I’ve been quite shocked recently by some of the information and messages I’ve seen via social media relating to the risks associated with pregnancy and childbirth.
For example, this piece written by Milli Hill states
If you believe everything you read, then you probably think that childbirth is one of the riskiest activities any human can undertake. Actually, it isn’t, and statistically you’re massively more likely to meet your maker behind the wheel of your motor.
Others have re-tweeted the piece and are keen to promote a similar message. Tweeting a graphic from the NHS Choices ‘Atlas of Risk’, Sheena Byrom states
‘Let’s put pregnancy & birth in UK into perspective. It is NOT a risky business’
But let’s look a bit more closely at the figures. In the UK, in 2009 there were 4,125 still born babies and 2,511 neonatal deaths (6,636 in total). This compares with the total number of traffic related deaths in the UK (according to the Atlas of Risk) of 2,680. Sadly, we know that some of these stillbirth and neonatal deaths would be unavoidable, even with the very best midwifery and medical care. But we also know (for example from the 2013 Cumbria confidential maternity inquiry), that many could be avoided. The UK still has very poor perinatal death figures compared with other developed countries.
But these figures alone do not give an accurate perception of relative risk. In the UK, we spend considerably more time travelling on roads than we do in childbirth. The total exposure to the risks of road travel for the whole population is therefore considerably higher.The actual risks associated with childbirth have been scientifically reviewed in this paper published by the International Journal of Obstetrics and Gynecology. The paper found that the relative risk of death on your day of birth in the UK is approximately 430 times the risk associated with a 200 mile car journey.
In a week’s time, I’ll be going on holiday with my family and 2 children and doing a car journey of a similar distance. In preparation, this week I’m going the get the car serviced and I’m going to carefully check the tyre pressures and tread. The night before the journey, I will make sure I get plenty of rest. When we set off, I will check that everyone is wearing their seatbelts properly and I will drive with care, sticking to the speed limit and leaving a good distance between my car and the car in front. My wife and I will have made a conscious choice about the journey; knowing the risks of travelling by car with the people we love the most. Being acutely aware of risks and possible consequences, helps us make informed decisions and better judgements about how we behave.
The truth is that sometimes in pregnancy and childbirth, things can and do go wrong. Sometimes subtle changes, a low temperature in a newborn baby, a fluctuation in a CTG reading, can be a sign that something is seriously wrong and intervention is needed. The truth is that ‘you’ (and this is a collective ‘you’ as we were all once babies in the womb), are not ‘massively more likely to meet your maker behind the wheel of your car’, you are in fact 430 times more likely to die during the process of childbirth than you are during a 200 mile car journey on the UK’s roads. The day of your birth is the most dangerous day of your life up until you reach the age of 92.
Does this mean women should be fearful of childbirth? I don’t think so. But it does mean that midwifes and maternity professionals should not be ignorant of the risks or seek to underplay them. It means that staff providing front line maternity care should be trained and supported in recognising when medical help is needed. It means that we need a culture in maternity services whereby multidisciplinary professionals work collaboratively to ensure mothers are supported in achieving normal birth whenever possible, but which effectively deliver life saving intervention when needed; a culture which isn’t afraid to talk about stillbirth and preventable neonatal death but instead embraces such stories as opportunities to learn, share insights and influence behaviour. Most of all, we need to empower women to make informed choices, based on truthful information and not ignorance