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In Britain, there has been an increased emphasis on the use of risk assessments in mental health services over the past 20 years. Mentally disordered offenders subject to Section 41 of the Mental Health Act 1983 (England and Wales) are defined as posing a serious risk of harm to others. They are thus dealt with by forensic mental health services, which are often seen as specialists in risk assessments. This paper is based on original research in three mental health trusts in the South of England which was carried out between March 2009 and September 2011. The paper examines mentally disordered offenders’ awareness and attitude to formal risk assessments in relation to theories of governmentality. Service users subject to Section 41 of the Mental Health Act 1983 were aware that their level of risk was being assessed by professionals caring for them but were commonly unaware of the content of these assessments. These risk assessments were viewed by participants as a means through which professionals measured and monitored behaviour. Although participants often referred to levels of risk, they did not view risk screening schedules as objective, but rather emphasised the need to persuade staff that their risk had reduced. Despite showing a limited awareness of the content of these risk assessments, participants generally identified more risks, in relation to their vulnerability, than did the professional assessments. However, participants generally identified fewer risks in relation to the dangers they posed to others than did professional staff. [ABSTRACT FROM PUBLISHER]

In this paper, we examine discourse in public deliberations in pre-development locales in the UK and US about advantages and disadvantages of future shale development ('fracking'). We aimed to understand how people anticipate potential health effects, broadly construed, of environmental toxicity and disturbance in the context of planned, but not yet implemented, energy development. In day-long deliberations with small, diverse groups in two cities in each country (London, Cardiff in the UK; Los Angeles, Santa Barbara in the US), participants discussed impacts on health and well-being using three main rubrics: 'It's money or health', 'Why take chances?' and 'Beyond the tipping point'. Throughout, participants framed health as an intrinsically moral issue, with collective responsibility as a dominant normative frame. We identify the concept of compound risk to underscore effects of multiple risks and hazards on people's sensibilities about anticipated future health and environmental harm. The findings demonstrate how and why diverse publics in pre-impact sites in both countries saw shale extraction as high stakes development that poses significant, often unacceptable, risks to human and environmental health and well-being. Risks extended beyond toxicity to broad threats to health, including, for some, the end of life as we know it on the planet. Overall, participants' discussions of health were more connected to social categories and their underlying moral principles than to technological details. This work contributes evidence of blurred boundaries between environment and health as well as the importance people place on social risks in the context of proposed energy system change. [ABSTRACT FROM AUTHOR]

This paper explores the contribution of script theory to understandings of animal health risks. Script theory has long played an important role in studies of health and risk, yet the application of script theories is often vague and confused. Theories from different ontological perspectives are conflated resulting in an overly cognitive and asocial understanding of health behaviour with the potential to misinform health promotion strategies. The paper addresses these problems by applying the concept of script formulations to an analysis of farmers' understandings of bovine tuberculosis in farmed cattle. Drawing on interviews with 61 farmers in England and Wales, the paper argues that farmers reveal animal disease to be a scripted event, but that these scripts also order identity and provide a form of moral accountability for farmers' behaviour. This has implications for attempts to communicate animal disease risks and suggests that a more productive approach is to reorganise governance structures and relationships between farmers and government. [ABSTRACT FROM AUTHOR]

In this paper, we examine why risk-based policy instruments have failed to improve the proportionality, effectiveness, and legitimacy of healthcare quality regulation in the National Health Service (NHS) in England. Rather than trying to prevent all possible harms, risk-based approaches promise to rationalise and manage the inevitable limits of what regulation can hope to achieve by focusing regulatory standard-setting and enforcement activity on the highest priority risks, as determined through formal assessments of their probability and consequences. As such, risk-based approaches have been enthusiastically adopted by healthcare quality regulators over the last decade. However, by drawing on historical policy analysis and in-depth interviews with 15 high-level UK informants in 2013–2015, we identify a series of practical problems in using risk-based policy instruments for defining, assessing, and ensuring compliance with healthcare quality standards. Based on our analysis, we go on to consider why, despite a succession of failures, healthcare regulators remain committed to developing and using risk-based approaches. We conclude by identifying several preconditions for successful risk-based regulation: goals must be clear and trade-offs between them amenable to agreement; regulators must be able to reliably assess the probability and consequences of adverse outcomes; regulators must have a range of enforcement tools that can be deployed in proportion to risk; and there must be political tolerance for adverse outcomes. [ABSTRACT FROM PUBLISHER]

This article considers how the concept of risk has been variously defined and deployed within research and UK social policy since the 1980s. The article does not present an in-depth historical narrative, but rather presents key trends over this period. The article begins with a short review of policy and risk rationalities from the 1980s onwards with a specific focus on the research ‘discovery’ of the ‘rationality mistake’ by the early 1990s. A short case study from the author’s own research is then presented to illustrate the ‘rationality mistake’ in a particular arena of UK government policy on the management of sexual offenders. The paper concludes by briefly considering actual and potential developments in risk research and relevant recent theorising, and finally the likelihood of social policy understanding the risk subject more fully. [ABSTRACT FROM AUTHOR]

This paper illustrates negotiations around risk between lay people and clinicians in relation to gastrostomy interventions for disabled children. These negotiations centre on differing interpretations of what constitutes risk in relation to the safety of oral feeding and a child's need for a feeding tube between parents, carers and clinical specialties. Drawing on Heyman's distinction between risk managers and risk owners, we show that not only do clinicians act as risk managers and parents and carers as risk owners, but that these distinctions often become blurred either because of the shifting dynamics of relations of care or because of the specificity of clinical practice. Parents become risk managers in relation to carers' roles, while clinicians become risk owners in relation to particular procedures which define their practice. This has implications for lay and expert interactions as well as professional accountability for those caring for children with complex medical conditions. Although not an empirical article, we draw on empirical work in the UK. We analyse both parental and professional constructions of risk based on observations of co-ordinating a clinical trial designed to evaluate the effectiveness of gastrostomy surgery. We also examine the diverse value systems used by different groups of professionals and lay carers which inform judgements about risk and feeding. We conclude by arguing that issues of risk in contemporary health care are not just examples of ‘manufactured uncertainty’ or of ‘negotiated power’ but constitute a dialectical relationship which breaks down the essentialist dualism of lay and professional constructions of risk. [ABSTRACT FROM PUBLISHER]

Medical accounts mostly frame non-suicidal self-hurting as an adverse event, the frequency of which has supposedly increased to a current ‘epidemic’ level, and which can be predicted probabilistically in terms of risk factors. This set of presuppositions gives rise to the common stigmatisation of those who present to Accident and Emergency services as a result of self-hurting. It is now being challenged in a small but growing body of social science literature which emphasises the diversity of self-hurting, and its range of socially situated meanings for those who self-hurt, family and health professionals. The present paper contributes to this research strand by discussing the accounts of their self-hurting given by a sample of 25 UK adults who had not been in contact with health or other services for this reason. The analysis focused on three value issues: the positive gains which motivated research participants to self-hurt; their own active efforts to mitigate associated risks; and the longer-term downsides which some respondents identified. [ABSTRACT FROM PUBLISHER]

This paper explores the role of value judgements in personal risk management through an in-depth case study involving a woman's treatment for anal cancer. Julia (pseudonym) agreed to have her pre-treatment medical consultation recorded, and participated in two subsequent interviews. Delving into a single case makes it possible to understand why an individual makes decisions in relation to the overall nexus of risks and benefits which they identify even though their choices may seem irrational to others. According to the colorectal nurse research interviewer, Julia ‘risked exploding’ as a result of ‘absconding’ (Julia's term) from hospital in order to have sex shortly after undergoing surgery. Although not to be interpreted literally, the above phrase encapsulates Julia’s risk blindness from a clinical perspective. The article will address the question of how one person came to put herself at unnecessary risk. The question will be considered in relation to non-communication about the interconnected web of issues which troubled Julia, including cosmology, mortality, being left with an unclean, leaky body, loss of economic viability and harm to family members and to close relationships. This analytical framework complements the more usual one in which attitudes towards a particular risk object are compared across cases. The article makes a contribution, within the limits of a single case study, to advancing knowledge about the neglected topic of individual risk consciousness. It will be argued that, in the absence of such analysis, personal decision-making about risks cannot be fully understood, appropriate advice given or sensitive policies developed. [ABSTRACT FROM PUBLISHER]

This article draws on data collected from a qualitative study designed to assess the effectiveness of an early intervention programme aimed to raise awareness of Child Sexual Exploitation (CSE) among young people. The programme was implemented by a large police force area, referred to as Shireland. Drawing on semi-structured interviews with practitioners implementing safeguarding policies within the police service, youth and social welfare work designed to support young people, we focus on the mobilisation of perceptions of risk and vulnerability as they translate in professional practice via a specific preventative initiative. More specifically, we wish to examine the extent to which blurring occurs between constructions of 'risk' and 'vulnerability' in relation to practitioners' understandings of the dangerousness of young people's behaviour. In our analysis, we draw attention to a palpable tension apparent in the interview narratives of those involved in delivering the programme, between expressed understandings which on the one hand universalise vulnerability and, on the other, extricate specific risk factors. [ABSTRACT FROM AUTHOR]

When making decisions about whether to transfer residents to hospital, care home staff consider the possible benefits and risks of different courses of action. However, to date, an in-depth and theoretically informed engagement with these decision-making processes and their associated behaviours has been lacking. We conducted an ethnographic study of care home staff's decision-making about resident hospital transfers in England between May 2018 and November 2019. We combined staff interviews at six care home sites, with 30 members of staff, with 113 hours of ethnographic observation at three care homes sites. 'Risk' and risk management emerged as important overarching themes. In this article we conceptualise staff decision-making about potential hospital transfers for residents as a form of risk work. In doing so, we identify the different forms of risk knowledge that staff used to conceptualise risk and explore the ways staff navigated tensions between different forms of risk knowledge. We highlight the ways individual understandings of risk were influenced by social interactions with others, both at an interpersonal and organisational level, before identifying strategies that staff use to manage risk. By understanding transfer decisions explicitly in terms of the different forms of risk that care home staff manage, our analysis provides new insights into hospital transfers from care homes and contributes to the wider literature around risk work, demonstrating the utility of this concept in researching organisations that fall under the umbrella of social care, which have been previously neglected in academic research. [ABSTRACT FROM AUTHOR]

Drawing upon data collected within 20 focus groups with consumers from five European countries, in this article we investigate how perceptions of human health risk and current anxieties regarding agricultural food production affect citizens' acceptance of the use of an emerging biotechnology, synthetic biology, in the development of vaccines for animals bred for food production. In focus group discussions in Austria, the UK, Poland and Denmark, participants tended to value the positive potential of synthetic vaccines if they could solve existing problems. Participants argued that the technology could be beneficial for animal welfare and was a potential solution to the problem of risks to human health posed by the use of antibiotics on livestock. The perceived drawbacks of antibiotic use affected the discussions towards acceptance of synthetic biology and the use of vaccines in meat production despite concerns over the potential risks. The participants from Spain stood out in that their acceptance of the synthetic vaccine appeared to be disconnected from concerns about risks related to the use of antibiotics. Participants from all countries found the vaccine to have potential uses, but also expressed concerns about health risks for consumers. In general consumers were perceived as those bearing the heaviest burden of risk, while pharmaceutical companies were perceived as likely to benefit most from production of the vaccine. We found that institutional trust and national contexts of (dis)engagement with science influenced the participants' understandings of the degree to which the synthetic livestock vaccine had a fair risk-benefit balance. [ABSTRACT FROM AUTHOR]

The use of HIV Treatment as Prevention (TasP) has radically changed our understandings of HIV risk and revolutionised global HIV prevention policy to focus on the use of pharmaceuticals. Yet, there has been little engagement with the very people expected to comply with a daily pharmaceutical regime. We employ the concept of HIV citizenship to explore responses by people living with HIV in the UK to TasP. We consider how a treatment-based public health strategy has the potential to reshape identities, self-governance and forms of citizenship, domains which play a critical role not only in compliance with new TasP policies, but in how HIV prevention, serodiscordant relationships and (sexual) health are negotiated and enacted. Our findings disrupt the biomedical narrative which claims an end to HIV through scaling up access to treatment. Responses to TasP were framed through shifting negotiations of identity, linked to biomarkers, cure and managing treatment. Toxicity of drugs – and bodies – were seen as something to manage and linked to the shifting possibilities in serodiscordant environments. Finally, a sense of being healthy and responsible, including appropriate use of resources, meant conflicting relationships with if and when to start treatment. Our research highlights how HIV citizenship in the TasP era is negotiated and influenced by intersectional experiences of community, health systems, illness and treatment. Our findings show that the complexities of HIV citizenship and ongoing inequalities, and their biopolitical implications, will intimately shape the implementation and sustainability of TasP. [ABSTRACT FROM AUTHOR]

Many long-term care systems are seeking to address problems of growing demand, increasing expense, and higher user expectations. For many of them fostering care at home and private care arrangements are attractive options. The long-term care sector in England is typical of these systems. Over the last 2 decades, government policy in England has placed stronger emphasis on people’s choice and control when receiving care services. People with care and support needs may be eligible for public funds to employ care workers or to use them in other ways promote their well-being. These financial transactions are a major part of the policy of personalisation in adult social care, as confirmed by the Care Act 2014. Drawing on findings from life story interviews with 31 migrant care workers who had worked for disabled or older people in England, conducted 2011–2013, we note the potential for expanding the sociologically inspired concept ‘personalised risk’. This necessitates an appreciation of risks potentially faced by the multiple parties in the care relationship and a differentiated set of structural risks. Applying a multilevel analysis we highlight the potential risks of ‘informality’ of employment conditions experienced by directly employed care workers, the ‘emotional’ content of care worker-employer relationships, and ‘intimacy’ of employer/employee roles. In this article, we offer an empirical based contribution to the wider discussion of risks and risk theory derived from policy changes being adopted by many developed countries that increasingly emphasise individual responsibility for personal welfare within an uncertain and mobile social world. [ABSTRACT FROM PUBLISHER]

In this article, I examine the ways in which risk is constructed and managed by those involved in the pregnancy and childbirth of women who use drugs, including the women themselves. I discuss how constructions of risk influence maternal care outcomes and the understanding of choice, often in the form of stigmatisation. In this article, I draw on data from a qualitative research study that I conducted in 2011 in a western Canada city in which I interviewed 13 pregnant and parenting women who had used drugs during their pregnancy. In this article, I show how the everyday risk construction of pregnancy, labour and delivery is compounded significantly by drug use and the stigmatisation associated with this perceived risk-taking behaviour. The participants in the study often internalised this understanding of risk and this manifested itself in delays in accessing maternal health and social care services. The women in the study had different understandings of risk and these were structured by the women’s own understanding of general risk factors during their pregnancy, as well as their experiences of the constructions of risk and risk management by health and social care professionals. While structural life chances can constrain women’s feelings of self-efficacy, services that promote clients’ ability to make choices can facilitate reduced stigmatisation and facilitate the development of more compassionate and autonomous approaches to risk management. [ABSTRACT FROM AUTHOR]

The notion that ‘older’ mothers experience elevated risks during pregnancy and childbirth has proliferated since the mid-twentieth century. In this article, we take the contemporary concern with age as a starting point from which to historicise and contextualise the concept of maternity risk. To this end, we examine maternal hygiene manuals (self-help guidebooks on motherhood and pregnancy) published between 1880 and 1920 in Canada, the United States and the United Kingdom. Our analysis of these manuals indicated that pregnancy during this period was presented as a potentially dangerous affair that required constant surveillance by the self (and others) to ensure favourable pregnancy outcomes. A dominant theme that emerged from the manuals was that the expectant mother was morally responsible for mitigating a range of risk factors, including adequate exercise, sleep, fresh air, as well as for choosing an appropriate father and ensuring his health. At the same time, the manuals indicated that the failure to seek out expert advice and take up responsible practices was linked to adverse consequences for the expectant mother’s health, and her newborn’s health and moral character later in life. We conclude this article by discussing how findings from our historical data can provide an important context for understanding risk discourses around pregnancy as historically specific and culturally contingent, especially with respect to risks associated with maternal advanced age. [ABSTRACT FROM AUTHOR]

Over the past 50 years, two things have changed for women giving birth in high-income nations; birth has become much safer, and now takes place in hospital rather than at home. The extent to which these phenomena are related is a source of ongoing debate, but concern about high intervention rates in hospitals, and financial pressures on health care systems, have led governments, clinicians and groups representing women to support a return to birth in ‘alternative’ settings such as midwife-led birth centres or at home, particularly for well women with healthy pregnancies. Despite this, most women still plan to give birth in high-technology hospital labour wards. In this article, we draw on a longitudinal narrative study of pregnant women at three maternity services in England between October 2009 and November 2010. Our findings indicate that for many women, hospital birth with access to medical care remained the default option. When women planned hospital birth, they often conceptualised birth as medically risky, and did not raise concerns about overuse of birth interventions; instead, these were considered an essential form of rescue from the uncertainties of birth. Those who planned birth in alternative settings also emphasised their intention, and obligation, to seek medical care if necessary. Using sociocultural theories of risk to focus our analysis, we argue that planning place of birth is mediated by cultural and historical associations between birth and safety, and further influenced by prominent contemporary narratives of risk, blame and the responsibility. We conclude that even with high-level support for ‘alternative’ settings for birth, these discourses constrain women’s decisions, and effectively limit opportunities for planning birth in settings other than hospital labour wards. Our contention is that a combination of cultural and social factors helps explain the continued high uptake of hospital obstetric unit birth, and that for this to change, birth in alternative settings would need to be positioned as a culturally normative and acceptable practice. [ABSTRACT FROM AUTHOR]

‘Delay’ has been used in the cancer literature since the 1930s to describe the period between self-detection of a concerning sign of possible disease and presentation to a health professional. This linguistic choice carries an implication of blame for apparent failure to manage a risk appropriately, drawing attention away from the contemporaneous perspectives of those who respond to suspicious indicators more or less quickly. We present findings from a grounded theory study of accounts given by 45 patients about their slower or quicker journeys to a diagnosis of cutaneous malignant melanoma, a cancer which can ‘hide in plain sight’. There has been little research exploring in qualitative detail patients’ perspectives on their decision-making about what subsequently turn out to have been signs of this most risky of skin cancers. The findings frame referral time-lapses in terms of normalisation of symptoms, sometimes buttressed by reassurance derived, ironically, from health promotion messages, disconfirmation of patients’ concerns by their general practitioners and prioritisation of other life concerns. We argue that a shared sense of urgency surrounding melanoma self-referral derives from a clinical representation of current knowledge which conceals numerous evidential uncertainties. [ABSTRACT FROM AUTHOR]

In this article, we compare accounts given by young carers and specialist support workers about the riskiness of becoming a carer relatively early in life. We argue that since the mid-1990s, the policy response has problematised the comparatively early adoption of a caring role as a risk factor for future personal development. This temporal issue has become societally organised around concern about NEETs (young adults not in education, employment or training). Such a concern is predicated on cultural assumptions, now being undermined in response to economic crisis, about the existence of a critical age for transition to adulthood, successful navigation of which requires a time-limited period of personal freedom. Our findings suggest that, whereas support workers mostly see young caring in terms of risks to future prospects, young carers themselves identify not only current stresses, but also personal gains, from their experiences. Instead of categorising the timing of their caring as a source of risk, young carer respondents questioned service shortcomings which they felt made it harder for them to cope in the present, particularly inadequate social service support for relatives with disabilities and insensitivities in the education system. They did not see service providers as helping them to manage their futures. We locate this tension in risk social science debates about individualisation, transition to adulthood in late-modern society and risk management for those deemed vulnerable. [ABSTRACT FROM AUTHOR]

Concern about health-related risks dominates modern day public health discourses on young people's health. Based on ‘official’ notions of health, the public health risk-based approach not only downplays the potentially different meanings young people attach to concepts of health, but it also has a tendency to problematise and pathologise young people and their health. Drawing on findings from an ethnographic study with young people aged 15–16 years in England (n= 55); in this article, I examine young people's understandings of health and health-related risks. I used group discussions, individual interviews and observational work in a school and surrounding community settings to collect the data on which this article is based. In this article, I show the importance young people in my study attached to ‘being happy’ and ‘having fun’, but also how dominant constructions of youth as a time of risk were taken up and reproduced by young people themselves to create and sustain differences amongst young people. I examine the implications of these differences for young people's health and the possibilities for empowerment – highlighting some of the emergent contradictions between young people's constructions of the ‘healthy self’ and ‘risky’ young Other. Specifically, in this article, I highlight young people's preference for a more positive conceptualisation of their health, one which recognises the importance of their shared social positioning for the promotion of health. [ABSTRACT FROM AUTHOR]

Risk categorisation provides a routine and necessary contribution to the way people make sense of and impute predictability in a complex human world of which their knowledge is limited. It is a precursor to the development of risk management strategies. Risk categorisation schemes can vary depending on the underlying perspective and knowledge used in their construction. There are estimated to be between 120,000 and 300,000 Gypsies and Travellers in the United Kingdom. They have been categorised on the one hand as a group that is ‘at risk’ suffering wide-ranging inequalities and on the other they can be seen as the archetypical ‘other’ posing risks to normative stability. Public policies to manage their health risks have been limited in contrast to policies to address their ‘otherness’ status which have aimed to exclude, relocate and forcibly remove them from public space. Little is understood about the way in which Gypsies and Travellers categorise and manage the risks to their health within the context of adverse public policies. In-depth qualitative interviews were undertaken during 2010 and 2011 with 39 Gypsies and Travellers aged between 18 and 66 years comprising 20 females and 19 males living in an area of South East England. Respondents framed risk in terms of threats to their health, culture and traditional way of life and issues of trust were central to this. They sought to devise risk management strategies that would maintain boundaries between their community and outsiders who were perceived to be the source of risks to their health. A consequence of their risk management strategies was the potential perpetuation of threats to their health and well-being. [ABSTRACT FROM AUTHOR]

Citizens of developed societies are troubled by those who commit ‘irrational' crimes against the person. Reoffending by ex-patients following their release from secure mental health services triggers particularly intense angst when amplified by media and political scrutiny. Forensic mental health service providers are expected to minimise the occurrence of such transgressions by releasing only those patients who are judged acceptably unlikely to reoffend. However, reoffending probabilities can only be estimated by observing behaviour in secure institutional settings designed specifically to prevent patients from transgressing. The article explores this ‘inductive prevention paradox' which arises when the implementation of measures designed to avoid an adverse event obscures direct observation of what might have happened if prophylaxis had not been attempted. The analysis presented draws on data obtained in 1999–2003 from two qualitative studies in medium to low secure UK institutions, one providing forensic mental health services and the other forensic learning disability services. We explored the views of 56 staff members and 21 patients about risk management in forensic services and undertook additional 25 staff interviews for case studies of the 21 patients. The wider applicability of the inductive prevention paradox will be considered in the Discussion. We argue that the prognostic limitations arising from prevention have been underestimated by policy makers and in official inquiries; and that the prevailing personal risk assessment framework needs to be complemented by greater attention to the environments which patients will be discharged into. [ABSTRACT FROM PUBLISHER]

Policy discussion of teenage sexual behaviour has been strongly influenced by a political agenda that characterises teenage pregnancy as a potential ‘risk’ of sexual activity. This presumed risk framework, however, depends upon an assumption of shared value judgements about the social undesirability of teenage parenthood, and the moral undesirability of teenage abortion. Drawing on three qualitative research projects undertaken in England between 2003 and 2009, this article looks at the complex processes of individual pregnancy decision making, in a context of competing values and moralities. It provides insights into, and understandings of, underlying tensions in the processes through which different degrees of personal autonomy may be experienced, and suggests that when autonomous decision making is compromised, often due to tensions in competing value systems, young women may experience ambivalence or regret about the decision they have made. [ABSTRACT FROM PUBLISHER]

With reference to two comparative UK biotechnology case studies, spanning recent decades, this article outlines the main features of what might usefully be expressed as ‘reflex regulation’. This includes a set of reactive institutional habits, routines and reflexes that continue to characterise the regulation of the biosciences in the UK. Methodologically, the article draws on long-term social scientific engagement with policy-making in the field of xenotransplantation in the 1990s and, a decade later, the politics of trans-species embryo stem cell research. Our focus in this article is on questions of time and timing in the temporal relationships between developments in bioscience, policy-making and wider political deliberation. Both case studies exhibit a range of persistent policy-making features, specifically a range of temporal reflexes including: the largely uncritical susceptibility of policy communities to promissory scientific claims by key entrepreneurial scientific stakeholders; a perceived policy need to react rapidly to often unchallenged claims about imminent benefit; a tendency towards the construction of regulatory measures that are often poorly adapted to long-term socio-technical processes; and an institutionalised historical amnesia whereby policy communities fail to critically reflect on the periodicities of hype and disappointment. These features of science governance, we argue, continue to inhibit and narrow the opportunity for a potentially more ‘reflexive’ as opposed to ‘reflex’ science policy. [ABSTRACT FROM PUBLISHER]

In this article, we examine the ways in which risk is categorised in childbirth, and how such categorisation shapes decision-making in the risk management of childbirth. We consider the ways in which midwives focus on and highlight particular adverse events that threaten the normality of childbirth and the life of the mother and/or her baby. We argue that such a focus tends to override other elements of risk, especially the low probability of such adverse events, resulting in ‘an ever-narrowing window of normality’ and a precautionary approach to the management of uncertainty. We start our analysis with a discussion of the nature of childbirth as a fateful moment in the lives of those involved, and consider the ways in which this fateful moment is structured in contemporary society. In this discussion, we highlight a major paradox; although normal childbirth is both highly valued and associated with good outcomes in countries like the UK, there has been an apparent relentless expansion of ‘the birth machine’ whereby birth is increasingly defined through the medicalised practices of intensive surveillance and technocratic intervention. We explore the dynamics that create this paradox using ethnographic fieldwork. In the course of this work, the lead author observed and recorded midwives’ work and talk in four clinical settings in England during 2009 and 2010. In this article, we focus on how midwives orientate themselves to normality and risk through their everyday talk and practice; and on how normality and risk interact to shape the ways in which birth can be legitimately imagined. We show that language plays a key role in the categorisation of risk. Normality was signified only through an absence of risk, andhad few linguistic signifiers of its own through which it could be identified and defended. Where normality only existed as the non-occurrence of unwanted futures, imagined futures where things went wrong took on a very real existence in the present, thereby impacting upon how birth could be conceptualised and managed. As such midwifery activity can be said to function, not to preserve normality but to introduce a pathologisation process where birth can never be categorised as normal until it is over. [ABSTRACT FROM PUBLISHER]