Special Circumstances

Learn strategies and techniques to lower your risks

Doctor Examining a Pregnant Woman

Prepare for navigating special circumstances

Carefully Consider Your Options

Your Hospital's Practices Impact Your Outcome

Between The Years 2017 & 2018 the Mortality Rate Rose

Racial Disparities

It is important to carefully consider your options, especially in the United States, because the maternity care system we have is woefully broken. Women in the United States have worse outcomes than almost all of the other developed nations in the world. 

"The U.S. maternal mortality rate has significantly increased from 7.2 deaths per 100,000 live births in 1987 to 16.7 deaths per 100,000 live births in 2016, and the data indicate that more than half of these deaths are preventable"

The high cesarean rate in our country is one factor that may increase maternal mortality. Choosing your care provider selectively with this in mind. You can ask them for their cesarean rate and for the rate of the hospital where they have attending privileges. 

"One study by a doctor at Harvard found, however, that the hospital where the woman is delivering her baby is the key determinant of whether or not she will undergo a surgical delivery"

"Consumer Reports finds that your odds of having a c-section can be over nine times higher if you pick the wrong hospital"

The tragic fact is that the rate is continuing to rise. We are not going in the right direction,

"Among the findings, in 2018:

-658 women died of maternal causes in the United States.
-The overall maternal mortality rate was 17.4 deaths per 100,000 live births.
-The maternal mortality rate gets higher with each older age group; women ages 40 and older die at a rate of 81.9 per 100,000 births, meaning they’re 7.7 times more likely to die compared to women under age 25.
-The maternal death rate for black women was more than double that of white women: 37.1 deaths per 100,000 live births compared to 14.7. It was also more than three times the rate for Hispanic women (11.8)."



Harvard business review reports,


"Black women are three to four times more likely to die in childbirth than white women — regardless of education, income, or any other socio-economic factors."

Young Mother Expecting

Our Choices Matter


What can we do with this knowledge to protect ourselves?


Choose your care provider with their statistical outcomes and methods of practicing in mind. They should have a cesarean rate that is lower than the national average and preferably lower than 10%.  The World Health Organization determined through a "systematic review of available studies...  and a worldwide country-level analysis using the latest available data" that,


"At population level, caesarean section rates higher than 10% are not associated with reductions in maternal and newborn mortality rates. "

Mitigate Risk


What other choices can we make to lower our risk profile? 


At then end of the day we are a statistic of the institution and provider that we walk away from. We take the results home with us. The more we know about the inner workings of the system, the more we can advocate for best care and evidence-based standards. ​It is ideal to set ourselves up with a provider who follows these in the first place, because the very act of having these conversations, while in labor, might shift the blood flow, create tension, send the mother into fight or flight and create fetal distress simply from the distress of the mother.


Through the next few pages we will explore techniques for interacting with providers and staff, when absolutely needed, that may reduce the likelihood of introducing distress. We will explore ways to communicate and develop skills to implement in the event that we find ourselves facing hospital procedures or interventions that we need to evaluate. We will learn tools that help us to quickly assess if a recommended course of action is relevant to us, how it impacts our risk profile and how to have the conversation with the hospital staff to maximize positive interactions and outcomes.  We will also increase our knowledge and awareness of many routine procedures and common interventions and discover ways to access them within a framework that maximizes safety and positive outcomes and learn how to better determine if they are relevant for us.

The documentary, The Business of Being Born, is a fantastic resource for learning more about how the system works. It clearly shows how one thing may lead to another and how routine procedures, interventions and hospital attitudes and cultures impact the birth process.

"While midwives preside over the majority of births in Europe and Japan, fewer than ten percent of American mothers employ them, despite their proven record of care and success. How do American doctors make their choices regarding the way their patients give birth, and who is intended to benefit?"


The Thinking Woman's Guide to a Better Birth

by Henci Goer

This book is another fantastic resource for decision making. It is slightly outdated, but the content and findings are relevant.


Follow the links below to learn more about common procedures, interventions, labor medications and more