The risks of childbirth in historical perspective

This research network combines the disciplinary approaches of historians and midwives to investigate the concept of childbirth "risk" from a historical perspective.

The concept of risk stands at the heart of childbirth-management in Britain today, and seems to provide a suitably objective measure to guide practice and policy; yet the hegemony of that concept is open to challenge on a number of grounds. It is relatively novel historically, and post-dates most of the great advances in the technical management of birth; its theoretical meaning is problematical, as has been widely discussed in the social sciences; and in practical terms its application has led to paradoxes, such as the concentration of normal births in obstetric units designed to deal with difficult cases.

The project will bring a fresh perspective on this issue by approaching it historically. Conversely, it will enrich the discipline of history by bringing the theme of risk into focus in the specific context of childbirth. The history of childbirth has flourished in Britain for some time (the PI and co-I are leading contributors to this field), but until now, risk has played at the most a walk-on part in studies of this theme. So too historians in general have been slow to take up the interest in risk that has been underway for a generation and more in the social sciences, through the work of such scholars as Mary Douglas, Ulrich Beck and Anthony Giddens. Addressing risk in the history of childbirth will help to open the historical discipline at large to risk as a topic.

The core activities of the network will be three themed workshops, followed by a concluding workshop to plan publications arising from the themed workshops.

The outcomes of the project will comprise a cross-disciplinary network; theme issues of two academic journals, one in midwifery or healthcare studies and the other in history; a mobile exhibition on childbirth structured around the theme of risk; a series of 30 videos of historical "birth stories"; and the groundwork for further, and wider, cross-disciplinary collaboration.

The first workshop (Brighton) will consider definitions, perceptions and conceptions of risk, focusing particularly on the historical development of the concept of risk and on the ways that risk is perceived, and conceived, by different constituencies.

The second meeting (Leeds) will focus on representations of risk, systematically analysing different styles (e.g. epidemiological statistics versus individual stories), forms (such as visual versus verbal) and settings (including technical literature, the internet, the mass media, and museum displays).

The third workshop (London) will be devoted to the significance of risk for each of the main relevant constituencies: mothers, fathers, midwives, doctors, health-care planners, policy-makers, and media commentators.

The final meeting (Leeds) will be restricted to the steering committee and advisory board, and will be devoted to hammering out the shape of the two themed journal-issues. A key priority will be to maintain the cross-disciplinary perspective of the network within the (necessarily) discipline-specific formats of the two outputs.

Engagement will continue after the project through two channels, with the possibility of a third. (a) A mobile exhibition, to be created in the Thackray Museum (project partner) and with the use of their collections, will be toured for display in other museums around the country. (b) Short (3-5 minutes) videos of historical "birth stories", each discussed by a midwife and a historian in such a way as to illuminate risk, will be made publicly available. In addition (c) participant Gemma Newby will make a pitch to Radio 4 for a 30-minute documentary, informed by the network, on the history and significance of childbirth risk.

There are five groups of beneficiaries:
[1] Childbirth practitioners: Midwifery is not just an academic discipline but also a practical one, and a better understanding of risk will benefit all practitioners, not least because risk is perceived in different ways by the woman, by clinicians and by health services managers. Both midwives and obstetricians are pulled between the mantra of "choice in childbirth" and practice "guidelines" which tend to be interpreted as firm rules and thereby to militate against such choice. Thus "risk" works against choice, and since this tension is at the heart of practical midwifery and obstetrics, illuminating risk has considerable potential benefits for both professions. The obstetricians and midwives in the workshops will enable us to reach both these groups.

[2] The general public, particularly expectant parents: Benefits to practitioners (above) flow on to parents, but parents will also benefit directly. Risk in general is poorly understood by the public, and childbirth risk particularly so; expectant parents are bombarded with conflicting messages, pertaining to "natural" childbirth and to the "dangers" of childbirth. An informed understanding of risk will empower mothers- and fathers-to-be to balance these conflicting considerations. As is explained in "Pathways to Impact", we will reach expectant parents in various ways, particularly through short videos of historical "birth stories" interpreted to illuminate risk.

[3] Maternity services planners and administrators: A clearer understanding of risk and its complexities will be highly beneficial to those planning and running the delivery of maternity services, in view of the practical importance of risk and its ambiguities. Services are allocated on a risk basis, but the economics are undermined by patient choice, since even patients who are designated as "low-risk" tend to choose consultant-led units, leading to pressure to close down the (cheaper and possibly safer) midwife-led units - e.g. at Northallerton, North Yorkshire. Thus the balance between risk and risk-perception, which will be a motif of the network, has considerable implications for those who allocate maternity resources, and our profile of participants will enable us to reach this audience.

[4] Museums: The Thackray Museum (project partner) will benefit considerably from the project, as will the many other museums whose remit extends to midwifery and childbirth. Because risk is the central concept in the culture of childbirth-management, there is a strong public need to understand it, yet it is a difficult concept to grasp. Thus museums concerned with childbirth have a need, indeed a responsibility, to engage with risk, yet risk is also not easy to display in a museum setting, because it is an abstraction and a subtle one at that. The PI and Dr Laura King, together with the Thackray Museum, explored these issues in a University-of-Leeds-funded pilot project in 2014. The key finding was that parents-to-be are keen to find out more about childbirth risk and believe that museums can and should help them to do so: they are not squeamish but rather are hungry for information. The mobile exhibition that the network is to produce will be the first attempt (so far as we are aware) to organize a childbirth display around the theme of risk, and will thus be an exemplar to museums at large.

[5] The media: It falls to the mass media to mediate between the technical discourse of risk and the perceptions of the public. Rather than merely criticizing the media for superficiality, sensationalism and so on, the network will seek to engage constructively with journalists and to help them carry out their task responsibly. Participants therefore include both a historian of the media (Adrian Bingham) and a radio producer with extensive Radio 4 experience (Gemma Newby).