UK Maternity Services 'Risk Culture' : Is the Professional Status of Midwives 'At Risk' ?

UK maternity services, accounting for a significant proportion of National Health Service litigation claims, are increasingly regulated by ‘risk management’ standards. Such standards, aimed at improving the safety of maternity care and reducing litigation, inevitably associate childbirth with risk, and the control of professional behaviour in managing such risk. The growth of this ‘risk culture’ within maternity services poses significant threat to professional status claims.

This paper presents findings of a Doctoral ethnographic study observing the real time impact of the ‘risk culture’ within an English National Health Service maternity department. Litigation and subsequent increasing regulation has fuelled the social construction of a ‘risk discourse’ surrounding maternity care. Aligned with the assertion that modern society has become increasingly risk averse (Beck, 1992), professional anxiety regarding risk has provoked socialisation amongst doctors and midwives that control over the childbirth process promotes risk minimisation. The stereotypical medical interpretation of risk, based upon fear of uncertainty and pathophysiology, has consequently permeated all aspects of pregnancy and childbirth. This in turn has led to the subscription of the ‘biomedical model’ as the prominent paradigm in managing maternity care, fuelling control, intervention and the ‘medicalisation’ of childbirth. Such ‘medicalisation’ has cemented doctor-led, intervention-laden management firmly within modern childbirth, with midwifery-led, naturalistic childbirth becoming an ever-decreasing occurrence. A professional identity crisis has ensued amongst midwives in that the role of the midwife in the 21^st century is in a state of flux, raising concerns for the professional status of midwives within future childbirth provision.

 The ‘risk culture’ in the UK has provoked significant inequalities between the professional status’ of doctors and midwives within modern maternity care. The role of midwives as autonomous practitioners in normal childbirth is eroding, therefore is the ‘risk culture’ in the UK placing the midwifery profession ‘at risk’ of deprofessionalisation?