Comparing Quality In Childbirth: Key Questions For Doctors And Hospitals

I've heard from a lot of moms this week about our new online tool for Comparing Childbirth in Massachusetts. It offers a side-by-side review of hospitals using five quality measures.

OK, these mothers say, quality measures are important, but I don't want to make a decision based on stats alone.

So here's a way to translate these measures (which experts say are good ways to assess quality) into an action plan. It's a list of questions you can use when choosing the doctor or midwife who will help deliver your baby. Please add your own below!

Question: What is your C-section rate?
Background: Many childbirth experts say 15 percent is a good target rate. If the rate for your doctor or the hospital where he or she works is higher, have a conversation about why.

Question: When you are called to the labor floor, do you still have responsibilities in the office?
Background: Some hospitals have or are moving to scheduled hours for OBs in Labor and Delivery units. But in many places an OB is pulled between office hours, labor and sometimes surgery as well. Some childbirth experts say these time pressures push doctors to opt for more C-sections that are medically necessary.

Question: What is your practice regarding elective inductions? Do you induce women before 39 weeks if everything is going well? How long do you suggest women wait, past their due date, to be induced?
Background: Many childbirth experts say babies should not be delivered before 39 weeks to avoid complications, and because babies need the last two weeks for brain, lung, and other vital organ development. Some hospitals wait until two weeks after a mom's due date to induce because waiting for labor to begin naturally can help women avoid a C-section. But inductions are needed in cases where the mom or baby are in distress.

Question: Once you find a doctor you like, if he or she is part of a larger practice, ask...Do all the doctors in your practice share the same philosophy about: inductions, epidurals, when to declare a mom is no longer making progress in labor?

Background: Many doctors will tell you that the two most common reasons for a C-section are failure to progress in labor and concerns about a drop in the fetal heart rate. Doctors and midwives have different thresholds for concern about the fetal heart rate and for "failure to progress." One hospital in Boston told a woman over 40 that "geriatric moms" are allowed to labor for 12 hours and then moved to an operating room for a C-section.

Question: What kind of breastfeeding support does your hospital offer? Are lactation coaches available 24/7?
Background: Most moms I spoke to for this project said they did not get enough help learning to breastfeed while in the hospital. If your hospital or pediatrician offers help after you've gone home, you are a lucky woman!

Question: What is your episiotomy rate?
Background: Many childbirth experts say a natural tear heals faster and leads to few complications that an intentional spin to enlarge the vaginal opening.

Question: Do you have jacuzzis and can I get in anytime during labor?
Background: Hospitals with jacuzzis have different rules about how many centimeters a woman must be dilated before they can get into the tub.

Question: Are you comfortable if I bring a doula to the hospital to help with my labor?
Background: Some OBs remind women that labor takes a long time and is tiring for everyone involved. If you think having a professional coach might help, ask you doctor or hospital if they provide or would accommodate a doula.