Dialogues of obstetric risk in the first trimester of pregnancy: Insights from a hospital ethnography

This study examines how obstetric risk is constructed and negotiated through interactions between healthcare professionals and pregnant women during the first trimester screening ultrasound consultation in a public maternity hospital in Spain. This pivotal consultation serves as both a key diagnostic tool for gestational complications and a significant emotional milestone for families. Through ethnography, primarily observations and informal conversations conducted between March and June 2023, the research explores how "risk" shapes decision-making in obstetrics. Findings showed that the first trimester ultrasound consultation is a complex social space where medical risk assessment coexists with emotional and social implications of the first visual encounter with the unborn baby. While medical professionals prioritize formalized risk assessment, they also engage in emotional labor and communicative strategies, including subtly redirecting interactions. They also actively participate in the symbolic appropriation of the fetus, which helps bridge women's and clinician's realities through the acknowledgment of the ultrasound's social and emotional significance. Decisions are made under high uncertainty, where expert knowledge plays a central role, and social, cultural, and emotional contexts are not always fully integrated. The study highlights communication gaps due to the disparity between professionals' and patients' knowledge, particularly in high-risk scenarios, where statistics often fail to convey the deep personal meaning of potential adverse outcomes. Biomedicalization of pregnancy risks can introduce new forms of existential uncertainty for women, potentially limiting their autonomy. These findings illustrate the complexity of obstetric risk communication and the need to integrate social, emotional, and cultural dimensions into prenatal care.