Julie Palmer 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 earlycareer researchers ID: 286837
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Slide1
3D Foetal Ultrasound: Social and Clinical Meanings
Julie PalmerSlide2
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 Slide3
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.Slide4
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 workshopSlide5
IntroductionsSlide6
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’ scanningTo prompt ideas/questions/discussion!Slide7
2-, 3- and 4DSlide8
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 visualSlide9
Social and Clinical Roles
Dating pregnancy (in place of LMP)
Assessing foetal growth
Identifying multiple pregnanciesPrenatal screeningPrenatal 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)Slide10
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 personhoodSlide11
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
)Slide12
Commercial, non-diagnostic, 4D scans
Emerged in UK 1998 (earlier in US)
Market expanded when 4D became widely available (2003 onwards)
Commercial ScanningSeparate 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 productsSlide13
UK scanning companies include:
Babybond
Babyview
See your Baby
Meet your Baby
Take a Peek
Window to the Womb
BabyPremierSlide14
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-£200Slide15
Social and Clinical Meanings
Balance is shifted
Social meanings take priority (screening complete)
Must distinguish service from NHS scansProfessional 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
babySlide16
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).Slide17
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’?