The Curse of the ‘high risk’ label. (And how to avoid it)

It may just be coincidence, or it may be a growing trend, but more and more women seem to be given the label ‘high risk’ at some point in their pregnancies these days. One argument may be that this is down to women being generally older and less healthy entering pregnancy today than perhaps 10 or 20 years ago, another may be down the ever shifting parameters of things like Gestational Diabetes or ‘raised’ BMI, or the rising numbers of c-sections in first pregnancies, but whatever the reason, its something we seem to be seeing more and more. But does being given this label, increase the chances of intervention in itself?

 

When a woman’s pregnancy is labelled ‘high risk’ a number of things happen. 

When we are told that something we are about to do is ‘risky’, it changes the way in which we approach it. Reducing risk becomes the ultimate goal. The ultimate goal of those looking after us and the ultimate goal of us ourselves. We begin to feel anxious about giving birth and try to take steps to make things as safe as we can. 

If we perceive our endeavours as ‘risky’, we are more likely to accept assistance. The first assistance we tend to accept as ‘par for the course’ of having a ‘high risk’ pregnancy, is giving birth on a labour ward- you know, ‘just in case’. Now we know when looking at research of both uncomplicated and some more complex pregnancies, that simply being on the labour ward increased the chances of intervention- both c-sections and instrumental births, increases the chances of epidural use and augmenting labour and decreases the chances of a spontaneous, vaginal birth. 

Why does this happen on labour wards?

Well, it’s likely down to a combination of 2 main factors. Firstly, the environment itself. Once you understand the importance of the environment on the physiology of birth (both your emotions and your hormones), you can see why a brightly lit hospital room, with beeping machines and great big bed in the middle of the room for us to lay patiently on in labour, is unlikely to support physiological birth in the same way that home, or a home from home environment would do. Secondly, when things are AVAILABLE to us, we are more likely to use them. And that goes for both healthcare professionals and women alike. If getting an epidural meant waiting for 20 minutes for the anaesthetist to come to the bed you are already laying in, it’s a pretty simple choice. If getting an epidural meant getting in a car or ambulance or and changing spaces entirely, you’re only really going to do it when you REALLY REALLY want to! The same goes for any other kind of intervention- if a baby could be born more quickly with the help of instruments and they’re right there, its easier to offer and easier to say yes.. if it required all that moving, it’s only likely to happen when its truly needed. 

If you’ve already been told your pregnancy is ‘high risk’, what can you do?

The very first thing you need to do is understand what this actually means for you.

 

The way that ‘risk’ is presented to us really can transform how we feel about it.

A woman opting for a vaginal birth after a caesarean has around a 0.5% chance of scar rupture. Sounds scary! She is labelled ‘high risk’. 

A woman opting for a vaginal birth after a caesarean has around a 99.5% chance of her scar not rupturing. Sounds pretty promising really! 

A man in his 50s has around a 2% chance of suffering a heart attack. Could you imagine if we made him spend that whole year in hospital ‘just in case’? 

You need to understand what the complications may be, the ACTUAL chance of these things happening, and the research from which these deductions have been made. This article explains it well.

You need to weigh up all your options. 

And yes, you do have options. If initially it feels like you only choice is ‘labour ward’, it may be worth meeting with a consultant midwife to discuss your place of birth options. From a legal perspective, home is always an option for all women. However, depending on your own circumstances that may or may not feel like a good choice. Hospitals are allowed to set their own rules as to who may or may not use a birth centre- however, it’s certainly worth a conversation! You may like to work with your healthcare team to put together an ‘out of guidelines care plan’, which means your birth choices are put together in a way that is very personalised to you, even if they don’t automatically sit in the hospital guidelines and protocols. 

Maybe a labour ward really does feel like the right choice?

That doesn’t mean you have to sit on a bed, strapped up to machines, waiting for your baby to be born, despite what the movies may have you believe! Many more tips for a positive birth on a labour ward here, but if (in difference circumstances) labour ward wouldn’t have been your number one choice, then make your midwife aware of this! Midwives are wonderful people, and their expertise lies in supporting physiological birth. You can make specific requests such as turning out the lights and keeping off the bed, but simply asking your midwife how she can help support you to get the positive experience you want- sounds really obvious- but isn’t something many women do! Tell them what you were hoping for, and ask if there’s anything extra they can do! Your midwife can likely get you a ball or mat, encourage you to mobilise, show your partner some massage techniques, run you a bath- they are on your TEAM! 

Even if you opt for an induction or caesarean, in the right circumstances these can be truly positive choices too! Have a browse through the birth-ed hub for our articles on all kinds of ‘what if’ situations and how to make them positive!

‘High Risk’ doesn’t mean ‘risky’ and shouldn’t be a barrier to you getting the positive birth experience you truly deserve. On all our courses (online and in person) we cover all the ‘what if’ situations and how to make them truly positive. Want to take the next step to the kind of birth you REALLY want?