The Organisation of Care: How Professionals Perform, Routinise, and
Downgrade Screening for Down’s Syndrome in the Prenatal Clinic
1
Gareth M. Thomas1
Cardiff University, 12 Museum Place (2.05), CISHeW, Cardiff, UK, CF10 3BG
ThomasG23@cf.ac.uk
Screening for Down’s syndrome constitutes a routine practice in UK prenatal care; in
2011, over 500,000 pregnant women in England and Wales opted for the procedure,
amounting to a 74% uptake rate. However, few researchers have explored how this
routinisation – of prenatal screening becoming a ‘normal’ and taken-for-granted practice
– is accomplished, particularly in everyday clinical interactions. Drawing on an
ethnography of two UK-based hospitals and by taking account of the clinic through an
interactionist lens, I explore how Down’s syndrome screening is organised, performed,
routinised and, ultimately, ‘downgraded’. I define downgrading as practices which
denigrate and minimise the importance, value, and/or reputation of someone or
something. Specifically, I identify how Down’s syndrome screening is downgraded in
three interrelated ways.
First, the task of screening is relegated from consultants to midwifes/sonographers
who act as an unwitting ‘mop-up service’ (Bosk 1992), that is, those who do the ‘dirty
work’ (Emerson and Pollner 1976) of the clinic. Drawing on Latimer’s (1999)
‘constituting of classes’, I explore how screening is categorised into a hierarchy of values
and, in turn, framed as polluting the purity of the (technical) clinical space, meaning that
it is reclassified as a non-technical matter. Second, professionals construct Down’s
syndrome screening, inside and outside of consultations, as a routine affair via both social
processes (e.g. its description as a ‘simple test’) and cultural materials (e.g. doors
remaining open during consultations). Third, professionals downgrade screening as a
tedious duty which does not permit the performance of an authentic or imagined
midwife/sonographer role. They invest value in tasks which afford them a chance to
become acquainted with parents and to do something for them. However, professionals
detach from Down’s syndrome screening on a consistent basis since it represents ‘handsoff work’, that is, labour which is monotonous and cannot regularly offer the rewards of
more ‘interesting’/demanding activities.
In short, I capture how prenatal screening for Down’s syndrome becomes
routinised on account of its depersonalisation, trivialisation, and downgrading via both
human and nonhuman interactions, thus reaccomplishing certain hierarchies and
identities in the clinic. The downgrading of screening is attributable to both
professionals’ personal values and several organisational constraints (the threat of legal
action, time restrictions). The work of professionals, then, is inhibited and patterned
according to each institution and the various negotiations, routines, and stipulations
enacted in the clinic (Timmermans and Berg 1997). Nonetheless, I conclude by
recognising the importance of critically attending to mundane routines and banal
interactions in the clinic. My arguments will appeal to sociologists, anthropologists, and
STS scholars interested in the social study of medicine, professions, and organisations,
and who make their claims from an interactionist perspective.