High Risk vs. Low Risk

Pregnancy

Keeping with the pregnancy labels theme I want to know what you all think of the terminology ‘High risk vs low risk’ and have you been labelled one of these in pregnancy?

I remember doing my midwifery training and a friend told me that her sister was having a baby and she was told that she was “high risk”. My friends words were… “High risk of what exactly… becoming ill? A cesarean? Having a Stillbirth??” And this really stuck with me. What are midwives or doctors actually saying when we say this term?

Because even though you may fall into a category that may increase your chances of an intervention happening, you still can’t really say that the risk of that intervention is HIGH. It may be higher than others but for lots of things it’s still more than likely going to be very low. Take a VBAC (vaginal birth after cesarean) as an example, you’d fall into the high risk category and be advised to have your baby on a delivery suite where Drs are present. But your chance of having a cesarean is between 25 and 28% which is only slightly higher than the uk average and the main risk is the scar rupturing which is in fact a 0.5% risk. A risk that I’m not saying should be ignored but carefully considered when weighing up all of your options.

If you have a raised BMI you could be classed as high risk, “too” young or “too” old, existing medical conditions the list goes on. My point is not that these characteristics go unrecognised but the classification and terminology used is improved. I wonder if telling someone in their pregnancy they fit a certain risk category what effect that has on their decision making during birth and the anxieties that brings during the pregnancy. We’re saying that the one category is free from concerns and will lead in a healthy birth, where as the other category will be filled with problems, potential complications and managed medically, often without considering a holistic approach. The term “high risk” gives reason to worry and encourages choices to be made from a place of fear and risk adversion.

Risk is not just about statistics and numbers it’s about a women’s experiences, her perceptions, thoughts and beliefs. Risk is subjective. One woman’s risk of a cesarean is another woman’s first choice. The risk of a stillbirth will always feel higher to a pregnant mother who’s had someone close by experience the heartbreaking effects of this, should the mothers feelings of risks be ignored in this situation if she fits the “low-risk” pregnancy category?

Words are everything in pregnancy. It’s as much about what we think we say as to what’s actually interpreted.

Photo creds Little Cheltenham

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