Five Things You Should Know About Your Delivery Site

None of us likes to think about it, but women can and do experience life-threatening emergencies during childbirth. And here’s something maybe you didn’t know: Black women in the U.S. are three times as likely as white women to find themselves in such a devastating circumstance. A 2016 study1 revealed that black women in New York City were twelve times more likely to suffer a pregnancy-related death than their white counterparts. That’s unconscionable by anybody’s standards.

Make No Mistake About It, Hospitals Matter

Data suggest that a significant number of these tragedies could be prevented with higher-quality health care. In other words, the choice of hospital in which you deliver your baby is a critical one, that must be considered carefully. Your health and that of your child may hang in the balance!

So, what are the variables and conditions to consider as you choose your doctor, and therefore your hospital? In our book, Black, Pregnant & Loving It, we explain the importance of asking your potential doctor where he or she has “privileges”—in other words, where is he or she permitted to practice medicine? Does your doctor deliver babies at a teaching hospital? A community hospital? How near or far from your house is it?

According to the study cited above, teaching hospitals report a lower rate of life-threatening incidents among pregnant women than do other similar institutions. These hospitals, which are usually privately owned, tend to have Level 3 or 4 newborn nurseries (more about that below) and use specific clinical protocols that have been identified as indicators of quality-improvement efforts by hospitals. And they excel at delivering low-birth-weight babies.

In light of these facts, it clearly benefits black women to get picky about their choice of doctors and hospitals—with an eye toward ending up at a teaching hospital if at all possible. Here are some specific questions to ask any obstetrics professional you interview:

5 Things You Should Know About Your Delivery Site 

1. Is it a teaching hospital?

Teaching hospitals provide clinical education and training to current and future health professionals. “They serve as centers of research and innovation, helping to develop new treatments and cures,” says the American Hospital Association. They also tend to provide the most sophisticated diagnostic and treatment services.

The 2016 - 17 Best Hospitals Honor Roll,  lists the top twenty hospitals (out of nearly 5,000 evaluated). Most, if not all of them are teaching hospitals with extensive educational services and research resources.

2. What is the level of the newborn nursery?

Level 1 nurseries are for healthy newborn babies, while Level 2 nurseries are for babies born at thirty-two weeks and up that require special care. Levels 3 and 4 nurseries are neonatal intensive care units, employed mainly in births at under the thirty-two-week mark. While we all hope for a routine full-term delivery, anything can happen. Particularly if your pregnancy is high-risk in any way, you’ll want to make sure your hospital is equipped to handle any complication that may arise.

3. Does the hospital routinely deal with the delivery of low-birth-weight babies?

Questions two and three go together, of course. Hospitals with Level 3 or 4 nurseries report a higher percentage of successful outcomes with low-birthweight babies. They deliver more of them, so it stands to reason that they are more proficient at it.

4. Is the hospital privately owned?

There are two kinds of hospitals: private and public. Private hospitals tend to be more up-to-date in their methods and technology than public hospitals. They also tend to be smaller and admit fewer patients, and their staff-to-patient ratio is more favorable. The downside is this: Because they are privately owned, they can turn away patients who are not experiencing an emergency; are more particular about the forms of insurance they accept and cost more in general.  

5. What is your protocol if a woman starts losing too much blood after delivery?

“Protocols” are precise and rigid plans of action for a specific problem. Since hemorrhage after childbirth is life-threatening, it’s important to know how your healthcare team might deal with it. The kind of answer you are looking for can be - we can engage in transfusion therapy. This essentially means the team has relatively easy access to red blood cells, plasma, and platelets in case of postpartum hemorrhage.

1.  Elizabeth Howell, MD, MPP; Natalia N. Egorova, PhD, MPH; Amy Balbierz, MPH; Jennifer Zeitlin, DSc, MA; Paul L. Hebert, PhD. Site of delivery contribution to black-white severe maternal morbidity disparity, United States, Am J Obstet Gynecol 2016;214.e143-152.

So what do I do if I'm NOT loving it?

It can be better.  Life in general can be better.
You just need a plan, so here it is!

My Plan

First: Some Prep Work, Un-Distort the Distorted

What soundtrack keeps getting played in your head and heart?                             
It's too hard . . .                         
I can't because . . . 
I don't have . . . 
I am trying but . . . 

Write out that distorted soundtrack.  Really, write it out.

Now cross out all of those words and change the track, Un-distort.
You must think and believe:
 I can and I am able.
I can think.
I can figure it out.
I can do it.

Complete the following sentence.
I am good at ___________________________________________________________________

I like to ________________________________________________________________________

Let these thoughts guide your pursuits in life.

Next: See and Touch Your Dream

One Step at a Time

Answer the question, how do I imagine my future?  ____________________________________

Break down that dream to what you can reasonably achieve in one year. Your ultimate dream may take you a couple of years to achieve, which is why it is important to start with one year at a time, one step at a time. Write out:
By the end of 12 months I want to achieve: ___________________________________________

Find an object that represents that future. Keep it someplace where you can see it every day, a couple of times a day. Visualize yourself in the future you desire. Literally play out in your mind how you would look and the things you would do if you were living your desired future, right now. 

Be Careful How You Proceed

What are the four big steps or goals you need to take in the next 12 months to get you to where you want to be in one year? Work backwards in time because all four steps or goals are sequential and together in time order they should get you to achieve your goal in one year. 

Keep the following key concepts in mind and use them to increase your chances of living the future you want and deserve. The first concept is the importance of starting where you want to end up and work backwards. You must always keep your mind on your end result and dedicate yourself to shrinking that gap between where you are currently and where you are going to be. Be prepared for this challenge because once you have a clear vision of where you really want to be, when you compare it to where you are currently it’s easy to get discouraged. The task can seem impossible. But you must resist those discouraging feelings. That is the reason why it’s so important to break down the large vision into smaller, even baby steps that are achievable now. This process is much like a rubber band being stretched up and down. The lower part represents your current situation and the upper part is where you really want to be, the tension in between demands relief from the discomfort. The rubber band, aka your current life, wants to snap back to no tension.  Here is where we can lose our way. Because the tension can become too uncomfortable we can easily give up or settle for less than where we really wanted to be. But, if you are dedicated and you have good old fashion grit, stick it out. Use the tension to pull your rubber band/your life upwards, not back down to where you are comfortable, and unsatisfied. It’s often during these times that we get creative; necessity truly is the mother of invention. 

Another vital strategy for you to use is to literally identify the obstacles that will prevent you from achieving you goals and the mini steps towards your goals. For every goal and mini step you must dedicate some time to identifying those people, thoughts and/or situations in your life that keep you stuck and prevent or slow down any of your attempts to move on. This is a very important stage in the process because without it you will most likely end up the way most of our New Year’s resolutions and dieting attempts end up, not achieved. The tendency to maintain a relationship that is not healthy, or a dead end job that is destroying your confidence, or even dependency on something or someone is certainly an obstacle to success. So spend a good amount of time figuring out the structures in your life that will work against effort towards achieving your dreams. Complete the following phrase for each goal and mini step:
An obstacle to achieving this goal is . . .   
A word to the wise, for many of us an obstacle will be fear. Once you acknowledge that you are afraid, ask yourself, what would you do, what acts would you engage in, who would you talk to, to achieve these goals if you weren’t afraid? 
If I weren’t afraid I would . . . 
Drill down some more and ask yourself, is there real danger in this act because danger is very different from fear. No one should put herself in a dangerous situation. We do want to avoid danger. However, fear is something different. Fear is an emotion that takes place in your mind. Yes, it can be a legitimate emotion especially if you are in a dangerous situation. We are talking about the fear that women often have about what will happen in the future, thereby keeping us stuck, like prisoners in the present. Let’s be clear. If you feel that an act is genuinely dangerous, meaning you can lose your only source of income or someone could get sick, then make realistic alterations to your goal. I can’t do it that way but I can . . . 
For example, if your fear boils down to you really being worried about looking like a fool, or being rejected, make your move. Don’t sacrifice an opportunity that you have right now because of fear of possible rejection. Here’s the thing, if you don’t ask it’s an automatic “no”. You would have rejected yourself. Go for it! It is a possibility that it might be no, but sooner or later it will be a “yes”. So write out all of your goals and be as detailed as possible with names and conditions. The time line below serves as an example for plotting out your goals starting with where you want to be then plotting the mini steps to help you achieve your goal.

Last & Fourth Goal
I will ______________________________________________________ by one year from today.

Third Goal

I will ______________________________________________________ in 9 months from today.

Second Goal

I will ______________________________________________________ in 6 months from today.

First Goal

I will ______________________________________________________ in 3 months from today.

Now break down those three month goals into mini steps that you can accomplish in 30 -day one month periods.

You can do it.  It can be better!