Risk assessment as routine: A conversation analysis of midwives' risk surveillance practices in midwife-led care during labour.

Abstract

This study examines how risk surveillance and management are interactionally accomplished in midwife-led intrapartum care. Using conversation analysis, the paper explores how midwives initiate risk assessment activities, announce outcomes, and navigate cases where potential risks are detected. The data were 37 audio/video-recorded interactions between midwives and labouring women in two UK midwife-led units. Conversation analytic methods were used to identify recurrent interactional practices. All data are British English. Midwives routinely construct risk surveillance as a taken-for-granted aspect of care through practices including presumptive scheduling and pronouncing initiation of activities. When no issues are detected, midwives might either treat outcomes as unremarkable by not announcing them or employ closing-implicative positive assessments. Announcements of deviations from the norm are typically delayed, delicately delivered and lead to recommendations for further investigations or interventions. Midwives treat risk surveillance as a routine institutional requirement while working to minimise its disruption to labouring people. Risk surveillance comprises a significant portion of midwife-led care and midwives navigate potentially conflicting demands between enacting their duty to conduct risk assessments while upholding midwifery philosophy of care. Consideration should be given to women's limited optionality in engaging in risk assessments and conversation analytic insights can inform relevant training.