How to choose the right maternity ward

How to choose the right maternity ward: factors to take into account

The choice of maternity is an important decision because it influences the follow-up of the pregnancy and the way of living the childbirth. But what are the criteria to remember to be sure not to make a mistake when making a decision? Sometimes factors beyond our control come into play, primarily our health and that of the baby. Moreover, if those who live in very urban areas are lucky enough to be able to hesitate between several establishments, this is not the case for those who live in a region where maternity hospitals are rare. In some cases, the choice is made, constrained and forced, on the only available establishment. For all other expectant mothers, the decision is made according to their own wishes.

To fully understand how the situation is now, it is necessary to go back a few years. For nearly twenty years, we have witnessed many changes in the management of childbirth. In 1998, in fact, the health authorities decided to reorganize hospitals and clinics so as to allow all women to give birth in conditions of maximum security and to give each baby care adapted to his needs. In this logic, many small units were closed. The remaining maternities are now classified into three levels.

Maternity type 1, 2 or 3: at each level its specificity

There are just over 500 maternity hospitals in France. Among these, the establishments listed as level 1 are the most numerous.

• Level 1 maternities:

Level 1 maternities welcome “normal” pregnancies, those who do not seem to present any particular risk. In other words, the vast majority of pregnant women. Their mission is to detect possible risks during pregnancy in order to direct future mothers to more suitable maternity hospitals.

Their equipment allows them to face any scenario and to deal with unforeseen difficult deliveries. Closely related to a level 2 or level 3 maternity hospital, they must, if necessary, ensure the transfer of the young woman and her child to a structure better able to deal with the problems that arose during childbirth.

• Level 2 maternities:

Type 2 maternities are equipped witha neonatal medicine or neonatal intensive care unit, either on site or nearby. Thanks to this particularity, they are able to ensure the follow-up and delivery of a normal pregnancy when the future mother wishes, but also to manage more complicated pregnancies (in case of gestational diabetes or hypertension for example). They can especially accommodate premature babies 33 weeks and older requiring care, but not heavy respiratory care. In the event of a serious problem identified during childbirth, they perform, as soon as possible, the transfer to type 3 maternity closest with which they operate in close connection.

• Level 3 maternities:

Level 3 maternities havean individualized intensive care unit or a pediatric and maternal intensive care unit. They are specially empowered to monitor high-risk pregnancies (severe hypertension, multiple pregnancy, etc.) and welcome premature babies under 32 weeks. Babies who will need intensive supervision, even heavy care, such as resuscitation. These maternities are networked with level 1 and 2 establishments and provide them with assistance when making an important decision. However, they can welcome any future mother who wishes, even if her pregnancy is progressing normally, especially if she lives nearby.

The levels do not necessarily prejudge the quality of establishments and the know-how of their staff. They are essentially a function of the existing medical infrastructures in pediatrics and neonatal resuscitation. In other words, they only take into account the presence of teams and equipment necessary to provide intensive care to newborns suffering from serious health problems (malformations, distress, etc.) or prematurity of less than 32 weeks.

In addition, in all regions, the different types of maternity hospitals work in a network to optimize the quality of care offered to expectant mothers and babies. For example, a medical team may decide to hospitalize in a type 2 or 3 maternity unit an expectant mother who seems to have to give birth prematurely before 33 weeks. But, if after 35 weeks, everything is back to normal, this future mother will be able to return home and bring her child into the world, at term, in the maternity hospital of her choice.

If, instead of giving birth as planned in a type 2 or 3 maternity hospital, we find ourselves in an emergency in the labor room of a level 1 unit, no need to panic. the obstetrical block is more or less the same everywhere, the medical teams have identical skills. All maternities are able to perform difficult deliveries, vaginally or by cesarean section, in the presence of a midwife gynecologist or to perform obstetric maneuvers specific. They also have an intensive care anesthetist, a pediatrician and several midwives on their team.

The mother-to-be will therefore benefit from the assistance of a complete quality medical team and will be transferred as soon as possible with her newborn to the maternity level 2 or 3, better able to provide them with the necessary care.

Analyze your wishes to better choose a maternity hospital

When everything looks good, it’s up to you to think things over before choosing one maternity ward over another. The first step is to properly identify their needs and expectations. It is essential to make an informed decision. Remember that from one establishment to another, a lot is different.

Some maternities are known to have a more medicalized approach. And even if you only stay there for a short time, this stay is a very important stage in your life as a mother. The more maternity will be adapted to your deep needs, the better you will live your childbirth and its consequences. If in your region, there is no urgency to register for a maternity ward (in some places are rare and you have to book very quickly), give yourself time, wait to be sure of yourself and find out more. contact the establishments likely to welcome you. First, try to determine what you are looking for on the “geographic” plan and medically.

Start with the place and ask yourself simple questions. Do you consider proximity to be an essential criterion? Because it’s more practical: your husband, your family are not far away, or you don’t have a car, or you already know midwives or maternity doctors … So, no hesitation, register as closely as possible.

The need for security can play a decisive role. As we have said, all maternity hospitals are able to take care of all deliveries, even the most delicate. But if you have a restless temperament, the thought of eventually being transferred during childbirth, or soon after, to a better-equipped maternity hospital may disturb you. In this case, carry your choice directly to the maternity level 3 closest to you.

While knowing that this type of approach does not necessarily reassure very anxious women. Technical equipment is not the only answer, you have to know how to discuss your fears with the doctor and the midwife of the establishment. Corn other factors must also be taken into account : the type of childbirth desired, the presence or not of a “natural” room, pain management during childbirth and after, preparations, breastfeeding assistance, length of stay.

Define what type of childbirth you want

In most maternities, we offer a fairly “standard” delivery which consists, schematically, of examining you when you arrive, putting yourself under monitoring and putting in the epidural when you ask for it. An infusion instills oxytocics (oxytocin) in your body which will regulate the contractions. Then, the midwife will break the bag of water, if this did not happen spontaneously. You thus spend the time of the “work” rather serene, until the moment when the dilation is complete. It is then time to push, under the direction of the midwife or the gynecologist, and welcome your baby.

Some women want to get more involved with this model. Thus they delay the installation of the epidural or even do without it and develop very personal strategies. It is a less medicalized, more natural childbirth. Midwives can suggest to the expectant mother to take a hot bath with analgesic effects, to go for a walk, to swing on a ball … And of course to support her in her project or, if she changes her mind, to switch to a more medicalized mode. 

A good way to prepare for this type of childbirth is: the “birth plan”, which is written around 4 months of pregnancy during the prenatal interview of the 4th month. This idea comes from Great Britain where women are encouraged to write their wishes for childbirth in black and white. This “project” results from a negotiation between the obstetric team and the couple for personalized care.

The project is discussed with the team on specific points. For that you have to write what you want. In general, the discussion revolves around fairly recurring questions : no episiotomy when possible; high mobility during work; the right to keep your baby with you when it is born and to wait until the umbilical cord has finished beating before cutting it. 

But you have to know that we can’t negotiate everything. In particular the following points: intermittent auscultation of the fetal heart rate (monitoring), vaginal examination by the midwife (within a certain limit, she does not need to do one every hour) , catheter placement so that an infusion can be set up quickly, injection of oxytocins into the mother when the baby is discharged, which reduces the risk of bleeding at the time of delivery, all actions taken by the team in the event of an emergency.

Know how the pain will be managed

If you don’t even consider the idea of ​​painful sensations ask about the terms of the epidural, on the rate practiced in the establishment and on the permanent presence of the anesthesiologist (he can be on call, that is to say reachable by telephone). Also ask if it is “reserved” for the maternity ward or if it also takes care of other services. Finally, be aware that in a medical emergency (a cesarean for example), the anesthesiologist may not be available at the time, so you will have to wait a bit. 

If you are tempted to try without an epidural, like that, “simply” to see, do you confirm that you will still have the ability to change your mind during childbirth. If you have decided to do without an epidural or in the event of a formal contraindication (there are few), ask what are the other pain management solutions (techniques, other medications…). Finally, in all cases, find out how the pain will be managed after childbirth. This is an important point that should not be overlooked.

To discover in video: How to choose maternity?

Maternity: find out about preparations for childbirth

Preparation for childbirth often begins at the end of the second trimester of pregnancy. Social Security fully covers 8 sessions from the 6th month of pregnancy. If the preparation is not mandatory, it is strongly recommended for many reasons:

They teach effective relaxation techniques to decamber the back, relieve it and chase fatigue. The future mother learns to move her pelvis through rocking exercises, to locate her perineum.

The sessions allow you to learn and familiarize yourself with all the phases of childbirth. Better information helps to fight the anxieties linked to the stories of catastrophic births or to a lack of knowledge of this moment.

If the planned epidural was not possible during childbirth, the techniques learned would then prove to be invaluable in “controlling” pain. The courses often offer the opportunity to get to know the midwives of the maternity hospital, so maybe the one who will assist you on D-Day.

Maternity: specify the stay you want

Thinking about your needs after the birth of your child (even if it is difficult to assess) will also guide you in your choice of establishment. The first question to ask naturally concerns the length of stay in the maternity hospital.

If you have decided to breastfeed your baby Find out if the maternity ward has midwives specifically trained to help breastfeeding? Are they available enough to give you the time and support you need?

You must take into account different elements:

• Are the rooms individual or not? With shower in the room?
• Is there an “accompanying” bed so that the father can stay?
• How many workers are there in “suites of layers”?
• Is there a nursery? Can the baby spend his nights there or does he sleep near his mother? If he stays in the mother’s room, is it possible to seek advice at night?
• Are there plans to teach the mother the essential childcare skills? Do we do them for her or do you encourage her to do them herself?

Visit the maternity ward and discover the team

You have set your own expectations in all areas. It is now a question of informing you about what the different establishments offer you in reality, in terms of reception, security and support. Do not hesitate to use word of mouth and ask your friends. Where did they give birth? What did they think of the services offered by their maternity ward?

Ask to meet all the staff, find out who will be present on the day of delivery. Is the doctor still there? Will the epidural be asked early? Conversely, are you sure you can benefit from it? Will you be able to request an epidural that allows you to move around (for this, the maternity unit must have certain equipment)? How do you relieve the discomfort of after nappies? What is the maternity policy towards breastfeeding? Also take into account that you have very good contact with the maternity staff or, on the contrary, that the current does not pass between you and the midwives.

And then don’t hesitate to change your mind and look for another establishment. The idea is that these few days will help you recover and start your new life as a new mother.