Giving birth involves many personal decisions, including choosing the location of delivery. Many expectant parents desire a specific hospital, perhaps one with a highly-regarded maternity ward. However, the ability to give birth at any hospital is not a simple yes or no answer. The choice is highly regulated by financial agreements, physician credentials, and federal emergency laws, all of which must align for a planned hospital birth to be possible.
Insurance Coverage and Network Constraints
The most common limitation on hospital choice is the financial framework established by health insurance. Hospitals and insurance companies contract to determine which facilities are “in-network” and which are “out-of-network” for a specific plan. Choosing an out-of-network hospital for a planned delivery leads to substantially higher out-of-pocket costs, as the insurer covers a significantly smaller percentage of the bill.
Planned deliveries often require pre-authorization from the insurance provider to ensure coverage. If an out-of-network facility is chosen, the patient may be responsible for large deductibles, co-pays, and coinsurance amounts. Selecting a non-participating hospital can also expose the patient to “balance billing.” This occurs when the facility charges the patient the difference between its full price and the lower rate the insurance company pays, resulting in unexpectedly large bills for a planned procedure like childbirth.
The Necessity of Physician Affiliation
The relationship between the patient’s obstetrician-gynecologist (OB/GYN) and the hospital is a second limitation. A physician must be granted “hospital privileges” by a specific facility to admit patients and perform deliveries. These privileges are not automatic; they are granted based on the doctor’s training, experience, and the hospital’s credentialing process.
Most OB/GYNs limit their practice to one or two hospitals where they maintain these privileges. If a patient chooses a hospital where their primary physician lacks privileges, the doctor cannot attend the birth. The patient would instead be attended by an on-call physician or another affiliated doctor from the hospital’s staff. Therefore, the chosen hospital must align with the facilities where the physician is credentialed to practice.
Emergency Delivery Protocols
The rules governing planned deliveries are superseded when an emergency situation arises, such as a patient presenting in active labor. The federal Emergency Medical Treatment and Labor Act (EMTALA) requires all Medicare-participating hospitals with emergency departments to provide a medical screening examination. This determines if an emergency medical condition, including active labor, exists. This screening and necessary stabilizing treatment must be provided regardless of the patient’s insurance status or network affiliation.
A pregnant woman has an emergency medical condition if she is in active labor and cannot be safely transferred before delivery, or if transfer threatens the health of the patient or child. Hospitals must stabilize the condition, which means proceeding with the delivery of the child and placenta. EMTALA applies only to true emergencies or active labor; it does not grant the right to an elective, planned delivery at a non-affiliated hospital. Once the patient and newborn are stabilized, the hospital’s obligation under EMTALA is fulfilled, and standard insurance rules apply for continued care.