Robin G. Jordan, CNM, PhD, is coordinator of the antepartum care courses for the Frontier School of Midwifery and Family Nursing and has practiced full-scope midwifery for 17 years in home, birth center, and hospital settings.
Risk Assessment and Risk Distortion: Finding the Balance
Version of Record online: 24 DEC 2010
2009 American College of Nurse Midwives
Journal of Midwifery & Womens Health
Volume 54, Issue 3, pages 191–200, May-June 2009
How to Cite
Jordan, R. G. and Murphy, P. A. (2009), Risk Assessment and Risk Distortion: Finding the Balance. Journal of Midwifery & Womens Health, 54: 191–200. doi: 10.1016/j.jmwh.2009.02.001
- Issue online: 24 DEC 2010
- Version of Record online: 24 DEC 2010
- pregnancy complications;
- pregnancy surveillance;
- risk assessment;
Pregnancy and birth have been conceptualized as medically problematic, with all pregnant women considered at risk and in need of medical monitoring. Universal application of risk scoring and surveillance as preemptive strategies in an effort to reduce risk is now standard obstetric practice. Labeling women “high risk” can result in more unnecessary interventions and have negative psychologic sequelae. When perceived pregnancy risk is out of proportion to the real risk, and when risk management procedures are applied to all women with benefit for only a few, the use of technology in caring for pregnant women becomes normalized. A learned reliance on technology can diminish women's own authoritative knowledge of pregnancy and birth. This may also have the unintended consequence of contributing to birth fear, a phenomena becoming more widely recognized. Health care provider-patient communication about pregnancy risk can be presented in a manner that encourages informed compliance rather than informed choice. Evidence-based risk assessment is essential to providing optimal prenatal care. Using tools such as the Paling Palette can help health care providers present balanced and readily understood information about risk.