Another basic decision involves where you will give birth. Most women choose the hospital. Some women choose to have their babies in freestanding birthing centers or at home. You can make the decision on where to have your baby in much the same way you choose your caregiver: Find out what options you have and ask questions about issues that are important to you.
If you prefer to have your baby in a hospital, the next question is, which hospital? Most caregivers have privileges in one hospital, but many use more than one. Tour each of the hospitals your caregiver uses. It also may be useful to tour other hospitals -- for comparison purposes, if nothing else.
It's important to choose a facility at about the same time you choose a caregiver, so you can match the caregiver with the facility. You might discover, for example, that you prefer a hospital where your caregiver does not have privileges. If so, and if you do not feel a strong tie to your caregiver, you might decide to change caregivers to use the facilities that appeal to you.
If your community has more than one hospital, you might be surprised at how different they are from one another in their facilities, policies, and philosophies of care. Most hospitals offer tours of their maternity ward. You should call the hospital to sign up for a tour.
What do you look for when touring a hospital? You can use the following questions to help evaluate a hospital's obstetrics area.
- How do you feel about the overall atmosphere of the obstetrics unit? Does it seem comfortable? Will you have some privacy during your stay there? Many hospitals, for example, have attractive private labor rooms and bathrooms.
- What provisions are there for the mother's comfort? Some have very comfortable labor beds, while others have very narrow, hard labor beds. Some provide nice touches like rocking chairs, couches where the partner can rest, showers and tubs to use for pain relief, and beanbag chairs for getting into comfortable positions. Others make no extra provisions for the comfort of either mother or father.
- Does the hospital have birthing rooms (attractively decorated rooms where the mother can labor, give birth, and spend time with her newborn afterward)? In some hospitals, the birthing room is the only room the mother is in throughout her entire hospital stay. In others, labor and birth take place in the birthing room; she then goes to a postpartum room for one or more days before going home. In still other facilities, labor takes place in one room, the mother is moved to another room when she is about to deliver, she may go to another room to recover, and then she goes to still another room for the rest of her hospital stay. Many hospitals are beginning to convert their maternity facilities so that a woman can labor, deliver, and recover in the same room (a so-called LDR room).
- What does the nursery look like? Are the mothers encouraged to keep their babies with them in their rooms, or do the babies spend most of their time in the nursery?
- Do the nurses seem friendly and warm? What about the person leading the tour? Is she friendly and does she answer your questions, or is she simply herding you through brusquely? (Some hospitals are so busy they don't take potential clients on a tour of the actual facilities. In place of a tour there may be a slide show and discussion of policies and procedures with a member of the staff.)
- Ask some specific questions about admitting procedures. Ask to see the general consent forms that require your signature when you arrive at the hospital. Be sure to read these in advance and clarify any questions you may have. It is certainly not easy to read consent forms carefully if you are already in labor.
Prepare your questions about hospital procedures in advance of your visit. How you phrase these questions may determine the thoroughness of the response. For example, if you ask, "What usually happens to the baby after he or she is born?" you will learn more than if you ask, "What is the hospital's procedure for routine newborn care?" There may be few hospital policies for such care, but there are certainly customs, and those are what you want to know about.
You might ask for a step-by-step description of what usually happens after a woman in labor arrives at the hospital. For example:
- Do most women have a nurse assigned to them alone, or do the nurses take care of more than one woman in labor at a time? Are they understaffed sometimes, and what do they do if this happens?
- Do women usually receive pain medications, or do many women use little or no pain medication? If a woman desires an unmedicated childbirth, is she actively encouraged and supported in this by the nurse?
- Do most women receive intravenous fluids, continuous electronic fetal monitoring, rupture of the membranes, oxytocin (a hormone that causes contractions), and episiotomies?
- Does the hospital have a high rate of cesarean births? Ask how cesareans are usually done; for example, what type of anesthetic is usually used, and is the father encouraged to be present? (Write down anything you don't understand to discuss with your caregiver later.) Can a woman who has previously had a cesarean attempt to deliver vaginally?
- How long is the usual hospital stay? (The terms of your health insurance may also determine how long you can remain in the hospital after an uncomplicated delivery.) Is there a short-stay or early-discharge program that allows mothers and babies to go home within a few hours after the birth? Does the hospital provide any kind of follow-up?
Clarify the costs of labor and delivery rooms, nursery charges, postpartum care, and so forth. Of course, you will also need to check your insurance policy, if you have one, to see how much you will have to pay.
If you choose an alternative caregiver, you may want to give birth in a different setting, Go to the next page to find out more about out-of-hospital births.