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  • Writer's pictureSmartBirth

What is Safety?

Updated: Apr 19, 2020

Have you ever asked a doctor, “Is it safe?” Have you ever wondered if a medication is safe during pregnancy or if a procedure is safe during birth? Have you ever stopped to think about what “safe” even means? Is safety a complete lack of risk? How “safe” is safe enough?

Safety can be defined as an acceptable balance of risks and benefits. Risk can never be eliminated completely (There's no such thing as a risk-free birth!). Attempts to eliminate risk often come with risks of their own and a poorer quality of life. For example, you can eliminate the risks of traveling (via car, plane, train, or boat) by never going anywhere, but what kind of life would that be? You could stay home 24/7, but there are risks inside your home as well! As long as you are alive, you can never completely escape risk.

Even though we can’t eliminate risk, we can decrease risk down to a level that we are comfortable with in order to obtain the desired benefits. In other words, safety is a spectrum. You get to define what is safe for yourself.

For the example of taking medication during pregnancy, there are several categories of medications. Category A medications are ones where human studies have shown a lack of risk to the fetus. Category B medications are where animal studies have shown a lack of risk to the fetus, and Category C medications are where animal studies show there is a risk and there are no human studies. You may decide that you will only take Category A medications. Other people may decide that Category B or C medications are “safe enough” in order to obtain the benefits of the medications. Your care provider should help you weigh the risks and benefits of all your options, but ultimately it is up to you to decide if something is safe enough for you or not.

We build safety into our lives in two ways – we prevent risk, and we mitigate risk. Going back to the example of risks associated with traveling, instead of preventing the risks by staying at home 24/7, we can mitigate the risks. We mitigate the risks of traveling by using things like seat belts, driving cars with air bags, using the proper car seat for our children, etc. These are all tools we use to mitigate the risk, in case something bad happens.

For a birth-related example, consider the increased risk of stillbirth in pregnancies beyond 42 weeks gestation. You can choose to prevent that risk by having your baby prior to 42 weeks (via induction or c-section). Or you can choose to mitigate that risk. Remember, mitigating a risk is like putting down a safety net in order to lessen the risk. For our risk of stillbirth example, you can mitigate the risk of going past 42 weeks by agreeing to extra monitoring such as non-stress tests (NSTs) and biophysical profiles (BPPs). However, remember that if you want to avoid the risk of stillbirth in a post-term pregnancy by inducing or having a c-section, you’re actually trading the risk of stillbirth for the risks of either an induction or c-section. (Remember, there's no such thing as a risk-free birth!)

Also, because safety is an acceptable balance between risk and benefits, you have to talk about benefits as well. If the benefits are small, it doesn’t take much risk until an option no longer feels safe. If a benefit is large, it may be wise to accept more risk. If you're interested in learning more, download our free Decision Making Guide for a discussion of what all you should consider when making a decision in pregnancy or birth.

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