Description
AbstractIn the UK, midwife-led care is available for low-risk pregnant individuals expected to have a ‘normal’ delivery at full term. Despite midwives’ emphasis on the physiological normality of labour, national guidelines mandate continuous risk surveillance throughout the intrapartum period. NICE Guidelines, for example, require frequent monitoring of fetal heart rate, maternal pulse, blood pressure, and temperature. Despite the low-risk context, this paper explores the situated accomplishment of risk surveillance in interactions between labouring women and midwives using conversation analysis.
The study, based on 37 recorded interactions in two UK midwife-led care units from 2018 to 2019, reveals two ways in which risk surveillance is interactionally routinised. Firstly, midwives implicitly refer to NICE guidelines, incorporating them into routine care. For instance, a midwife might say, "I've got to be listening to the baby about every 15 minutes." Secondly, midwives frequently use presumptive formats to initiate surveillance activities, such as stating, "I need to do your pulse."
These activities are presented as taken-for-granted, and as not requiring explicit verbal agreement, although this is commonly forthcoming. Positive assessments may be used to indicate no risk has been detected. However, when risk is detected, it is not generally immediately disclosed and may first lead to rechecking (e.g., following a monitoring, a second midwife says ‘((Midwife’s)) just asked me to count these heart beats…’). The disclosure of risk detection is handled delicately (e.g., Baby’s heartrate’s a little lower than: when you came in…’). This information prompts risk management planning, involving increased observation frequency or changes in assessment methods. In some cases, transfer to obstetric-led care may be recommended.
The study concludes that the seemingly low-risk nature of midwife-led care is contingent on ongoing risk surveillance. Risk surveillance is interactionally produced as both required and routine. Risk detection implicates increased surveillance and/or transfer to obstetric care.
| Period | 1 Jul 2024 → 3 Jul 2024 |
|---|---|
| Held at | Conversation Analysis and Clinical Encounters, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdo |
| Degree of Recognition | International |