Conclusiones bajo objetivos específicos o categorías

While a sense of worry and anxiety was felt to some degree by all participants, it was

experienced in different ways for those who had been designated to have high risk pregnancies. Two interviewees, Ainsley and Monique described being diagnosed as high risk early on in their pregnancies. This diagnosis meant that both women received more than the usual number of medical ultrasounds, between 8 and 12. While both women were aware of the medical necessity of their numerous ultrasounds, they were critical of the ways in which these procedures were performed, and the fact that they did not feel any sense of reassurance after leaving their medical ultrasounds. The health of their fetuses was only confirmed later, after the radiologist had

interpreted the results and issued a report. The delay in receiving a positive diagnosis meant that neither Monique nor Ainsley felt particularly reassured by their medical ultrasound experiences. In fact, they described feeling an increase in anxiety immediately following their medical ultrasounds as they were left waiting for test results to be delivered by the doctor. Monique noted,

Ultrasound providers are not allowed to, umm, interpret the results, right? It’s not within their scope of practice, so while they know the answer...you have wait for the radiologist to get the report, then they read the report, they get the report, someone else types the report, then they send it to your healthcare provider, then you make an appointment and you go, like two weeks later...I just fe[lt] such anxiety about leaving that room, I [was] so glad to get out of there.

The lack of immediate results was concerning for Monique, in that she felt she was left to worry for two weeks before she would be able to know if her fetus was healthy.

Interestingly both Ainsley and Monique were also more involved in the medical management of their pregnancies due to their occupations: Monique as a nurse and Ainsley as a birth doula and prenatal massage therapist. By virtue of their occupational training, Monique and Ainsley both claimed to have a familiarity with the medical system with which pregnant women are involved. This familiarity manifested as a level of understanding that medical and technological

interventions into pregnancy (such as ultrasound) were in fact necessary, in the context of their pregnancies. This is not to suggest, however, that Ainsley and Monique were unaffected by the uncertainty and fear experienced by other interviewees. In fact, Ainsley suggested that,

at any point in time, things could go wrong...you’re always in a bit of a panic until you hear the heartbeat.

Ainsley’s assertion is indicative of the different ways anxiety and uncertainty manifests for women with differing social, occupational and class backgrounds. For instance, Ainsley has the benefit of formal training in anatomy and physiology, as is required by her profession, as well as a job which positions her as an intermediary for pregnant women and the medical system. Even with the benefit of formal training and institutional knowledge, neither Ainsley nor Monique was immune to the feelings of anxiety and uncertainty experienced by women who were less

connected to the medical system. Although they described their medical ultrasounds at the time as “terrifying” (Ainsley) or “uncomfortable” (Monique) both women viewed their medical ultrasound procedures as necessary, and as ultimately successful in that they both had healthy children at the time of our interviews.

Of all the participants in this research, Monique was the most direct in her criticism of the medicalization of pregnancy. Although she was clear that she “was not threatened by healthcare” Monique suggested that the setting in which medical ultrasounds are performed, treat pregnant women as if they are sick. She offered,

It is, you know, everything you don’t want out of the medical system, at a time when things are great, you know so, you’re not in the medical system because you’re sick, you’re there because you’re having a baby...when you’re sitting in their office, you’re sitting there with a person hacking next to you!

For Monique, the distinction between being sick and being pregnant is a very important one. Given the number of ultrasounds she received during her high risk pregnancy, Monique had a lot of experience with both the technology and the technicians performing the scans. Most of these experiences she categorized as negative. Part of her negativity was due to more broad criticisms of the healthcare system in general, such as her suggestion that pregnant women should not be viewed the same as other patients, given that they are not sick. Her negativity was also, however, due to the anxiety she experienced around her diagnostic appointments. Monique explained,

I’m generally not a person who is threatened by healthcare but it’s, umm, you are a little anxious, like this is the first time you get to see what the baby is like, and if there are any problems, and you know, that’s why you’re there, to see if there’s any problems, so you know, by the end of your appointment, in your mind, you know, your baby has three heads [laughs]!

Monique went on to describe her medical ultrasound technician as “stone-faced” which was disconcerting for her as she was trying to read her technician’s facial expressions for any signs of worry or danger. As previously mentioned, Monique described at length her frustrations that diagnostic information is gathered and disseminated between numerous individual medical practitioners (such as general practitioner, radiologist, ultrasound technician) before it is given to pregnant women as patients. Monique explained,

I am a strong proponent of people having the information that they want out of

healthcare...in what other scenario is it okay for, umm, somebody who wants information about their own health or the health of their child to be told, I have the information and you’re not allowed to have it, by your healthcare provider? Never. I can’t think of [any other scenario]. So why is it suddenly okay when it comes to pregnancy and your own children, that people find that okay to withhold information?

The information to which Monique is referring is the sex of her fetus. She felt that the sex of her fetus was information that she wanted to have and thus strongly objected to her medical

ultrasound provider’s policy not to release that information until after a doctor has confirmed the results. Monique suggested that in part, due to this lack of information,

I just [felt] such anxiety about leaving that room, I [was] so glad to get out of there.

Monique’s anxiety was due to the organization of the medical management of pregnancy which distanced her from information about her fetus, as well as the particular interactions she had with her technician. Perhaps especially because her pregnancy was considered high risk, Monique highly valued the reassurance that she felt could be provided by ultrasound. Although it was clear she understood the purpose and importance of diagnostic scans, she was critical of the fact that,

[They’re] looking for negatives - like, I get that, I mean, that’s why people go to their healthcare providers, but there’s no focus on why you’re actually there, right? And there’s no reassurance, there’s no nothing, you’re just treated like you’re sick.

Although Monique recognized that the purpose of diagnostic ultrasound is to detect fetal abnormalities, she felt that, more broadly, pregnancy should be treated as a celebration. In describing a lack of focus on “why you’re actually there” Monique was referring to her

understanding of pregnancy as separate from other kinds of medical concerns that might position her as a patient within the medical system.

The positioning of pregnancy as tenuous and risky reinforces the need for medical intervention. As participants responses indicate, the medical management of pregnancy shifts authority and much of the decision making from women to medical professionals. Given that pregnant women will encounter medical ultrasound prior to elective ultrasound, (if they choose to purchase) it is important to consider their experiences with ultrasound in medical settings, and to determine what impact these experiences had on their decision to purchase elective ultrasound. The next section will focus on participants’ experiences with medical ultrasound.