Risks, Values, and Decision Making Surrounding Pregnancy

Abstract

Assessing, communicating, and managing risk are among the most challenging tasks in the practice of medicine and are particularly difficult in the context of pregnancy. We analyze common scenarios in medical decision making around pregnancy, from reproductive health policy and clinical care to research protections. We describe three tendencies in these scenarios: 1) to consider the probabilities of undesirable outcomes alone, in isolation from women's values and social contexts, as determinative of individual clinical decisions and health policy; 2) to regard any risk to the fetus, including incremental risks that would in other contexts be regarded as acceptable, as trumping considerations that may be substantially more important to the wellbeing of the pregnant woman; and 3) to focus on the risks associated with undertaking medical interventions during pregnancy to the exclusion of demonstrable risks to both woman and fetus of failing to intervene. These tendencies in the perception, communication, and management of risk can lead to care that is neither evidence-based nor patient-centered, often to the detriment of both women and infants.

A metasynthesis of risk perception in women with high risk pregnancies

“…Women are more likely to contextualise the risks within their life circumstances, whereas doctors may view them as isolated medical issues (Lyerly et al 2007). Thus women may adapt their treatment so that it is manageable within their situation.…”

Risk perception of women during high risk pregnancy: A systematic review

“…Women are more likely to contextualise the risks within their life circumstances, doctors to view them as isolated medical issues (Lyerly, Mitchell et al 2007). Decisions viewed outside their context are more likely to seem irrational to professionals (Lupton 1999).…”

Untitled

“…The highest agreement rate was reported among those counseled by obstetrician with 2-4 years of experience (83.3%). Counseling in outpatient department was more effective in resulting in women`s agreement compared to counseling in inpatient department (63.3% versus 27.3%), p=0.001 [10][11][12][13][14][15]. In the first counseling session, the highest success rate was reported by women in the age group 26-35 years (69.4 %), p=0.002.…”