#2. Decide where you will have your baby

Welcome to my birth and postpartum guide, item #2. Congrats on the upcoming addition to your family! Please take care of yourself and best of luck with your preparations. This is one piece of a 10-part guide. Feel free to explore the other pieces from the introduction page.

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If you plan to birth in a hospital, this will be largely determined by where your provider has hospital privileges. If you live in a metro area, and have a choice between two or more hospitals, I find that Google and Yelp reviews are often the most informative — search for “birth.” 

There are also some more objective hospital quality reporting systems, however, these are often so objective as to be rendered meaningless and rarely show statistically significant differences. 

A Health Affairs article (free access) summarized the state of maternity quality reporting:

“Despite the substantial morbidity associated with childbirth in the United States, there is currently no national system for reporting maternal complications.The number of obstetrical deliveries far exceeds other common causes of hospitalizations for which performance reporting already exists, but the quality of obstetrical care is not systematically reported in the United States. The Joint Commission collects a small number of quality measures, but maternal outcomes are not publicly reported.30

And yet, quality varies dramatically, “Working with a large nationally representative sample of more than 750,000 obstetrical deliveries in 2010, we found substantial differences in rates of major complications in US hospitals. Women delivering vaginally in a low-performing hospital were twice as likely to experience a major complication, and those delivering by cesarean section were nearly five times more likely to experience a major complication, compared to women giving birth in a high-performing hospital.” 

The most widely-available “quality” measure is the rate of c-sections performed in first-time births. However, from the Health Affairs article, “Interestingly, we found that hospitals with higher cesarean delivery rates had lower complication rates for women having either a vaginal or a cesarean delivery, compared to hospitals with lower cesarean rates.” And as a mom who experienced both a 4th degree tear from a vaginal birth and planned c-section, healing from the c-section was a piece of cake compared to the botched vaginal birth. I was pretty much completely recovered from the C-section by 8 weeks postpartum, while I experience ongoing issues from my tear.

Here are a few other places to check:

This USA Today database contains data from a minority of states.

A minority of hospitals nationwide also provide data to Leapfrog, including some helpful maternal quality measures. 

Medicare Hospital Compare has data from all hospitals, but is limited around maternity data. Once you go to their website, you can choose hospitals in your area to compare.

You will also want to consider what makes sense for your baby. If you think you are likely to need NICU services, then find a hospital with a strong NICU offering all of the services you are likely to need. 

Lastly, if you think (or know) you might need a c-section, I strongly recommend finding a hospital that provides family-centered cesareans as policy.

All that said, my last piece of advice (again from VERY limited experience) is that I would be cautious about choosing a “baby friendly” hospital. These practices can be implemented poorly. For example, these hospitals sometimes push breastfeeding so hard as to make it impossible to get supplemental food for your baby, even if you think he is hungry and your milk hasn’t come in. I struggled to get supplemental food for my first child until he had lost 12 percent of his birth weight and was dropping quickly. There are stories of women sneaking in formula to feed their baby at these hospitals, even though formula use in the early days when a mother is also trying to breastfeed her infant does not appear to reduce long-term breastfeeding success

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