When we talk about the “risk” of something, generally we mean the likelihood of it happening. Though the risk and the likelihood are slightly different these two words are often used interchangeably.
Another way is by saying that something is a risk. For example, there’s a risk of post-partum haemorrhage after birth. Although it is important to find out what the events are, this is not super helpful because it is not quantified. Birth is risky; whether that be vaginally or by caesarean – both have risks.
The likelihood risk of something happening can be reported in many ways. For example, when talking about the “risk” of a 3rd or 4th degree perineal tear:
- 100 out of 10,000 will tear
- 9,900 out of 10,000 will not tear
- 1 in 100 will get tear
- 99 out of 100 will not tear
- 1% will tear
- 99% will not tear
All these points are exactly the same, just written a different way. Even though they all mean the same, sometimes seeing it written a certain way makes us feel more or less concerned about it.
Have a look at the following picture;
Look at how in 100 people, 1 woman will tear. Some people will look at this picture and focus on the number of greyed women, others will look and assume they are the one red woman. The same data, the same “risk” as the dot points above, yet it is presented and interpreted differently.
Another issue around defining risk is around the language. Did you know if you are induced you are more than 3 times more likely to have a uterine rupture (if you haven’t had a caesarean before)!? Sounds scary doesn’t it? But let’s look at the numbers;
- If you have not had a caesarean, your risk of uterine rupture is 0.007%.
- If you have never had a caesarean, but you are induced, your risk of uterine rupture is 0.022%
See? Over three times “risky”… however 0.022% is still an extraordinarily low risk. So low that I can guess most midwifes and obstetricians don’t mention it when they talk about induction. Without knowing the specific stats, it’s easy for language to increase the fear. This is sometimes accidental, but sometimes a purposeful use of words. No one has lied if they tell you something is 3 times more “risky” – it is up to you to find out how “risky” it was to start with and recognise when it is subjective language instead of objective numbers.
There are two types of risk when we discuss the maternity health care system;
- Institutional risk
- Individual risk
Institutional risk is the risk that the hospitals monitor. For example, hospitals could collect stats on how many 3rd or 4th degree tears or emergency caesareans occur in the hospital. If that is the “risk” that is currently being monitored, they may advise an intervention to avoid that particular risk and keep their reporting low.
Individual risk is the personal risk to you. This is how you feel and the follow on from your birth. You may know that something is a 20% “risk” of occurring but decide that the consequence of that is low. Or, you may decide that even though something is 0.001% likely to happen, the consequence would be too great and you’d rather find an alternative way to prevent that happening – whatever it may be. These are the choices that you and your birth partner make. Your birth team has no way of knowing how you think and what you prioritise. They may assume they know, but don’t always get it right. This is why it is so important to ask questions and use your B.R.A.I.N. thinking when alternative pathways are presented to you; only you can decide which “risks” you are willing to take.
Decrease the risks
Having a baby is risky. There is a likelihood (however small) that something can go wrong no matter which pathway you choose. It is up to you to educate yourself to make choices based on individual risk, rather than institutional risk. There is no harm in asking questions – using your B.R.A.I.N. and doing your own research will give you the best opportunity to make the right choices.