Does your idea of delivery comfort have less to do with the bed you’ll give birth in, and more to do with the medical backup you'll have on hand? If so, a hospital is probably the most comfortable choice for you — putting you in good company.
Giving birth in a hospital is by far the most popular choice of expectant couples in the United States. And it’s the recommended choice for women who have what’s considered a “high-risk” pregnancy (e.g. if you’re 35 and over, are pregnant with multiples or have a condition such as gestational diabetes).
A hospital birth also offers the most options in terms of who will handle your delivery. While most birthing center and home births are attended by midwives (certified or direct entry), your hospital birth can be overseen by an OB/GYN, a family physician or a certified nurse-midwife (94 percent of CNM deliveries are, in fact, in regular hospitals). Doulas are welcome too.
Just as there are pros and cons for every choice you'll make when it comes to your childbirth experience, there are pluses and minuses when it comes to having your baby in a hospital.
Advantages of a hospital birth
Some of the plus sides of a hospital birth include:
- It may be the safest option. If you're considered high-risk, it's the safest childbirth environment for you and your baby. Ditto if an unforeseen complication arises during labor (such as a prolapsed cord or placental abruption, for example).
- It’s close to an operating room. If you need a cesarean section (either planned or emergency), it's the only place you can have one. And you won't have to be transferred mid-labor if it looks like you'll need one — you'll just have to move from your birthing room to the operating room.
- It offers the most advanced technology. On-staff pediatricians and, in many hospitals, sophisticated newborn medical technology are available should your baby need immediate medical care.
- You have easy access to pain relief. Anesthesiologists on staff are almost always available to provide pain relief medications as you request, from epidurals to narcotics.
Downsides of a hospital birth
Some of the disadvantages of a hospital birth are:
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- Hospitals, especially larger ones, can seem impersonal and intimidating. Taking a tour ahead of time can help you feel more familiar — and more comfortable — at your hospital of choice. Keep in mind, though, that hospitals are doing more and more to have a "family-friendly" feel in the labor and delivery wing.
- Even private rooms aren't that private. There's a lot of coming and going in hospital rooms. It may often seem like there's a round-the-clock revolving door of residents, nurses and other hospital staff members hovering around your bedside. You can expect to get less rest at a hospital for the same reason ("time to check your blood pressure again!").
- Separations are often routine. Even if you've chosen to "room in" with your baby, there will be times when hospital routines will separate you, including for newborn screenings.
- Hospital policies rule. Though hospitals are more open to birthing alternatives than ever before (if only to keep up with the demands of expectant parents who've come to expect more), they're bound by protocols and procedures — which means you will be too. Still, chances are good that with the help of your practitioner you'll be able to create a birth plan that gives you the delivery experience you want, even in a hospital setting.
Without a doubt, hospitals have come a long way since the days when deliveries took place in cold, uncomfortable, sterile delivery rooms. Today, the equipment's still sterile (and that's a good thing), but the surroundings are typically far from it.
If your hospital has an official policy of family-centered maternity care (many do), you can expect birthing rooms that are comfortable, homey and designed in warm, soothing colors.
Your room may have medical necessities hidden behind armoires, dim lights, private bathrooms (including showers and baths for hydrotherapy relief during labor) and ample space — including sofa beds — for family members, a doula, etc.
Finding the right hospital for you
It’s never too early to start researching hospitals — especially some of the more popular facilities, which may have a limited number of spaces in their labor and delivery suites. Check online and ask friends for recommendations.
Take a physical or virtual tour of the facility you’re most interested in using, if possible. A good time is around weeks 30 to 34 of pregnancy. This will give you a chance to ask questions, clear up the smaller details and meet some of the staff who will be assisting you on your delivery day.
A few things to consider:
- Is the hospital in your insurance network? Although the Affordable Care Act now requires all insurance plans to cover maternity care, the deductibles, coinsurance, copayments or similar charges for each service can still vary, up to an out-of-pocket maximum for in-network providers. If you’re out of network, however, the charges can skyrocket.
- What amenities does the facility offer? Consider the type of birth you’re hoping to have. If you’d prefer a water birth, for example, you may want to ask whether the facility offers or allows birthing tubs. If price is less of a factor than convenience, you may also want to consider if the facility offers labor, delivery, recovery and postpartum (LDRP) rooms, where instead of moving between several rooms from labor through recovery you’ll stay put in the same one.
- What’s the C-section rate? Rates of C-sections can vary widely from hospital to hospital, from 7 percent to nearly 70 percent, so it’s a good idea to look into your facility’s rates online. If your hospital of choice has particularly high rates, you can ask why when you visit.
- Does the facility support breastfeeding? If you’re planning to breastfeed, you may want to check if your hospital is a certified “Baby-Friendly Hospital." The Baby-Friendly certification means the hospital follows World Health Organization (WHO) and UNICEF guidelines to support mothers in successful breastfeeding, including allowing mothers and infants to room together 24 hours per day. Don’t fret if your hospital isn’t on the list either: Just be sure to ask about the breastfeeding assistance your hospital offers when you take your tour.
The cost of a hospital delivery
Your hospital will work with your insurance company to determine what your co-pay will be. While the Affordable Care Act guarantees some low- or no-cost prenatal and infant care, insurance companies vary on the amount charged for your hospital care and stay during labor, delivery and recovery.
How much you pay out-of-pocket depends on factors including treatments needed for you and your baby, the facility at which you deliver, your health insurance and more.
Learn more about the cost of pregnancy and delivery, and be sure to verify your specific co-payments, deductibles, premiums and out-of-pocket costs with your insurance company early on so you can budget accordingly.
Also be aware that if you haven’t already rented or purchased a breast pump, the Affordable Care Act mandates coverage — which means you may be able to get one for free. The hospital gift shop may also rent equipment.
Which is better, a home birth or a hospital birth?
The American College of Obstetricians and Gynecologists (ACOG) says that hospitals and birthing centers are the safest place to deliver. That said, home birthing can still be a safe option, provided your pregnancy is considered low-risk, the birth is well-planned and attended by a physician or certified nurse-midwife, and you’re fully educated on the risks and benefits.
In other words: A hospital or birthing center offers you and your baby more protection should complications come up while you’re laboring or delivering. But that doesn’t take home birthing off the table — and for some families, it can be the right choice.
That’s true even now with COVID-19. The health and safety benefits of hospital and birthing center births outweigh the potential risks associated with the virus, maintain ACOG and the American Academy of Pediatrics.
Of course, pandemic or not, it’s always worth talking with your doctor or midwife if you have questions or concerns about your birth setting. Together you can decide on an option that feels both safe and comfortable, so you can have the best birth experience possible.
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