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June 11, 2014

“At Risk” or “High Risk” – We Should Say What We Mean

Over the last few years, I keep using the term “normal, low-risk VBAC” and I’ve found others have begun to use it as well. After all, isn’t less than 1% of a risk really a LOW risk of it? Especially if the actual risk of death or severe complication is even lower?

Evidently, It’s all in the eye of the beholder.

When I did searches for ACOG and defining what “high risk” means, there really isn’t any true definition. It’s like there is an imaginary line wherein doctors get the heebie jeebies and they call any risk a “high” risk.  So where is this cut-off and why is this word so prevalent in our society when it comes to medical care?

One definition states “of, relating to or characterized by risk” and another states:

                             high-risk

                             adjective Referring to an ↑ risk of suffering from a particular condition Infectious disease Referring to an ↑ risk for exposure to blood-borne pathogens,                                     which occurs with blood bank technicians, dental professionals, dialysis unit staff, EMTs, ER staff, IV therapy teams, lab, and medical technologists,                                             morticians, OR staff, pathologists, phlebotomists, surgeons, etc
So, according to this definition, ANY risk above average risk is suddenly “high” risk and average or normal risk isn’t readily defined.
And this is how having twins comes to be called “high risk” when some might be absolutely normal risk for having twins and others might be of a slightly higher risk or a much higher risk for certain conditions.  So how do we know what is normal risk, what is average risk, what is high risk? I’ll be exploring this through the next few posts.
Right now, many women are at high risk for having a cesarean just by virtue of walking in their local hospital. Normal women having healthy pregnancies have a 1/5 chance of having a cesarean without any further rise in complications during birth. So, all women are now at high risk? Are their doctors telling them?
There will be more on this over this week because I really want to explore this topic but we need to start holding doctors and nurses accountable to their language.
There is no “high risk” there is only risk. And my risk is either a relative risk or an absolute risk and you really only have a guess as to what my risk might be.
If we spent more time explaining to women that really, we don’t know what their risk IS even though we have an idea of what it MIGHT be in pretty rigid circumstances, then perhaps women would start understanding their care better.
Unfortunately, we’ve created a society where once you’ve told a woman she is high risk, she immediately agrees to whatever the doctors/nurses/hospitals say because she’s convinced that she and her baby are in very real danger of something that is very large and immediate.
This chart of ACOG’s helps outline exactly why they use terms like “high risk” in order to get women to consent to care rather than giving them choices and explaining individual risk. Are any of these procedures advisable? Recommended? Safe? Most individuals won’t feel it matters because they are told they are at “high risk” and it needs to be done. It’s horribly sloppy critical thinking on the part of the public, even if they WOULD choose these particular procedures, etc. And it’s intellectual laziness on the part of medical care to not allow individuals actual informed decision-making.

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