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Midwifery activity in the labour room coalesces around routine surveillance practices. When engaging in such practice, midwives have to cope with attempting to instil a sense of confidence in the mother's embodied ability to give birth to her baby spontaneously while concurrently attending to an array of riskfocused tests and measurements. Midwives are vigilant about the potential harm that may come to mother and baby while at the same time they are responsible for facilitating a normal birth. This article sets out to explore the tension between these two tasks and shows how routine midwifery practice during labour can communicate certain understandings about birth. Using empirical evidence taken from an ethnographic study of midwifery talk and practice, attention is given to how midwives' activity during labour and birth implicitly introduces a sense of danger, an imagined risk that confines practice and operates to unsettle normality.

although every health professional should maintain basic competence to assist unanticipated breech births, establishing enhanced training and standards for those who support planned breech births may help protect users and providers of maternity services, while introducing greater choice and flexibility for women seeking the option of vaginal breech birth.

Specialist breech teams may facilitate the development of expertise within maternity care settings. Evaluation of expertise based on enablement of women and colleagues, as well as outcomes, will potentially avoid the pitfalls of alienation produced by some forms of specialist authority.

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Citation: Scamell, M. (2016). The fear factor of risk -clinical governance and midwifery talk and practice in the UK. Midwifery, 38, pp. 14-20. doi: 10.1016Midwifery, 38, pp. 14-20. doi: 10. /j.midw.2016 This is the accepted version of the paper.This version of the publication may differ from the final published version. Permanent AbstractObjective: Through the critical application of social theory, this paper will scrutinise how the operations of risk management help to constitute midwives' understandings of childbirth in a particular way. Design and setting:Drawing from rich ethnographic data, collected in the southeast of England, the paper presents empirical evidence to critically explore how institutional concerns around risk and risk management impact upon the way midwives can legitimately imagine and manage labour and childbirth.Observational field notes, transcribed interviews with various midwives, along with material culture in the form of documentary evidence will be used to explore the unintended consequences of clinical governance and its risk management technologies.Key conclusions: Through this analysis the fear factor of risk in midwifery talk and practice will be introduced to provide an insight into how risk management impacts midwifery practice in the UK.

This is the accepted version of the paper.This version of the publication may differ from the final published version. Permanent repository link AbstractIn this article we examine the impact of evidence-based practice with its shift from individual autonomous practice based on personal experience and intuition (embodied knowledge) to collective control of work based on encoded knowledge (guidelines and protocols) on , midwife practice. We focus on the ways in which midwives use of partograms and associated vaginal examination to monitor and manage the progress of labour. The partogram represents (amongst other things) a timetable for dilation of the cervix during labour and women who fail to keep up with this timetable are shifted from a low to high risk category and subject to additional surveillance and intervention. In this article we draw on empirical evidence taken from two independent ethnographic studies of midwifery talk and practice in England undertaken in 2005-2007 and 2008-2010, to describe the ways in which midwives practice vaginal examinations during labour both complies with, while at the same time creatively subverts the scientific-bureaucratic approach to maternity care. We argue that the success of the labour care provision in the policy current context depends as much upon midwives' routine techniques of subversion, as it does upon midwifery compliance to standardised care policy objectives. Moreover, the suggestion is that although divergent in nature, each way of practicing is mutually dependent upon the other: the space afforded by midwifery creativity not only co-exists with the scientific-bureaucratic approach to care, it sustains it.