Child births in hospital

Birthing Centers and Hospital Maternity Services (for Parents)

You'll make plenty of decisions during pregnancy, and choosing whether to give birth in a hospital or a birth center is an important one.

Giving Birth at a Hospital

Traditional hospital births are still the most common option. This means the mother-to-be moves from a labor room to a delivery room and then, after the birth, to a semiprivate room.

In a hospital birth:

Pain medicines are available during labor and delivery, if a woman wants them.
Labor can be induced, if necessary.
The baby is usually electronically monitored throughout the labor.

Doctors "manage" the delivery with their patients. A birth plan can help a woman communicate her preferences, and her doctor will abide by these as much possible.

Many hospitals now offer more options for low-risk births, often known as family-centered care. These may include private rooms with baths (called birthing suites) where women can labor, deliver, and recover in one place without having to be moved.

A doctor and medical staff are still on hand. But the rooms create a nurturing environment, with warm, soothing colors and features that try to simulate a home-like atmosphere that can be very comforting for new moms. Rooming in — when the baby stays with the mother most of the time instead of in the infant nursery — also is more common.

Many hospitals offer childbirth and prenatal education classes to prepare parents for childbirth and parenting classes for after the birth.

How many people may attend the birth varies from hospital to hospital. In more traditional settings, the limit might be three support people during a vaginal birth. In a family-centered setting, more family members, friends, and sometimes even kids might be allowed. During a routine or nonemergency C-section, usually just one support person is allowed.

A variety of health professionals oversee hospital births:

Obstetrician/gynecologists (OB/GYNs) are doctors with at least 4 more years of training after medical school in women's health and reproduction, including both surgical and medical care. They can handle complicated pregnancies and also do C-sections.

Look for obstetricians who are board-certified, meaning they have passed an examination by the American Board of Obstetrics and Gynecology (ACOG). Board-certified obstetricians who go on to receive further training in high-risk pregnancies are called maternal-fetal specialists or perinatologists.

If you deliver in a hospital, you also might be able to use a certified nurse-midwife (CNM). CNMs are registered nurses who have a graduate degree in midwifery, meaning they're trained to handle low-risk pregnancies and deliveries. Most CNMs deliver babies in hospitals or birth centers, although some do home births.

Registered nurses (RNs) attend births to take care of the mother and baby. If you give birth in a teaching hospital, medical students or residents might attend the birth. Some family doctors also offer prenatal care and deliver babies.

Anesthesia, if needed, will be administered by an anesthesiologist. A variety of pain-control measures — including pain medicine and local, epidural, and general anesthesia — are available in the hospital setting.

Giving Birth at a Birth Center

Women who deliver in a birth center usually have already given birth without any problems or have a low-risk pregnancy (meaning they are in good health and are not likely to develop complications).

Women are carefully screened early in pregnancy and given prenatal care at the birth center to monitor their health throughout their pregnancy.

Epidural anesthesia usually isn't offered at birth centers. So women are free to move around in labor, get in the positions most comfortable to them, spend time in the jacuzzi, etc. Comfort measures (such as hydrotherapy, massage, warm and cold compresses, and visualization and relaxation techniques) are often used.

A variety of health care professionals work at birth centers, such as registered nurses, CNMs, and doulas (professionally trained providers of labor support and/or postpartum care). A doctor usually isn't on-site and medical interventions are rare. But most birth centers work with obstetric and pediatric consultants as a team. Nurse-midwives provide care during a woman's pregnancy, labor, and delivery. The OB/GYN consultants are available if she develops complications that put her into a higher risk category.

The baby's heart rate is monitored often during labor, typically with a handheld Doppler device. Birth centers do have medical equipment available, such as IV lines and fluids, oxygen for the mother and the infant, and other equipment necessary to treat sick babies and moms.

A birth center can provide natural pain control and pain control with mild narcotic medicines. But if a woman decides she wants an epidural, or develops complications, she must be taken to a hospital.

Birth centers provide a homey birth setting for the mother, baby, and extended family. In most cases, they're freestanding buildings, though some are attached to a hospital. They often include amenities such as private rooms with soft lighting, showers, whirlpool tubs, and a kitchen for the family to use.

Look for a birth center that is accredited by the Commission for the Accreditation of Birth Centers (CABC). Some states regulate birth centers, so make sure the birth center you choose has all the proper credentials.

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Which One Is Right for Me?

How do you decide whether a hospital or a birth center is the right choice for you?

Some things to consider:

If you've chosen a health care provider, find out if he or she can only practice at a particular hospital or birth center.
Check with your health insurance carrier to see which options are covered. Often, major insurance companies cover accredited birth centers as well as hospitals.

Some risk factors might mean that you're not eligible to deliver in a birth center, such as:

being older than 35
carrying multiples
having gestational diabetes or high blood pressure
having a breech-positioned baby

And if you want interventions such as an epidural or continuous fetal monitoring, a hospital is probably the better choice for you.

A birth center can be an option for women who:

don't have significant problems in their medical history
have a low-risk pregnancy
want a natural birth with minimal medical intervention or pain control
want friends or family members there for the birth

To help with your choice, arrange a tour of the hospital or birth center. This lets you make sure that the staff is friendly and the atmosphere is one in which you'll feel relaxed.

How hospitals inflate bills for healthy births by labeling them 'emergencies' : Shots

When Caitlin Wells Salerno and Jon Salerno's first son, Hank, was born, his delivery cost the family only $30. Gus' bill came in at more than $16,000, all told — including the $2,755 ER charge. The family was responsible for about $3,600 of the total. Rae Ellen Bichell/KHN hide caption

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Rae Ellen Bichell/KHN

As a conservation biologist, Caitlin Wells Salerno knows that some mammals — like the golden-mantled ground squirrels she studies in the Rocky Mountains — invest an insane amount of resources in their young. That didn't prepare her for the resources she would owe after the birth of her second son.

Wells Salerno went into labor on the eve of her due date, in the early weeks of coronavirus lockdowns in April 2020. She and her husband, Jon Salerno, were instructed to go through the emergency room doors at Poudre Valley Hospital in Fort Collins, Colo., because it was the only entrance open.

Despite the weird vibe of the pandemic era — the emptiness, the quiet — everything went smoothly. Wells Salerno felt well enough to decline the help of a nurse who offered to wheel her to the labor and delivery department. She even took a selfie, smiling as she entered the delivery room.

"I was just thrilled that he was here and it was on his due date, so we didn't have to have an induction," she says. "I was doing great."

Gus was born a healthy 10 pounds after about nine hours of labor, and the family went home the next morning.

Wells Salerno expected the bill for Gus' birth to be heftier than the $30 she'd been billed four years earlier for the delivery of her first child, Hank. She'd been a postdoctoral fellow in California, with top-notch insurance, when Hank was born. They were braced to pay more for Gus' delivery — but how much more?

Then the bill came.

The patient: Caitlin Wells Salerno, a conservation biologist at Colorado State University and a principal investigator at Rocky Mountain Biological Laboratory. She is insured by Anthem Blue Cross Blue Shield through her job.

Medical service: A routine vaginal delivery of a full-term infant.

Total bill: $16,221.26. The Anthem BCBS negotiated rate was $14,550. Insurance paid $10,940.91 and the family paid the remaining $3,609.09 to the hospital.

Service provider: Poudre Valley Hospital in Fort Collins, Colo., operated by UCHealth, a nonprofit health system.

What gives: In a system that has evolved to bill for anything and everything, a quick exam to evaluate labor in a small triage room can generate substantial charges.

The total bill was huge, but what really made Wells Salerno's eyes pop was the $2,755 charge for "Level 5" emergency services included in that total. It didn't make any sense.

Emergency room visits are coded from Level 1 to Level 5, with each higher level garnering more generous reimbursement, in theory commensurate with the work required. Dr. Renee Hsia, a professor of emergency medicine and health policy at the University of California, San Francisco and a practicing ER doctor, says Level 5 charges are supposed to be reserved for serious cases — "a severe threat to life or very complicated, resource-intense cases" — not for patients who can walk through a hospital on their own.

So, why did Wells Salerno's bill include a "Level 5" charge? Was it for checking in at the ER desk, as she'd been instructed to do? She recalls merely going through security in the ER on her way to labor and delivery, but she seemed to have been charged as though she'd received care there — like a patient with a heart attack or someone fresh from a car wreck. That ER charge was the biggest item on the bill, other than the charge for the delivery itself.

Over the past 20 years, hospitals and doctors have learned there's great profit in upcoding visits. After all, the insurer isn't in the exam room to know what transpired. An investigation by the Center for Public Integrity found that between 2001 and 2008 the number of Level 4 and 5 visits for patients who were sent home from the ER nearly doubled to almost 50% of visits. In Colorado, the Center for Improving Value in Health Care looked at emergency visit billing from 2009 to 2016 and found that the percentage of emergency visits coded as Level 5 steadily grew from 23% to 34% for patients who have commercial insurance.

After repeated calls in which she questioned the line item on her bill, Wells Salerno eventually got a voicemail from the billing department, which she shared with us. The person who left the voicemail explained that "the emergency room charge is actually the OB triage little area — before they take you to the labor and delivery room."

A customer service representative later explained the charge was for services given there when a nurse placed an IV for antibiotics, and her doctor checked her dilation and confirmed her water had broken — although none of that was actually performed in the Emergency Department. And those services, performed before every delivery, are traditionally not billed separately — and are routine, not emergency, procedures.

Caitlin Wells Salerno was in good enough shape during labor with baby Gus to snap this selfie with husband Jon as she walked to the delivery room. So when the hospital bill included a charge for emergency services, the couple thought it had to be a mistake. Caitlin Wells Salerno hide caption

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Caitlin Wells Salerno

Some hospitals provide that package of services via an "obstetrical emergency department." OB-EDs are licensed under the main Emergency Department and typically see patients who are pregnant, for anything from unexplained bleeding to full-term birth. They bill like an ER, even if they aren't physically located anywhere near the ER.

TeamHealth — a health care staffing company owned by the investment company Blackstone, and known for marking up ER bills to boost profit — essentially says an OB-ED can be as simple as a rebranded obstetrical triage area. In a white paper, the company says an OB-ED is an "entrepreneurial approach to strengthening hospital finances," because with "little to no structural investment" it allows hospitals to "collect facility charges that are otherwise lost in the obstetrical triage setting."

The OB Hospitalist Group, which is owned by a private equity company, markets a tool to help OB-EDs calculate levels of emergency care. In a case study, OB Hospitalist Group reported that hospitals "leave a lot of money on the table" by billing OB-ED visits as Level 1 and 2 emergencies when they could be considered Level 4 emergencies.

An Arizona facility said its revenue increased $365,000 per quarter after turning its obstetric triage area into an OB-ED. Poudre Valley Hospital's website doesn't list "OB-ED" as part of the facility's offerings, though UCHealth documents do reference OB-ED beds in other facilities.

KHN spoke with four other women who, after giving birth at Poudre Valley in 2020 and 2021, received ER charges on their bills after healthy births. They had no clue they had received emergency services. One wrote a warning note on Facebook to other moms in the area after getting a whopping charge — for the 10 minutes she spent in the triage room, while fully dilated and in active labor.

In Wells Salerno's case, UCHealth and her insurer have an agreement that Anthem BCBS pays a lump sum for vaginal delivery, rather than paying for line items individually. "Being seen there in OB-ED did not impact this bill whatsoever," says Dan Weaver, a spokesperson with UCHealth.

But in one of the other moms' cases, it did make a difference: The hospital received $1,500 from the insurer for that charge, and the mom was on the hook for an additional $375 for coinsurance.

Ge Bai, a professor of accounting and health policy at Johns Hopkins University, says it's a "questionable" billing practice and one that can matter to those who don't have the same kind of insurance as Wells Salerno — and to those who have no insurance at all.

Dr. Mark Simon, chief medical officer with OB Hospitalist Group, says OB-EDs can help women avoid being admitted to the hospital too early in labor, ensuring timelier, more appropriate care.

UCHealth's Weaver says such departments can also help pregnant patients with actual emergencies like preterm labor, preeclampsia or vaginal bleeding get quick care from specialists available 24/7 — often without having to be admitted to the hospital. But at hospitals like Poudre Valley, healthy women having healthy births also get routine "OB-ED" treatment, without their knowledge.

Weaver says the only time someone in labor would not go through the OB-ED — and therefore the only time they would not receive the emergency charge — is if they have a scheduled induction or cesarean section or are directly admitted from a provider's office.

Hsia, the UCSF researcher and ER doctor, is unconvinced by Weaver's arguments that these sorts of charges benefit patients: "If they're actually going to charge a special fee that you didn't get directly admitted from your physician, that's absolutely ridiculous," Hsia says.

Wells Salerno's "OB-ED" exam was performed by her clinician, but the OB-ED charge still showed up on her bill.

Resolution: Wells Salerno eventually threw in the towel and paid the bill.

"I was at a very vulnerable time during pregnancy and immediately postpartum," she says. "I just felt like I had kind of been taken advantage of financially at a time when I couldn't muster the energy to fight back."

The fact that two healthy brothers could come into the world with such different overall price tags isn't surprising to Dr. Michelle Moniz. "There is no clinical reason that we have this level of variation," says Moniz, assistant professor of obstetrics and gynecology at the University of Michigan and its Institute for Healthcare Policy and Innovation. Her research shows that people with private insurance pay anywhere from nothing to $10,000 for childbirth.

"You don't get what you pay for," says Wells Salerno, who maintains that — despite the price difference in the cost of their deliveries — both of her children are equally "awesome."

The family expected the bill for Gus' birth in April 2020 to be heftier than the $30 they were billed four years earlier for the delivery of his older brother, Hank. They had better insurance back then. But the $2,755 charge for high-level emergency services for a routine delivery seemed outrageous to them. Rae Ellen Bichell/KHN hide caption

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Rae Ellen Bichell/KHN

The takeaway: Anything in our health system labeled as an emergency room service likely comes with a big additional charge.

Data from the Colorado Division of Insurance shows that Poudre Valley typically received about $12,000 for similar births in 2020 — about 43% more than the typical Colorado hospital. So the more than $14,000 Wells Salerno and her insurer paid is very high.

Expectant parents should be aware that OB-EDs are a relatively new feature at some hospitals. Ask whether your hospital has that kind of charge and how it will affect your bill. Ahead of time, ask both the hospital and your insurer how much the birth is expected to cost. In Colorado, the Center for Improving Value in Health Care offers a price comparison tool for common medical procedures, including vaginal delivery.

If you do require a genuine ER encounter, look at your bill to see how it was coded, Levels 1 to 5 — and protest if your visit was misrepresented. Ask "Has this bill been upcoded?" You are the only one who knows how much time you spent with a medical provider and how much care was given and where. Here's a chart that will help with the proper definition of each level.

Know that victory is possible. At least one mom won the battle and got the emergency charge removed from her Poudre Valley Hospital birth bill. To make that happen she had to put in hours on the phone with UCHealth, have a lot of confidence and had to emphasize to everyone she spoke with that an emergency charge for a routine delivery just didn't — and doesn't — make sense.

Bill of the Month is a crowdsourced investigation by NPR and Kaiser Health News that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

CHOOSE A DOCTOR FOR BIRTH | City Clinical Hospital. F.I. Inozemtseva

Nobody likes the unknown. She frightens us, but in childbirth this is not at all necessary: fear intensifies pain and spends more strength. So you should use every opportunity to create a pleasant and familiar environment for yourself during childbirth. And you need to start by getting to know the doctor who will take delivery. True, there is one nuance here: a personal doctor is possible only during contractual childbirth.

Define criteria

Before looking for a doctor, the expectant mother must decide how she sees her birth and what, in fact, she wants from the doctor? Does she want to give birth as naturally as possible or does she agree to some kind of intervention? Maybe the woman is set up for a vertical birth or is planning to spend the first stage of labor in some other way (for example, in a bath)? Does she expect active help from the doctor or does she only want observation and non-interference in the birth process? You can draw up a whole birth plan for yourself, in which you write all your wishes, doubts and questions. And only having understood something about your childbirth and about what kind of help is expected from a doctor, you can start looking for a specialist who will help to carry out all this.

Where can I find it?

Ideally, if the same doctor will manage the pregnancy and delivery. This is possible only in large medical clinics or in maternity hospitals, which have their own consultation centers. For nine months of constant communication, the doctor and the expectant mother will become, if not friends, then close acquaintances for sure. A woman will trust her doctor, and he will know all the features of her body, as well as the state of health and even the nature of her unborn baby.
But you can choose a doctor and immediately before childbirth, they sign a contract already from the 36th week of pregnancy. We advise you not to postpone the acquaintance, you need to meet with the doctor at least a few times to make sure how you fit each other. Indeed, sometimes the first impression is deceptive, and it will be too late to change the doctor during childbirth.

List of doctors and midwives for concluding a contract for childbirth in the maternity hospital at the GKB im. FI Inozemtseva on Fortunatovskaya street

F. I. Inozemtseva on Upper Pervomaiskaya Street

Who will help you find a doctor?

Probably the first thing that pregnant women look for when looking for a doctor is the reviews of friends and acquaintances who have already given birth, the so-called word of mouth. This is convenient: you can directly ask a young mother a bunch of questions, at the same time get yourself a first impression of the doctor - is this the person you need. Still, of course, you can read reviews on the Internet, but here it is difficult to count on reliability. After all, it is impossible to understand through the screen what kind of person is talking about the doctor, it is likely that his preferences will be very far from yours. Well, already having come to the clinic or maternity hospital, you can additionally ask for advice there. In the department where the contract for the management of pregnancy or childbirth is concluded, there are always specialists who will help you choose a doctor, taking into account the preferences of the expectant mother, and not even one. Well, then it remains only to go to get acquainted with the doctor.

First meeting

At the first meeting, in addition to any medical aspects, one should also pay attention to the character of the doctor. Some women need a kind doctor, others a strict one. Someone would prefer a talkative doctor, and someone - a laconic one. There are mothers who feel good with a cheerful person, while others need a serious specialist. All this is also important, because a woman should feel comfortable in the company of her doctor, she needs to establish contact with him. If the expectant mother takes her husband with her to the birth, then his opinion will also be important here, because then three people will already interact in childbirth. Therefore, it is necessary to come to the first meeting with the future dad.
There is one more thing - the doctor will also evaluate the couple with whom he will then have to work, so we must take into account that he, too, should be comfortable with future parents.

We pay attention

Next, we look at whether the doctor is positive? Yes, there are doctors who immediately see a problem in every complaint, not a solution, expect the worst, and even voice their concerns to the expectant mother. You need to part with such a doctor, because how pregnancy and childbirth will proceed depends largely on the psychological mood of the mother. And where can I get it if the doctor scares the woman all the time?
The doctor should also be friendly to the expectant mother and take into account her opinion.

Important little things

Discuss with the doctor all the points that concern you: how to call him for childbirth, what time he will arrive, whether he will be on vacation and whether he will leave the city. Find out how the doctor relates to pain relief in childbirth, stimulation of contractions, puncture of the fetal bladder, etc. Tell him about your wishes, because the doctor cannot read the thoughts of his patients and, not knowing what a woman wants or does not want, will act as usual, not the way she expects. You must not only voice your preferences, but also find out how the doctor treats them, so that later it does not turn out that the doctor either did not hear the woman, or did not agree with her, but simply did not focus on this.
If the mother does not yet know what she wants from childbirth and the doctor, then you need to ask the doctor to tell you about how he prefers to conduct childbirth, what he considers necessary to do and what not, and why. After that, it will be easier for a woman to form her own opinion.

If you find a doctor with whom you are on the same wavelength, hold on tight to him. With such an assistant, childbirth will be much more productive than without it!
http://www.mama-journal.ru/

WHAT TO BRING WITH YOU TO THE Maternity Hospital WHEN ADMISSIONING FOR BIRTH

What should be the bag for the maternity hospital? The main requirement 一 is that the bag must be washable. From a cloth bag or suitcase, you will be asked to transfer things to bags or transparent plastic bags. At the onset of labor or the outflow of amniotic fluid, a list of what to take with you to childbirth should be prepared in advance. These are the following documents:

exchange card (the main document of a pregnant woman)
passport, compulsory medical insurance policy, SNILS (if available)
birth certificate (provided that it was issued to you by the LCD),
medical documentation not included in the exchange card (ultrasound data, consultations of other specialists, extracts, etc.).

You can take with you to the maternity hospital when you are admitted to the maternity ward:

washable slippers
mobile phone with charger
compression stockings
ml.)

All medical care in the maternity hospital is provided free of charge in accordance with the medical and economic standards (MES) of Moscow. There is no need to come to the maternity hospital in advance before the start of labor activity in the absence of indications.

Scheduled hospitalization in the maternity hospital is carried out if there are indications in the direction of the doctor of the antenatal clinic.

Emergency hospitalization is carried out in the presence of emergency indications by the ambulance team (AMB), or in case of self-treatment with complaints to the emergency room of the obstetric and gynecological center.

Post-natal items You must bring after delivery, when you are transferred to the post-natal unit.

List of things for the mother and newborn in the postpartum department and for discharge.

The postpartum department of our maternity hospital provides the most necessary for the mother and her child. After giving birth, relatives and friends can give you the following things in a bag or in a light small bag made of polymer materials to the postpartum department:

disposable underpants - 1 pack
postnatal pads - 1 pack
small cotton towel for the body
soap, toothbrush and toothpaste
shower slippers
Abdominal postoperative bandage (necessary for patients after cesarean section)

List for the child in the postpartum department:

Diabs - 1 packaging (from 2 to 5 kg)
Wet napkins
Children's soap or gel
Cream protective under diaper

If the discharge takes place in the summer, then the child, depending on the air temperature outside, will need a vest, a bodysuit, a hat, a light blanket.