Having Your Baby in Boston: Choosing a Care Facility

hospital birthCongratulations, 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 labor and delivery location — is difficult to navigate. Boston has the highest number of hospitals per capita of any city in the US. 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.

You: First, know thyself

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? One tool you can use to help crystallize your thoughts about your birth experience is a birth plan like this one.

What’s your insurance situation?

Consider calling your insurance provider before selecting a care facility. Ask what your plan’s rules are regarding in-network and out-of-network providers and hospitals. If the plan provides greater coverage in-network, ask 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. If you’re working, how understanding is your employer about medical appointments? This might affect your decision about your care facility based on appointment hours and proximity.

Them: 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

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.

What matters most?

This terrific interactive tool created by WBUR compares hospitals across Massachusetts and can help you visualize what your best options look like, depending on which quality measures (C-section rate, episiotomy rate, early elective deliveries) matter the most to you.

comparing hospital birth quality measuresFinding “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 (example) or you can check out a third-party site like HealthGrades.com, where you can find reviews, recommendations, and other information.

Convenience factor

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.

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.

Bedside manner

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.

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 find a 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 combat labor starts, you’ll all be moving toward a common goal (incidentally, that’s how we defeated Germany at Normandy).champagne

Swank factor

There’s a trend toward patient-satisfaction-focused care in the healthcare industry, resulting in hospitals offering perks more often seen at hotels. There’s no correlation to quality of health care, but it might make your stay more comfortable. How much does this matter to you? Would added benefits like guest rooms, pedicures, champagne, or gourmet meals influence your decision? What about around-the-clock lactation consulting? Jacuzzi labor tubs?

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.

Did you have a baby in Boston? Were you happy with your choice? Comment below to help women like you make their first decision as moms.

1 COMMENT

  1. I planned to have my baby at Mt Auburn Hospital because I was low risk my whole pregnancy. Then suddenly at the very end, my baby became high risk. So I delivered at BI. They have a great NICU team there and I’m happy with my choice because it was best for my baby. In the end, just know that your labor plan can change at the drop of a hat and be OK with being flexible and adjusting your expectations. That’s the most important thing I learned.

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