People in the “Women should birth where they feel safest.”  You hear this a lot in the birth change movement.  Midwives, doulas, CBEs, advocates and allies — we all support women’s choice in birth place.  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, and then arrives in labor greeted by people, machines, and drugs all sending the same message: your body probably won’t work. Fortunately, while your body fails, you can feel safe, we’re here to make sure you safe.  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.

The majority of women birthing in US hospitals spend labor attached to IVs, medications, and fetal monitors.

What happens in a woman’s psyche in the presence 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?  What happens to  her confidence?  What happens to her ability to go deep inside and let her body do its work?  We know what often happens physically — labor stalls.  A mental or psychic shift must happen at this point, even for women who have a strong 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?

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  1. July 27, 2010

    This is a really good post, Erin. Thank you for sharing your perspective.

    • August 4, 2010

      Thanks for reading Jenn. I wonder what your local hospital’s birth climate is like?

  2. Mary #
    July 28, 2010

    Excellent Erin…loved it!

  3. Lisa #
    July 29, 2010

    “Can this truly be accomplished in the US within institutional settings, among institutional protocols and procedures?”

    It’s called consumer demand :-). Also CIMS has started a recognition program for Nurses called Mother-Friendly Nurse Recognition Program which helps to promote L&D nurses that are educated about and practicing mother friendly care in the hospital. The L&D nurse is a pivotal player in one’s hospital experience and should be an advocate for his/her patients.

    Good blog post.

    • August 4, 2010

      Thank you Lisa. You are right, one can not overestimate the role of nurses in women’s birth experiences in the hospital! Consumer activism IS a primary ingredient in the push toward birth change in the US. I love being a witness to all the mamas roaring with their instincts!

    • Suzanne #
      December 17, 2010

      Lisa,

      I am a nursing student and will hopefully be an L & D nurse in a few more months before going to school to become a CNM. This is the first I have heard of the Mother-Friendly Nurse Recognition Program. Where can I go to find out more about it? Also, what does CISM stand for? The only acronym I know for it is Critical Incident Stress Management, and I know that can’t be right :-)

      Thanks!

      Suzanne

      • Suzanne #
        December 17, 2010

        whoops, I meant CIMS, darn dyslexia!

        Suzanne

        • December 19, 2010

          Hi Suzanne, CIMS stands for the Coalition for Improving Maternity Services. You can learn more about the Mother-Friendly Childbirth Initiative and Mother-Friendly Nurse Program at http://www.motherfriendly.org/

  4. August 4, 2010

    Hi Erin!
    Thank you for your insightful comment on my little blog and for introducing yourself. Your blog is lovely and I can’t wait to read it.
    Lisa

  5. amyelizabethsmith #
    August 5, 2010

    What a wonderful and passionate post. My sister-in-law “delivered” in the hospital last year and I saw so many things that I regret for her, but for her it was “normal;” her and most of my family still don’t understand my decisions. My husband does, and that’s all that matters.

    Thanks for linking your blog and for checking mine out. I’m so excited to let my body do the work — due in 2 weeks now (my CPMs tell me to count on it being longer….) :)

    Best wishes, Amy

  6. Erika #
    August 9, 2010

    You never answered the question; what ingredients do = feeling safe? Now that would really be something to have a recipe for feeling safe. Of all the challenges that homebirth midwifery offers, overcoming birth fear is by far the most daunting.

    • August 9, 2010

      Thanks for your comment Erika. I cannot answer this question for all women — it can’t be answered uniformly. Our internal worlds are one of a kind. It would be like declaring which thoughts and feelings makes people orgasm, or fear being alone. I raise the question for discussion knowing that, as humans, we can utilize both internal and external barometers or measures of safety. From my experience working with and knowing women in pregnancy and birth, some are more aligned with an internal framework of safety, and others it is more external. For example, there are women who will enter into their labor and birth with an inner sense of safety and security that comes from a deep familiarity, comfort and trust in their bodies. And some women derive a sense of comfort and safety largely from external sources, like their care provider, or an ultrasound, or listening to their baby on a doppler, etc. Probably the majority of women utilize some combination of internal and external forces.

      Fear of birth is an obstacle for women wherever they plan to give birth, home or hospital. We have an entire culture of women believing their bodies probably won’t work adequately in labor, or that they won’t be able to cope with the pain. I think some amount of fear is normal and necessary in birth and it is something I have been wanting to write more about. As pregnant women we stand on the brink of the unknown. We know that a completely mysterious, magical, and probably painful undertaking lies ahead, and ultimately we must go the journey alone. Some fear is only sensible, but ideally we are able to temper that fear with a knowing and trust in our bodies’ ability to move through the process of birth, just as thousands of generations of women have before us.

  7. Clara #
    July 15, 2011

    Seems to me like you’re implying that being in a hospital is what causes a woman to doubt their body’s ability to work, rather than simply being aware that our bodies can and do stop working according to plan…

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