Define “Safe”

In chapter 5 of Dr. Rixa‘s Born Free dissertation, she discusses risk and safety in birth.

How do you define “safe”?

Is “safe” defined solely as a birth in which both mother and baby survive? In that case, birth is universally defined as safe, since most mothers and babies survive birth even in Sierra Leone, which has the highest maternal and infant mortality in the world. And even among the unassisted births that most obstetricians and even many midwives warn against are safe.

Is safety defined as only births that happen in a high-tech hospital with the high-risk obstetrician in the room and the neonatal doctor just down the hall?

Rixa goes even further — does the woman feel safe?

I daresay that in many births, the mothers do not feel safe — they feel on edge, fearful that something will go wrong because all the technology is in use which must mean that all the technology is necessary to keep them and their babies safe. Some women choose unnecessary C-sections because they do not feel safe in attempting a vaginal birth — afraid that either they or their babies will be damaged or killed. Or maybe their doctors have told them that they must have this intervention or that intervention, so they think that either they or their babies are or will be at risk if they decline. They may be physically safe — that is, these women may not be in danger of their lives or a serious injury, but do they feel safe?

A lot of women do feel safest and best in the hospital, so for them, a home birth would make them feel unsafe (regardless of how safe it actually is or would be). But I remember a doula on an email list I’m on saying several months ago that she couldn’t remember the last hospital birth she’d attended in which the staff (nurses and doctor) were relaxed during labor. Instead, she said that the labors were always very tense, as if the nurses and doctor were on edge, just waiting for something to go wrong, and only seeming surprised when it didn’t.

If “safe” is defined as only those births that take place within the hospital, then any birth outside those parameters that ultimately ends in the safe birth of the child and without serious maternal injury or death is viewed as “lucky.” Hospital-birth advocates may even try to say that every safe out-of-hospital birth is anomalous, or an exception — or even if it is admitted that they are the rule and not the exception, it will still be intoned that such births are risky.

But it depends on how you define “safe.” And until everyone involved in birth can agree on a definition of “safety in birth,” there will never be agreement on which births are safe and which are risky.


One Response

  1. YES! Everyone who hears that our daughter was born at home says I was lucky something didn’t go wrong. Yet the child I birth perfectly normally in a hospital is the one I feel lucky for. I’m lucky that I knew enough to stop interventions, because he would have been sectioned for sure, I was in labor for three days!

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