There has been a shift in healthcare philosophy in recent decades beyond simple requirement of client consent to treatment towards a more intricate notion of informed choice. Debate continues as to whether advocacy of shared decision-making in maternity care is more rhetoric or reality. In the context of management of so-called ‘prolonged’ pregnancy, the scope and authenticity of informed choice withers under scrutiny. It is considered that induction of labour at this juncture in pregnancy has become routinised, affecting an illusion of safety and depressing maternal stimulus to exercise choice. The offer of induction for advanced gestation has thus acquired normative power. Observation during clinical practice has revealed that there may be ethical failings in risk communication, manifested in data manipulation and scaremongering. However, a culture of powerlessness constrains midwives and compels them to seize the risk agenda and adopt the ‘medical standard’ for this common intervention.

Lindsay Skyrme - Student Midwife, Swansea University