Imaging and Imagining the Fetus: The Development of Obstetric Ultrasound by Malcolm Nicolson, John E. E. Fleming (review)

Ultrasound fetal images, familiar to many around the world, have been studied and written about widely. Those of us researching the social and cultural aspects of this technology know the barebones of its history. Its “invention” in the late 1950s by Ian Donald a Glasgow obstetrician-gynecologist curious about potential medical uses for military and industrial sonar. Its initial appearance as the peaks and valleys of an A-scope line and its subsequent development as a more pictorial representation of maternal and fetal anatomy. Its first clinical use made, not by Donald, but by Marjorie Marr, a nurse using ultrasound to determine the position of the fetal ahead. With Nicolson and Fleming’s book, Imaging and Imagining the Fetus: The Development of Obstetrical Ultrasound, we now have a richly researched historical account of this technology.

Nicolson, a medical historian at the University of Glasgow, and Fleming, an engineer who worked with Donald’s team in the 1960s, describe their historiography as posthumanist, influenced by the social construction of technology view of science as heterogeneous assemblages and by Haraway’s writing on cyborgs as a human–machine symbiosis. They aim to offer a detailed exploration of “the development of obstetrical ultrasound as a particular sequence of complex interactions between physical entities (sound waves, piezoelectric crystals, potentiometers, and the like), the biological substrate of the human body, and human actors from a variety of backgrounds and with diverse skills and interests” (p. 8).

With this approach, the book is particularly strong in detailing the problems and solutions encountered by Donald and his team of engineers and physicians as they experimented with, modified, rejected, and mastered various forms of scanners, transducers, and images. Nicolson and Fleming even reenacted Donald’s first experiment with ultrasound technology. Recognizing that ultrasound offered a “radically novel” way of seeing women’s internal anatomy (p. 135), the authors pay particular attention to both moments of insight and understanding by Donald and his team, as well as their errors in creating and interpreting scans. The process by which ultrasound imaging becomes black boxed, no longer requiring an engineer’s skills and knowledge, increasingly an exercise in measuring the fetus, but remaining an interaction among machine, patient, and operator is nicely elucidated. Nicolson and Fleming have also done a very good job of linking the development of this technology to details of Ian Donald’s biography, including his training, forceful personality and keen interest in technology, and his relationships with colleagues and competitors. Furthermore, ultrasound’s emergence, development, and routinization is discussed within the broader context of social inequality, inadequate health care prior to the NHS, and a lack of public confidence in obstetrics (p. 56) in the 1950s to the 1970s Glasgow. Donald’s views on the social role of the obstetrician are discussed as is his moral condemnation of the birth control pill, premarital sex, and abortion except for some instances of fetal impairment. Ian Donald not only believed women would benefit from seeing their fetus via ultrasound but also used the images to try to dissuade women from having an abortion (p. 239).

Nicolson and Fleming elected “not to interrupt the flow of [their historical] narrative with theoretical digressions or engagement with the work of other scholars” (p. 7), a decision that may limit the volume’s utility for readers, particularly those whose primary interest is not ultrasound imaging. Drawing upon key concepts and ideas from other work in the social construction of technology would increase the volume’s pedagogical and comparative value. The wealth of research on women’s experiences of fetal imaging is largely ignored, nor do they explicitly connect their historical account with current and controversial ultrasound practices such as bonding or nondiagnostic scans using 3D ultrasound, or the attempts in some American states to mandate women...