Ontological Politics and Medical Maternity Care in Germany – Prenatal Decision Making from a Praxeographic Approach

Annemarie Mol argues that medical knowledge production in health care is a form of ontological politics because the production of facts is shaped within the practices of health care itself (Mol 1999). In my talk I will illustrate in which way medical maternity care in Germany is a form of ontological politics. In Germany, maternity care is performed almost exclusively by obstetricians. Check-ups and ultrasound examinations are directed at detecting risks or jeopardized health in pregnant woman and fetuses as early as possible in otherwise healthy pregnancies. From the point of medical ethics it is argued that the offer of diagnostic testing helps women to make better and more informed choices about their future life as parents. In my talk I would like to highlight how the offer of prenatal testing procedures is embedded in the routine processes of medical maternity care and ultrasound examinations. Drawing on praxeographic perspectives and empirically based on participant observation of maternity care and ultrasound examinations in obstetricians’ offices I want to call into question that more choice is a source of empowerment and freedom. I will explore how the assumption of informed consent and autonomous decision making is framed in the routine practices of maternity care and how “choice” comes to represent a specific form of ontological government. I will also discuss Annemaries Mols (2008) suggestion to switch from a “logic of choice” to a “logic of care” and how this approach might be more in accordance with how prenatal decisions are actually made.