1. An introduction to the workshop ‘3D Foetal Ultrasound: Social and Clinical Meanings’ Julie Palmer

2. Aims  To present some key ideas and concepts  To introduce 3-/4D ultrasound technology, including its clinical use and social significance  To introduce ‘non-diagnostic’ scanning  To prompt ideas/questions/discussion!

3. Theorising Foetal Ultrasound  Foetus as ‘cyborg’ (Haraway)  Ultrasound as a ‘hybrid practice’ (Taylor)  Ultrasound imagery as ‘semiotic object’ (Mitchell)  Meaning is multiple, fluid, context dependent, viewer dependent  Making meaning is an active process (Mitchell, Palmer)  Meaning is historically and culturally specific (Mitchell & Georges)  Attitudes to technology  The iconic, public foetus  Privileging the visual

4. Social and Clinical Roles  Dating pregnancy (in place of LMP)  Assessing foetal growth  Identifying multiple pregnancies  Prenatal screening  Prenatal diagnosis  Making the pregnancy ‘real’  Technological quickening (Duden 1993)  Encouraging compliance with health advice  Reassurance  Iatrogenesis?  Maternal-foetal ‘bonding’  A chance to ‘meet’ the baby  ‘baby’s first picture’ (Mitchell 2001)

5. Tensions and Contradictions  Social and clinical meanings can ‘clash’  e.g. issues around informed consent. Are women consenting to prenatal testing or attending appointments to see the baby or get the pictures?  Social and Clinical uses of ultrasound can be contradictory  Prenatal testing constructs a ‘tentative’ pregnancy (Rothman), potentially delays ‘bonding’  Viewing ultrasound imagery constructs the foetus as ‘baby’/ foetal personhood

6. Tensions and Contradictions  How do we distinguish social from clinical meanings? (and do we need to?)  e.g. Ambiguity of reassurance and bonding  Can we ‘purge’ ultrasound of its ‘cumbersome non-medical (emotional, cultural) connotations’ ?(van Dijck, 101)  Pleasures and Dangers  Ultrasound as a technology of medicalisation, surveillance. Visualisation is objectifying, visual data replaces embodied knowledge; technology constructs foetus as patient and neglects the pregnant subject.  Women generally report that they enjoy ultrasound examinations (Bricker)  ‘the pleasure and danger of dropping out of one’s own picture should not be underestimated (Lehner)

7. Commercial, non-diagnostic, 4D scans  Emerged in UK 1998 (earlier in US)  Market expanded when 4D became widely available (2003 onwards)  Commercial Scanning  Separate from NHS  Range of Services or solely non-diagnostic scans  Different terms: ‘bonding scan’, ‘entertainment scan’, ‘boutique scan’, ‘keepsake scan’  24-32 weeks gestation  Services offer a chance to see your baby in a relaxed environment, promise a more enjoyable experience than NHS, 4D technology, and a range of take-home products

8. UK scanning companies include:  Babybond  Babyview  See your Baby  Meet your Baby  Take a Peek  Window to the Womb  BabyPremier

9. A typical scan ‘package’  25 - 45 mins appointment  A 4D scan viewed in real-time on a big screen  Partner, family members and other guests  Growth report/health check  Take-home still images  Take-home DVD, 4D moving images, with ‘soundtrack’  Optional extras include:  Keyrings  File for iPod or similar  Picture frames

10. Social and Clinical Meanings  Balance is shifted  Social meanings take priority (screening complete)  Must distinguish service from NHS scans  Professional skill and knowledge important  Sonographers are key to helping clients get their bearings, and interpreting the images on the screen and making them socially meaningful  Interpretation is necessary even with 4D imagery  Expectant-parents also take an active role in making the imagery personally meaningful  ‘collaborative coding’ (Palmer)  Family resemblance  Not a baby but my baby

11. Controversies around non-diagnostic scans  Is it safe?  ‘The HPA advises that although there is no clear evidence that souvenir scans are harmful to the foetus, “parents-to-be must decide for themselves if they wish to have souvenir scans and balance the benefits against the possibility of unconfirmed risks to the unborn child”  Accused of not taking ultrasound seriously enough  ‘entertainment’  ‘shopping mall scans’  Accused of claiming a benefit to bonding for which there is only inconclusive evidence.  Does ultrasound have any effect on bonding?  Is improving bonding a ‘medical’ goal?  Diverging from the ‘proper’ purpose of ultrasound  ‘this service is being offered for non-clinical reasons, and it is not providing what scans were intended to provide in a medical sense – clinical information about the baby (Beech 2005).

12. Problems with critiques of non-diagnostic scans so far  Rely on a clear separation of social and clinical functions for ultrasound that is difficult to maintain  Clinically-driven ultrasound is a ‘hybrid practice’ (Taylor)  ‘Bonding’ becomes the acceptable justification for scanning  Does not take account of wider social context  the social significance of ultrasound and popular familiarity with sonograms; consumerism during pregnancy and patients as consumers  Do not take into account women’s experiences of non- diagnostic ultrasound  Why do women access non-diagnostic ultrasound services?  How do women make sense of non-diagnostic scans? Do women experience ‘ultrasound bonding’?

13. References  Beech, B. (2005) "Ultrasound." AIMS 17 (1). Available online: http://www.aims.org.uk/Journal/Vol17No1/ultrasound.htm  Haraway, D. J. (1997). Fetus: The Virtual Speculum in the New World Order. In Modest_Witness@Second_Millenium. Female Man©_Meets_Oncomouse™. New York, Routledge: 173-212.  Lehner, S. (1996). "My Womb, The Mosh Pit." Women & Performance: a journal of feminist theory 9(1): 179-185.  Mitchell, L. M. (2001). Baby’s First Picture: Ultrasound and the Politics of Fetal Subjects. Toronto, University of Toronto Press.  Mitchell, L. M. and E. Georges (1997). "Cross-Cultural Cyborgs: Greek and Canadian Discourses on Fetal Ultrasound." Feminist Studies 23(2): 373-401.

14. References  Palmer, J. (2009) The placental body in 4D: everyday practices of non-diagnostic sonography. Feminist Review 93(1): 64-80  Rothman, B. K. (1988). The Tentative Pregnancy: Prenatal Diagnosis and the Future of Motherhood. London, Pandora Press.  Taylor, J. S. (1998). Image of Contradiction: Obstetrical Ultrasound in American Culture. In Reproducing Reproduction: Kinship, Power and Technological Innovation. S. Franklin and H. Ragoné. Philadelphia, University of Pennsylvania Press: 15-45.  van Dijck, J. (2005). The Transparent Body: A Cultural Analysis of Medical Imaging. Seattle, WA, University of Washington Press.