Arnott B, Meins E Links among antenatal attachment representations, postnatal mind–mindedness, and infant attachment security: A preliminary study of mothers and fathers. Bull Menninger Clin. 2007; 71:(2)132-49

Normal Birth Rates for England 2010-11. 2011. (accessed 20 May 2015)

Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ. 2011; 343

Foetal damage caused by alcohol ‘equivalent to attempted manslaughter’. 2014. (accessed 20 May 2015)

Centers for Disease Control and Prevention. Births-Method of Delivery. 2013. (accessed 20 May 2015)

Choosing Wisely. About us. 2015. (accessed 20 May 2015)

De Jonge A, Mesman J, Mannien J, Zwart J, Van Dillen J, Van Roosmalen J Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study. BMJ. 2013; 346

Complicating Conditions of Pregnancy and Childbirth. 2011. (accessed 20 May 2015)

Gibbons L, Belizan JM, Lauer JA, Betran AP The Global Numbers and Costs of Additionally Needed and Unnecessary Caesarean Sections Performed Per Year: Overuse as a Barrier to Universal Coverage. World Health Report (2010) Background Report 30.Geneva: World Health Organisation; 2010

Grace SL, Evindar A, Stewart DE The effect of postpartum depression on child cognitive development and behaviour: A review and critical analysis of the literature. Arch Womens Ment Health. 2003; 6:(4)263-74

Health and Social Care Information Centre. NHS Maternity Statistics 2010-2011. 2011. (accessed 10 July 2015)

Hellerstein S, Feldman S, Duan T China's 50% caesarean delivery rate: is it too high?. BJOG. 2015; 122:(2)160-4

Hofberg C, Ward MR Fear of pregnancy and childbirth. Postgrad Med J. 2003; 79:(935)505-10

Huxley ALondon: Chatto and Windus; 1932

Percorso nascita: promozione e valutazione della qualita do modelli operative. Le indagini del 2008-2009 e del 2010-2011. 2012. (accessed 10 July 2015)

Australia's mothers and babies 2010. Canberra: Australian Institute of Health and Welfare National Perinatal Epidemiology and Statistics Unit. 2012. (accessed 10 July 2015)

Kitzinger SLondon: Pinter and Martin; 2015

Main M, Hesse E Parents' unresolved traumatic experiences are related to infant disorganized attachment status: Is frightened and/or frightening parental behavior the linking mechanism?. In: Greenberg MT, Cicchetti D, Cummings EM Chicago, IL: University of Chicago Press; 1990

Making normal birth a reality. Consensus statement from the Maternity Care Working Party.London: National Childbirth Trust/Royal College of Midwives/Royal College of Obstetricians and Gynaecologists; 2007

Saving Lives, Improving Mothers' Care.NPEU, Oxford: MBRRACE-UK; 2014

Molina-Hernández M, Téllez-Alcántara NP Antidepressant-like actions of pregnancy, and progesterone in Wistar rats forced to swim. Psychoneuroendocrinology. 2001; 26:(5)479-91

Nolan MLondon: Routledge; 2011

Office for National Statistics. Births in England and Wales by Characteristics of Birth 2, 2013. 2014. (accessed 9 July 2015)

Vincent Priya JShaftesbury, Dorset: Element Books; 1992

Winnicott DW Primary maternal preoccupation. In: Winnicott DW London: Tavistock; 1958

Perceptions of risk: How they influence women's and health professionals' choices

02 August 2015
9 min read
Volume 23 · Issue 8


The need to ensure the survival of the species by offering pregnant and labouring women special protection has been expressed in primitive human societies through elaborate rituals and superstitions, and in contemporary society, through the provision of antenatal and intrapartum care by health professionals. Modern maternity services tend to highlight the medical risks of pregnancy and birth. Women, however, may place such risks in a broader context which includes risks to their emotional wellbeing and therefore, to their capacity to bond with their baby. Given current understanding of the importance of the first 1000 days of a baby's life, women's desire to have a labour that does not jeopardise this early relationship, is entirely logical. While both health professionals and women are dedicated to ensuring the safety of mother and baby, their definitions of ‘risk’ may sometimes lead to women's decision-making being contested and the need for ‘negotiation of disagreement’

Physiologically and culturally, women are programmed and supported to provide an optimum environment for their unborn baby. Animal studies suggest that raised levels of progesterone during pregnancy provide a natural anti-depressant (Molina-Hernández and Téllez-Alcántara, 2001); its calming effect promotes a slower pace of life, and underpins the nesting instinct that inclines mothers-to-be to stay close to home and to people they know and places they perceive as safe, such as the maternity hospital. Pregnancy rituals found in every culture are driven by a desire, both at the level of the individual and society, to keep the pregnant woman and her unborn child, safe. What constitutes ‘risk’ is defined culturally and according to how advanced a particular society is in relation to its access to technology and the sophistication of its health care services.

Superstition is rife in pregnancy, but its basis is evolutionary. For example, native American women may be ‘taken to the water’ at the start of their pregnancy to bathe in waters imbued with herbs that protect the child against harm; special blessings may be bestowed on African women of certain tribes to protect them and their unborn children against malevolent spirits (Vincent Priya, 1992). While such rituals may seem unusual, many cultures in advanced societies have their own practices and superstitions driven by the primeval need to minimise risk and promote the safety of the mother and baby. In the UK, some women have been known to not eat strawberries during pregnancy to avoid their baby having a birth mark. Furthermore, women and men in antenatal classes may express a wish not to talk about caesareans because doing so may increase their likelihood of having one. Superstition represents the commitment of the community to the survival of the race, and the commitment of the mother to the survival of her child. It is part of what the psychologist, Donald Winnicott (1958), described as, ‘primary maternal preoccupation’.

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