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Risk Assessment and Risk Distortion: Finding the Balance


  • Robin G. Jordan CNM, PhD,

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    • 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.

  • Patricia Aikins Murphy CNM, DrPH

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    • Patricia Aikins Murphy, CNM, DrPH, is an associate professor and holds the Annette Poulson Cumming Presidential Endowed Chair in Women's and Reproductive Health at the University of Utah College of Nursing, and is Deputy Editor of the Journal of Midwifery & Women's Health.

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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.