Antenatal care in Sweden is voluntary but offered to all pregnant persons. It is organised in accordance with a standardised programme where midwives do pregnancy check-ups and inform about pregnancy, childbirth and becoming parents. But a standardised programme can be difficult to apply to the varying individuals’ wants and needs.Through interviews with midwives and observation of parental education, the article attends to the tension that arises between standards and voluntariness in antenatal care and the often-invisible alignment work done by midwives to make knowledge attractive and palatable to parents-to-be. It does so by showing that the recipients wanting the knowledge becomes important for it to be moved with stability and integrity without losing meaning. The article contributes to ongoing discussions about how scientific knowledge is turned into practice by elucidating the affective dimensions of alignment work and how feelings may facilitate or hinder the movement of knowledge.

This article is about the feelings – affect – induced by the digital rectal exam of theprostate and the gynaecological bimanual pelvic exam, and the care doctors are orare not instructed to give. The exams are both invasive, intimate exams located ata part of the body often charged with norms and emotions related to gender andsexuality. By using the concept affective subject, we analyse how these examinations aretaught to medical students, bringing attention to how bodies and affect are cared foras patients are observed and touched. Our findings show both the role care practicesplay in generating and handling affect in the students’ learning and the importance ofthe affect that the exam is (or is not) imagined to produce in the patient. Ours is amaterial-discursive analysis that includes the material affordances of the patient anddoctor bodies in the affective work spaces observed.

The authors encourage a continuous attentiveness to thinking and caring about the challenges medical students will encounter during sensitive discussions. 

Context

Teaching intimate examinations to medical students has been recognised as difficult because of the anxious feelings that the students may experience. For their professional development, previously incorporated understandings need to be relearned: how to transgress boundaries that regulate intimacy and physical closeness, learning to examine and touch other peoples' bodies, and talking about things that are otherwise taboo.

Objectives

This paper compares how students learn to perform two intimate examinations: (i) the digital rectal examination (DRE) of the prostate, and (ii) the bimanual pelvic examination (PE) and analyses how norms and expectations affect how students learn to approach them.

Methods

This study is based on ethnographic work: in‐depth qualitative interviews with two urologists and nine medical students in semesters four, eight and 11 of a medical education programme in Sweden, observations of three learning sessions where 16 students performed the PE on professional patients, and 2 days of observations at a urology outpatient clinic.

Results

The educational approach to the PE and DRE differ. The PE is taught as sensitive and to be handled with care, using a well‐documented learning concept including interpersonal and technical skills. The patient's exposed position in the gynaecological chair, possible previous negative experiences of PE or sexual exploitation are taken into account. In contrast, there is no educational concept for teaching the DRE. The students perform their first DRE on a clinical patient. The DRE is also handled with care, but with less sensitivity. The patients' possible previous negative experiences are not discussed and are thus made invisible.

Conclusions

Well‐established routines in performing the PE help doctors and students to be attentive to patients' emotions and previous experiences, and remind them to perceive the examination as sensitive. Aligning the teaching of the DRE with that of the PE will improve how the male prostate patient is approached.

Vissa undersökningssituationer kan upplevas som intima och känsliga, både för läkaren och för patienten. Prostataundersökningen är en sådan situation. Från det medicinska perspektivet lyfts dock inte alltid prostataundersökningen fram som särskilt känslig, utan kan behandlas som vilken rutinkontroll som helst. Denna inställning påverkar hur läkarstudenter får lära sig att utföra prostataundersökningar. I detta kapitel visar jag vad som kan förändras och göras annorlunda genom att kontrastera med den gynekologiska undersökningen – en annan kroppsligt intim situation som har mycket gemensamt med prostataundersökningen men som lärs ut på andra sätt.

Pregnancies and childbirths are not just biological or medical events. Childbirths are also emotionally intense situations, not only for the parents-to-be but also for those who work in delivery care. In addition, pregnancies and childbirths are sociocultural situations; there are norms regarding the normal birth.

The study investigates how future midwives learn about the interactive and emotional work involved in supporting women in delivery care. It focuses on norms about the normal birthing trajectory and on how a midwife should encounter patients’ feelings and handle her own feelings in a “proper” way. Based on observations of collaborative group discussions within Swedish universitybased midwifery education, the study shows how students negotiate the appropriate feeling norms in normal birth, as well as in complicated and even tragic situations. In focus are their discussions on how to support the birthing women, their partners, and the babies, and the categorization work needed to recognize potential deviations from the normal birth. The study is based on a situated learning perspective on education, and combines sociological and anthropological approaches to emotions to elucidate how students within midwifery education negotiate the professional handling of normal and complicated births and the attendant feeling norms.

Graviditeter och förlossningar är inte bara biologiska eller medicinska händelser. Förlossningar är också känslomässigt intensiva situationer, både för de blivande föräldrarna och för dem som arbetar inom förlossningsvård. Graviditeter och förlossningar kan dessutom ses som sociokulturella händelser och det finns normer om den normala förlossningen.

I avhandlingen undersöks hur framtida barnmorskor lär sig att stödja kvinnor inom förlossningsvården och det interaktiva och emotionella arbete som det innebär. Avhandlingen fokuserar på normer om den normala  förlossningstrajektorian samt hur en barnmorska ska bemöta patienternas känslor och hantera sina egna känslor på ett ”korrekt” sätt. Baserat på observationer av basgruppsgruppdiskussioner under den universitetsförlagda delen av en barnmorskeutbildning, visar studien hur barnmorskestudenter förhandlar känslonormer i relation till normal förlossning samt till komplicerade och även tragiska situationer. I fokus är studenternas diskussioner om hur de kan stödja de födande kvinnor, deras partners och barn samt den kategorisering som behövs för att identifiera eventuella avvikelser från den normala förlossningen. Studien bygger på ett situerat lärandeperspektiv på utbildning och kombinerar sociologiska och antropologiska förhållningssätt till känslor för att på så sätt belysa hur studenter inom en barnmorskeutbildning förhandlar hur normala och komplicerade förlossningar bör hanteras och de känslonormer som framkommer.