New mom Ashley Trusler did her research, took the birth classes, took a tour and decided to have her little bundle, Jackson, four months ago at St. Thomas Midtown.

“I asked a lot on the tour,” Trusler says. “Like ‘What would happen in an emergency?’ They did a pretty good job of explaining things we didn’t ask, too.”

And, her friends had had babies there.

In the end, Trusler really liked her nurses and had a memorable, uncomplicated birth experience.

Amanda Figueroa, 30, is expecting her second baby girl in July. Three years ago at a Florida hospital, daughter Zoe was breech and wouldn’t turn, which led to a C-section performed by a doctor she’d never met before.

All was well and the care was good, but this time Figueroa hopes for a different experience and is planning a vaginal birth after Cesarean, or VBAC, with a midwife.

Figueroa has had her prenatal care at Eve’s New Beginnings and will deliver her baby at a hospital, possibly Nashville General Hospital, but might look for a hospital closer to her home.

“I learned a lot from my first one,” she explains. “Now, though, I know my body is made to do this. I like her holistic look at things. She listened, she’s kind and it’s like family there.”

Choices. From birth plans to doctors to hospitals to birthing centers, mothers-to-be have more choice and information than ever.

Diego and Kristen Salinas watch as Ellie Fischer, RN, replaces the security bracelet on their newborn baby girl. Diego and Kristen welcomed Adeline Salinas into the world on May 5 at Vanderbilt Medical Center. This is their first baby.

-- Michelle Morrow | The Ledger

“In Nashville, especially in the past few years, there’s been an explosion of options,” says certified nurse midwife Addie Graham, whose practice delivers at St. Thomas Midtown.

And unlike many other health events that create a scary crisis-mode, families can plan the birth day for months. Ratings, mommy-blog posts, internet searches and the all-important word-of-mouth bear on decisions about the big day.

“You can almost compare it to planning a wedding, with that dream in your mind of what that moment should be,” explains Kim Fox, a partner at Jarrard, Phillips, Cate & Hancock, a health care communications firm with offices in Brentwood and Chicago.

“Labor and delivery is about choice and that’s what needs to be marketed,” Fox adds. “People expect quality care, good nurses. They’re not necessarily researching that.

“They are researching the experience and all those things they think about. The softer things.”

For many, it’s a combination of the softer things and high level of care.

Brittany Sears, 29, had no doubt she would have her baby at Williamson Medical Center. After her twin sister delivered there, she was all in.

“I saw it firsthand,” she recalls. “I liked the way things ran. The nurses, the staff, everybody knew your name.”

After a relatively uncomplicated pregnancy, Sears had an emergency C-section after days of being treated for recurring nausea and vomiting. One ultrasound check couldn’t find the heartbeat.

“In 5 minutes, they had me back for an emergency C-section,” she adds, remembering the doctor’s words, ‘It’s OK. We’re here. We’re going to keep you both safe.’”

Born five weeks early, Harper stayed for 10 days in the NICU. The experience wasn’t what she planned, but Sears was pleased with their care.

“They were very supportive and were with her every step,” she says.

Make it clear

Transparency is a demand. As patients pay more out-of-pocket than ever before, Fox says, they want to compare.

“Health care is having more retail attributes, and consumers want it to be transparent about cost and quality.”

“Transparency is what women have been looking for for a long time,” says CNM Addie Graham. “In decades past, there was no power of decision-making. Those were the days of being knocked out and having a forceps delivery.”

A 2014 Forbes article asserts there’s been a shift from provider empowerment to customer empowerment. Fox agrees.

Part of that is social media’s role in every venue.

“The biggest mistake a hospital can make is to mess up on the experience side,” Fox says. “If a mom expects this great experience and it’s bad, years ago maybe she’d tell three or four people. Now you tell hundreds.”

But, the savvy hospital uses that same media to its benefit.

“That’s where we get info out there about what we do, and we share stories there,” adds Joann Ettien, COO and administrator at Women’s Hospital at Centennial.

The hospital delivered about 3,500 babies in 2016. About 7,000 babies were born throughout the TriStar network of hospitals.

“Health care is confusing for the average person,” Fox points out. “It’s not on your mind until you need it. But it’s different for labor and delivery.”

More information can be found using online tools like Healthcare Bluebook, Hospital Compare, and a star rating with Medicare, she says.

“Those are all a step in the right direction, but health care is not a normal buying experience,” she adds. “We’re not shopping for a dress on Amazon. “Everyone is trying to figure it out.”

Hospital marketers understand that need, but true transparency is, well, scary.

“No one wants to be first to be transparent,” Fox notes. A good example of the kind of transparency she is talking about is Piedmont Healthcare in Atlanta, which posts infection rates, patient surveys and more.

The emergence of social media and growing access to the internet accelerated the need for choice in health care, Fox says. “And, having a choice calms me down.”

“We’re really in a transitional stage in Nashville,” explains Graham of University Community Health Services, a non-profit with eight midwives and primary care.

“Back just a few years, you would choose a hospital because it’s the biggest or it’s the prettiest,” she says. “Now, with more options available, that’s becoming how people choose.”

She predicts that the number of birth centers inside hospitals is going to increase.

“A lot are looking at midwives,” adds Ettien from Centennial. “We’re working on a birthing suite complex, with oils, massage, whatever they need.”

St. Thomas Midtown is also planning a remodeled, homey, low-intervention center, Graham adds. “Many want that homey feel in the hospital. That’s something really exciting.”

“At Vanderbilt, we have the whole range, from those who want epidurals to those who want close to zero intervention,” says Dr. J. Michael Newton, director of Vanderbilt University Medical Center’s Labor and Delivery department.

Laboring tubs are popular at VUMC, he adds, especially with those in the care of the School of Nursing’s midwife practice. Over a 12-month span, VUMC delivered 4,500 babies.

“Even first time moms know in general what they’re looking for,” he points out. “They tend to know ahead of time if they want a midwife.”

“A draw for Vanderbilt is that we have every specialty and expertise in the building,” Newton says. “Even moms with no complications want that available.”

“Moms are focusing on individual care plans,” Ettien adds. “Parents come in with a custom birth plan, which we like, so we can do exactly what they want.”

Figuring out what moms want also comes through physician-liaisons who ask ob/gyns what patients are looking for and by listening to feedback through community education, she explains.

From sibling classes to an ob/gyn emergency department, Centennial responds to what patients want, Ettien adds.

“Women want to be educated about their health care, the delivery and pain management whether it’s epidural or natural. They want options,” adds Dr. Shaun Samples with WOMEN Obstetrics & Gynecology.

“Social media has changed the way the patient sees things,” says Samples, who has practiced for eight years.

“Sometimes they see things and think it’s the truth. So if they’re scared about something, I have to understand where they’re coming from.”

Her practice markets with its user-friendly website, social media, sponsoring events such as the upcoming Diaper Dash on May 27, where she’ll be pushing her own two little ones, a 3-year-old and an 8-month-old.

Not to be outdone, ever, in this health care business, is word-of-mouth.

“Patients I’ve delivered tell their friends to come see me,” Samples says.

VUMC’s Dr. Newton would agree. “Word-of-mouth is everything in medicine.”

“It’s more powerful than marketing,” Graham adds. “It’s huge. We have a section on our new obstetrics form asking how did you hear about us. Inevitably, they say a friend or family member told me about you.”