Aim
We explored the dynamics of neonatologist–parent communication and decision‐making during medical rounds in a level three neonatal intensive care unit.

Methods
This was a qualitative study, with an ethnographic approach, that was conducted at Turku University Hospital, Finland, from 2013 to 2014. We recruited eight mothers and seven couples, their 11 singletons and four sets of twins and two neonatologists and observed and video recorded 15 medical rounds. The infants were born at 23 + 5 to 40 + 1 weeks, and the parents were aged 24–47. The neonatologists and parents were interviewed separately after the rounds.

Results
Four patterns of interaction emerged. The collaborative pattern was most consistent, with the ideal of shared decision‐making, as the parents’ preferences were genuinely and visibly integrated into the treatment decisions. In the neonatologist‐led interactional pattern, the decision‐making process was only somewhat inclusive of the parents’ observations and preferences. The remaining two patterns, emergency and disconnected, were characterised by a paternalistic decision‐making model where the parents’ observations and preferences had minimal to no influence on the communication or decision‐making.

Conclusion
The neonatologists played a central role in facilitating parental participation and their interaction during medical rounds were characterised by the level of parent participation in decision‐making.