1. Contemporary ways of knowing the fetus during pregnancy
Franziska Wadephul
Julie Jomeen
Lesley Glover
Faculty of Health and Social Care
University of Hull
2013 SRIP Conference, Hull
Slide 1
I am presenting some of the results of a study I undertook for my PhD, which explored issues around three-dimensional ultrasound scans in pregnancy, particularly women’s experiences of these scans and their psychological impact. My focus today will not be on 3D scans themselves, but I will just say a little bit about them.
You can see an image from a 3D scan here. They use essentially the same technology as conventional scans, but computer software is used to render the image in three dimensions. The image is also coloured to make it look ‘friendlier’. You may also have heard about 4D scans, which have the added dimension of time, as in recordings, DVDs, videos, of 3D scans.
3D scans currently have limited clinical use, but have been available for the last ten, fifteen years through private scanning companies. Private 3D scans are not offered as diagnostic scans, but marketed as ‘bonding scans’ or ‘reassurance scans’ – an opportunity for pregnant women, their partners and families to see and ‘meet’ the baby. (A little note on terminology … fetus … baby.) 3D scans are ideally carried out between 25 and 30 weeks of pregnancy to obtain the best images.
For my PhD I used a number of research approaches. I did a critical discourse analysis of scanning company websites, case studies using interview and questionnaire data and interviews using interpretative phenomenological analysis, IPA. In this presentation I will talk about some of the results from the IPA study.

2. Background: Knowledge about the fetus
Barbara Duden: historical shift in how we obtain knowledge about the fetus (Duden 1993):
Haptic  Optic
Haptic: fetal movement
Optic: scans
Implications for autoritative knowledge, power relations, conceptualisation of the fetus
This presentation is about how pregnant women acquire knowledge about the fetus, how they get to know the fetus. The historian Barbara Duden has argued that this is something that has changed considerably over the last few hundred years, from about the 17th century onwards.
Up until then, pregnant women were really the only ones who had direct access to knowledge about the fetus, through fetal movements and physical changes in the body. Quickening, the first fetal movements, were for example what confirmed the pregnancy, which had important social and legal implications. This was knowledge only the pregnant woman herself had access to.
Over the centuries this changed significantly, to a point where now a lot of the knowledge and information about the fetus is not directly accessible to pregnant women themselves, but relies on the mediation of experts and technology. This has important implications for what is considered authoritative knowledge, power relations and issues of control, as well as the conceptualisation of the fetus, both at the level of the individual pregnant woman and at that of society.
Duden has suggested that these changes have involved a shift in how we aquire knowledge about the fetus, a shift from the haptic, movement and touch, to the optic, ultrasound scans. So in contemporary maternity care a considerable amount of information about the fetus is acquired through visual means, through scans. This information is largely clinical and diagnostic. However, the role of scans also extends to how women relate to the fetus and there is a large body of research into the effect of scans on the maternal-fetal relationship. Even though this research is contradictory, the argument is often made that seeing the fetus on a scan image enables pregnant women to relate to them more closely.

3. The IPA Study
Aim: To explore how women experience 3D scans and what psychological impact these scans have.
Interpretative phenomenological analysis (IPA): phenomenological, interpretative, ideographic (Smith et al 2007)
6 women
Semi-structured in-depth interviews
Pre- and post-scan interviews
The aim of the IPA study was to epxlore how women experience 3D scans and what the psychological impact of these scans is. However, I will only talk about some of the findings in this presentation, and these findings do not relate directly to this rationale but were more ‘coincidental’ – serendipity? The findings I am talking here relate to how women experience getting to know the fetus.
We used IPA because we wanted to explore how women experienced these scans and what meanings they attached to them. IPA is a relatively recent qualitative research approach which orignated in health psychology but is now used in a number of other disciplines. The focus is still very much psychological though. It is a phenomenological approach as it is concerned with how people experience a particular phenomenon and how they make sense, attach meaning, to it. Consequently participants’ voices are evident thoughout the whole of the research process. IPA is also interpretative as the researcher interprets what the participants have said. In this sense there is a double hermeneutic: the researcher tries to make sense of the participants’ sense-making. IPA is also clearly ideographic in that the focus is on the individual, or a small number of individuals. It does not aim to generalise, but to explore participants’ experiences in detail and increase understanding of a particular phenomenon.
For this longitudinal study six women were interviewed before and after 3D scans. The first interviews took place just before the scan; these were in-depth, semi-structured interviews, either face-to-face or by telephone, depending on what was possible. The second interview was a brief telephone soon after the scan and the third interview another in-depth semi-structured interview by phone or face-to-face. Two of the women only completed two of the interviews, but we have from before and after the scan for all women.
All interviews were transcribed verbatim and then analysed using a process of making conceptual notes at different levels of analysis and grouping the emergent themes into superordinate themes, themes and subthemes.

4. Findings: emerging themes
‘Experiences of pregnancy’
Feelings about / during pregnancy
Control
Identity
‘Getting to know the baby’
The visual baby
Getting in touch with the baby
Imagining the baby
Two superordinate themes emerged from the interviews. The first was concerned with the women’s experiences of pregnancy. I will not talk about this in detail now, but just want to note that while there were some similarities, it was striking how different the experiences of pregnancy were for the six women, in terms of physical experience, emotional impact, attitude to pregnancy etc.
The second superordinate theme, which I will talk about today, was ‘getting to know the baby’ and was concerned how the women experienced and conceptualised the emerging relationship with their unborn child, and, in particular, how they acquired knowledge about the child.
There were three themes within this superordiante theme: ‘the visual baby’, relating to ultrasound scans, ‘getting in touch with the baby’, about fetal movement and interaction with the baby, and ‘imagining the baby’, about how the women thought and felt about the baby. I will look at each of these themes in turn now.

5. The visual baby ‘To see if everything is ok’ Wanting to see
‘… I think it’s a good opportunity for everyone, to, you know, get that sort of glimpse, and so when the baby is here you all settle as a family.’
‘Seeing her on the screen kind of makes that more sort of … it kind of makes it more real. Even though you have that bump and feel her move, when you see her on the screen, you’re like, you know, yeah, you’re in there.’
‘I would like to see and know that everything is ok.’
‘I’m just really curious what she looks like, to be honest.’
‘To see if everything is ok’
Wanting to see
Integrating the baby into the family
The baby as ‘a little person’
Professionals looking
‘it looked like a proper little person’
‘they look for various things’

6. Getting in touch with the baby
‘I think she likes voices most, she, I think maybe she is a little social interaction fiend and she’s like, ooh, voices … and she sort of reacts and wakes up, maybe, I don’t know.’
‘her back is kind of where my belly button is, so every time he strokes that, she moves around. You know, so, it’s nice. It makes me think she is quite playful and, you know.’
‘... it’s nice to kind of feel her movement, I know that she’s alright…’
The moving baby
Interacting with the baby

7. ‘I feel absolutely very attached’
Imagining the baby
Creating an image of the baby
The baby as a person
Talking about the baby
Feelings about the baby
‘I keep saying he, I’ve just got a very strong feeling that it’s a boy …’
‘I feel absolutely very attached’
‘… I think at this stage obviously I imagine what she’s like and what she does.’
‘I do think about her as a little person. I think of her as you know of growing a little person inside me, which is a nice feeling, so I do think of her in those terms.’

8. Seeing and Feeling an enjoyable & amazing experience
knowing more about the baby
believing the baby is ‘real’
meeting the baby

9. Haptic and Optic
‘woman’s flesh, in spite of all evidence to the contrary, remains quick even in the age of the fetus’ Duden (1993:55)
‘… I don’t know really it’s given me any insight into that, I don’t think you see enough … I probably got more information on sort of personality just by, sort of movement and time, times of day she wakes up and … the fact that if I drink a fizzy drink and she wakes you know, like, ooh, she likes sugar! You know, those kind of things more than what I saw on the screen. But I suppose if you start to put the two together you build more of a picture.’

10. Haptic and Optic
‘We’ve been doing relaxation exercises, all about getting to know the baby, imagining the baby’s environment, and I started to notice how the baby responds to that … and because I’ve now got an image in my head, I’m imagining him or her, what they’re doing while I’m doing these relaxation exercises. … cause I’m starting to recognise a bit of a pattern to movement, I couldn’t do that last week, so if he doesn’t do that, I think, come on, wake up, you know, if he’s having a lie-in, I was joking he was having a lie-in yesterday morning, umm, just silly little things really, putting these traits on a little being, I think the scan combined with the relaxation exercises has really strengthened that.’

11. Conclusions
Movement still important, despite dominance of visual images
May have some advantages over scan images
But little research interest in movement!
Implications for practice

12. References
Duden, B. (1993) Disembodying Women. Perspective on Pregnancy and the Unborn. Cambridge, Mass.: Harvard University Press
Smith, J.A., Flowers, P. and Larkin, P. (2009) Interpretative Phenomenological Analysis. Theory, Method and Research. London: Sage