An experienced obstetrician knows when to let pregnancy progress naturally

Declining fertility and rising maternal age are reshaping how pregnancy is managed, prompting changes in both clinical practice and patient expectations. Dr John Smoleniec, director of the feto-maternal unit at Liverpool Hospital, Sydney, talks about the key challenges and evolving practices in maternal-fetal medicine in an interview with with Unnikrishnan S. Edited excerpts:

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What is a high-risk pregnancy? A pregnancy is considered high-risk when there’s an increased chance of complications for the mother or baby.

This can be due to factors like age, twins, IVF, diabetes, or fetal growth issues. But risk is relative — what's high-risk in one population may be normal in another. Good judgment and context matter more than rigid charts.

Population differences also matter. A woman who is small in build, such as many women of Asian descent, may naturally have smaller babies. On international growth charts, these babies might be labeled high-risk due to size, even though they are normal for their population. This highlights the need for careful clinical judgment and customised assessment rather than relying solely on standard charts.

The real challenge is distinguishing genuine risk from statistical outliers. An experienced obstetrician knows when to act and when to let a pregnancy progress naturally. Overuse of technology or misinterpretation by non-experts can lead to unnecessary interventions, creating anxiety and undermining trust.