Most of our labor doula clients are Black women, families of color, or white women who fall outside of an “easy” pregnancy (they are often over 35, high risk, have had previous pregnancy or infant losses, or of larger body size). And for families like this, who may be used to feeling discriminated against, or have not had an easy pregnancy, hospital birth can be complex.
It is important that you know that you can have a safe hospital birth.
We also are not in the business of sugar-coating things. There is a reason why you’re asking.
The US maternal healthcare system does not treat everyone equally, stats are not great for mothers or infants, and doctors and nurses are often stretched thin and under lots of pressure. So let’s dig into how to make yourself and your baby(ies) safer.
How to Make Hospital Birth Physically Safe
For high-risk pregnancies, a hospital is a safe choice. And if you would like access to pain medication like an epidural, a hospital is the only choice.
We depend on medicine, OBGYNs, Midwives and hospitals, and we should. Still, in the face of scary statistics for Black mothers and really the US overall, we also have to help ourselves. Here are our recommendations:
Get information on what to expect during labor, and during hospital birth.
When having a hospital birth, we believe that you’re safest if you take a childbirth education class that covers not only unmedicated birth, but various interventions.
Get information on your own pregnancy health.
You are your own best advocate, and you’ve lived in your body your whole life. You deserve to understand what is happening to you, and your baby. If you have a health condition, make sure that you ask how it may impact your birth. If you are a pregnant woman of color, find out the reasons behind maternal mortality. Key causes to note include:
- Cardiomyopathy
- Pulmonary Embolism
- High blood pressure and pre-eclampsia
- Postpartum hemorrhage
In our online class Attain, we talk about what to keep track of during your pregnancy, such as your blood pressure and the results of various tests.
Have honest conversations with your provider about your fears.
Yes, even uncomfortable conversations about your race, age, sexuality and past health history. There is nothing shameful about you, so you don’t have to make other people comfortable while sacrificing your own needs.
Know some key phrases to improve your labor and delivery care.
- “I would like that noted in my chart.” If you have a concern that is being dismissed, have it written down. It will ensure that your record is accurate, and may get someone to take action on your behalf.
- “Do we have time to think about this?” There are some decisions that don’t need to be made immediately. Others are more urgent. Ask if you have time to make a decision or get more information.
- “Can you explain that to me one more time? In lay terms, like I’m 12!” Because doctors and nurses (and even midwives) are experts and see birth all day long, they sometimes forget to slow down. Ask them to make sure that you understand their recommendations.
How to Make Birth Emotionally Safe
There is another component to safety- your mental and emotional well-being. We think that a safe birth also includes minimizing birth trauma.
You may be choosing to have a hospital birth because something in your medical history makes it the safest option. In some cases, access to medication and intervention as needed is exactly what keeps you and your baby safe. That may mean that emotionally, it feels like the right decision, and you’ll be safe, emotionally.
But other times a hospital is just the default option, or it is chosen because you like your OBGYN or Midwife, or because of insurance. In that case, you may need to do a little bit of work.
Get help to deal with any trauma you have.
If you’ve had a negative experience in a hospital, or any sexual or reproductive trauma, birth can bring that right back up. We know that it can be challenging, but we’re big fans of therapists, support groups and good friends that you can have honest conversations with.
Make a plan to manage discrimination during birth, whether based on race, size, gender, age, sexuality, or something else.
It’s pretty shitty that we have to tell you to expect something negative.
And to be honest, as a doula, I go into every client’s birth believing and expecting good things are going to happen. It’s not false optimism- I say a prayer, set an intention of a good outcome for all, and treat the rest of the team well (this includes doctors, nurses and midwives, and of course clients and their family). I do not believe that birth rooms should be a battle ground and I know that what I do can make this birth better.
The reality is though, that as a doula I am often a major part of the plan to manage potential discrimination.
So I believe in a plan. It is much better to have had an uncomfortable conversation, and never have to use the plan, than to be blindsided. So here are some things that you can do:
- Before birth, get your team in order. Educate your partner, hire a doula who you feel safe with, and go in prepared.
- During birth, you can talk to the charge nurse and patient advocate (in that order).
- After birth, share your experience on the Birth without Bias app.
Write a birth plan that makes your priorities clear and includes a plan B.
When our labor doula clients use our birth planning template, we start with how they want to feel at the end of their experience, and then think about what will make them feel that way. For example, if you want to feel safe, will it be helpful to know what’s going on? In that case, we narrate what’s happening for you, and ask the nurse to explain a second time.
We also discuss under what circumstances an induction, epidural or cesarean may come up, and your concerns. We don’t dwell on the negative, but we work to ensure that you have knowledge, and are empowered. Your birth plan isn’t complete without this.
Taking these seven steps goes a long way to making the hospital safer for you and your baby. And they are all within your power.
If you want more preparation for a safe and good hospital birth, especially as a Black woman, we’ve pulled together all of our resources in Attain, our online course.
