title: Midwives' and obstetricians' perceptions of risk and its impact on clinical practice and decision-making in labour: An integrative review.
abstract: BACKGROUND
  Risk and risk assessment are increasingly affecting how maternity services are governed with rates of intervention continuing to rise in obstetric-led services for low-risk women.
  
  
  OBJECTIVE
  This review synthesises original research that examines how perceptions of risk impact on midwives' and obstetricians' facilitation of care for low-risk women in labour.
  
  
  METHODS
  A five stage process for conducting integrative reviews was employed. A robust search strategy incorporated electronic searches in The Cochrane Database of Systematic Reviews, EBSCO, EMBASE and Scopus from 2009 to 2014. The initial search resulted in the retrieval of 2429 articles which were reduced to 14 through a systematic process.
  
  
  RESULTS
  The results of this review revealed an over-arching theme of an assumption of abnormality in the birthing process leading to unnecessary intervention and surveillance. Three sub-themes are presented under this central theme - (1) external influences on risk perception that include practice guidelines and professional responsibility; (2) influence of personal fears and values on risk perception focusing on differing attitudes to physiological birth; (3) impact of professionals' perceptions of risk on women's decision-making in labour.
  
  
  CONCLUSIONS
  Practice is influenced by an assumption of birth as abnormal and is compounded by issues such as institutional risk management, lack of midwifery responsibility, fear of involvement in adverse outcomes and personal values regarding physiological birth. These findings suggest that a shift in focus away from risk and towards health and wellbeing in the planning of maternity care may go some way towards providing a solution to the increasing intervention rates for low-risk women.
authors.affiliation: Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland. Electronic address: Sandra.healy@ul.ie.
authors.forename: Sandra
authors.initials: S
authors.lastname: Healy
authors.affiliation: Institute for the Study of Knowledge in Society, University of Limerick, Limerick, Ireland.
authors.forename: Eileen
authors.initials: E
authors.lastname: Humphreys
authors.affiliation: Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.
authors.forename: Catriona
authors.initials: C
authors.lastname: Kennedy
mesh_terms: D000328:Adult; D003657:Decision Making; D005260:Female; D006801:Humans; D007743:Labor, Obstetric / Q000523:psychology*; D008880:Midwifery / Q000379:methods*; D009721:Nurse Midwives / Q000523:psychology*; D009774:Obstetrics / Q000379:methods*; D036801:Parturition; D010465:Perception; D010820:Physicians / Q000523:psychology*; D011247:Pregnancy; D011795:Surveys and Questionnaires
keywords: Childbirth; Decision-making; Midwifery; Obstetric; Risk