Week 21: The priority of safety vs. other values

A while ago a friend got me to thinking about the concept of “Safety First.” If we actually adhered to that principle, we’d never leave our houses, we’d never climb mountains, we’d never do sports, etc… There are so many things that we do in life where safety figures in importance, but is definitely not first.

In birth, where would I put safety? And more importantly, what would I prioritize ahead of it?

Personal bodily autonomy. This means that if increased safety is to be found in a place where my right to make decisions about my own body – including decisions affecting my fetus – will not be respected, I will not willingly go there. Luckily, I am beginning to believe that my backup hospital is not such a place, and that my autonomy would be respected, but I have heard of places around the country where this is not so.

There are many institutions that do not respect women’s autonomy; and there are people that will not respect it in spite of their institution’s stated policies. In studying this problem, both institutional policies and informal culture are important, and people with medical authority (ie doctors) as well as people without medical authority (ie nurses) have the power to violate this principle.

What does it mean for me to have my bodily autonomy respected? For example, if I go in hospital with a written birth plan that says “Please do not touch me anywhere without my express verbal consent,” it will be followed. For example, if I say I do not want an IV in spite of policy, I will not have one forced into me. For example, if I am unable to verbally consent because of being deep in labor, I will still not be touched if and until I am able to consent, and then only if I do.

Relationship. My relationship with my caregivers is one of the main determinants of my health and that of my fetus. If I were to gain a modicum of increased safety by handing over my care to someone with whom I have no relationship, I would not do it. If I were to gain my life by doing so, I would do it – so there definitely is a line.

One could have many philosophical arguments about where the line of “safety” falls. Some would say that a 0.5% decrease in the chance of a bad outcome warrants going against your principles; I disagree with that argument but would agree that say a 50% chance of death would make me go against them if I thought I could be saved. I am considering where my personal line falls, and the gray area is most difficult. Most likely if I went into labor at 36 weeks I would choose to stay at home with my caregivers, or alone with my family and community if they would not attend me. But what about 35? 34? The earlier we go, the more I’d be willing to give something up in return for greater safety for my fetus.

Gratitude. This does not conflict with safety but I feel it is important to mention. I want to conduct myself in pregnancy and labor with a sense of deep gratitude to my friends and family, my community, my body and the world around me. Any of those things, especially the world around me, could fail to protect me at any point, but I do not want to lose my gratitude.

Spirit. A hospital is a spiritless place most of the time. Some caregivers lack it anywhere. If I hadn’t found the midwife I did, and couldn’t find any that embodied spirit, I would have kept looking.

Safety. Without protecting ourselves against what we can foresee and prevent, we would be throwing ourselves away needlessly. I’d never do a free climb, or bike recklessly – taking basic safety precautions for those activities does not, in my opinion, interfere with any of the more important elements.


About investigatingbirth

My investigations of birth began in 2009 when I was trained as a doula. I helped women consider the evidence on common interventions, and helped them prepare for the physical and emotional challenge of giving birth. After some time it became clear to me that there was another type of challenge that I was unable to adequately prepare them for, the challenge of the maternity system. But it was only after my own traumatic birth in 2013 that I realized how little I had understood. I began to ask questions that few around me - doulas, nurses, midwives, doctors - were comfortable hearing. Questions like: Under what circumstances, and for what reasons, do doctors not practice informed consent? How do hospitals deal with other patient populations vulnerable to abuse? How does loss of professional autonomy, for obstetricians, and professional authority, for midwives, impact the quality of care they are capable of providing - regardless of their training? This blog will collect noteworthy information that attempts to answer these and other questions. Most of what you see here will be aggregated from other sources and analyzed. You will also see original interviews, and the occasional opinion piece or personal story, as I try to piece together a clear picture of the system in which American women give birth.
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