Latest update: September 15th, 2013
Having a baby today is all about making decisions. Which doctor to go to. Which hospital to deliver at. What are your health concerns. Do you want to go natural. Do you want convenience. Where is your insurance accepted. Which hospital has the best reputation. Etc., etc., etc.
Living in New York, with over a dozen major, top-quality hospitals within driving distance, the umbrella of choices becomes that much larger. In contrast to smaller cities where expectant parents are limited to two or three respected hospitals, New York offers a wealth of top doctors, hospitals, and other health resources.
So whether it’s you or a loved one who is expecting to give birth in the near future, let this article serve as a starting point for your research in making this most important decision. As any new mom can attest (this reporter included!), the quality of your birth environment and experience has a critical impact on your emotional wellbeing and early bonding with your newborn. So take your time, do your research and make the choice that’s best for you.
How to Choose a Hospital and Healthcare Provider
Madeline Jaffe, a parent-family education manager and childbirth educator at St. Luke’s-Roosevelt Hospital Center said the first step is for a women to actually plumb the depths of her own psychology and figure out what her personal needs are and what type of healthcare consumer she is.
“While some people may want to go to a provider that’s very directive, where the healthcare consumer feels that this individual is highly trained with years of experience and ‘who am I to question them’ others may prefer a more natural and holistic attitude, where they feel, ‘if something’s not broken, don’t fix it.’” Those people should have a different healthcare provider, one who is not quick to do interventions but will let things take a natural course, Jaffe said.
“Some people are in love with 21st century technology and embrace all the bells and whistles, and some hospitals in the city have a reputation for being more high-tech. They’ll have doctors on staff who will not necessarily embrace a more natural approach, and they may push epidurals, push testing, they may be quicker to induce rather than take a wait and see attitude.”
The most important thing, Jaffe said, is to have a partnership with your physician or midwife and discuss your needs and expectations so you can chart your course.
Services to Look For in a Hospital
When evaluating a hospital, Jaffe recommends looking at the kinds of services the hospital provides:
* Do both midwives and physicians deliver?
* What level of Neonatal Intensive Care Unit (NICU) do they have? (Expectant parents should look for a level 3 which provides for all situations.) What sort of NICU services do they provide?
* Do they have a maternal/fetal health medicine department and offer genetic testing and counseling?
* Do they offer a variety of courses, ranging from childbirth classes to parenting classes?
* Do they have lactation consultants 24/7 or only a few times a week?
* Does the hospital provide for rooming-in, allowing the baby to stay with the mother immediately after birth, which is good for bonding and early development?
* Do they have 24-hour OB anesthesia, allowing you to get pain relief whenever necessary?
Sara Chana Silverstein, a doula and lactation consultant who practices in LA and NY, recommended finding a hospital that is registered as “baby-friendly.” This means a new mother has the option of “rooming-in” and having the baby stay with her, as opposed to staying in the nursery, as well as the opportunity to breastfeed on the birthing table, among other things. “You can call a hospital to find out if they are registered,” she said.
Silverstein also recommended finding out if they have lactation consultants on call – a lot of hospitals advertise lactation consultants, but once you’re at the hospital you may find out they only come in twice a week for a half-day, which may not be when you need them.
“People should always take a tour to see the facility,” Silverstein suggested. She said that often in the big hospitals in NY where hundreds of babies are delivered each month, it can feel like giving birth in a factory – “you tend to be like a number.
“New York hospitals are very, very crowded. The nurses tend to be very frustrated due to the intense workload, so many people giving birth in such small areas, and so many different demands coming from physicians, midwives and then women coming in with their doulas,” Silverstein said.
But while a smaller hospital may boast a more personalized, homey experience, they may not offer as high a level of NICU services or medical expertise as a larger hospital.
Obviously, women should know whether or not they’re high risk and choose a hospital with physicians who are knowledgeable in their area of risk, Jaffe noted.
Jaffe also said that while there’s a tremendous commitment in New York City to diversity, “you want to see if that’s practiced.” Expectant parents can get a sense from the classes or conversations with their healthcare provider if they are open to different ethnicities and religious groups.
“My own personal experience, being an observant Jew and knowing the issues that concern observant Jews, made me more sensitive to the Muslim women who come to classes with their own particular religious requirements.”
Doulas, birthing centers and home birth
Because of the rising C-section rate in New York – most major NY hospitals are tending towards a rate of 30% or more, in contrast to a rate of 15% previously recommended by the World Health Organization, (they officially withdrew their recommendation in 2010, saying that “there is no empirical evidence for an optimum percentage,”) along with other reasons – including crowded hospitals, routine interventions and impersonal medical care, many women are opting for more natural methods, such as birthing centers or home births, or at the very least, having doulas accompany them to hospital births.
According to Silverstein, who has worked as a doula in all the major hospitals in NYC, “the doctors are so busy and overwhelmed that to get them to give you the attention you need, you have to be in crisis.”
In addition, she said that nurses, especially in NY, are going to be very quick to do what’s best for them – not necessarily what’s best for you.
She gave an example of one client she worked with who was admitted to a hospital to give birth, and the nurses were about to treat her for group B strep, a condition Silverstein asserted her client did not have. The nurses showed Silverstein the woman’s name in their computer as having the condition. Silverstein demanded they run another test, and it turned out the woman did not have group B strep – there was another woman in the hospital directory with the same name – and Silverstein’s client was about to have an unnecessary procedure. “These things happen all the time in New York,” said Silverstein.
Hospitals often have many protocols about interventions, including induction and augmenting of labor, monitoring of the baby’s heart rate, episiotomies, using forceps and vacuums to ease delivery and more. Natural birth advocates attest that these are often done unnecessarily for women with low-risk pregnancies and that they also introduce many risks for the mother and baby. Because of this, Silverstein contends that home birth is the safest way to give birth in New York – and if a woman opts for a hospital, she should make sure to have a doula or an assertive friend or family member accompany her.
Many OB/GYN practices frequented by Jewish women in the NY-area who have Medicaid are huge, meaning that you rarely see the same doctor twice. According to Silverstein, this means a woman’s chances of creating a meaningful relationship with her healthcare provider, in which he or she is focused and understanding of your expectations for birth, is lessened.
In contrast, choosing a practice with a midwife – who is usually more accessible and less time-crunched than a doctor – and selecting a birthing center can create a more personalized experience which is respectful of a woman’s emotional needs during pregnancy and delivery. This also diminishes the use of interventions.
Birthing centers offer a comforting, calming environment with Jacuzzis, tubs and home-style furnishings, and usually allow an entire family or group of people to accompany the laboring woman, in contrast to one or two extra people usually permitted in a hospital delivery room.
Several hospitals, including St. Luke’s – Roosevelt and NY Methodist Hospital, have birthing centers connected to the hospital – which gives a woman immediate access to hospital-level care should she require it – but there are few options for freestanding birthing centers as many have recently closed due to funding issues, according to Jaffe.
The Brooklyn Birthing Center is still operating, however, and is well regarded by parents and healthcare professionals alike.
In order to deliver safely in a birthing center, Silverstein cautioned that expectant mothers should be in good health. “If someone were obese or diabetic, I wouldn’t want them in a birthing center, or if they have a history of high blood pressure or another kind of medical history. Usually people who decide to give birth in a birthing center know they have to be in good health.”
Women should also be confident in their pain management, as she said there are usually no epidurals available in birthing centers, though there may be other pain management options.
Even more women are opting for home births, which Silverstein asserts is the safest way to deliver in New York. She estimates that her neighborhood in Crown Heights has one of the highest rates of home birth in the country – “not because people are hippy and alternative, but because it’s really the safest place to give birth in New York.” It’s also one of the least expensive methods for insurers, and NY State law requires all insurers to cover at least one midwife care option. Medicaid also covers home births.
Silverstein also encouraged people to discard their outdated stereotypes of unhygienic home births. “Home birth midwives are all RN licensed midwives; they can resuscitate babies; they bring oxygen and they bring IVs,” she said.
Maimonides Medical Center Number One in New York State
Maimonides Medical Center in Brooklyn boasts the biggest baby business in New York State, delivering nearly 8,000 babies each year. It also has one of the lowest rates of delivery by cesarean section, 23.1% as of 2011. This may be partially due to their openness to midwives; nearly 20% of women at Maimonides delivered with a midwife in 2011, while in 2007, 13% of women delivered with a midwife, suggesting that this number is on the rise. Maimonides is also the only hospital in New York City that provides volunteer doulas on a nearly round-the-clock basis. Operated by N’shei C.A.R.E.S. (Community Awareness Responsibility Education & Support), a division of Agudah Women of America, these doulas provide parents with non-medical services such as advice during labor on breathing, positioning, relaxation techniques, as well as massage and other natural pain management. Maimonides has a strong commitment to encouraging breastfeeding; 90% of babies born there in 2011 were fed at least some breast milk.
The birthing center at Maimonides includes 11 labor and delivery suites, as well as four additional rooms for the care of high-risk women. New moms can choose from 24-hour a day rooming-in as well as daytime-only rooming-in with their babies.
Thanks to their state of the art NICU, quality support services and top-notch doctors, surgeons and specialists, the New York State Department of Health gave Maimonides the status of Regional Perinatal Center, making them the referral center for the South Brooklyn community.
The Heavy Hitters – Hospitals in New York with the Most Live Births in 2011
Maimonides (Brooklyn): 7,968 live births; 6,094 natural, 1,828 cesarean (23.1%)
St. Luke’s Roosevelt Hospital Center: 6,637 live births; 4,735 natural, 1,746 cesarean (26.9%)
Mount Sinai: 6,232 live births; 4,030 natural, 2,049 cesarean (33.7%)
NY Presbyterian – Cornell: 5,698 live births; 3,537 natural, 1,994 cesarean (36.1%)
NY Methodist Hospital: 5,422 live births; 3,385 natural, 2,006 cesarean (37.2%)
NYU: 4,654 live births; 3,289 natural, 1,260 cesarean (27.7%)
Columbia Presbyterian: 4,508 live births; 2,681 natural, 1,698 cesarean (38.8%)
Lenox Hill: 4,183 live births; 2,510 natural, 1,571 cesarean (38.5%)
Beth Israel: 3,956 live births; 2,820 natural, 953 cesarean (25.3%)
Data collected by the NY State Department of Health, available online at http://hospitals.nyhealth.gov/maternity.php.Rachel Wizenfeld
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