The Everyday Work of Healthcare Professionals: An Ethnography of Screening for Down’s Syndrome in UK Antenatal Care
Author: Thomas, Gareth M, thomasg23@cf.ac.uk
Department: School of Social Sciences
University: Cardiff University, United Kingdom
Supervisor: Professor Joanna Latimer and Professor Adam Hedgecoe
Year of completion: 2014
Language of dissertation: English
Keywords:
Disability
, Ethnography
, Professionals
, Reproduction
Areas of Research:
Health
, Professional Groups
, Science and Technology
Abstract
This thesis reports on a UK-based ethnography of prenatal screening for Down’s syndrome across two hospitals. By studying the mundane and routine practices of the clinic, I initially capture how Down’s syndrome screening is organised and how its sedimentation as a taken-for-granted aspect of pregnancy contributes to the procedure being ‘downgraded’. This downgrading accomplishes hierarchies of valued/valueless work and professional specialities and also, therefore, of certain professional identities. In what follows, I explore the conduct of care and how professionals detach from Down’s syndrome screening by assigning responsibility for decision-making to parents-to-be. Professionals’ devotion to the rhetoric of ‘informed choice’ and ‘non-directive care’ also naturalises screening as a ‘normal’ part of pregnancy, this routinisation being extended by parents-to-be (often with professionals) privileging the ‘social’ rather than ‘medical’ dimension of ultrasound scanning. I continue by analysing how Down’s syndrome itself is constituted both inside and outside screening encounters. During consultations, the condition is rarely discussed and is substituted with dominant discourses of ‘risk’, ‘problem’, and ‘abnormality’. The condition is subsequently constructed as a negative pregnancy outcome. This intersects with the production and reproduction of ideas around perfection in the social practices and cultural materials of the clinic and how, if a diagnosis is established, the unborn ‘baby’ is recast as a ‘foetus’. By making this move, the unborn baby is denied personhood and a termination of pregnancy is made possible. To conclude, I highlight how the routine practice of prenatal screening for Down’s syndrome has transformed antenatal medicine, invigorated parental expectations, shaped issues around reproductive politics, and cultivated certain body-society relations.
