City Research Online

Abstract

Problem
Antenatal risk assessment and classification dominates midwifery care but may not be improving outcomes and may introduce iatrogenic harm.

Background
Midwifery-led care and birth settings promote good birth outcomes and women’s experiences. In the United Kingdom increasing numbers of women are classified as having high-risk pregnancies and therefore recommended to have obstetric-led care and birth settings, restricting the number of women accessing midwife-led care.

Aim
Evaluate and integrate literature on the effectiveness, justification and impact of antenatal risk assessment and classification as performed in the UK.

Methods
Integrative literature review of 16 articles from 2000 to 2025, from midwifery and obstetric perspectives.

Findings
Many antenatal risk assessments did not improve outcomes due to inconclusive tests, lack of treatment options and difficulties balancing risks. The assessments and proposed treatments were not clearly communicated to women and assumed benefit and acquiescence in the absence of evidence. Risk assessment processes could create physical and emotional iatrogenic harm to women.

Discussion
Reductive medical-model risk assessments and subsequent care pathways are not compatible with women-centred care and lead to known benefits of midwifery care being under-utilised. Biopsychosocial risk assessment could be culturally and value sensitive, better address social determinants and inequalities, offer genuine choice and control for women and increase the use of women-centred midwifery services while enhancing safety.

Conclusion
UK antenatal risk assessment lacks efficacy in improving outcomes, risks iatrogenic harm and can negatively affect women’s experiences. A shift to relational models of midwifery antenatal risk assessment could be more women-centred, personalised and culturally specific, possibly leading to better outcomes overall.

Publication Type:	Article
Additional Information:	© 2026 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Publisher Keywords:	Antenatal, Pregnancy, High-risk, Midwifery, Pregnant woman, Risk assessment
Subjects:	R Medicine > RG Gynecology and obstetrics
Departments:	School of Health & Medical Sciences School of Health & Medical Sciences > Department of Nursing & Midwifery
SWORD Depositor:	Symplectic Administrator

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