Sunday, July 15, 2012

Should 'low-risking' make mothers nervous?

When it comes to pregnancy and birth, chances are really rather good that nothing truly bad will happen. The vast majority of low-risk mothers and babies are fine...except, there are some who aren't.

In the Netherlands, there has been recent reports that high risk women who are cared for by obstetricians in hospitals have better outcomes in terms of morbidity and mortality than low risk women who are cared for by midwives who plan on giving birth at home. That should give some pause for thought - the women who should expect worse outcomes (high-risk patients) actually have better outcomes than many of their low-risk counterparts.

Yet in many parts of the world, there are calls to limit the choices of low-risk women in terms of the care that they can expect to be able to access. In the UK, the new head of the College of Midwives is calling for midwifery led care to be the default care pathway for low-risk women. Here in British Columbia - there have been aggressive campaigns for normal birth (see The Power to Push and Optimal Birth BC) in addition to increased funding for both midwifery and Homebirth. Here in Victoria, it is pretty much impossible for a low-risk woman to choose to be cared for by an OBGYN. In Ontario - Don Drummond recently called for the delisting of elective cesarean sections for the Ontario Health Insurance Plan.

Much of the push for normal and natural childbirth is motivated by a desire to save healthcare dollars, but what has not been answered is the cost at which these savings will be had. How many mothers who want access to epidural pain relief will have to rely on less effective forms of pain relief? How many mothers will be subjected to unneccessary perineal tears? How many mothers will lose their wanted children? How many mothers will suffer PTSD or PDD? How many children will be permanently disabled, because right up until birth, everything was low risk, until suddenly it wasn't? How many women will have their own autonomy violated?

It is one thing to support choice and provide options - and in the context of well-informed patients this should be actively pursued. It is quite another to download risk onto those who would choose to avoid it, particularly in the name of saving money when it is not the system that bears the true cost of bad outcomes.

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