Choosing Where to Give Birth on Long Island

Author: Igel Cudiera

When you are deciding where to give birth on Long Island, start with your health and your pregnancy, because they determine whether a hospital, a birth center, or a planned home birth is a safe fit for you. Then compare the settings that fit on the things that matter most to you, such as the level of care available, pain relief options, who can be with you, travel time, and insurance coverage, and ask each place the same questions.

This guide walks through the three main settings, explains what hospital "levels of care" mean in New York, and gives you questions to ask before you decide. If you are just starting to learn about your choices, our overview of what Nassau County families should know about birth options covers the basics.

Your Three Options: Hospital, Birth Center, or Home

Hospital Birth

Hospitals can offer epidurals. According to the American College of Obstetricians and Gynecologists (ACOG), an epidural is the most common type of pain relief used for childbirth in the United States. Hospitals also differ in the level of care they provide for higher-risk pregnancies and for newborns, which is explained below.

A hospital birth does not have to mean a different care team. Our midwives also attend planned hospital births on Long Island.

Birth Center Birth

According to ACOG and the Society for Maternal-Fetal Medicine, "birth centers are freestanding facilities that are not considered hospitals." They provide care for people with low-risk, uncomplicated pregnancies: one baby, at full term, in a head-down position, who are expected to have an uncomplicated birth.

New York's rules for midwifery birth centers describe care for patients at low risk who need a stay of less than 24 hours after birth, with a licensed midwife as the attending provider for birth. The same rules state that forceps and vacuum extraction are not permitted, that general and regional anesthesia (which includes epidurals) are not given at the center, and that labor is not induced or sped up with medication.

One point causes confusion. The American Association of Birth Centers (AABC) notes that hospitals often call their labor and delivery units "birth" or "birthing" centers, while an independent birth center is separate from and not owned by a hospital. When a place calls itself a birthing center, it is worth asking which kind it is. Our guide to licensed and unlicensed birth centers covers what to check.

Planned Home Birth

ACOG's position on planned home birth is worth reading in full: "Although the American College of Obstetricians and Gynecologists believes that hospitals and accredited birth centers are the safest settings for birth, each woman has the right to make a medically informed decision about delivery." ACOG lists factors it considers critical, including the appropriate selection of candidates for home birth, a qualified, licensed birth attendant, ready access to consultation, and access to safe and timely transport to a nearby hospital. ACOG also considers a baby who is not head down, a multiple pregnancy, or a prior cesarean birth to be absolute contraindications to planned home birth.

If home birth is something you are considering, you can learn how our midwives approach home birth on Long Island and talk through whether it fits your pregnancy.

Start With Your Health and Pregnancy

Your health is the first filter. New York's rules for midwifery birth centers define a patient at low risk as someone with a normal medical, surgical, and obstetrical history; a normal, uncomplicated pregnancy as determined by adequate prenatal care; and prospects for a normal, uncomplicated pregnancy and birth.

Birthing Center Long Island describes who its care suits: "Care here is generally a good fit if you are carrying one baby, your pregnancy is uncomplicated, you are at full term when labor begins, and you want a low intervention birth with continuous support." It also notes that "some pregnancy histories and conditions make a hospital the safer setting." Your midwife can talk with you about whether your pregnancy fits, and you can learn more about our midwifery care.

What Hospital "Levels of Care" Mean in New York

Hospitals are not all equipped for the same situations. ACOG and the Society for Maternal-Fetal Medicine describe four levels of maternal care, from basic care (level I) to regional perinatal health care centers (level IV), and each higher level includes and builds on the capabilities of the lower levels.

New York has its own system. The New York State Department of Health explains that perinatal regionalization ensures there are hospitals that can provide a full range of services for pregnant women and their babies in a geographic region, and that each hospital receives a designation indicating the level of care it can provide. In plain terms, according to the state's NYS Health Profiles site:

• Level 1 Perinatal Centers care for normal and low-risk pregnant women and newborns and do not operate neonatal intensive care units (NICUs).
• Level 2 Perinatal Centers care for women and newborns at moderate risk and operate NICUs.
• Level 3 Perinatal Centers care for patients who need increasingly complex care and operate NICUs.
• Regional Perinatal Centers provide the highest level of care and operate NICUs.

You can look up any New York hospital's designation on NYS Health Profiles. Your prenatal care provider can tell you whether your pregnancy calls for a hospital with a particular level of care.

Questions to Ask Before You Choose

If You Are Considering a Hospital

People often ask which hospital is the best place to give birth on Long Island. There is no single answer, and "Best Of" lists are not a medical measure. New York's Maternity Information Law requires each hospital to provide information about its childbirth practices and procedures, and the New York State Department of Health publishes it so families can compare. The Department notes that this information alone doesn't tell you that one hospital is better than another for you, but that it can be used when discussing your choices with your licensed midwife or other prenatal care provider. You can find it on the state's hospital maternity information page.

• What is this hospital's perinatal designation, and does it have a NICU?
• What do the state's maternity statistics show for this hospital, such as its cesarean rate?
• Which pain relief options are available, including epidurals and options without medication?
• How many support people can be with me, and what is the policy on doulas?
• Can I move around, use different positions, or labor in water?
• Will my own midwife or prenatal care provider attend my birth there?
• Is the hospital in my insurance plan's network?

If You Are Considering a Birth Center

• Who will attend my birth, and how many people are usually present?
• What happens if I need a hospital during labor, and how does a transfer work?
• What comfort measures and pain relief options are available?
• How long will I stay after the birth, and what follow-up care is included?
• What are the eligibility criteria, and what could change them during pregnancy?
• Is the birth center in my insurance plan's network?

ACOG and the Society for Maternal-Fetal Medicine note that each birth center should have an established consultation, collaboration, or referral system to meet the needs of the woman or infant. In New York, midwives must have collaborative relationships for consultation, collaborative management, and referral, and must make information about those relationships available to their patients, so it is reasonable to ask.

If You Are Considering a Planned Home Birth

• Does my pregnancy meet the criteria for a planned home birth?
• Who will attend the birth, and what equipment will they bring?
• How would consultation work if a concern came up?
• Which hospital would I go to if I needed one, and how far is it from home?

Pain Relief and Your Labor Preferences

Think about how you would like to manage labor pain before you choose a setting. ACOG suggests finding out what types of pain relief are available at your hospital or birthing center and thinking about your options before labor starts.

If an epidural matters to you, plan for a hospital birth. Birthing Center Long Island's FAQ says that "epidurals are not approved for use at a birthing center," and that if a client wants one, "the attending midwife will arrange a transfer to a hospital so that the client can get what she desires."

If you hope to labor with fewer interventions, ACOG notes that many common obstetric practices are of limited or uncertain benefit for low-risk women in spontaneous labor, and that labor care may include techniques such as intermittent auscultation (checking the baby's heart rate at intervals) and pain relief without medication. ACOG also reports that during the first stage of labor, water immersion has been found to lower pain scores without evidence of harm. Our page on water birth explains how laboring in water works.

Support People and Doulas

Who will be with you can shape your experience. ACOG states that continuous one-to-one emotional support from support personnel, such as a doula, is associated with improved outcomes for women in labor.

New York law gives you the right to designate a doula. Under Public Health Law Section 2500-m, when you are admitted to a hospital or freestanding birthing center for delivery, you may designate a doula, and the facility shall not deny that doula access to you, except during emergencies or when access could compromise the safety of the patient or health care team. If you are interested, you can learn about doula support.

Practical Long Island Considerations

Location matters more than many families expect. Before you decide, it can help to think through:

• How long it takes to get from your home to each place at different times of day.
• Who will drive you, and who you will call when labor starts.
• For a birth center or home birth, which hospital you would go to if you needed one, and how long it would take to get there.
• Where your prenatal visits will take place, and how often you will need to travel.

If Plans Change: Three Settings, One Team

Plans can change during pregnancy or labor. ACOG and the Society for Maternal-Fetal Medicine recommend that birth centers and hospitals with basic or specialty care collaborate with higher-level facilities to develop and maintain maternal transport plans.

At Birthing Center Long Island, the homepage describes "Three Birth Settings, One Team": home birth, birth center, and planned hospital birth. Our midwives also attend planned hospital births, so if your needs change, you may be able to continue with the same team. The center's FAQ notes that it "has protocols in place to transfer to a hospital if necessary." Your midwife can explain how a change of plans would work for your own pregnancy, and our third trimester checklist includes making a hospital transfer plan.

Insurance and Cost

Coverage can shape your choice. HealthCare.gov lists pregnancy, maternity, and newborn care, both before and after birth, among the essential health benefits that all Marketplace plans cover. Whether a specific hospital or birth center is in your plan's network is a separate question: AABC suggests checking with your health plan to see if it includes freestanding birth centers in its network.

Our guide on how to verify your maternity benefits lists the questions to ask your insurer, our article on birth center and hospital costs compares the two, and our insurance information shows the plans the center may work with.

When to Start Deciding

It helps to start comparing settings early in pregnancy, so you have time to tour, ask questions, and confirm coverage. Our guide on when to book a birth center explains the timing.

A Note From Our Midwifery Practice

There is no single right place to give birth. The best fit is the one that matches your health, your pregnancy, and what matters to you, and that fit can change along the way. Bring your questions to a visit, ask each place the same ones, and give yourself time to decide.