Inescapable burden of choice? The impact of a culture of prenatal screening on women's experiences of pregnancy.

ABSTRACT

Drawing on research in progress, this paper examines the costs for pregnant women of trends towards routine screening in pregnancy. In particular, the notion that the array of choices contingent with prenatal screening may constitute an unwelcome ethical burden for pregnant women will be considered, as well as the extent to which women are able to give free and informed consent for screening. The development of new technologies in the area of reproductive health, including new tests to detect fetal abnormality during pregnancy, has triggered considerable ethical debate about the possible benefits and dangers of such screening. While such debate has tended to focus on the value of the individual technologies themselves, the ethics of how the technologies are implemented, of how the encounter between lay people and biotechnology is best to be conducted, have received comparatively little attention. This is particularly true in the case of prenatal ultrasound, a technology which has increasingly become part of routine prenatal care for the majority of pregnant women. This discussion will consider whether such screening may contribute to an ideological climate in which it may no longer be possible to experience pregnancy as a 'normal' embodied state. As an area of concern identified by participants in this research, the issue of informed consent for prenatal screening will be a key focus, including a brief case study highlighting one participant's experience.

KEY WORDS

Prenatal screening, pregnant embodiment, choice, ethics, informed consent

Working in the field

While my research is framed within a sociological perspective, my interest in prenatal screening first arose during my experiences as a registered midwife within the New Zealand hospital system. The notion of pregnancy as a normal life event, as distinct from a state of imminent pathology and risk, underscores the philosophy and practice of midwifery. Yet, working within the hospital system I was well aware of the ideological tensions between the idea of pregnancy as a normal life event, and the medicalised model of health. Such ideas have become deeply entrenched within popular culture, with the result that, in my experience, a large component of midwifery care involved counselling women to help overcome a deep-seated fear of birth and a belief that pregnancy was far from a normal life state.

Within this clinical environment the received view of prenatal screening is that it exists generically as a health benefit for all pregnant women. Historically, however, these technologies have tended to be selectively offered to 'at risk' groups, such as older mothers and those with a family history of fetal abnormality (Ettore 1999).