Women's Experiences of Prenatal Ultrasound in the Context of Atypical Findings
AdvisorMoules, Nancy J.
AuthorPowell, Christopher David
Committee MemberEstefan, Andrew
ClassificationObstetrics and Gynecology
Subjectprenatal ultrasound, atypical images, disability, Down Syndrome, hermeneutic research, eugenics
MetadataShow full item record
AbstractPrenatal ultrasound (U/S) can play a vital role in supporting reproductive choice. As a diagnostic modality, U/S provides clinical data that inform approaches to managing complicated pregnancy. The capability of U/S to detect fetal anomalies intensifies the hunt for clinically suspicious features and consequently advances the frontier of prenatal intervention. These features of U/S create tension between ideologies about how pregnancy should be experienced and set conditions that complicate physician-patient relationships. In light of ethical concerns about the dialogue in which atypical U/S images are presented to patients and what these images mean to them, I interviewed six participants to further understand women's experiences of prenatal U/S, in the context of atypical findings. I used tenets of philosophical hermeneutics to guide my analysis of the text of our conversations, which revealed how language surrounding atypical U/S is laden with prejudice against women's decisions to maintain atypical pregnancies. Participants assumed that U/S is routine, with little to no awareness that it is a procedure they can decline. There was a prevailing belief that U/S sessions would be positive experiences that carry no risk. However, autonomy and personal values are threatened in the setting of clinically remarkable U/S images. The concept of risk is problematic to physician-patient dialogue about potentially difficult decisions in the wake of discovering fetal anomalies. The current language of risk fails to bridge the abstract ideas of numeracy with real-world practice. Risks arise when physicians' biases overshadow a patient's preference to decline diagnostic testing altogether, or to decline abortion when anomalies are detected. Participants who gave birth to babies with Down syndrome shared grave concerns about U/S's potential role in systematically eradicating trisomy-21. Their experiences give reason to seriously consider the history of eugenics in the context of prenatal screening, and how the current application of U/S threatens human diversity. Physicians must acknowledge how language reinforces power dynamics that transform clinical encounters into experiences of acute and lasting injury to their patients. A hermeneutic approach to practice can enhance communication about the challenges ensuing from atypical U/S and restore ethical integrity to physician-patient dialogue.
CitationPowell, C. D. (2019). Women's Experiences of Prenatal Ultrasound in the Context of Atypical Findings (Unpublished doctoral thesis). University of Calgary, Calgary, AB.
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