ABSTRACT
Not unreasonably, the lay public regard childbirth as a normal event and assume that it will result in a happy, healthy mother holding a happy, healthy baby. Broadly, this is true, but, even today, one in 10,000 mothers will not survive pregnancy and delivery, and seven in every 1,000 babies will be stillborn or die soon after birth. There is also a perfectly reasonable lay assumption that significant risk factors will be detected in advance and alternative management will be adopted, leading to a better outcome. One major problem is the definition of the word ‘significant’. In a recent study of unselected women, the average perception was that a caesarean section would be carried out when the risk of avoidable stillbirth became greater than one in 4,000. For pregnant women, this threshold was far lower at one in 20,000. Most epidemiological studies indicate that the risk of a healthy term baby dying during labour is around one in 3,000; if the above statistics are taken logically, it follows that most women would not want their babies put through the risk of labour. In contrast, women who had chosen to be booked for home confinement had a far lower average threshold of one in 100 at which they would wish for intervention.
