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.