What is the difference between low risk and high risk pregnancy?
And how will it affect your options for birth??
Being aware of where you are on the risk spectrum can be incredibly empowering for pregnant women. Learning the reasons and understanding how this label affects you is important so that you can still decide how you want your birth to be and what elements of your labour you can specifically ask for under the correct circumstances for you.
There is no doubt that women who are labelled as “Low Risk” have an easier time of it.
You will have less worries because you are able to have the pick of the facilities in the area, you have no extra appointments to attend, and your pregnancy is considered less dangerous! When the day of your birth arrives, you will be monitored intermittently as a matter of routine, and will be able to stay at home for as long as you want to in early labour.
Low Risk women can give birth at home, in a midwife-led-unit or an obstetric led unit without any prior consultation, and you will be accepted based on your Low-Risk status and can use water if you decide to at any point.
In comparison, a High Risk women has a less easy time in pregnancy for many different reasons, but on the whole, it’s because it can mean that you or your baby’s life can be threatened by complications. This in itself is very stressful and very time consuming having to attend a large number of appointments for tests/ scans and discussions with your Consultant. You may be told from the outset what will happen to you during pregnancy, labour and birth and it is usually in a language that omits the word choice. Typically High Risk women are often brought in for a controlled induction before the baby is ready to be born, and chances are the woman will automatically accept whatever she is told simply because she thinks she is on the ‘danger list’.
What is important to know is that if you are a women who has been labelled as High Risk, there are many reasons why you may not actually need to have a medicalised labour and birth and there are still many options available to you.
Lets unpick it!
What might you be considered High Risk for?
1. An existing medical condition that affected you before your pregnancy
2. A medical condition that came about because of your pregnancy
3. Maternal Age
4. Previous pregnancy history and/or previous Caesarean Section
5. Maternal weight
6. Multiple pregnancy (twins, triplets etc:-)
7. IVF pregnancy
8. Breech presentation at full term
Firstly I want to be clear that some of these examples are very serious and we are lucky that we have such robust screening methods to help identify where our mothers and babies need help to ensure their safety. However in many of these cases, the risks given to the women are relevant for pregnancy, but are not relevant when it comes to giving birth at all. For example:- In the case of an IVF pregnancy, the woman is not high risk once the pregnancy is established and the due date is drawing near. These women should be removed from consultant-led care and be put back on the Low-Risk pathway as long as there are no other existing medical conditions.
Personalised care pathway
Labelling women affects the care they receive, and it can undermine their own belief in birth, but the good news is that things are starting to improve. In some hospitals that have an alongside Midwife Led Unit (AMU), we are seeing that they are starting to take women on a case by case basis who have previously been ruled out of using a birth centre. These High Risk women may now be considered to have their baby in the AMU even if they are consultant-led. One example might be a woman who has had a previous caesarean section, and has decided that she would like to have a Vaginal Birth (VBAC) this time around without the strict guidelines that an obstetric led labour ward imposes on her.
Another example of a more ‘personalised care pathway’ is when a woman, who is considered overweight, or a geriatric mother (Over 40, and yes this is a genuine term), decides that she would like to have more monitoring during pregnancy rather than an automatic induction at 39/40 weeks.
Women who are expecting twins may not have been “allowed’ for many years to give birth vaginally resulting in a de-skilling of midwives, however with more and more women standing their ground and refusing a c-section, many hospitals are starting to witness multiple vaginal birth, which enables the medical professionals to become more confident in attending them.
Knowing your own status means you can discuss with your doctor/midwife and anticipate how your needs can be met, even under High-Risk circumstances.
You can then sit down with your midwife/obstetrician and write out your own specific birth care plan based on your preferences. This is essential to ensure that your wishes are documented, so that on the day of your birth you do not run into any issues which may result in you finding yourself fighting against a medicalised birth that is simply based on a “one size fits all” policy.
Word of warning:- It is important that you know, when you are planning to give birth in a low risk environment and have been labelled as ‘High Risk’, you may well see your pregnancy notes being documented with the phrase “against medical advice”. This can be hard to read and often scary, however if you have done your research, and for you the risk of intervention is greater than the risk of giving birth in an obstetric unit or having an induction for example, then having this wording on your notes is just about careful documentation and is nothing to worry about.
Lastly is is very important for you to know that if for any reason you became labelled as High Risk at the start of your pregnancy, but things have changed along the way, you can speak to your midwife to ensure that you are taken off that pathway, and are put back onto midwife led care.
This article from the RCM website talks about how health care professionals should be careful around women with the language they use. https://www.rcm.org.uk/news-views-and-analysis/views/high-risk-language-in-maternity-care