Choosing the right obstetrician/gynecologist and hospital can make a big difference in your pregnancy and delivery experience. For many of you with an existing relationship with an OB/GYN, I hope you will take a moment to reconsider your decision. This is not an indictment of your relationship with your doctor. However, you have different needs during pregnancy, which may or may not be met by your existing doctor or their hospital affiliation.

Surprisingly, I start the process of doctor selection based on the hospital. I do this for two simple but big reasons: the baby, and availability of anesthesia. Delivering a healthy, full-term baby can be performed at any hospital with maternity services. However, babies with special needs or who are premature need extra services found in more specialized hospitals. In the medical community, we have devised a system of hospital services for maternity care ranging from the most basic to the regional referral centers. Basic maternity hospitals can deliver babies over 5½ pounds and care for them adequately. Intensive maternity hospitals can care for babies over 2 pounds. Regional Perinatal Centers can deliver babies of any weight and tend to their more demanding medical needs.

Here are several examples to help you understand the different roles the hospital plays:

A woman is 30 weeks pregnant, in premature labor and delivery may happen—She will be transferred to a Regional Perinatal Center or certain Intensive maternity units for care. In this way, the baby will have the best chance to prosper after delivery.

A pregnant woman's baby is known to have a serious birth problem —She should deliver at the closest center able to deal with her baby's special needs; either an Intensive or Regional Perinatal Center would be an appropriate place for her to deliver.

Please realize, if you are transferred to a different hospital, your doctor may not be able to continue caring for you.

The second important issue about selecting your hospital—and your doctor— centers around the availability of anesthesia for pain relief during labor. Epidural anesthesia is very commonly available across the U.S. Unfortunately, it is not universally available or given upon your request.

In some hospitals or doctors' practices, they will not give an epidural until you are dilated beyond a predetermined number (4-5 centimeters is a common practice). The reason for this rule may be as simple as the anesthesiologist not wanting to come in and stay for many hours to tend to the epidural, or it may be the doctor's belief that an early epidural slows down labor (this is a controversial point to some, but not to me). In either case, you may have many hours without the option of an epidural.

Here are a few questions to ask before choosing your hospital:

1. Can your nursery care for premature babies?

2. Where do you transfer babies for more specialized care?

3. Is the hospital anesthesia available 24 hours a day, every day, for laboring patients?

4. Is epidural available upon my request?