Safety in birth: the contextual conundrums faced by women in a ‘risk society’, driven by neoliberal policies

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This paper looks at how some women negotiate the complexities of safety and risk through the medical and social discourses around birth. It looks at some of the powerful forces at work that shape these discourses and thus women's decision making. The purpose of this paper was to attempt to understand more deeply the contextual constraints faced by women (and midwives) as they consider the medico/technical moralities of risk and negotiate over-stretched and under-resourced NHS services in Britain, and at the same time protect and nurture their babies and families, emotionally and spiritually as well as physically. I believe that if we can understand more about our experiences as women and midwives in this current context, we might be more able to identify our collective experiences, and work together for the changes we all need. Where there is less understanding, women and midwives are at a disadvantage and cannot easily challenge the drive towards privatisation, which necessarily means increasing profits through greater efficiency, and the concurrent and linked standardisation of ideology and practice. This paper draws on a qualitative study during which I interviewed 30 women four times each from early pregnancy until six to eight months after birth (Edwards 2005), and ongoing work with women planning home and hospital births. The experiences of women planning home births and those whose decisions challenge accepted obstetric ideology, are a rich source of data, and pose particularly searching questions about cultural assumptions from which birth practices derive, and the context in which they are located. I suggest that while women strive to exert (necessarily limited) activity during the childbearing period, due to the impact of current risk society, standardised practices, and a relentless reduction in the welfare state due to neoliberal health care policies, their efforts and those of midwives are severely restricted even in a relatively affluent context.

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