Childbirth

Parents generally are free to select the place at which their child will be born. They may choose a hospital, their own home, or a birthing center staffed by midwives, if such centers are available in their area.

Under federal law, a hospital equipped to handle delivering babies is prohibited from turning away mothers who are in active labor, even if the woman is uninsured. This law, which also prohibits hospitals from turning away other patients who are in urgent need of care, is called the Emergency Medical Treatment and Active Labor Act. It also is referred to as the anti-dumping law.

If parents are considering an at-home delivery, they should make sure the mother receives good prenatal care and that the health care provider believes the delivery will not pose significant risks to the mother or child. If the delivery is risky for the mother or child, the mother should deliver at a hospital equipped to handle high-risk cases.

Some states allow nurse-midwives to deliver children at the parents' home or at a birthing center. Other states allow nurse-midwives to practice only at hospitals or under the direct supervision of a physician.

As health care technology improves and as health insurance companies seek to reduce the cost of health care, it is common for mother and child to remain in the hospital for only a short period of time after delivery. A federal law called the Newborns' and Mothers' Health Protection Act regulates the length of hospital stay following childbirth for which insurance companies must pay. Under the law, group health plans, including health maintenance organizations (HMOs), must pay for a hospital stay of at least 48 hours following a vaginal delivery and 96 hours following a delivery by cesarean section. A woman’s doctor, after consulting with the woman, may agree to earlier discharge.

If a patient (or the parent of a patient) believes that a hospital stay should be longer than the period for which the insurance company or HMO is willing to pay, the patient may appeal the decision to deny coverage. The patient’s contract with the health insurance company or HMO will specify the details of the appeal system. It is common for the first appeal to be informal one--a phone call or letter to the insurance company or HMO. If the informal appeal is not satisfactory to the patient, a more formal appeal usually can be taken, such as a hearing before administrators or physicians who work for the insurance company or HMO. If that also fails, the patient might be entitled (depending on the nature of the contract and the state in which the patient lives) to seek outside relief, such as through the court system or a neutral arbitrator.

Fathers or other family members may wish to be present at the delivery of a child. The decision of whether or not fathers or other family members are allowed in the delivery room normally is left to the hospital. Most hospitals permit fathers to be present during delivery, although many hospitals prefer that the father and mother have gone through some training before the delivery, such as a Lamaze class. Parents should check with their hospital about other rules and about what persons other than fathers are allowed in the delivery room.