Transformations: Gender, Reproduction, and Contemporary Society

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

2. 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'

3. Dos and Don’ts 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 Don’t 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 Don’t try to lose weight while pregnant Source: BBC Health website

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

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

6. 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)

7. 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)

8. 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_children/Antenatal_Screening/Topic/2056/

9. 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

10. 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

11. 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

12. 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

13. 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?

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

16. 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 of pregnancy

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

18. 12 weeks - Twins 20 weeks

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

20. 3D/4D screening technologies Less need for interpretation

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

22. 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

23. 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