How are Assessment and Risk Related?
Assessments during pregnancy are aimed at determining risk factors, then using that data to inform preventative care. Often we hear terms such as "high risk" and "low risk" regarding pregnancy. When we assume all pregnancies are "normal"or a variation of normal, and take on a disposition that assessments are not necessary, then we are indeed taking unnecessary risks. The absence of assessment directly increases risk. Good assessment can determine risk and lead to the most appropriate care to protect the safety of both mothers and babies.
The Importance of "Risking Out"
Not all women and their preganancies should be considered good candidates for out-of-hospital or midwife attended birth. Midwives who work in the hospital setting already have criteria to which they adhere to determine if a pregnant woman's risk factors are appropriate for midwifery care. Midwives who do not work in hospitals determine their own criteria, and some believe that all pregnancies are a "variation of normal".
Other countries that rely heavily upon midwives for maternity care, both in and out of hospitals, have very clear, thorough, and strict guidelines for screening women for risk factors. This process is called "risking-out". For example, many home birth advocates refer to the Netherlands as having great outcomes in home birth. While that claim is debatable, much of their success has to do with the fact that their midwives are educated according to high standards, and they strictly screen and risk out any women who presents deviations from normal pregnancy
such as malpresentation, high blood pressure, multiples, etc. Check out this laundry list of risk factors that midwives in the Netherlands assess as part of routine care: Dutch Home Birth Standards
to ensure their clients are low risk.
Out-of-hospital birth in Michigan, literally has NO risking out criteria defined. It is up to an individual midwife to determine her scope of practice. It is important to ask any potential midwife, "What is your risking-out criteria?" Ask for a copy in writing.
For some Michigan midwives, there is no such thing as a high-risk pregnancy. Providing adequate Informed Consent
means that midwives are required to inform clients of all risks in a given situation. Rarely does that happen in out-of-hospital birth becasue it is difficult to inform a client of risks when the hypothetical midwife believes all birth to be normal. If you are working with a midwife who tells you assessments
are unnecessary, or that what would normally be considered "high risk" is, "just a variation of normal", you would be better served to find a new midwife. A midwife who accurately knows her limitations, and appreciates the role of assessments in preventative care, is one who values safety.
Which Assessments Matter Most and Why?
Please read the following link to learn more about key assessments during preganncy, how they work, and why they are important: The Delicate Relationship Between Assessment and Safety
For Further Reading...