Posted by My OB said WHAT?!?.
Oct
28
Posted by My OB said WHAT?!?.
“You Can’t Determine If A Pregnancy Is Low Risk Until After The Fact.”
“You can’t determine if a pregnancy is low risk until after the fact.” – OB to mother who was sharing that she would like to have a home birth.
There are 32 comments to this post.
road2vba2c had this to say,
Oct 28, 2011 @ 6:47 pm (Quote)
So let’s just schedule you for a c-section at 38 weeks…
Note: if planning a homebirth, just skip the OB and go straight for a CPM…
Ooh, bonus points for my iPod auto-typing “homebirth”!
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I’m of two minds about this.
On the one hand, in some sense it’s true. Once in a while something sudden and unexpected happens during birth. It’s well to have a plan in case something does happen.
On the other hand, a lot of expected and risky things usually happen during hospitalized birth.
You need to balance the risks. It would be nice if hospital childbirth were a no-risk option, but unfortunately it isn’t. One has the feeling that this OB doesn’t recognize the risks of hospitalized childbirth at all.
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krp_2000 Reply:
October 29th, 2011 at 12:29 am (Quote)
I can also kind of understand it. My pregnancy was considered low risk until 2 days before I had to deliver via c/s at 34w1d due to HELLP. Only then could they classify it as high risk. Now of course all future pregnancies will be high risk, but I kind of understand what the OB is saying – there’s no way to know for certain that *nothing* will happen. It sounds like s/he’s using that to try to scare the OP into not having a homebirth, though, which is not cool. S/he should have told the OP what risks there are in a homebirth vs. hospital birth and under what situations the OP would need to go to the hospital immediately instead of making this statement.
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Dreamy Reply:
October 29th, 2011 at 12:24 pm (Quote)
there’s no way to know for certain that *nothing* will happen
Of course. Everybody knows that. It’s axiomatic regarding… life in general, and some situations in particular.
But that’s not “what the OB is saying.” The OB is not saying “there’s no way to know for certain that *nothing* will happen” (before it happens, or doesn’t).
The OB is saying “there’s no way to know or guess the risk of *anything* happening before it happens.”
And I don’t think it’s just semantics. It’s a pervasive belief that just because “anything can happen,” you should assume just about everything WILL happen and create brand NEW risks– often of more severe complications.
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Jess Reply:
October 30th, 2011 at 5:44 pm (Quote)
EXACTLY.
Of course you can’t predict what the outcome will be with any given pregnancy. That would be *telling the future*.
It’s about risk assessment. Risk assessment is not fortune telling. It’s evaluating the likelihood of certain events based on statistical evidence. That’s how you know whether a pregnancy is “high risk” or “low risk”. That’s how you know ANYTHING is high or low risk.
A person in generally good health can develop type 2 diabetes at a young age without any obvious warning signs. It happens. But it’s extremely rare that it happens that way. It’s much more coomon in people with either a strong family history of it, or who are extremely overweight and sedentary. Or both. So we can reasonably come to the conclusion that if you have a family history of diabetes and are extremely overweight and sedentary, then you are at a “high risk” of developing the disease. If you maintain a healthy weight, exercise regularly, and have no family history of it, then you are at a “low risk” of developing it.
Being at a “low risk” of developing a disease doesn’t mean that you should ignore warning signs or assume it won’t happen to you. But it would also be a little extreme to have yourself constantly screened. So we weigh the risk, and act accordingly. (And of course, have a Plan B in case the unlikely DOES happen….like in a homebirth, have a hospital transfer plan in place. Being “low risk” doesn’t mean being unprepared.)
People who have a family history of colon cancer are urged to have a colonoscopy at a much younger age than most people. Same concept. High risk.
So why is it that the practice of *risk assessment* is so easily applied in other areas of medicine, but this OB seems to completely misunderstand the concept? Or is he just intentionally undermining it?
The statement is simple: “You can’t deterine if a pregnancy is low risk until after the fact.” That’s pretty straight forward, and it’s utterly stupid. Yes, you can. And you do. And you run like hell from any educated person who doesn’t know how.
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Dreamy Reply:
October 30th, 2011 at 6:22 pm (Quote)
I see your EXACTLY and raise you an AMEN!
It’s not like non-smokers who live in Montana (cleanest air in the US) and have no family history of the disease don’t get lung cancer. Lung cancer killing more Americans than any other cancer, it’s not even like our no-history non-smoking Montanan has an infinitesimal risk of developing it, though it is very low.
However.
If he develops lung cancer, that doesn’t make him retroactively at high risk for developing it. That’s patently absurd.
I think most (if not all) of the doctors who say this about pregnancy and birth (and I have heard it said by more than one) don’t technically “mean” it, in a completely literal sense. But that doesn’t mean that they don’t essentially believe it on a subconscious level– which is scary. And regardless of their belief, what’s truly galling is that they continue to perpetuate it. Doctors who tell their patients that there is no way of even making an educated guess as to outcomes (implied: so you should allow them to make all your decisions for you) are not doctors who are interested in giving their patients the facts, allowing them to weigh risks and benefits, and obtain informed consent. And they’re certainly not scientists.
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Jess Reply:
October 30th, 2011 at 6:41 pm (Quote)
Indeed….it ties into the old “God complex” seen in some OBs. The attitude that you’re unlikely to even SURVIVE pregnancy without their highly specialized care. The need to control everything, and the belief that as long as THEY are in control, that the outcome will inevitably be better.
I mean, if I were one of those non-somking Montanans with no family history of cancer, but I INSISTED on seeing an oncologist regularly (and recieving extensive and invasive screening and tests “just to be safe”), instead of a general practitioner, just because “you never know”, people would think I was nuts and call me a hypochondriac and probably refer me to a therapist instead LOL.
Not trying to knock anyone for choosing obstetrical care in a low risk pregnancy…..choose whomever you trust. I’m just sayin’……think about this doctor’s statement from THAT perspective and he almost sounds nutty.
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Dreamy Reply:
October 30th, 2011 at 7:08 pm (Quote)
No, I know exactly what you mean. Of course, if our society told us that we should ALL see oncologists on a regular basis, have everything biopsied yearly “just in case,” etc., the Montanan wouldn’t look so crazy… at first and second glance, at least.
I honestly suspect that the reason there’s so much “pay no attention to the man behind the curtain” flim-flammery and doublespeak in OB (and a couple of other specialties– just moreso than in others) is that on some level, they are rightfully insecure. What I mean is that (as you know) the way their specialty is and has been used for low-risk pregnancy has so little basis in science that if OB were used for the cases it should be used for, well… 90% of OBs would be out of work (even being conservative, at least 70%). In the beginning, OBs knew this, and veerrrry slowly (IMO), verrrrry subtly and veerrrrrry subconsciously built their specialty on a faulty foundation of specious reasoning. (Of course I don’t mean that all obstetric practices– or many of them, in themselves– are built on specious reasoning. But the overuse of them on low-risk women is.)
But the point is, those are the foundations and history of the specialty as practiced the vast majority of the time, so it’s almost entirely logical that statements as in the OP would come out of the mouths of highly-educated and presumably intelligent people.
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Jess Reply:
October 30th, 2011 at 7:36 pm (Quote)
I totally agree. They are trained in only one approach to pregnancy and birth, and I think that the intelligent, educated people who make those kind of statements truly believe that their specialty IS the only safe way for birth to be handled. Of course, their education, however extensive, is over-specialized….they are educated primarily in pathology. But pregnancy is not inherently pathological. I think that in honing their skills in dealing with pathology, they begin to see it even where it doesn’t exist, and are unequipped to handle NORMAL situations without somehow diagnosing and “treating” them.
And it’s so true, if obstetrics were only applied where needed, ALOT of OBs would be unemployed. I believe, as you do, that it was a progressive change….it’s only logical, a doctor can spend a lot of time tending to women one at a time in their own homes, making very little money in the process. Or they can have them all admitted into one floor of a hospital, monitored by a nursing staff, and “deliver” half a dozen of them in one day, and make a killing doing it. All you have to do is convince them that it’s a good idea. They’re not going to come because it’s easier for YOU, but if you dig deeply enough, you’ll find all kinds of “what ifs” to justify whatever you want. Midwives are quacks, birth is dangerous, scary and brutal, but we save you from it. And it just escalated as the technology becema emore advanced. Not that the technology isn’t a blessing for small percentage, but due to the vast expense, its now on a mission to justfy itself through constant use. Much like it’s users 
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lilmrsmchenry had this to say,
Oct 28, 2011 @ 8:12 pm (Quote)
Somebody needs to brush up on the definition of risk.
The medical definition of risk: Pronunciation: /ˈrisk/ Function: n1 : possibility of loss, injury, disease, or death 2 : a person considered in terms of the possible bad effects of a particular course of treatment poor surgical risk>— at risk : characterized by high risk or susceptibility (as to disease) at risk of developing infections>
This is evaluated by “risk factors”.
Ok, I had more snarkiness but this seriously just made me tired in the middle of typing it. It’s like they failed middle school health class.
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Maddy Reply:
October 29th, 2011 at 7:25 am (Quote)
Yeah, pretty much this. It’s not like it’s that hard for a doctor to evaluate the risk factors and come up with a general prognosis of high or low risk. [S]He’s just being selfish by acting as if he has no way of estimating whether or not she has a high risk pregnancy. Basic principle of risk: you guess BEFORE the final outcome!
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Does this work both ways? If a mother walks into this doctor’s office with a very complicated obstetric history, chain-smokes, eats a terribly unhealthy diet, doesn’t exercise, etc, does the doctor say, “I can’t call you high-risk until something goes terribly wrong, so you’re fine!”
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And you can’t tell if playing Russian roulette is risky until after you’ve shot yourself in the head, either. Nope. Couldn’t hazard a guess.
And of course, if you can’t tell that it’s high risk, you ALSO can’t tell it’s low risk. Guess no one can be ineligible for home birth due to high risk factors then, huh?
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SculptorAlison had this to say,
Oct 29, 2011 @ 9:10 am (Quote)
Good think I’m seeing a midwife who’s trained to know whether it’s too risky for me to birth at home or not. That way I don’t really need you to weigh in on the subject.
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It seems like both this OB and most of the posters don’t understand the meaning of the term “risk.” Risk is the possibility of a future event. After the fact, there is no risk of something happening. Saying something is “low risk” does not mean “no risk.” Low risk is whatever you define it to be, e.g. 10% risk that x, y, or z will happen. If x, y, or z does, in fact, happen, that doesn’t mean that it still wasn’t low risk. It just means that that instance was part of the 10%.
Example – if I flip a coin, there is a 50% risk it will be heads, 50% risk it will be tails. After I flip it, it’s done. There is no longer a probability. It was either heads or tails (or on its side, but let’s leave that aside for the moment). Just because it was 100% tails doesn’t mean that *before* the flip, there was a 100% chance/risk of it being tails.
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What a retarded statement. It relies on the premise that bad outcomes only happen to people “at risk” for them.
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Childbirth is not dangerous the way many doctors make it out to be. But the fact of the matter is that things can go wrong. That’s true with everything in life, though, so I don’t understand how that can be a legitimate excuse for interventions. I can not wrap my mind around the logic behind comments like this one.
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Add Your Comment.
Well, then, I hope you refer all your clients to perinatologists, because we’d better assume they all have high-risk pregnancies!
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