What are your priorities? You’re not going on a cruise; you’re having a baby. Make sure you have what you need and want medically before you think about the extras. Consider what if, during delivery, your baby runs into trouble. What if she goes into distress, is not receiving adequate oxygen, and needs to be delivered by cesarean section as soon as possible? How long might it take the doctor to start a cesarean? Five minutes? Fifteen minutes? Twentyfive minutes? Would you believe all of the above, depending on the hospital? If it’s the middle of the night, Hospital A may have an anesthesiologist on call but not in the building. In such situations, your compromised baby, your baby in lifethreatening trouble, will have to wait until the anesthesiologist arrives. This “decision to incision” time (typically no more than 30 minutes), the time it takes from deciding you need a cesarean to the time required to assemble the necessary staff and equipment, transfer you to an operating room, administer the anesthetic, and start the operation, is critical. The clock starts ticking the minute your baby is in distress, and if she’s not receiving enough oxygen, time is the enemy. Most hospitals have a specific “decision to incision” time. What’s the standard at the hospital you’re considering? You may not want to think about this, but if you need an emergency C-section, you need to be in the right place. Before you decide on a hospital, read a little further so you can ask the right questions and make careful choices.
Guidelines to Follow When Selecting a Hospital
When making the decision about where to give birth to your baby, look for:
- A subspecialty hospital that has 24-hour-a-day staffing of healthcare professionals including specialist doctors such as OB/GYNs, perinatologists, and anesthesiologists
- AWHONN (The Association of Women’s Health, Obstetric and Neonatal Nurses)-certified labor and delivery nurses and AWHONN-certified neonatal intensive care unit nurses
- Twenty-four-hour-a-day staffing of lab technicians
- An operating room on the same floor as the labor and delivery unit
- A high-tech neonatal intensive care unit
- A blood bank
Questions to Ask When Evaluating a Hospital’s Obstetric Care
Some of these questions are intentionally hard-hitting, because it’s better to identify possible issues now than to discover them when you’re in labor.
- I understand that hospitals are separated into levels for the purposes of providing care to pregnant women and their newborns. What level is this hospital for obstetric care? Does it offer basic care, specialty care, or subspecialty care? (Remember, TIOP level I is often called basic care, level II is specialty care, and level III is subspecialty care. Alternatively, the rating system of The Joint Commission for the Accreditation of Healthcare Organizations, now referred to as “The Joint Commission” or JCAHO, is the opposite, with level 1 being the best, usually a large regional teaching hospital with subspecialty care; level 2 offering specialty care; and level 3 typically a small local hospital offering basic care only.)
- If problems develop during delivery and my doctor decides a cesarean is necessary, how long will it take before surgery can begin?
- Is this a standard time that the hospital adheres to or could it be longer in some cases?
- What’s the typical staffing ratio of labor and delivery nurses per women in labor? (It should be one to one for patients in labor.)
- How many labor and delivery rooms do you have?
- How many operating rooms do you have for cesarean sections? Can you do more than one C-section at a time?
- Is the operating room in the labor and delivery unit?
- What do you do if the operating rooms are full?
- My blood type is (fill in the blank). How quickly could I get blood or blood products if there’s an emergency such as a hemorrhage? Would this hospital have adequate supplies of my blood type?
- Complications can occur at any hour of the day or night. I need to know how the hospital is equipped to handle them. Is there an anesthesiologist in the hospital at all times? If not, how long before one can get to the hospital?
- If for some reason my doctor isn’t able to get to the hospital for my delivery, is there an obstetrician on call in the hospital for these types of situations?
- Is there a perinatologist or a pediatrician in the hospital at all times?
- Are there residents at the hospital? Are they always supervised by a board-eligible or board-certified obstetrician?
- Once I give birth, who evaluates my baby?
- Is there a neonatal intensive care unit?
- Does the unit have the ability to resuscitate and stabilize the baby in the delivery room?
- In a life-threatening emergency for mother and baby, who is saved first? (This is an important question to ask if you are giving birth at a faith-based hospital.)
- Are radiology and pharmacy services available 24/7?
- What does “on call” mean at the hospital? (Remember, there are no national or state rules regarding what “on call” means. There may not even be a hospital rule requiring “on call” medical staff to stay within 30 minutes of the hospital.)
- If genetic testing indicates a high probability that my baby will be born with devastating problems, does hospital policy preclude me from terminating the pregnancy?