Women March 10, 2021

Tips for choosing a maternity hospital

Kacey Eichelberger, MD

Maternal and Fetal Medicine
Greenville, SC

Preparing for a new baby is one of the most exciting experiences of a lifetime – and one that you want to be as safe as possible. So, what should you consider when you’re choosing a maternity hospital?

The Leapfrog Group, a national nonprofit organization that reports on the safety and quality performance of U.S. healthcare facilities, recommends that you consider three measures when looking for a birthing hospital:

1. Rate of early elective deliveries
2. Rate of NTSV cesarean deliveries
3. Rate of episiotomies

Kacey Eichelberger, MD, explained why these measures are important.

Early elective delivery

A pregnancy is considered “full term” between 39 and 40 6/7 weeks; however, over the past decade there has been a rise in the rate of women with low risk pregnancies requesting to be  induced before that time. According to The Leapfrog Group, these early term elective inductions exceed the rate of inductions that are medically necessary (i.e., recommended by your doctor when the pregnancy becomes complex).

Although an early elective induction might be tempting when you’re close to the end of your pregnancy, Dr. Eichelberger said it’s important to wait until your baby is full term unless there are medical reasons to deliver early.

“The lowest risk for neonatal complications is when a baby is born between 39 and 41 weeks. Inducing earlier can lead to problems for both the mother and baby. Mothers are more likely to need a cesarean section and have a higher risk for postpartum complications. Babies induced earlier than 39 weeks are at higher risk for respiratory problems and may even need to be admitted to the NICU. Although the difference between 37 and 39 weeks may not seem like a big deal, from a newborn perspective, those last few weeks are critically important.”

NTSV cesarean delivery rate

According to the U.S. Centers for Disease Control (CDC), 31.7% of babies born in the U.S. are born via cesarean delivery – or C-section.  While C-section births are critically important for some mothers and babies, they are, of course, a surgery and can be associated with increased long-term complications for women.

“There are times when a C-section is necessary for the health of the mother and baby, and those deliveries are both beautiful birth experiences and often life saving,” said Dr. Eichelberger. “That said, the larger goal now is to safely reduce the number of first time C-sections, since the primary indication for a cesarean delivery in the U.S. is having a previous cesarean delivery.”

Babies born by scheduled C-section have significantly higher rates of respiratory complications, infections and prolonged length of stay in NICUs compared to babies delivered vaginally. Health risks to women include increased rates of infection, hemorrhage and hospital readmission.

The term “NTSV” refers to a first-time pregnancy (nulliparous) that has reached its 37th week or later (term) and consists of one baby (singleton) in the head-down position (vertex). The NTSV cesarean delivery rate, then, is the percentage of these moms who give birth via cesarean delivery. The Leapfrog Group defines excellence in birthing hospitals in the U.S. based in part on those that have a low NTSV cesarean delivery rate and, therefore, a higher vaginal birth rate for first-time moms. 

Episiotomy

An episiotomy involves making a surgical cut to the vagina during childbirth.

“Historically, episiotomies were used based on a common belief that they prevented extensive tearing of the vagina during childbirth and preserved the connective tissue support of the pelvic floor,” explained Dr. Eichelberger. “However, research shows that routine episiotomies don’t actually prevent these problems. Instead, they can lead to infection, pain and blood loss.  Routine episiotomy should not be a part of most birth experiences.”

Dr. Eichelberger said episiotomies may be necessary in situations when the baby needs to be delivered quickly, such as if the baby has an abnormal heart rate or if the baby’s shoulders get stuck. But this is not a common occurrence. According to The Leapfrog Group, birthing hospitals of excellence should have an episiotomy rate less than 5%.

How can you find out a hospital’s safety rating?

Hospitals may share this information on their websites. Or you can go to The Leapfrog Group’s website.

What else should parents consider when choosing a maternity hospital?

Dr. Eichelberger said there are some other questions parents should consider, including:

• What pediatric services does the hospital offer? What would they do if your baby needed extra help at the time of delivery?
• Is the hospital a Baby-Friendly Hospital, supporting international standards for newborn care and breastfeeding?
• Are there lactation consultants on staff?
• Does the hospital offer prenatal, childbirth, breastfeeding and parenting classes?
• Will the baby stay with me in my room 24/7?
• Can my partner stay with me in the room?