Ultrasound scans as risk rituals in obstetric prenatal care in South Africa

Abstract

In this article I examine collective maternity risk understandings and practices from the dual-perspective of obstetricians and pregnant persons, focusing in particular on the role of ultrasound scans. Contributing to socio-cultural theories on collective risks, I draw upon data from a two and a half year, multisite ethnography that traced fourteen women and seven obstetricians’ corresponding experiences of private-sector childbirth in Cape Town. My findings show that ultrasounds, as habitual practices, are well-established as safe, yet generate medico-legal risks for obstetricians and delivery risks for pregnant women, while managing risks to the unborn. The unborn, culturally sanctioned as precious, emerges as central to the purposes of the ultrasound risk ritual that warrants both self-protective precaution and collective duty on behalf of both social groups. Directed by the same injunctions but for markedly different ends, this dual-perspective suggests an important addition to the risk rituals literature, while adding further important insights into the literature on ultrasounds. By examining the ultrasound scan as risk ritual with a dual-function, the unborn as the object of the risk ritual is both at-risk and poses risks to the groups taking part. Legal processes, risk aversion, and technocratic obstetric care delineate the unborn as a risk that 1) places obstetricians in danger of litigation for negligence 2) places women in danger of delivery by c-section within high-risk birthing cultures, and 3) reconfigures birthing intervention as normal and necessary.

Keywords:

• risk rituals
• ultrasound
• obstetrics
• South Africa
• c-sections
• unborn

Acknowledgments

I owe a debt of thanks to the participants who generously shared their pregnancy journeys with me and the doctors who graciously opened the doors to their practices to me during my doctoral research. I am grateful to the Centre for Social Science Research at UCT for their generous support of my doctoral dissertation. I am grateful to the NRF for their support of the first two years of doctorate. I am grateful to the South African DSI/NRF Centre of Excellence in Human Development at Wits who provided me with a postdoctoral fellowship to convert my thinking from the doctorate into this paper. I am also grateful to the editor and anonymous reviewers of Health, Risk & Society whose comments and edits greatly improved this paper. Finally, I am grateful to Prof Elena Moore who has been my supervisor and champion since I began my academic journey as a postgraduate student and has continued to play that role all the way through to my post doctorate. I dedicate this, my first single authored, peer reviewed paper, to her.

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Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.