Pregnancy and childbirth are normal life events. About 85% of all pregnancies and deliveries have normal outcomes. Because
of this, low-risk pregnant women have the option of giving birth at home. Some women, on the other hand, are uncomfortable
with this choice, and feel safer in a hospital where high-tech facilities are available if needed. Other women are considered
high-risk, and they need to deliver at a hospital where an obstetrician can oversee their labour and delivery.
There are three different levels of labour and delivery care available at different hospitals. These are referred to as low-risk
care, specialty or high-risk care, and subspecialty care. The level of care is based on the individual needs of the mother
and baby. After the baby is born, mother and baby may require different levels of care, but every effort will be made to keep
them together at the same hospital.
Low-risk care
These hospitals provide care for low-risk women throughout labour and delivery. Community hospitals often provide low-risk
care. Many of these hospitals have birthing rooms where you can labour, deliver your baby, and remain with your baby for the
rest of your hospital stay. Birthing rooms are equipped for low-risk deliveries where fetal monitoring, intravenous fluids,
and pain medication including epidurals can be administered. They are often quite cozy, with low level lighting and a soft
comfortable bed that can be moved into different positions to make labour more comfortable. Some low-risk care hospitals have
a different set-up where the woman gives birth in a birthing room and then is moved to another room soon after delivery to
stay with her baby. Many times the father can also stay in the room.
A few hospitals offer the option of having a birthing chair or stool instead of a birthing bed. The birthing chair allows
the woman to squat during labour, which is more comfortable than lying down. The birthing chair lets the woman take advantage
of gravity to help the baby move through the birth canal during labour.
Your health care provider will oversee your labour and delivery in the hospital. This is usually the same health care provider
as the one you visited throughout your pregnancy.
If you have seen a midwife throughout pregnancy, there is a good probability that she will remain with you throughout your
labour and delivery. If your labour becomes high-risk, your midwife will need to transfer your care to a physician, most likely
the obstetrician on call at the hospital.
If you have seen your family doctor or obstetrician throughout pregnancy, it is likely that a hospital nurse or midwife will
be with you through most of your labour. The doctor will check on you intermittently and lead you through the actual delivery.
Sometimes a different health care provider may need to watch over you if your regular provider is not available.
Hospitals that provide care for low-risk pregnant women are able to detect and provide care for unanticipated problems that
may affect the mother or baby during childbirth. They are able to provide anaesthesia, radiology, ultrasound, and laboratory
services at any time of the day or night as required. They need to be able to conduct a caesarean section within 30 minutes
of deciding to do the surgery. The surgery is done by an obstetrician. Hospitals providing care for low-risk women have blood
and blood products readily available in case a transfusion is needed. They also need to be able to identify if a mother is
high-risk and transfer her to a hospital that provides the required specialty or subspecialty services.
After childbirth, these hospitals provide postpartum care for both the mother and her new baby. Hospitals that provide care
for low-risk women and babies must be able to resuscitate and stabilize newborns if necessary, and evaluate and care for them
until they are discharged from hospital. They stabilize and transfer newborn babies and mothers who need specialty or subspecialty
care to an appropriate facility. These hospitals also provide nursing care to babies who have been returned to low-risk care
from a hospital that provides the required specialty or subspecialty services.
Specialty care
Hospitals that provide specialty services have the same responsibilities as hospitals providing low-risk care, and they also
offer a number of extra services. They take care of high-risk mothers and babies, some of whom are transferred in from low-risk
care hospitals. They also provide care for premature babies weighing 1500 g (3 lbs 5 oz) or more, and for other newborn babies
with health problems that are expected to improve quickly. Some hospitals have neonatal intensive care units (NICUs) with
doctors called neonatologists who specialize in the care of newborn babies.
Reasons to transfer a woman and her baby from low-risk care to specialty care include premature labour after 32 weeks, fetal
growth restriction with low levels of amniotic fluid in the womb, a form of severe high blood pressure called pre-eclampsia,
a problem with the placenta called placenta previa, or an inflammation of the fetal membranes called chorioamnionitis. There
are numerous other reasons why a newborn baby or her mother might need to be transferred to another hospital during or after
delivery.
Hospitals that provide specialty services are also able to stabilize very ill newborn babies and transfer them to hospitals
that provide subspecialty services if necessary.
Subspecialty care
Hospitals that provide subspecialty services provide comprehensive health care services before, during, and after childbirth
for mothers and babies of all risk categories. These include mothers and babies who are transferred from other hospitals.
Mothers and babies who should be treated in hospitals that provide subspecialty services include:
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mothers with complex medical or surgical problems
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babies who require complex care upon delivery
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babies with serious birth defects
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premature babies born at less than 32 weeks of pregnancy
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newborns with a birthweight of less than 1500 g (3 lbs 5 oz)
After childbirth, sometimes the mother needs to continue receiving care at a hospital that provide subspecialty services while
the baby is well enough to be treated at a another hospital. Conversely, sometimes the mother gives birth and stays in the
hospital where her baby was born while her baby is transported to a hospital that provides subspecialty services.
This forced separation presents challenges for mother, her newborn baby, and the father. The parents may feel that they cannot
bond very well with their baby, but they should keep in mind that bonding takes place over a period of weeks or months, well
after the time that their baby is back home. There may be challenges in terms of travelling between hospitals, the cost of
obtaining accommodations close to the baby’s hospital, and arranging for child-care for older brothers or sisters.
Sometimes it is helpful to speak with a social worker or chaplain at the hospital to help ease the distress of being separated.
