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Lecture 5: Embodied Experiences of Pregnancy in a Technological Age Dr Sherah Wells Sherah.Wells@warwick.ac.uk Transformations: Gender, Reproduction, and Contemporary Society PPupdateSWells11.12

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The gestation of a lecture Part 1 Dos and Donts Introduction to antenatal testingPart 2 Gender, risk, responsibility and decision-making Part 3 Ultrasound in a visual society: a Light and Sound Show'

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Dos and Donts in Pregnancy Eat fish, but not more than 2 portions oily fish/week and no shark, swordfish, marlin Drink plenty of water Avoid mould ripened soft cheese (brie, camembert) and blue-veined cheese (stilton) Avoid pate, avoid soft eggs, avoid liver, consider avoiding peanuts Avoid unpasteurised milk Cook all meat thoroughly and wash all fruit and veg Wear gloves if gardening Dont change cat litter Take a folic acid supplement Make sure you get enough iron No more than 4 cups coffee per day, less if drinking cola Avoid alcohol Avoid smoking Avoid drugs Avoid people with chicken-pox Dont try to lose weight while pregnant Source: BBC Health website

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Antenatal testing: Screening Calculation of the statistical risk that a condition is present

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Antenatal testing: Diagnostics Confirmation of a condition (tests are invasive and include a risk of miscarriage).

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Common screening tests Blood tests for genetic conditions (sickle cell anaemia; thalassemia; cystic fibrosis) Blood tests for chromosomal abnormalities (Downs syndrome) Blood tests for multifactorial disorders (Spina bifida; Anencephaly) Ultrasound scans (foetal viability) Nuchal fold (Downs syndrome)

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Diagnostic tests Chorionic Villus Sampling (CVS) (Downs syndrome; sickle cell anaemia; thalassemia; cystic fibrosis) Amniocentesis (all the above plus spina bifida; anencephaly) Ultrasound scans (Spina bifida; Anencephaly)

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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 http://www.healthtalkonline.org/Pregnancy_child ren/Antenatal_Screening/Topic/2056/

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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 Downs]. Source: http://www.healthtalkonline.org/Pregnancy_children/Antena tal_Screening

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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_childr en/Antenatal_Screening

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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_childr en/Antenatal_Screening

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Decision-making: Further Tests Following a screen positive, parents have to decide whether to have further diagnostic tests 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 Is choice always really a choice? Whose choice is it?

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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?

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Nilsson: The autonomous, extra- terrestrial embryo/foetus Source: http://www.lennartnilsson.com/child_is_born.html 20 weeks 7 weeks

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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 Womens haptic hexus (embodied knowledge of pregnancy) is displaced by the optic hexus (visual knowledge of pregnancy Visual Medical Knowledge

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Ultrasound: The sound and light show Bonding with a greyish blur Social birth precedes biological birth 20 weeks 12 weeks

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12 weeks - Twins 20 weeks

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Fathers and Ultrasound Scans Seeing the baby as real Feeling like a father Respect and trust for Technology The authority of healthcare (professionals)

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3D/4D screening technologies Less need for interpretation

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Marketing http://www.ultrasoundnow.co.uk/obstetric/3d-and-4d-baby- scan/

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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 scans meaning for the couple

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Conclusions New technologies create new needs and demands Technologies do not evolve in a vacuum. They are subject to social constraints. Focus on technology can divert attention from power struggles in human relationships