Normalizing Birth

Understanding the True Risks for Pregnancy and Birth Complications

Sep 26, 2008 Brenda Lane

Mothers today are inundated with the risks for themselves and their babies; however it is crucial to explain risks in terms that are understandable.

The message that birth and pregnancy are normal and healthy is not getting across to parents in our culture today. Medical providers seem to fixate on the most remote risks to their patients, convey that information to their patients in ways that parents seldom understand and often guide them into making decisions that may include invasive and unnecessary surgery and intervention.

Looking at Statistical Risks of Birth and Pregnancy

Dr. Andrew Kotaska, the Clinical Director of Obstetrics and Gynecology in Yellowknife, BC recently presented information on the culture of risk in pregnancy and birth at the 2008 DONA International Conference in Vancouver, BC. Dr. Kotaska's research on risk estimation includes the following scale to describe risks in terms consumers can relate to and understand:

1/1 Risk - Certain

1/2 Risk - Likely

1/10 Risk - Common

1/100 Risk - Uncommon

1/1,000 Risk - Rare

1/10,000 Risk - Very Rare

1/100,000 Risk - Negligible

1/1 Million Risk - Theoretical

How does this proposed scale of risk estimation relate to pregnancy and birth? It means that mothers need to be given not only the real risk to them and their babies, but in understandable and meaning comparisons that can help them make informed decisions. Medical caregviers should not be overestimating (or underestimating) the risks to mothers when disclosing this information.

Explaining The True Risks of Pregnancy and Birth

For example, here are some of the risk comparisons that carry a 1/1,000 risk related to birth:

1. A 1 in 1,000 chance is the true risk of stillbirth from 41-42 weeks gestation. This means that the risk of stillbirth is still considered to be rare from 1-2 weeks after the mother's due date. Some care providers encourage induction to avoid or prevent stillbirth. However, knowing the true risk might help mothers realize that an induction prior to 42 weeks may not be medically-indicated.

2. A 1 in 1,000 risk is equivalent to the true risk of a baby becoming infected with GBS when the mother tests positive, but does not receive antibiotics. This might make us question the routine use of antibiotics for all mothers who are GBS positive since the true risk to their baby in becoming infected is rare.

If we take pregnancy issues out of it and compare it to other 1/1,000 risks, this is also the same risk described by Dr. Kotaska in his lecture of his own yearly risk of death for himself as a 40 year old non-smoking male living in Canada.

Are We Over-Inflating the VBAC Risks?

What about the true risks of VBAC and uterine rupture? Well, here are the facts. Even if you schedule a cesarean, you still have a risk of uterine rupture. Few care providers tell their patients that.

Among mothers with a repeat cesarean, their risk of uterine rupture was 1.5/1,000. If a mother goes into labor spontaneously, her risk of uterine rupture goes up only slightly to 5.2/1,000. Adding prostaglandins to the labor does increase the mother's chance of a uterine rupture to 24/1,000. However still putting this into perspective, that is still only about 2% of mothers who have the risk of uterine rupture even if their labor is induced.

Are Care Providers Underestimating True Risks of Early Cesareans?

Dr. Kotaska also believes that care providers should not be underestimating the true risks in other procedures. For example, it is common for doctors to recommend an early cesarean prior to the mother's due date to reduce the possibility that the mother's labor will start. The true risk to her baby is that if she has an elective cesarean earlier than her due date from 38 weeks to 38 weeks plus 6 days, there is a 1/140 chance that her baby will need to be taken to the NICU and receive ventilation or oxygen due to respiratory distress. Remember this statistic we described above was uncommon, but it is not in the rare category.

How to Normalize Birth?

Thankfully, parents in today's childbearing age are beginning to ask questions and learn more about the true risks of certain procedures. Parents need to be encouraged to stand up for what they believe in and change providers and places of birth if they are not supported in their plan.

Kotaska and other birth experts recommend that caregivers should be reassuring their patients that birth is normal. It is our job as parents to believe that.

The copyright of the article Normalizing Birth in Pregnancy & Childbirth is owned by Brenda Lane. Permission to republish Normalizing Birth in print or online must be granted by the author in writing.

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Comments

Sep 26, 2008 11:42 PM

Carmen Sofia Grant :

This is a great article. I was being forced into a c-section by my doctor because I had a 3rd degree tear during my first labor. He told me that the "trauma" would only repeat itself if I tried a vaginal delivery again and the best "least traumatic" thing to do would be a c-section. Last I checked, going under the knife is a little more traumatic than going through natural labor, which is what a woman's body is supposed to do. It is normal, natural pain that subsides in a few days. Needless to say, I switched my doctor, had my second baby vaginally with no drugs, and I didn't even tear one centimeter.

Sep 27, 2008 6:36 AM

Brenda Lane :

Thank you for sharing your story!

Sep 27, 2008 1:33 PM

Lizz Shepherd :

The risk of uterine tear is constantly shoved at mothers to make them agree to a C-section. I actually confronted a doctor about the risk and told her that it wasn't common to have a uterine tear during a VBAC. She then argued and told me that it wasn't rare and that she had had it happen three times. That's THREE times- in 15 years as an OB/GYN. That's what doctors are telling us is commonplace.

Sep 27, 2008 6:18 PM

Amy Kreydin :

Thank you for this article, as a birth doula I see far too frequently the misinformation or disinformation on intervention statistics. How can someone make an INFORMED consent when they aren't given appropriate information? Dr. Kotaska's scale seems very easy to follow and I'm sure will be a great help for women and their partners.

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