Although it is the patient who must consent to medical intervention, it is the
physician who must provide the information necessary to make the decisions.
Risk-benefit analysis in obstetrics is complicated because there are two
patients and many social factors involved. The starting point for risk analysis
in pregnancy is the risks of pregnancy itself. A woman must be warned that
women die in childbirth, that 6 percent of children have some congenital
abnormality, that things may happen in her pregnancy that will adversely affect
the baby, and that some babies are inadvertently injured during birth. The
woman must be warned about geographic risks such as high altitude and the
limitation of local birth and emergency facilities.
The purpose of this background information is to establish the baseline risks
of pregnancy. Understanding these risks is necessary to understanding the risks
and benefits of various medical interventions. This is especially important for
women who have been exposed to misinformation about the birth process. Some
women believe that modern medicine is a conspiracy to subjugate women. While
obstetric care could be made much more responsive to the needs of pregnant
women, dispensing with medical attendance is not a proper response to this
problem.
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