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"High Risk" and "Low Risk" Pregnancy Debunked

During pregnancy you may hear the terms "High Risk" and "Low Risk" used to describe your pregnancy. Despite having these labels attached to them, many people are not aware of what they mean. Risk is an inherent part of life, permeating every decision we make and every action we take. From mundane choices like crossing the street to significant life-altering decisions, understanding and managing risk is crucial for navigating life. However, using categories to define a person's pregnancy can directly influence the maternity care they receive, and their birth outcomes. I'm here to tell you all about the potential impact of these labels and how you can do your own risk assessments to help you make informed choices, and be in control of your experience.

diagram of handwritten 'risk' in the centre and arrows around it pointing to associated words or ideas

Defining Risk

Risk can be defined as the probability of an event occurring and the potential consequences associated with it. Put in simple terms, risk is exposure to potential threat or danger.

Risk in Maternity Care

Many pregnant individuals will be exposed to the concept of risk at their very first pregnancy contact. At the point of accessing care, usually you will be asked to fill out a form about yourself which is used by healthcare providers to plan your care. The 'booking appointment' is typically undertaken by a midwife before 10 weeks of pregnancy and involves a series of risk assessments, leading to recommendations about the care you will be offered throughout your pregnancy journey. You may be told that you have a 'high risk' or 'low risk pregnancy' - and although I don't personally use this language, I'm here to explain what it means and how to help you assess individual risks and make informed choices about your care.

"High Risk" and "Low Risk" Pregnancy Debunked

wooden blocks representing a scale of risk from low to high

As mentioned, I am not a fan of using these two broad categories to define a person's pregnancy. This is because every person and every pregnancy is unique, and making sweeping statements or putting people into boxes can have a huge impact on their care. The heavy focus on risk from the very first appointment enforces the idea that pregnancy and birth are dangerous and pose a threat to mother and/or baby. This medicalised view of birth automatically instils a sense of anxiety in pregnant parents, leading them to believe that the process is unsafe. This in itself can interfere with birth physiology, but also fosters disempowerment increasing the chance of a negative birth experience. However, because this terminology is still widely used I will give you a brief description of them.

"Low Risk"

This usually means that there have not been any factors identified which require specialist input in your care. Sometimes you may hear the phrase "Midwife led care" meaning you have not been referred to an Obstetric or other medical consultant.

"High Risk"

This term is usually used to describe a pregnancy in which there are multiple healthcare professionals overseeing the care plan. This could be because of social, medical, obstetric or other factors including (but not limited to);

  • Pre-existing medical conditions

  • Body Mass Index above or below certain thresholds

  • Taking regular medications

  • Previous obstetric complexities (such as having a premature baby or caesarean section)

  • Current obstetric complexities (such as gestational diabetes or pre-eclampsia)

Assessing and Managing Risk

image of two hessian bags balancing on opposite sides of a scale, labelled risk and reward

Managing risk involves identifying, assessing, and reducing potential threats. In pregnancy this may manifest in different ways. As mentioned above, being given a label of "high risk" or "low risk" may directly impact your experience. Moving away from these broad terms, and looking at a person more holistically can help with care planning and ensure safe, effective and personalised care. This may sound confusing, but there is no such thing as a one-size-fits-all approach to birth. We are all unique and should be treated as such avoiding generic plans that might be unsafe, unethical and can jeopardise your birth rite of passage.

There are numerous factors which could increase certain risks in your pregnancy to various degrees, and lots of different ways in which your maternity team propose to reduce such risks.

These may include (but are not limited to);

  • Receiving care from various specialist healthcare professionals

  • Giving birth in a particular location

  • Taking a particular medication

  • Accepting a screening test offer

  • Extra scans/blood tests

  • Monitoring tests

Once you know what your actual risk factors are and what interventions are being offered, you can start to develop a bespoke plan for your care.

How to do a Risk Assessment

Here are some key steps in the risk management process:

Risk Identification: This involves identifying and understanding potential risks that could affect yours or your baby's health during pregnancy, birth or postpartum.

Risk Assessment: Once risks are identified, they need to be assessed in terms of their likelihood and potential impact. This helps you decide if a risk feels like a significant threat to you. It can be useful to think about this on a scale to help with this process. Below is an example of a risk assessment matrix to help you visualise this.

Table showing Risk Assessment matrix of potential consequences vs likelihood of event occurring

Risk Mitigation: Once you have assessed a risk, care plans can be developed to mitigate or minimise the impact. This may include one or more of the things mentioned above, or something else.

The Role of Risk in Decision-Making

Understanding risk is essential for making informed decisions. Weighing the potential risks of something against the expected benefits is crucial for achieving desired outcomes. This may come naturally to some, but many find this process daunting so it is important to involve care givers and your birth supporters in this process. Risks can never be eliminated, but if you feel well informed and supported, you're more likely to have a positive pregnancy and birth experience.

Whichever risks have been identified for you and/or your baby, it is important to look at the benefits and drawbacks of the care plans being presented to you, and decide which interventions (if any) you would like to accept. This is because interventions (as well as risks) have potential consequences, and accepting interventions may impact the path that your pregnancy and birth take.

For example, accepting continuous monitoring of your baby's heartbeat during labour, may mean that you are less able to mobilise during labour, or restrict your access to a birthing pool. Therefore it is important to way up the pros and cons of continuous monitoring against the benefits of an active labour and use of a birthing pool. In order to make a fully informed choice, you need to know;

  • What the actual or perceived risks are to your baby

  • The extent to which continuous monitoring may reduce the risks

  • The risks associated with not having continuous monitoring

  • Any alternative options

Once you have this information, you can weigh it up with the benefits and risks of the alternative options - in this case, using a birthing pool and having an active labour.

Closing Thoughts

Having debunked the outdated high risk and low risk pregnancy labels, I would like to encourage you to take back control of your pregnancy and birth care. Whilst it is important to acknowledge risks in pregnancy and birth, being put into a "high risk" or "low risk" category detracts from your individual needs, wishes and circumstances. If risks are identified during your pregnancy or birth, they should be assessed by yourself and your care provider to make the most appropriate care plan for you. Always do a risk vs benefit analysis, not only regarding the identified risk, but also any interventions offered to reduce said risk. This will help you to feel in control of the process and make the decisions that are best for you and your baby, leading to a more positive and empowering birth experience.

For more information or personalised advice regarding your care, contact Abbi or book a free consultation on the link below

Abbi Linnett, Midwife

07474 732 272


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