An exploration of midwives’ and obstetricians’ perceptions of risk in relation to care practices for low risk women and normal childbirth

This thesis explores how midwives’ and obstetricians’ perceptions of risk affect care practices for low-risk women and normal childbirth. Four academic papers are incorporated into the thesis. The research aims to provide an understanding of how perceptions of risk may contribute to intervention during birth. Areas investigated include factors that contribute to midwives and obstetricians feeling safe or unsafe when facilitating birth, their trust in physiological birth and their attitudes towards the importance of achieving normal birth A systematic integrative review was undertaken (Paper 1), synthesising data from 13 studies, identified on the basis of a pre-determined search strategy. This review highlighted an assumption of abnormality in the birthing process. Following this, a discussion paper (Paper 2) was published that presented an over-view of the current structures and processes of maternity care, incorporating preliminary results from the primary qualitative study into the discussion. The primary qualitative study (Papers 3 and 4) involved analysing data gathered from semi-structured interviews with 16 midwives and nine obstetricians recruited from hospitals, midwifery-led units and the community. The findings highlight that in the current climate of risk management and intense surveillance of birth, midwives’ professional identity as promoters and protectors of normal birth is in jeopardy. Fear of litigation and implication in adverse outcomes and an increased focus on risk management duties are contributing factors. Apparent is that outcomes, particularly infant and maternal mortality rates, take precedent over compassionate, holistic care where the former are the quality markers currently used to assess maternity care. This thesis concludes that midwifery must become more pro-active in supporting physiological birth. There must be a refocus on how maternity care is organised and reflection on the hierarchy of outcomes if services are to become more woman-centred. Implications of the findings of this thesis on maternity practice and policy are discussed in the final chapter.