When protagonists adjust frames to restore fluid and continuous
interactions
In situations where dialogue is blocked or where the emotional charge is
high, temporarily or definitively abandoning the frame of
medico-scientific expertise can sometimes be, for practitioners, the
only way of restoring interaction. A shift into the repertoire of
medical authority or compassion, repeated as many times as is necessary,
can revitalise interactions.
So when explanations relating to DS are interrupted by the partner of a
woman, who asks “Excuse me, but does this concern us?”, the
midwife realises that the information has not been understood. She
therefore momentarily ceases to impart knowledge to the couple, and
brings her subjectivity into play to reassure them: “You are 30
years old, I’m not worried, but I have to talk to you like this; it’s so
that I can explain”. The incursion into the reassuring medical
authority frame enables the midwife to return to that of
medico-expertise. The interactions continue, the midwife pays attention
to the couple’s needs and mobilises resources to support her actions:
Midwife: “Amniocentesis is the only way to be sure”.
Partner: “As you said, there’s a risk, so it’s better not to do
that”.
Midwife: “It all depends on what is important for you. If this
pregnancy is very important and you don’t want to risk a miscarriage,
then I say ‘fine’. If you tell me that you don’t want a child with Down
Syndrome, then I also say ‘fine”’.
Partner: “It’s her decision”.
Midwife: “We can take our time. We can meet again in a few days
so that I can explain again.
Woman: “I prefer to think about it. […] What if
we redo the ultrasound to look again at the neck?”
Midwife: We only do that at the start of the pregnancy”.
The decision is deferred, the midwife notes down the information she has
given to the woman and a new appointment is made.
The temporary abandon of the medico-scientific expertise frame and the
incursion into that of medical authority for reasons of solicitude
allowed to restore the course of interactions. In France, many
consultations demonstrated this type of adjustment.
More rarely, the practitioner’s recourse to the medical authority frame
causes a turning point in the course of the consultation. In France, a
woman of Muslim faith consults the geneticist who had monitored her when
the child she had given birth to one year ago died of a genetic disease
only a few days old. Pregnant again, she is terrified that it might
happen again: