Risk and decision-making: Communication between health professionals and pregnant women at risk of preeclampsia in Catalonia

Abstract

The biomedical model of attention focuses on preventive risk assessment to mitigate the apparition of future diseases. In the event of a pregnancy classified “at risk” of preeclampsia, screening undertaken in first-term ultrasound controls determines which patients receive preventive treatment. This article examines women's narratives on the communication dynamics with health professionals by drawing on an eight-month ethnographic fieldwork, between 2022 and 2023, in a Barcelona hospital's obstetrics department and 24 semi-structured interviews with women in the postpartum period. The participants of this study had been classified at high risk of developing preeclampsia, which is determined through a screening undertaken during the first trimester of pregnancy, or had a diagnosis of preeclampsia. The results suggest that risk classification significantly impacts the decision-making process and the technical parameters. As we contend, participants experienced difficulties receiving quality information and communicating with professionals, making shared decision-making challenging. As we conclude, doctor-patient dialogue and shared decisions are increasingly replaced by institutional protocols where patients feel their knowledge and experiences have little room.