Congratulations — you’re having a baby! From now on, everything in your life will seem overwhelmingly chock full of options. So, it’s a fitting initiation to motherhood that one of the first decisions you’ll make — your Boston labor and delivery location — is difficult to navigate.
In my work as a doula, I’ve seen families with serious medical conditions walk away from the hospital in awe of the care they’ve received. I’ve also seen families leave confused and disappointed by the actions of the providers they encountered.
Boston has the highest number of hospitals per capita of any city in the U.S. The good news is that this means more choice. The flip side is that it’s more difficult to determine which one is right for you.
But take a deep breath, read the tips below, and have confidence that you’ll know what’s best as you prepare to have your baby.
First, consider your wants and needs
The easiest questions to answer are about you and your family, so that’s a good place to start. Get with your partner and start talking about this early.
What’s your health like?
Do you have any special challenges like disability, language barriers, obesity, chronic disease, high blood pressure? What about baby? Are you carrying multiples? Do you have a high risk factor for genetic disorders? You’ll want to choose a care facility and provider that have proven track records of handling patients like you.
Not your first rodeo?
If you’ve already had a baby, use experience to guide you. What was your first birth like? What would you change? I was given a generous episiotomy with my son that made recovery very difficult, so for the birth of my second child I knew I wanted a place that had a low episiotomy rate and provider that was philosophically against them.
What does your ideal birth look like?
Is it a quiet, intimate experience focused on you and your partner? Or would you be more comfortable with having as many skilled hands on deck as possible in case things go wrong? Think about whether you expect to use pain medication or intermediary options like nitrous oxide, which may not be offered everywhere.
What’s your insurance situation?
It seems obvious, but before you get too excited about giving birth at the same place as your best friend, be sure your insurance covers that hospital or care facility. Ask what your plan’s rules are regarding in-network and out-of-network providers and hospitals. If insurance doesn’t cover the hospital or birth center you desire, call the finance department and ask about creating a payment plan. Home birth may not be covered, but providers are great at working with families to give them the care they desire and deserve. If you’re not sure where to start, ask your insurance company for a directory of places in your area. Here’s a list of other questions you may want to ask.
What’s your support system like?
Do you have family members around to support you? If not, you may want to hire a doula (find one in your area here) to help you through your birth experience. How understanding is your employer about medical appointments? This might affect your decision about your care facility based on appointment hours and proximity.
Second, do your research
It may seem counterintuitive, but the place you choose to deliver can impact your birth outcome more than your health, your birth plan, or the proclivities of your doctor. That’s why it makes sense to prioritize where you’ll deliver before choosing who will help you deliver there.
Hospital vs. birth center vs. home
The broadest decision you’ll make is whether you want to deliver in a hospital, birth center, or at home. There are woefully few birth centers to choose from in the Boston area. Answering this overarching question first can really narrow your options. If a home birth is right for you, you might start by working with a midwife to guide your decisions about your care. Practices like Roots Midwifery or Birth Matters Midwifery are some of the best to seek care from outside of the hospital.
What matters most?
Though it will take some time to compare hospitals side by side, look at each of your options in terms of the quality measures (C-section rate, episiotomy rate, early elective deliveries) that matter the most to you. If you have a high-risk pregnancy or expect to use the NICU (neonatal intensive care unit) or a Level II or Level III special care nursery, that may narrow your choices.
Your ideal postpartum situation is important to consider as well. Do you want to be in a place where there are many people trained in basic lactation support? Is the nursery open for all babies all the time? When will you have follow-up appointments and check-ins with your providers?
Finding “the one”
Once you determine your desired place of birth, you can move on to finding a list of practitioners who deliver there. You can find a doctor associated with a care facility directly through that facility’s website, or you can check out a third-party site like HealthGrades.com, where you can find reviews, recommendations, and other information.
If checkups happen at the same location as delivery (this isn’t always the case, so you should ask), it’s a place you’ll be seeing a lot of during your pregnancy. Consider factors like proximity to home and work, your transportation options, ease of appointments, cancellation policy, and wait time. Also, keep in mind distance may be key if you have a family history of fast labors, have emergency needs, or will feel more comfortable with a hospital that is literally close to home.
Third, assess the fit — is it a match?
Once you’ve narrowed the playing field to a few providers at one or two care facilities, the subjective stuff begins. Here are some things that will help you feel out the fit when you see your facility and meet your potential providers in person.
Do you feel comfortable with this person? What’s her communication style? Is she a quiet listener? A high-energy ray of sunshine? Think about dealing closely with this person in an emotional or stressful time. What would that be like? I found that my ideal doctor was, in fact, much like me. A fast-paced, active, enthusiastic talker. But this same doctor would be possibly the worst provider were my introverted husband having our baby.
You should also get a feel for how your provider will make decisions about your care. Questions like, “How do you decide when to order a C-section?” or “What would you do if I was in the pushing phase and had trouble progressing?” can uncover their care style.
If you haven’t had great interactions with your providers or the staff, remember that you can switch to another provider!
Don’t forget the team
As much as you love your provider, chances may be slim that she will be the one to deliver your baby, so it’s important to match with an entire practice and facility. You should also keep in mind that your care team during labor will include reception staff, nurses, midwives, etc. Find folks you like and make you feel well cared for. Ask open-ended questions like, “Do your views on ____ align with the rest of your colleagues here?” or “How would you describe your colleagues?” or “What made you want to practice at ____?” Making sure your views align with those of your care team will ensure that even if your birth plan goes out the window once labor starts, you’ll all be moving toward a common goal.
The rule of three
It’s hard to make time in a busy schedule to feel out providers and facilities, but you’ll do yourself a favor to interview at least three potential providers before making a decision. You’ll have a better feel for your range of options and be more confident in your ultimate decision.
Having a baby in Boston and need a full list of local hospitals and birth centers? Check out our guide!
This article was originally written by Erin Eby and published in 2015. It was updated in 2023 by Dashanna Hanlon and Ashley Dickson.