Are You Really Safe, or Just Feeling Safe?

In Cynthia Gabriel’s book, Natural Hospital Birth: The Best of Both Worlds, she devoted a whole chapter to feeling safe in pregnancy and delivery. As a doula, her perspective regarding feeling safe in labor and delivery in a hospital setting brings up important issues effecting deliveries. Is it possible to feel safe, but not be safe? It is possible to be safe but not feel safe?

Being safe is and has been mainly the purview of the obstetrician, the hospital, and labor and delivery nurses. After 45 years, I can tell you there is a large variation in the competence of those working with you in delivery. The expertise of those taking care or you is one measure of safety. You should ask those who will be attending your birth the following questions:

1. The c-section rate for the obstetrician, the obstetrician’s group, and the hospital,
2. Their complication rate for hemorrhage, infection, deep vein thrombosis (DVT) and pulmonary embolism (PE),
3. Who will likely be the one to delivery my baby, and
4. What is the maternal mortality rate of the obstetrician and hospital?

It could be argued that the complication rate may not tell you much about competency because obstetricians who deliver a large number of high risk patients will have higher numbers of complications. Even if your obstetrician delivers more high risk patients than another, your chosen physician can still have a low maternal mortality rate. Risk in and of itself should not be used alone to make a decision in health care. Dr. Hans Duvefelt does a good job of explaining the need to consider more than risk factors in deciding the course of treatment.

There is one thing you can’t control. The baby must get delivered. So concentrate on the choices you can make. For example, your ability to move around while you’re in labor depends upon several choices:

1. If you have internal fetal or contraction monitors, walking around or even changing your position will become difficult or even impossible.
2. With an epidural, it’s virtually impossible to move around freely.
3. If you have a Foley catheter, you will have a hard time moving at all.

You will need an advocate, someone to represent you, your wishes, and your best interests. This is a relationship that begins with your pregnancy and lasts throughout your birth and delivery and postpartum. Ask your obstetrician if he or she is willing to work with another professional in your delivery such as a midwife or a doula.

A doula is an advocate. Hundreds of mothers come into the hospital with good labor, which then stops or becomes dysfunctional after arriving at the hospital. As physicians, we were trained to think these moms were just nervous and that they never were in labor. They were then either sent home or induced. Some of them we “slept” with 15 mgs of morphine and 200 mg of Seconal. Many would sleep through labor and wake up complete and ready to push. This actually works very well. As long as the person watching the monitor strip is skilled and in good communication with the physician, there should be no problems with this. Who wouldn’t like to sleep through the major part of their labor?

So what is it that interferes or stops labor on admission to the hospital? None other than adrenaline, the “fight or flight” hormone. Adrenaline stops labor and for most mammals that might serve to benefit the mother and baby. Take a doe in labor. If a hunter comes along, her labor stops and she gets up and runs to safety.

There are many fears associated with labor and delivery. If you don’t like IVs and you are given one, adrenaline may kick in and stop your labor. The same is true of many elements of the usual hospital labor and delivery routine. When you come to the hospital and are admitted to labor and delivery, often without your informed consent, you are likely to receive, in this order:

1. an IV,
2. external and internal monitors to track fetal activity and contractions,
3. IV Pitocin, which causes painful contractions,
4. an epidural,
5. a foley catheter,
6. be confined to bed, and
7. artificial rupture of membranes (amniotomy)

This course of treatment generates multiple opportunities for your body to react with adrenaline, as well as fetal distress, morbidity, mortality, and expense, and often leads to c-sections. I’ve spent the better part of my obstetrical years trying to decrease interventions, cost, and fear in deliveries. In my patients, I have always worked to not only keep them safe, but also support their feeling of being safe. How did I do this?

• listened to what my patients were telling me.
• welcomed children and fathers to my patient’s office visits, actively engaging their families in prenatal and postpartum care, encouraging not only fathers but children to bond with the new baby.
• saw my patients whenever I thought they needed to be seen whether insurance paid for the visits or not.
• saw my patients one week postpartum and as often as necessary even though insurances failed to reimburse me for these visits.
• looked for signs of depression during my patients’ first visits and worked to prevent it, and if necessary, find early treatment for my patents.
• watched blood pressure levels very carefully and treated elevated blood pressure early if necessary.

Feeling safe and being safe are not the same thing. Attending to those things which help you feel safe during your pregnancy will go a long way in allowing you to have the kind of pregnancy and delivery you choose.