title: Representing and intervening: 'doing' good care in first trimester prenatal knowledge production and decision-making.
abstract: This article investigates processes of knowledge production and decision-making in the practice of the first trimester prenatal risk assessment (FTPRA) at an ultrasound clinic in Denmark. On the basis of ethnographic material and interviews with professionals facilitating FTPRAs in Denmark, we draw attention to the active engagement of health professionals in this process. Current professional and policy debate over the use of prenatal testing emphasises the need for informed choice making and for services that provide prospective parents with what is referred to as 'non-directive counselling'. Studies focusing on professional practice of prenatal counselling tend to deal mainly with how professionals fail to live up to such ideals in practice. In this article we extend such studies by drawing attention to practices of care in prenatal testing and counselling. In doing so, we identify three modes of 'doing' good care: attuning expectations and knowledge, allowing resistance and providing situated influence in the relationship between the pregnant woman and the professional. Such practices may not be seen as immediately compatible with the non-directive ethos, but they express ways of reducing emotional suffering and supporting a pregnant woman's ability to make meaningful choices on the basis of uncertain knowledge. As such, these practices can be seen as representing another (caring) solution to the problem of paternalism and authoritarian power. In opposition to an ethics aiming at non-interference (non-directiveness) such modes of doing good care express an ethics of being locally accountable for the ways in which programmes of prenatal testing intervene in pregnant women's lives and of taking responsibility for the entities and phenomena that emerge through such knowledge production.
authors.affiliation: Steno Health Promotion Centre, Gentofte, Denmark. ntsc@steno.dk
authors.forename: Nete
authors.initials: N
authors.lastname: Schwennesen
authors.forename: Lene
authors.initials: L
authors.lastname: Koch
mesh_terms: D003142:Communication; D003657:Decision Making; D003718:Denmark; D037001:Directive Counseling; D005007:Ethnology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011295:Prenatal Care / Q000379:methods*; D011369:Professional-Patient Relations; D036301:Qualitative Research; D018570:Risk Assessment / Q000379:methods; D016216:Ultrasonography, Prenatal