Women as moral pioneers? Experiences of first trimester antenatal screening

Abstract

The implementation of innovative medical technologies can raise unprecedented ethical, legal and social dilemmas. This is particularly so in the area of antenatal screening, which is dominated by the language of risk and probabilities. Second trimester serum screening for Down's syndrome and neural tube defects has a well-established place in antenatal care. Increasingly, first trimester screening with biochemical and ultrasound markers is being proposed as advance on this, yielding higher detection rates of Down's syndrome at an earlier gestational age. This article explores the experiences of 14 women offered innovative first trimester screening, which takes place within the context of a detailed ultrasound scan. The study is set within the UK, where recent policy changes mean that the offer of screening for fetal anomalies, particularly Down's syndrome, will become a routine part of antenatal care and offered to all pregnant women. This paper focuses on the significance of the scan in first trimester screening, and some of the potential dilemmas for women that can result from this. It then discusses the ways in which women made their decisions about screening, in particular, their work as 'moral pioneers'. We found that the part played by the ultrasound scan in first trimester screening, particularly in relation to the higher-quality images now being obtained, has the potential to introduce new and novel ethical dilemmas for pregnant women. Although concerns have been raised about pregnant women viewing ultrasound scans as benign, many of the women reported having thought carefully through their own moral beliefs and values prior to screening. It seems that whatever other implications they may have, first trimester screening technologies will continue the tradition of pregnant women acting as 'moral pioneers' in increasingly complex settings.

Rates of prenatal screening across health care regions in Ontario, Canada: a retrospective cohort study

“…mending universal offer of prenatal screening, uptake varies by maternal preferences, [15][16][17][18][19][20] provider practice patterns [21][22][23][24][25] and maternal sociodemographic characteristics. [26][27][28][29][30][31][32] In light of the shifting and increasingly market-driven landscape of prenatal screening in Canada, 33 we examined the screening rates for publicly insured tests across health care regions in the province of Ontario.…”

Parents' dilemmas and decision making on the outcome of pregnancy after prenatal diagnoses of fetal anomalies

“…Problemi u psihološkom prilagođavanju ove dece pod nepovoljnim su uticajem nivoa stresa njihovih roditelja, za koji je utvrđeno da je viši u odnosu na populacione norme (Giallo, Gavidia-Payne, 2006). Takođe, utvrđeno je da braća i sestre dece sa ometenošću snažnije doživljavaju porodične konflikte i svakodnevni stres i teže se nose sa njima, u odnosu na decu čija braća/sestre pripadaju tipičnoj populaciji (Nixon & Cummings, 1999) Većina žena detaljno razmatra sopstvena moralna uverenja i vrednosti pre pristupanja prenatalnom skriningu (Williams et al, 2005). Čak i nedovoljno pouzdani pozitivni nalazi skrining testova mogu kod trudnica izazvati psihološku krizu i stanje otuđenja od sopstvenog fetusa, praćenu strahom od genetskog testiranja i dobijanja potvrde da sa njihovim fetusom nešto nije u redu (Getz & Kirkengen, 2003).…”

Seeing the Baby, Doing Family: Commercial Ultrasound as Family Practice?

“…It seems certain that women have internalised the medicalization of pregnancy to some extent (Rothman, 2014) and yet it is also clear that ultrasound has become a social landmark for women during pregnancy and is often anticipated with pleasure (Molander et al, 2010, Garcia et al, 2002. Scholars have pointed to the potential for tension between the social significance of ultrasound and its clinical aims, with each threatening to disrupt the other (Taylor, 1998) not least because ultrasound has the potential to raise questions about the health of the pregnancy and the foetus, requiring women to make complex decisions based on probabilities and risk calculations (Williams et al, 2003, Mitchell, 2004.…”