An Elephant in the Consultation Room?: Configuring Down Syndrome in British Antenatal Care

Abstract

This article is based on an ethnographic study of prenatal screening for Down syndrome in two British health care institutions. Drawing on observations of everyday hospital life and interviews with health care professionals, I identify how a discussion of Down syndrome is avoided during prenatal screening consultations. This relative silence is created and upheld because of three things: (1) the British public is considered as knowing what Down syndrome is; (2) the organization of care dictates that the condition is not classified as important enough to justify an explanation within consultations; and (3) professionals frequently admit to having minimal knowledge of Down syndrome. This absence, together with the condition being categorized as a risk or problem, helps produce and uphold its status as a negative pregnancy outcome. I conclude by highlighting the contributions that this article has for anthropologically exploring how ideas around disability intersect with the proliferation of reproductive technologies.

Experiences and expectations in the first trimester of pregnancy: a qualitative study

“…Within qualitative research, much attention has been dedicated to the extraordinary biological and social dramas of pregnancy such as infertility, prenatal diagnosis or premature birth. However, within recent years, there has been a growing interest in pregnancy as an everyday experience . These studies explore pregnancy through a methodological and theoretical focus on the daily activities through which the pregnancy and future child are made important (or unimportant) in the lives of pregnant women and their partners.…”

Special Issue: Complexity, Routines, and Reflexivity in Professional Work

“…We are interested in both how the experiences of tensions relate to (changes in) the practices of how risk work is accomplished, and how these tensions may remain partially veiled; never being fully exposed or confronted and thus remaining awkward in experiences of everyday work (see, for example, Thomas, 2016). Or indeed there are other instances where one might expect a controversial or apparently incongruous risk management policy-such as requiring health professionals to screen for risk of radicalisation-to create all kinds of tensions for professionals, but where this policy can be experienced relatively unproblematically through its incorporation into familiar professional discourses (Chivers, 2018).…”

“…How these types of individual-level tensions are experienced and negotiated by practitioners has not, to our knowledge, been considered in the literature. However, relevant empirical findings include those healthcare practitioners who do not follow the same advice they give patients (Gale et al, 2011;Raude, Fischler, Lukasiewicz, Setbon, & Flahault, 2004), or who do follow it but with ambivalent feelings (Armstrong-Hough, 2015, Thomas 2016). …”

“…Despite the tensions and anomalies which begin to surface amid risk work, the habits and learned practices of workers, and various lifeworld processes may prevent these tensions from being fully exposed and subjected to rational scrutiny. Those carrying out risk work continue, more or less informally, to pragmatically muddle through and adjust their practices in relation to risk knowledge, the interventions they are part of and their social relations with clients, but with these tensions continuing to bear on their everyday experiences (Thomas, 2016).…”

“…Practitioners have case-loads to get through or workshops to deliver. They may feel that they are not paid to question but to deliver (Thomas, 2016). Where risk knowledge is experienced as problematic in terms of truth and/or legitimacy then, rather than being challenged, other informal ways of handling uncertainty are drawn upon-such as alternative heuristics and/or trust (Zinn, 2008).…”