I've been reading a lot of interesting posts on Twitter lately discussing a four letter word which is rapidly becoming the elephant in the room as far as providing maternity care goes so I thought I would have a go at trying to give my perspective via a forum which isn't limiting me to 140 characters.
The concept of RISK is emotive. Being 'risk averse' seems to be something which is considered negative, a form of defensive practice and, from some of the posts I've been reading, not something that midwives should be supportive of if we want to be considered truly supportive of the birth process. However, The Cambridge English Dictionary defines the term as being '"unwilling to take risks or wanting to avoid risks as much as possible" which I have to admit I feel comfortable with and, should anyone wish to evaluate my practice, would be happy with that description.
Alongside the subject of risk is the statement I see repeated with almost the same frequency that 'a healthy baby isn't all that matters'. To contextualise, to point being made is that outcomes should also be measured by the mothers experience of birth and not the condition of baby alone but there is the risk that this could read, to some, that the experience is more important than the outcome and that is wrong.
Being risk averse does not mean the primary focus is on the baby, there are many variables involved in a good outcome. A healthy baby does not mean that the mothers wishes have been ignored, to suggest that the two are mutually exclusive is irresponsible and does nothing to promote trust and respect between families and professionals.
I liken the concept of risk management in pregnancy and birth to crossing the road. In both scenarios there is an identified risk: that statistically despite this being an everyday process, there will be occasions where there will be an adverse outcome. That is a fact, not a scaremongering tactic, and we do women, their partners and their babies a great dis-service if we choose not to acknowledge this in case it prejudices the decision making process.
To minimise the chance of an adverse outcome when we cross the road we would need to identify potential hazards, for example the obstruction to the drivers vision which may prevent him from seeing us cross, or the 60mph speed limit which gives us less time to cross, and look for a solution which enables us to still cross the road, but in a safer place where the desired outcome of reaching the other side of the road in one piece has a greater chance of being achieved. The same can be said when discussing and planning maternity care, and in particular, place of birth.
Some women live on that quiet country lane which is quiet, calm and traffic is infrequent. She will have had a healthy, uneventful pregnancy and, after discussing the options of where to cross the road (or give birth) will have many options open to her where the outcome will still be the same, however she must still be aware of the fact that she cannot predict the rogue driver who may decide to make an appearance at the time she chooses to cross. Caution should still be applied, even on an empty road.
For the woman who lives near the motorway (or has a slightly more complicated pregnancy) the traffic may not be so calm, but she still wants to cross the road safely. The potential hazards need to be identified so that she can decide where to cross and it may be that the traffic is so heavy she may need to seek an alternative way of getting to the other side, however, there will be times when the traffic slows and even stops so that, if she is ready, she can make her way safely across without the help that is available.
To manage risk it has to be identified. Acknowledging it exists and looking at how to minimise it is good practice. Risk taking rarely saves lives except in disaster movies and patient safety should not be considered as the antithesis to patient choice. Good communication skills, knowledge sharing and respect all contribute to ensuring the two can work together in providing a positive and safe outcome for all.
Mags also blogs at http://mancmidwife.wordpress.com