Choosing where to give birth is one of the bigger decisions in a pregnancy. In many areas you may have only one or two realistic options, but where you do have a choice, it helps to know what to compare: the hospital's level of maternal and newborn care, its quality and safety practices, its approach to labor and birth, and practical matters like insurance and distance.
This guide is general information. Discuss your options with your obstetrician, family doctor or midwife, especially if your pregnancy is considered high risk. If you have heavy bleeding, severe pain, signs of preeclampsia such as a severe headache or vision changes, or any concern that you or your baby is in danger, call 911 or go to the nearest emergency department.
Start with your clinician
In the US, your choice of hospital is often tied to your prenatal care provider, because obstetricians and midwives usually deliver at specific hospitals. If a particular hospital matters to you, ask early in pregnancy where your provider has privileges, or consider choosing a provider based on the hospital.
Levels of maternal care
Hospitals differ in how well equipped they are for complications. Medical organizations including the American College of Obstetricians and Gynecologists describe four levels of maternal care:
| Level | Name | Suited for |
|---|---|---|
| Level I | Basic care | Uncomplicated pregnancies, with the ability to stabilize and transfer unexpected problems |
| Level II | Specialty care | Moderate risk pregnancies |
| Level III | Subspecialty care | More complex conditions, with maternal-fetal medicine specialists and intensive care |
| Level IV | Regional perinatal health care center | The most complex maternal conditions and critically ill patients, often serving as a referral center |
Some states formally designate these levels. Others leave it to the hospital. Ask the labor and delivery unit which level it provides.
Levels of newborn care
Newborn care is also organized in four levels, described by the American Academy of Pediatrics. A Level I nursery cares for healthy full-term babies. A Level II special care nursery can manage babies born moderately early or with moderate illness. Level III and Level IV neonatal intensive care units (NICUs) care for very premature or critically ill newborns, and Level IV units can perform complex surgery. See Children's Hospital vs Pediatric Unit for more on pediatric care settings.
If you are expecting twins, have a known health condition, or your baby has a condition found on a prenatal scan, a hospital with a higher-level NICU may avoid a transfer after birth.
The CMS Birthing-Friendly designation
The Centers for Medicare & Medicaid Services (CMS) introduced a Birthing-Friendly hospital designation, shown on Medicare.gov Care Compare. Hospitals receive it when they report that they participate in a statewide or national perinatal quality improvement collaborative and have put evidence-based maternal safety practices in place. The designation focuses on safety processes, not on specific outcomes, and hospitals self-report. You can browse birthing-friendly hospitals in our directory.
Other quality information to look at
- Cesarean rate for low-risk first births: often called the NTSV cesarean rate, this looks at first-time mothers with a single, full-term, head-down baby. Rates vary widely between hospitals. Some states and The Leapfrog Group publish them.
- Overall hospital quality: the CMS Overall Hospital Quality Star Rating gives a general picture. See How CMS Star Ratings Work.
- Patient experience: HCAHPS survey results show how patients rated communication and care. See What Is the HCAHPS Patient Survey?.
- Baby-Friendly designation: hospitals designated by Baby-Friendly USA follow practices that support breastfeeding, such as skin-to-skin contact and rooming in.
Questions to ask on a hospital tour
Many hospitals offer in-person or virtual tours. Useful questions include:
- What level of maternal care and newborn care do you provide?
- Is an obstetrician and an anesthesiologist in the hospital 24 hours a day?
- What pain relief options are available, and is an epidural available at any time?
- Do you have midwives, doulas or support for unmedicated birth? Can I bring my own doula?
- How do you support skin-to-skin contact and breastfeeding?
- Will my baby room in with me? What happens if my baby needs the NICU?
- How many support people can be present during labor and after birth?
- What is your policy on eating and moving around during labor?
- Can I have a private postpartum room, and is there a cost?
- How do you handle postpartum hemorrhage and high blood pressure emergencies?
Distance and timing
A hospital with more services is not helpful if you cannot get there in time. Think about travel time in traffic or bad weather, especially if you have had fast labors before. In rural areas, the nearest hospital with labor and delivery may be far away. Some critical access hospitals deliver babies, while others have closed their obstetric units. Ask your clinician about a plan for getting to the hospital.
Insurance and costs
- Confirm the hospital and your delivering provider are in network. Anesthesiologists and neonatologists may bill separately. The No Surprises Act protects you from surprise out-of-network bills from certain providers at an in-network hospital.
- Medicaid covers roughly 4 in 10 births in the US. Most states now extend postpartum Medicaid coverage to 12 months after birth.
- If you are uninsured or face high costs, ask about financial assistance. See Hospital Financial Assistance.
If labor starts somewhere unexpected
Under the Emergency Medical Treatment and Labor Act (EMTALA), any hospital with an emergency department that participates in Medicare must evaluate a person in active labor and either deliver the baby or arrange a safe transfer. You will not be turned away because of insurance.