Choosing a New York Hospital for High-Risk Delivery

Selecting the right hospital for a high-risk pregnancy is one of the most important medical decisions an expectant family will make. In New York State, not all hospitals are equipped to handle complex deliveries, premature births, or serious maternal complications. Understanding how hospitals are designated, what services they offer, and how they perform can make a meaningful difference in outcomes.

This guide breaks down New York’s hospital system for perinatal care, explains what to look for when choosing a facility, and provides concrete data to help families navigate this critical decision.

What Makes a Pregnancy High-Risk?

A pregnancy is considered high-risk when there are factors that increase the chance of complications for the mother, baby, or both. These factors can exist before pregnancy or develop during it.

Common reasons a pregnancy may be classified as high-risk include:

• Maternal age under 17 or over 35
• Pre-existing conditions such as diabetes, high blood pressure, or heart disease
• Pregnancy complications like preeclampsia, placenta previa, or gestational diabetes
• Expecting multiples (twins, triplets, or more)
• History of preterm labor or previous pregnancy loss
• Fetal conditions diagnosed during pregnancy, including growth restrictions or congenital abnormalities
• Previous cesarean delivery or uterine surgery

When any of these factors are present, delivering at a hospital with the right level of care becomes essential.

How New York State Designates Hospitals for High-Risk Births

New York maintains one of the most structured hospital designation systems in the country for perinatal care. The New York State Department of Health formally reviews and designates hospitals based on their capability to handle complex pregnancies and critically ill newborns.

This system, called perinatal regionalization, creates a hierarchy of care. Not every hospital is authorized to provide the same level of service. The designation a hospital receives reflects its staffing, technology, subspecialty access, patient volume, and clinical outcomes.

Hospitals are periodically reassessed to maintain their designation. Those that cannot meet the standards for higher-level care are expected to transfer patients to facilities that can.

Regional Perinatal Centers Offer the Highest Level of Care

At the top of New York’s system are Regional Perinatal Centers, or RPCs. These are hospitals with the most advanced resources for both maternal and newborn care. Only 17 hospitals in New York hold this designation.

RPCs are equipped to manage the most serious complications, including extremely premature births (before 28 weeks), maternal organ failure, complex fetal surgeries, and high-risk conditions that require subspecialists such as maternal-fetal medicine physicians, neonatologists, pediatric surgeons, and genetic counselors.

Women with known high-risk conditions are often referred to RPCs before delivery. In emergency situations, patients may be transferred from lower-level hospitals to an RPC to access life-saving interventions.

Understanding NICU Levels and What They Mean for Your Baby

If there is a chance that a baby will need intensive care after birth, the hospital’s Neonatal Intensive Care Unit (NICU) level becomes a deciding factor. New York uses a tiered NICU system, with Level IV being the most advanced.

Level I Nurseries

These are well-baby nurseries found in most maternity hospitals. They provide care for healthy newborns and can stabilize babies who develop minor issues before transferring them if needed.

Level II NICUs

Also called special care nurseries, these units care for babies born at 32 weeks or later who are moderately ill. They can provide oxygen support, IV nutrition, and monitoring, but cannot perform surgery or manage the most premature infants.

Level III NICUs

These units care for babies born before 32 weeks or those with serious medical or surgical conditions. They have neonatologists available around the clock, ventilator support, and can provide advanced respiratory care. Some Level III NICUs can perform certain surgeries.

Level IV NICUs

The highest designation, Level IV NICUs are found only at Regional Perinatal Centers. They provide the full range of neonatal care, including complex surgeries, ECMO (heart-lung bypass for newborns), genetic specialists, and long-term support for the most fragile infants.

New York has 56 hospitals with NICU beds, but only a subset have Level III or IV capabilities. Families expecting a very premature baby or one with a known condition should plan to deliver at a hospital with at least a Level III NICU, and preferably Level IV if available in their region.

Top-Ranked New York Hospitals for High-Risk Delivery

Several New York hospitals have earned national recognition for their maternal and neonatal care. Rankings and designations offer useful starting points when evaluating options.

NewYork-Presbyterian Morgan Stanley Children’s Hospital and Alexandra Cohen Hospital

This hospital system holds Regional Perinatal Center designation and operates Level IV NICUs at both its Manhattan campuses. NewYork-Presbyterian has earned Magnet recognition, a national honor for nursing excellence, and consistently ranks among the top pediatric hospitals in the country. The maternal-fetal medicine and neonatology teams manage some of the most complex cases in the region.

Mount Sinai Hospital

Mount Sinai earned a five-ribbon ranking from Newsweek for maternity care and is known for its advanced perinatal programs. The hospital’s NICU and maternal services are supported by robust research programs and subspecialty access.

NYC Health + Hospitals System

Four hospitals within this public system—Bellevue, Elmhurst, Lincoln, and Woodhull—received “High Performing Maternity” recognition from U.S. News & World Report in 2025. These hospitals serve diverse, often underserved populations and have invested heavily in reducing disparities in maternal and newborn outcomes.

St. Joseph’s Health Hospital in Syracuse

For families in Central New York, St. Joseph’s operates a Level III NICU and holds Baby Friendly designation, a credential that reflects strong support for breastfeeding and family-centered care. It serves as a regional hub for high-risk deliveries outside the New York City metro area.

What to Ask When Evaluating a Hospital for High-Risk Delivery

Beyond designation and reputation, families should ask specific questions to understand what a hospital can and cannot provide.

Subspecialty Access

Does the hospital have maternal-fetal medicine specialists on staff? Are neonatologists in-house 24/7 or on call? What pediatric surgical subspecialties are available, and are they located on-site or do they require transfer?

Transfer Protocols

If complications arise that exceed the hospital’s capabilities, what is the process for transferring the mother or baby? How quickly can a transfer happen, and where would the patient be sent?

Outcome Data

Hospitals in New York are required to report certain outcome measures. Ask about the facility’s cesarean section rate, particularly for low-risk first-time mothers, as this can indicate practice patterns. Inquire about rates of severe maternal morbidity, unexpected newborn complications, and exclusive breast milk feeding at discharge.

Family Support Services

High-risk deliveries often involve extended NICU stays, emotional strain, and complex medical decisions. Does the hospital offer NICU psychologists, social workers, lactation consultants, and parent support groups? Are there accommodations for parents to stay near their baby?

Equity and Anti-Disparity Initiatives

Does the hospital participate in quality improvement networks focused on reducing racial and economic disparities in maternal and newborn outcomes? New York City’s Maternity Hospital Quality Improvement Network is one example of such an initiative.

Maternal Mortality and Severe Morbidity Rates in New York

While New York has some of the best hospitals in the nation, the state still faces serious challenges in maternal health, particularly among Black and low-income women.

In 2022, New York City’s pregnancy-associated mortality ratio reached 66.4 deaths per 100,000 live births, the highest since 2016. Statewide, the maternal mortality rate in 2023 was 22.4 deaths per 100,000 live births, slightly above the national average.

Non-Hispanic Black women in New York face a maternal mortality rate five times higher than non-Hispanic White women. Severe maternal morbidity, which includes life-threatening complications such as hemorrhage, stroke, or organ failure, occurs in 284 per 10,000 live births in New York City, with disproportionate impact on Black birthing people.

These statistics reflect systemic issues including access to care, implicit bias in clinical settings, and social determinants of health. They also underscore why hospital choice matters. Facilities that actively work to address disparities, measure their outcomes by race and income, and implement evidence-based safety protocols can make a measurable difference.

Geographic and Access Considerations in New York

New York’s perinatal resources are concentrated in New York City and a few upstate academic centers. Families in rural areas or smaller cities may face limited options.

About half of all births in New York occur in New York City, where access to Regional Perinatal Centers and Level IV NICUs is relatively strong. Upstate, families may need to travel significant distances to reach a hospital with advanced capabilities, particularly for the earliest preterm births or rarest maternal conditions.

If travel to a higher-level facility is necessary, some hospitals and insurers can assist with accommodations, transportation, or temporary housing for family members. Planning ahead is critical, especially if a high-risk condition is diagnosed before labor begins.

What Happens When a Hospital Cannot Provide the Care You Need

If a delivery becomes more complicated than a hospital is equipped to handle, maternal or neonatal transfer may be necessary. New York’s regionalization system is designed to facilitate these transfers, but they are not without risk.

Transferring a laboring mother to a higher-level hospital is almost always preferable to transferring a critically ill newborn after birth. This is why prenatal identification of high-risk conditions and planned delivery at the appropriate facility is so important.

In emergencies, helicopter and ambulance transport can move patients quickly, but distance, weather, and timing all factor into outcomes. Families should ask their prenatal provider whether their pregnancy meets criteria for delivery at a Regional Perinatal Center, and if so, advocate for that referral.

How New York Is Working to Improve High-Risk Perinatal Care

New York State continues to refine its hospital designation system. The Department of Health conducts site visits, reviews clinical data, and consults expert panels to ensure that hospitals meet rigorous standards.

Upcoming changes include strengthened protocols for birthing centers, updated performance benchmarks, and efforts to expand access to high-quality care in underserved regions. Public health programs are also targeting maternal mortality and morbidity, with a focus on eliminating racial disparities and improving postpartum care.

For families, these policy efforts translate into a more transparent, accountable, and equitable system. Hospitals are increasingly expected to report outcomes publicly, participate in quality improvement collaboratives, and demonstrate that they are providing evidence-based, family-centered care.

Making the Decision That Is Right for Your Family

Choosing a hospital for a high-risk delivery is not a decision to take lightly. It requires research, questions, and sometimes difficult conversations with providers.

Start by understanding your specific risk factors and what level of care they require. If you have been told your pregnancy is high-risk, ask your obstetrician or maternal-fetal medicine specialist which hospitals in your area are best suited to your situation.

Tour the facilities if possible. Meet the team. Ask about their experience with cases like yours. And trust your instincts about where you will feel safest and most supported.

No hospital can eliminate all risk, but the right hospital, with the right team, can provide the expertise, technology, and compassionate care that give both mother and baby the best possible chance.