Congratulations, you’re pregnant! Are you newly discovering your pregnancy journey and faced with the decision of choosing who your Obstetrician-Gynecologist (OBGYN) or a Midwife will be? It’s essential to consider that your chosen provider typically has privileges at a specific hospital, which will be the primary location for delivering your baby.
Considerations
When selecting a hospital for your delivery, it’s important to consider various factors. If you anticipate a high-risk delivery requiring advanced neonatal care, you’ll want to choose a hospital equipped with a high-level neonatal care unit. Additionally, if you have specific preferences for your labor experience, such as opting for a water birth or utilizing Nitrous oxide (laughing gas) for pain relief, you’ll want to ensure that these options are available at the hospital you choose.
Midwife vs OBGYN
An OBGYN is a physician who has completed medical school and a residency in Obstetrics and Gynecology. Certified Nurse Midwives are registered nurses who first obtain a bachelor’s degree in nursing, then obtain a graduate level degree in Midwifery. In Maryland, DC, and Virginia, Midwives have full scope of practice meaning they independently provide prenatal care and manage low-risk vaginal deliveries in a hospital setting. Although not every hospital utilizes midwives, one study found that midwifery patients have a much lower rate of intervention and a 30 to 40% decreased risk of cesarean compared to their OB/GYN patient counterparts (Souter et al., 2019). Keep in mind that these findings could also be due in part to the fact that midwives generally only see low-risk healthy patients who would most likely need less intervention. When a midwifery patient becomes too high risk or is in need of a cesarean, an OB/GYN will take over their care, and in some cases, a specialized high-risk OB/GYN, called a maternal-fetal medicine specialist, will also assist in your care.
NICU level of care
Neonatal Intensive Care Units (NICUs) offer a comprehensive spectrum of care tailored to newborns’ needs, considering their medical conditions and gestational age. Level I NICUs, typically situated within postpartum units, cater to healthy newborns. Level II NICUs are designed to accommodate infants born prematurely at 32 weeks and beyond, or those with minor medical concerns requiring specialized attention. They may provide services such as phototherapy for jaundice or respiratory support for babies with mild breathing issues. Level III NICUs offer an elevated level of care for critically ill or extremely premature infants, equipped with advanced medical equipment and staffed by a multidisciplinary team proficient in managing complex medical conditions, performing minor surgeries, and delivering continuous monitoring and life-saving interventions. Finally, Level IV NICUs represent the pinnacle of neonatal care, offering the most advanced interventions, specialized surgical procedures, and access to a comprehensive range of pediatric medical subspecialists.
Consider C-Section and Episiotomy rates
As per the Leapfrog Group, an organization conducting the nationwide Leapfrog Hospital and Ambulatory Surgery Center (ASC) Survey, hospitals are recommended to maintain a cesarean section rate of 23.6% or lower. Additionally, hospitals should aim for an episiotomy rate, which involves an incision made in the birth canal during childbirth, of 5% or less.
Local Hospital Statistics and Offerings:
Sibley Memorial hospital (The Palisades, DC)
Rate of Cesarean: 33%
Episiotomy: 2.8%
Level II NICU
No midwifery group
Bonus: Updated rooms
Medstar Georgetown (Georgetown, DC)
Rate of Cesarean: 28.9%
Episiotomy: 0.7%
Level IV NICU
No midwifery group
Medstar Washington Hospital Center (Columbia Heights, DC)
Rate of Cesarean: 28.9%
Episiotomy: 0.6%
Level III NICU
Utilizes Midwives
Bonus: Offers nitrous oxide for pain relief
George washington Hospital Center (Foggy Bottom, DC)
Rate of Cesarean: 33%
Episiotomy: 2.8%
Level III NICU
Utilizes Midwives
Bonus: Metro accessible, offers labor tubs for labor and water birth delivery, and nitrous oxide for pain relief
Shady Grove (Rockville, MD)
Rate of Cesarean: 29.3%
Episiotomy: 5.17%
Level III NICU
Utilizes Midwives
Bonus: Offers labor tubs
Holy Cross Hospital (Silver Spring, MD)
Rate of Cesarean: 28.4%
Episiotomy: 2.2%
Level III NICU
Utilizes Midwives
Inova Fairfax (Fairfax, VA)
Rate of Cesarean: 32.9%
Episiotomy: 2.4%
Level IV NICU
Utilizes Midwives
Inova Alexandria (Alexandria, VA)
Rate of Cesarean: 31.5%
Episiotomy: 4%
Level III NICU
Utilizes Midwives
Bonus: Offers Nitrous oxide for pain relief
Virginia Hospital Center (Arlington, VA)
Rate of Cesarean: 26.5%
Episiotomy: 1.6%
Level III NICU
Utilizes Midwives
Conclusion
Regardless of the provider or hospital you choose to give birth at, remember that you are your own best advocate. You know your body best, so communicate your needs, concerns, and preferences clearly with your healthcare team. Don’t hesitate to ask questions, seek clarification, or voice any uncertainties you may have during the birthing process. You have the right to advocate for yourself and your baby’s well-being every step of the way.
References
All Cesarean and episiotomy rates used in this article can be found at https://ratings.leapfroggroup.org/ by searching the hospital’s name and looking under maternity care.
Souter, V., Nethery, E., Kopas, M. L., Wurz, H., Sitcov, K., & Caughey, A. B. (2019). Comparison of Midwifery and Obstetric Care in Low-Risk Hospital Births. Obstetrics and gynecology, 134(5), 1056–1065. https://doi.org/10.1097/AOG.0000000000003521
