3D Foetal Ultrasound: Social and Clinical Meanings

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’?