Baby's First Picture: Ultrasound and the Politics of Fetal Subjects (review)

It is hard to remember a time when baby books did not have a page for "My photo inside my mommy's tummy." Prenatal ultrasound images are artifacts of medical screening procedures, yet they are socially ubiquitous—seen on refrigerator doors; faxed to bemused but excited grandparents-to-be; featured in television commercials, Hollywood films, and billboard advertisements; and posted on personal Web sites for all and sundry to view. The nearly complete saturation of ultrasound imaging in prenatal care in North America and, increasingly, the Western world, has resituated the fetal image beyond pregnancy care books into the visual realm of popular culture. The interplay between religious, cultural, legal, and medical conceptualizations of a sentient, autonomous, and agentic fetus has many feminist researchers and health care activists concerned that the woman in whose body the fetus resides has slipped from view, with significant consequences.

In the first social science book on the topic, anthropologist Lisa M. Mitchell presents a finely textured and carefully nuanced examination of the routinization of prenatal ultrasound and women's experience with this technology in a specific cultural context. She conducted ethnographic observations and interviews with forty-nine Canadian women prior to, during, and after two routine prenatal scans at a major metropolitan hospital in Montreal. Mitchell's analysis explores the contradictions posed by a medical screening procedure designed to detect anomalies in fetal growth and development with the social and cultural meanings and values surrounding fetuses, motherhood, and medicalized reproduction. Most important, she provides a much needed perspective on how pregnant women give meaning to and the diverse ways they manage, contest, and negotiate their understanding of these blurry, moving gray-scale images of an entity within their bodies. She also examines the role of sonographers and physicians in "showing the baby" during the ultrasound examination. Her analysis situates the medical encounter and the visual image it creates within the larger cultural context in which these "fetal images may engage, contest, and transform other meanings, for example, about nature, technology, identity, normality, gender and motherhood" (4).

Why be concerned with a routine, even mundane aspect of prenatal care that most women uncritically accept and even look forward to? Mitchell gives many compelling answers to this question. First, like many developments in clinical medicine, obstetrical ultrasound is not strongly indicated by evidence-based research attesting to its safety, efficacy, or economic utility. Rather, it is itself a cultural construction of what it means to provide modern, comprehensive, and scientific prenatal care. Additionally, Mitchell provides ethnographic data showing how the production, description, and deployment of these fetal images within the medical setting not only construct fetal patienthood, but also mirror, reflect, and shape historically and culturally specific understandings of fetal personhood. Far beyond providing women with a transparent, unproblematic view of their baby, the creation and production of fetal images contributes yet another moral lens with which to monitor and evaluate pregnant women's compliance with cultural prescriptions for being a "good mother."

Mitchell raises important theoretical concerns about embodied perception and problematizes the "naturalness" with which fetal personhood occurs in Western culture and particularly within these Canadian ultrasound encounters; however, the richest component of her analysis emerges from her chapters on women's accounts of their experience and understanding of their pregnancy, their fetus, and the ultrasound itself. Most of the women in Mitchell's study were eager to see the prenatal ultrasound image for a variety of reasons: to confirm their belief in the pregnancy, because their doctor advised the procedure, to determine fetal sex in some cases, and to assess the general health and well-being of the baby. Through several vignettes, Mitchell shows how the fetus is simultaneously constructed as an object of clinical examination while at the...