Transformations: Gender, Reproduction, and Contemporary Society

1. Transformations: Gender, Reproduction, and Contemporary Society Week 8: Embodied Experiences of Pregnancy in a Technological Age Dr. Maria do Mar Pereira m.d.m.pereira@warwick.ac.uk

2. Making Babies

3. Making Babies

4. http://www.youtube.com/watch?v=FUZaiXZUYJ4& http://www.youtube.com/watch?v=geAjS9JyASU& http://www.youtube.com/watch?v=PGrZZ7Ef2f0

5. Egg and Sperm: A Scientific Fairy Tale ‘Genderstereotypes [are] hiddenwithinthescientificlanguageofbiology.’ Welearn‘about more thanjustthe natural world in highschoolbiologyclass; we (…) lear[n] about cultural beliefsandpractices as iftheywerepartofnature’. (Martin, 1991: 485 – 486) ‘[B]ecomingaware of when we are projecting cultural imagery onto what we study will improve our ability to investigate and understand nature. Waking up such [gendered] metaphors, by becoming aware of their implications, will rob them of their power to naturalize our social conventions about gender.’ (Martin, 1991: 501)

6. The Gestation of a Lecture • The Dos and Don’ts of Pregnancy: Antenatal testing and the medicalisation of pregnancy • Gender, risk, responsibility and decision-making • ‘Ultrasound in a visual society: a Light and Sound Show'

7. The Medicalisation of Experience • Medicalisation – the expansion of medical rationality and jurisdiction into the realms of previously non-medically defined phenomena – as central feature of history of western societies since 17th century (Oakley, 1980, 1984). • Has led to the establishment of medicine as the dominant discursive and institutional framework for the surveillance and management of (both ‘healthy’ and ‘ill’) bodies. • Has led to a reconfiguration of the conceptualisation and experiences of reproduction  pregnancy becomes defined and treated as inherently risky medical conditions, necessitating active medical and technological monitoring and intervention. • Technological development played central role  can be understood both as a cause and result of growing medicalisation (Spallone and Steinberg, 1987; Reiser, 1978)

8. The Medicalisation of Pregnancy • According to Oakley (1980), the framework for conceptualisation and management of pregnancy in Western societies has 5 major features: • the definition of reproduction as a specialist subject in which only doctors are experts in the symptomatology of childbearing; • the associated definition of reproduction as a medical subject, analogous to other pathological processes as topics of medical knowledge and intervention; • the selection of limited criteria of reproductive success; • the divorce of reproduction from its social context; • the restriction of women to maternity and their typification as ‘naturally’ maternal.

9. The Dos and Don’ts of Pregnancy Eat fish, but not more than 2 portions oily fish/week and no shark, swordfish, marlin Drink plenty of water Avoid mould ripened soft cheese (brie, camembert) and blue-veined cheese (stilton) Avoid pate, avoid soft eggs, avoid liver, consider avoiding peanuts Avoid unpasteurised milk Cook all meat thoroughly and wash all fruit and veg Wear gloves if gardening Don’t change cat litter Take a folic acid supplement Make sure you get enough iron No more than 4 cups coffee per day, less if drinking cola Avoid alcohol Avoid smoking Avoid drugs Avoid people with chicken-pox Don’t try to lose weight while pregnant Source: BBC Health website

11. Antenatal Testing Screening = calculation of the statistical risk that a condition is present Diagnosis = confirmation of a condition (tests are invasive and include a risk of miscarriage). A positive screening result leads to the choice of undergoing diagnostic tests All tests are voluntary – but how easy is it to decline?

12. Common Screening Tests • Blood tests for genetic conditions (sickle cell anaemia; thalassemia; cystic fibrosis) • Blood tests for chromosomal abnormalities (Down’s syndrome) • Blood tests for multifactorial disorders (Spina bifida; Anencephaly) • Ultrasound scans (foetal viability) • Nuchal fold (Down’s syndrome)

13. Diagnostic Tests Chorionic Villus Sampling (CVS) (Down’s syndrome; sickle cell anaemia; thalassemia; cystic fibrosis) Amniocentesis (all the above plus spina bifida; anencephaly) Ultrasound scans (Spina bifida; Anencephaly)

14. Understanding and Assessing Risk Understanding risk information is difficult: • Relies on the knowledge and communication skills of the health professional • ‘False positives’ cause unnecessary anxiety • Benefits of screening vs. the anxiety it may cause Screening/diagnostic tests do not simply reduce anxiety and risk; they also contribute to produce them. During the testing period, women experience their pregnancies as ‘tentative’ (Rothman, 1986).

15. The Experience of Risk Testimonies posted on webforum for discussion of alpha-fetoprotein tests (www.babycentre.co.uk/tips/1487.html): • ‘I had my ultrasound and amniocentesis done two days ago and now I have to wait 2 weeks for the results. I am so worried and I can't stop thinking about it. I am so worried that I am giving myself anxiety attacks.’ (Shani) • ‘Like most of you, for the past four days I've been living on a roller coaster of fear, feeling like every ounce of joy has been sucked from this pregnancy.’ (Erin) • ‘This has been the longest week and a half on earth. … It’s so scary. I don't think I've cried this much in my whole life.’ (Michelle)

16. Decision-Making: Further Tests Following a screen positive, parents have to decide whether to have further diagnostic tests. But… Is ‘choice’ always really a choice? Whose choice is it? Despite being (more or less explicitly) presented as optional, prenatal screenings are often perceived by pregnant women as a ‘choice’ which they feel they are not free to refuse. Markens, S., C. H. Browner et al. (1999) ‘“Because of the risks”: how US pregnant women account for refusing prenatal screening’, Social Science and Medicine, Vol. 49, No. 3, pp. 359-369.

17. Decision-Making After Diagnosis Following a diagnosis, parents are faced with several choices: Foetal surgery or similar treatment Continuing with the pregnancy without intervention Termination of the pregnancy But… Is ‘choice’ always really a choice? The possibility of testing and acting on test results creates new norms and expectations for foetal health, growth and develop-ment, and makes ‘quality control’ a central concern of the medical surveillance and management of pregnancy (Rothman, 1989), reinforcing a ‘perfect-child mentality’ (Blank, 1993).

18. The Politics of Representation of the Embryo/Foetus 7 weeks 20 weeks

19. Visual Medical Knowledge • Based on the assumption that what we see must be true • Its routinisation and centrality in pregnancy has created an alternative epistemology of pregnancy where women’s haptic hexus (embodied knowledge) is displaced by the optic hexus (visual knowledge of pregnancy) • It has significant effects on how we conceptualise the status of the foetus (personhood, autonomy, who is the patient), and has thus played a central role in debates on abortion • Changes men’s experiences of pregnancy (seeing the baby as ‘real’, and feeling like a father)

20. Ultrasound: a Sound and Light ‘Show’ Another implication of ultrasound: • it enables both individual and collective ‘bonding’, whereby social birth comes to precede biological birth 20 weeks 12 weeks

21. 3D/4D Ultrasound Technologies • Why wait till the end of your pregnancy before you can meet your baby? • At Meet Your Baby, we can scan and show you your baby live in 2D, 3D or 4D dimensions on our large flat screen monitors. During your baby bonding ultrasound scan, we can even determine the sex of your baby. • Our highly qualified and experienced Ultrasound Sonographers, only operate the latest GE Voluson Ultrasound Scanning machines in our state of the art baby bonding scanning suites, to give you the best opportunity to see some really remarkable and magical images. • (www.meetyourbaby.co.uk)

22. 3D/4D Ultrasound Technologies • ‘3D/4D scanning is an amazing three dimensional picture of your baby on the screen. Your baby can be seen moving, yawning, sucking its thumb and even smiling.  A truly magical experience! (…) • You will receive a CD of your scan which you can then use to reproduce the pictures… and e-mail them to friends. You will also receive a DVD… to be played time and time again. • PLEASE NOTE: We consider all our scans to be diagnostic and never scan just for entertainment. The health of you and your baby is our primary concern so our sonographers will be checking that your baby is developing normally. ’ • Package 1. £190.00: 45 minute appointment with DVD, CD, 6 printed pictures and pregnancy progress report • Package 2. £150.00: 45 minute appointment with CD, 6 printed pictures and pregnancy progress report (www.ultrasoundnow.co.uk)

23. The Medicalised Pregnancy as an Experience of Ambivalence • What is sociologically interesting about women’s and men’s experiences of the medicalised pregnancy is that it is an experience both of alienation and elation (Petchesky, 1987). • Screening and foetal imaging technologies are both both empowering and disempowering, distressing and reassuring, sources of anxiety and comfort, forms of controlling pregnant women and of helping them feel in control of their pregnancies. • Thus, we must recognise the complexity and ambivalence that characterise embodied experiences of pregnancy in a technological age.