1. Week 8 Embodied Experiences of Pregnancy in a Technological Age Caroline Wright Transformations: Gender, Reproduction, and Contemporary Society

2. Making Babies

3. http://www.youtube.com/watch?v =FUZaiXZUYJ4& http://www.youtube.com/watch?v=geA jS9JyASU& http://www.youtube.com/watch?v=PGrZZ7Ef2f0

4. Egg and Sperm: Scientific Fairy Tales ‘Gender stereotypes [are] hidden within the scientific language of biology.’ We learn ‘about more than just the natural world in high school biology class; we (…) learn about cultural beliefs and practices as if they were part of nature’(Martin, 1991: 485 – 486) ‘First, a wastefully huge swarm of sperm weakly flops along, its members bumping into walls and flailing aimlessly through thick strands of mucus. Eventually, through sheer odds of pinball-like bouncing more than anything else, a few sperm end up close to an egg. As they mill around, the egg selects one and reels it in, pinning it down in spite of its efforts to escape. It’s no contest, really. The gigantic, hardy egg yanks this tiny sperm inside, distills out the chromosomes, and sets out to become an embryo’ (Freedman, 1992) Freedman, David H. (1992) ‘New Theory on how the Aggressive Egg Attracts Sperm’, Discover, June, Available online: http://discovermagazine.com/1992/jun/theaggressiveegg55 Martin, Emily (1991) ‘The Egg and the Sperm: How Science Has Constructed a Romance Based on Stereotypical Male-Female Roles’, Signs, Vol. 16, No. 3, pp. 485-501 Moore, Lisa Jean (2007) Sperm Counts: Overcome by Man’s Most Precious Fluid, New York: New York University Press

5. The Gestation of a Lecture 1. The Medicalisation of Pregnancy: Dos and Don’ts and Antenatal screening and testing 2. Gender, risk, responsibility and decision-making 3. ‘Ultrasound in a visual society: a Light and Sound Show'

6. Medicalisation – the expansion of medical rationality and jurisdiction into the realms of previously non-medically defined phenomena – central feature of history of western societies since 17 th 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 The Medicalisation of Experience

7. 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 (so birth (re)defined as inherently risky, non-experts discredited) the selection of limited criteria of reproductive success the divorce of reproduction from its social context (so subject to complex technologies, bypassing women’s experiences, eg. technological quickening) the restriction of women to maternity and their typification as ‘naturally’ maternal (so happily pregnant, yet we know many women experience medicalized pregnancy as an anxious time, full of risk and uncertainty) The Medicalisation of Pregnancy

8. 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 Avoid unpasteurised milk Cook all meat thoroughly and wash all fruit and veg Heat ready meals and leftovers to maximum before eating Wear gloves if gardening, don’t change cat litter, avoid sheep during the lambing season Consider not dying your hair in first 12 weeks of pregnancy Avoid saunas, jacuzzis, hot tubs, steam rooms Avoid using solvent-based paints and stripping old paintwork Take a folic acid supplement, make sure you get enough iron Avoid supplements containing vitamin A, including cod liver oil, fish oils No more than 2 cups coffee per day, less if drinking cola Avoid alcohol, avoid smoking, avoid recreational drugs Avoid people with chicken-pox Avoid X-raysSource: Adapted from BBC Don’t try to lose weight while pregnant Health website

10. Antenatal Testing Screening = calculation of the statistical risk that a condition is present Diagnosis = confirmation of a condition (tests are invasive and involve 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?

11. Common Screening Tests Blood tests for genetic conditions (Huntington disease; sickle cell anaemia; thalassemia; cystic fibrosis) Blood tests for probability of chromosomal abnormalities (Down’s syndrome) - Screen negative : less than 1 in 250 chance - Screen positive: more than 1 in 250 chance Blood tests for multifactorial disorders (Spina bifida; Anencephaly) 12 week ultrasound scans (foetal viability, dating pregnancy) - Crown rump length indicates length of pregnancy - 10 weeks = 3cm; 12 weeks = 5-6cm; 13 weeks = 7cm Nuchal Translucency (Down’s syndrome) - False positive rate of 5%

12. Diagnostic Tests Chorionic Villus Sampling (CVS): Testing a sample of placental tissue (Down’s syndrome; sickle cell anaemia; thalassemia; cystic fibrosis) 10-15 weeks, 2% risk of miscarriage Amniocentesis (all the above plus spina bifida; anencephaly) 18 weeks, 0.5% risk of miscarriage Ultrasound scans (Spina bifida; Anencephaly)

13. Understanding and Assessing Risk Understanding risk information is difficult: - Relies on knowledge/ communication skills of 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 them. During the testing period, women experience their pregnancies as ‘tentative’ (Rothman, 1988): - Nancy, interviewed in Rothman’s study of experiences of amniocentesis, describes 3 week wait for results as : ‘a period of suspended animation because I was trying to deny the reality of the pregnancy to myself because of the fear of bad results. It was very difficult especially as the baby had started to move’ (1988: 103).

14. Experiences of Risk and Responsibility Testimonies posted on BabyCentre webforum about ante-natal tests: ‘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). See also: http://www.healthtalk.org/peoples-experiences/pregnancy- children/antenatal-screening/topicshttp://www.healthtalk.org/peoples-experiences/pregnancy- children/antenatal-screening/topics Focus on individualised risk management in ‘risk society’, decisions about prenatal testing and potential termination constructed as personal choices, bringing responsibilities: ‘If the mother doesn’t know about it [foetal abnormality] she can’t be blamed for going through with it [pregnancy]… If you don’t have it [amniocentesis] and you have a Mongol [baby with Down’s] you blame yourself, and if you have it and lose the baby you blame yourself’ (interviewee in Farrant, 1985, p. 118)

15. Decision-Making: Further Tests? Following a screen positive, pregnant women have to decide whether to have further diagnostic tests. 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 Is ‘choice’ always really a choice? Whose choice is it?

16. 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 Is non-directiveness by medical professionals fair? Is ‘choice’ always really a choice? Whose choice is it?

17. Testing and acting on test results creates new norms for foetal health, growth and development ‘Quality control’ becomes central to medical surveillance and management of pregnancy Aim is clearly the ‘perfect child’, ‘normal’, ‘healthy’ ‘By cloaking prenatal screening in language of ‘choice’ and autonomy, women are encouraged to participate in the workings of this powerful apparatus, to measure and identify anomalies so they can be reported and extinguished’ (Vanstone et al, 2014, p. 65) ‘Prenatal screening… [puts] the onus … on women to detect and abort foetuses with disabilities or to provide care for children with disabilities, obscuring the responsibility of society to help all people live to their full potential’ (Vanstone et al, 2014, pp. 66-67) Disability Rights Perspective

18. The Politics of Foetal Representation 20 weeks 7 weeks

19. Based on the assumption that what we see must be true Ultrasound passes soundwaves through the body which produce echoes, from which distance, size and shape of objects inside can be guaged Its routinisation and centrality in pregnancy has created an alternative epistemology of pregnancy where women’s haptic hexis (embodied knowledge) is displaced by the optic hexis (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, ‘bonding’) Visual Medical Knowledge

20. Individual and Collective ‘Bonding’ Ultrasound 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)www.meetyourbaby.co.uk

22. ‘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. Depending on the package you choose we can also save the scan onto 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. £95.00: 30 minute appointment with CD, 10 thermal images, baby sexing if requested and pregnancy progress report Package 2. £150.00: 45 minute appointment with CD and DVD of 2D, 3D and 4D images, 10 thermal images, 4 printed 3D pictures, baby sexing if requested and pregnancy progress report (www.ultrasoundnow.co.uk)www.ultrasoundnow.co.uk 3D/4D Ultrasound Technologies

23. 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 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. Medicalised Pregnancy as Ambivalence