Biomedical Engineering Reference
In-Depth Information
6
A normal pregnancy?
Women's experiences of being
at high risk after ultrasound
screening for Down syndrome
Sonja Olin Lauritzen,
Susanne Georgsson Öhman and
Sissel Saltvedt
Introduction
The development of medical technology in the fi eld of reproductive health
has been quite dramatic through recent decades. New technology has been
developed, and also introduced into medical practice, making possible new
types of assessments of deviance from normality. Some of these technologies,
such as the ultrasound scan, have been turned into routine tests in clinical
practice. Today, the ultrasound scan is part of health surveillance of pregnant
women in most high-income countries. It was fi rst introduced as a method
to provide information of importance for a safe delivery, 1 but the ultrasound
technology has gradually become more sophisticated and it is now possible to
detect an increasing range of foetal abnormalities, even earlier in pregnancy.
One of the recent developments in this direction, that we will address in this
chapter, is nuchal translucency screening at ultrasound examination for early
detection of Down syndrome (Snijders et al . 1998). Nuchal translucency
screening is currently being tested and evaluated in Sweden as well as in other
countries, and discussed as a possible new routine method to be included in
national programmes of health surveillance of all pregnant women. 2
The development of the new ultrasound screening for Down syndrome,
as do other technologies to detect foetal abnormality, raises a series of
psychological and ethical questions (Williams et al . 2002; see also Chapter
4 in this volume) as well as questions concerning the social impact of
this screening, some of which we want to address in this chapter. From a
sociological point of view, the ultrasound screening, targeting all pregnant
women, can be discussed and problematized as an exponent of 'surveillance
medicine' (Armstrong 1995). Of particular interest is the shift in the medical
gaze inherent in this paradigm, from the actual to the potential presence of
disease or disability, and thus a focus on early detection of deviance from
normality. This shift, and the increasing medical-technological possibilities
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