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April 2, 2003

Seeing the Fetus: The Role of Technology and Image in the Maternal-Fetal Relationship

JAMA. 2003;289(13):1700. doi:10.1001/jama.289.13.1700
Seeing the Fetus: The Role of Technology and Image in the Maternal-Fetal Relationship

It is only in the last 30 years that it has been possible to visualize the living fetus. Before then, its life was often acknowledged at "quickening," when the pregnant woman first noticed it moving within the uterus. With the new ability to see the fetus as an independent organism, however, both medical science and society now envision the maternal-fetal relationship as beginning at a much earlier stage in fetal development. Visual imagery, specifically sonography, has become an important representation of that relationship. Consider a recent television commercial featuring high-resolution 3-dimensional sonographic images of a third-trimester fetus or a Time cover story describing Alexander Tsiaras' beautifully detailed, computer-enhanced images of fetal development as "at the forefront of a biomedical revolution."1 These contemporary biomedical images of the fetus are changing public perception of the unborn and may shift the balance of legal rights from the maternal to the fetal body.

Due in part to laws restricting human anatomical dissection, accurate depictions of the fetus did not appear until 1799, when Samuel Thomas Soemmerring published plates of staged embryonic development.2 And it was not until 1965, when Lennart Nilsson's photograph of an 18-week fetus appeared on the cover of Life, that the image of a fetus became widely recognized.

The photographic quality of modern sonography, given its role in fetal measurement and diagnostics, carries with it a connotation of objectivity that may deflect attention from the cultural assumptions that give these images such authority. Fasouliotis and Schenker write, "The biological maternal fetal relationship has not changed but the medical model of that relationship has shifted emphasis from unity to duality. Physicians no longer look to the maternal host for diagnostic data and a therapeutic medium; they look through her to the fetal organism and regard it as a distinct patient in its own right."3

Casper agrees that as fetal imaging technology advances, so does the likelihood of seeing the fetus as an entity separate from its maternal host.4 Mirroring the improved resolution of the fetal image has been the growth of "fetus as patient" advocates who explicitly argue for equal and competing interests of the fetus.5 When the fetus is increasingly visualized as a person, resolving ethical tensions between the welfare of the mother and fetus becomes a contest between their rights and obligations.3 Pateman has argued that the assumption of the impregnable male body was implicit in the work of Locke and Rousseau, which continues to influence current debate.6 Liberal political theories have generally not accorded the pregnant body any unique individual rights. Against this ambiguous political context, biomedical images of the fetus gain meaning.

The fetal image in popular culture is frequently depicted without reference to the pregnant woman's body.7 Nilsson's photographs and Tsiaris' computer models depict the suspended, solitary, floating fetal individual without the maternal placenta, the gravid uterus, or the maternal vascular system that nourishes the fetus. In standard representations of pregnancy such as medical texts or the film The Miracle of Life, women's bodies are represented as oceanic environs: fertile media in which life grows.8,9 Duden has argued that "the public image of the fetus shapes the emotional and the bodily perception of the pregnant woman."2 The mother and fetus are represented not as equal individuals, but rather as a biological matrix and its product. While modern in medium, these images echo ancient depictions of the pregnant body. In Aristotle's biology, for instance, women were considered only as hosts to men's seed.10

The visual technologies of the latter 20th century have reconfigured and amplified the ancient concept of woman as a principally generative space. In her discussion of fetal surgery, Casper agrees that the fetus has become a conceptual entity independent from the mother.4 Whether or not the sonogram in its focus on the fetus in effect "erase[s] women,"4 there is a growing consensus that visual imagery of the fetus is changing the medical and cultural status of the maternal-fetal relationship.

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