Fetal ultrasound and our image oriented society

An excerpt from Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank published by W. W. Norton & Company, 2010 (paperback January 2011).

On eBay, you can buy a fetal ultrasound scrapbook that has a poem on the first page that begins, “I loved you from the start.” It comes with Care Bear stickers. One of them is a pregnant rabbit eating pickles and ice cream with the caption, “ultrasound cravings.” If you’re really enthusiastic, you can buy your very own machine for personal use or to make some extra money. Machines range from $15,000 to $200,000.

The marketing of ultrasound like photo booths in malls rankles physicians. In 2005, fetal ultrasound specialists launched the Keepsake Ultrasound Task Force under the umbrella of the American Institute of Ultrasound in Medicine. Participants worried that women will get overdosed with ultrasound or get false reassurance from the photographs. Though safe for diagnosis, “ultrasound energy has the potential to produce biological effects,” the committee concluded.

The FDA is angry too. It opposes the use of medical devices for nonmedical uses. But it has not shut down the centers. A few doctors suspect the FDA’s enforcement is lax because if they shut down the entertainment centers, they’ll have to take away the antiabortion centers, too. Antiabortionists have tried, unsuccessfully so far, to pass laws requiring that every pregnant teenager watch a three-dimensional ultrasound of her fetus before having an abortion.

Ultrasound is energy. High doses are used to heat and heal muscle injuries. It is used in other countries, but not in the United States, as an alternative treatment for cancer. If it’s therapeutic—or if it’s changing muscle physiology somehow—there is a chance that it could affect the baby, particularly at excessive doses for a long time. Doctors say that the low does used for a few exams during the pregnancy are safe, that the benefits outweigh any potential minimal risk. They worry about excessive doses for long periods. Any risk, no matter how miniscule, outweighs the benefits when there is no medical reason for the exam, say doctors.

Advocates insist the photo session helps mothers bond with their babies. They point to studies that seem to defend their case. Dr. Joshua Copel, a professor of obstetrics and gynecology at Yale University and president of the American Institute for Ultrasound in Medicine, advocates three-dimensional ultrasound for medical uses only. “My only take,” he said, “is that for several million years, mammals have bonded to their young without ultrasound and we have done reasonably well as a species based on our mother’s nurturing us until we can take care of ourselves. There is no reason to think that we need something additional to feel the right things towards our babies. I say to women, if you want it do it, but the relationship you form with your child is how you respond for the next 18 years. I’m not convinced 3-D ultrasound has anything to do with it.”

Ultrasounds will inevitably become clearer and will be used more frequently as part of the prenatal exams. On the bright side, couples can go home from their doctors with snapshots, reassured that everything is okay and with some concrete evidence that their baby—at least physically—seems to be growing according to the books. The problems arise as our technology advances faster than the ability to interpret it. What happens when the doctor spots a mark on the baby? Could it be a defect in the image itself or does it signal greater troubles? What happens if there is something that does not quite look like every other baby, but no one is sure what to do.  In 1996, New York Times science writer Natalie Angier wrote about the harrowing ordeal when she and her husband were told that their 20-week fetus may  have clubfoot. They spent the rest of the pregnancy preparing for the worst, and then the baby was born completely healthy without any signs of clubfoot.

When ultrasound works well, it picks up defects that can sometimes be corrected before birth, sometimes shortly after. Ultrasonographers continue to defend the use, pointing to all the great things that the imaging machines have done to help women. But bioethicists worry. They are concerned about the growing numbers of women, like Angier, who are told that something may be terribly wrong when the baby is perfectly fine. (Doctors did tell Angier that her baby may have had clubfoot that corrected itself before birth. Did seeing the foot help anything?) They also fear that images deemed healthy can be falsely reassuring. Dr. Sheryl Burt Ruzek, a professor of health education at Temple University, told Angier that ultrasounds, particularly when a pregnant woman has several, have “created false expectations that by having repeated screenings we can improve the likelihood of a good outcome of pregnancy. The search for the perfect child is making women very anxious about reproducing.”

The advent of sophisticated user-friendly fetal ultrasound speaks, in many ways, to our image-oriented society. We need a film clip (something to put on YouTube perhaps?) to show the world and to prove to ourselves that we what we think is happening is real and meaningful. And yet, fetal ultrasonography has made a much more profound impact on pregnancy, one that had not been foreseen by its pioneers. In the beginning, the pregnant woman was housing an unknown, invisible creature. She alone was the patient. The sophisticated microscopes and imaging tools have given the fetus its own identity. There is now a full-fledged medical field of fetology along with a batch of legal and ethical debates about the care of the unborn. As Kevles points out in Naked to the Bone, “Ultrasound images have contributed as perhaps no other imaging technology to polarizing attitudes about the personhood of fetuses, embryos, even unfertilized eggs.”

Randi Hutter Epstein is a medical writer and adjunct professor at The Graduate School of Journalism, Columbia University.  She is the author of Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank.

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