How to choose the hospital where to give birth? Practical advice

How to choose the hospital where to give birth

Some mothers-to-be know right from the start where they will give birth to their baby, while others are undecided until the very end about which structure to choose for the birth (perhaps because the gynecologist works in a hospital where there is no obstetrics ward. ... it can happen!). The future mother finds herself having to deal with the different and multiple characteristics of the structures. Nowadays many hospitals have specialized giving the possibility to choose between various types of birth while the offers of private or semi-private structures multiply. So here are all the aspects to take into consideration and how to choose the hospital where to give birth.

Keep in mind that the Ministry of Health is closing down the birth centers that practice less than 500 parts year precisely because they would not guarantee the right degree of safety. So find out about this data before considering the birth center near your home.

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Hospital or clinic?

Hospitals are larger and usually facilities better equipped for emergencies and assistance to mother and child: a doctor, a midwife and a pediatrician are available 24 hours a day all the time, ready to intervene at any time. It is true that hospitals are usually places where one turns to in case of illness and a woman ready to start a new life might feel uncomfortable in that context.

Le private facilities instead they are very places comfortable, but where everything will be at your expense if you do not have an agreement, while if the National Health System has an agreement you could only pay an extra for a single room, for example. In the private facility, the future mother will be followed by her trusted gynecologist, obstetrician and nurses who will be totally available to her.

Criteria for choice

But what are the important things to evaluate for choosing the right structure for your birth? First of all, you can find out about which facilities for childbirth assistance are present in the area, make contact and go and visit the place directly. The most important points to consider are:

• the percentage of caesarean sections and induced deliveries (which should not exceed 10-15% of the total);
• the use of episiotomy as a routine practice and the use of drugs such as oxytocin;
• the possibility of giving birth in water;
• the possibility of using epidural anesthesia;
• the possibility for the woman to choose the position to take during labor and delivery;
• if it is allowed for one or more people chosen by the mother to attend the birth;
• if the baby is left with the mother immediately after delivery;
• if the baby is placed in the thermal crib;
• the possibility of keeping the child in their own room (rooming-in);
• if the baby is given artificial milk supplements.

Neonatology level

In choosing the hospital it is advisable to take into account the level of neonatology, i.e.specialized assistance for newborns. Il third level it is the highest and offers specific assistance, especially for newborns premature and for those who have some problems at birth. The first level offers basic care and the second level a little more specialized assistance, but in the most serious cases, after stabilizing the child, he will arrange to transfer him to a more suitable facility.

In general, if you have a high-risk pregnancy and risk giving birth well in advance, it is better to rely on a third-level structure. In the event of a full term birth, you may very well choose a hospital with a lower level of neonatology.

Preparation course and the opportunity to visit the ward or meet the midwives

Many structures organize preparto courses, aimed at pregnant women from 28th week of pregnancy. Participating is useful both to talk about topics that may be useful to you (labor, birth and first baby care), and to get to know the hospital or the midwives who work there. The ideal would therefore be to attend the preparation course in the hospital where you would like to give birth. Knowing the midwives is important because if you find yourself in the delivery room with a midwife you already know, it will be very helpful.

Presence of the father in the delivery room and visits after birth

Now more and more hospitals offer the possibility for future fathers to be present in the delivery room and to cut the umbilical cord at birth. However, there are still some structures that do not allow fathers to attend the birth. So, if your partner / husband is willing to support you during the birth, choose a facility where he can enter. And find out in advance about the tests required to attend the birth: many hospitals want salmonella, carried out in the last month before the expected date of delivery. Finally, also ask if, after the birth of the child, fathers have the possibility to enter at other times besides the classic visiting hours.

Childbirth in analgesia

An epidural can be a lifesaver for many women. However, not all hospitals guarantee the presence of an anesthetist 24 hours a day. If you intend to request the birth in analgesia, then look for a facility where you can request one at any time. And remember that in order to have an epidural you will need to visit the anesthetist in the last weeks of pregnancy (usually within 36st week).

Modernity of labor and delivery techniques

Will you be free to move during labor or will you have to stay still on the bed? It seems like a trivial question, but it is very important. The most modern facilities leave pregnant women the possibility of managing labor in the best way, choosing the position they find most comfortable and giving them the possibility to feel free to walk, stay on the ball, get on their knees or find the most suitable position to feel less. ache. The same goes for childbirth: in more "ancient" structures only childbirth lying on the bed is provided, while more modern structures allow women to make other choices in total freedom, such as water birth or seated birth and so on. .

Read also: Useful post-partum services

Nido o rooming in?

Not all hospitals are organized the same way. There are facilities where children are kept in the nursery and mothers, during the period of hospitalization after childbirth, can visit them at certain times to breastfeed them. In others, however, rooming in is implemented, i.e. the child stays in the room with his mother day and night.

• In the first case, the mother will have time to recover from the birth and rest before returning home, without having to take care of the baby immediately. However, calculate that some hospitals with crèches do not provide the possibility of taking babies to the mother's room if she cannot get up. So in the event of a caesarean delivery, you may not be able to see your baby for 1 full day.
• In the second case, the mother will have to take care of the baby from the beginning and will have the baby around 24 hours a day. If the mother is very stressed by the birth, it could be a bit difficult. But do you want to add the joy of not detaching yourself from your child for a moment? The intermediate solution could be to choose a hospital that favors the rooming in, but also gives mothers the opportunity to use the nursery in case of need.

Early breastfeeding

Another question to ask when choosing a hospital is whether the facility favors breastfeeding or whether the baby is given formula after birth. In fact, there are hospitals that support women in choosing breastfeeding and in making the baby attack immediately after birth. If you hope to be able to breastfeed your baby naturally, in these facilities you will find specialized personnel who will be able to help you solve any problem and answer your doubts to start breastfeeding in the best way. It can also be useful to know if breastfeeding on demand or by schedule is favored.

Any other business

Here are other things to consider: Caesarean relationship / natural birth, use of the episiotomy technique, public or private facility, proximity to the home, number of beds in each room, bathroom in the room or corridor.

Whatever your choice, contact the various hospitals in advance to understand how they are organized, if it is possible to visit the maternity ward and find out what services they offer, in order to make a reasoned choice based on your wishes. And choose a hospital that inspires confidence, without paying too much attention to the stories of friends or acquaintances.

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10 questions to ask yourself when choosing the hospital to give birth

The Dove e Come Mi Curo portal, which collects data on health facilities and the country, has created a Decalogue to be able to choose the structure that best suits your needs. Let's see together what are the questions that are important to ask yourself before choosing where to give birth.

• Do you have enough births per year to be considered safe?

Il volume of parts performed in a year is an important safety index. According to the new national guidelines, the minimum parameter is 500 parts year, below this threshold a structure cannot be considered safe. Where and How Do I Care? He created a in which it is possible to know the number of births performed each year and from the analyzes it emerges that the accredited public or private structures that carry out births in the country are 488, of these those that carry out a number greater than 1000 parts per year they are 36%, those who do not reach the minimum threshold of 500 births and therefore could not guarantee the safety of the woman and the child are 23%. The best structure in the country for volumes of parts is theSant'Anna hospital in the city.

• Does it respect the right proportion of deliveries by caesarean section?

Often the Caesarean section it is performed without there really being the need and national guidelines set the percentage of caesarean sections at 25% as a reference for structures that perform a number of deliveries greater than 1000, while at 15% for structures that perform less than 1000 deliveries. The data analyzed by Where and How Do I Care? show that the percentage of caesarean sections remains too high, especially in southern hospitals.

I 10 hospitals more careful to respect the limits of the use of caesarean section are:

1. Sant'Anna hospital in the city (Piedmont)
2.  Papa Giovanni XXIII Hospital in the city (Lombardy)
3. A. Gemelli University Hospital in the city (Lazio)
4. Careggi University Hospital of Florence (Tuscany)
5. Brescia Civil Hospital of Brescia (Lombardy)
6. Sant'Orsola Polyclinic - Malpighi of Bologna (Emilia the city)
7. Padua Hospital (Veneto)
8. Vittore Buzzi Children's Hospital in the city (Lombardy)
9. Maggiore Pizzardi Hospital of Bologna (Emilia the city)
10. Filippo del Ponte Hospital in Varese (Lombardy)

The experts also specify that the Vittore Buzzi Children's Hospital in the city, the Filippo del Ponte Hospital in Varese and the MB Foundation for the Child and his Mother in Monza perform less than 10% of primary caesarean sections.

• Is it among the structures awarded with the Pink Stamps?

The pink sticker is an acknowledgment that theNational Observatory on Women's Health (ONDa) assigns to hospitals more attentive to women's needs. To find out if the chosen hospital is among the awarded ones, just go to the Dove e Come mi Curo? Website. and look for the Pink Stamps (1 to 3) among the certifications.

• Does it guarantee epidural analgesia 24 hours a day?

Since 2008, birth with epidural analgesia has been included in the Essential Levels of Assistance, yet still today in many structures the epidural is not guaranteed and women are forced to give it up, especially if they give birth at night or at the weekend. If you want to give birth with an epidural, it is good to choose a hospital that offers it 24 hours a day, 24 days a week.

• Do you have a Neonatal Intensive Care Unit?

In case of high-risk pregnancy, twins or complications it is very important to choose a facility that has one Neonatal Intensive Care Unit. In physiological pregnancy, it is sufficient to ensure that the structure has 'transport in utero' or 'neonatal emergency transport' (STEN).

• Is it equipped for cord blood collection?

The collection of the umbilical cord, to be donated to public banks, is still a service available in a few structures.

• Does it offer rooming-in service?

Most facilities and birth centers now practice the rooming-in, which provides for the possibility of keeping the baby with you all the time (or having him sleep in the nursery from midnight to six). Keeping the baby in the room facilitates the initiation of breastfeeding and strengthens the primary bond between mother and baby. Even the attention that is directed towards the beginning of thenursing it is important: are there midwives and nurses who support the new mother in the early stages?

• Can the father enter the delivery room?

According to the Report on the event of birth in the country (CeDAP) for the year 2022, 91,83% of the woman has the father of the child next to her at the time of birth, but it is good to inquire about this possibility first.

• Is it easily accessible?

The distance from your home is still a factor to consider, as is the availability of parking.

• Does it have a bath for the water birth or other tools that facilitate the birth?

After selecting some structure based on the parameters related to safety and the indispensable requirements, you can choose a structure that allows us to give birth as we prefer: for example in water or in any case with a active childbirth. Some hospitals are equipped with a tub for water birth or with tools that facilitate birth: such as the backrest, the Dutch stool or special lowered beds. It is better to inquire in time about the possibilities offered by the chosen structure.