3D Foetal Ultrasound: Social and Clinical Meanings

Julie Palmer

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

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.

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

Introductions

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!

2-, 3- and 4D

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

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)

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

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)

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

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

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

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

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).

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’?