{"title":"Risk assessment as routine: A conversation analysis of midwives' risk surveillance practices in midwife-led care during labour.","authors":"Clare Jackson","doi":"10.1016/j.pec.2025.109279","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Method: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p><p><strong>Practice implications: </strong>Consideration should be given to women's limited optionality in engaging in risk assessments and conversation analytic insights can inform relevant training.</p>","PeriodicalId":49714,"journal":{"name":"Patient Education and Counseling","volume":"140 ","pages":"109279"},"PeriodicalIF":3.1000,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Patient Education and Counseling","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.pec.2025.109279","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/7/29 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: 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.
Method: 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.
Results: 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.
Conclusion: 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.
Practice implications: Consideration should be given to women's limited optionality in engaging in risk assessments and conversation analytic insights can inform relevant training.
期刊介绍：
Patient Education and Counseling is an interdisciplinary, international journal for patient education and health promotion researchers, managers and clinicians. The journal seeks to explore and elucidate the educational, counseling and communication models in health care. Its aim is to provide a forum for fundamental as well as applied research, and to promote the study of organizational issues involved with the delivery of patient education, counseling, health promotion services and training models in improving communication between providers and patients.
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