The type of medical care you need before, during and after pregnancy depends on your health and that of your baby. Talk to your health care provider about levels of medical care available at the birth center and hospital where you plan to have your baby. You also need to discuss the levels of care available for newborns at the center you plan to have your baby so that if your baby gets any complications, the hospital is well prepared to handle it.

How can i get the right level of care during pregnancy ?

You need to ask your provider these questions to determine the right level of medical care you need.

• is your pregnancy at risk for complications
• what level of medical care is available at to area
• what kind of care you need during  pregnancy to keep you and your baby safe
• what will happen if you or your baby need medical care at a location different from where you had your baby
• where you can go if you need higher  level of medical care

There are 5 levels of medical care

• birthing centers
• level I , basic care
• level II , specialty care
• level III , subspecialty care
• level IV, regional perinatal  health centers

What kind of medical care do you get at a birthing center ?

A  birthing center is like a home environment where you can get medical care and give birth. Some birthing centers  are located at hospital and others are their own facilities.

You can deliver at a birthing center if :

• you have a healthy pregnancy and carrying just one baby
• your provider doesn’t think you’ll have any complications during labor and delivery
• you are at least 37 weeks pregnant and your baby is positioned head down

These are some of the health care providers who work at the birthing center.

• midwives : health care provider with special education in women of all ages including pregnant women
• family practice doctor : a doctor who can takes  care of every member of your family. They can care for you before, during and after pregnancy. They can also deliver your baby
• An obstetrician (also called OB) : a doctor with special education and training to take care of pregnant women and deliver babies

Birth center do not offer the following services

• cesarean delivery
• operative vaginal delivery in which the doctor  uses tool such as forceps or vacuum to help the baby through the birth canal
• anesthesia which is medicine to reduce or prevent pain

What kind of care do you get at a level I hospital ?

These hospitals offer basic care to low risk pregnant woman. You need at least a level I medical care if you :

• are at least 37 week pregnant with twins
• are trying to have vaginal birth after cesarean VBAC
• need a cesarean section or you’re at  low risk for complications
• are at least 37 week pregnant and have mild preeclampsia

These level I hospital have the same health care providers as birthing center and in addition nurses  who are trained to care of women with complications. The hospital have access to resources such as ultrasound and labs for testing. They can also give you an

• anesthesia
• perform an emergency c- section
• give blood transfusion

What kind of medical care do you get at a level II hospital ?

These hospitals are prepared to care for women with high risk pregnancy complications. These include severe preeclampsia and placenta previa. They provide level 1 medical services as well as have specialists and nurses who are trained to take care for  high risk pregnancies. these specialists include :

• maternal – fetal medicine specialists : These are OBs with special education  and training to take care of  women with high risk pregnancy.
• anesthesiologist with special training and experience in treating pregnant women.

Level II hospitals  have more medical equipments and testing options. These include special equipment for obese women and tests like ultrasound, computed tomography scan (also called CT or CAT scan) and sometimes magnetic resonance imaging (also called MRI).

What kind of care do level III hospitals provide ?

They care for pregnant women and babies with more severe  and complex complications. In some areas, they have  the highest level of care available. You will need a level III medical care if :

• you’re at very high risk for bleeding such as women with placenta previa
• you have adult respiratory distress  syndrome
• you have a condition like preeclampsia that is getting worse

They provide services offered at level II hospital plus nurses with special training to care for women with complex  and severe complications. They also have doctors who specialize in newborn care, critical care,infectious diseases and medical  problems that affect the heart, blood and kidneys. They   have ultrasounds, CT scans and MRI and other tests for more complex conditions. They have an intensive care  unit where a team of providers care for people with life threatening conditions .

What kind of care do level IV hospitals provide ?

They offer the highest level of medical care to babies and pregnant women. You need level IV care if :

• you have severe heart disease or liver failure or if you need a heart or brain surgery
• have pulmonary hypertension
• need a transplant

They offer level III services  and have the best resources and the most experienced providers to care for women with the most serious medical conditions before, during and after pregnancy.

NOTE

The march of Dimes, the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics  all believe the safest place to give birth is hospital or birthing center. If you’re planning on having a home birth, talk to your health care provider to make sure it is a safe choice. You should know that in cases of emergencies, hospitals and birth centers are well equipped to handle that.