Consent and understanding the difference between relative and absolute risk

Consent

Before proceeding with any course of action relating to your care during pregnancy and in labour healthcare providers must obtain your consent. Sometimes the way in which recommendations can be presented to you it is not always clear that you have a choice, but you absolutely do! In fact the NICE Guidelines actually recommend healthcare providers encourage you to ask questions and ensure you fully understand the options available to you. The below bullet points are taken directly from the NICE Guidelines for intrapartum care:

·       Encourage the woman to ask questions

·       If possible, give her time to think about the options and

·       Help her make a supported decision.

·       Obtain consent before carrying out the chosen care option or intervention.

You should have full confidence when asking questions about any recommendations made to you and far from being a surprise to healthcare providers this should be something they not only expect, but also encourage. It is your right to make informed decisions regarding your care.

Informed Decision Making

In this process, there are no right or wrong answers; it's about having the necessary information and evidence to make informed decisions, ensuring a positive reflection on your experience as you confidently affirm the choices made were right for you and your baby. You will have a sense of control in the decision making process, along with a clear understanding why certain precautions or interventions took place to benefit the health of both you and your baby.

Being fully informed ensures that a birth which does not follow your ideal preferences can still be a positive experience, as you will feel confident that what took place was the best course of action on the day and you were in a position of calm control. When we are uncertain about why interventions or precautions took place or question if they were truly necessary this can lead to a negative and more stressful experience of birth and you can be left feeling that birth is something that happened to you. Unless there is an urgent medical need you should always be given the time and opportunity to discuss and consider your options.

Risks: Understanding the difference between Relative and Absolute Risk

The primary motivation behind many recommendations is to mitigate or minimize risks. It is essential that you understand whether the risks are being presented to you in a relative or absolute context. This is because risks can sound far more alarming when presented relatively compared with the absolute risk.

An example would be when your waters break before going into labour at term:

The risk of serious neonatal infection is 1% Vs 0.5% when membranes are still intact and that this could increase over time.

What you could hear in this situation is:

·       The risk of serious neonatal infection has doubled, or gone up by 100%, this represents a relative risk.

·       However the absolute risk of serious neonatal infection is 1%

The absolute risk sounds far less alarming and could therefore, significantly impact the way in which you respond to that situation.

This underscores the importance of receiving information about risk in terms of absolute risk and understanding the distinction between absolute and relative risk. It empowers you to make informed decisions during pregnancy and labour, ensuring a more positive and less stressful birthing experience. This knowledge allows you to have confidence in the choices made and maintains a sense of control, ultimately shaping a more favourable birth story.

Conclusion

Being clear that you do have a choice and understanding the differences in the way that risks can be presented to you should empower you to ask questions and enhance your confidence in your decision making.

As part of my hypnobirthing courses I talk in detail about communicating confidently with care provider, the right questions to ask and the importance of informed decision making. If you would like to understand more on this topic please contact me and enrol in one of my courses.