The importance of terminology when discussing risks in pregnancy

Dear Editor, I read with interest the article titled, ‘How do risk management principles fit with the reality of clinical midwifery?’ by Evette Sebastien Roberts published in the British Journal of Midwifery, volume 27, number 11. I want to congratulate the author on a thought-provoking piece that is timely and relevant. However, I would like to express my concern about how the term ‘normality’ is equated to mean low risk. For example, in the concluding remarks, the author comments on trying to achieve an ‘equilibrium between risk surveillance and normality’ (Sebastien Roberts, 2019); implying that normality means no risk.

Normality implies a physiological process rather than a pathological one. It does not imply that there are no risks. Equating the two terms and using them synonymously is erroneous and can be dangerous—something that in part led to the tragedies of Morecambe Bay.

I believe strongly that we need to move away from any notion that midwives deal with no risk and this article sums up this shift change in risk awareness excellently. As an obstetrician, I see midwives successfully looking after high-risk women on a daily basis, albeit with obstetric input, and they are vital in ensuring labour is not over medicalised. However, risk is a continuum which can shift extremely quickly. Being appropriately trained to identify risks and escalate appropriately once they arise should be seen as a key skill of any midwife, not something to shy away from by focusing on delivering ‘normality’