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How do risk management principles fit in with the reality of clinical midwifery?

02 November 2019
Volume 27 · Issue 11



Risk assessment and management has become a key focus in midwifery practice, in light of failings in maternity care. Whilst studies have explored risk management within healthcare, it has not looked at its impact on normal midwifery practice.


To review the literature exploring how risk management principles fit with clinical midwifery.


A literature search was undertaken electronically as well as a search by hand. Nine papers were identified as suitable for the literature review. Data was extracted and used to inform the themes.


Three themes were identified: midwives being with women; midwives and normality, and increased sensitivity to risk; and organisational risk technologies and blame.


There is a mismatch between clinical midwifery culture and risk management. Risk categorisation and increasing risk surveillance clearly have an impact on midwifery practice. However, more research is needed to explore how midwives navigate around these systems.

Risk assessment and management is extremely important in midwifery. However, it is unclear how its principles fit with day-to-day clinical midwifery practice. While midwives are the inherent leaders of normality, there are ongoing challenges under the auspices of risk management which instil fear of being blamed when things go wrong, especially around fetal monitoring in labour (The Royal College of Midwives, 2010; Healey et al, 2016).

Risk management, which is the central component of clinical governance, is concerned with improving safety and quality of care (Doherty, 2010). Clinical governance is defined as ‘a framework through which health service organisations are accountable for continually improving the quality of their services and safeguarding high standards of care, by creating an environment in which excellence in clinical care will flourish’ (Department of Health, 1998).

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