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The midwife in the 'risk' society

Abstract:

Midwifery practice in the current New Zealand context is beset with both challenges and possibilities. As midwives we have achieved our aim of autonomous practice. The new challenges that are faced relate now to managing care in an environment which, to a large extent, remains dominated by a techno-rational model of birth. The vision of providing care which would enhance and protect the normal process has been constrained by societal attitudes still dominated by the notions of modernity: control, technology and individual choice (Beck, 1999). The key concept which reflects this state of being, certainly in the Western world, is that of ‘risk’. Risk plays a dominant role in Western society and impacts on the lives of midwives both in the assessment of risk in the women we care for, and in the management of our own risk within the current medico-legal context. This risk paradigm directly challenges the model of birth as a normal part of human existence and presents challenges for midwives as we attempt to enact in practice this model of normality. Midwives are faced with a significant paradox in attempting to work a ‘birth is normal’ paradigm within a ‘birth is risky’ context. I propose that risk and how it is currently constructed contribute significantly to increasing intervention and escalating medico-legal action. It is a core issue for maternity care in general and midwifery in particular.

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informed choice, risk assessment, risk aversion, risk management, societal attitudes