The medicalisation of pregnancy and childbirth has been encouraged by the continuing growth of technology that can be applied to the reproductive journey. Technology now has the potential to fully separate reproduction from the human body with the prospect of ectogenesis—the gestation of a fetus outside of the human body. This paper considers the issues that have been caused by the general medicalisation of pregnancy and childbirth and the impact that ectogenesis may have on these existing (...) issues. The medicalisation of pregnancy and childbirth is criticised for its impact on the relationship between doctors and pregnant women and the way in which doctors treat fetuses. It is argued that ectogenesis may cause more imbalance in the doctor and intended parent relationship and may result in an increased lack of clarity regarding a doctor’s duty to the fetus. This paper finds that extensive guidance and revised legislation will be necessary to minimise the impact of ectogenesis on the existing issues caused by the medicalisation of reproduction. (shrink)

This article examines the barriers to quality health care for transgender, nonbinary, and gender-expansive people (TGE) who become pregnant and give birth, identifying three central themes that emerge from the literature. These insights suggest that significant reform will be necessary to ensure access to safe, appropriate, gender-affirming care for childbearing TGE people. After illustrating the need for systemic changes that untether rigid gender norms from the provision of perinatal care, the article proposes that the Midwives Model of Care offers a (...) set of values and clinical practices that are well-suited to meet the needs of many TGE patients during pregnancy and childbirth and which should be incorporated into the healthcare system more broadly. (shrink)

Teens' experiences with reproductive health care have been ignored by both the “social problems” moral discourse on teen pregnancy and feminist critiques of medicalization. These perspectives are both gendered and racialized in ways that marginalize African American teen mothers. Interview data with 51 poor African American teen mothers suggest that their reproductive experiences occur within very different contexts than those that have inspired feminist criticisms of medicalization. Before their pregnancies, teens are largely denied access to formal health care services (...) and reproductive information and knowledge, and once pregnant, like adult women, they alternately embrace and resist specific aspects of medical care. Their perspectives provide insights into women's experiences with the formal medical system from an understudied social location, and their narratives expand our understanding of how women's and girls' sexuality is socially constructed as problematic and managed, controlled, and regulated in particular ways depending on their social locations. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Negotiating Maternal IdentityAdrienne Rich’s Legacy for Inquiry into the Political-Philosophical Dimensions of Pregnancy and ChildbirthCandace JohnsonGiving birth has been described as the crossing of an imaginary threshold, which separates an independent maternal self from some sort of dual or subordinate existence. The metaphor of a border has also been employed to demonstrate this transformation, which may be liberating, oppressive, or some complex combination thereof (Weir 2006; Martinez 2004). (...) What happens, in psychic and sociopolitical terms, in the journey across this border? Can a woman, as an independent, autonomous being, preserve her identity, her selfhood as a mother? Is the transition to motherhood an expression of culture or nature? The answers to these questions are infinitely complex, yet are at the core of philosophical, political, and personal explorations of the maternal. Central to these explorations are academic critiques and personal responses to the biomedical mediation of the transition to motherhood. For some women, medical intervention in pregnancy and childbirth is inherently oppressive, whereas for other women such intervention is a marker of privilege. In a groundbreaking volume published in 1998, Margaret Lock and Patricia Kaufert argue that women respond to different biomedical interventions in pragmatic ways, which reflect their lived experiences. They claim that “it is more appropriate to understand women’s responses in medical settings as reflecting their daily experiences as part of a domestic group, a community, or a society” (19). [End Page 65]I would like to advance this analysis by suggesting that women respond to biomedical intervention in pregnancy and childbirth in ways that reflect not simply their practical needs and realities, but important details about inequality and identity. Women’s relative degrees of power and agency in society are expressed through their preferences for care during pregnancy and childbirth. In addition, and in connection with the (structural) dynamics of inequality, these preferences reflect the complexities of shifting, negotiated, maternal identities. In order to consider the ways in which women negotiate maternal identity through their preferences concerning care during pregnancy and childbirth, I will examine the contributions of Adrienne Rich, which effectively serve as the foundation for this and countless other areas of women’s and gender studies. In Of Woman Born, Rich dedicates two full chapters to childbirth, and explains in these chapters that the institution of childbirth has come to dominate and eclipse women’s experiences. Moreover, the patriarchal circumscription of childbirth is reinforced by the isolation of childbirth (and motherhood) from other life events. Rich demonstrates these problems through the metaphor of “giving birth to oneself ” (29), which has (at least) two distinct meanings: self actualization and self replacement.My investigation into these meanings will include an examination of Rich’s philosophical treatment of pregnancy and childbirth and an assessment of the sociopolitical implications of both conceptions of “giving birth to oneself.” I will then subject these conceptions to empirical testing, as Rich insists. Such empirical testing is crucial because the social and political dimensions of the institutions of childbirth and motherhood are complex and differ from one context to the next. Rich explains that[t]o hold power over others means that the powerful is permitted a kind of short-cut through the complexity of human personality. He does not have to enter intuitively into the souls of the powerless, or to hear what they are saying in their many languages, including the language of silence. Colonialism exists by virtue of this short-cut—how else could so few live among so many and understand so little?(65)This essay will avoid a similar shortcut often taken by theorists, which builds philosophical arguments without empirical support. The empirical cases to be considered in the context of philosophical debate include Canada, Honduras, and Cuba, and details of each case will be drawn from extensive interview data from a larger empirical study.1 In the Canadian context, resistance to the constraining effects of motherhood as institution is reduced to resistance to medical regulation of pregnancy and childbirth. The benefit indicated by this resistance is that women have found ways to expand their range of options and reinterpret the birthing event, thereby integrating it into other realms [End Page 66... (shrink)

_The Ethics of Pregnancy, Abortion and Childbirth_ addresses the unique moral questions raised by pregnancy and its intimate bodily nature. From assisted reproduction to abortion and ‘vital conflict’ resolution to more everyday concerns of the pregnant woman, this book argues for pregnancy as a close human relationship with the woman as guardian or custodian. Four approaches to pregnancy are explored: ‘uni-personal’, ‘neighborly’, ‘maternal’ and ‘spousal’. The author challenges not only the view that there is only one (...) moral subject to consider in pregnancy, but also the idea that the location of the fetus lacks all inherent, unique significance. It is argued that the pregnant woman is not a mere ‘neighbor’ or helpful stranger to the fetus but is rather already in a real familial relationship bringing real familial rights and obligations. If the status of the fetus is conclusive for at least some moral questions raised by pregnancy, so too are facts about its bodily relationship with, and presence in, the woman who supports it. This lucid, accessible and original book explores fundamental ethical issues in a rich and often neglected area of philosophy in ways of interest also to those from other disciplines. (shrink)

While the Internet has emerged as a significant resource for women negotiating the questions and circumstances that arise during conception, pregnancy and childbirth, it remains unclear what role the Internet plays in challenging the current biomedical paradigm and empowering women to make meaningful choices. This article explores how women use the Internet to manage their pregnancies and mediate their doctor–patient relationships, particularly examining the role of social class and personal health history in shaping such Internet use. Drawing from (...) in-depth interviews with white middle-class mothers, the findings show that rather than using technology to resist the dominant biomedical paradigm, most women turned to online resources that affirmed mainstream medical authority and continued to rely on their doctors. By providing the means to confirm normalcy and take control in their reproductive experiences, the Internet enables socially privileged women to more fully perform the informed patient role in order to demonstrate their competence as mothers. (shrink)

Pregnancy and childbirth have become a dangerous journey for Black women as harrowing stories of death and near‐death experiences resonate within Black communities. While the causes of pregnancy‐related morbidity and mortality are well documented, little is known about how Black Canadian women feel protected from undesirable maternal health outcomes when accessing and receiving pregnancy and intrapartum care. This critical qualitative inquiry sheds light on Black women's perceived sense of safety in accessing pregnancy and intrapartum care. (...) Twenty‐four in‐depth interviews were conducted with Black women who were pregnant or had given birth. Five interconnected themes were generated through thematic analysis: (1) There is a lot of prejudice towards us, (2) We are treated as sick bodies, (3) There is a lot of stereotypes towards us, (4) Our care is lacking in quality, and (5) We feel unsafe in the healthcare system. These themes highlight the perils faced by Black women accessing pregnancy and intrapartum care. The right to safe motherhood and equitable care for Black women should be a national priority in Canada to avert a looming crisis. (shrink)

Philosophical inquiry into pregnancy, childbirth, and mothering is a growing area of interest to academic philosophers. This volume brings together a diverse group of philosophers to speak about topics in this reemerging area of philosophical inquiry, taking up new themes, such as maternal aesthetics, and pursuing old ones in new ways, such as investigating stepmothering as it might inform and ground an ethics of care. The theoretical foci of the book include feminist, existential, ethical, aesthetic, phenomenological, social and (...) political theories. These perspectives are then employed to consider many dimensions of pregnancy, childbirth, and mothering, which are of central importance to human existence, but are only rarely discussed in philosophical cannons. Topics include pregnancy and embodiment, breast-feeding, representations – or the lack thereof – of pregnant and birthing women, adoption, and post-partum motherhood. (shrink)

This paper aims to problematize pregnancy and support the development of a safe alternative method of gestation. Our arguments engage with the health risks of gestation and childbirth, the value assigned to pregnancy, as well as social and medical attitudes toward women’s pain, especially in labor. We claim that the harm caused by pregnancy and childbirth provides a prima facie case in favor of prioritizing research on a method of extra corporeal gestation.

In the mid-twentieth century film studios sent their screenplays to Hollywood's official censorship body, the Production Code Administration, and to the Catholic Church's Legion of Decency for approval and recommendations for revision. This article examines the negotiations between filmmakers and censorship groups in order to show the stories that censors did, and did not, want told about pregnancy, childbirth and abortion, as well as how studios fought to tell their own stories about human reproduction. I find that censors (...) considered pregnancy to be a state of grace and a holy obligation that was restricted to married women. For censors, human reproduction was not only a private matter, it was also an unpleasant biological process whose entertainment value was questionable. They worried that realistic portrayals of pregnancy and childbirth would scare young women away from pursuing motherhood. In addition, I demonstrate how filmmakers overcame censors’ strict prohibitions against abortion by utilizing ambiguity in their storytelling. Ultimately, I argue that censors believed that pregnancy and childbirth should be celebrated but not seen. But if pregnancy and childbirth were required then censors preferred mythic versions of motherhood instead of what they believed to be the sacred but horrific biological reality of human reproduction. (shrink)

Coming to Life: Philosophies of Pregnancy, Childbirth and Mothering is a superlative collection of essays that does what too few scholarly works have dared: it takes seriously the philosophical significance of women’s lived experience. Every woman, regardless of her own reproductive story, is touched by the often restrictive beliefs and norms governing discourses about pregnancy, childbirth and mothering. Thus the concerns of this anthology are relevant to all women and central to any philosophical project that takes (...) women’s lives seriously. In this volume 16 authors- including both established feminists and some of today’s most innovative new scholars- engage in sustained reflection on the experiences of pregnancy, childbirth and mothering, and on the beliefs, customs, and political institutions by which those experiences are informed. Many of the topics in this collection, though familiar, are here taken up in a new way: contributors think beyond the traditional pro-choice/pro-life dichotomy, speak to the manifold nature of mothering by considering the experiences of adoptive mothers and birthmothers, and upend the belief that childrearing practices must be uniform despite psycho-sexual differences in children. Many chapters reveal the radical shortcomings of conventional philosophical wisdom by placing trenchant assumptions about subjectivity, gender, power and virtue in dialogue with women’s experience. The volume is diverse both in its content and in its scholarly approach; certain of the essays are informed by their authors’ own experiences, others draw from extant narratives; many engage such canonical thinkers as Plato, Aristotle, Nietzsche and Heidegger, while others draw from the works of contemporary feminists including Sara Ruddick, Iris Marion Young, Virginia Held, Julia Kristeva and Luce Irigaray. All readers, regardless of their philosophical training and commitments, will find much to appreciate in this volume. (shrink)

Cancer diagnosed during pregnancy is a rare event. The most common type of malignancy diagnosed in pregnant women is breast cancer, whose incidence is expected to raise in the next future due to delayed childbirth, as well as to the increased occurrence of the disease at young age. Pregnant women diagnosed with breast cancer are exposed to multiple sources of stress, which may lead to poorer obstetric outcomes, such as preterm birth and low birth weight. In addition, (...) class='Hi'>pregnancy involves physiological changes in the breasts that may blur the signs of cancer, with delayed diagnosis and poor prognosis. However, the lived experience of these women was investigated in very few studies. Given this scenario, we conducted this qualitative study to describe and understand women’s subjective experience of being diagnosed with breast cancer during pregnancy. The study was conducted following the principles of Interpretative Phenomenological Analysis. Participants were five women with breast cancer diagnosed during pregnancy, purposefully recruited at a public hospital during medical visits and interviewed at treatment initiation. The interview transcripts were analyzed using thematic analysis. The textual analysis led to the identification of three main themes related to: the emotional storm experienced after cancer diagnosis, and the importance of receiving appropriate information and being focused on treatment decisions; physical changes and comparisons with healthy women, associated with feelings of sadness and inadequacy; being positive, feeling free to disclose all kinds of emotions, religion and spirituality as sources of strength. The paradoxical coexistence of pregnancy and cancer represents a stressful experience for women and their loved ones. Adopting a systemic perspective may be important to understand the effects of such a complex condition, also considering its impact on healthcare workers. (shrink)

It has recently been reported that some hospitals in the UK have placed a blanket restriction on the provision of maternal request caesarean sections as a result of the COVID-19 pandemic. Pregnancy and birthing services are obviously facing challenges during the current emergency, but we argue that a blanket ban on MRCS is both inappropriate and disproportionate. In this paper, we highlight the importance of MRCS for pregnant people’s health and autonomy in childbirth and argue that this remains (...) crucial during the current emergency. We consider some potential arguments—based on pregnant people’s health and resource allocation—that might be considered justification for the limitation of such services. We demonstrate, however, that these arguments are not as persuasive as they might appear because there is limited evidence to indicate either that provision of MRCS is always dangerous for pregnant people in the circumstances or would be a substantial burden on a hospital’s ability to respond to the pandemic. Furthermore, we argue that even if MRCS was not a service that hospitals are equipped to offer to all pregnant persons who seek it, the current circumstances cannot justify a blanket ban on an important service and due attention must be paid to individual circumstances. (shrink)

Traditionally reproduction, gestation and childbirth have all been regarded as being primarily a woman's domain. As natural reproduction occurs inside a woman's body, respect for autonomy and bodily integrity requires the pregnant woman to have the conclusive say over the fate of the embryo/fetus growing within her. Thus traditionally the ethics and law of reproduction is dominated by the importance of respecting women's reproductive choices. This paper argues that emerging technologies demand a radical rethink of ethics and law in (...) the area of reproduction. The creation and storing of embryos outside of a woman's body and maintaining a pregnancy in a brain dead woman's body and future possibilities such as ectogenesis and male pregnancy raise important issues that cannot simply be answered by appealing to the rights of women to control their bodies. There are those who argue that when reproduction or reproductive products exist outside of a woman's body each gamete donor should have an equal say over the fate of the embryo/fetus. Others, however, argue that giving an equal say to gamete donors in practice usually means allowing the male donor to veto the reproductive enterprise and this is unacceptable. As a result it has been suggested that women should be favoured when it comes to such reproductive choices. This paper examines both sides of this debate in order to answer the fundamental ethical and policy question: 'Is there any reason why women should necessarily retain control over reproduction rather than simply over their own bodies?'. (shrink)

Fruit d’un colloque organisé en 2009 par l’Université de l’Oregon, le présent ouvrage dirigé par Sarah LaChance Adams et Caroline Lundquist, paru en 2013, tente d’esquisser une philosophie de la grossesse, de l’accouchement et de la maternité. Les différentes contributions tendent à montrer que ces thèmes, loin d’être en marge des questions philosophiques, peuvent permettre une redéfinition du sujet, de l’intersubjectivité, ou encore de l’éthique, tout en prenant soin d’éviter l’essentialisme...

Part graphic novel, part feminist and philosophical analysis, The Pregnancy ≠ Childbearing Project explores how pregnancy can be a meaningful and distinct phenomenon from childbirth and does not equate with childbearing or the production of children.

This study examined the relation of altered states of consciousness to neuroticization, spiritual experience, and divergent thinking in a sample of women at late pregnancy and post-delivery. The results suggest that stress associated with imminent childbirth is linked to higher levels of ASCs and that neuroticization and spirituality seem to be implicated in the induction of ASCs.

The Dutch system of obstetric care is often recommended for midwife-attended births, the high number of home deliveries, and the low rate of intervention during pregnancy and labour. In this contribution, the question is addressed whether processes of medicalization can be demonstrated in the Dutch midwife practice. Medicalization of pregnancy and childbirth is often criticized because it creates dependency on the medical system and infringement of the autonomy of pregnant women. It is concluded that medicalization is present (...) in the practice of Dutch independent midwives, however it is less clear and outspoken than in hospital policies. (shrink)

French philosopher Helene Cixous stressed the importance of feminine writing. She believes that women should take part in sharing their experiences from their own novel points-of-view. We discuss that while pregnancy is an experience unique to women, it has been misappropriated by patriarchal structures throughout the years. The pregnancy bump, which is more than just evidence of the uterus stretching to accommodate the fetus, is a symbol of a woman's triumphs and struggles all throughout conception, pregnancy, and (...) childbirth. We show that women have already gone beyond the bump and challenged existing patriarchal systems through different means, as Cixous has enjoined women to do. With this, it is asserted that the philosophy of pregnancy be reconceived as well, in order to escape existing boundaries that constrict the discourse to ethical issues of rape, abortion, and medical interventions, making it face issues that surround women's experience of pregnancy, as well as deeper meanings the pregnant body itself represents. (shrink)

Background A significant number of women experience childbirth as traumatic. These experiences are often characterised by a loss of control coupled with a perceived lack of support and inadequate communication with health care professionals. Little is known about the choices women make in subsequent pregnancy(s) and birth(s), or why they make these choices. This study aimed to understand these choices and explore the reasons behind them. Methods A longitudinal Grounded Theory Methods (GTM) study involving 9 women was conducted. (...) Over half of the participants had a formal diagnosis of PTSD and/or PND related to the previous birth. Interviews were carried out at 3 timepoints perinatally. These findings are from the first interviews at 12-20 weeks. Results From the first days of pregnancy, this cohort of women were focused on concerns that this birth would be a repeated traumatic experience. The women were deliberately searching out and analysing information about their choices in this pregnancy and birth, and making plans which had two aims; firstly to avoid a repeat of their previous birth experience, and secondly to avoid a loss of control to other people during the birth. The women considered a range of birth choices, from elective caesareans to freebirth. Some women felt well supported by those around them, including health care professionals, partners, friends and family. Others did not, and were anticipating conflict in trying to assert their birth choices. Many early relationships with health care professionals were characterised by fear and mistrust. Discussion Women who have previously experienced a traumatic birth become pregnant again, have a strong desire to avoid a repeat experience and to feel in control of their birth choices. Access to robust information appears to help reduce uncertainty and arm women in their discussions with professionals. Similarly making plans and seeking to have them agreed with health care professionals at an early stage is used a way to reduce the risk of having a further traumatic experience. Implications for practice include supporting women in formulating and confirming pregnancy and birth plans at an early stage to reduce uncertainty and foster a sense of control. (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)

Images abound of women throughout the ages engaging in various activities. But why are there so few representations of childbirth in visual art? Feminist artist Judy Chicago once suggested that depictions of women giving birth do not commonly occur in Western culture but can be found in other contexts such as pre-Columbian art or societies previously considered "primitive." Chicago's own exploration of the theme resulted in the creation of The Birth Project (1980-85): an unprecedented series of eighty handcrafted works (...) of art created in a variety of needlework techniques by more than 130 artisans that celebrate the experience of birth and a woman's transformation into motherhood. But why is The Birth Project an aberration from today's norm? What are the reasons that childbirth remains a taboo subject in our visual culture? Why is the birthing experience--so pervasive for women--so infrequently celebrated, even by female artists? (shrink)

This chapter discusses how phenomenologies of pregnancy challenge traditional philosophical accounts of a subject that is seen as autonomous, rational, genderless, unified, and independent from other subjects. Pregnancy defies simple incorporation into such universal accounts since the pregnant woman and her unborn child are incapable of being subsumed into traditional theories of the subject. Phenomenological descriptions of the experience of pregnancy lead one to question if philosophy needs to reject the subject altogether as central, or rather to (...) revise traditional descriptions of the subject. The chapter examines both options and argues for the later. The exploration of pregnancy in feminist theory upholds the value of working from the subject’s lived experience, but indicates that it is possible without viewing the subject as a disembodied universal agent. Finally, it discusses how phenomenologies of pregnancy are attuned to discussing difference thereby aiding philosophies that take into account the political, historical, and cultural conditioning that shape experience and theory. (shrink)

Phenomenologically grounded research on pregnancy is a thriving area of activity in feminist studies and related disciplines. But what has been largely omitted in this area of research is the experience of childbirth itself. This paper proposes a phenomenological analysis of childbirth inspired by the work of Merleau-Ponty. The paper proceeds from the conviction that the concept of anonymity can play a critical role in explicating the affective structure of childbirth. This is evident in at least (...) two respects. First, the concept of anonymity gives structural specificity to the different levels of bodily existence at work in childbirth. Second, the concept of anonymity can play a powerful explanatory role in accounting for the sense of strangeness accompanying childbirth. To flesh these ideas out, I focus on two attributes of birth, sourced from first-person narratives of childbirth. The first aspect concerns the sense of leaving one’s body behind during childbirth while the second aspect concerns the sense of strangeness accompanying the first encounter with the baby upon successful delivery. I take both of these aspects of childbirth seriously, treating them as being instructive not only of the uniqueness of childbirth but also revealing something important about bodily life more generally. Accordingly, the paper unfolds in three stages. First, I will critically explore the concept of anonymity in Merleau-Ponty; second, I will apply this concept to childbirth; finally, I will provide an outline of how childbirth sheds light on the broader nature of bodily life. (shrink)

Mindfulness and the Birth Sphere draws together and critically appraises a raft of emerging research around mindfulness in healthcare, looking especially at its relevance to pregnancy and childbirth. This is an essential read for all those interested in mindfulness in connection to pregnancy and childbirth, including midwives, doulas, doctors and birth activists, whether involved in practice, research or education.

Several factors related to fetal risk render it more or less acceptable in justifying constraints on the behavior of pregnant women. Risk is an unavoidable part of pregnancy and childbirth, one that women must balance against other vital personal and family interests. Two particular issues relate to the fairness of claims that pregnant women are never entitled to put their fetuses at risk: relative risks and relatives' risks. The former have been used—often spuriously—to advance arguments against activities, such (...) as home birth, that may incur risk; the latter implicate the nature of relationships in determining the acceptability of coercing or precluding activities. Motivated reasoning by clinicians and judges leads to inaccurate risk assessments, and judgments based on false claims to objectivity. Such judgments undermine the moral and legal standing of pregnant women and do not advance the interests of fetuses, pregnant women, families, or states. (shrink)

The development of artificial womb technology is proceeding rapidly and will present important ethical and theological challenges for Christians. While there has been extensive secular discourse on artificial wombs in recent years, there has been little Christian engagement with this topic. There are broadly two primary uses of artificial womb technology—ectogestation as a form of enhanced neonatal care, where some of the gestation period takes place in an artificial womb, and ectogenesis, where the entire gestation period is within an artificial (...) womb. Ectogestation for the latter weeks or months of pregnancy could be possible within a decade or so, while ectogenesis for humans is far more speculative. Ectogestation is likely to significantly decrease maternal and neonatal morbidity and mortality, and so there is a strong case for supporting its development. Ectogenesis, however, may bring a number of challenges, including the commodification of children, and the pathologizing of pregnancy and childbirth. Its long-term effects on those who are created through this process are also unknown. In the event that it becomes ubiquitous, we may also find the central theological significance of pregnancy and birth diminished. The dilemma for Christians is that the development of ectogestation seems likely to normalise the use of artificial gestation, and, in time, pave the way for ectogenesis. (shrink)

In a recent article in this journal, Alex Mullock, Elizabeth Chloe Romanis and Dunja Begović provide an analysis of gestational surrogacy and uterus transplantation (UTx) from the perspective of those who may decide to act as gestational surrogates and womb donors, referred to as ‘womb‐givers’. In this article, I advance two sets of claims aimed at critically engaging with some aspects of their analysis. Firstly, I argue that the expression ‘womb‐givers’ obscures the biologically, socially and politically salient issue that those (...) who engage in these practices are primarily persons and women. My contention is that this is of substance in discussions of the burdens and benefits of gestational surrogacy and UTx, which need to consider the specific position that women occupy in society, and the hierarchies that mediate their lives, experiences and preferences. Second, I argue that, if one were to take seriously the experiences and preferences of the women who may engage in these practices, and their bodily autonomy, then gestational surrogacy and UTx should be regarded as biologically and sociopolitically incommensurable. Mullock et al. overlook important aspects of gestational surrogacy, such as the embodied nature of pregnancy and childbirth, the sociopolitical significance of these experiences, and the often‐oppressive social norms that shape them. Whilst biology is not destiny, I suggest that it is socially and politically ‘sticky’ when it comes to this significance and norms, especially within the sphere of reproduction. Towards the end of the article, I query the authors' conceptualisation of bodily autonomy and of the instruments that enable its respect and promotion. (shrink)

Sexual exploitation and abuse (SEA) by United Nations (UN) peacekeepers causes severe physical and psychological consequences. Where SEA leads to pregnancy and childbirth, peacekeepers typically absolve themselves of their paternal responsibilities and paternity suits are largely unsuccessful. The lack of support for peacekeeper-fathered children (PKFC) tarnishes the image of the UN who fails to implement a victim-centred approach to SEA. Analysing shortcomings in the provision of support, this article presents an evaluation of the UN’s accountability system from the (...) perspective of PKFC families. In-depth interviews with thirty-five PKFC and sixty mothers demonstrate local barriers to child support and paternity claims in eastern Democratic Republic of Congo. We discuss PKFC’s need for assistance and their mothers’ attempts to navigate an opaque international legal system. The findings cast light on their limited access to UN subsidies and offer recommendations to better implement existing UN goals of justice and victim-oriented policies. (shrink)

Despite the entrenched acceptance of normal science in health care, it appears that authoritative, positivist, linear, risk averse, certainty-based thinking can only get us so far along the route of optimum health. This paper examines labor and childbirth as a paradigm case of a complex adaptive system (CAS) and offers the example of techniques used in a master-level course on normal childbirth to illustrate how maternity care clinicians can be introduced to complexity-based thinking through reflexive analysis of real (...) life clinical narratives. It suggests that these techniques might be used as a basis for answering the question, what is likely to work for this person, in this situation, given the range of evidence, and given their values and beliefs, my values and beliefs, and my clinical skills and knowledge? Topics discussed in this paper include complexity, pregnancy, and childbirth; mainstreaming complexity-focused decision making in maternity care; and using story in practice. In conclusion, complexity theory appears to offer a good explanatory model for pregnancy and childbirth, both in general, and for specific individuals. Future work in this area should examine the efficacy and limits to formal story telling in maternity care, with the aim of increasing optimal maternity care for mothers and babies, and for the staff and organizations that deliver the care. (PsycINFO Database Record (c) 2010 APA, all rights reserved). (shrink)

In this issue of the JME, age-old questions around how to balance the interests of mother and fetus are revisited in two separate contexts: alcohol consumption during pregnancy, and maternal request caesarean sections. Both have been the subject of recent controversy in the UK, with March 2022 seeing the introduction of new National Institute for Clinical Excellence Quality Standards on combatting foetal alcohol spectrum disorder 1; and the publication of the long-awaited Ockenden Review into a series of failures in (...) NHS maternity care.2 Both raise important questions about the role of healthcare professionals in policing women’s choices during pregnancy and childbirth, and of the importance of deference to and trust in those choices. In this issue’s Feature Article, Rebecca Bennett and Catherine Bowden explore recent proposals to enhance the screening of pregnant women in order to prevent instances of fetal alcohol spectrum disorder through more accurately determining the true prevalence of alcohol consumption during pregnancy.3 Public Health England has suggested research into tools such as blood biomarkers and meconium testing,4 which could better identify those women who are consuming alcohol ‘covertly’ and so make FASD diagnoses more straightforward. As Bennett and Bowden rightly suggest, such a move is unlikely to realise the kind of public health or welfare gains which would justify this level of interference with the women’s autonomy, and may even result in more harm through discouraging engagement with antenatal care. However even absent these very intrusive methods of surveillance, the precautionary principle which underpins such policies — namely that in the absence of evidence that any alcohol is safe, women should be instructed to avoid it altogether — is itself difficult to justify. The evidence on alcohol consumption during pregnancy is mixed. While it is widely accepted that heavy …. (shrink)

The transition to parenthood is both a joyous and a challenging event in a relationship. Studies to date have found mostly negative effects of the birth of the first child on the parental relationship. We propose that partners' pre-pregnancy individual happiness may serve as a buffer against these negative effects. We predicted that parents who are happy prior to pregnancy fare better in terms of relationship commitment after childbirth than unhappy parents. To test our prediction, we used (...) data of a 5-wave longitudinal study among 109 Dutch newlywed couples who had their first child during the study and a comparison group of 55 couples who remained childless. We found that the relationship commitment of fathers with higher pre-pregnancy happiness and fathers with a partner with higher pre-pregnancy happiness increased slightly in the years after childbirth, whereas the relationship commitment of fathers with lower pre-pregnancy happiness and fathers with a partner with lower pre-pregnancy happiness decreased. In addition, the relationship commitment of mothers with a happier partner prior to pregnancy decreased only slightly across the transition to parenthood but showed a steeper decline for mothers with a partner with average or lower pre-pregnancy happiness. In line with the idea that happiness acts as a resource when partners have to deal with relationship challenges, individual happiness predicted changes in relationship commitment for parents, but not for partners who remained childless. (shrink)

A fresh explication of the Thomist justification of self-defense casts off the hobbles of the principle of double effects to find a more secure footing in the historical development of subjective natural rights by medieval jurists, and a straight-forward application to the latent threat of death in childbirth posed by non-consensual pregnancy. By articulating the implicit Thomistic right to defensive abortion in terms of conditional rights bestowed in Creation as correlative to particular natural law duties, justly proportionate limits (...) to defensive abortion are identified, and balanced against the forfeited or reserved natural rights variously imputed to conceptus and embryo in non-consensual pregnancies. Subsequently, the varieties of involuntary consent are examined from a Thomist perspective with a view to their relevance in justifying recourse to a rehabilitated practice of defensive abortion when free and full consent to impregnation and childbirth is absent. (shrink)

Artificial womb technology for extracorporeal gestation of human offspring (ectogenesis or ectogestation) has profound ethical, sociological and religious implications for Muslim communities. In this article we examine the usage of the technology through the lens of Islamic ethico-legal frameworks specifically the legal maxims (al-Qawaid al-Fiqhiyyah) and higher objectives of Islamic law (Maqaṣid al-Shariah). Our analysis suggests that its application may be contingently permissible (halal) in situations of dire need such as sustaining life and development of extremely premature newborns, for advancing (...) fetal medicine and avoiding maternal co-morbidities during fetal treatment, and for enabling motherhood for women without functional wombs, or who face grave medical risks in pregnancy. However, its application may be proscribed (haram) for enabling healthy women to avoid pregnancy and childbirth, or to achieve parenthood equity. Specification of these views to particular policy, legal contexts and Fatwa will require multidisciplinary Shariah-based bioethical deliberations between jurists, policymakers, and scientists. (shrink)

Several factors related to fetal risk render it more or less acceptable in justifying constraints on the behavior of pregnant women. Risk is an unavoidable part of pregnancy and childbirth, one that women must balance against other vital personal and family interests. Two particular issues relate to the fairness of claims that pregnant women are never entitled to put their fetuses at risk: relative risks and relatives' risks. The former have been used—often spuriously—to advance arguments against activities, such (...) as home birth, that may incur risk; the latter implicate the nature of relationships in determining the acceptability of coercing or precluding activities. Motivated reasoning by clinicians and judges leads to inaccurate risk assessments, and judgments based on false claims to objectivity. Such judgments undermine the moral and legal standing of pregnant women and do not advance the interests of fetuses, pregnant women, families, or states. (shrink)

This book provides extensive and critical engagement with some of the most recent and compelling arguments favoring abortion choice. It features original essays from leading and emerging philosophers, bioethicists and medical professionals that present philosophically sophisticated and novel arguments against abortion choice. The chapters in this book are divided into three thematic sections. The first set of essays focuses primarily on unborn human individuals--zygotes, embryos and fetuses. In these chapters it is argued, for example, that human organisms begin to exist (...) at conception and that zygotes, embryos and fetuses are persons. These chapters also explore questions about whether or not zygotes, embryos and fetuses are part of their mothers' bodies. The second set of essays focuses primarily on elective abortion and the debates surrounding it. These chapters consider whether or not opponents of abortion are commonly hypocritical, how opponents of abortion should think about adoption, how emerging technologies may affect the current debate and whether or not those participating in the debate should rely on analogies to support their case. Finally, the third set of essays shifts focus from the legal and moral status of elective abortion to its place in medical practice. In these chapters it is argued that elective abortion embodies a kind of ableism, and that elective abortion is medically unnecessary, harmful to women's mental health and that telemedicine abortion poses significant risks to women's health. Agency, Pregnancy and Persons offers an up-to-date examination of unborn human beings, the debates surrounding elective abortion and the place of elective abortion within medical practice. It will be of interest to medical professionals and those who work in philosophy, bioethics and medical ethics alike. (shrink)

Savulescu J. Is current practice around late termination of pregnancy eugenic and discriminatory? Maternal interests and abortion. J Med Ethics 2001;27:165–71. Lachlan de Crespigny contributed in a major way to the conceptualisation, design, administration of surveys, ….