The medico-scientific expertise frame
This frame was predominant in our observations, articulating a moral stance that supports the actors’ ability to make rational and autonomous choices3,4 with a grid for understanding situations based on the medico-scientific rationale at work in evidence-based medicine. This is the frame that dominates the ‘therapeutic modernity’.2 Practitioners are tasked with helping women decide whether to continue with the investigations, and therefore accept the risk of miscarriage when a sample is taken. This presupposes that women have acquired sufficient expertise regarding the model for calculating risks and interpreting their significance, and that practitioners have provided clear information without engaging their own subjectivity. The actions taking place within this frame thus essentially involve providing/receiving/asking for scientific and technical information relating to the nature of the risks, their value and mode of calculation, how the medical acts are performed, and the aetiology and consequences of the suspected pathologies.
All the consultations we observed began in the medico-scientific expertise frame with the practitioner explaining the risk as being the reason for the consultation. “I’m seeing you today to discuss the results of the blood test. It allows us to evaluate the statistical risk of having a child with Down Syndrome. Your risk is…” (Midwife, France). Detailed technical information is then provided, depending on the type of risk.
“It would appear that you have contracted a toxoplasmosis. […] The risk of transmission increases with the term. At the beginning of the pregnancy it is 1%, at 9 months it is 80% of babies who are contaminated. [but]the consequences are not the same. If it is before 15 weeks, there can be serious consequences. Toxoplasmosis attacks the entire organism but the most serious consequences are on the brain” (Consultant, France).
Once the information on possible foetal anomalies has been given, the practitioner provides details on the risk of miscarriage when a sample is taken. The risk is frequently weighted by information on the expertise of the operator, designed to reassure: