Birth

This paper reconsiders Tommie Shelby's (2016) analysis of procreation in poor black communities. I identify three conceptual frames within which Shelby situates his analysis—feminization, choice-as-control, and moralization. I argue that these frames should be rejected on conceptual, empirical, and moral grounds. As I show, this framing engenders a flawed understanding of poor black women's procreative lives. I propose an alternative framework for reconceiving the relationship between poverty and procreative justice, one oriented around reproductive flourishing instead of reproductive responsibility. More generally, (...) the paper develops a methodological challenge for nonideal moral and political philosophy, especially concerning the obligations of the oppressed. Specifically, I argue that in the absence of descriptive and conceptual accountability, the "moral gaze" of the philosopher risks preserving, rather than destabilizing, oppressive ideologies. (shrink)

Is moral or other regret for abortion an indicator that abortion may not be morally or prudentially choice worthy? This paper examines the work of Kate Greasley in this area, who offers an explanation of any asymmetry in openness to regret between women who have abortions and women who give birth. The latter, not unlike Derek Parfit’s 14-year-old who conceives deliberately, may feel duty-bound not to regret their decision (in their case, to continue their pregnancy) and to affirm the life (...) of their child. In response to Greasley, testimonial evidence of one group cannot be dismissed simply because regret may be less available to another group of decision-makers. Moreover, if moral regret for childbearing is uncommon, this is not because mothers have a moral duty, as Greasley argues, not to regret even a morally mistaken choice to conceive. On the contrary, one must separate the evaluation of choices and of the results of these choices, whether positive or negative. Regret, while not infallible, can elucidate values at stake in choices, and testimonial evidence in the form of regret should be taken more seriously in regard to certain kinds of choice. (shrink)

RESENHA: STONE, ALISON. Being Born: Birth and Philosophy. Oxford: Oxford University Press, 20219. ISBN: 978-0-19-884578-2.

The past few years has seen a resurgence in the public interest in space flight and travel. Spurred mainly by the likes of technology billionaires like Elon Musk and Jeff Bezos, the topic poses both unique scientific as well as ethical challenges. This paper looks at the concept of generation ships, conceptual behemoth ships whose goal is to bring a group of human settlers to distant exoplanets. These ships are designed to host multiple generations of people who will be born, (...) live, and die on these ships long before it reaches its destination. This paper takes reproductive ethics as its lens to look at how genetic enhancement interventions can and should be used not only to ensure that future generations of offspring on the ships, and eventual exoplanet colonies, live a minimally good life but that their births are contingent on them living genuinely good and fulfilling lives. The paper makes the further claim that if such a thesis holds, it also does so for human enhancement on Earth. (shrink)

This special issue of the Journal of Medicine and Philosophy focuses on unintended intrauterine death (UID) and preterm delivery (both phenomena that are commonly—and unhelpfully—referred to as “miscarriage,” “spontaneous abortion,” and “early pregnancy loss”). In this essay, I do two things. First, I outline contributors’ arguments. Most contributors directly respond to “inconsistency arguments,” which purport to show that abortion opponents are unjustified in their comparative treatment of abortion and UID. Contributors to this issue show that such arguments often rely on (...) a grossly oversimplified picture of abortion opponents’ views. Furthermore, contributions in this issue weigh in on issues regarding UID with theoretical import and therapeutic implication beyond the inconsistency argument debate. These papers can be mined for principles that better inform us about anembryonic pregnancies (i.e., nonviable pregnancies in which a gestational sac exists but no embryonic pole can be seen via transvaginal ultrasound), UID-prevention research, the law concerning UID (especially post-Dobbs), policies for handling embryonic remains, and moral psychology as it relates to UID, emotion, and empathy. In each case, conceptual philosophical analysis might bring about therapeutic benefits for those affected by UID. Philosophers, therefore, are in position not only to provide clarity—careful analysis and discussion of UID and related phenomena—but are also in position to genuinely help people affected by UID. (shrink)

We read commentaries on our feature article ‘The ethics of consent during labour and birth: episiotomies’1 with gratitude and interest. Nearly all commenting authors agree that consent for in-labour procedures is necessary and ideally given at the point of intervening. Both Shalowitz & Ralston and Stirrat note that this is already required by professional statements and guidelines in the USA2 and UK3, respectively, but also note that practice does not yet conform. The Americans authors helpfully emphasise the importance of multilevel (...) institutional measures for closing this gap, including consent policies and reporting mechanisms, as well as ongoing education.2 The UK writer seconds the role for education within wider shared decision-making and informed choice approaches, and generously commends our paper for close study by all maternity care providers. Others add a cautionary note. Lee applauds all our recommendations, but notes our proposals cannot fully secure autonomy because of, among others, epistemic injustice and other power differentials.4 Kumar-Hazard and Dahlen worry that opt-out consent is equal to substitute decision-making; weakens women’s rights; and is open to abuse.5 Nelson and Clough object to our willlingness to work within a flawed conceptual framework, which ought to be challenged.6 We agree that there are limits to what our proposal can do. It cannot rectify unequal distributions of epistemic credibilities, either in general or in any particular interaction. Risk communication is never neutral;7 “even the most well-meaning healthcare professionals …. (shrink)

Bobier and Omelianchuk argue that the Birth Strategy for addressing analogies between abortion and infanticide is saddled with a dilemma. It must be accepted that non-therapeutic late-term abortions are either, impermissible, or they are not. If accepted, then the Birth Strategy is undermined. If not, then the highly unintuitive claim that non-therapeutic late-term abortions are permissible must be accepted. I argue that the moral principle employed to defend the claim that non-therapeutic late-term abortions are morally impermissible fails to do so. (...) Furthermore, the principle that people have a right to bodily autonomy can be used as an argument for the conclusion that non-therapeutic late-term abortions are permissible and is intuitively stronger than the intuition for the opposite of this conclusion. This is because people having a right to bodily autonomy explains the impermissibility of rape and sexual assault. Consequently, the posited dilemma is defused and does not undermine the Birth Strategy. (shrink)

Unconsented episiotomies and other procedures during labour are commonly reported by women in several countries, and often highlighted in birth activism. Yet, forced caesarean sections aside, the ethics of consent during labour has received little attention. Focusing on episiotomies, this paper addresses whether and how consent in labour should be obtained. We briefly review the rationale for informed consent, distinguishing its intrinsic and instrumental relevance for respecting autonomy. We also emphasise two non-explicit ways of giving consent: implied and opt-out consent. (...) We then discuss challenges and opportunities for obtaining consent in labour and birth, given its unique position in medicine.We argue that consent for procedures in labour is always necessary, but this consent does not always have to be fully informed or explicit. We recommend an individualised approach where the antenatal period is used to exchange information and explore values and preferences with respect to the relevant procedures. Explicit consent should always be sought at the point of intervening, unless women antenatally insist otherwise. We caution against implied consent. However, if a woman does not give a conclusive response during labour and the stakes are high, care providers can move to clearly communicated opt-out consent. Our discussion is focused on episiotomies, but also provides a useful starting point for addressing the ethics of consent for other procedures during labour, as well as general time-critical medical procedures. (shrink)

PurposeThe relation between fear of childbirth and gestational age is inconclusive, and self-reported need for help regarding this fear has never been investigated. This study aimed to determine the prevalence and course of FoC according to gestational age, to identify risk factors for the development of FoC, the influence of this fear on preferred mode of delivery, and self-reported need for help.MethodsNulliparous pregnant women of all gestational ages completed an online survey. The study consisted of a cross-sectional and a longitudinal (...) analysis. Women who completed the survey in the first or second trimester were approached again in their third trimester. The Wijma Delivery Expectancy Questionnaire Version A was used with a cut-off score ≥ 85 to define presence of fear of childbirth. Questionnaires indexing social support, anxiety, symptoms of depression, preferred mode of delivery, and self-reported need for help were included.ResultsIn total, 364 women were enrolled at T0, and 118 out of 184 eligible women were included in the longitudinal analysis. Point prevalence of FoC at T0 was 18.4% with no significant difference between trimesters. In the longitudinal sample, the prevalence of FoC decreased from 18.6% to 11.0%, p = 0.004. Although mean scores for FoC decreased significantly, p < 0.001, scores increased in 41 women. The presence of FoC was associated with elevated anxiety, less family support, prenatal care of the obstetrician by choice, preference for a cesarean section, and for pain relief. Women with FoC were more likely to actively seek for help compared to women without FoC.ConclusionWhile FoC is common in each trimester, prevalence decreases over the course of pregnancy. Women with FoC are often actively seeking for help, suggesting that this fear should be addressed better, and help should be offered accordingly. (shrink)

This article explores post-cesarean shame to understand how normative birthing ideals are tied to neoliberal and popular feminist expectations of what it means to be a “good” mother. Drawing on narratives shared on motherhood blogs, we note that feelings of shame associated with cesareans are tied to social pressures for unmedicated, vaginal birth. Rather than critique nonmedical or “natural” birth, this article explores the affective implications of approaching birth as a curated and controllable process. We conclude with suggestions for practitioners, (...) moms, and their supporters on how to make room for births that are not good. (shrink)

The common liberal understanding of reproductive autonomy – characterized by free choice and a principle of non-interference – serves as a useful way to analyse the normative appeal of having certain choices open to people in the reproductive realm, especially for issues like abortion rights. However, this liberal reading of reproductive autonomy only offers us a limited ethical understanding of what is at stake in many kinds of reproductive choices, particularly when it comes to different uses of reproductive technologies and (...) third-party reproduction. This is because the liberal framework does not fully capture who benefits from which reproductive options, the extent of the risks and harms involved in various reproductive interventions, and the reasons for why people are driven to make certain reproductive choices. (shrink)

This paper is a response to a recent paper by Bobier and Omelianchuk in which they argue that the critics of Giubilini and Minerva’s defence of infanticide fail to adequately justify a moral difference at birth. They argue that such arguments would lead to an intuitively less plausible position: that late-term abortions are permissible, thus creating a dilemma for those who seek to argue that birth matters. I argue that the only way to resolve this dilemma, is to bite the (...) naturalist bullet and accept that the intuitively plausible idea that birth constitutes a morally relevant event is simply mistaken and biologically misinformed. (shrink)

This book brings together an international collection of experts in reproductive ethics, law, disability studies, and medicine to explore the challenging future of reproduction and children. From the medical to the social and from the financial to the legal, the authors explore the expanding impact of reproductive genetics on our society. New advances in genetic technologies are revolutionizing the practice of reproductive medicine. We have expanded our ability to detect genetic changes in embryos and fetuses in ways that potentially allow (...) to identify, treat, or prevent a growing range of diseases. The development of gene-editing technologies raises questions about the possibility of removing disease-causing variants from embryos before pregnancy implantation. The growing sophistication of prenatal genomic sequencing offers us glimpses into the whole genome of the developing fetus. And, the increasingly sophisticated science of 'gene matching' allows us greater and greater foreknowledge of how the genomes of two individuals will combine in a future child. This is an indispensable book on the newest developments in bioethics caused by the sciences. Chapter 5 is available open access under a Creative Commons Attribution 4.0 International License via link.springer.com. (shrink)

Philosopher Fiona Wollard recently advocated interpreting the achievements of women while giving birth. People readily recognize men-related achievements, like running a marathon, but not achievements related to giving birth. We expand on Woollard's notion of reproductive achievements, comparing them with ideas of human enhancement, which aims at humans becoming "stronger and faster". Criticisms to evolutionary psychology challenge its defense of a notion of a fixed human nature, and its disregard for the experience of birth. Some female scholars link human evolution (...) to the presence of premature infants requiring attention from mothers and alloparents. They explain why this gave an advantage to the human species, enhancing cooperation and other desirable traits. Other scholars develop philosophies of birth, mostly based on Arendt's conception of natality, questioning a human nature not sensitive to gender, excluding birth and childhood. Then we move to transhumanism, proponent of human enhancement. Transhumanism questions our biological inheritance for being flawed and outdated, including giving birth, restricting this to a source of great suffering. This assessment of the given does not consider its ambiguous, dialectical character. Because of that, tinkering with nature both accomplishes and frustrates the goals of human enhancement. (shrink)

During the COVID-19 pandemic, several hospitals implemented “birthing alone” policies, banning companions from accompanying individuals giving birth. We offer an ethical analysis of these policies. First, we examine them through a consequentialist framework of risks and benefits. Second, we consider the significance of birth, highlighting the unique ways in which risks, relationships, and rights are understood in the context of obstetrics. We conclude that birthing alone policies are largely unjustified, as the harm they are certain to cause outweighs their possible (...) benefits and because they fail to take into account what matters to mothers. (shrink)

This paper critically analyses ‘the paradox of autonomy and consent in maternity care’. It argues that maternity care has certain features that increase the need for explicit attention to, and respect for, both autonomy and rigorous informed consent processes. And, moreover, that the resulting need is considerably greater than in almost all other areas of medicine. These features are as follows: (1) maternity care involves particularly socially sensitive body parts that are regularly implicated in consent‐centred procedures, as well as in (...) unconsented interventions, in ordinary, non‐medical life; and (2) much of maternity care (especially intervening in childbirth) is medically unique, in that it harms one patient (the mother) not primarily for the promotion of her own health but for the benefit of another (the baby). The apt comparison, within medicine, is therefore with non‐therapeutic research and transplantation medicine—both of which have elevated consent requirements characterized by very rigorous consent processes. At the same time—and this delivers the titular paradox—the importance of autonomy and consent in maternity care is at particular risk of being denied or disregarded. Jointly, these considerations make a very strong case for change: attention to and respect for autonomy and consent should be (1) core values; (2) key points of practical attention in the years ahead; and (3) central quality indicators in maternity care. (shrink)

Islam gives legal precedence to purity of lineage and known parenthood of all children. In Islam treatment to infertility using IVF is permitted within validity of marriage contract with no genes mixing. The paper shows that the Qur’ān, the word of Allah, and science, the deeds of Allah are not in major conflicts in defining the start of human life. The Holy Qur’ān provides an elegant description of origin, developmental stages of intra-uterine life. The Hadith explains two positions one that (...) believes human embryo get ensouled at conception and the other after 40 days of conception. The paper aims to find that Islam confers moral respect to human embryo, but it also clarifies the absence of full human rights to a developing foetus. In Islam, human embryonic use is probably permissible for therapeutic and reproductive purpose keeping intact the principles of Shari’ah. (shrink)

In this paper, the concept of birth affirmation is clarified in both the psychological dimension and the philosophical dimension. In the psychological dimension, we propose two interpretations: 1) Possible world interpretation: Even if I could imagine a possible world in which my ideal was realized or my grave sufferings were resolved, I would never think, at the bottom of my heart, that it would have been better to have been born to that possible world. 2) Anti-antinatalistic interpretation: I would never (...) think, at the bottom of my heart, that it would have been better not to have been born. In the philosophical dimension, we propose the following interpretation: The comparison of betterness or worseness between the actual world and a possible world and between my having been born and my not having been born should be impossible. In the final part of this paper, the differences from other related concepts and frequently asked questions are discussed. (shrink)

Obstetric violence – psychological and physical violence by medical staff towards women giving birth – has been described as structural violence, specifically as gender violence. Many women are affected by obstetric violence, with awful consequences. The phenomenon has so far been mainly investigated by the health and social sciences, yet fundamental theoretical and conceptual questions have gone unnoticed. Until now, the phenomenon of obstetric violence has been understood as one impeding autonomy and individual agency and control over the body. In (...) this article I will argue that the phenomenon of obstetric violence occurs in a specific state of embodied vulnerability and that might be destructive for subjectivity since it fails to recognize that state and instead disallows support and demolishes relationships and interdependence. This might introduce a conceptual shift and the phenomenon might be reconceptualized as a moment where vulnerability is misrecognized and ambiguity, relations and support are banned. In this case violence is recognized as cutting the original links to our bodies and the world that constitute our phenomenological condition, instead of as hurting the autonomous subject. Obstetric violence, thus, calls to be reflected upon through de Beauvoir’s ideas on ambiguity, the embodied and situated subject and the subject as essentially construed in relations. I believe that de Beauvoir’s conception of the authentic embodied subject as necessarily ambiguous – immanent and transcendent at the same time and ineludibly linked to the world and its others – will be extremely useful for construing this new understanding of how obstetric violence happens and of what precisely constitutes its damage. (shrink)

Childbirth in the United States is in crisis. This is especially true for Black and brown mothers. This childbirth emergency constitutes a failure of the social contract: because society has failed to provide minimally decent care for all birthing mothers, but especially for Black and brown mothers, it is necessary to allow mothers to choose home birth. I amplify the voices of Black and brown scholars and midwives to defend home birth, and I argue that home birth is safe and (...) empowering and that it is rational for those who desire it to choose it. (shrink)

Background: Obstetric labor and childbirth are mostly regarded as a physiological process, whereas social, cultural, psychological and transcendental aspects have received less attention. Labor support has been suggested to promote labor progress. The aim of this study was to investigate whether continuous labor support by a midwife promotes labor progress and vaginal delivery.Material and Methods: A randomized controlled study at a university hospital in Sweden in 2015–17. Primiparous women with singleton pregnancy and spontaneous labor onset were randomized to continuous support (...) or standard care during delivery. The primary outcome was the duration of active labor. Secondary outcomes were delivery mode, women's need of labor analgesia and satisfaction with delivery, maternal cortisol levels, and neonatal morbidity.Results: Continuous support was followed by shorter active labor 11.0 ± 5.7 h compared to 13.7 ± 3.9 h with standard care. Women in the continuous support group tended to have lower cortisol levels and low cortisol during the first and second stages of labor were correlated with shorter active labor. Continuous support was followed by spontaneous delivery in 73%, instrumental delivery in 24% and emergency cesarean section in 3% in contrast to standard care which was followed by spontaneous delivery in 62%, instrumental delivery in 24% and cesarean in 14%. The continuous support group received combined analgesic methods more often. Women's satisfaction with delivery and neonatal morbidity were comparable.Conclusion: Continuous labor support was followed by shorter active labor compared to standard care. Women with continuous support had a high rate of vaginal delivery and tended to have lower cortisol levels during all stages of active labor reflecting a lower stress level. Low cortisol was correlated to shorter active labor. Based on these results, we recommend continuous labor support for all primiparous women during active labor. (shrink)

It has been shown that various types of stress initiate different physiological and neuroendocrine disorders. Oxytocin is mainly produced in the supraoptic nucleus and paraventricular nucleus of the hypothalamus. Hypothalamic OT has antistress effects and attenuates the hypothalamic–pituitary–adrenal axis. One mechanism behind the antistress effects of OT is mediated through the inhibition from GABAA receptors on corticotropin-releasing factor expression at the PVN. Various manual therapies such as acupuncture, transcutaneous electrical nerve stimulation, and massage initiate the stimulation of somatosensory neurons of (...) the body. It is well-known that TENS simulates OT expression, while it inhibits CRF expression at the PVN following chronic stress loading in rodents. Upregulation of OT expression at the hypothalamus is activated by the somatosensory stimulation, which is mediated via the spinothalamic pathway. Thus, somatosensory stimulation is beneficial in treating stress-associated symptoms. Hypothalamic OT is associated with the social behaviors, including maternal care and affiliation. Childhood neglect and/or child abuse are severely responsible for deleterious long-term effects on the cognitive/social activity and behavioral development. At parturition, a profound amount of OT is released into the systemic circulation in response to vaginal and cervical stimulation caused by the body of fetus, which induces the onset of maternal behavior. Peridural anesthesia effectively impairs the sensitivity to vaginal and cervical stimulation at parturition. OT levels in cerebrospinal fluid is significantly reduced following peridural anesthesia. The vaginal delivery mothers had significantly more OT pulses than the caesarian section mothers. Due to low levels of endogenous OT, maternal behavior could be interrupted by epidural anesthesia and CS at parturition because of the reduction of the usual sensory input from the genitalia. (shrink)

The emerging area of philosophy of birth is invaluable, first, to diagnose fallacious assumptions about the relation between the womb and reason, and, ultimately, to challenge potentially damaging narratives with major impact on birth care. With its analysis of eighteenth-century epistemic and medical discussions about the role of the uterus in women's reasoning, this article supports two arguments: first, that women's “flawed thinking” was a premise drawn by many modern intellectual men, one that was presented as based upon empirical evidence; (...) and second, that the pervasive construction of the uterus as an element that renders women wild, uncontrollable, and irrational continues to influence contemporary obstetrics, even as today's medicine and science consider themselves to be free of any such prejudices.This article shows the role that Giacomo Casanova played in debunking these prejudices and presents his short manuscript on the issue as an important contribution to the literature of the Enlightenment, with its argument against women's supposed “natural” inferiority and for the idea that differences in education were to blame for women's subordinate position in society.Detailed analysis of the “thinking uterus” debate illuminates the different ways in which various arguments from/by the “anti-uterine” lobby were used to justify the subordination of women: sometimes emphasizing the connection between the uterus and thought and sometimes negating it, but always concluding that women's inferiority is to be found in some known or yet-to-be-discovered anatomical, and mainly sexual, deficiency or problem. (shrink)

Research suggests that some fathers and birth partners can experience post-traumatic stress disorder after witnessing a traumatic birth. Birth-related PTSD may impact on many aspects of fathers’ and birth partners’ life, including relationship breakdown, self-blame and reducing plans for future children. Despite the potential impact on birth partners’ lives there is currently no measure of birth-related PTSD validated for use with birth partners. The current study therefore adapted the City Birth Trauma Scale for use with birth partners. The City Birth (...) Trauma Scale is a 29-item questionnaire developed to measure birth-related PTSD according to DSM-5 criteria: stressor criteria, symptoms of re-experiencing, avoidance, negative cognitions and mood, and hyperarousal, as well as duration of symptoms, significant distress or impairment, and exclusion criteria or other causes. A sample of 301 fathers/birth partners was recruited online and completed measures of birth-related PTSD, bonding, and demographic details. Results showed the City Birth Trauma Scale had good reliability and psychometric and construct validity. The fathers/birth partners version has the same two-factor structure as the original scale: general symptoms and birth-related symptoms, which accounted for 51% of the variance. PTSD symptoms were associated with preterm birth and maternal and infant complications. Overall, the City Birth Trauma Scale provides a promising measure of PTSD following childbirth that can be used in research and clinical practice. (shrink)

Advances in reproductive medicine have opened up new scenarios, changing our experience and our understanding of what it means to be a parent. Literature and cinema have quickly turned their attention to new forms of reproduction, and often do what doctors in centres for assisted reproduction advise against: they reveal secrets, re-unite the various different protagonists, who make the new life possible, and explore the dramatic and sometimes tragic entanglement of birth stories. Significantly, literary and filmic stories also give voice (...) to those whose voice is seldom heard: the children. In my contribution, after providing a brief summary of the history of assisted reproductive technologies, I discuss some contemporary novels and films, in English and Italian, that deal with these new scenarios. Examples include The Kids Are All Right (2010) by American director Lisa Cholodenko, Google Baby (2009) by Israeli director Zippi Brand Frank, Venuto al mondo [Brought into the world] (2012) by Italian director Sergio Castellitto, Carissimi [Dearest] by Italian writer Letizia Muratori, Non mi vendere, mamma! [Do not sell me, mom!] (2016) by Italian writer Barbara Alberti, and Katherine Carlyle (2015) by British novelist Rupert Thomson. I argue that each birth has a story and that we cannot struggle free from the stories that make us any more than we can ignore the fact that we were brought into the world. (shrink)

The number of cesarean sections performed globally has been consistently rising since the 1980s.1 The number of cesareans performed now greatly exceeds the number that experts predict are necessary.2 In Brazil, the world's "cesarean capital," over half of births are surgical. In the United States, approximately one third of babies are delivered by cesarean, and in the United Kingdom around 26 percent of births are by cesarean.3 Cesarean section can be a life-saving intervention when vaginal birth poses a risk to (...) woman or fetus.4 However, some doctors believe that cesareans performed in the absence of an emergency carry substantial risks for limited or no benefit (Wagner 2000... (shrink)

Recently, I argued that human subjects in artificial wombs (AWs) “share the same moral status as newborns” and so, deserve the same treatment and protections as newborns. This thesis rests on two claims: (A) “Subjects of partial ectogenesis—those that develop in utero for at time before being transferred to AWs—are newborns,” and (B) “Subjects of complete ectogenesis—those who develop in AWs entirely—share the same moral status as newborns.” In response, Elizabeth Chloe Romanis argued that the subject in an AW is (...) “a unique human entity…rather than a fetus or a newborn.” She provides four lines of response to my essay. First, she argues that I have “misconstrued” what birth is. Once we correct that error, it becomes clear that subjects of partial ectogenesis have not been born. Second, she argues that my claims imply that non-implanted embryos (existing in vivo) “would also be ‘born.’” But that is absurd. Third, she claims I fail to “meaningfully respond” to distinctions she draws between subjects of ectogenesis and neonates. Finally, she criticizes my essay for focusing on subjects of AWs rather than focusing on pregnant persons (who should be at the “centre” of debates over AWs). I respond to each of these charges. In doing so, I reaffirm that (contra Romanis) some subjects of ectogenesis are newborns and all subjects of ectogenesis—even those that have not been born—share the same moral status as newborns. (shrink)

Women are routinely subjected to penetrating surveillance during pregnancy. On the surface, this may appear to flow from a cultural commitment to protect babies – a cultural practice of “better safe than sorry” that is particularly vigilant given the vulnerability of fetuses and babies. In reality, pregnancy occasions incursions against human rights and well-being that would be anathema in other contexts. Our cultural practices concerning risk in pregnancy are infused with oppressive norms about women’s responsibility for pregnancy outcomes and the (...) demands of extreme self-sacrifice from women to protect their fetuses. Of particular concern is our culture’s willingness to enforce norms concerning risk during pregnancy using coercive measures including forced cesarean sections and criminal penalties for exposing fetuses to risk. This chapter will consider assaults on self-determination, bodily integrity and privacy inherent in such interventions, as well as the structural violence and “mangled pieties” that buttress such practices in our unjust society. (shrink)

Background and Objectives: Mother's general health, including spiritual well-being, is a prerequisite for neonatal health. This study aimed to investigate the relationship of maternal spiritual well-being with the nutritional behavior and psychological parameters of neonates. Methods: In this cross-sectional study, a total of 101 women with non-emergency cesarean delivery were evaluated by convenience sampling method at Amiralmomenin Hospital in Grash, Iran. The study instruments consisted of demographic characteristic form, standard breastfeeding assessment tool, infant physiological parameters registration form, and spiritual well-being (...) scale. Before delivery, the standard breastfeeding method was instructed to the mothers, and their mental health scores were recorded. After delivery, nutritional behavior was recorded by the relevant instrument. Furthermore, the physiological parameters of the newborns were recorded by a tympanic thermometer, pulse oximetry, and neonatal examination. The data were analyzed using descriptive and inferential statistics, as well as correlational tests. Results: The majority of pregnant women had a moderate level of spiritual well-being. Based on the Pearson correlation test, maternal spiritual well-being showed no significant relationship with mean nutritional behavior and neonatal physiological parameters. Conclusion: Maternal spiritual well-being did not significantly affect the nutritional behavior and physiological parameters of the neonates on the first days after birth. It is suggested that similar studies be performed in different hospitals to evaluate the correlation between these parameters. (shrink)

The reception of Elaine Scarry’s landmark text, The Body in Pain, focuses in part on exploring how pain might be understood as beneficial or therapeutic. Childbirth is often cited as the paradigmatic instance of this kind of beneficial pain. This essay examines conceptualizations of labour pain in biomedical, natural childbirth and reproductive justice movements that explore the limits of Scarry’s description of pain as ‘unshareable’. Political struggles over pain in childbirth centre on the legibility of pain in labour. Feminist and (...) natural childbirth activists have developed an understanding of pain at birth as central to maternal subjectivity, where pain is a biopolitical force and its management a means of self-transformation. Alongside calls for reproductive justice, the essay considers how the visibility and expressivity of labour pain could contribute to what Imogen Tyler and Lisa Baraitser term a new ‘natal politics’ that addresses concerns for the disproportionate injury and death experienced by Black birth givers. (shrink)

Novel regulatory elements that enabled expression of pre‐existing immune genes in reproductive tissues and novel immune genes with pregnancy‐specific roles in eutherians have shaped the evolution of mammalian pregnancy by facilitating the emergence of novel mechanisms for immune regulation over its course. Trade‐offs arising from conflicting fitness effects on reproduction and host defenses have further influenced the patterns of genetic variation of these genes. These three mechanisms (novel regulatory elements, novel immune genes, and trade‐offs) played a pivotal role in refining (...) the regulation of maternal immune systems during pregnancy in eutherians, likely facilitating the establishment of prolonged direct maternal–fetal contact in eutherians without causing immunological rejection of the genetically distinct fetus. (shrink)

Several lines of evidence suggest that children born via Cesarean section are at greater risk for adverse health outcomes including allergies, asthma and obesity. Vaginal seeding is a medical procedure in which infants born by C-section are swabbed immediately after birth with vaginal secretions from the mother. This procedure has been proposed as a way to transfer the mother's vaginal microbiome to the child, thereby restoring the natural exposure that occurs during vaginal birth that is interrupted in the case of (...) babies born via C-section. Preliminary evidence indicates partial restoration of microbes. However, there is insufficient evidence to determine the health benefits of the procedure. Several studies, including trial, are currently underway. At the same time, in the clinic setting, doctors are increasingly being asked to by expectant mothers to have their babies seeded. This article reports on the current research on this procedure and the issues it raises for regulators, researchers, physicians, and patients. (shrink)

English law is unambiguous that legal personality, and with it all legal rights and protections, is assigned at birth. This rule is regarded as a bright line that is easily and consistently applied. The time has come, however, for the rule to be revisited. This article demonstrates that advances in fetal surgery and (anticipated) artificial wombs do not marry with traditional conceptions of birth and being alive in law. These technologies introduce the possibility of ex utero gestation, and/or temporary existence (...) ex utero, and consequently developing human beings that are novel to the law. Importantly, therefore, the concepts of birth and born alive no longer distinguish between human beings deserving of legal protection in the way originally intended. Thus, there is a need for reform, for a new approach to determining the legal significance of birth and what being legally alive actually encompasses. Investigating the law of birth is of crucial importance, because of the implications of affording or denying the subjects of new reproductive technologies rights and protections. A determination of the legal status of the subject of fetal surgery or an artificial womb will determine what can and cannot be done to each entity. Moreover, the status afforded to these entities will drastically impact on the freedoms of pregnant women. (shrink)

A half century ago electronic fetal monitoring was rushed into clinical use with the promise that the secrets of fetal heart rate decelerations had been discovered and that the newly discovered knowledge would prevent cerebral palsy with just in time cesarean sections preventing babies from experiencing asphyxia, which was thought to be the primary cause of cerebral palsy. In the years since electronic fetal monitoring’s debut, it has been discovered that asphyxia is a rare cause of cerebral palsy. At the (...) same time electronic fetal monitoring use increased to 85% of all labors, the C-section rate increased to 33% without an attributable decrease in the rate of cerebral palsy. What went wrong with electronic fetal monitoring? The answer lies in a new analysis of the physiologic theories concerning fetal heart rate decelerations, demonstrating that the earlier electronic fetal monitoring theories were wrong. This revelation is only the latest evidence that electronic fetal monitoring use today... (shrink)

Alison Stone investigates how human existence is conditioned by the fact that it begins with birth. How does birth shape the way we are in the world, and the meaning of our lives? Philosophers have written much about death, but neglected birth. Stone brings natality into philosophical view, offering fascinating insights into the human condition.

Ectogenesis, or the use of an artificial womb to allow a foetus to develop, will likely become a reality within a few decades, and could significantly affect the abortion debate. We first examine the implications for Judith Jarvis Thomson’s violinist analogy, which argues for a woman’s right to withdraw life support from the foetus and so terminate her pregnancy, even if the foetus is granted full moral status. We show that on Thomson’s reasoning, there is no right to the death (...) of the foetus, and abortion is not permissible if ectogenesis is available, provided it is safe and inexpensive. This raises the question of whether there are persuasive reasons for the right to the death of the foetus that could be exercised in the context of ectogenesis. Eric Mathison and Jeremy Davis have examined several arguments for this right, doubting that it exists, while Joona Räsänen has recently criticized their reasoning. We respond to Räsänen’s analysis, concluding that his arguments are unsuccessful, and that there is no right to the death of the foetus in these circumstances. (shrink)

In this article, we discuss decision making during labor and delivery, specifically focusing on decision making around offering women a trial of labor after cesarean section. Many have discussed how humans are notoriously bad at assessing risks and how we often distort the nature of various risks surrounding childbirth. We will build on this discussion by showing that physicians make decisions around TOLAC not only based on distortions of risk, but also based on personal values rather than medical data. As (...) a result of this, we will further suggest that the party who is best epistemically situated to make decisions about TOLAC is the woman herself. (shrink)

Obstetric violence—violence in the labor room—has been described in terms not only of violence in general but specifically of gender violence. We offer a philosophical analysis of obstetric violence, focused on the central role of gendered shame for construing and perpetuating such violence. Gendered shame in labor derives both from the reifying gaze that transforms women's laboring bodies into dirty, overly sexual, and “not‐feminine‐enough” dysfunctional bodies and from a structural tendency to relate to laboring women mainly as mothers‐to‐be, from whom (...) “good motherhood” is demanded. We show that women who desire a humane birth are thus easily made to feel ashamed of wanting to be respected and cared for as subjects, rather than caring exclusively for the baby's well‐being as a good altruistic mother supposedly should. We explore how obstetric violence is perpetuated and expanded through shaming mechanisms that paralyze women, rendering them passive and barely able to face and fight against this violence. Gendered shame has a crucial role in returning women to “femininity” and construing them as “fit mothers.” To stand against gendered shame, to resist it, on the other hand, is to clearly challenge obstetric violence and its oppressive power. (shrink)

The development of biotechnologies has broadly interfered with a number of life processes, including human birth. An important moral question arises from the application of such medical technologies to birth: do biotechnological advancements violate human dignity? Many valid arguments have been raised. Yet bioethicists are still far from reaching a consensus on how best to protect the dignity of human birth. Confucianism is an influential ethical theory in China and presents a distinctive understanding of human dignity. In this paper, we (...) reconstruct the two Confucian concepts of dignity—namely, universal dignity and personal dignity. We then apply these concepts to human birth in the context of biotechnologies involving embryos and genetic enhancement. We conclude that the dual Confucian understanding of dignity contributes a valuable perspective to the question of whether biotechnologies related to human birth violate human dignity. (shrink)

Arendt’s “natality,” a promising foundation for humanness that might be expanded to include those with profound cognitive disabilities, emerges in part out of Arendt’s creative interpretation of Augustine. Returning to Augustine provides natality with resources to escape the weaknesses of Arendt’s thought when viewed from the perspective of disability theory: The traps of grounding human dignity in rationality, of downplaying expressions of creativity in non-political spheres, and of denigrating the role of the body.

Medical literature on the protective effects of salpingectomy against ovarian cancer has challenged Catholic health care institutions to reexamine policies that prohibit tubal sterilization at the time of cesarean section. Salpingectomy performed for a woman whose fallopian tubes are known or suspected to have a serious and present pathology—risk-reducing salpingectomy—is morally justifiable as a therapeutic intervention. However, salpingectomy performed at the time of another medically indicated procedure, such as cesarean section, on an otherwise fertile woman whose fallopian tubes are presumed (...) to be healthy—opportunistic salpingectomy—constitutes direct sterilization and fails to meet the conditions of double effect. Moreover, until magisterial guidance clarifies the right application of Catholic teaching to the specific question of opportunistic salpingectomy, Catholic health care institutions should, out of prudential judgment and to avoid scandal, avoid establishing institution policies that permit the practice. (shrink)

This essay offers a critical analysis of Hannah Arendt's notion of natality through the lens of Adriana Cavarero's feminist philosophy of birth. First, I argue that the strength of Arendtian natality is its rootedness in an ontology of uniqueness, and a commitment to human plurality and relationality. Next, I trace with Cavarero three critical concerns regarding Arendtian natality, namely that it is curiously abstract; problematically disembodied and sexually neutral; and dependent on a model of vulnerability that assumes equality rather than (...) asymmetry. This last issue is further developed in the final section of the essay, where I examine the idea that birth, for Cavarero, becomes the very concept by which we can distinguish and normatively differentiate acts of care and love from acts of wounding and violence. Upholding the normative distinction here depends on a conceptual distinction between vulnerability and helplessness. To maintain the ethical potential of the scene of birth, I argue that we have to insist on the very characteristics Cavarero attributes to it—ones, as this essay aims to show, that are ultimately missing in the Arendtian account thereof. (shrink)

The main claim of this article is that the plasticity of the human formation process does not consist in receiving passively an already-given shape, like hot wax stamped by a seal. Rather, it creates ever new shapes and makes a person overcome her own self-referential horizon. Furthermore, I argue that this formation process is directed by desire, meant as “hunger for being born completely” (Zambrano). The human being comes into the world without being born completely, and it is precisely such (...) hunger that directs human positioning into the world. (shrink)

The thesis of this paper is that – in order to avoid trivializations – a Philosophy of Birth needs to elaborate a precise concept of transformation and distinguish it carefully from that of adaptation. While transformation goes beyond the limited self-referential perspective of an individual and, on the social level, of the gregarious identity, adaptation aims at strengthening or preserving the old self-referential equilibrium. Transformation is driven by what Zambrano has called, with an exceptionally happy expression, the “hunger to be (...) born completely”. Such a hunger pushes one to continue one’s own birth through the encounter with the Other. Transformation has a creative feature that is made possible by two factors: the surplus of the effect over the cause, and the priority of the real over the possible. These premises lead to a radical questioning of the primacy of the possible on the real, at least as it has been conceived so far in mainstream Western philosophy, with few exceptions, such as Schelling, Bergson and Scheler. In the first part of this text, I shall consider a new Philosophy of Birth in the light of the concept of transformation and in this regard deal with several core themes such as the hunger to be born completely, the new beginning, creative time, the priority of the real over the possible, the limits of finalism, the surplus of effect over cause, and the creative force that expresses itself in the act of ideation. In the second part, I shall analyze the relation between birth and death and focus especially on their intimate and reciprocal connection by referring to the image of the seed that, after falling on the ground, germinates and breaks its own integument. (shrink)