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Ultrasound Images and How We See the Fetus

Recent release of video footage showing Planned Parenthood official Deborah Nucatola describing collection and costs of fetal tissue has attracted attention and controversy.

With this controversy playing out in background, the Wall Street Journal published a new report on the overuse of ultrasounds.

The article argues that low-risk pregnancies do not need the average 5.2 scans American women now receive in the months before delivery.

Ultrasounds can help doctors assess fetal development and discover abnormalities, and some physicians may order more of them than necessary to avoid overlooking something.

Still, there are significant nonmedical reasons why many patients seek out those extra ultrasounds and even go to buy additional boutique “4-D” ultrasounds.

Expectant parents want to “see” their babies, and ultrasounds may help with parent-child bonding.

The images give waiting mothers and fathers a chance to “Get to Know Your Baby Before It’s Born,” in the words of a General Electric promotional slogan.

Seeing and sharing ultrasound pictures have acquired cultural importance as milestones in the American experience of pregnancy. Of a wanted pregnancy, that is.

Beyond arguments over whether Planned Parenthood’s provision of fetal tissue for research constitutes sale or donation, what startles in Nucatola’s comments is her detailed description of picking out organs. “We’ve been very good at getting heart, lung, liver, because we know that, ‘I’m not gonna crush that part, I’m gonna basically crush below, I’m gonna crush above, and I’m gonna see if I can get it all intact.”

For the liver, she said, “Most providers will do this case under ultrasound guidance, so they’ll know where they’re putting their forceps” – a very different use, we should note, of that technology that gives moms a peek into the womb.

On one hand, this provision of fetal tissue from abortion could be described as Planned Parenthood’s president, Cecile Richards, described it, “programs that help women donate fetal tissue for medical research.”

That is, given the legality of abortion, if a woman chooses to end a pregnancy, she might have help in donating the extracted tissues for research purposes, which might have potential to benefit others.

But Nucatola’s painstaking inventory of fetal organs comes closer to expressing the same thing a very different way: pregnant women who abort make available the parts of the eliminated fetus, parts that can be seen and separated out, sufficiently identifiable and valuable to require precision in extracting intact human organs, while the rest of the body above or below is crushed.

Here’s why the contrast of these news events is instructive. In both reports, a medical procedure is employed for the monitoring, progress or termination of a pregnancy.

In both cases too, validity of the procedure is not assessed mostly in medical terms, of the health of woman or baby, but carries moral, cultural and emotional freight beyond the procedure itself.

In my own pregnancies, ultrasounds were underwhelming; I confess obtuseness in deciphering those black-and-white prints.

I did not need a picture to know I was carrying a baby, and I “met” my babies through the rolls, kicks and jabs they directed at my surrounding innards.

Historically, men and women did not rely on images to bear news about a coming baby, as Nick Hopwood and Tatjana Buklijaz demonstrate in their Making Visible Embryos project.

A woman’s feeling of fetal movement, called quickening, was evidence of pregnancy.

Still, for many, seeing is believing: Nothing matches those pictures for prompting recognition of the reality of the developing baby. Parents stare at them to look for parts, check sex, guess family resemblance.

When we want to recognize this as a baby, we do, with great care; when we do not want to recognize this as a baby, we do not, though great care still might be taken in looking for parts. The difference is not with the creature in utero but in how we see and name it.

Cecile Richards followed conventions of polite speech when responding to the Nucatola video, describing the extracted materials as tissues, but the Wall Street Journal article shows no embarrassment at referring to the creature alternately as fetus, “the unborn,” even “baby,” worrying about the effects of sound waves on its health.

The point is not that the fetus being imaged and admired by doting parents-to-be is the same as the fetus being carefully dismantled in order to preserve some of its organs for medical research.

Of course it is the same, a point too obvious to dwell upon. The point, rather, is how fluent our forked-tongue speech has become in describing the same thing in different contexts.

One might have predicted that these parallel views and vocabulary could not persist together, that one would have to give way, either the neutralized terminology of fetal tissue, or the other, through pressure exerted by the fact that, as Hopwood and Buklijaz note, “Images of human embryos are everywhere,” in magazines and movies and friends’ Facebook posts.

Maybe there’s something to be said for even more ultrasound images.

Agnes R. Howard teaches history at Gordon College in Wenham, Massachusetts, specializing in early America, particularly colonial New England. A version of this article first appeared on The Anxious Bench, where she blogs regularly.