1. Private 4D ultrasound scans in pregnancy: between medicalisation and control Franziska Wadephul*, Julie Jomeen* and Lesley Glover** * Faculty of Health and Social Care, University of Hull, UK ** Department of Clinical Psychology and Psychological Therapies, University of Hull, UK
Background
Two intertwined strands have run through the history of medicine and reproduction: attempts by the medical profession to gain control over pregnancy and birth, and women’s attempts to retain control and make choices in their reproductive lives (Cahill 2001; Oakley 1984). Women’s sense of control in pregnancy and childbirth is recognised as being important for mental well-being (Bernazzani et al. 1997). Control, however, is a complex issue, comprising both internal and external aspects. In addition, individual women may conceptualise and approach control differently (Green and Baston 2003; Schneider 2002).
Obstetric ultrasound as a screening and diagnostic tool is part of pregnancy for the majority of women in the UK (Manning, Shah and O’Brien 2007). However, the significance of ultrasound scans extends beyond the clinical context. The majority of women welcome scans and express a desire for more than the one or two scans routinely offered in the UK. During a scan, women are usually able to view the monitor, receive detailed feedback and are given images of the fetus. Scans thus have taken on meaning in a social context. The last two decades have seen the emergence of private 3D/4D scans as an increasingly popular choice for pregnant women.
Aims
The aims of this poster are to present possible issues and highlight research questions relating to control and private 4D ultrasound scans.
3D image of a fetus at 23 weeks
Methods
A semi-structured literature search was conducted using several search engines with the search terms ‘medicalisation’, ‘control’ and ‘pregnancy’. This returned a large number of references, many of which were discarded due to limited relevance. Hand searches of reference lists of relevant papers identified further literature. Twenty-five papers were finally included.
What are 4D scans?
The ultrasound scans most commonly used for routine obstetric scans are 2-dimensional. Over the last two decades 3-dimensional scans have become possible. The addition of the dimension of time (i.e. movement) has given rise to 4-dimensional scans. These scans are being increasingly offered by commercial companies, and are usually advertised as ‘bonding scans’.
Findings
Medicalisation & control
Issues of medicalisation and control in reproduction are complex.
How women seek to gain control has changed over time.
Women have historically embraced medicalisation as a means of control, as well as campaigning against it.
Control in relation to ultrasound scans
Women have played a role in shaping scan procedures, helping to turn scans into ‘social occasions’.
Scans appear to offer women the opportunity to take control over uncertainty.
Scans may also reduce the amount of control women have over pregnancy and childbirth.
Discussion
It is feasible to suggest that women pay for private scans in an
attempt to increase control over their pregnancy and relation-
ship with the fetus. Conversely, it could be argued that ultra-
sound scans have become an established part of pregnancy, firmly embedded in a medical framework, which makes it impossible to separate them from this context. Hence women might have internalised the message of medicalisation to such an extent that technology provides the only way they feel they can take control.
While maternity care in the UK has moved to a large extent from a paternalistic model to a model of choice, it seems paradoxical that some women exercise this choice by using a technology which is part of the paternalistic model.
Future areas of research
What are the motives of pregnant women and their partners who choose private scans?
How do women and their partners conceptualise control in this context?
What effect to 4D scans have on women and their partners’ sense of control?
2D image of the same fetus at 23 weeks
References
Bernazzani, O., Saucier, J.-F., David, H. and Borgeat, F. (1997). Psychological factors related to emotional disturbances during pregnancy. Journal of Psychosomatic Research, 42(4),
Cahill, H.A. (2001). Male appropriation and medicalization of childbirth: an historical analysis. Journal of Advanced Nursing, 33(3),
Green, J.M. and Baston, H.A. (2003). Feeling in control during labour: concepts, correlates, and consequences. Birth, 30(4),
Manning, S., Shah, S., O’Brien, P. (2007). Ultrasound scanning in pregnancy. British Journal of Midwifery, 15(7),
Oakley, A. (1984). The Captured Womb. Oxford: Martin Robertson.
Schneider, Z. (2002). An Australian study of women’s experiences of their first pregnancy. Midwifery, 18(3),
3D image of a fetus at 23 weeks
Acknowledgements: Many thanks to Samantha and Mark Hepburn for providing the images.
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Poster presented at the 2010 Society for Reproductive & Infant Psychology conference in Leuven, Belgium (Sept 2010)