Ultrasound is a central component of the sociotechnical system that has been built up around prenatal diagnosis over the past six decades. While fetal testing predates the widespread uptake of ultrasound during the mid-1970s, the safe and effective use of second-trimester amniocentesis, a mainstay of prenatal diagnosis, has been largely dependent on the availability of visual ultrasound guidance. Ultrasound imaging has also become the basis of many other tests that are used to identify structural abnormalities prenatally, as well as for an increased risk of chromosomal disorders like Down syndrome. The two books reviewed in this essay offer complementary views of the development and application of ultrasound in obstetric practice, as well as of the social and political uptake of the images that ultrasound is used to produce.
The social impact of ultrasound and other fetal-imaging technologies has been thoroughly examined by scholars from feminist and cultural studies over the past three decades. Many of the resulting accounts have been quite critical of the use of ultrasound in extending the medicalization of pregnancy, in particular by overshadowing pregnant women’s embodied experiences in the course of assessing fetal health and age. Scholars also have traced how the pro-life movement has used ultrasound as a tool for personifying the fetus. Ultrasound imagery allows the fetus to be portrayed as seemingly independent from the body of a woman and as fully human in its apparent expressions of emotion and pain. In response, feminist scholars have drawn on close textual analysis to critique the use of ultrasound [End Page 730] in constructing the fetus as an autonomous person, deserving of individual rights and protections from early in development. The contributions considered here do an excellent job of examining the changing diversity of ways in which ultrasound images of the fetus have been produced, manipulated, and interpreted.
Malcolm Nicolson and John E. E. Fleming’s Imaging and Imagining the Fetus: The Development of Obstetric Ultrasound (Baltimore: Johns Hopkins University Press, 2013. Pp. 336. $50) describes the slow development of ultrasound, from a wartime technology to a widely used clinical tool. This book is largely built around a biographical account of Ian Donald, a British physician and researcher who played a central role in developing ultrasound imaging for everyday use in gynecology and obstetrics. In addition to their focus on Donald, Nicolson and Fleming aim to reveal the overlooked role of engineers and other nonacademic actors in designing and improving new medical technologies. As part of this, we are introduced to a number of private-sector engineers and technicians who helped Donald to make ultrasound imaging technologies more useful, legible, and acceptable to practicing physicians.
Nicolson and Fleming contextualize the development and application of ultrasound within traditional medical practice by tracing the professional training of Donald in “the clinico-anatomical method and the postmortem examination” (p. 4). Ultrasound eventually offered physicians the opportunity to examine a living patient in much the same way that they might look for the structural causes of a disease during an autopsy. Gynecological practice, the authors argue, was an ideal area to demonstrate the clinical value of ultrasound due to its usefulness in identifying soft tissue growths and cysts. Ultrasound also entered clinical practice as opinions were turning against using X-rays for routine bodily screening due to the dangers of radiation.
The capability of ultrasound imaging to safely identify new growths in the uterus, whether cancerous or fetal, also made the technology extremely useful in obstetric practice. Nicolson and Fleming return multiple times to a quote from Donald suggesting that ultrasound finally allowed clinicians to see “behind the iron curtain of the maternal abdominal wall” (p. 80). Donald valued ultrasound because it assisted in determining whether or not a woman was pregnant with a viable, healthy fetus. Indeed, the authors suggest, by the mid-1970s, “the pregnant woman was no longer the chief arbiter of condition of her fetus” (p. 201). To get to this point, however, significant technological development and visual training had been required.
During its early years of...