Risk, safety, fear and trust in childbirth

Despite the international recognition that the concept of risk, and its minimization through active management, has come to dominate almost every aspect of childbirth across the world (Bryers and Teijlingen, 2010; Smith, Devane and Murphy-Lawless, 2012; Maclean, 2014; Skinner and Maude, 2016), practitioners working in maternity services, who are those managing perinatal risk on a daily basis, tend to assume that a mutually shared techno-rational understanding to risk prevails across the multidisciplinary maternity care team (Skinner, 2008). In this chapter this tendency will be subjected to critical scrutiny, the links between risk and birth practices will be explored, and an opportunity for trust and practice development will be introduced. The chapter will explore three interlinked propositions: the first is that the operations of the techno-rational approach to risk are not as self-evident as they appear, and that they do not necessarily coincide with an evidence-based approach to care. The second is that the contemporary understanding of risks in maternity care is intrinsically linked to increasing application of technology. The third proposition explored in this chapter is that critical evaluation and analysis of how risk operates in maternity care provides a unique opportunity for hope where birth can be reframed as a trustworthy physiological process worthy of protection.