The Fetus In Utero

Constructing Images of the Fetus In Utero

Once restricted to the privacy of the doctor’s office, ultrasound images of the fetus are now immediately recognizable in the public arena, through advertising and social media, where posts tagged “baby’s first pic” are commonplace. These depictions of the fetus in utero have become iconic and are arguably the most easily recognized medical image. How and why did this happen? And at what price and to what end?

This exhibition takes an historical approach to this question by exploring the complex evolution of the fetal image in Western Christian culture. We show that before images of the fetus in utero entered the digital age, they have been deployed in three distinctive ways over the past 500 years. First, during the Renaissance, the fetus in utero transformed from an object of divine mystery to one of “rational” inquiry at the hands of male anatomists. Second, from 1700–1965, images of the fetus in uterus underwent a process of medicalization through the male medical gaze. Third, from 1965–present, the fetus in utero has been curated as a public image by a variety of individuals and movements steeped in social and political contexts.

Curated by Brian Callender, MD, Assistant Professor of Medicine, The University of Chicago; and Margaret Carlyle, Postdoctoral Researcher and Instructor, Stevanovich Institute on the Formation of Knowledge, The University of Chicago. This virtual exhibit was created by Teodora Szasz and Ashleigh Cassemere-Stanfield of the Research Computing Center in collaboration with the primary curators.

The Fetal Image & Seeing the World

The story of the image of the fetus in utero told here is one of both historical change and continuity. While the content of the fetal image has changed over time, through new obstetrical and imagining technologies, its function has not. The fetal image has always served as a tool to both reflect and enact certain worldviews. It has never been a value neutral image, but rather exhibits the imprint of social, cultural, and political considerations. The naturalization of the fetal image in religious, medical, political, and entertainment contexts, in turn, has conditioned how we see the world.

In the present-day context, in which reproductive rights are being challenged across America, the time is now more urgent than ever to understand the history of the fetal image. Indeed, the fetal ultrasound’s most powerful and ideologically driven use in our times has been in the context of the abortion debate. In their attempts to limit reproductive rights, the right-to-life movement has extensively used the fetal ultrasound to promote their cause. By presenting and ventriloquizing fetuses, this movement has curated both still and moving images to assert “fetal autonomy” while disembodying the pregnant woman. Such imagery targets the viewer’s emotions in ways to assert “fetal personhood,” while serving as powerful tools in legislative campaigns aimed at restricting women’s reproductive rights.

The fetal image has also achieved iconic status in social media, entertainment, and commerce. In the seemingly more benign context of pregnancy and “gender reveal” announcements, the fetal ultrasound has become a digital badge of impending parenthood, curated with aims of sharing knowledge to a large, but often anonymous, digital social world. Images of the fetus have also been deployed in advertisements to sell cars and snack chips, expanding and further defining how we both utilize and interpret these images.

As this exhibit details, the visual culture of the fetus in utero has a long history that continues to be shaped by the contexts in which these images are produced, consumed, and interpreted. These are to be sure specifically Western contexts and the fetal imagery in other knowledge cultures, from Chinese and Arabic traditions for example, remain to be explored. Moreover, the exhibit reminds us that even the most advanced imaging technologies, although they seem to directly show reality, actually require interpretation through our current sociocultural and political contexts.

A note on terminology: Like the images presented, the terms “mother,” “fetus,” and “utero” are not value free. They have appeared in specific contexts, from clinical settings to debates about reproductive rights. We employ “mother” as a term that has been used historically to describe a pregnant woman, maternal body, or maternal vessel, while recognizing that it has been deployed problematically and prescriptively in the context of the abortion debate. We likewise use “fetus” and “utero” as shorthands for terms whose medical and political meanings have changed over time.

The “Mysterious” Fetal Image

From 1450–1700, the fetus transformed from an object of divine “mystery” to one deemed worthy of secular study. During this period, the fetus was literally brought out from the “dark” and “mysterious” uterus and onto the dissecting table, where it was scrutinized and demystified, before entering graphically into the Renaissance tradition of anatomy atlases that exhaustively mapped the human body for the first time. From fetuses at the center of a “blooming” uterus to free-falling acrobats, the singular fetus and series of fetal presentations presented in these books were used primarily for training surgeons, midwives, and physicians in the art of childbirth. Such images were also sources of discussion for theologians and natural philosophers interested in debating the nature and origins of human life. This included the theory of epigenesis, by which fetuses began as nondescript “blob-like” embryos before transforming over the period of gestation into more complex beings.

The Medicalized Fetal Image

From 1700–1965, the fetal image attained status as an object of medicalization whose visual ‘home’ became the obstetrical textbook. Medicalization of the fetus owed much to the mechanization of childbirth, in which the surgeon’s instruments usurped the midwife’s hands as the tool of choice in the delivery room. Male surgical “triumph” in childbirth was also facilitated by the rise of hospital and clinical spaces, where the new science of obstetrics cultivated ways of seeing the fetus in utero that privileged scientific rationality and measurement of both the fetus and the female body. In this period, the fetus appears as a geometric puzzle piece within the uterus, the subject of serialized growth, and an object disembodied from the pregnant body. The disappearance of the female body is indeed a theme of iconography from this period and one that reflects the overwhelming clinical interest of the male medical gaze.

The Public Fetal Image

From 1965–present, fetal imagery has attained status in popular culture while maintaining its traditional medical role. This phase is bookended by two striking images of the fetus. On one end is the fetus’ very public debut in April 1965 as a photograph of an 18-week-old free floating figure on the cover of Life magazine. The fetus, disembodied from the pregnant body, appears to be an astronaut in outer space. This photograph appeared before audiences in the thick of the Cold War “Space Race” between the US and the former USSR and marks a pivotal point in the visual culture of the fetus. On the other end, often in the form of the fetal ultrasound, is the fetus’ twenty-first-century entry into cyberspace and its now-common usage in both advertisements and social media outlets. The fetal ultrasound has also been co-opted for ideological reasons, to frame a narrative of “fetal independence” and motherhood in reproductive rights debates. During this period, the image of the fetus has been cultivated beyond the medical domain by both individuals and groups to service social, political, and cultural objectives.

Fetal Imagery and “Reproductive” Technologies

The three phases of graphic representation shown here are inseparable from the evolution of two kinds of “reproductive” technologies. First, the development of medical technologies used in childbirth, like obstetrical forceps designed to extract infants during obstructive births, has reconceptualized notions of fetal in/dependence, pregnancy, and childbirth. Second, technologies of mechanical, and then digital, image reproduction have transformed the ways in which we disseminate and perceive images of the fetus in utero. To the longer traditions of woodcuts, engravings, lithographs, and photographs, the twentieth century has added internal imaging techniques like the x-ray and ultrasound. The next frontier is the third dimension of mapping the body, in the form of the 3D printable fetus in utero.

Unveiling the Mysteries of the Fetus in Utero (1500–1650)

During the period from roughly 1500–1650, images of the fetus in utero appeared more frequently than ever before in anatomical atlases and medical treatises designed for trainees of surgery, medicine, and midwifery. The high quality of image production was made possible by the introduction of mechanical means of printing. The printing press permitted the large scale production and distribution of such textbooks to a wider audience of readers, in both Latin and vernacular languages, and at a more affordable price.

Other important changes were afoot that contextualize how the fetus was graphically presented in these pioneering instructional and anatomical books. The Christian worldview of the Middle Ages persisted into the Renaissance, albeit the challenge of the Protestant Reformation to Catholic orthodoxy in the Latin West reinvigorated debates about the nature of humans and their role on earth. What all sects of European Christianity shared was the argument for divine design: that a knowing God gave life to all creatures great and small. This extended to the realm of human conception, referred to as “generation” up until 1800, perhaps in keeping with a biblical notion of creation or “genesis.”

The medieval distinction between the microcosm (the corrupted earthly, ever-changing human realm) and the macrocosm (the divine, perfect, unalterable heavens) was being revisited by secular authorities in this period without being entirely overthrown. There was an increasing interest on the part of burgeoning natural philosophers, anatomists, and medical practitioners to discover, catalog, taxonomize, and decode the microcosm in order to arrive at new truths about the natural world. This extended to a renewed fascination with marvels, prodigies, and supernatural beings, including claims of monstrous babies and mothers.

A bold new approach to the human body, the highest order animal of the microcosm, was ushered in by the Anatomical Renaissance of the mid-sixteenth century. The anatomist Andreas Vesalius’ (1514–64) groundbreaking publication De humani corporis fabrica libri septem or On the Fabric of the Human Body in Seven Books (1543) made a call for the systematic and intensive dissection of the human body. In this work, Vesalius critiqued his contemporaries’ slavish reliance on the textual traditions of ancient Greek physicians like Galen (129–200/216? CE) and Hippocrates (460?–370? BCE), thereby paving the way for undoing orthodoxies that had influenced medicine and anatomy for some 1400 years.

Although man, and indeed the male body, was deemed the measure of all things human, anatomists like Vesalius also sought to dissect female corpses. Their interest was in learning about the gravid uterus and the mother’s unique role in giving life. The uterus as an organ of generation had long been held as mysterious. The interior of the female body was deemed invisible and unknowable when compared to their male counterpart whose organs of generation were more readily visible. Notions of mystery surrounding female generation stemmed from a long-standing—and today, clearly sexist—view of female “hysteria” (from the Greek term for uterus, hystera or ὑστέρα) dating back to the ancients. This view held that the female uterus wandered throughout the body and perturbed both her body and mind.

Although many Renaissance anatomists did not subscribe to this theory, a great deal of ignorance surrounded both human conception and the nature of human development in utero. The sixteenth-century emergence of corporeal dissection facilitated an interest in accessing the female generative body and put to rest some ancient theories, while also raising new questions about the specificity of women’s anatomy. A more systematic view of the fetus in utero would require the dissection of many gravid uteruses at various stages in human development, and with it, new conventions of graphic representation emerged.

Not all was dark and mysterious in this period. Nor was everything new. As the term “Renaissance”—rebirth—suggests, lines of continuity were also apparent. The aesthetic conventions of classical statuary are well in evidence in Renaissance depictions of embodied mothers, who appear to be iterations of the revered Venus de Milo, the ancient Greek statue who is presented as the picture of female health: both voluptuous and muscular. While the Venus de Milo’s missing arms have vexed onlookers for centuries, mothers appearing in Renaissance anatomy were also presented in various degrees of dis/embodiment, depending on the viewpoint being favored. In some cases, she is depicted assisting in her own dissection, by flaying her abdomen for all to peer into her gravid uterus.

Another feature of this era of black and white woodcuts and engravings is the portrayal of cartoon-like fetal acrobatics in spacious wombs, where playful gymnastics, including diving and free falling poses, are seemingly the order of the day prior to delivery. While playful and unrealistic from our contemporary vantage point, these images likely had clinical utility. In serving as diagrammatic interpretations of fetal positions within the uterus, these images, in combination with tactile evaluation and the initial presentation of the fetus in the birth canal, could affirm fetal position, thereby guiding clinical decisions during the birthing process.

The Art and Science of (Man-)Midwifery
(1650–1750)

During the eighteenth-century Enlightenment, male surgeons and physicians took an increasing interest in a domain traditionally considered to be the vocation of midwives. The reasons for this interest were numerous, with some regional variation. In France, for example, state pressures to reduce infant mortality resulted in King Louis XV (1710–74) providing Mme du Coudray (1712?–94) with a royal pension in order to tour the country and improve birthing practices through her innovative teaching methods. She trained male and female students in various birthing postures on a simulative mock-woman made of real pelvic bone and textiles that she referred to as both her “phantom” and “machine.”

Mme du Coudray worked alongside, and sometimes in opposition to, a number of male practitioners who were making professional claims to childbirth. They did so primarily, though not exclusively, by way of instruments, which they argued were superior to human hands in delivering infants in the case of fetal malpresentation. French practitioners, like François Mauriceau (1637–1709) and Jean-Louis Baudelocque (1745–1810), pioneered new instruments and identified professionally with their surgical ingenuity. Extractive devices like forceps were commonly used to assist in delivery, while in more radically obstructive cases, such ominous-looking devices as the “crochet” (a sharp metal hook) or the “tire-tête” (a corkscrew-like implement) were implemented. While these tools often saved the mother, they sacrificed the fetus during removal. These instruments and their use increasingly appear in illustrated midwifery manuals, further medicalizing the fetus in utero.

The intrusion of male medical authority in midwifery extended across Europe and in both America and colonies in the Americas. The male takeover of traditional midwifery was not without opposition, however. The English midwife Elizabeth Nihell (1723–76), who had trained at the prestigious Hôtel-Dieu of Paris maternity ward, was a staunch adversary of male “instrumentarians.” She complained that they applied excessive, violent force in childbirth through their cold metal tools in cases that simply required patience and manual dexterity. Other women took male encroachment on their profession as motivation to improve and expand their own techniques and textual output.

The German midwife Justina Siegmund (1636–1705) stands out as an enterprising practitioner who overcame the jealousy of male colleagues while also presenting novel solutions to complicated birthing positions in her illustrated manual Court Midwife (1690). In this work, Siegmund presents an ingenious two-handed technique using a sling, in order to rotate the fetus in utero presenting its shoulder into the more optimal head-first position. This method demonstrated that instrumental intervention and hand-based delivery were not inherently oppositional, and moreover, that textile-based instruments like slings also had their place in infant delivery alongside rigid metal ones. Her inclusion of the latest embryological and anatomical engravings from experts in the field, including the Dutch physician Govard Bidloo (1649–1713) featured elsewhere in this exhibition, also showed that Siegmund was at the cutting edge of her field.

From Midwifery to Obstetrics
(1700–1900)

By the early nineteenth century, the man-midwife had asserted his professional authority in a field that was transforming into a science known as obstetrics. The man-midwife, or “accoucheur” as he was known in France, rose to prominence over the female midwife, in a process that transformed the profession and medicalized childbirth.

Although one might expect in this period of disciplinary upheaval, the continued exclusion of the mother or her disembodiment in graphic anatomy, nineteenth-century visual depictions often present a re-embodied mother. This was a departure from the Enlightenment period, when “butcher shop meat” was a common mode of maternal portrayal. Presenting an embodied mother provided an opportunity to convey the Victorian virtues of gentility and modesty. However, if the mother now appeared more fully and transparently, she was nonetheless presented with moral and social objectives in mind.

In this regard, Enlightenment and Victorian visuals shared in a prescriptive discourse of pregnancy in which the female body should be presented through either the male medical gaze or a broader societal gaze. In the case of the Enlightenment practitioners focused on ‘rationalizing’ the body, the mother was disembodied from the process in order to assert their authority or to do the ‘social good’ of improving childbirth and decreasing infant mortality. Once this process was near completion and the ‘science of childbirth’ routinized in the nineteenth-century hospital environment, attention arguably turned to the re-embodied mother, in order to reflect the social pressure to safeguard reproduction as a means to ensure a workforce during the Industrial Revolution.

The move towards a hierarchical and male-dominated vision of childbirth, and the extension of graphic representations of the fetus in utero to the moral and social realms, was not to the exclusion of female practitioners, however. French women like Mme du Coudray (c. 1712–94) and Mme Boivin (1773–1841), for instance, found themselves at the cutting edge of disciplinary change. Unusually for a woman in this period, Mme du Coudray obtained a pension from King Louis XV (1710–74) in order to undertake a twenty-five-year mission to educate both men and women in the art of birthing. Mme Boivin wrote textbooks, including her multi-edition Memorial on the Art of Childbirth (1817), trained cohorts of students at the Paris Maternity hospital, and invented instruments like an internal “pelvimeter,” a diagnostic tool designed to predict difficult labors due to a too-narrow pelvic passageway.

Finally, depictions of the fetus in utero in this period of disciplinary ferment fed off changes in imaging technology. Copperplate engraving, which had replaced woodcut printing, persisted in this period. It is a technique by which an image is drawn by an illustrator before being etched onto a copperplate by an engraver, and then inked for mechanical reproduction. Lithograph techniques were also used, which permitted printing from either a stone or metal plate using chemical processes. Interactive flap anatomies and life-size posters designed for classroom use also contributed to visualizing the fetus in utero. The traditions of artisanal drawing, etching, and engraving would all be revolutionized by the end of this period, with the advent of photography and the x-ray.

The Consolidation of the Male Medical Gaze (1800–1900)

Male-driven medicine was consolidated in the new space of the hospital, where old traditions of birthing were whitewashed, both figuratively and literally, by the sanitized clinical environment. Along with obstetrics, the emerging discipline of gynecology cemented male dominion over the female body. The result was the emergence of the male medical gaze, which asserted a new visual advantage over and control of patients in ways that reduced their agency when compared to earlier periods.

The cultivation of the nineteenth-century male medical gaze in the clinic was a continuation of the male takeover of midwifery that began during the Enlightenment. This gaze was facilitated by the introduction of new norms in the birthing chamber that allowed the practitioner to easily visualize, access, and interact with female reproductive anatomy. The moves towards reclinable birthing beds and gynecological examination tables favoring a recumbent position, often with inbuilt stirrups and arm restraints, facilitated practitioner control over an increasingly vulnerable patient. This was in contrast to the upright posture in which most women gave birth in the age of midwifery, where purpose-built stools were the norm.

The development of illustrated medical textbooks was another aspect of the consolidation of the male medical gaze in obstetrics. With several exceptions, including the French midwife Mme Boivin (1773–1841), male physicians set the iconographic agenda and directed teams of artisans accordingly. The main trace of their power position in curating the visual archive of the fetus in utero comes in the form of hands—hands that perform digital examinations, that wield instruments, that restrain patients. The French obstetrician Adolphe Pinard (1844–1934), for instance, was applauded for his dexterous use of palpation, the technique of manually ‘feeling inside’ the pregnant body from the outside in order to assess fetal position. Yet far from being a new technique, palpation is simply another way of describing the hands-based repertoire traditionally used by the midwife in diagnosis and delivery.

The obstetrical textbook is as interesting for what it visualizes as what it does not. Indeed, underlying many nineteenth-century depictions of the fetus in utero is a voyeuristic element. Interactive flap anatomies, which originated in the Renaissance, were nonetheless presented in new ways in this period: large-scale, full-color lithograph flaps invited readers to peel back numerous layers of the female interior in order to peer through the transparent “curtain” that is the amniotic sac. In this sense, the modesty veil of the early modern period approximates a Victorian era “peep show” curtain. The presence or absence of pubic hair, bare breasts, and external genitalia may also reveal a pleasure-seeking undertone attesting to the male prerogative of the new obstetrical textbook tradition.

The Fetus Dissected,
The Fetus in Folio

The transformation of human anatomy into a scientific endeavor required new visuals that would capture and showcase the increasing complexity and medical value of the human body. Images of the fetus in utero have similarly evolved, taking prominence in the familiar or ‘classic’ anatomical texts that have contributed significantly to the fetus’ visual history. The materials in this case present the fetus in utero in the large-scale anatomy atlases known as ‘folios’ that were first popularized in the eighteenth century.

The fetus’ graphic entry into the folio tradition begins with a backstory: the re/turn to corporeal dissection in the late medieval period. The dissection of female corpses, particularly for the purposes of demystifying her organs of generation, was a prerequisite to studying, and then illustrating, the fetus in utero. In Antiquity, human dissection was largely forbidden, leaving Greek and Roman anatomists to dissect animals like Barbary apes, who were deemed suitable stand-ins for humans given their number of shared features. This prohibition on dissection contributed to the creation of anatomical images, including those of the fetus in utero, which were more imaginative than representative of reality.

From Antiquity to the Renaissance, there were several cultural and religious deterrents to bodily dissection. The most important of these was undoubtedly a Christian argument that the human body must remain intact for possible resurrection after death. For this reason alone, the dissectors of the Anatomical Renaissance like Vesalius went to great lengths to obtain corpses deemed suitable for dissection. “Suitable” bodies included persons who had been hanged or otherwise publicly executed for capital crimes, given that their moral transgressions on earth had already jeopardized their chances of salvation and resurrection. Even in these cases, certain municipalities required that corpses be retrieved from sites of execution outside the town limits, out of respect for the relatives of the deceased.

Thus Christian Europe had to become culturally comfortable with the medical uses of dissection before humans—let alone women—could be regularly opened up by anatomists for study. The normalization of dissection as a legitimate scientific activity was also facilitated by the rise of temporary scaffold structures that eventually became permanent, dedicated anatomy amphitheaters in Italian city states and the Netherlands, and then, across Europe. These venues were dedicated to teaching and research on the human body, functioning as an extension of the university Medical Faculty as the locus of innovation from which new images would emerge.

Opening up female bodies via dissection required another layer of care and attention given the broader culture of the strict segregation of the sexes outside of marriage. Physicians were not expected to touch patients outside of checking their pulse, for instance, leaving male anatomists to adopt techniques to combat potential charges of moral impropriety in handling female cadavers. One was to preserve the woman’s modesty by shrouding breasts and genitalia in textiles while other parts were being dissected—at least, this became a convention for anatomical teaching, both in situ and in textbook illustrations. Over time, the medicalization of the female body enacted by and through the male gaze reached a radical iconographic conclusion: that her body could be chopped and cleaved to reveal only the parts deemed most important or strictly necessary for obstetrical training. In this case, the mother’s sense of bodily integrity and personhood is compromised for the medical lesson at hand, as if dismembered “butcher shop meat” that must be sacrificed in service to the fetus.

The medicalized images presented here and elsewhere are open to further layers of interpretation. Many of those presenting mothers as merely reproductive vessels do so in evocative ways that betray a level of curation and staging that trespasses beyond mere pedagogical utility. Bare breasts primed for postpartum feeding, straight-on views of thighs spread apart for childbirth, and agonized-but-beautiful facial poses all hint at voyeurism. Indeed, there is potential for all such iconography to enter into the realm of sexually titillating or pornographic presentation. Underlying all imagery, whether taken as medicalized, sexualized, or some degree of both, is a notion of conventional female beauty that is encapsulated perhaps most clearly in the turn-of-the-twentieth-century life-size Pilz female “manikin.” She appears in full color with a period-appropriate lithe physique, symmetrical features, coiffed hair, and artful makeup. The tension between traditional representations of the female body and those of the pregnant mother as a scientific subject has often reconciled in favor of the fetus in utero, while nonetheless retaining traces of the maternal body.

The development and evolution of obstetric atlases and manuals aligned with a broader movement in medicine at this time that focused on consolidating its scientific culture and professional clinical practice. This progression embraced visuals that were stripped of artistic flourishes and presented standardized, yet realistic, images that conveyed clinically useful information. In terms of obstetric images, where the clinical focus shifted to the fetus, the depiction of the mother is rare and, when present, she often serves merely to orient the fetus within a corporeal geography. The mother has been increasingly measured and subsequently pathologized when she deviated from a “normal” morphology that best accommodates the fetus and facilitates safe and efficient childbirth. Similarly, images of the fetus in utero, while becoming more realistic, are presented in a way that stresses the dangers the fetus may encounter, often requiring mechanical intervention. Far removed from the spacious and nurturing uterus presented in earlier images, the fetus now appears more closely as it does in the ‘reality’ of our modern secular world. While created in the service of clinical objectives, these images represent a significant shift in the visual culture of the fetus in utero.

Photography and the Fetus

Photography as a technology that “captures” reality is often considered objective, and for this reason, has been readily adapted to medicine and use in anatomical and clinical texts. However, photographing human tissue in black and white was technically challenging, often resulting in images of an indistinct mass of tissue, blood vessels, and organs, as some of these images attest. Additionally, early photographic technology was limited in what it could see; it did not yet allow for visualization of the fetus in utero. As a result of these limitations, early obstetrical photographs often depicted deceased mothers and fetuses in various stages of dissection, resulting in images not palatable for dissemination beyond the medical domain. The voyeuristic concerns of obstetrics and the harshness of the medical gaze were further called into question by the early use of photography in obstetrics.

Photographs like those found here of anonymous—and perhaps unwitting and unwilling— female patients raise questions about the changing standards of patient consent and the powerful position of male medical authority in this period. The violence done to the body is clear and invites a modern-day feminist critique of female erasure. Not only is the mother often removed from these images, what remains of the female body is reduced to its most useful fragments and bones relevant to reproduction—the uterus and pelvis. However, these images also suggest that the evolution of obstetrics at the hands of male practitioners was premised on notions of ‘progress’ that privileged some viewpoints over others. In this case, the mother’s erasure from decision-making in childbirth is treated merely as the collateral damage of the longer arc towards transparency in fetal representations.

Owing to both its content and the novelty of stereoscopic technology, The Edinburgh Stereoscopic Atlas of Obstetrics makes a unique contribution to the visual culture of the fetus in utero. Comprised of 100 images, published in four volumes between 1908 and 1909, this atlas adopts the entertainment aspect of stereoscopy with the obstetrical medical gaze, resulting in a visual spectacle that both captivates and repels. The morbid specimens in these images come to life through the illusion of 3D. Forced to view through the stereoscope to achieve the 3D effect, the viewer’s gaze is directed at images that are often gruesome and bordering on illicit. While the display of the anatomical specimens in the atlas serve as photographic updates of many of the graphic representations seen in prior eras, viewing these images as intended invokes a sense of voyeurism. While presented as an educational object, the utility of this atlas, beyond its novelty, has been questioned. It nonetheless remains a pioneering atlas containing some of the first published photographs of a live childbirth.

While the technology of early photography was limited in its ability to capture the fetus in utero and the images that were created were primarily confined to the medical domain, subsequent developments in photography significantly altered the visual culture of the fetus in utero. These modifications created an opportunity for these images to spread far beyond the traditional medical and educational domains. This new era in the visual culture of the fetus in utero began in April 1965, with the publication of Lennart Nilsson’s now iconic photographs in Life magazine.

The Invisible Fetus Becomes Visible: The X-Ray

The discovery of the x-ray in 1895 ushered in a new era of medical imaging. For the first time, technology provided the ability to visualize the interior of a living human without having to cut through one’s skin. In keeping with the scientific fervor of the era, this technology was widely used in medicine, and the images it created were more broadly disseminated in popular culture, in part due to the rise of photography and the popular print press. While a clear symbol of the scientific progress of humanity, the x-ray image was also a reminder of our mortality, as it stripped us bare and revealed our skeleton, the bodily remnants of death. Similar to photography, the radiograph was considered to represent the objective truth of the body. In becoming a primary source of information about an individual, the x-ray further intensified the male-driven medical gaze, which fragmented and objectified the body. The process of creating and interpreting a radiograph required the isolation of parts of the body from the whole, as an act of technological dismemberment.

Following the discovery of the x-ray, it did not take long for the field of obstetrics to utilize this technology to visualize, for the first time, a fetus inside of a living mother. From an obstetrical perspective, these images allowed for confirmation of a pregnancy, assessment of fetal position, estimation of gestational age, and evaluation for abnormalities of the fetal bones. Additionally, the x-ray allowed for assessment of the maternal pelvis and its suitability for childbirth. While it seems obvious now, the harmful effects of fetal exposure to radiation were not well known at the time, and it took decades before the use of the x-ray on the pregnant female fell out of favor, to be replaced by a new, emerging technology: the ultrasound.

Despite falling out of favor as an imaging modality of the pregnant mother, the x-ray represents a notable shift in the development of the visual culture of the fetus: the once invisible fetus, still hidden within the uterus, was now visible from within the living mother. The medical gaze had acquired the technological capability to see what was once invisible, and in doing so, further disembodied the mother and isolated the fetus. In these images, the mother has often been reduced to a skeletal presence—the pelvis, lower back, and hips—that cradles and protects the fetus. The fetus, not yet born, has already been reduced to a skeleton, a symbol of death. As previous images attest, the maternal uterus was often represented as a nourishing and protective environment for the fetus, but in these images, the uterus disappears and the bony structures of the mother appear as a vessel for the fetal skeleton.

Nonetheless, the x-ray and the images it produced represents a significant shift in how the fetus in utero was visualized. While the x-ray produced images of the fetus in utero from a living mother, they were not widely disseminated or commonly provided to the mother as a pregnancy “keepsake.” On one hand, early x-ray technology did not facilitate the easy and rapid production of images that could be provided to mothers. These images very much remained within the domain of the medical profession, to be used for medical purposes. On the other hand, upon looking at these images, one may question if this was an image that a mother would want to keep even if she could. The emergence of ultrasound, however, would profoundly change these dynamics, allowing for wide dissemination of the fetal image.

Twinning the Fetus in Utero

Although the phenomenon of twins and multiples is as old as human reproduction itself, their prominence in obstetrical textbooks suggests that they were medically prevalent if not also challenging, as well as culturally novel. The notion that twins develop a special, life-lasting bond in utero has a long history, and in the images presented here, they are occasionally depicted embracing or facing each other, as if deep in conversation. On other occasions, they appear like nesting dolls inside an egg or puppets attached by string-like umbilical cords.

Early modern practitioners differentiated between identical and fraternal twins, though the nature of both was inscribed in a larger debate about the origins of human conception. Were humans pre-formed at the moment of their conception, merely requiring time and energy to grow to adult size? And if so, did the preformed parts reside in the female egg (ovist theory) or the male sperm (spermist or animalculist theory)? If humans were not pre-formed, then were they the product of “epigenesis”—that is, a spontaneously generated lower order form who morphologizes into the more complex full-term fetus over the course of the gestation period?

More in-depth investigations of fetal biology in the nineteenth century would provide answers to these questions, just as anatomical investigations of the placement of twins in utero would reveal their precise configuration. While identical twins are the result of a single fertilized egg that grows in the same amniotic sac, fraternal twins emerge from separately fertilized eggs that develop in distinct sacs. The notion that an egg or ovum can split into two or more clones, or that multiple eggs can simultaneously be fertilized, was and remains a fascinating biological phenomenon that has been studied across the animal kingdom.

Competing theories aside, multiple fetuses presented practitioners with a particular set of challenges during childbirth. The medical concern over twins was focused on managing risk. This was especially the case in the early modern period before the advent of imaging technology that would reveal twins in utero prepartum, knowledge that would in the modern period allow practitioners to prepare for the various eventualities of delivery. In the absence of x-ray vision, such practitioners as the eighteenth-century French midwife Mme du Coudray (ca. 1712–94) warned that all fetal presentations during delivery should be treated with the possibility of twins or multiples in mind. For instance, one should not assume that an arm and a leg presenting themselves are necessarily from one child. Additionally, twins safely nestled in utero often appear oriented in the opposite direction, meaning that one of the two would present itself in the risky breech (foot-first) position.

The advent of the x-ray and then ultrasound facilitated delivery of twins and permitted practitioners to anticipate potential birthing complications and devise delivery strategies accordingly. In fact, twins are often by default categorized as high risk births and the medical establishment today views favorably on C-sections for such delivery, an operation that was considered very dangerous in the early modern period.

Charting Fetal Development: from Generation to Reproduction

Before about 1800, the term used for conception by laymen and medical experts alike was “generation.” This was eminently suitable given the prevailing Christian worldview and its etymological kinship with the biblical concept of creation or “genesis.” From about 1800 onward, however, “reproduction” became the preferred term. Its underlying notion of copying can be understood against the backdrop of rapid industrialization and the introduction of mechanical means of mimicking human labor that extended from the factory floor to new technologies of imaging, such as the advent of lithography and photography.

Up until about 1800, there were also a variety of competing theories for the origins of human life, though the argument for divine design was generally accepted as the starting point for any particular theory in the Christian West. The two most popular theories of human origins debated in the early modern period were preformationism and epigenesis.

According to preformationism, humans exist in their complete form even before they are conceived, requiring merely time and nourishment as embryos in order to grow from miniature to adult size. The question that remained was: where did preformed life reside before conception—in the female ovum or the male sperm? According to the ovist model, life originated in the female egg or ovum. Adherents of the spermist (or animalculist) theory believed, on the other hand, that the preformed parts were found in the head of the male sperm, based on their observation of sperm motility in semen samples examined with the newly invented microscope. The theory of epigenesis, on the other hand, held that humans developed spontaneously from an undifferentiated mass or lower order being to a more complex one over a series of morphological transformations resulting in a full-term infant at nine months.

Both theories could accommodate Christian theology given that the origins of both ‘mini me’ (preformationism) and ‘the blob’ (epigenesis) was a purposive God. Fetal development in the early modern works featured here showcase this range of conception theories. The fetus comes under many guises, from a nondescript mass to a recognizable baby, as well as everything in between: skeletons, doughboys, and little people.

Of these two early modern theories of conception, epigenesis more clearly aligned with nineteenth-century breakthroughs in evolutionary biology, which provided a new way of looking at and visually depicting the fetus in utero. In the grand scheme of the evolution of living things from a single common ancestor over deep time, fetal development was a rapid, singular process. Briefly put, evolutionary biologists—inspired by the English naturalist Charles Darwin’s ground-breaking work On the Origin of Species (1859)—understood fetal transformations as a developmental series. The fetus morphologized during its gestation period in utero, and in this process, became more complex. A variety of biologists, including German theorists from Samuel Thomas von Sömmering (1755–1830) to Ernst Haeckel (1834–1919), contributed to the creation of a new graphic convention of presenting the fetus’ serialized development in utero. By often removing the fetus from the uterus and presenting its developmental narrative in sequence, the fetus attained autonomy and a sense of personhood.

The serial or sequential model of human development also permitted biologists to distinguish more clearly between the embryo and the fetus, each of which aligned with specific periods of human gestation. This demarcation, in turn, has fueled a variety of debates over fetal personhood in modern-day litigation, from the permissibility of late-term abortion to determining parentage in the cases of in vitro fertilization.

Ultrasound and the Fetal Image

The development of the ultrasound as an imaging modality and its subsequent use in obstetrics marks a pivotal period in the visual culture of the fetus in utero. Arguably the most recognizable medical image, the fetal sonogram has become iconic. Over the course of its technological development, the ultrasound has attained increasing capability to visualize in greater detail and complexity the fetus in utero.

Occurring within the context of the increased medicalization and socialization of pregnancy, the fetal ultrasound has become a routine clinical procedure during pregnancy, while the images it produces have contributed to a public narrative around pregnancy. This allowed the fetal sonogram, in combination with sensationalized photography and the rise of the internet and social media, to project images of the fetus in utero into the public domain, to be curated in cyberspace by the parent(s)-to-be and deployed as a political tool.

But why the fetal ultrasound? The emergence and dissemination of the sonogram as the dominant image within the visual culture of the fetus can be traced back to the technology itself and how it came to be utilized in obstetrical practice. Compared to other imaging modalities (CT, MRI, X-ray), the ultrasound is relatively easier to use, safer (avoids radiation exposure), less expensive, and importantly, produces moving images that can be viewed in real-time. For these reasons, ultrasound has become a versatile and commonly used technology in medicine, including in obstetrics. From a clinical perspective, the ultrasound provides medically relevant information about both the fetus and pregnant woman, including confirmation of pregnancy, fetal measurements, fetal anatomy including abnormalities, location of the placenta, and amount of amniotic fluid. Despite its clinical relevance, the ubiquitous use of ultrasound in obstetrics has been criticized for contributing to the medicalization of pregnancy. The images it produces, on the other hand, have been critiqued for contributing to the emergence of the public pregnancy.

However, the fetal sonogram did not attain iconic status until the images achieved enough clarity that they could be easily interpreted and, in turn, readily distributed to parents-to-be for further distribution beyond the clinic and into the public domain. Fetal sonograms from the early era of ultrasound technology are unrecognizable when compared to contemporary images. A brief timeline of the obstetric ultrasound illustrates how the visual culture of the fetal sonogram evolved with the technology to its present-day aesthetic and how, in the process, the sonogram became socially “readable” through its presentation of a discernible fetus in utero.

An early ultrasound from a 1966 publication measures the diameter of the fetal head, here referenced as two sharp peaks occurring 90mm apart. This A-mode (amplitude) technology was rudimentary and limited in its clinical utility.

This ultrasound image from a 1972 publication shows the diameter of the fetal head in cross-section. The B-mode (brightness) ultrasound technology used to produce these images marked a significant advancement in ultrasound imaging, allowing for the first two-dimensional images. While the early images from B-mode technology were black and white, by the mid-1970s, images could be rendered in gray scale and permitted greater distinction between bones, tissue, and fluid. This technological capacity is what permitted the construction and normalization of the now-common ultrasound imagery presenting the fetus as a cross-sectional ‘silhouette.’

A pivotal point in the development of the ultrasound was the introduction of real-time sonography in the late 1970s. Prior to this development, images were made in similar ways to taking a photographic snap-shot. For the first time, real-time ultrasound allowed the pregnant woman to directly participate in viewing the images as they are being created. This ability ushered in an era of patient-directed ultrasound, whereby the ultrasound experience extended beyond a medical procedure and took on broader social significance. The ultrasound industry participated in this transition by creating machines with screens that swivel towards the patient for easier viewing, with built-in printers to print “keepsake” images for the parents-to-be, and installation of imaging programs that enhance the images, with colored filters, for example.

This series of sonograms depicting the fetal body shows the incremental improvement of image clarity and reduction in background “noise” from 1985, 1990, and 1995 respectively, an era in which the obstetric ultrasound became common clinical practice during pregnancy.

The subsequent development of 3D rendering provided increasing clarity and life-like images that further enhanced the iconography of the fetal ultrasound. 4D technology has added motion to 3D images. The data from these ultrasound images is also being used to create 3D printed models of the fetus in utero.

The Fetus’ Very Public Debut: Life Magazine

The fetus’ very public debut in April 1965 as a photograph of an 18-week-old free-floating figure on the cover of Life magazine marks a pivotal point in the history of its visual culture. Taken by the photojournalist Lennart Nilsson (1922–2017), the image quickly gained iconic status after its publication, selling eight million copies within four days of its release. The magazine claimed that the image was the “first published photograph of a living fetus inside a uterus.” The accompanying photo essay is entitled “The Drama of Life Before Birth,” suggesting that the fetus is a character in a sweeping, propulsive visual narrative.

This photograph was one of a series of career-making images by Nilsson, who photographed fetuses like these in the context of ongoing abortion debates in his native Sweden. Although later in life he appeared agnostic on the issue of abortion, at the time this and other images were published in his book A Child is Born (1965), Nilsson was enthralled by the anti-abortion physician, Per Wetterdal. It was through Wetterdal that Nilsson gained access to the first fetuses he ever photographed at a Stockholm Women’s clinic.

While these images proved pivotal in debating new abortion legislation in Sweden at the time, they were presented in America less controversially, as examples of the wonders of the human biological world. What very few if any consumers of these iconic fetal images knew then, as now, was the degree of curation required to produce such healthy looking specimens: Nilsson used backlighting and other photographic techniques to present the fetus as if alive, where in fact he primarily photographed aborted fetuses. Feminist scholars have pointed out that although the cover image was of a living 18-week-embryo, taken using a wide angle lens and a surgical scope equipped with a flash beam, the other images in the spread were of embryos that had been surgically removed from the uterus and were no longer viable. In her work on the history of fetal and embryo specimen collection in the United States, Lynn Morgan writes of the irony—not just in Life, but in many other popular and scientific works on pregnancy and human development—of using images of dead fetuses to (mis)represent life. Morgan’s work reminds us that fetal images are open not only to interpretation, but also to manipulation.

Nilsson’s Life cover photo is exceptional not only because of its claim to be the first of a living embryo, but also because the placenta is visible. In recent decades, feminist scholars have interrogated the ways in which contemporary images of the fetus tend to erase the pregnant body, so that the fetus appears to float in isolation, what Rosalind Petchesky has called “a tiny man, or homunculus,” suspended in the empty vessel of the womb. Others have compared this trope to that of an astronaut free floating in the darkness of space, which Petchesky suggests speaks to an older, Hobbesian view of humans as “disconnected solitary, individuals.” In her work on abortion rhetoric, Celeste Condit argues that anti-abortion groups have obscured parts of the fetal image that might be perceived by the public as unpalatable or even monstrous, such as a reptilian “tail,” and instead have focused on more familiar images of small feet and hands. Condit argues that this manipulative technique leads us to see images of small feet or hands and visualize a fully-formed human in their place. Scholars argue that obscuring the maternal presence, or portraying pregnant bodies as empty vessels, promotes fetal “personhood” at the expense of the pregnant woman, who becomes invisible as the fetus becomes hyper-visible and fully human, purportedly but dubiously capable of attaining legal and political status.

The 1965 Life article was followed up twenty-five years later with a similar article, titled “How life begins,” again featuring Nilsson’s photography on the cover and in the article. The images in this issue demonstrate the new technological capabilities of photography, serving to consolidate the recognizability of fetal imagery in the popular press.

Viewers are encouraged to look at a reproduction of the full 1965 article at the interactive desk.

Written with Chloe Hall

The Social and Cultural Fetus

Although ultrasound remains a standard component of prenatal care, the fetal image has become what anthropologist Julie Roberts calls “hypermobile,” moving far beyond the realm of the clinic and clinical practice. Images of fetuses have become icons, almost instantly recognizable in social, commercial, and political contexts. And, like religious icons, seemingly untouchable images that serve evangelizing agendas. Examining modern and contemporary uses and interpretations of the image of the fetus in utero reveals shifting and contested attitudes about fetal “personhood,” the pregnant body, and the family unit.

Fetal sonograms are unique among medical images in the way they bridge private and public worlds. Medically, sonograms are performed in order to identify fetal anomalies, and may shape patients’ private decisions to continue with or to terminate a pregnancy. Yet, as more commonly deployed, fetal images are widely disseminated in the public sphere. For example, they may be used by happy parents-to-be to spread the news of their pregnancy or to “gender reveal” the fetus to their social networks. They are also used to advocate the idea that fetuses are “persons,” in support of the argument that to terminate a pregnancy is to end a life, and to advance specific policy positions and legislation about pregnancy options.

Others argue that, far from alienating mother from fetus, fetal imaging creates a closer bond between parent and child. In The Public Life of the Fetal Sonogram, medical anthropologist Janelle S. Taylor describes theories on the “psychological benefits” of fetal sonograms. For example, some clinicians argue that if pregnant women see images of their fetus early in pregnancy, they may be more likely to adhere to physician recommendations for prenatal care, including curbing their consumption of alcohol and drugs. These theories are poorly supported by evidence, but speak to the power attributed to fetal images: that they can seemingly create more virtuous mothers, and more connected nuclear families. Ultrasound technology has evolved to facilitate this parental bonding, while contributing to its marketability in the public domain. Taylor notes that it has long been a standard practice for American ultrasound companies to incorporate a “swivel monitor” that can be turned to face parent(s)-to-be in the exam room, as well as printers for “souvenir photos” of sonograms that can be sent home with parents.

In addition to viewing fetal images, doppler technology allows one to hear the fetal heartbeat. The relatively recent commercialization of the sonogram, by way of “keepsake ultrasound” businesses, capitalizes on its role in helping parents-to-be conceive of themselves as a family unit, through “bonding” sessions, long before a baby is born. These businesses offer “early peek packages,” gender checks, and jewelry and memory books to display the images. However, the non-medical, recreational use of ultrasound during pregnancy is discouraged by multiple professional medical organizations, as well as the US Food and Drug Administration, which regulates medical devices including ultrasounds. Indeed, ethicist Rebecca Kukla notes that “the primary purpose of the eighteenth-week ultrasound, as it is represented in our culture, is not diagnostic but social.” The extent to which the fetal sonogram is deployed in social media and beyond affirms this statement, as the image has crossed over from the medical domain into the public domain for broader consumption.

Sonograms are disseminated through social networks via holiday greeting cards, baby-shower invites, and social media posts. On webpages that offer suggestions on ways to announce one’s pregnancy, the fetal sonogram is inescapable. Indeed, fetal images have become part of the social currency of parenthood. Sonograms also appear in advertising targeted to families, including a campaign featuring the tagline, “Is something inside telling you to buy a Volvo?”

Written with Chloe Hall

The Political Fetus

The fetal sonogram’s most powerful and ideologically driven use has without a doubt been in the context of debates about reproductive rights. Since second wave feminists secured reproductive rights for women in the United States and beyond, the manipulation of fetal imagery has become the stock-in-trade of the anti-choice movement. So much so that the fetal ultrasound has become the most potent tool for political and legislative action adopted by the right-to-life movement.

The perceived power of the fetal ultrasound is often utilized in legislation targeted against abortion. Several states have implemented laws that require doctors to offer pregnant women a chance to see a sonogram before a pregnancy is terminated. In a more extreme example, legal scholar John Robertson describes Oklahoma’s requirement that the “ultrasound screen be visible to the woman, though she may avert her eyes” at least one hour before an abortion. If she chooses to avert her eyes, law mandates that she listen to a doctor or sonographer describe the fetus to her in detail. Texas has a similar law in place. In Michigan, a 2005 bill was introduced that would require women to look at images of their own fetus before an abortion; previously, the law had required women to view generic images of a fetus at the same gestational age as their pregnancy, 24 hours before an abortion.

These laws suggest that anti-abortion legislators and advocates believe in the power of looking at and engaging with fetal images, and in their role as powerful tools that can shape decision-making. This legislation is often based on the unsubstantiated theories of parental “bonding” described above. Though several studies have shown forced viewing of the fetal image to have no effect on a woman’s decision to abort, the Texas and Oklahoma laws seem to suggest that if a woman sees the fetus she is carrying, it may compel her to keep the pregnancy out of a sense of connection and a “natural” maternal instinct to nurture. In fact, such is their faith in the power of the fetal image, that anti-abortion organizations such as Focus on the Family have invested heavily in ultrasound technology at Crisis Pregnancy Centers, where free, non-medical ultrasounds are often offered, against the recommendation of medical professional organizations. Additionally, images from fetal ultrasounds are frequently used in anti-abortion literature and propaganda, where they are used to convey “personhood” and fetal “autonomy.” These materials are powerful reminders that the pro-life movement has capitalized on fetal images in order to colonize the abortion debate.

In medicine, ultrasound technology is used to confirm a normal pregnancy or to identify fetal, and sometimes fatal, anomalies. For pro-choice advocates, ultrasound technology can thus empower pregnant women to make fully informed decisions about pregnancy options, including abortion. In this context, the fetal image is presented as an objective piece of information that can guide clinical decision-making. Pro-choice advocates have criticized anti-abortion groups for portraying fetal images as the “ultimate” symbols of life in order to manipulate the emotions of patients, lawmakers, and the general public.

While both sides of the abortion debate weave sensationalized narratives that evoke strong emotions of fear, pain, and disgust in order to promote their cause and provoke the public, the anti-abortion side has more forcefully used fetal imagery in order to advance its cause. Anti-abortion advocates have focused on the process and aftermath of abortion. The 1984 video Silent Scream claimed to show the process of an abortion from the “victim’s” point of view, using ultrasound technology. In contrast, pro-choice advocates have focused on the aftermath of illegal abortions, and on stories of the underground, pre-Roe v. Wade world of unlicensed practitioners and scared, desperate mothers. While each side uses similar rhetorical techniques to shift their audience’s empathy, either towards the “vulnerable,” yet autonomous fetus, or towards the pregnant woman who has run out of options, they do not draw on fetal imagery equally. While anti-abortion advocates selectively present full-term fetuses to inculcate a notion of abortion-as-death, pro-choice advocates have generally presented access to fetal imagery as one among many factors in the decision-making process during a pregnancy. For pro-choice advocates, the ultrasound machine—which does not appear in accounts of illegal, “back alley” abortions—primarily offers reassurance in its promise of providing medically accurate data in a safe, clean, fully licensed medical facility. The pro-choice approach to the ultrasound and the fetal sonogram is ideological, but not prescriptive: it empowers women to make informed decisions.

Written with Chloe Hall

The Future of the Fetal Image

Through much of human history, a woman understood pregnancy to begin with a “quickening,” a combination of physical and emotional signs felt by the mother, instead of with an image. Tracing the history of the fetal image in utero allows us to see the way in which an invisible ‘mystery’ became visible and medicalized, and then moved beyond the medical realm to permeate culture, commerce, and politics. From Renaissance woodcuts to contemporary 3D ultrasounds, the development and evolution of the visual culture of the fetus in utero is a fascinating journey shaped and propelled by religion, science and medicine, attitudes about motherhood and the female body, print and imaging technology, and philosophy.

Now, it is possible to 3D-print an image of a fetus that can not only be looked at, but touched. As medicine and imaging technology continue to develop, so too will our engagement with the image of the fetus in utero. As news of the first child born from a cadaveric uterine transplant reaches the world, new questions about the image of the fetus in utero arise—if the uterus has long been thought of as a kind of vessel, what does it mean that it can now be temporarily implanted in another body? Our engagement with the fetal image and how we, as a society steeped in religion, science, the humanities, technology, and politics, create, engage with and use these images will continue to shape its visual culture.

What does the future of the fetal image hold? The “keepsake” fetal hologram? The 3D animated fetus? Virtual reality visits to the womb? The in-utero live-stream video or ultrasound? Undoubtedly, the path forward will indulge us with images—including textured, touchable ones—that both excite and challenge how we view, interpret, and employ them.

Written with Chloe Hall