Perspectives on risk, or risk in perspective?

We live in a world where there are many perspectives on risk. Entire professions now exist to advise us on how to recognise risk, avoid risk and manage risk (Gardener 2009). Some have strategically focused on supporting a culture of safety but inevitably there is a tendency to end up with a risk focus. Despite one in ten people entering hospital experiencing an adverse event, and around half of these being preventable (WHO 2008), researchers argue that the debate around safety in maternity care often does not focus on the harmful activities of health providers and health care organisations but on the behaviours and characteristics of women (Sandall et al 2010). We still resort to the 'too fat, too sick and asking for it' mantra when yet again the caesarean section rate creeps up. This is despite the fact we know that the increase in caesarean rates is happening in all groups of women irrespective of age, race, health or socioeconomic status (MacDorman et al 2008). Meanwhile the maternal mortality rate has doubled in the US over the past 20 years (Amnesty International 2010) despite more being spent on health care than in any other country in the world (Organisation for Economic Co-operation and Development 2009) and it is increasing or remaining unchanged in other developed countries (Sullivan et a 2008). Likewise, in ten developed countries in the world, despite a five fold increase in caesarean section over recent decades, the incidence of cerebral palsy remains steady at 1:500 births (Maclennan et al 2005) and perinatal mortality has barely altered. Are we stagnating in maternity care because we have lost the balance between risk and safety? Are we so focused on certain risks that we have begun to ignore or even create other risks