NICU Level at hospital...

bcnoelle

So I chose my ob/gyn because she is affiliated with the hospital I gave birth to my son at and we have mutual friends. She is great and my full term birth c-section hospital experience (w a different ob/gyn who dropped my insurance) was great. Fast forward to this pregnancy. I am advanced maternal age, single artery umbilical cord, and at 19 weeks cervix went to 1.7 mm. I had an emergency cerciage, am seeing an MFM, and getting weekly untrasounds (cervix is about 3 cm). I'm almost 22 weeks. Just realized that my hospital is only Level II NICU, but supposedly may be able to use certain Level III techniques for 24 hours (prior to transfer i would guess). Level IIs cant do much for babies born earlier than 32 weeks. A nearby hospital has a level III. Would you change ob-gyns ASAP to one practicing with the Level III NICU just in case? I'm going to talk to my doc Tuesday about it...

Ylvelill

I just changed mine, but I am only 12 weeks and I did not have a long relationship with my ob before hand.

I think the thing to talk to your ob is what happens if you go into labor earlier, can you be transferred to the other one, will you be separated from your babies?

bcnoelle

Thanks for your input...yes, these are questions I'll have to ask. I just also am concerned with the level of care in the first 24 hours for a preemie and transporting a preemie. I truly wish I could have a doc affiliated at each hospital.

bcnoelle

That's a good thing to find out about. I'm not really sure if the MFM would be the one to deliver my baby or if a plan could be in place that prior to 32 weeks I should go to labor/delivery at Level III hospital.

Ylvelill

Normally the MFM do not deliver, they mostly monitor from my understanding. But it can never hurt to ask.

24karat

MFMs rarely deliver. With my twins, the plan was to deliver at our MFM's affiliated hospital (the only Level III in our region, 1.5hrs away) if I went into labor before 35wks. If I made it past 35wks, MFM, OB, and midwife were okay with me delivering at my local hospital (17min away) instead. Both hospitals are in the same system so my records were at both and the doctors were already in communication. Is something like this possible for your situation?

MissChanandlerBong

I don't know if this is "normal" or not, but I'll tell you my experience.  With DD, I had been seeing a regular OB affiliated with a Level II hospital throughout my pregnancy.  When I started showing symptoms of cervical incomptence (bleeding, dilated, bulging membranes, etc.), I had an emergency cerclage placed and was put on hospital bed rest at the Level II hospital.  After a week, I was then transferred to the Level III hospital.  At the other hospital, I saw different doctors/MFMs, but my original OB still came to see me and check up on me, and talked with the new doctors during that week.  I went in to labor after a week there, and the new doctors delivered the baby.  After my 6-week follow-up, I went back to my old OB. 

So, even though my OB didn't actually deliver the baby, he still stayed in touch at the other hospital while I was there.  I have no idea if he was affiliated with the hospital or just checking in to see how things progressed, or what happened.  It was all a blur. 

I guess my point is, ask your doctor what the plan is.  You will definitely want to deliver in the Level III hospital and not risk a transport if you deliver early, and your OB should be prepared for that. 

 

iqwedding3

Oh hell yes I'd change.  We chose our NICU first, OB second.  You could ask if your OB has privileges at a level 3 hospital.

bcnoelle

Thanks for all of the responses.  I'm going to see about every possibility, but at the end of the day I think I need to make sure that I deliver at the Level III hospital. I'm surprised that the hospital I had previously delivered at is only Level II...everything was recently renovated and it's supposedly the "luxury" hospital.  I guess looks can be deceiving when it comes to the level of the NICU.

ajsweeton

Level III nicus are few and far between so just because a hospital has been renovated that doesn't mean the NICU will be state of the art. I chose our hospital and drs for the level III NICU. The hospital hasn't been renovated for awhile though and they even still have shared postpartum rooms. Anyway, my MFM is going to deliver but I'm high risk for many reasons as well. If I were you I'd just make sure your MFM is affiliated with the level III NICU so that if you go into labor early they can deliver there.

chicagobride_07

I would (and did) switch to deliver at a hospital with a level III NICU. Hopefully you will not need it. I had a planned c section at 34 weeks. LO was in the NICU for 15 days. Afterwards, my pedi told me that if I had delivered at the hospital with the level 2 NICU she would have needed to have been transported (airlifted?) to the hospital with the level 3 facilities. I'd make the switch just for piece of mind. GL!

babylimas

My situation is different since my kid is high risk, not so much me. We had to transfer for the higher level NICU and the PCICU. I stayed with my original OB until 3rd tri, then I was transferred to the MFMs at the second hospital who deliver high risk. My local OBs will handle my follow up care once I'm out of the hospital. I would definitely transfer to the higher level NICU if there is a risk of laboring early.

There is a big distance difference for me, so I'm told I should still run to my local hospital if I need monitoring or have a scare. If labor is imminent like my water broke, drive the hour to the other hospital.

bcnoelle

Thanks for the feedback. There are 2 Level III NICU hospitals within 5 miles and one seems affiliated with the hospital I'm supposed to deliver at. I'll ask my ob/gyn if she has privileges at this other level III. It's kind of ridiculous because I'm literally driving pass a level III NICU to get to the hospital with the level II NICU. Thankfully, I live in a city with several options.

sexyntexy

This is a random question but related. The hospital I deliver at is a level III but there is a children's hospital with a level IV NICU close to me too. From doing a little bit of research it looks like you can't actually deliver at the children's hospital and they have to be transferred. Anyone else know anything about children's hospitals and delivery options? It would be nice to just go to the children's hospital if I went into labor early but I'm thinking that isn't a possibility.

bcnoelle

sexyntexy said:

This is a random question but related. The hospital I deliver at is a level III but there is a children's hospital with a level IV NICU close to me too. From doing a little bit of research it looks like you can't actually deliver at the children's hospital and they have to be transferred. Anyone else know anything about children's hospitals and delivery options? It would be nice to just go to the children's hospital if I went into labor early but I'm thinking that isn't a possibility.

I read up on NICU levels via Wikipedia and they don't even list a level IV. I wouldn't think you could deliver at a children's hospital, but might as well ask your ob/gyn about this hospital and if babies get transferred there from the hospital you'll deliver at.

24karat

sexyntexy said:

This is a random question but related. The hospital I deliver at is a level III but there is a children's hospital with a level IV NICU close to me too. From doing a little bit of research it looks like you can't actually deliver at the children's hospital and they have to be transferred. Anyone else know anything about children's hospitals and delivery options? It would be nice to just go to the children's hospital if I went into labor early but I'm thinking that isn't a possibility.

Children's hospitals generally do not have L&D facilities since they cater to children, not maternal care. A few have the capabilities to provide L&D care for women who know ahead of time that their baby will need immediate care there, such as major surgery after birth. If your primary concern is PTL (no heart defects etc) I would stay with your primary hospital even with PTL since they have the Level III NICU and are equipped for L&D. Plus they have your records which, in a high risk pregnancy especially, is important.

Level III is the highest level NICU (to my knowledge) so I'm not sure where the Level IV comes in...

sexyntexy

I found they were a level IV from their website. Maybe because they are specifically for children. Here is an excerpt and the link. There is a hospital across the street so I guess that's always an option if I go into labor really early.

Cook Children's is a level IV NICU, which means we offer the highest level of NICU care in Tarrant County.

We're able to provide care for the smallest and medically fragile newborn babies, as well as provide special treatments and surgeries, only available in a level IV NICU. We also offer specialized services that are found in only a handful of NICUs across the country.

https://www.cookchildrens.org/SpecialtyServices/nicu/chooseNICU/Pages/Specialty-programs.aspx

sexyntexy

bcnoelle said:

sexyntexy said:

This is a random question but related. The hospital I deliver at is a level III but there is a children's hospital with a level IV NICU close to me too. From doing a little bit of research it looks like you can't actually deliver at the children's hospital and they have to be transferred. Anyone else know anything about children's hospitals and delivery options? It would be nice to just go to the children's hospital if I went into labor early but I'm thinking that isn't a possibility.

I read up on NICU levels via Wikipedia and they don't even list a level IV. I wouldn't think you could deliver at a children's hospital, but might as well ask your ob/gyn about this hospital and if babies get transferred there from the hospital you'll deliver at.

Wikipedia does list a level 4 there just isn't any info listed about it.

Looks like AAP recognizes IIIC which is the same as a level IV according to this website. I'm definitely not a NICU guru I just got that level off the hospital's website. https://preemies.about.com/od/allaboutthenicu/qt/What-Is-A-Level-4-Nicu.htm

Britt&Max2010

Right now we are fighting to have our care transferred to another perinatology clinic that delivers at the level III NICU.  We are currently with the same team who followed us during our first pregnancy, but when I went into PTL at 30w we were ambulanced to the hospital with the level III NICU.  This time we would prefer to just be at the correct hospital versus risking another emergency transfer, however, the perinatal clinic that delivered my daughter will only do a consult with me right now to determine if I qualify for their services.  Being that I am pregnant after cancer, have a clotting disorder (on Lovenox and baby aspirin), shortened cervix during previous, developed pre-e with placental abrubtion at 30w (delivered a beautiful daughter at 3lbs 2oz who is almost two and perfect) I am REALLY hopeful they will take me, but I guess it is up to them!  I fully believe in preparing for the worst while hoping for the best, which is what we are trying to do now.  Good luck to everyone!!