Book Review: Mitchell, Baby's First Picture

Lisa M. Mitchell
Baby's First Picture: Ultrasound and the Politics of Fetal Subjects
University of Toronto Press, 2001, 258 pp.
$24.95 paper (0-8020-8349-8), $60.00 hardcover (0-8020-4810-2)

"Baby's first picture" is familiar to anyone engaged with contemporary reproduction in Canada or the U.S. as fetal ultrasound, one of the most routine medical procedures and most popularly recognized milestones of pregnancy. In this ethnography of ultrasound in contemporary Canada, Mitchell explores the relationship between ultrasound, the social construction of fetality, and the politics of reproduction more broadly. She reveals how images produced by sound waves and interpreted by technicians are treated as "real pictures" by both medical experts and prospective parents. These interpretations of ultrasound scans are commonly structured to lend weight to fetal personhood. Women with normal pregnancies take pleasure in "meeting the baby" through ultrasound: they use ultrasound to calm fears, involve partners, and even to gain confidence in dealing with doctors. For some, learning fetal sex during pregnancy helps to personalize the fetus. While Mitchell realizes that many women find ultrasound to be a positive experience, she goes on to develop a more critical analysis of routine ultrasound practices, focusing on how they exacerbate perceptions of conflict between women and their fetuses and relate to aspects of social control in pregnancy. Her engaging book will be of interest to scholars working in feminist studies, technology studies, and the sociology of medicine, gender, and reproduction.

An anthropologist, Mitchell uses multiple methods to generate a wealth of data. She observed over one thousand ultrasounds, interviewed obstetricians and ultrasound technicians at a hospital in Quebec, conducted longitudinal interviews with 49 women categorized as having "normal" or low-risk pregnancies, and even participated in a couple of the births. She employs court cases, popular representations of the fetus, and, substantially, other anthropological accounts of ultrasound in Greece, Mexico, and the U.S. to show the ways in which the uses and meanings of this technology and fetality are culturally specific and un-"natural." The multiple perspectives of this methodology provides Mitchell's study with its vitality and authority. Notwithstanding these strengths of her approach, there are instances where Mitchell could provide more clarification of her methodology, including specifying her multiple samples, the contexts in which the interviews were conducted, and her recruitment of male partners and management of their participation.

Consistent with existing literature, Mitchell's work shows that ultrasound allows doctors to circumvent women as a source of information about their pregnancies and encourages women to substitute heavily interpreted images for their embodied experiences of pregnancy. Sonographers seek to assess the fetus for abnormalities, while prospective parents often expect only a positive bonding experience and an image for their baby scrapbooks. Thus, this research captures the difficulties that emerge from the intersection of diagnostic and more entertainment-oriented practices. (Given the growing popularity of 3-D ultrasound technology in "lifelike" sepia tones and "fetal photo booths," attention to this intersection is especially timely.) The routineness and recreational aspects of ultrasound take on additional gravity as Mitchell traces controversies over ultrasound's status as "risk-free." Her data show that "only a handful" of women she interviewed had discussions with their doctors about the reasons they were having an ultrasound and the possible risks — both medical and social — of the procedure.

Mitchell repeatedly points to the ways in which sonographers "read" not only ultrasounds, but also patients. She documents how sonographers assess prospective parents' "bonding" with the fetus during the procedure; for example, a father's presence or absence from the scan was often seen as an indication of his overall involvement in the pregnancy. They may refuse to "see" fetal sex if parents appear interested for the "wrong" reasons. Behaviors such as maternal smoking or obesity may provoke sonographers' comments which imply or explicitly suggest fetal harm, sometimes beyond the evidence available through ultrasound technology. For example, a sonographer describes the womb of a woman who smokes: "we can see the smoke in it" (p. 136). These comments are indicative of the increasing surveillance of pregnant women, emphasis on their self-discipline, and consequential construction of a conflict between woman and fetus illustrated more generally in literature on reproduction.

This work also documents how women themselves may also become critical of ultrasound. Mitchell's longitudinal data shows that the powerful effects and positive experiences of ultrasound are, in many ways, specific to the first scan (16-20 weeks) in which the entire fetus can be visualized at once. These effects are also temporary: by the time fetal movement can be felt, many women in Mitchell's sample feel they have more authority over their pregnancies and their relationship to the fetus. As a result, Mitchell shows that the second routine ultrasound is usually less pleasurable for women than the first. (The main exception to this is for prospective parents seeking and gaining knowledge of fetal sex.) In some cases, usually after ultrasound has failed to anticipate problems with a birth, some women become very critical of ultrasound. Mitchell shows that part of ultrasound's power stems from the ways the first ultrasound is situated among other experiences of pregnancy. Its power may be similarly circumscribed.

Mitchell concludes her book by outlining concrete strategies for validating the female subject in prenatal ultrasound. These include requirements for consent to the procedure; provision and discussion of information on the diagnostic limits of ultrasound, safety, likelihood of inaccurate results, and the emotional and social implications of viewing an ultrasound; training ultrasound technicians to avoid personification and sentimentalization of the fetus; eliminating routine identification of fetal sex; and selective rather than routine ultrasound use. Overall, these strategies are cogent and appropriate to Mitchell's concern with reproductive politics throughout the book. Indeed, the fact that many are not already in place is quite shocking. But some of Mitchell's recommendations to alter or restrict the uses of this technology sit uneasily with her emphasis on the ways in which women have helped to construct the practices and meanings of ultrasound in contemporary reproduction. Mitchell's work raises the intriguing and complicated questions of whether restrictions on technology can alter ideas of fetal subjectivity that are increasingly prevalent in our cultures, and if these restrictions will come at the expense of the pleasure and reassurance women find in fetal ultrasound. In this sense, Mitchell's final chapter captures a familiar tension between our feminist desires to protect the rights of women and the desires of many women.

Danielle Bessett
New York University
bessett@mail.soc.nyu.edu

Danielle Bessett is a graduate student at New York University. Her dissertation focuses on constructions of normality and risk in pregnancy.



		Canadian Journal of Sociology Online September - October 2002 Lisa M. Mitchell Baby's First Picture: Ultrasound and the Politics of Fetal Subjects University of Toronto Press, 2001, 258 pp. $24.95 paper (0-8020-8349-8), $60.00 hardcover (0-8020-4810-2) "Baby's first picture" is familiar to anyone engaged with contemporary reproduction in Canada or the U.S. as fetal ultrasound, one of the most routine medical procedures and most popularly recognized milestones of pregnancy. In this ethnography of ultrasound in contemporary Canada, Mitchell explores the relationship between ultrasound, the social construction of fetality, and the politics of reproduction more broadly. She reveals how images produced by sound waves and interpreted by technicians are treated as "real pictures" by both medical experts and prospective parents. These interpretations of ultrasound scans are commonly structured to lend weight to fetal personhood. Women with normal pregnancies take pleasure in "meeting the baby" through ultrasound: they use ultrasound to calm fears, involve partners, and even to gain confidence in dealing with doctors. For some, learning fetal sex during pregnancy helps to personalize the fetus. While Mitchell realizes that many women find ultrasound to be a positive experience, she goes on to develop a more critical analysis of routine ultrasound practices, focusing on how they exacerbate perceptions of conflict between women and their fetuses and relate to aspects of social control in pregnancy. Her engaging book will be of interest to scholars working in feminist studies, technology studies, and the sociology of medicine, gender, and reproduction. An anthropologist, Mitchell uses multiple methods to generate a wealth of data. She observed over one thousand ultrasounds, interviewed obstetricians and ultrasound technicians at a hospital in Quebec, conducted longitudinal interviews with 49 women categorized as having "normal" or low-risk pregnancies, and even participated in a couple of the births. She employs court cases, popular representations of the fetus, and, substantially, other anthropological accounts of ultrasound in Greece, Mexico, and the U.S. to show the ways in which the uses and meanings of this technology and fetality are culturally specific and un-"natural." The multiple perspectives of this methodology provides Mitchell's study with its vitality and authority. Notwithstanding these strengths of her approach, there are instances where Mitchell could provide more clarification of her methodology, including specifying her multiple samples, the contexts in which the interviews were conducted, and her recruitment of male partners and management of their participation. Consistent with existing literature, Mitchell's work shows that ultrasound allows doctors to circumvent women as a source of information about their pregnancies and encourages women to substitute heavily interpreted images for their embodied experiences of pregnancy. Sonographers seek to assess the fetus for abnormalities, while prospective parents often expect only a positive bonding experience and an image for their baby scrapbooks. Thus, this research captures the difficulties that emerge from the intersection of diagnostic and more entertainment-oriented practices. (Given the growing popularity of 3-D ultrasound technology in "lifelike" sepia tones and "fetal photo booths," attention to this intersection is especially timely.) The routineness and recreational aspects of ultrasound take on additional gravity as Mitchell traces controversies over ultrasound's status as "risk-free." Her data show that "only a handful" of women she interviewed had discussions with their doctors about the reasons they were having an ultrasound and the possible risks — both medical and social — of the procedure. Mitchell repeatedly points to the ways in which sonographers "read" not only ultrasounds, but also patients. She documents how sonographers assess prospective parents' "bonding" with the fetus during the procedure; for example, a father's presence or absence from the scan was often seen as an indication of his overall involvement in the pregnancy. They may refuse to "see" fetal sex if parents appear interested for the "wrong" reasons. Behaviors such as maternal smoking or obesity may provoke sonographers' comments which imply or explicitly suggest fetal harm, sometimes beyond the evidence available through ultrasound technology. For example, a sonographer describes the womb of a woman who smokes: "we can see the smoke in it" (p. 136). These comments are indicative of the increasing surveillance of pregnant women, emphasis on their self-discipline, and consequential construction of a conflict between woman and fetus illustrated more generally in literature on reproduction. This work also documents how women themselves may also become critical of ultrasound. Mitchell's longitudinal data shows that the powerful effects and positive experiences of ultrasound are, in many ways, specific to the first scan (16-20 weeks) in which the entire fetus can be visualized at once. These effects are also temporary: by the time fetal movement can be felt, many women in Mitchell's sample feel they have more authority over their pregnancies and their relationship to the fetus. As a result, Mitchell shows that the second routine ultrasound is usually less pleasurable for women than the first. (The main exception to this is for prospective parents seeking and gaining knowledge of fetal sex.) In some cases, usually after ultrasound has failed to anticipate problems with a birth, some women become very critical of ultrasound. Mitchell shows that part of ultrasound's power stems from the ways the first ultrasound is situated among other experiences of pregnancy. Its power may be similarly circumscribed. Mitchell concludes her book by outlining concrete strategies for validating the female subject in prenatal ultrasound. These include requirements for consent to the procedure; provision and discussion of information on the diagnostic limits of ultrasound, safety, likelihood of inaccurate results, and the emotional and social implications of viewing an ultrasound; training ultrasound technicians to avoid personification and sentimentalization of the fetus; eliminating routine identification of fetal sex; and selective rather than routine ultrasound use. Overall, these strategies are cogent and appropriate to Mitchell's concern with reproductive politics throughout the book. Indeed, the fact that many are not already in place is quite shocking. But some of Mitchell's recommendations to alter or restrict the uses of this technology sit uneasily with her emphasis on the ways in which women have helped to construct the practices and meanings of ultrasound in contemporary reproduction. Mitchell's work raises the intriguing and complicated questions of whether restrictions on technology can alter ideas of fetal subjectivity that are increasingly prevalent in our cultures, and if these restrictions will come at the expense of the pleasure and reassurance women find in fetal ultrasound. In this sense, Mitchell's final chapter captures a familiar tension between our feminist desires to protect the rights of women and the desires of many women. Danielle Bessett New York University bessett@mail.soc.nyu.edu Danielle Bessett is a graduate student at New York University. Her dissertation focuses on constructions of normality and risk in pregnancy. http://www.arts.ualberta.ca/cjscopy/reviews/baby.html October 2002 © CJS Online Click here to download PDF file < Back to Current Table of Contents