What an exciting time for you and your family! Your anticipation probably began even before your positive pregnancy test. Soon you will be making an important decision about where to have your baby. There are several things to consider in order for you to have the safest, best birth experience for you.
You will want to consider: the type and philosophy of the practice that will deliver your baby; the choice of hospitals you will have, along with the services provided — including how high-risk pregnancies are handled should you need that level of care; and the kind of lactation and postpartum support that will be provided.
Type of Practice
The obstetric practice can include a solo-physician practice, a group-physician practice and a collaborative practice with midwives.
The days of the solo obstetrician delivering each baby have become limited for many reasons, including safety (too many competing demands) and fatigue. As a result, most physicians have some kind of coverage arrangements. You should feel comfortable asking about coverage arrangements and voicing any of your concerns.
You should also inquire whether the practice has a physician in the hospital at all times to cover the patients in labor. In smaller practices or rural settings, this may not be a reasonable expectation. Some patients choose midwifery care and may never meet a physician. If you are interested in having a midwife, be sure to ask about coverage arrangements and how emergencies are handled.
The Hospital Setting
You may want to consider the distance of the hospital from home or work, the patient accommodations, family friendliness — even food service and décor.
You should also inquire about additional obstetric support services. Is there an anesthesiologist in the hospital at all times, or is this provider on call from home should a patient in labor request an epidural, or if an emergency occurs?
If a baby were to have unexpected problems at birth, what are the arrangements for pediatricians?
Can the hospital handle high-risk situations, or would you and/or your baby need to be transferred to another hospital? If so, where will you go?
What types of breastfeeding and postpartum education are available to you?
It is important to become educated about the birthing process. There are many ways to get information these days, including word of mouth, pregnancy/parenting Web sites and childbirth education classes.
Remember that most deliveries are low risk and can occur in just about any hospital setting. However, no matter which hospital or birthing center you choose, you will need to know what will happen in the event of an unexpected complication.
Susan Mann, MD, has been a practicing ob/gyn since 1988 at Harvard Vanguard Medical Associates and Beth Israel Medical Center, with an interest in patient safety.