1. 3D Foetal Ultrasound: Social and Clinical Meanings Julie Palmer

2. Biomedical Visualisations and Society  To critically explore the social and political implications of biomedical imaging  To gain technical knowledge of visualisation  To foster collaboration and networking between early- career researchers

3. Tuesday  12.30 – 13.00 Registration and Lunch (provided) A117  13.00 – 14.30 Introduction to the workshop. Julie Palmer and Frances Griffiths  14.30pm Coffee/Tea  15.00 – 15.30 Travel to Babybond, Coventry (minibus provided)   15.30 –17.30pm Visit to Babybond with Jan Steward.  17.30 – 18.00 Return travel to the University of Warwick (minibus provided)  19.00 Dinner (provided) at Scarman House (#52 on campus map) for participants and speakers.

4. Wednesday  9.30 –11.00 Lecture by Dr. Lisa M. Mitchell, Room A041 “Making Images, Making Meaning: Ultrasound Fetal Imaging in and out of the Clinic”  11.00 –11.30 Coffee/Tea  11.30 – 13.00 Facilitated discussion   13.00 – 14.00 Lunch (provided)   14.00 – 15.00 Moving Forward Time to plan outcomes of the workshop

5. Introductions

6. 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!

7. 2-, 3- and 4D

8. Social and Clinical Meanings  Foetus as ‘cyborg’  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  Meaning is historically and culturally specific (Mitchell & Georges)  Attitudes to technology  The iconic, public foetus  Privileging the visual

9. 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)

10. 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

11. 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)

12. 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

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

14. A typical ‘package’  A 4D scan viewed in real-time on a big screen  25 - 45 mins  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  Picture frames  £100-£200

15. 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

16. 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).

17. 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’?