Professor Mark Baker, NICE's clinical director, indicates he is puzzled by the increase in medical interventions in health settings. However, social research on midwifery practice provides a clear explanation for the apparent paradox that while normal childbirth is highly valued and associated with good outcomes in the UK, there has been a relentless expansion of the hospitalisation and medicalisation of childbirth associated with increased complications with caesarean sections, forceps and ventous deliveries.
Mandie Scamell in her study of midwifery practice shows midwives aspire to provide normal deliveries, but in reality their awareness of the ever present possibility of harmful outcomes (and the blame they would receive if they occurred) means that a birth can only be classified as normal once the baby has been safely delivered and both mother and baby are well. Thus hospital practices tend to create an environment in which all births are categorised as risky, and there needs to be an ever present vigilance and willingness to intervene. In this context imagined futures in which things go wrong are a reality and dominate decision making.
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