Methods: We conducted a secondary analysis of 145 transcribed initial prenatal care visits in order to quantify and contextualize discussions of risk during prenatal assessments. Two investigators (BTE, FM) independently applied open codes to all instances where providers mentioned the word “risk”, identifying the context and content of the conversation. Codes were then organized and collapsed into thematic categories. NVivo 10 facilitated qualitative analysis.
Results: Obstetric providers mentioned the word “risk” 510 times in 110 of the 145 audio-recorded visits (mean = 4.8 times/visit; range = 1-17). Providers primarily discussed risk in the context of fetal chromosomal abnormalities (e.g. Down Syndrome). Risk was also readily discussed in regards to patients’ obstetrical and social histories (e.g. prior preterm delivery, gestational diabetes, depression, smoking or substance abuse). Messages about risk were more often framed in regards to risk to the fetus, with less attention to potential risks to the mother. Maternal risks were usually discussed in the context of three overarching categories: medical risks, obstetrical risks, and social or behavioral risk. Numerical descriptions of risk were utilized often. Final analyses will identify the relative frequency and salience of risk categorizations.
Conclusion: Reports of underutilization of prenatal care among ‘high-risk’ patients may reflect an incongruency in patients’ risk perceptions and providers’ risk assessments. We found that obstetric providers primarily talk to patients about risk in the context of genetic and inherited disorders. It is possible that because this constitutes theoretical risk rather than personal risk, this diminishes the sense in a patient that she indeed is a ‘high-risk’ patient. Furthermore, providers tended to discuss risks that can be modified through behavior change or medical intervention (e.g. smoking cessation or genetic testing). Providers may be more inclined to discuss risk factors that can be addressed by a clear course of action; while failing to convey other important risk-factors or concerns to patients. This study is a first step in understanding the nature of prenatal risk-communication and physician disclosure about pregnancy-related risks. Further research is needed to assess the effectiveness of providers’ risk-communication by exploring patients’ risk perceptions in relation to risk assessments provided during prenatal consultations.