risk and thus prevent harm, alters the nature of responsibility. The decision to act, or not, in the face of predicted risk will be regretted if harm or loss occurs that could have been averted.[33,42] Thus, the choice to accept risk and possible negative consequences became controversial. In this context, the decision to act to avoid predicted risk is always right and immune to failure and critique, because even if things go wrong one had acted correctly by choosing to avert risk and its consequences.[33,47] Risk and risk selection in maternal and newborn care Medical interventions, broadly defined, have always been present in MNC. However, the nature of these interventions changed over time. In pre-modern times, MNC was predominantly provided by women in the community who were skilled in midwifery practices. These ‘wise women’s’ knowledge was based on observation and experience combinedwithwhat they learnedasmothers, whichwas handeddown throughgenerations of attending women.[48] Midwives did not use instruments to assist at birth, but they had a variety of techniques, including herbal remedies, chants, invocations, charms positioning, movement, and hands-on manoeuvres to prevent mortality.[49] These techniques were ‘researched’ long before it was understood as such; they were tried, evaluated, adjusted as more subtle variables became clear, and moved into practice or abandoned.[50,51] Pregnancy and birth have become a much safer process in terms of mortality — especially in high-income countries — as a result of scientific discoveries about hygiene and nutrition, the organization of hospitals, and the specialties of obstetrics and neonatology.[49,50,52– 55] During the 19th and 20th century, medical interventions became more mechanical and more automated, including blood transfusions,[56] induction of labour,[57] and vacuumassisted delivery.[58] Advancements in medicine made in the 20th century brought new ways of preventing and treating maternal and perinatal mortality, such as antibiotics [56], and anti-D immunoprophylaxis.[59] Modern science, technology, and hospitals radically changed the perception of the nature of pregnancy and birth. In pre-modern societies pregnancy and birth were seen as natural, physiological, and healthy events until proven otherwise.[60–62] Modernity introduced a biomedical and technocratic discourse, first in the Western-industrial countries,[63] and later elsewhere.[64] Amajor turning point was the acceptance of the Descartes’ mind-body dualism in the 17th century. Philosopher René Descartes conceived the body as a machine governed entirely by the laws of physics, that could be taken apart and reassembled in an effort to fully understand its structure and function.[53,65–67] In this discourse, male bodies were considered the norm and conceptualized as ‘advanced’, ‘purified’, and ‘celestial’. Female bodies were regarded as ‘natural’, ‘primitive’, ‘terrestrial’, and 24 1 CHAPTER 1
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