Making Sense of Risk in Pregnancy and Birth

In this post, we’ll talk more about how understanding risk can be helpful with decision-making, as well as more about high-risk pregnancy.

Decision-Making and Risk

Decision-making is part of the pregnancy, birth, and parenting experience. I talk more about the decision-making process in this blog post:

🧭 Making Decisions for Your Body, Birth, and Baby

Risk is an important consideration when making decisions, but it can be hard to understand and interpret. 

Also, if you’re considering two options, each of those options is associated with some amount of risk. For example, if you’re considering getting a vaccine, there is risk with both getting and not getting it. Knowing how to understand and compare the type and level of risk is key.

Relative vs Absolute Risk

Risk can be presented to you as relative or absolute. This is when you’re comparing a specific risk associated with more than one option.

Let’s look at a generic example. You need to decide between Option A and Option B, and you want to know the risk of Complication X associated with each of those options.

Here’s an example of relative risk:

With Option B, you have a 50% higher risk of Complication X, compared to Option A.

Relative risk, expressed as a ratio or percentage, compares the risk of Complication X with Option A to the risk of Complication X with Option B.  

Here’s the same information presented in terms of absolute risk:

With Option A, 2 out of 100 people will develop Complication X. With Option B, 3 out of 100 people will develop Complication X.

Absolute risk provides the actual probability of Complication X occurring in a given population with Option A to the actual probability of Complication X occurring in a given population with Option B. 

I created an infographic on this that also includes a visual aid for understanding absolute risk:

Which one makes the risk of choosing Option B feel more significant than it really is?

When making medical decisions, information presented in terms of absolute risk can provide more clarity than when information is presented in terms of relative risk. You can still compare the risk of one option to the risk of another, while also getting a sense of whether overall risk is high or low. You can also ask your care provider if visual aids are available to help you make a decision.

It’s also important to know that when fear-mongering tactics are being used, risk is often presented in terms of relative risk, rather than absolute.

Check out the link below for a specific example of using absolute risk to understand the risk of stillbirth at 41 and 42 weeks of pregnancy:

🔗 Talking about Due Dates | Evidence Based Birth®

High-Risk Pregnancy

No pregnancy is without risk. Some can be considered “low-risk” and others “high-risk”.

Defining a Pregnancy as High-Risk

So how exactly do we define a low or high-risk pregnancy? Well, it depends. There actually isn’t a universal definition. You have to consider the context. What is the reason behind labeling a pregnancy with one of these labels or the other? How will this be applied to your pregnancy? Let’s look at some examples of how these definitions can be used:

• Identifying a need for more specialized care
• Setting boundaries for safe home or birth center birth
• Deciding on the necessity of additional monitoring or testing during pregnancy
• Deciding on the use of specific medical interventions during birth

The National Institute of Child Health and Human Development has a list of possible factors that could create a need to label a pregnancy as high-risk, which are divided into four categories: 

• Existing health conditions (like high blood pressure or diabetes)
• Age (both teens and those over 35 and pregnant for the first time)
• Lifestyle factors (like alcohol, tobacco, or drug use)
• Conditions of pregnancy (like gestational diabetes or pregnant with multiples)

For a full list and more information, check out this link:

🔗 What are some factors that make a pregnancy high risk? | National Institute of Child Health and Human Development

Understanding and Managing a High-Risk Pregnancy

It’s important to understand what high-risk really means. It doesn’t mean you can’t have a healthy pregnancy and birth. It also doesn’t mean you will definitely need a lot of medical interventions during birth. It just means you or your baby are at a higher risk of either developing a health condition or having complications related to an existing health condition. Also, a pregnancy can start out as high-risk or become high-risk later on.

Your care provider may also recommend more specialized care or extra testing and monitoring. They may recommend specific treatments or medical interventions. A high-risk pregnancy may also affect which options are available to you. It will depend on your specific situation. 

Also, just because you are at a higher risk of developing a health condition, doesn’t mean it will ever happen. For example, if you are over age 35 and are pregnant for the first time, you may be considered high-risk. But you can absolutely go on to have a healthy pregnancy and birth with no complications. Utilizing informed decision-making can help ensure you are getting the care you need, while avoiding any medical interventions that you don’t.

In general, there are things you can do to help “clear the path” and lead you toward the best possible outcome for your pregnancy. Here are some ideas:

• Manage existing health conditions before and during pregnancy
• Eat a well-balanced diet of nutrient-dense foods
• Exercise regularly 
• Attend routine prenatal care appointments
• Manage stress
• Get adequate rest

Despite our best efforts, however, complications can still arise. Pregnancy and birth are unpredictable, with many factors outside of our control. 

Getting Support

Support is important for all pregnant and birthing people, but a high-risk pregnancy can bring some additional challenges. It’s normal to feel a wide range of emotions during a high-risk pregnancy. It can bring additional worries about your own health or that of your baby. It can require extra prenatal care, which is sometimes tough to balance with work and other obligations. It can limit your options and affect what you were envisioning for your birth.

It can be helpful to communicate with those closest to you and share how you’re feeling. If there are people in your life that can offer additional help during this time, don’t be afraid to ask for or accept it. Support can ensure you are able to focus on your health and wellness during this time, doing what you can to have the best possible outcome.

Also, if you are experiencing a high-risk pregnancy, a highly recommend checking out this book:

📚 Pregnancy Brain: A Mind-Body Approach to Stress Management During a High-Risk Pregnancy