This chapter moves on from the case-study material for the four women presented in chapter 8 and the quantitative findings relating to pregnancy ‘outcome’ discussed in chapter 9 to attempt a synthesis of how all the women in the study regarded their participation in it.

A critical focus of this part of the analysis is the notion of risk. The women who took part in the SSPO study were not only exposed to the ‘risk’ of taking part in research, they had been identified as ‘at risk’ in the narrowly biological sense of having already given birth to at least one baby weighing less than 2500 g. In using a quantifiable measure of risk derived from the medical domain, the study thus participated in a particular conceptualization of women and motherhood – one which prioritizes a set of meanings attached to motherhood by people other than mothers themselves. The challenge – the ethical requirement – here is to invert the analysis, and allow the women themselves to speak about their own conceptualizations of risk and mothering within a broader framework that includes the ‘social’ risks of material disadvantage and inadequate social support, the hazards of being identified as ‘at risk’ by health professionals, and any personal costs consequent on participation in the research process itself.

Although the potential benefits of using the medical risk approach have been widely publicized, its potential harm is scarcely ever mentioned; such harm must include that resulting from ‘unwarranted intrusion in women's private lives, from superfluous interventions and treatments, from creating unnecessary stress and anxiety, and from allocating scarce resources to areas where they are least needed’ (Alexander and Keirse 1989: 361). Clinical trials are planned, conducted and used largely by medical and academic scientists, with the subjectivity of participants taken seriously only at the point of trial entry, where there is a (limited) obligation to consider the provision of conditions for ‘informed’ consent. After that, it is implicit in the clinical trial methodology that evaluation of benefit lies firmly in the domain of medical science.