“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.