesarean with plans for a vaginal birth after cesarean (VBAC)
- Those with babies with known conditions such as congenital anomalies, abnormal fetal testing, malpresentation, fetal growth restriction or preterm labor
- A high risk for hemorrhage including: a history of postpartum hemorrhage, placenta previa/accreta spectrum, coagulopathy or anemia, prior cesarean delivery
- Patients that will need pain management options such as epidural analgesia
In addition to having the appropriate specialists on hand to care for the birthing patient, those with underlying conditions may need a neonatal intensive care unit or NICU.
“I think having an excellent NICU is such a critical service that helps manage all the unexpected challenges. It is particularly important if you are a high-risk pregnancy. Having a NICU allows your baby to have immediate on-site care without the delays associated with transferring a baby from one place to another,” said Dr. Thung. “The NICU staff can stabilize and treat premature or ill babies, reduce the need for mother-baby separation, and bring quick access to specialists such as neonatologists, respiratory therapists and pediatric surgeons.”
What should you consider when picking a hospital?
Not all hospitals are the same, so patients should familiarize themselves with what is offered. Some things that may be available in a hospital setting include:
- Birth tubs or hydrotherapy
- Wireless fetal monitoring
- Dedicated 1:1 nursing during active labor
- In-house anesthesiologists
- Pediatrics 24 hours a day
- Lactation consultants
- Postpartum support services
It’s also a common misconception that all hospital births require medications or intervention.
“Birth centers and hospitals are not the opposite of each other. Many hospitals provide low intervention care and birth centers built into their standard unit,” said Dr. Thung. “A hospital does not necessarily mean you will receive more interventions. Interventions into your care or your baby’s care are based upon medical need.”
Get to know your options
Taking a tour can help familiarize patients with their options. They can also look up location policies to see if certain considerations are available. For example, a patient who wants a VBAC should make sure they are delivering at a hospital that can support that plan.
