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“It looks like there’s no heartbeat” Imaging and imagining the obstetric ultrasound

When my pregnancies ended with the words: “Oh, it looks like there’s no heartbeat”, the word miscarriage jarred. Had I carried my baby badly? Was it my fault? I didn’t feel like a broken uterus, I felt like a heartbroken mother.

As so often in women’s healthcare, I’ve since discovered it’s not just me. Could I tell you a story? During the pandemic, a woman went to hospital for a first trimester ultrasound. The sort of scan that has become routine, since in 1956, the British obstetrician Ian Donald repurposed a piece of military sonar equiptment and used it to scan, not enemy waters, but the waters of a woman’s womb.

Because of covid-19 restrictions, the woman had to attend her first trimester scan alone. Her partner was desperate to hear their baby’s heartbeat. So she took out her phone. 

“That’s illegal,” said the sonographer, “women are not allowed to record or take photographs during an ultrasound.”

The Guardian newspaper ran this story. A barrister called the ban “unlawful.” But the British Royal College of Radiographers defended the ban, saying: “A pregnant woman holding a phone leads to a taut abdomen which makes scanning very difficult.” 

Underlying this clash, between the maternal and the obstetric, is a series of misunderstandings and obfuscations, over what the ultrasound represents and to whom. It’s a complex story that I’ve been looking at for several years. My interest started when I wanted to understand my own experiences of recurrent miscarriages. So I did what doctors are taught to do. I went to the library. There, I read 300 obstetric papers on recurrent miscarriage. In those papers, I found the deceased foetus to be linguistically obliterated, with euphemisms like “products of conception.” 

Those papers didn’t address the questions I was grappling with: 

How does seeing a foetal ultrasound image make a pregnant woman feel? 

What effect does the muffled static of a still heartbeat have on her grief?

Does it matter that the maternal language used by women differs radically from the clinically-detached language of obstetrics?

In search of answers, I started looking closely at women’s stories. I discovered that in many contemporary novels and memoirs, baby-loss revelations in the ultrasound suite are followed immediately by fantasies of mothering. 

For example, in the novelist Maggie O’Farrell’s essay about miscarriage, Baby and Bloodstream, which forms part of her non-fiction account of near-death experiences, I am, I am, I am, Seventeen Brushes with Death, the story opens in an ultrasound suite and develops into a moving elegy for her deceased “waif” child.

“I can’t look away from the screen, even when the radiologist starts talking again, even when they say I can get dressed, I want to burn that ghost-pale form into my retina.”

O’Farrell’s relational frame of grief and memorialisation recurs in many contemporary ultrasound texts by women.

Historical novelist Hilary Mantel was among the first women in England to undergo an ultrasound, an experience she describes in her memoir, Giving up the Ghost:

“The senior registrar examined me and thought I was pregnant. He winked at me.

‘That’s a baby in there,’ he said, confidently patting my swollen abdomen…But there was no baby. Not Catriona, Not Modestine, not anyone, only the ghost of my own heartbeat.”

Mantel named the children she will not have, an undeniably maternal act.

Candace Carty Williams’ debut novel Queenie begins with Queenie having an ultrasound examination as part of a contraceptive coil check. Queenie learns of a miscarriage during the check. From a medical perspective, the scan evidences a scientific triumph. The doctor says, “It can happen with most forms of contraception. Most women don’t know about it. At least it’s done the job.”

Queenie, lying on the couch, her feet still in stirrups, has fantasies of motherhood, as she recalls her ex-boyfriend Tom’s grandmother musing over what Queenie and Tom’s babies would have looked like: “Oh you two will have beautiful babies.” Later, at home, Queenie imagines embodied pregnancy:

“Would I have been ready? I asked myself, stroking my stomach.”

These are just three texts, spanning four decades, but the same maternal-foetal emotions towards a specific baby or babies is depicted, after an ultrasound scan. This maternal-foetal bond was something I read about time and again across the collection of books I have come to call “the miscarriage canon”. Across genres, across continents, women name their products of conception and imagine mothering them.

I was in the library when I learned that as first trimester ultrasound images became widespread as proxy pregnancy announcements, women also began memorialising foetal deaths. In New York, women adapted an ancient Buddhist ritual, Mizuko Kuyo, literally meaning “children of the waters”, to remember those who only knew the waters of their mother’s womb.

New Jewish rituals have been written by Rabbis responding to couples needing to grieve foetal deaths that are not recognised in orthodox law.  One common feature of the rituals, whether in Anglican Cathedrals or at Neopagan shrines, is writing the names of the dead. As Hilary Mantel wrote, “What’s to be done with the lot, the dead, but write them into being?”

Image credit: Polaroid of an Ultrasound Scan, London, England 1981, Science Museum, London, from the Wellcome Collection, with thanks. 


O’Farrell, Maggie. I Am, I Am, I Am: Seventeen Brushes With Death. Vintage, 2017.

Carty-Williams, Candice. Queenie. London: Trapeze, 2019.

Mantel, Hilary. Giving up the Ghost: A Memoir. Repr. London: Fourth Estate, 2013.

Anderson, Richard W., and Elaine Martin. ‘Rethinking the Practice of Mizuko Kuyō in Contemporary Japan: Interviews with Practitioners at a Buddhist Temple in Tokyo’. Japanese Journal of Religious Studies 24, no. 1/2 (1997): 121–43.

Dickstein, Stephanie. ‘Jewish Ritual Practice Following a Stillbirth’. YD340:30.1996a, 1996.

Lamm, Maurice. The Jewish Way in Death and Mourning. Rev. ed. Middle Village, NY: Jonathan David Publishers, 1999.

Prichep, Deena. ‘Adopting A Buddhist Ritual To Mourn Miscarriage, Abortion’., 15 August 2015.

Reed Banks, Debra. ‘Response to Miscarriage’. Y 1991a (1991): 340:30.

Shadows, Between the. ‘A Requiem Ritual for an Unborn Child’. Between the Shadows (blog), March 2018.

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