Word-thought for the day: replacing risk with chance

Risk and chance: which word is less likely to evoke a stress response?

Almost any time we use the word risk in relation to childbirth, we could choose to use the word chance instead. The meaning stays the same but it is no longer cloaked in fear. – Sara Wickham.

This is one of my favourite things to say and share.

I originally posted something on this a few years ago after talking to midwives and medical students about statistics and the language that we use when we talk to women about evidence and decision-making.

I am concerned that, whether by accident or design, the language that is used tends to over-emphasise the potential downsides of certain courses of action (or inaction) in ways that range from unhelpful to downright misleading.

I could say lots more about this, and have discussed it in almost every book that I have written.

But today I want to focus on just the one word: risk.

Because almost any time we use the word risk in relation to childbirth, we could choose to use the word chance instead. The meaning stays the same but it is no longer cloaked in fear.

We also need different ways of saying ‘low risk’ and ‘high risk.’ Those are also inaccurate and misleading terms, and I’ve written more on this in several of my books as well.

The decisions that we make about our pregnancy and childbirth journeys can shape our experiences, health and lives, as well as those of our families. But those decisions can be complex. This book is a guide to the different perspectives and approaches that exist, and it offers tips, tools and ways of thinking which will help you make the decisions that are right for you.

We could say that there are some women who are healthy and have an average chance of having a problem (previously known as ‘low risk’) and other women who may be healthy or may have one or more challenges (though they may still be healthy overall) and who have a slightly elevated chance of a problem. Those women are sometimes referred to as ‘high risk’ but, when we look at the statistics, we often see that the chance of a problem is often only slightly higher in absolute terms. And the overall chance is still very low.

It is common, for instance, for a woman to be told that she has two or four times the risk of having a particular unwanted outcome if she doesn’t agree to an intervention that is being offered. But it’s often the case that, when we look at the statistics that relate to this outcome, we find that even a women with every risk factor still has more than a 99 per cent chance of not having a problem, regardless of whether or not she agrees to the intervention.

So it’s very unhelpful to use relative risk, as we are often dealing with rare events which then end up sounding more common than they really are. And no matter how we categorise or label people (and I have serious concerns about doing both), problems are never inevitable. In the vast majority of situations, things will go well. More on that here.

The problem is that many people don’t have the time, will, energy and/or understanding to say all of that and explain the nuances.

It’s great that some things can be expressed in a picture and a sentence or two.

But so many things can’t, and we have to account for those too.

If you’re bothered by the way in which the notion of risk is used in maternity care, and would like to read about a different viewpoint, or find a resource to recommend to clients, then have a look at my book, What’s Right For Me? Making decisions in pregnancy and childbirth.

It was written specifically to help women and families to find their way through the information maze and work out which is the right path for them. You can find out more about it here.