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% 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 born injured. 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. Although 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.