Assessing Pregnancy Risk

February 18, 2017

 

 

"Between 41 and 42 weeks, your risk for stillbirth DOUBLES."

 

Your breath stops short. Your 40-week prenatal appointment had been pleasant and excited until the topic of induction came up, but now you're scared. Stillbirth DOUBLES?!

 

You wanted to avoid induction, but what can you do? You reply quietly, "...Okay. Schedule me."

 

Do you see a problem here?

 

Perhaps you -- the reader -- are of the mindset that babies come when they're ready, and you are dead set on labor beginning spontaneously. Maybe you're the kind of person who is so done being pregnant in that last month that induction sounds like a miracle (hang in there!). Maybe you're not currently expecting, but you have been, plan to be, or know someone who is. It really doesn't matter.

 

I've shared this scenario NOT because of the actual decision that was made, but because of HOW the decision was made.

 

We need to be very careful when making important medical decisions based upon the word "risk."

 

To understand why, read on.

 

What is risk?

 

"Between 41 and 42 weeks, your risk for stillbirth DOUBLES." This statement is an example of RELATIVE RISK.

 

Relative risk tells us how prevalent a condition is, comparing one group of subjects to another (for example, babies born at 41 weeks gestation versus 42 weeks). You can recognize statements of relative risk if you hear things like "risk increases by an additional 30% if..." or "that course of action will triple your risk of..."

 

Something that relative risk doesn't tell us is HOW LIKELY it is that something will ACTUALLY happen. That's called ABSOLUTE RISK.

 

So, going back to our example, what's the absolute risk? Depending upon the study, the absolute risk of stillbirth during late term pregnancy might look something like this:

 

41 weeks

4-6 out of 10,000

 

42 weeks

8-12 out of 10,000

 

Between those weeks, relative risk of stillbirth does, in fact, double. However, absolute risk indicates that the likelihood of stillbirth is extremely slim (0.0012%). Knowing that, would you (in my sample scenario) have made a different choice about induction? At the very least, maybe asked more questions?

 

Please don't misunderstand me. To the handful of families who are affected by fetal loss, the statistics matter very much. Being a member of that small subset represents an enormous, life-changing heartache. I don't seek to minimize them or their pain.

 

However, induction (and its follow-up interventions) introduces a new set of risks... so the argument to "induce all to save a few" is not a cut and dried policy. What to do?

 

For the patient's part, consenting to a medical intervention based upon relative risk (in this case, induction because "stillbirth risk doubles after 41 weeks") does not qualify as "informed consent." You deserve to know the real numbers -- what the actual likelihood of danger is -- when working with your care provider to make the best decision for your individual circumstances. 

 

While your care provider or birth facility might prefer to avoid certain risks due to personal preference or liability, you might have different ideas about acceptable risks as a consumer and parent. Your personal beliefs, your childbirth philosophy and objectives, your health and lifestyle, maternal intuition... there are many factors that will sway you one way or the other.

 

In summary...

 

As an educator and doula, my focus is empowering families to communicate effectively with their care providers and make informed, personal decisions. 

 

--and I'm confident your new understanding of "risk" will aid that process! Don't settle for relative risk at any point during your prenatal care, labor, or postpartum. Impress your care provider and honor your patient autonomy by expecting statements of absolute risk.

 

When making important decisions, the way we talk about risk matters.

 

Megan Hamzawi  is a certified educator and birth doula. Her class is ideal for birthing people and partners who prioritize individualized healthcare, informed consent, health-promoting nutritional choices, and active participation in the birth process.

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Welcome to Joy Love Birth. I'm Megan -  a wife, mother, childbirth educator,  & doula. Congratulations on your pregnancy, and keep up the good research!

 

 

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