3D Foetal Ultrasound: Social and
Clinical Meanings
Julie Palmer
Biomedical Visualisations and Society
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To critically explore the social and political implications of
biomedical imaging
To gain technical knowledge of visualisation
To foster collaboration and networking between earlycareer researchers
Tuesday
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12.30 – 13.00 Registration and Lunch (provided) A117
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13.00 – 14.30 Introduction to the workshop. Julie Palmer and Frances
Griffiths
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14.30pm Coffee/Tea
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15.00 – 15.30 Travel to Babybond, Coventry (minibus provided)
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15.30 –17.30pm Visit to Babybond with Jan Steward.
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17.30 – 18.00 Return travel to the University of Warwick (minibus
provided)
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19.00 Dinner (provided) at Scarman House (#52 on campus map) for
participants and speakers.
Wednesday
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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”
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11.00 –11.30 Coffee/Tea
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11.30 – 13.00 Facilitated discussion
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13.00 – 14.00 Lunch (provided)
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14.00 – 15.00 Moving Forward
Time to plan outcomes of the workshop
Introductions
Aims
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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!
2-, 3- and 4D
Social and Clinical Meanings
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Foetus as ‘cyborg’
Ultrasound as a ‘hybrid practice’ (Taylor)
Ultrasound imagery as ‘semiotic object’ (Mitchell)
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Meaning is multiple, fluid, context dependent, viewer dependent
Making meaning is an active process
Meaning is historically and culturally specific (Mitchell &
Georges)
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Attitudes to technology
The iconic, public foetus
Privileging the visual
Social and Clinical Roles
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Dating pregnancy (in place of LMP)
Assessing foetal growth
Identifying multiple pregnancies
Prenatal screening
Prenatal diagnosis
Making the pregnancy ‘real’
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Encouraging compliance with health advice
Reassurance
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Technological quickening (Duden 1993)
Iatrogenesis?
Maternal-foetal ‘bonding’
A chance to ‘meet’ the baby
‘baby’s first picture’ (Mitchell 2001)
Tensions and Contradictions
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Social and clinical meanings can ‘clash’
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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
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Prenatal testing constructs a ‘tentative’ pregnancy (Rothman),
potentially delays ‘bonding’
Viewing ultrasound imagery constructs the foetus as ‘baby’/
foetal personhood
Tensions and Contradictions
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How do we distinguish social from clinical meanings? (and do
we need to?)
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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
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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)
Commercial, non-diagnostic, 4D scans
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Emerged in UK 1998 (earlier in US)
Market expanded when 4D became widely available (2003
onwards)
Commercial Scanning
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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
UK scanning companies include:
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Babybond
Babyview
See your Baby
Meet your Baby
Take a Peek
Window to the Womb
BabyPremier
A typical ‘package’
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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:
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Keyrings
File for iPod
Picture frames
£100-£200
Social and Clinical Meanings
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Balance is shifted
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Sonographers are key to helping clients get their bearings, and
interpreting the images on the screen and making them
socially meaningful
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Social meanings take priority (screening complete)
Must distinguish service from NHS scans
Professional skill and knowledge important
Interpretation is necessary even with 4D imagery
Expectant-parents also take an active role in making the
imagery personally meaningful
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‘collaborative coding’ (Palmer)
Family resemblance
Not a baby but my baby
Controversies around non-diagnostic scans
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Is it safe?
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Accused of not taking ultrasound seriously enough
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‘entertainment’
‘shopping mall scans’
Accused of claiming a benefit to bonding for which there is only
inconclusive evidence.
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‘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”
Does ultrasound have any effect on bonding?
Is improving bonding a ‘medical’ goal?
Diverging from the ‘proper’ purpose of ultrasound
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‘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).
Problems with critiques of non-diagnostic
scans so far
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Rely on a clear separation of social and clinical functions
for ultrasound that is difficult to maintain
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Does not take account of wider social context
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Clinically-driven ultrasound is a ‘hybrid practice’ (Taylor)
‘Bonding’ becomes the acceptable justification for scanning
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 nondiagnostic ultrasound
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Why do women access non-diagnostic ultrasound services?
How do women make sense of non-diagnostic scans? Do
women experience ‘ultrasound bonding’?