Paper short abstract:

This paper explores the perceptions of healthcare professionals on sharing reproductive decisions with patients in high-risk contexts. It suggests that gynaecologists and midwives approach pregnancy and childbirth differently, as they have different understandings of what ‘risk’ means.

Paper long abstract:

Within the biomedical model of attention, pregnant people undergo a screening process to determine the risks they may present during their pregnancy, with an aim to select those who will receive preventive interventions to mitigate possible future complications. This article explores health professionals’ perspectives on the appropriate level participation for “at-risk” pregnant patients in decision-making processes related to pregnancy, follow-up, and delivery. Drawing on 8 months of ethnographic fieldwork in the obstetrics area of a hospital in Barcelona and semi-structured interviews with 24 professionals (15 gynaecologists and 9 midwives), this study shows the rationalities of health professionals in determining the role of patients as active agents within risk circuits of attention. The findings reveal that sharing decisions is a challenge not only in relation to patients, but also between the different professionals attending births, gynaecologists and midwives, who understand and define risk in different ways. The findings suggest that the growing demand from patients for more information and participation in their reproductive processes is perceived by doctors as conflicting with their moral and legal responsibilities. As midwives often find themselves in visions that are more aligned with patients' requests, tensions between professionals emerge, generating a context of friction that does not go unnoticed by the patients.

Keywords: Female reproductive health; patient agency; shared-decision making; risk; preeclampsia.