Psychological Safety in Pregnancy and Birth: Why It Matters
Psychological Safety in Pregnancy and Birth: Why It Matters
Pregnancy and birth are some of the most significant experiences in a family’s life. The journey to bring a new life into the world is filled with excitement, uncertainty, and sometimes, fear. There are so many opinions and options flooding the “Birth World” these days, that it often overwhelms mothers and creates uncertainty and decision fatigue. In such a critical period, the concept of psychological safety becomes paramount. If you have never heard this term, please continue to read.
What is Psychological Safety?
Psychological safety refers to a climate in which individuals feel secure in expressing concerns, asking questions, and sharing ideas without fear of criticism or negative consequences. It was originally coined in the context of work environments, but its relevance extends far beyond the workplace—especially in healthcare, and more specifically, in maternity care.
When we talk about psychological safety in pregnancy and birth, we mean creating an environment where expectant parents can openly communicate their needs, preferences, and fears without feeling judged or dismissed. It's about fostering trust, respect, and transparency between the patient, their support system, and the healthcare team.
Why is Psychological Safety Crucial During Pregnancy and Birth?
Reduces Anxiety and Fear Pregnancy and labor naturally come with physical and emotional stress. For many, it’s the unknowns that cause anxiety—uncertainty about their body, the baby, the process, or the outcome. When psychological safety is prioritized, women feel safe to express these concerns and seek answers, which helps reduce fear and empower them with knowledge.
Encourages Informed Decision-Making Empowered mothers make empowered choices. When expectant parents feel safe to ask questions or voice their opinions, they are more involved in their care. This fosters informed consent and shared decision-making, ensuring that choices made during pregnancy and delivery align with their values and preferences.
Improves Communication with Healthcare Providers Psychological safety allows for open communication between patients and providers. This is critical in scenarios where something might not feel right—whether it’s a physical symptom or a gut feeling. In an environment lacking psychological safety, patients might hesitate to speak up, which can delay necessary interventions and negatively impact outcomes.
It is important to be aware early in your care if the provider your chose for yourself is able to provide psychological safety. Ask yourself - do I feel comfortable sharing my thoughts and ideas with my doctor or midwife? Are they listening to me / do I feel heard? Do I feel seen? Do they consider my previous experiences and opinions? Do they pause to explain things to me and my partner, or are they always rushing? If your provider does not seem to have enough time to fully consider you and look at the big picture - you are on a potential path for this experience to repeat in Childbirth. It is highly important to discuss all your Birth Wishes with your Care provider and make sure everyone is on the same page.
As a Doula, this is why I love creating a Birth Plan with my clients. This is a time where we sit down and I listen to the family’s Birth Wishes, I educate them about all their options and then together we come up with a plan that best suits their history and desires and increases confidence with the whole process. Then I highly encourage that each family takes this plan to their care-provider and talks about every aspect of it to make sure there are no “surprises” on the day of their Birth. It is important to note that every Birth is unique and often we are not able to follow the Plan fully, understanding that and being flexible is important. This is why a relationship of trust is crucial with your birth team, especially in situations if your Birth will take unexpected turns.
Now, lets get back to the benefits of Psychological Safety…
4. Supports Positive Birth Experiences The emotional experience of childbirth stays with a mother for a lifetime. Birth is not just a physical event; it is deeply psychological and emotional. When women feel safe, heard, and respected throughout the process, they are more likely to look back on the birth positively, regardless of whether the birth went according to plan. As a Doula, I am trained and responsible for supporting the mother emotionally, that is why statistically having a Doula support you in Childbirth significantly increases the satisfaction of overall birth experience. The emotional support provided by doulas was also seen to reduce anxiety and stress during the labor period and reduce the length of labor. Women with a doula during childbirth helped raise their confidence and autonomy throughout labor. (*National Library of Medicine/ Study on Doula support. 2023).
5. Enhances Maternal Health Outcomes Psychological safety has been linked to better health outcomes. Studies have shown that stress and anxiety during pregnancy can negatively impact both the mother and baby. On the other hand, a supportive and trusting environment can help reduce complications, promote healing, and improve postpartum recovery.
Doula care in perinatal care is significantly correlated with positive delivery outcomes including reduced cesarean and premature deliveries. Doula support is also shown to improve breastfeeding success, with quicker lactogenesis and continued breastfeeding weeks after childbirth. (*National Library of Medicine/ Study on Doula support. 2023).
Barriers to Psychological Safety in Maternity Care
Despite its importance, psychological safety isn’t always a given in maternity care. There are various barriers that can undermine it, including:
Medical Hierarchy: In some settings, there may be a clear hierarchy where the healthcare provider’s ways of communication overshadow the patient’s voice, making mothers feel they can’t speak up or question decisions. Hospital policies may come into play too. The policies take YEARS to change and often are outdated and not backed up by a recent research and data.
For example, many hospitals will not allow Doulas into the OR to support the family if a C-section decision is made, even though each Doula is trained and is knowledgeable to support a surgical delivery. These policies changed during COVID times and have not been reverted. This policy alone often causes stress and detachment from an essential caregiver and does not benefit the Birthing family at all.
Cultural Norms: Some cultural attitudes may discourage individuals from questioning authority figures or from expressing emotions openly. How we grew up matters, these experiences often resurface well into adulthood, especially in vulnerable situations.
Personal Trauma: Some women may have previous trauma—whether from healthcare experiences or other life events—that can make it difficult for them to trust or feel safe.
It is unfortunate, but some care providers rarely have time to discuss past trauma with mothers during prenatal visits, and then it comes front in center during the Birth, when it may be too late to discuss and make a supportive plan.
I want to encourage every mother to look into the past trauma and fears in correlation to Childbirth and discuss them with your Doulas and care-providers. All of this surfaces during Childbirth and being prepared and aware will make for a better and less traumatic experience for you. Fears and trauma must be acknowledged, validated, educated and supported.
Biases and Discrimination: Racial, ethnic, and socioeconomic biases can significantly affect how care is provided, often leading to unequal treatment and a lack of psychological safety for certain groups.
As much as we want to close our eyes on this, this is present in our modern day perinatal care and I have seen it with my own eyes. This is where patient advocacy comes front and center for me as a Doula.
How Can We Foster Psychological Safety During Pregnancy and Birth?
Patient-Centered Care Psychological safety starts with a commitment to patient-centered care. This means focusing on the unique needs, desires, and values of the individual. Providers should prioritize listening, validating feelings, and providing information in a way that is understandable and empowering. If your provider is not providing this essential thing to you, please consider finding the one who will!
Open and Non-Judgmental Communication Healthcare teams should encourage patients to ask questions, express concerns, and participate in decision-making without fear of judgment. Offering multiple ways to communicate—whether during appointments or via follow-up calls—helps build trust.
Collaborative Care Teams A culture of collaboration between doctors, midwives, nurses, doulas, and support persons fosters an environment where diverse voices are heard. The more perspectives included in the birth experience, the more psychologically safe it becomes for the mother and her family.
Trauma-Informed Care For many women, the birth experience can trigger feelings of vulnerability or fear, especially if they’ve experienced trauma in the past. A trauma-informed approach that recognizes and acknowledges these feelings is essential in fostering psychological safety.
Cultural Competence and Sensitivity Care providers should strive to understand and respect the cultural backgrounds and beliefs of their patients. This can help build a sense of safety, particularly for marginalized groups who may already feel alienated within the healthcare system.
If you are still reading - THANK YOU! You made it and now you are more aware and equipped to advocate for a Psychological Safety for your family!
Pregnancy and childbirth are monumental experiences that deserve care on both the physical and emotional fronts. Psychological safety is the foundation upon which trusting relationships between mothers and healthcare providers should be fostered.
As a Birth Worker, it is my vow to provide Psychological Safety and Advocate for it with each family I get to serve. If you ever want to chat on this topic with me - please reach out!