Life or death: Why black women’s hospital choice for childbirth matters

None of us likes to think about it, but women can and do experience life-threatening emergencies during childbirth. And here’s something maybe you didn’t know: Black women in the U.S. are three times as likely as white women to find themselves in such a devastating circumstance. A 2016 study¹ revealed that black women in New York City were twelve times more likely to suffer a pregnancy-related death than their white counterparts. That’s unconscionable by anybody’s standards.

Make no mistake about it, hospitals matter

Data suggest that a significant number of these tragedies could be prevented with higher-quality health care. In other words, your hospital choice for childbirth is a critical one, which must be considered carefully. Your health and that of your child may hang in the balance!

So, what are the variables and conditions to consider as you choose your doctor, and therefore your hospital? In our book, Black, Pregnant & Loving It, we explain the importance of asking your potential doctor where he or she has “privileges”—in other words, where is he or she permitted to practice medicine? Does your doctor deliver babies at a teaching hospital? A community hospital? How near or far from your house is it?

According to the study cited above, teaching hospitals report a lower rate of life-threatening incidents among pregnant women than do other similar institutions. These hospitals, which are usually privately owned, tend to have Level 3 or 4 newborn nurseries (more about that below) and use specific clinical protocols that have been identified as indicators of quality-improvement efforts by hospitals. And they excel at delivering low-birth-weight babies.

In light of these facts, it clearly benefits black women to get picky about their choice of doctors and hospitals—with an eye toward ending up at a teaching hospital if at all possible. Here are some specific questions to ask any obstetrics professional you interview:

Questions to ask about the delivery site

1.  Is it a teaching hospital?

Teaching hospitals provide clinical education and training to current and future health professionals. “They serve as centers of research and innovation, helping to develop new treatments and cures,” says the American Hospital Association. They also tend to provide the most sophisticated diagnostic and treatment services.

The 2016 – 17 Best Hospitals Honor Roll,  lists the top twenty hospitals (out of nearly 5,000 evaluated). Most, if not all of them are teaching hospitals with extensive educational services and research resources.

 What is the level of the newborn nursery?

Level 1 nurseries are for healthy newborn babies, while Level 2 nurseries are for babies born at thirty-two weeks and up that require special care. Levels 3 and 4 nurseries are neonatal intensive care units, employed mainly in births at under the thirty-two-week mark. While we all hope for a routine full-term delivery, anything can happen. Particularly if your pregnancy is high-risk in any way, you’ll want to make sure your hospital is equipped to handle any complication that may arise.

3. Does the hospital routinely deal with the delivery of low-birth-weight babies?

Questions two and three go together, of course. Hospitals with Level 3 or 4 nurseries report a higher percentage of successful outcomes with low-birthweight babies. They deliver more of them, so it stands to reason that they are more proficient at it.

4. Is the hospital privately owned?

There are two kinds of hospitals: private and public. Private hospitals tend to be more up-to-date in their methods and technology than public hospitals. They also tend to be smaller and admit fewer patients, and their staff-to-patient ratio is more favorable. The downside is this: Because they are privately owned, they can turn away patients who are not experiencing an emergency; are more particular about the forms of insurance they accept; and cost more in general.

5. What is your protocol if a woman starts losing too much blood after delivery?

“Protocols” are precise and rigid plans of action for a specific problem. Since hemorrhage after childbirth is life-threatening, it’s important to know how your healthcare team might deal with it. The kind of answer you are looking for can be – we can engage in transfusion therapy. This essentially means the team has relatively easy access to red blood cells, plasma and platelets in case of postpartum hemorrhage.

1. Elizabeth Howell, MD, MPP; Natalia N. Egorova, PhD, MPH; Amy Balbierz, MPH; Jennifer Zeitlin, DSc, MA; Paul L. Hebert, PhD. Site of delivery contribution to black-white severe maternal morbidity disparity, United States, Am J Obstet Gynecol 2016;214.e143-152.