Childbirth within the risk society. Exploring midwives’ understanding of risk in childbirth and its influence on decision-making and practice

Abstract

This qualitative study explores how midwives working in a labour ward setting make sense of risk in childbirth and how their perception of risk influenced their practice and decision-making. Despite being aware that childbirth has never been safer in high-income developed countries, childbirth is currently being managed in a climate which views all childbirth as risky with possible catastrophic events waiting to happen. Risk discourse has permeated the heart and soul of midwifery practice. In light of the modern preoccupation with risk and its negative connotations, along with the blame culture which has pervaded maternity care, it is worth investigating midwives’ understanding of risk in childbirth and to what extent midwives can promote a ‘birth is normal’ mindset whilst working in an environment which sees birth as inherently risky. A qualitative research method was used to gather data from seven participants using in depth semi-structured interviews. Whilst all participants brought different subjective interpretations of their experiences, all seven midwives shared similar concerns and views in their responses. Findings show that all midwives conceived as childbirth as an event which poses several risks which midwives have to be on the lookout for and necessitate the regular and meticulous monitoring of mothers to confirm that all was within the normal parameters of how labour should progress. In this study, although acknowledging the unpredictable nature of birth, midwives did not look at childbirth as only normal in retrospect but tried to highlight the normality of birth. Practising in a culture of risk augmentation led midwives to perform unnecessary monitoring and interventions to ensure that neither the mother nor the baby was at risk. This issue was further compounded by the increasing litigious culture and midwives’ fear of being held accountable for adverse outcomes, leading to a ‘just in case’ way of practising. Moreover, the study found that the excessive power and involvement of the medical profession even in the care of low-risk women was having an impact on the midwifery profession and the way midwives cared for women. Midwives were not fully allowed to practise the way they think is best for the mother as they had to comply with doctors’ overweening impositions and outdated protocols which focus on risk aversion. Overall the current obstetric-driven belief that birth is risky and needs to be managed to avoid adverse outcomes vis-à-vis the belief that birth is a safe physiological process has had far reaching effects both on birthing women and the midwifery profession.