[102,106,107] Also, in pregnancy and birth risks are prone to change and some outcomes remain unforeseen while other predicted outcomes never happen. The uncertainty underlying the calculation of risk is rarely discussed.[108,109] Within the contemporary biomedical discourse in MNC, risk is understood as an objective quantity that exists independent of the assessor, creating the idea of a ‘true’ or ‘objective’ risk, appealing to neutral science. Acknowledging uncertainty within this discourse may weaken professional authority.[110] Rothstein (2007) states that framing decisions in terms of probabilities is an attempt to legitimize the failures of rational decision making, by explicitly anticipating the possibility of failure.[111,112] Uncertainty opens the door for the influence of power in shaping risk selection: not all understandings of risk are equal.[60,113] Risk theorist Beck (1999) points out that all risks are real, but the knowledge about them is socially constructed. The process of the construction of the understanding of risk is a power game, where power lies with the one who gets to define risk.[114,115] Douglas (1990) highlights that some risks are politically ‘selected’ to support a given argument, whilst others are overlooked.[116] This political dimension of risk is concealed when different interpretations of risk are treated as intellectual disagreements over ‘objective’ science,[116] leaving room for decisions about risk based on personal or professional beliefs and interests rather than scientific evidence. This is clearly illustrated in our historical study.[117–119] Blind spots in risk selection The subjectivity of risk can lead to ineffective risk selection, resulting in the underuse and overuseof care, disparities in care, anddisrespectful care. The contemporary understanding and use of risk selection has blind spots that impede optimal alignment between women’s needs and MNC. This misalignment is visible in (1) the lack of women-centred care, (2) the disregard for overuse of care, and (3) the little attention to primary prevention. A women-centred approach Women-centred care is suggested as a way to better address women’s needs, and to align MNC with those needs.[4] However, contemporary risk selection is professional-centred. In the interaction between women and professionals, the power lies with professionals. It is they, and not women, who detect and confirm risk and determine access to care. It is argued that the biomedical model of MNC has extended the power of the medical profession.[120] Professional knowledge is universalized and generally held in higher status while women’s knowledge is devalued,[98,120] further centring professionals and the use of objective and pathology-focused approaches in risk selection. Begley and colleagues (2019) argue that professional power is enhanced by asymmetry in knowledge between professionals and women, where professionals have more medical technical power due to their education.[121] 166 7 CHAPTER 7