Entre sombras e feixes de luz: um estudo observacional Psicanalítico no contexto da ultrassonografia pré-natal.

Abstract

The ultrasound exam has become routine in prenatal care, considered a low-risk technology, widely used in all social classes, including in rural areas of African countries. Despite being used by Medicine in a technical way in the follow-up of pregnancy, we estimate that the exam has an impact on subjectivities, since it involves the sharing of emotions and feelings between physicians and parents, requiring caution so that it does not become a threatening experience. Due to the fact that it anticipates foetal images, it became part of the early process of building parenthood and openness to affiliation. This qualitative research, referenced in Psychoanalysis, aimed to analyse the intersubjective field in the context of prenatal ultrasound as a possible anticipatory to the construction of parenthood and openness to affiliation. More specifically, we intend to: (1) Observe the interplay of objective and subjective elements in the affective environment of the prenatal ultrasound exam; (2) Uncover evidence of the construction of parenting and the beginnings of the relationship with the foetus, in the context of observation of prenatal ultrasound; (3) To analyse, based on the impact of prenatal ultrasound images and in the intersubjective field, the crossing of technology in promoting expectations in parents (parenting) and openness to affiliation. Field work was developed as an application of the Bick method of observation, divided into two moments: the first stage involved observation, once a week, over five months. In the second moment of the research, three pregnant women were accompanied by the observer in their ultrasound exams until the delivery was approaching. After the end of the observations, a semi-structured interview was conducted with these three mothers. The reports of Bick's observations and supervision, as well as the transcripts of the interviews, were triangulated and analysed, which allowed the construction of discussion axes. The results indicate that: a) regarding the construction of parenthood, some feelings of the pregnant women, arising from past histories, such as pregnancy losses, were captured by the observer during the USG examination, but not valued or even recognized, even known, by the medical team; b) the image of the foetus on the screen seemed to help the construction of motherhood/parenthood, by promoting anticipation, as it expanded the imaginative field of mothers around the foetus, and possibly of fathers, and made it possible to ensure the proper development of the pregnancy. With regard to the fathers, it was not possible to observe them in the USG examination, but to follow what their companions brought about them, because, due to the health protocol of Covid-19, they were unable to accompany the pregnant women. We also did not have parents' narratives in the interviews; c) the intersubjective field of USG was marked by the complexity of affections that provoked encounters and disagreements between subjectivities. Intersubjective meetings took place when there were fertile exchanges and dialogues between physicians and pregnant women about foetal images. At these moments, we think that a psychosocial placenta/envelope was formed that nourished affections between the dyad and supported the mother in the psychic elaboration of the pregnancy, promoting anticipations as a way of accessing the symbolization that seemed to insert the child in the family history. On the other hand, we also observed that disagreements occurred when ultrasound technology was used only as a technical resource, with the function of teaching and construction of medical reports; with little space for implied care and latent subjective aspects. At these times, the examination seemed more linked to the mechanical and automatic, with no room for experiencing the new and the living.; d) the gaze of the observer, as a container of the various projections, as a systematic presence, and “live company” seemed to impact the intersubjective field of the exam, based on what was observed in the attitudes of the doctors and pregnant women, as echoes of their posture ; e) the baby, with its movements, sometimes captivated and invited those present to look at itself, promoting a possible decrease in the doctors' psychic defences, opening up to affective exchanges, allowing the entry of playfulness beyond the rigor of the technique. We consider it important and feasible to broaden the perspective of the team involved in prenatal care, including the one that performs the ultrasound exams, for an assistance that opens space for the reception of ambivalences and the meanings created around the maternal/parental construction in its opening to affiliation. We hope that the 12 interdisciplinary dialogue in prenatal care may provoke reflections about the intersubjectivity at play in the shared experience in the ultrasound examination, stimulating contributions to the beginnings of the family and to the psychic anticipations that create the baby's subjectivity.