Sunday, 30 November 2008

Risk in Midwifery - who decides?

Risk is an interesting issue in midwifery and obstetric care. Risk is discussed all the time with women, but it often means different things to different people. Who decides what is high risk? High risk to whom?

This reminded me of a hospital appointment I attended with a client, her husband and their consultant. They were discussing risk in relation to their impending twin birth. The consultant, whom I trust and respect, was saying that he recommended an epidural for twin labours because of the high risk that the second twin might need to be born quickly by cesarean section or assisted delivery. My clients husband asked what he meant by high risk – the consultant replied that about 5% of second twins are born by emergency cesarean section. The husband laughed and said that 5% was nothing and as a racing driver, he faced death or serious injury every weekend – somewhere in the region of 50%! From his perspective, a 5% risk was minimal, but from the obstetrician's view point, this was a huge risk! The couple therefore decided that 5% was an acceptable risk of an unplanned caesarean for them and so declined epidural anaesthesia.

From their viewpoint, the benefits of mobility in labour outweighed the small chance that the mother would have to have an emergency general anaesthetic if she needed a caesarean section and there was not time to administer regional anaesthesia.
NB The risk of the second baby dying in labour was much less than this - around 3 in a thousand for term second twins - second twins have a higher mortality rate than first twins or singletons. See for instance Birth order, gestational age, and risk of delivery related perinatal death in twins: retrospective cohort study. - Smith GC, Pell JP, Dobbie R. in BMJ. 2002 Nov 2;325(7371):1004. -

1 comment:

  1. Risk is a very intersting issue eleanor and one I intend to look into a little closer. Watch the postings I am going to read a bit then get back here to write about risk.


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