Bonding with Baby - Why Ultrasound Is Turning Women against Abortion

by Mark Stricherz - December 2, 2002

Reprinted with permission.

His baby had seemed real to him from the moment when Rosemary spoke of abortion; but it had been a reality without visual shape-something that happened in the dark and was only important after it happened. But here was the actual process taking place. Here was the poor ugly thing, no bigger than a gooseberry, that he had created by his heedless act. Its future, its continued existence perhaps, depended on him. Besides, it was a bit of himself-it was himself. Dare one dodge such a responsibility as that?

- George Orwell, Keep the Aspidistra Flying

Ebony Smith was once only a street corner away from getting an abortion. Last October, Ebony, 17, was walking to her local Planned Parenthood clinic in the South Bronx. "I was scared and I was just about to finish high school and I didn't really know what to do," she says, recalling how she was vomiting nearly every day and how she feared her parents' reaction to the pregnancy. "I thought that [abortion] was my only option."

On her way to the clinic, she eyed a large billboard on the side of a building; it read, "Free Pregnancy Tests." She decided to check it out and went inside Expectant Mother Care, a crisis pregnancy center. The tests confirmed that she was six weeks pregnant. A counselor told her about abortion-how a doctor vacuums the embryo or fetus out of the mother's womb as you would a stray piece of popcorn on the carpet, and the guilt and bleeding that can ensue. That was one reason she decided not to abort.

The other was later seeing images of the fetus on the center's 3-D ultrasound machine. The tiny black-and-white images amazed her.

"I didn't realize that's something inside of you," she says excitedly. "That's when I decided I was not going to have an abortion. I could see the hands and the feet, and I could hear the heartbeat. It sounded like horses galloping-da-dum-da-dum-da-dum," she laughs.

Aside from helping her decide not to abort, the sonogram image did something else: It prompted her to work hard to graduate. "I knew I had to finish high school. It motivated me," she says. Less than seven months after she saw the sonogram, Josiah Collado was born. Ebony enrolled this fall at the State University of New York at Binghamton and plans to marry Nelson Collado next year.

In many ways, Ebony's case is typical. New evidence suggests that ultrasound plays a key role in persuading women not to have abortions. Psychologists say the reason for this is maternal-fetal bonding, the experience Ebony had when she saw and heard the heartbeat of little Josiah for the first time. Prenatal scientists have discovered that ultrasound triggers those feelings even in the first trimester-two to three months earlier than they had thought. And now that 3-D and 4-D ultrasound is going commercial-General Electric now runs a TV ad for its 4-D machine-many think that maternal bonding will have an even greater effect on pregnant women.

In short, ultrasound has become a major force in the country's abortion landscape. It has galvanized crisis pregnancy centers, which report seeing many more clients since the arrival of the new technology. And it is giving the pro-life cause a new tool to help persuade women to choose life.

Yet the vast majority of pregnant women in this country aren't as lucky as Ebony. The crisis pregnancy center she went to not only had an ultrasound machine-a service offered by only 341 of 1,800 centers in the nation, according to Heartbeat International, a Columbus, Ohio-based nonprofit-the machine is 3-D, a relatively rare technology. If it hadn't been for these things, Ebony's pre-born baby would have ended up like the 1.2 million that are aborted every year. This ought to change. And yet unless government steps in to help, it won't.

From Stories to Data

For decades, evidence about ultrasound's impact on abortion was merely anecdotal. In an oft-cited 1983 article in the New England Journal of Medicine, Drs. John C. Fletcher and Mark I. Evans found that the viewing of a sonogram image "in the late first or early mid-trimester of pregnancy, before movement is felt by the mother, may also influence the resolution of any ambivalence toward the pregnancy itself in favor of the fetus."

But in the nearly two decades since the appearance of this report, no researchers appear to have followed up on it. Neither Lawrence D. Platt, the past president of the American Institute for Ultrasound in Medicine, nor Delores H. Pretorius, a professor in the radiology department at the University of California at San Diego and a leading authority on 3-D ultrasound, could recall a single study on the topic. The federal government has similarly failed to look at the issue; ultrasound still isn't listed among the reasons for the decade-long drop in abortions. "Our society doesn't deal well with abortion. There's such a divergence between pro-life and pro-choice people," Pretorius explains.

Yet Pretorius, who is pro-choice, acknowledges ultrasound's power to change minds about abortion. Women find it "harder to abort their baby after seeing the image. I mean it's harder even for women with Tay-Sachs disease [a fatal genetic disorder that affects the brain]. They don't know whether the baby has the disease," she says.

Others agree. Eric Keroack, the medical director of A Woman's Concern, a crisis pregnancy center in Boston, has just completed an unpublished article on the topic. His study compares two 18-month periods in the center's recent history-before it used an ultrasound machine (July 1998 through 1999) and after it began using one (October 2000 through April 2002). Throughout, the type of clients was the same: women who told staff they were considering abortion. Of the 366 women tracked in the non-ultrasound phase, 58 percent aborted. But of the 434 women tracked in the ultrasound period, only 24 percent aborted. The abortion rate fell by 59 percent. And women were almost twice as likely to give birth to their babies. During the non-ultrasound phase, 33 percent of the women went on to give birth. That number jumped to 63 percent when the center had an ultrasound machine. (Nine percent of the women in the first cohort miscarried, as compared with 10 percent in the second cohort.)

Keroack, who says that he performed 30 to 35 abortions himself during his medical residency at Tufts University and early days as an OB-GYN, is up-front about his study's chief flaw-it couldn't follow the 35 percent of clients who didn't respond. One Washington, D.C.-area ultrasonographer, speaking on the condition of anonymity, said he doubted that 63 percent of women would choose life after seeing the sonogram. He agreed that sonograms persuade women to remain pregnant but estimated that figure was between 20 to 33 percent. Nevertheless, even those figures represent a major step for the pro-life cause.

Even pro-choicers have acknowledged the sonogram's power to change women's minds. Francesco Angelo, the medical director of the Family Planning Center in Mineola, New York, was quoted in the February 24 New York Times as saying, "The bottom line is no woman is going to want an abortion after seeing a sonogram."

But others are slower to grasp the significance of the new technology. In a February 2 Associated Press story, Kate Michelman, the president of the National Abortion and Reproductive Rights Action League (NARAL), disparaged antiabortion groups that encourage ultrasound use. Such groups, she said, fail to respect "women's capacity to understand what goes on in our bodies." At least one woman featured on NARAL's own Web site wouldn't agree. Shannon Lee Dawdy says that she and her husband "went for a routine ultrasound, and seeing our child for the first time made the pregnancy real for me" (emphasis added). (Dawdy aborted because the fetus had anencephaly, a rare neural tube defect.)

Maternal Bonding

Dawdy's feelings actually are relatively new in human history. Before ultrasound was used, a woman had less reason to feel attached to her baby during the first 16 to 18 weeks of pregnancy. The in-utero child was still too small to be felt, let alone seen. (Which is why early American law followed English common law in distinguishing this "pre-quickening" period from a "quickening" period.) The maternal bonding phenomenon seemed to begin at about 16 to 18 weeks into the pregnancy, when the mother could feel the baby kick in the womb.

Ultrasound has changed all this. Even during the first trimester, a woman who saw a sonogram image of her unborn child now felt attached to her baby. That is, she wanted to know and protect her child. For the image on the screen isn't just any tiny human-a generic photo of fetal development could show her that. It is hers, a human life she has helped create, a moving baby with a beating heart. It becomes impossible to refer to the baby as "uterine contents" or "the pregnancy" or a "product of misconception" (the sort of dehumanizing language favored by the New York Times). "There is a personalization of the fetus or embryo. The woman can see a hand and face move," Platt said.

In fact, scientists no longer really dispute the phenomenon. Numerous studies in the United States, Canada, and Europe have all found strong evidence for it. One early study showed that women who saw sonogram images early in pregnancy knew much more about their baby. In a 1980 article in the Journal of Obstetrics, Gynecologic, and Neonatal Nursing, three authors interviewed 100 women at a Pennsylvania hospital. The women's answers were the same regardless of class or race. Before the scan, the mothers believed their fetuses or embryos were inactive-they described their child as "sleeping," "floating," "growing," and "moving" (in order of frequency). After viewing the scan, they saw that the pre-born child was active-the mothers' responses in order now were "moving," "kicking," "growing," and "relaxing." The authors termed this change in views "considerable."

Maternal bonding has also been linked to changed behavior among expectant mothers. For example, a 1982 study in the journal Psychological Medicine found that in a randomized control group, women who saw a sonogram image of their fetus at 14 weeks or earlier and were given detailed information about prenatal development were less likely to smoke and drink than those women who had not seen their fetus's image.

The Vital Two Months

The real problem with ultrasound isn't the technology. It's that most women don't use the technology when it really matters: when they're deciding whether to abort. Instead of being done during the first trimester, when women are most likely to abort, sonograms are usually done when women are 16 to 18 weeks pregnant, according to gynecologists and ultrasonographers. By that time, it's too late.

Part of the problem is that ultrasound was long viewed by doctors with suspicion and indifference. The first modern scanner was used in 1966 in Germany, but for years the technology was practically unknown. Roe v. Wade doesn't even mention sonograms, despite citing such medical advances as artificial insemination and the morning-after pill. Up through the early 1980s, the technology's medical uses were scoffed at. In the standard textbook on ultrasound, Ultrasonography in Obstetrics and Gynecology, author Peter Callen opens one chapter this way: "When I began my involvement with diagnostic ultrasonography two decades ago, this chapter would have been considered ludicrous."

But around this same time sonogram images were improving, with the advent of real-time scanners and, a few years later, digital scan converters. In 1984 a famous 28-minute film, The Silent Scream, depicted a 12-week-old fetus being aborted. Yet fears of the technology persisted. The National Institutes of Health declined that year to endorse routine ultrasound screening in pregnancy, citing concerns about women's safety and doubts about its medical values. Both concerns turned out to be groundless, but doubts remained. Only a little more than half of the roughly four million pregnant women who were pregnant in 1990 used sonograms to detect pregnancy, according to the Centers for Disease Control and Prevention.

Since then, sonogram use has steadily risen. By 2000, 67 percent of pregnant women were using it. Ultrasound figures prominently in magazines like Parents, while a woman having a sonogram is today a familiar scene in daytime soap operas. Ultrasound machines have also turned into big business, with the industry reaping $1 billion in profits last year. And 3-D machines, which have been around since the mid-1980s, are finally entering the commercial sphere. They can show a fetus as young as nine and a half weeks with a head, arms, belly, and legs.

But many insurance companies are unwilling to pay for more than one ultrasound scan, which typically costs several hundred dollars, and they prefer to have it done later in the pregnancy. In poor parts of Los Angeles, Platt notes, a woman won't receive a scan till she's 25 weeks pregnant. The American College of Obstetricians and Gynecologists, the industry's association, doesn't recommend that all pregnant women undergo an ultrasound scan.

The abortion industry isn't exactly an enthusiastic backer of the early use of ultrasound either. Clinics don't require women to undergo sonograms before 14 weeks, let alone to view the image of the pre-born child. The National Abortion Federation, whose members perform half of the nation's 1.2 million abortions annually, has no mandatory sonogram policy for its 450 clinics in the United States, according to Vickie Saporta, the executive director of the National Abortion Federation.

At least one former abortion-industry worker has claimed that her clinic turned the ultrasound monitor away from women. Jo Ann Appleton, now the president of the Society of Centurions, a pro-life organization for former abortion-industry workers, was the former head nurse at Commonwealth Clinic in Falls Church, Virginia, from 1984 to 1989. She says her clinic performed ultrasounds only when the woman requested it: "We didn't show it to them [otherwise]. The idea was to keep their anxiety at a lower level."

Does Uncle Sam Want Them?

Pro-life organizations and churches tend to be the only institutions pushing for early sonograms. But since there's little money to be made in helping the poor and vulnerable, their budgets are absurdly meager; they do as much as they can with the little they're given. And this appears to be true even of crisis pregnancy centers that use sonograms.

I recently visited the Rockville Crisis Pregnancy Center, outside Washington, D.C. Located just off a bus stop in Rockville, Maryland, the center is on the second floor of a mustard-brown brick building. The counseling rooms are windowless, brightly lit, and painted in bright yellow and pink. The ultrasound machine itself looks unimpressive-a manila-colored EUB-405 Hitachi that weighs 40 pounds: about the size of a 12-inch TV.

Most of the clinic's clients are poor, from an ethnic minority, or in college, according to executive director Gail Tierney. They learn about the center not through the mainstream media, but via the Internet, the yellow pages, billboards, and word of mouth. Ultrasound scans are generally performed only one night a week, because it's hard to find a doctor who will work for free. This year's whole budget is $269,000, Tierney says.

As she talks, I detect a lingering bitterness toward national pro-choice leaders and groups. When I told Tierney, whose center was unfairly maligned in a story by the Washington Post, that one abortion clinic in the D.C. area assured me they perform ultrasounds before and after the abortion, Tierney replied, "Oh, that's good-show her what's left afterwards."

And yet Tierney can claim to have saved hundreds and maybe thousands of lives. On her wall she has pictures of past clients with their children. Getting ultrasound "was the best thing we've done in 15 years. The majority of the abortion-vulnerable women don't choose abortion after seeing their baby," Tierney says. The center sees 200 such women every year.

Still, Rockville is one of only two crisis pregnancy centers in the D.C. area with an ultrasound machine. By contrast, there are 15 abortion providers.

One of the major organizations trying to improve the ratio is the National Institute for Family and Life Advocates, a small Virginia-based nonprofit. Its mission is to convert such counseling centers into fully equipped medical offices that would offer ultrasound scans. Of the 789 centers it represents legally, about 200 have operating ultrasound machines, according to Thomas Glessner, the group's president and founder. NARAL recently named Glessner's nonprofit institute an "anti-choice organization to watch" in its 60-page booklet, "Choice Action Kit: Unmasking Fake Clinics."

Glessner himself is an unusual pro-life leader. He grew up in a small logging and farming town in Washington state, where his father was a Protestant minister. He inherited from his father a concern for social justice, and this concern led him to protest against the Vietnam War and serve as an officer in the Young Democrats Club at the University of Washington. Now 50, he is still very much a child of the 1960s. He and I met for lunch recently at Pete's Diner on Capitol Hill. "I Get Around" blared from the radio. Glessner, wearing a green-and-brown-patterned shirt, said, "Yeah, man, cool. The Beach Boys!" and started dancing a quick jig.

The story of how Glessner's organization became interested in sonograms highlights the precarious nature of the crisis pregnancy center movement. In the early 1990s, a handful of state attorneys general clamped down on pregnancy centers, which were accused of practicing medicine illegally. In fact, many of them had been administering pregnancy tests illegally without a nurse or physician. It was in this climate that Glessner's group embraced sonograms-not so much because it was thought they'd persuade women to choose life but for political reasons. "It was a defensive posture," Glessner said plainly. "It was done to avoid the claim, 'You're illegally practicing medicine.'"

The ultrasound machines ended up attracting new clients. "We saw a twofold increase in the number of women coming in, and there was a huge increase in the number of abortion-minded women who changed their mind," he said.

With impressive figures like that, Glessner is seeking to enlist federal support. He cowrote a bill in Congress, sponsored by Rep. Cliff Stearns (R-Fla.), that would help nonprofit health clinics to buy ultrasound equipment, authorizing $3 million this year in federal grants.

While that's pocket change by congressional standards, Glessner believes it could bring down the country's still-high abortion rate. A basic 2-D ultrasound scanner costs $20,000 to $25,000. If health clinics persuaded state, local, or business leaders to pick up the other half of the cost, they could buy nearly 500 machines. Enacting that bill would also represent an important step by the federal government on behalf of unborn human life. (In April, Alabama mandated that women seeking an abortion must undergo an ultrasound exam, although they are not required to look at the image.)

Stearns's bill went nowhere on Capitol Hill this year. But with a Republican-controlled Congress next year, its odds of passing are strong. President George W. Bush certainly knows about the power of ultrasound: At the Born-Alive Infants Protection Act signing ceremony in Pittsburgh, Pennsylvania, on August 5, he said, "Today, with sonograms and other technology, we can clearly see that unborn children are members of the human family. They reflect our image, and they are created in God's own image."

From Debating to Seeing

Indeed if compassionate conservatism is to mean anything at all, it should mean supporting the early use of ultrasound. What better use of government dollars is there? Sonograms not only improve quality of life. Poor women provide better prenatal care after seeing them (this helps explain why three pro-choice black members of Congress, who represent poor districts like Newark, New Jersey, and the south side of Chicago, support Glessner's legislation). They save lives. Ask any woman who's faced a crisis pregnancy, if she was lucky enough to have used one.

The manipulation of language has long been one of the hallmarks of the pro-choice position. But with ultrasound, words no longer matter so much: The abstract melts into the concrete and the personal. This powerful emotional appeal will continue to grow as 3-D ultrasound enters the mainstream. Embryos and fetuses, which represent the first of the six stages of human life (followed by infancy, childhood, puberty, adolescence, and adulthood), may at last be recognized-and protected-as human persons.

Mark Stricherz, a contributor to GetReligion.org and InsideCatholic.com, is the author of Why the Democrats are Blue: Secular Liberalism and the Decline of the People's Party (Encounter Books).