Transformations Week 6

Embodied Experiences of Pregnancy in a

Technological Age

The gestation of a lecture

Part 1

Dos and Dont’s

Introduction to

antenatal testing Part 2

Gender, risk, responsibility and decision-making

Part 3

‘Ultrasound in a visual society:

a Light and Sound Show'

Dos and Don’ts in Pregnancy

Eat fish, but not more than 2 portions oily fish/week and no shark, swordfish, marlinDrink plenty of waterAvoid mould ripened soft cheese (brie, camembert) and blue-veined cheese (stilton)Avoid pate, avoid soft eggs, avoid liver, consider avoiding peanutsAvoid unpasteurised milkCook all meat thoroughly and wash all fruit and vegWear gloves if gardeningDon’t change cat litterTake a folic acid supplementMake sure you get enough ironNo more than 4 cups coffee per day, less if drinking colaAvoid alcoholAvoid smokingAvoid drugsAvoid people with chicken-poxDon’t try to lose weight while pregnant

Source: BBC Health website

Antenatal testing

Screening = calculation of the statistical risk that a condition is present

Diagnosis = confirmation of a condition (tests are invasive and include a risk of miscarriage).

A positive screening result leads to the choice of undergoing diagnostic tests

All tests are voluntary – but how easy is it to decline?

Common screening tests

Blood tests for genetic conditions (sickle cell anaemia; thalassemia; cystic fibrosis)

Blood tests for chromosomal abnormalities (Down’s syndrome)

Blood tests for multifactorial disorders (Spina bifida; Anencephaly)

Ultrasound scans (foetal viability)Nuchal fold (Down’s syndrome)

Diagnostic tests

Chorionic Villus Sampling (CVS) (Down’s syndrome; sickle cell anaemia; thalassemia; cystic fibrosis)

Amniocentesis (all the above plus spina bifida; anencephaly)

Ultrasound scans (Spina bifida; Anencephaly)

Assessing/ understanding risk

Understanding the meaning of risk information can be difficult:• Relies on the knowledge and communication skills of the health professional• ‘False positives’ cause unnecessary anxiety• Benefits of screening vs. the anxiety it may

cause

How might screening/diagnostic tests make pregnancy a more or less worrying time for parents?

Assessing/ understanding risk

Interviewer: Did you feel that you had an adequate understanding of the risk information you were being given? [1:60 but risk reducing as pregnancy progressed]

Woman: It was meaningless. It was meaningless, because you never, you don't think about, risk is meaningless. What actually would've been useful would be to, say, compare it to, “Well, what's the risk about, of me having an accident if I get in a car? What's the risk of me, you know, being knocked over as I walk down the street?” And in that context it would've meant more…

[The couple decided not to have amniocentesis and the baby did not have Down’s].

Source: http://www.healthtalkonline.org/Pregnancy_children/Antenatal_Screening

Assessing/ understanding risk

One woman was delighted her risk was 1 in 1700 after the nuchal scan, having been 1 in 300 or 400 on the basis of her age alone, but she later had a baby with Down's syndrome. In retrospect discovering she was 'the one' made the figures seem meaningless.Source: http://www.healthtalkonline.org/Pregnancy_children/Antenatal_Screening

Assessing/ understanding risk

‘We got really lucky, I mean the doctor who did the scan, when she came out with our odds, she said that it was the lowest chance that she had seen in years. So we felt really reassured by that, as opposed to what the number would be to actually go and have the next step, something like amniocentesis.’

Source: http://www.healthtalkonline.org/Pregnancy_children/Antenatal_Screening

Decision-making: Further Tests

Following a screen positive, parents have to decide whether to have further diagnostic tests

Is ‘choice’ always really a choice?Whose choice is it?

Markens, S., C. H. Browner et al. (1999) ‘“Because of the risks”: how US pregnant women account for refusing prenatal screening’, Social Science and Medicine, Vol. 49, No. 3, pp. 359-369

Decision-making After Diagnosis

Following a diagnosis, parents are then faced with a number of choices:

• Foetal surgery or similar treatment • Continuing with the pregnancy without intervention• Termination of the pregnancy

Is ‘choice’ always really a choice?Whose choice is it?

Is non-directiveness by medical professionals fair?

Nilsson: The autonomous, extra-terrestrial embryo/foetus

Source:http://www.lennartnilsson.com/child_is_born.html

20 weeks

7weeks

Visual Medical Knowledge

What we see must be true (an assumption)

Medical gaze looked into corpses but is now trained on live bodies

Ultrasound relies on soundwaves to build up a picture

12 week ultrasound scan is routine, 20 week common

Women’s haptic hexus (embodied knowledge of pregnancy)is displaced by the optic hexus (visual knowledge ofpregnancy)

Ultrasound: The sound and light ‘show’

Bonding with a ‘greyish’ blur

Social birth precedes biological

birth

20 weeks12 weeks

12 weeks - Twins

20 weeks

Fathers and Ultrasound Scans

• Seeing the baby as ‘real’

• Feeling like a father

• Respect for and trust of: – Technology – The authority of healthcare

(professionals)

3D/4D screening technologies

Less need for interpretation

Marketing http://www.ultrasoundnow.co.uk

‘3D/4D scanning is an amazing three dimensional picture of your baby on the screen. Your baby can be seen moving, yawning, sucking its thumb and even smiling.  A truly magical experience!’

……..‘You will receive a CD of your scan which you can then use to reproduce the pictures… and e-mail them to friends. You will also receive a DVD… to be played time and time again.’

……..PLEASE NOTE:‘We consider all our scans to be diagnostic and never scan just for entertainment. The health of you and your baby is our primary concern so our sonographers will be checking that your baby is developing normally’…

……..

Package 1 - £190.0045 minute appointment with DVD, CD, 6 printed pictures and pregnancy progress report

Package 2 - £150.0045 minute appointment with CD, 6 printed pictures and pregnancy progress report

Is the Scan a Social or a Medical Event?

Medical professionals: gathering information about the ‘foetal patient’

Couples: seeking visual confirmation to share with their social network

‘Bad news’ will transform the scan’s meaning for the couple