To optimize the system of risk selection, midwives and obstetricians in the Netherlands have begun to look for a better way to determine the most appropriate care and care provider. This endeavor is hindered, however, by disagreement about what risk selection is and how it can be best organized and practiced.[21] International scientific literature does not offer a way out of these disagreements. Consider, for example, the varied ways risk selection is operationalized in research: as the planning and arranging of care,[22,23] as a cognitive skill,[24,25] and as a clinical tool.[26–28] Scholars also disagree about the level of risk that justifies medical interventions, as illustrated in the recent debate over offering induction of labour to all women at term in the International Journal of Obstetrics and Gynecology (2019).[29,30] The lack of clarity about risk selection hampers the development of an evidence base for its optimization. Current strategies for risk selection in MNC have been shaped by the ways risk is perceived in relation to pregnancy and birth, but also by the way risk is understood in society in general. Therefore, in this introduction, I begin with a description of the genealogy of contemporary risk selection in MNC, starting with the origin of the term ‘risk’. I then explore changes in societal understandings of risk in high-income countries, focusing on the way these changes have shaped contemporary risk selection in MNC. I conclude with a presentation of the aims of the research presented in this dissertation. The origin of the term risk Although people have long been preoccupied with risks in life, the word ‘risk’ is relatively new. One of the first recorded human practices of dealing with risk in a systematic way dates from circa 3200 B.C. in the Tigris-Euphrates valley, where consultants used signs from the gods to manage harmful, uncertain, or difficult decisions.[31] There is no agreement about the etymological origin of the word ‘risk’.[32–37] But there is agreement that the understanding of the word risk changed over time. It seems that the word first appeared as ‘risque’ in the 1674 Thomas Blounts Glossrophia,[38] originating from the Latin word ‘risigus’ or ‘riscus’.[32,33,36] According to some, it comes from the classical Greek ‘ριζα’, a navigational term meaning ‘root’, ‘stone’ or ‘cut of the firm land’ used by sailors entering uncharted waters as a metaphor for ‘difficulty to avoid in the sea’.[35,36] In Spanish, risk means ‘steep abrupt rock’, also suggesting danger for those at sea. According to others, the origin is linked to the Arabic word ‘rizq’, a term for the acquisition of wealth and good fortune.[32,34] With the advent of the printing press in the 15th century, the word spread to other countries.[32,33,39] In contemporary society, risk is understood to mean a combination of knowledge and uncertainty. When there is a risk, there must be uncertainty: something that is unknown 22 1 CHAPTER 1
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