Biomedical Engineering Reference
In-Depth Information
Ann-Cristine Jonsson
The negotiation and construction of normality through the
ultrasound examination
To shed light on the communication and negotiation of normality, I will draw
on an analysis of twelve observed and audio-taped ultrasound examinations
which are part of a larger empirical study of how the ultrasound image is
communicated and ascribed meaning in the interaction between the midwife
and the parents-to-be (Jonsson 2004). The participants in these twelve
examinations were couples, expecting their fi rst or second child together.
(Some of them had children in earlier relationships.) They all came for
routine ultrasound scans, and none of them had any illnesses or complications
related to the pregnancy that was known about beforehand.
One characteristic feature of the clinical encounter is that it is structured
by distinct phases that recur in every meeting (Drew and Heritage 1992). As
the structure, and the phases of the encounter, is shaped by the tasks that the
professional has to carry out, these phases will vary between different types of
clinical settings (Baggens 2002; Hydén and Mishler 1999; Silverman 1987;
Mishler 1984). The routine ultrasound examination proved, similar to other
clinical encounters, to be clearly structured by the professional tasks of the
midwife (Jonsson 2004). I have earlier described how the typical ultrasound
examination can be seen as structured into four distinct phases (ibid.). The
fi rst phase, the 'initial control', is a critical part of the examination during
which the midwife fi nds out if the baby is healthy or not. The midwife uses
the image on the screen fi rst of all as a tool to perform her professional tasks.
During the second phase, 'measurements', the midwife also uses the screen
image primarily as a diagnostic tool, but she also starts to interpret the image
to the parents. Proceeding to the next phase, 'showing the baby's body parts',
the midwife tries to make what is shown on the screen understandable to the
parents. During the last phase, 'taking the baby's picture', the midwife tries
to capture a picture that depicts the unborn baby in a 'baby-like' position
that resembles a portrait when she prints a paper copy of the screen image.
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Here, I will follow these phases of the ultrasound examination, phase by
phase, to explore the ways in which normality is negotiated and established
in the interaction between the midwife's professional perspective and the
parent's everyday perspective, through the ultrasound examination. First,
I will explore how the issue of normality is typically managed between the
different perspectives of the midwife and the parents in the clinical encounter,
and then look at how a suspicion about a potential deviance in the baby's
health is dealt with.
Localization and confi rmation of the baby's existence
In the fi rst phase of the ultrasound examination, 'initial control', the fact that
the baby exists is confi rmed by the midwife. In Example 1, we will follow
Lena and Lennart and their midwife through this phase. These parents-to-be
