Low risk care giving: How does the classification 'low risk' affect primiparous women in the current UK healthcare system? A critical exploration of the literature

Risk is a key concept in relation to maternity care and childbirth worldwide. It is one that is debated by policy makers, healthcare practitioners and researchers worldwide. In the United Kingdom (UK), where childbirth... [ view full abstract ]

Risk is a key concept in relation to maternity care and childbirth worldwide. It is one that is debated by policy makers, healthcare practitioners and researchers worldwide. In the United Kingdom (UK), where childbirth practices have changed exponentially in the last 50 years, birth has become increasingly institutionalised, with technology at the heart of caregiving in almost all birth settings. The biggest change took place between 1960 and 1985 when obstetricians and policy makers campaigned for 100% of births to take place in a hospital setting(Ministry of Health, 1970). The hospital may feel safer for women and within the current system many women fit with the set of rules, and follow the obstetric paradigm to the end goal, the safe passage of the baby, at all costs.

Of course this is not true for all women who are giving birth in the UK today, there are a minority who prefer to choose a birth outside of obstetric management with around 2.4% of women choosing homebirth as reported by the HealthCare Commission (HCC, 2008; National Audit Office, 2013). The latest findings from the Office of National Statistics suggest that the homebirth rate has remained unchanged for the previous 2 years prior to the report publication, yet the still birth rate also remains unchanged at 4.7% which puts into question the efficacy of obstetric medicine(ONS, 2013).The rising popularity of alongside and freestanding midwifery led units in the past five to ten years has empowered many more women to seek a birth experience less entangled in the medical model of care with current rates of birth in an alongside midwifery led unit reported at 5%(HCC, 2008). Virtually all women giving birth in an Freestanding Midwifery or alongside midwifery led unit will have a normal birth, defined by the Maternity Care Working Party in their Normal Birth Consensus Statement 2 by the Royal College of Obstetrics and Gynaecologists as “a birth without induction, regional or general anaesthesia, caesarean, instrumental delivery or episiotomy”(RCOG, 2007).

In this article I will seek to review the literature to explore the impact of the term ‘Low Risk’ on a primiparous woman for her birth place choice and care provision. I will draw on sociocultural concepts of risk and will reflect on the beliefs and assumptions of birth risk which impact on birth place preference. Further analysis will show how medical technology influences known constructs of birth as being ‘safe’ or ‘risky’ changing beliefs of birth for both different medical professionals, women and their families. I will finally seek to deconstruct the term ‘low risk’ and identify if its use is applicable in the current maternity system.