Women feeling “safe” in a hospital birth

Since recreating my website last month I have found myself stumbling around online, way too late at night, checking out birth blogs and advocacy sites, and loving all this birth change energy!    I notice the recurring theme of feeling “safe” in birth. Folks in the birth change movement — midwives, doulas, CBEs, advocates — often diplomatically attempt to support women’s choice in birth place with the adage “women should birth where the feel safest.”   Most women in this country give birth in hospitals. Are women going there to birth babies because they truly feel safe there?  What ingredients = feeling safe?

There’s the standard, albeit superficial, ‘healthy mom, healthy baby’ wrap offered up by women to partners and sometimes themselves, but what lies beyond the cheery one-liners? Where does emotional safety lie? Normal birth is so hidden and rare in our culture that the average woman may never even encounter it through her life experience or in the media. She has no models around her. We can see the challenges to trusting birth and feeling safe within a low-tech, instinctive birth model. So where then are American women birthing in the hospital finding their sense of safety?  To what extent is it external? Is it found in the presence of machines? Uniforms? Medical personnel? Medications?

What happens to a woman’s sense of safety when she adopts, consciously or subconsciously, the promise of safety that the medical model offers up, then arrives in labor and is received by people, machines, and drugs all sending the same message: your body probably won’t work……but while your body fails, you can feel safe, we are here to save you. Here’s the hep lock for when you can’t manage the contractions anymore and need an epidural, or when your baby needs to be born surgically, or when your uterus bleeds too much after birth. Here is your contraction monitor for you belly because your uterus probably isn’t working properly. Here is heart rate monitor for your belly because your baby will probably be in distress at some point.

What happens to her psyche in the face of people and things telling her that her body is not likely to work and she and her baby will have to be saved from near disaster? Does the external barometer simply keep rising? Thank god we’re here in the hospital where people and technology can avert disaster.  We know what often happens physically — labor stalls — but how does she maintain the emotional strength to continue to labor normally, feeling protected, nourished and safe?

A mental or psychic shift must happen at this point, even for women who have an internal barometer of safety  Women would need iron clad psyches to withstand the heaps of doubt showered upon them without any internal effect. Doulas are especially intimate with this dynamic. We have all heard and read the countless familiar birth stories of women who went into labor with every intention of trusting their inner voice and staying committed to a natural, physiological birth. Then the shift of power happens, sometimes slowly, often incrementally, with each procedure, protocol, or interaction with the staff.

Disclaimer: I am speaking broadly about emotional safety and hospital dynamics. (Similar dynamics can occur among midwife attended homebirths too, but that’s another post). There are nurses and doctors who are conscious of women’s emotional safety, and who do actively support normal, physiologic birth in the hospital. And there are women for whom all the forces line up in their favor, who have normal, physiologic births, and feel safe and confident despite of the fear and intervention around them. The shared experience of most American women however is revealed in the snowballing movement toward reclaiming autonomy in birth and is testament to the failures of modern obstetric practices.

What will it take to change hospital birth practices enough in this country so that women can, by default, arrive at the hospital in labor and retain their sense of inner safety and belief in their body’s ability to birth normally?  Can this truly be accomplished in the US within institutional settings, among institutional protocols and procedures?