Biomedical Engineering Reference
In-Depth Information
Second, this ultrasound screening is carried out in the fi rst trimester of the
pregnancy (gestational week 10-14), and thus intervenes in the life of the
pregnant women at an earlier stage of pregnancy than methods previously
used. As Statham
et al
. (1997) among others have argued, women's reactions
to pre-natal screening have to be understood within the context of the
psychology associated with pregnancy itself. Particularly the fi rst and last
trimesters of the pregnancy are characterized by an increased sensitivity
and anxiety. Third, in contrast to other screening targets, this chromosomal
abnormality has no other 'treatment' than selective abortion, and not all
women will consider a termination of the pregnancy as an option (Delholm
and Olsen 1992; Tymstra 1991).
In the exploration of the social impact of a new type of screening, it is
important to take account also of the social context of this screening. A
special feature of the ultrasound screening for Down syndrome is that it is
carried out within the context of the well-established and familiar maternity
health care services for all pregnant women, services that have a range of
tasks aiming at promotion of health and normality. Within this programme,
pregnant women will be offered various examinations and assessments of
their health, and the health of the foetus, as well as psycho-social support
and health educational sessions. This programme of maternity health care
seems to be understood by Swedish parents mainly as a means to check that
everything
is
'okay' (Bredmar and Linell 1999; Olin Lauritzen and Sachs
2001).
The individual pregnant woman of course brings her own expectations
and embodied experiences
5
to these encounters with the maternity services,
experiences that will guide her also if the assessments that are carried
out, explicitly or implicitly, 'question' the normality of the baby she is
expecting. These expectations will have to be understood also against the
back-drop of the way pregnancy in Western culture is understood to be
part of ordinary life, constantly referred to as normal or natural (also in
conversations between midwives and pregnant women, see Bredmar and
Linell 1999), albeit a unique and signifi cant experience in the life of the
individual woman.
The screening for Down syndrome is thus part of an ultrasound
examination, and ultrasound examinations are primarily understood as
confi rmation of normality and as a social event. The ultrasound examination
is in turn embedded in the well-established and 'supportive' maternity health
care services. As pointed out by Press and Browner (1997), broad patient
acceptance of a new form of prenatal screening can be accomplished 'under
the rubric of an older, and non-controversial, medical practice - routine
prenatal care' (1997: 987). Here, we want to explore the meaning and
signifi cance of screening for Down syndrome within the everyday life of the
woman, by looking further into women's experiences of the situation they
fi nd themselves in when normality is questioned after ultrasound screening
for Down syndrome in early pregnancy.
