Before ultrasound existed, very little was known about the embryo/fetus: until the early 19th century, a woman could only be certain she was pregnant* once she felt the fetus move inside her; later, the stethoscope placed on the pregnant woman's belly made it possible to hear the fetal heartbeat, and X-rays revealed its skeleton.
Developed starting in the 1940s but first used in practice in 1964 in Glasgow, ultrasound became part of routine obstetric care in the 1980s, changing the approach to pregnancy for both doctors and parents-to-be, and becoming an experience of primary importance in the building of the bond between parent and child.
It works using ultrasound waves at frequencies that have no negative biological effects on human beings. It is based on wartime technology developed for submarines (sonar systems, that is, sound-pulse systems that made it possible to determine the position of an enemy vessel). At first it was performed on women lying in a tub full of water.
By showing the real existence of the embryo/fetus, the ultrasound reveals to the woman her own powerlessness in the face of what is developing inside her, turning her into a spectator of something she has no way of acting on, while allowing the father to become aware of the pregnancy even before it shows any visible signs.
An ultrasound performed during pregnancy is very different from other kinds of ultrasound, because it involves a confrontation between objectivity and imagination. Usually the images that appear on the screen, commented on by the sonographer in a positive emotional context, enrich the parent's imagination, the mental image they are forming of their baby.
Even so, facing the ultrasound can also give rise to unsettling feelings, tied to the strangeness of the fetus. A wide gap between the imagined baby and the real one can inhibit fantasies about the baby of the imagination, or the images may reawaken fantasies of a parasitic, dangerous embryo/fetus, devouring from within. This helps explain why some women refuse to look at the screen.**
If the ultrasound represents the first encounter with the baby, the way the sonographer conducts themselves in presenting the baby to the parents is crucial, building a profound relationship, especially with the woman, because of the intense emotional exchange created between them through touch, gaze, and words.
This becomes a far more difficult stance to hold when the prenatal diagnosis reveals abnormalities that must be communicated to the parents. Confronting them with a malformation that calls for terminating the pregnancy, or with a condition that can be treated but requires special psychological preparation to welcome a sick child, means inflicting on them a wound, a humiliation that will strike them violently for the rest of their lives. There is no good way to communicate a catastrophe, but at least one can avoid making glaring mistakes, by respecting the silence of those who are living through a shock, and by receiving and supporting a pain that must find its way out and be worked through.
In this case, the sonographer must accept the role of persecuting object, as if they themselves had created the problem: they should not expect gratitude for a diagnosis made correctly! They must keep in mind that in this work they cannot afford to be wrong, yet cannot enjoy their own successes either: an error of excess creates needless anxiety, but an error of omission can have real consequences!
So, if the ultrasound confronts parents with reality, whether positive or difficult to accept, it is worth remembering that in many cases an early diagnosis can save a baby's life and give the parent the time they need to prepare to accept the child for who they are.
* Pregnancy tests only appeared in the 1930s/40s.
** This «symptomatic» attitude should encourage these women to do some work on themselves and on their own fantasies through psychotherapy.