Thursday 6 June 2013

Pregnant women aren't incubators - so why does medical advice treat them as though they are?

For today’s example of how not to talk to pregnant women, just look at the Royal College of Obstetricians and Gynaecologists (RCOG).  

These childbirth specialists have somehow managed to issue the most ridiculous, alarmist advice, that mothers-to-be should view everyday foods and objects as a potential source of danger to their developing child. 

The RCOG has been roundly criticised, for falling into the trap of using pseudo-science to alarm women who are already inundated unhelpful pregnancy advice, much of which is based more on superstition than science; but will the backlash stop women from worrying, or doctors from scaremongering? Sadly not. 

A conference of medical professionals held at the Royal Society of Medicine next week will discuss the way that advice and anxieties about pregnancy have been fuelled in recent years by a culture of fetal ‘imaging and imagining’, where the ability to see the fetus in the womb has contributed to a set of ideas about the fetus, and the pregnant woman, that are both inaccurate and insulting. 

Zoe Williams, journalist and author of What Not to Expect When You're Expecting, will talk about the strange elision of anti-abortion images and arguments and those routinely used in pregnancy advice and antenatal care. With the aggressive monitoring of pregnant woman’s behaviour, particularly in relation to what they eat and whether they drink or smoke, the idea has been encouraged that the fetus and the women are two separate individuals whose needs are at odds with one another. 

One consequence of this is that the pregnant woman becomes seen less as a person than as an environment for optimal fetal development; and that it is the role of health authorities and  public health campaigns to dictate to women how they should behave to achieve a healthy pregnancy. This is how you get to the kind of bizarre advice issued by the RCOG – that for women to do anything at all without considering the potential impact on her pregnancy represents a form of irresponsible risk-taking. 

Of course, fetal imaging has contributed to many genuine and important improvements in antenatal care. But at the same time, images of the fetus are misused as justifications for why, in the 21 century, it is permissible to treat women with wanted pregnancies as mere incubators, and women who terminate unwanted pregnancies as murderers. This represents a confusion between what ultrasound scans of the fetus can tell us (how a fetus looks) and what scans cannot (what a fetus is). 

This confusion will be addressed by Dr Stuart Derbyshire, Reader in Psychology at the University of Birmingham and an expert voice in the UK on the question of fetal pain. He argues that improvements in the clarity of fetal imaging encourages a view of the fetus as a ‘fragile person’, which in turn encourages a sense of danger regarding eating, drinking, exercising, being stressed or becoming sick during pregnancy. In fact, a more rational understanding of the fetus is that it is not yet a fully-formed, or socially conscious, member of society, and the womb is a highly safe and buffered environment. 

So a fetus might look like it is smiling - but once we ask ourselves, who can it possibly be smiling at?, we realise that there is something nonsensical about the idea that a fetus, developing on its own in the dark, sleep-like environment of the womb, can experience the kind of emotional interactions that it takes born babies several months to learn. We can also see how reading into images of the fetus the things that we want to see in born babies creates a huge emotional pressure for the pregnant woman, whether she wants to continue her pregnancy or not.  

Pro-choice advocates have long been aware of the way that images of developing fetuses are used to guilt-trip women about their decision to end a pregnancy through abortion. Anti-abortion campaigners display graphic, and inaccurate, photographs of fetuses that look like newborn babies, and infer from these images that fetuses can also act like babies: that they can smile, feel pain, even ‘walk’ in the womb. The exploitation of fetal imaging in this way has become more extreme in recent years, particularly in the United States of America, where a number of states have passed ‘mandatory ultrasound’ laws that require women seeking abortion to view a scan of the fetus before having the procedure. 

Professor Carol Sanger of Columbia Law School will describe the impact of these laws in a culture where, she says, women have become increasingly ‘fetusised’. When wanted pregnancies are now routinely announced by posting scan photos on social networking sites, and the diagnostic scan - which in Britain takes place at about 20 weeks of pregnancy - is often treated more as a social opportunity to ‘meet the baby’ than a clinical appointment to detect anomalies or growth problems, the idea that the fetus is the same kind of being as a newborn baby is no longer a prejudice promoted by anti-abortion campaigners on the margins. 

Women seeking abortion do not need an ultrasound scan to know that they will have a baby if the pregnancy develops. They have made the decision to have an abortion precisely because they do not want a baby, or cannot cope with having a baby, at that point in their lives. So the only point of forcing them to see an ultrasound scan can be to make them feel bad about their decision. 

For women with a wanted pregnancy, improvements in fetal imaging should improve the quality of antenatal care, through the ability to detect anomalies in the pregnancy more clearly and at an earlier stage. But through the overblown and unscientific pregnancy advice given to women, which implies that everything a pregnant woman eats or drinks passes directly to ‘baby’, as though she is feeding an infant blue cheese or red wine from a spoon, the use and abuse of fetal imaging has actually mystified pregnancy even further. Some of the literature displayed by the NHS to promote healthy pregnancy behaviour uses images that could have been taken directly from anti-abortion propaganda – and this should give us pause for thought. 

Despite technological advances that have made pregnancy and birth much safer, pregnant women are encouraged to feel neurotically self-conscious and fearful. This is really not what women should have to expect when they are expecting.  

'Abortion, motherhood and the medical profession’, a conference organised jointly by British Pregnancy Advisory Service and the Royal Society of Medicine, takes place on Wednesday 12 June 2013 at the Royal Society Of Medicine, 1 Wimpole Street, LONDON, W1G 0AE. View the programme here 

This article was originally written Jennie Bristow, bpas, for the Independent. 

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