In their paper, Romanis and Adkins delve into the potential impact of artificial amnion and placenta technology (AAPT) on cases of pregnancy loss1 that do not involve procreative loss. First, they call for more recognition of the negative feelings a person might have due to the premature end of their pregnant state. They claim that, should AAPT minimise concerns about prematurity as anticipated, individuals might feel pressured to opt for partial ectogestation to preserve their or their fetus’ well-being; (...) moreover, they point out that the feelings of loss in the context of AAPT are likely to be worse than the ones reported in neonatal intensive care units cases. Finally, they advocate for care pathways focusing on how the transfer of a fetus to the AAPT could affect the pregnant person, with particular attention to managing the grief potentially caused by the pregnancy loss. I praise the authors for such a call to action—especially since partial ectogestation is expected to become a reality in the short-term future—and I share their demands for additional and more attentive care of (formerly) pregnant patients. However, I am concerned that their approach is so focused on negative feelings towards pregnancy loss that it risks becoming …. (shrink)

Romanis and Adkins explore the near-term prospect of artificial amnion and placenta technology (AAPT) which is being developed to supplement the gestational process following the premature ending of a pregnancy.1 While fetal-centric narratives prevail in discussions surrounding AAPT, the authors subvert this trend by centering the experience of pregnant persons with respect to pregnancy loss. The overarching aim of their paper is to move beyond a ‘philosophical understanding of pregnancy towards practical-orientated conclusions regarding the care pathways (...) surrounding [AAPT]’ (Romanis and Adkins,1 p1). This commentary will critically examine the viability of this aim. Romanis and Adkins use the term ‘pregnancy loss’ to refer to the phenomenon where individuals experience a complex set of emotions following the premature ending of pregnancy, despite the survival of the gestated entity. Following Golish and Powell, the authors note how parents may experience contradictory emotions, such as joy mixed with grief, as well as a range of negative feelings including shame, disappointment and a sense of failure.2 At present, this phenomenon has been recognised among parents, particularly the (formerly) pregnant person, in the context of neonatal intensive care units (NICUs) when the infant survives preterm delivery and …. (shrink)

In this paper, we explore how the prospect of artificial placenta technology (nearing clinical trials in human subjects) should encourage further consideration of the loss experienced by individuals when their pregnancy ends unexpectedly. Discussions of pregnancy loss are intertwined with procreative loss, whereby the gestated entity has died when the pregnancy ends. However, we demonstrate how pregnancy loss can and does exist separate to procreative loss in circumstances where the gestated entity (...) survives the premature ending of the pregnancy. In outlining the value that can be attached to pregnancy beyond fetal-centric narratives, we illustrate how pregnancy loss, separate to procreative loss, can be experienced. This loss has already been recognised among parents who have experienced an unexpected early ending of their pregnancy, resulting in their child being cared for in neonatal intensive care unit. Artificial placentas, however, may exacerbate these feelings and make pregnancy loss (without procreative loss) more visible. We argue that pregnancy is an embodied state in which gestation is facilitated by the body but gestation itself should be recognised as a process—and one that could be separable from pregnancy. In demarcating the two, we explore the different ways in which pregnancy loss can be understood. Our objective in this paper goes beyond contributing to our philosophical understanding of pregnancy towards practical-orientated conclusions regarding the care pathways surrounding the artificial placenta. We make recommendations including the need for counselling and careful consideration of the language used when an artificial placenta is used. (shrink)

The commentaries in response to our feature paper1 are indicative of the varied perspectives that can be taken towards artificial amnion and placenta technology (AAPT) and more specifically its relationship with pregnancy (loss). Kennedy rightly argues that empirical research is essential for understanding the experiences of pregnancy loss and AAPT2 and our own advocacy of empirical research is evident in previous work.3–5 Kennedy also acknowledges the current impossibility of researching AAPT experiences since it has not yet (...) been applied in clinical settings. It is precisely for this reason that we draw on the reported experiences of neonatal intensive care (NICU) parents since they present the closest analogy which can be drawn with the technology.1 What we reject in Kennedy’s response, however, is the claim that the experiences of NICU parents have been ‘exploited’ by us.2 Studies documenting the experiences of NICU parents were drawn on to indicate that our considerations are more than mere speculation. As stated, the experiences of NICU parents, particularly the pregnant individual who experiences pregnancy loss, are the closest indication we have of how AAPT and what it entails may be experienced. To claim that this data is being exploited by us is to undermine the very purpose that such research is undertaken—to indicate how future care may be improved. It would be much more harmful to not use this information. While we believe that experiences of …. (shrink)

Each year in the UK there are approximately 250,000 miscarriages, 3,000 stillbirths and 3,000 terminations following a diagnosis of fetal-abnormality. This paper draws from original empirical research into the experience of pregnancy loss and the accompanying decisionmaking processes. A key finding is that there is considerable variation across England in the range of options that are offered for disposal of pregnancy remains and the ways in which information around disposal are communicated. This analysis seeks to outline the (...) key features of what constitutes effective communication in this context, where effective communication is taken to mean that patients are provided with the key information necessary, in an appropriate manner, so that they are fully able to make a decision. A primary source of evidence includes interviews with the bereaved and pregnancy-loss support workers, in order to understand how the options available, and associated necessary procedures, are communicated. In addition, patient information leaflets are also analyzed as they offer an important tool for information delivery at a difficult and emotionally charged time. Following this, an overview is provided of the information that these leaflets should contain, along with guidance on effective presentation of this information. (shrink)

In their article, Romanis and Adkins delineate pregnancy loss and procreative loss to show that the former is possible without the latter, as in the case of artificial amnion and placenta technology.1 Here, we are interested in examining the reverse—procreative loss without pregnancy loss—to further tease apart these two types of loss. We discuss two cases: being forced to continue a pregnancy despite fetal demise due to abortion restrictions and choosing to selectively (...) reduce a multifetal pregnancy. Our analysis buttresses the authors’ conclusion: due to our fetal-centric conception of pregnancy, we are only able to value pregnancy instrumentally (ie, for the fetus), not intrinsically. Understanding pregnancy as an embodied state rather than a process that not only acknowledges the intrinsic value of pregnancy for pregnant people but also encourages society to intrinsically value pregnant people is important. In 2022, the Supreme Court of the United States removed the constitutional right to an abortion in Dobbs v Jackson Women’s Health Organization, shifting the responsibility of determining abortion regulations to individual US states.2 Due to the Dobbs decision, there …. (shrink)

In this paper I take up (what I call) the pregnancy loss objection to defenses of abortion that deny fetal moral status. Though versions of this objection have been put forth by others—particularly Lindsey Porter’s in a 2015 paper—I argue that the existing versions of the objection are unsuccessful in various ways: failing to explain the ground of moral considerability that would apply to embryos/fetuses in very early pregnancy, lack of clarity about what it means to take (...) grief after miscarriage seriously, and implausible implications regarding pre-embryo and infertility cases. I go on to offer a more plausible version of the objection, which I apply only to mid-pregnancy and fetuses, by drawing on personal narratives of later pregnancy loss and abortion and emphasizing practices that indicate the relevant kind of mourning. I then take up the question of how experience of the sort I have in mind can function as evidence, by situating my version of the objection in a pragmatist ethical view. Finally I consider and respond to some worries about the very idea of taking experience of pregnancy loss to be evidence regarding fetal moral status. (shrink)

The problem of feeling guilty about a pregnancy loss is suggested to be primarily a moral matter and not a medical or psychological one. Two standard approaches to women who blame themselves for a loss are first introduced, characterised as either psychologistic or deterministic. Both these approaches are shown to underdetermine the autonomy of the mother by depending on the notion that the mother is not culpable for the loss if she "could not have acted otherwise". (...) The inability to act otherwise is explained as not being as strong a determinant of culpability as it may seem at first. Instead, people’s culpability for a bad turn of events implies strongly that they have acted for the wrong reasons, which is probably not true in the case of women who have experienced a loss of pregnancy. The practical conclusion of this paper is that women who feel a sense of guilt in the wake of their loss have a good reason to reject both the psychologistic and the deterministic approaches to their guilt—that they are justified in feeling upset about what has gone wrong, even responsible for the life of the child, but are not culpable for the unfortunate turn of events. (shrink)

In the first part of this paper, I argue that the positions set out in traditional debates about abortion are focused on the status of the fetus to the extent that they ignore the value and meaning of pregnancy as something involving persons other than the fetus. -/- In the second part of the paper, I build on Hilde Lindemann’s ideas by arguing that recognition of the related activities of calling a fetus into personhood and creating an identity as (...) a parent allow us to make sense of a variety of reactions to pregnancy and pregnancy loss while recognizing that pregnancy can and does have meaning for many people in many cases. (shrink)

Issues surrounding pregnancy loss are rarely addressed in Christian philosophy. Yet a modest estimate based on the empirical and medical literature places the rate of pregnancy loss between fertilization and term at somewhere between 40–60%. If miscarriage really is as common as the research gives us to believe, then it would seem a pressing topic for a Christian philosophy of the future to address. This paper attempts to begin this work by showing how thinking more closely (...) about pregnancy loss understood as a grievable event can have a profound impact on the way we think about particular theoretical debates in Christian philosophy and provide opportunities for the discipline to put its skills to use in the development of helpful conceptual and hermeneutical resources for those grieving such losses. However, this will require seeking out and taking seriously the testimony of those who have undergone pregnancy loss, as well as getting clearer on how best to conceptualize pregnancy and its loss in the first place. (shrink)

Because mourning and memorializing a miscarriage seems to imply acceptance of foetal personhood, feminists have been reluctant to address the often traumatic but common experience of pregnancy loss. Feminist anthropologists of reproduction have argued that adopting a view of personhood as constructed and negotiated, rather than inherent, solves this dilemma and enables the development of a feminist discourse of pregnancy loss. This article aims to make a critical contribution to such a discourse by analysing representations of (...) lost babies and children in online pregnancy loss memorials. It focuses on two genres of representation, idealized angels and medical ultrasound images. It argues that the dominance of a biological model of personhood limits the ability of both forms of representation to secure the status of memorialized children as real. However, pregnancy loss memorials do communicate the anguish of grieving parents, in part through the very unrepresentability of their loss. They also provoke a questioning of the taken for granted subject of `the child', whether imagined or real, absent or present. (shrink)

Clinical language applied to early pregnancy loss changed in late twentieth century Britain when doctors consciously began using the term ‘miscarriage’ instead of ‘abortion’ to refer to this subject. Medical professionals at the time and since have claimed this change as an intuitive empathic response to women's experiences. However, a reading of medical journals and textbooks from the era reveals how the change in clinical language reflected legal, technological, professional and social developments. The shift in language is better (...) understood in the context of these historical developments, rather than as the consequence of more empathic medical care for women who experience miscarriage. (shrink)

Starting from first person experience, I argue that early miscarriage may invoke a sense of loss that is enigmatic and ambiguous, often times complicated by the fact that the topic of miscarriage is culturally silenced. Understanding the frequency of such occurrences of early pregnancy loss (in terms of the “miscarriage iceberg”) adds to the existential need to conceptualize such losses as they bleed into life at its very emergence. The prevalent cultural discourse on loss, even when (...) it deals with ambiguity, is focused upon individuation and personhood, which may complicate the grieving process in the case of early pregnancy loss.In searching for alternative epistemologies to address early pregnancy loss and its consequent grief, I propose the following conceptual pathways to elucidate the nature of this loss. First, early pregnancy loss may be understood in terms of the dissipation of a pregnant constellation, thereby putting less emphasis on losing a “being” but rather a sense of participation. This clarifies the kind of loss involved but does not yet completely explain what kind of relationality is lost. Secondly, the grief involved in early pregnancy loss benefits from the Freudian-inspired theories of Pauline Boss and Judith Butler, who emphasize that grief entails absence and presence (Boss, The myth of closure: ambiguous loss in a time of pandemic and change. W.W. Norton & Company, New York, 2021) as well as a deep loss of identity given the loss of relational ties that inform identity (Butler, Stud Gender Sexuality 4(1):9–37, 2003). This deepens the account of grief but does not precisely address the loss of mere emergent relationality. Thirdly, following Gilbert Simondon’s theory on ontogenesis (Simondon, The genesis of the individual. In Crary J, Kwinter S (eds) Incorporations. Zone Books, New York, 297–319, 1992), pregnancy loss involves losing a bridge to a pre-individual relationality, due to which the formerly pregnant body cannot easily leap “back” into former forms of individuation nor leap forward into a socially recognized altered collectivity. This account is able to clarify the kind of relational loss involved in early pregnancy loss. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:One Interpreter's Journey of Interpreting for Pregnancy LossMarisa Rueda WillInterpreters have to know everything." This is what I thought as I watched and shadowed a seasoned interpreter at a world-renowned medical center, during my J-term internship. The fact that I had gotten this opportunity was still hard to believe. There I was, shadowing medical interpreters at one of the best hospitals in the world during my senior year (...) of college after abruptly dropping my secondary education minor to pursue a career in medical interpreting. I felt fortunate for the opportunity and seized the chance to learn from the best of the best.When that same institution hired me after I graduated college in 2006, my training consisted of shadowing other interpreters and having them shadow me. There was no strict process, just one-on-one on-the-job training. The training I received was the best it could be at the time, but not even close to what it takes for an interpreter to become confident and prepared to interpret for most appointments.Growing up I hadn't been interested in the medical profession. When I started working as an interpreter, I soon learned that in addition to my A and B languages, I also needed to learn a C language—the language of medicine. Just as I learned Spanish, I had to learn that a CAT scan was a type of imaging study, and a creatinine level was a measure of kidney function. I was fascinated by the language of medicine. The acronyms, medications, diseases, body parts, hormones, markers, genes, everything.As fascinating as medicine was, it wasn't the reason I considered medical interpreting my calling. As soon as I started working as a volunteer healthcare interpreter at a local free clinic, I knew it was the way I wanted to make a difference in the world. The Spanish speakers I was helping were low-income, underprivileged people with serious medical conditions and a host of other socioeconomic problems. These were people who needed help. These were people who needed to be heard. These were people who needed to be seen. As an interpreter, I would be able to give them a voice. Fast forward 18 years and I am still making a difference in the lives of patients with Limited English Proficient (LEP) by giving them the gift of communicative autonomy, or the right to be in control of and responsible for their own communication.Communicative autonomy is one of the founding principles of the medical interpreting profession. It differentiates the professionals from ad-hoc interpreters and bilingual family and friends. This is because upholding communicative autonomy means that regardless of my personal beliefs, I must remain impartial in all situations. I must interpret what is said and allow all parties involved [End Page 156] to guide the conversation as they see fit. Ideally, I only intervene to mediate for cultural or linguistic reasons when needed.Some of the most ethically conflicting cases I have had to interpret have centered around pregnancy loss and abortion. When I started interpreting, I was a young single woman with a relatively liberal view on reproductive rights. However, one stillbirth and three healthy pregnancies later, my personal beliefs on the subject have become more complicated. Each time I interpret for a loss or induced abortion, I must dig deep and ask myself if I can remain impartial. I can still remember the first time I faced this dilemma.One evening, I was called to interpret for a labor and delivery case. When I arrived, I was informed that it was an induction of an 18-week-gestation fetus that had tested positive for Down syndrome on genetic testing. At the time, I didn't have strong beliefs about abortion. I had never been pregnant and really wasn't sure where I stood on the spectrum of a woman's body, a woman's choice, and abortion is murder. However, there I was, smack dab in the middle of an elective abortion on a weeknight.The bereavement nurse was seasoned and experienced. If it hadn't been for her guidance and poise, the ordeal would have been... (shrink)

The placenta has played an important role in feminist theories of subjectivity; however, the placenta of feminist theory has been the fully functional placenta of what is considered a successful full-term pregnancy. Pregnancy loss, a topic that has been generally overlooked within feminist scholarship, is absent from feminist theories of the placenta. This article uses early placental development, particularly development that takes place before the placenta becomes fully functional as an organ for hormone production and interchange, as (...) a space through which to consider theorising subjectivity, reproduction and relation through pregnancy loss. In so doing, I argue that turning our attention to the placenta’s early development, regardless of outcomes, allows us to reimagine the role of process for feminist theories of subjectivity while also making room for a wider array of pregnancy outcomes, reinvigorating our ability to think about relations and models of hospitality that do not end as we might imagine. (shrink)

Voluntary abortions are relatively frequent and their care is complex due to the social stigma that surrounds these losses. This interpretive meta-ethnography of 11 original qualitative articles aims to synthesize the moral experiences of nurses and midwives who cared for women and couples that decided to abort or terminate the pregnancy due to foetal abnormalities. Lines of argument synthesis emerged after reciprocal and refutational translations, together with the metaphor, ‘Going with the flow or swimming against the tide’. Caring in (...) these situations was an ethical dilemma when a conflict existed between their professional duty and their moral principles. In these instances, care was associated with a significant emotional cost. They did not feel sufficiently prepared or with adequate resources, which favoured avoidance behaviours. However, the feeling of professional duty was stronger than their prejudices, and they became engaged in caring. These results could improve knowledge, clinical practice and education, being a (highly) reasonable representation of the phenomenon of interest. (shrink)

Given an equal sex ratio at conception, the excess of human males at birth can only be explained by greater loss of females during pregnancy. It is proposed that the bias against females during human development is the result of a greater degree of genetic and metabolic “differentness” between female embryos and maternal tissues than for similarly aged males, and that successful implantation and placentation represents a threshold dichotomy, where the acceptance threshold shifts depending on maternal condition, especially (...) stress. Right and left ovaries are not equal, and neither are the eggs and follicular fluid that they produce, and it is further hypothesized that during times of stress, the implantation threshold is shifted sufficiently to favor survival of females, most likely those originating from the right ovary, and that this, rather than simply a greater loss of males, explains at least some of the variability in the human sex ratio at birth. (shrink)

There is a significant debate over the moral status of human embryos. This debate has important implications for practices like abortion and IVF. Some argue that embryos have the same moral status as infants, children, and adults. However, critics claim that the frequency of pregnancy loss/miscarriage/spontaneous abortion shows a moral inconsistency in this view. One line of criticism is that those who know the facts about pregnancy loss and nevertheless attempt to conceive children are willing to (...) sacrifice embryos lost for the healthy children they ultimately have. I respond to this criticism and argue that on the most plausible accounts of well-being, these embryos are not made worse off and thus not “sacrifices.” I then make some more general remarks about what people’s typical views about pregnancy loss show about their views toward the moral status of embryos. (shrink)

A relational, feminist ethics of pregnancy sees the fetus as valuable both relationally and biologically, rather than minimized or ignored. Women are always at the center of ethical concern. To avoid gender-based discrimination, women’s bodily integrity, consent (to pregnancy), and physical “nestedness” (containment of the fetus within a person’s body) must be considered primary ethical concerns. This relational approach accounts for the significance of pregnancy and the grief of pregnancy loss while concurrently providing an ethical (...) justification for abortion. This refined framework has significant benefits because it can address a spectrum of ethical issues that arise around pregnancy. (shrink)

The purpose of this paper is to assess Profet’s (1992) and others’ hypothesis that nausea and vomiting in pregnancy (NVP) is adaptive. A number of studies have found an association between NVP and a decreased risk for early fetal loss (<20 weeks). It is assumed that the adaptive benefits of improved survivorship associated with NVP outweigh the minimal nutritional consequences. However, in populations that experience marginal levels of nutrition, NVP may have important nutritional consequences. To test these potential (...) consequences, a study on NVP, nutritional status, and pregnancy outcome was conducted among Turkana pastoralists, who experience seasonal and chronic nutritional stress. Interviews and anthropometric assessments were conducted on 68 pregnant Turkana women of Kenya during a 1993–1994 field season. The results from the case study suggest that women who experience NVP do encounter nutritional consequences in the later stages of pregnancy and are more likely to experience poor pregnancy outcomes. These results suggest that NVP may not be adaptive in all environmental settings, particularly among marginally nourished populations. (shrink)

IntroductionThere is a paucity of clinical guidelines for the routine assessment of maladaptive reproductive grief reactions in outpatient primary care and OB-GYN settings in the United States. Because of the disenfranchised nature of perinatal grief reactions, many clinicians may be apt to miss or dismiss a grief reaction that was not identified in the perinatal period. A significant number of those experiencing a reproductive loss exhibit signs of anxiety, depression, or post-traumatic stress disorder. Reproductive losses are typically screened for (...) and recorded numerically as part of a woman’s well-visit intake, yet this process often fails to identify patients emotionally troubled by a prior pregnancy loss.Materials and MethodsA summative content analysis of 164 recent website blogs from female participants who self-reported having experienced a miscarriage or abortion in their lifetime was conducted. The narratives were reviewed for details regarding the time span between the pregnancy loss and the composition of the blog post. The stories were analyzed for subsequent relationship problems and detrimental mental health conditions. Maladaptive reactions were contrasted for those that indicated a greater than 12 months’ time-lapse and those who had not.ResultsMore than a third of the women reported in the narrative that at least one year or more had passed since experiencing the miscarriage or abortion. For those women, the median time span between the loss and composing the blog was 4 years with a range of 47 years. Mental health conditions attributed to the reproductive loss by those who reported longer bereavement times included subsequent relationship problems, substance misuse, depression, suicidal ideation, and PTSD. The percent of reported maladaptive issues was more than double for those who reported that a year or more had passed since the loss of the pregnancy.DiscussionGrief reactions following the loss of a pregnancy may be prolonged or delayed for several months which can contribute to adverse biopsychosocial outcomes. Recognition and treatment of maladaptive grief reactions following a pregnancy loss are critical. Screening methods should be enhanced for clinicians in medical office settings to help identify and expedite the appropriate mental health assistance. (shrink)

In this article, we reflect on the particular temporal structure of pregnancies and prenatal entities with the aim to contribute to the field of the sociology of pregnancy. Medical models and technology shape today’s notion of pregnancy as a linear, nine-month developmental process that leads to the birth of a child. Through ultrasound technology and prenatal examinations, prenatal entities have thus historically gained a present ‘being’ as a developing, unborn child. While these ideas undoubtedly greatly influence the participants’ (...) interpretations, a culturalistic perspective on time alone does not do justice to the phenomenon’s lived tensions and the temporal complexity of the phenomenon. From a Schutzian perspective of time, we have worked out how practices of pregnancy and the production of meaning are shaped by an interwoven back and forth between orientations to the past, present and future. Drawing on relevant works from the sociology of pregnancy, we work out five modes of temporal references that mold the phenomenon of pregnancy: joint imagination of the couple, in which the born is anticipated as fantasies of the future, passivities of pregnancy, in which the desired future is experienced as unable to influence, the presentification of the unborn in and through visual and bodily-somatic contact moments, its futurization through the cultivation of a ‘not-yet’ and prenatal losses, as a critical rupture with the anticipated and desired future. Our analysis underlines the potential of a time sociological perspective on pregnancy and the constitution of relationships and persons. (shrink)

The debate on abortion has tended to avoid the psychological significance of an unwanted pregnancy, dominated istead by the strong emotions the subject excites. Eva Pattis Zoja examines the thoughts that surround a woman's decision to end a pregnancy, and presents the challenging thesis that voluntary abortion can often be a violent and unconscious act of self-realisation. Treating a theme which is central to our existence, the author makes no attempt to argue for or against, or to deny (...) the painful nature of the subject which she tackles, but instead looks at the way in which a decision to abort can affect a woman's inner life. (shrink)

Existing accounts of meaning in reproductive contexts, especially those put forward in debates concerning abortion, tend to focus on the (moral) status of the fetus. This issue on miscarriage, pregnancy loss, and fetal death accomplishes a shift this conversation, in the direction of pushing past embryo-centric value judgments. To put it bluntly, the miscarried embryo is not the one who has to live with the experience. The essays in this special issue are a significant addition to the scarce (...) literature on miscarriage and fetal death. Contributions are from specialists in continental and analytical philosophy, feminism, bioethics, theoretical and applied ethics, social and political philosophy, social epistemology and philosophy of language, narrative, aesthetics, popular culture, and gender studies. As guest editors, we sought to offer a variety of approaches to the topic, to further the understanding of miscarriage and fetal death as important to many areas of philosophy, especially social philosophy. We suggest that the unchosenness and invisibility of miscarriage are central to its seeming irrelevance to social identities and social norms of testimony, recognition, and ascription of significance to experiences. (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)

This article analyzes articles appearing in True Story from 1920 to 1985 that concern women's grief after pregnancy and child loss. They are discussed as a historical link between nineteenth-century consolation literature and current psychological and academic discussions of grief. True Story is a confession magazine marketed for working-class women, whose reproductive losses have generally been minimized or ignored by previous literary and current professional and journalistic treatments of maternal grief. Articles are examined within the constructs of confession (...) literature and within the larger context of women's popular literature. Like working-class women's experiences of reproductive loss, these areas have been largely overlooked, dismissed, or denigrated by literary scholars and sociologists. The moral tone of True Story gives women's first-person narratives about infant death and pregnancy an ambiguous prescriptive quality, in that both self-empowerment and self-blame are recommended. True Story reinforces traditional notions of motherhood and femininity, but subtly challenges patriarchal class relations in American society. (shrink)

Sacrificing one's own interests in order to serve another is, in general, supposed to be a good thing, an example of altruism, the hallmark of morality, and something we should commend to (but not always require of) the entirely-too-selfish human beings of our society. But let me recount a story that I hope will persuade the reader to start questioning this conventional philosophical wisdom. Last year, a friend of mine was talking with me about a mutual acquaintance whose two sons (...) were in the same nursery school as our sons. This woman, whom I will call Terry, had been pregnant with twins, but one of the twins had died during the fourth month of pregnancy, and the other twin had just been born prematurely at six months with a host of medical problems. We were discussing how stressful this woman's life had been while she was pregnant: she was a housewife, and her two boys, aged three and five, were lively, challenging, often unruly--a real handful to raise. Her husband worked long hours in a law firm, so the vast majority of the childcare and household chores fell on her shoulders. "You could see that she was exhausted by end of the first trimester," I maintained, "because her eyes were tired, and her cheeks were sunken--she looked almost like a cadaver." My friend agreed. I went on to blame her exhaustion on the fact that she had to do too much during a pregnancy that anyone would have found difficuIt. "I don't understand her husband," I maintained. "Surely he could how badly she looked. If he had concern for his future children, why didn't he do something to help her so that the pregnancy had a chance of going better? And if he loved her, why didn't he cut down his hours so that he could help out at home? Surely he could see just by looking at her that she was in trouble," My friend said nothing at the time, but after a week she called me, and told me that my criticism of this woman's husband had bothered her all week. "You're wrong about Terry's husband not caring enough about her, They have a good marriage," she insisted, and then she continued: "You know, you're not like us, We accept the fact that we should do most of the childcare and housework.. (shrink)

While much has been written on the moral and metaphysical status of fetuses in Christian bioethics, little thought has been given to how we might characterize the afterlives of the unborn, especially of those human biological individuals who die before even developing a body that could theoretically be resurrected. In this paper, I therefore undertake an examination of questions surrounding the afterlife, specifically as it relates to early pregnancy loss. I first lay out what I call the “problem (...) of weird heavens” that arises when we consider that significantly more unborn human beings have died than have been born in the history of humankind. I then go on to consider questions surrounding both the soteriological status of the embryo and the status of any resurrected “body” it might have. I conclude with the germs of an alternative approach mirrored on the idea of embryonic resorption and mystical union. (shrink)

This article is about the recognition of personhood when death occurs in early life. Drawing from anthropological perspectives on personhood at the beginnings and ends of life, it examines the implications of competing religious and customary definitions of personhood for a small sample of young British Pakistani Muslim women who experienced miscarriage and stillbirth. It suggests that these women's concerns about the lack of recognition given to the personhood of their fetus or baby constitute a challenge to customary practices surrounding (...) burial as a Muslim. The article suggests that these women's concerns cannot be adequately glossed as a clash of Islamic belief versus Western medicine. Rather, they represent a renegotiation of Islamic opinion and customary practices within the broader context of changes in the medical and social norms surrounding pregnancy loss and infant death in multi-ethnic British society. (shrink)

This article takes the rupturing of normative, linear, reproductive time that occurs in the event of miscarriage as a potentially generative philosophical moment—a catalyst to rethink pregnancy aside from the expectation of child-production. Pregnant time is usually imagined as a linear passage toward birth. Accordingly, the one who “miscarries” appears as suspended within an arrested journey that never arrived at its destination, or indeed, as ejected from pregnant time altogether. But here I propose to rethink both pregnancy and (...) miscarriage through the lens of “suspended time”—a theoretical move that shifts the accent from the future as the dominating frame of reference to the lived present. Drawing on work by Kathryn Bond Stockton, Lauren Berlant, Lisa Baraitser, and others, the article explores overlooked temporalities of pregnancy and miscarriage that operate not in the mode of futural projection or futural loss, but rather through present-oriented forms of adjustment and sensing, attachment and intimacy, maintenance and care. By “suspending the future,” then, we can resist the oppositional framing of pregnancy and miscarriage, because if pregnant time is not represented in exclusively future-oriented terms as being-toward-birth, then miscarriage need not be understood as pregnancy's undoing. (shrink)

BackgroundBeing pregnant is a vulnerable period for women with a history of eating disorders. A central issue in eating disorders is searching control of one’s body and food preferences. Pregnancy implies being increasingly out of control of this. Treatment and targeted prevention start with the patient’s experience. Little is known about how women with a history of eating disorder experience being pregnant.MethodWe interviewed 24 women with a history of eating disorder at the time of pregnancy, recruited from five (...) public pregnancy controls at local family health centers in Norway. Interviews were analyzed by means of ideal type analysis, with a particular focus on how the participants experienced pregnancy and perceived triggers in possible experiences of relapse or worsening during pregnancy. All participants completed the Eating Disorder Examination Questionnaire and were diagnosed by using the Eating Disorder Examination.ResultsOn becoming pregnant, 23 of the 24 participants experienced worsening or relapse of their disorder. This occurred both at first time and after several pregnancies, and either interviewed early or late in pregnancy. Ideal type analyses indicated seven different personal features associated with worsening or relapse: the “chaotic” “rigid” “perfect” “worried” “shameful” “motherhood fearing” and “the mother with lost identity” Perceived triggers of worsening or relapse were: “loss of control” “unpredictability” “competition” “change of appearance” “shame and nausea” and “loss of identity.”ConclusionPregnancy is a vulnerable period for women with a history of eating disorders. A great variation in personal psychological dynamics seems to interact with perceived triggers in worsening or relapse of eating disorder. Our findings have important implications in understanding mechanisms of relapse in pregnancy, preventing relapse and help tailoring adequate intervention. (shrink)

This paper proposes a phenomenological exploration of the first trimester of pregnancy. In this paper I have presented three core problems that might already appear in the first trimester of pregnancy: alienation, objectification, and loss of identity, which might cause emotional distress for the woman and further develop into depressive states. The goal of the paper is to indicate the kind of mindful approach we can use to reduce the impact of these problems.

In this article, I seek to address an aspect of the general inattention to miscarriage by examining a pressing topic: the moral meanings of pregnancy loss. I focus primarily on the import of such meanings for women in their ethical relationship with themselves, while also finding significant the meaning of miscarriage in community, that is, for our shared moral lives. Exploring miscarriage as a moral phenomenon is critical for figuring out miscarriage’s impact on our ethical self-conception—on how we (...) understand ourselves as moral agents—and in forming and deforming how we understand one another in the broader context of our moral communities—in intimate realms, in public realms, and in various realms in between. -/- I begin by articulating the need for a dedicated perinatal ethics, then developing an overview of this approach. It is against this backdrop that miscarriage’s complex moral meaning can best emerge. I then consider a few promising yet problematic concepts for comprehending the moral meanings of miscarriage, including moral agency, reactive attitudes (in this case, betrayal and guilt), moral responsibility, and moral standing. (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)

Background: Treatment of psychotic disorders in pregnancy is often ethically and clinically challenging, especially when psychotic symptoms impair decision-making capacity. There are several competing ethical obligations to consider: the ethical obligation to maternal autonomy, the maternal and fetal beneficence-based obligations to treat peripartum psychosis, and the fetal beneficence-based obligation to minimize teratogenic exposure. Objective: This article outlines an ethical framework for clinical decision-making for the management of chronic psychosis in pregnancy, with an emphasis on special considerations in the (...) previable and periviable period. Case Presentation: A 31-year-old gravida 2, para 1 with intrauterine pregnancy at 12 weeks and 4 days gestation was brought to the emergency department by her husband seven months after delivering her first child, due to sudden onset of behavioral changes that included self-isolation, not eating, and not taking care of her child. Her past medical history included hypothyroidism and inflammatory bowel disease, but no prior psychiatric illness. After being admitted to the psychiatric hospital, she continued to have poor oral intake and weight loss despite initial inpatient treatment with antipsychotics, levothyroxine, and discontinuation of corticosteroids. Her pregnancy was also complicated by the diagnosis of multiple fetal anomalies at 20 weeks gestation, when the fetus was periviable. Conclusions: For previable or periviable pregnancies, the patient and/or surrogate should decide whether to pursue prenatal genetic screening and invasive diagnostic testing, as well as whether to continue or terminate the pregnancy. When the choice is made to continue the pregnancy, initiation of long-term psychiatric treatment (including medications with potential adverse fetal effects) should be based on shared decision-making between the physician and the patient and/or surrogate. Although some pharmacologic interventions may have potential adverse effects on the developing fetus, the use of psychotropic medications can be ethically justified, even if the patient herself does not have the capacity to consent and requires a surrogate, when the goal is to restore maternal autonomy and minimize the risks of maternal and fetal harm from untreated psychiatric illness. (shrink)

Romanis and Adkins discuss pregnancy loss in relation to artificial amnion and placenta technology (AAPT) for treatment of extremely preterm infants.1 I agree with the authors that AAPT, although it is expected to provide better care for extremely preterm infants, will also be challenging for parents. I, therefore, commend Romanis and Adkins for promoting a more holistic care that includes parents and pregnant persons. However, I believe that they create two false dichotomies, one between the pregnant person/parent and (...) the fetus/child and one between current neonatal intensive care unit (NICU) and AAPT that hinder holistic care. Romanis and Adkins correctly point out that much of the discourse and care surrounding preterm deliveries focuses mainly on the infant. I agree with Romanis and Adkins that true holistic care should also include the parents rather than focusing exclusively on the child. However, the language they use to petition for more inclusive care can be problematic and counteractive to achieve holistic care. The problem is that they accuse any fetal/child consideration of being fetal-centric and, in the same breath, they state that it is something to be challenged. This attitude is problematic as it feeds into the rhetoric of the maternal–fetal conflict. This is a common rhetoric in reproductive and neonatal care used mainly in situations …. (shrink)

Despite significant efforts to support those bereaved by intrauterine death, they remain susceptible to avoidable psychological harm such as disenfranchised grief, misplaced guilt, and emotional shock. This is in part because the words available to describe intrauterine death—“miscarriage,” “spontaneous abortion,” and “pregnancy loss”—are referentially ambiguous. Despite appearing to refer to one event, they can refer to two distinct events: the baby’s death and his preterm delivery. Disenfranchised grief increases when people understand “miscarriage” as the physical process of preterm (...) delivery alone, for this obscures the baby’s death and excludes non-gestational parents, such as the father. Additionally, focusing on the delivery reinforces the mistaken idea that a gestational mother bears responsibility for her baby’s death, increasing misplaced guilt. When these terms instead shift the focus to the baby’s intrauterine death rather than the preterm delivery, they can obscure the physically difficult and often traumatic experience women have when they deliver their dead children, leaving women shocked by preterm delivery’s physical reality. Given their outsized role in framing the bereaved’s experiences, and their duty to avoid harming their patients, healthcare practitioners in particular should take special care to discuss intrauterine death and preterm delivery appropriately with patients and their families. Changing language to describe intrauterine death and preterm delivery clearly and precisely helps mitigate disenfranchised grief, misplaced guilt, and shock, while also helping to reframe the social response to intrauterine death, making it more obvious why certain steps, such as allowing bereavement leave following an intrauterine death, promote healing. (shrink)

Non-invasive prenatal testing is an emerging form of prenatal genetic testing that provides information about the genetic constitution of a foetus without the risk of pregnancy loss as a direct result of the test procedure. As with other prenatal tests, information from NIPT can help to make a decision about termination of pregnancy, plan contingencies for birth or prepare parents to raise a child with a genetic condition. NIPT can also be used by women and couples to (...) test purely ‘for information’. Here, no particular action is envisaged following the test; it is motivated entirely by an interest in the result. The fact that NIPT can be performed without posing a risk to the pregnancy could give rise to an increase in such requests. In this paper, we examine the ethical aspects of using NIPT ‘purely for information’, including the competing interests of the prospective parents and the future child, and the acceptability of testing for ‘frivolous’ reasons. Drawing on several clinical scenarios, we claim that arguments about testing children for genetic conditions are relevant to this debate. In addition, we raise ethical concerns over the potential for objectification of the child. We conclude that, in most cases, using NIPT to test for adult-onset conditions, carrier status or non-serious traits presenting in childhood would be unacceptable. (shrink)

BackgroundDuring a commercial surrogacy arrangement, the event of embryo transfer can be seen as the formal starting point of the arrangement. However, it is common for surrogates to undergo a failed attempt at pregnancy conception or missed conception after an embryo transfer. This paper attempts to argue that such failed attempts can be understood as a loss. It aims to reconstruct the experiences of loss and grief of the surrogates and the intended parents as a consequence of (...) their collective failure to conceive a surrogate pregnancy.MethodsDrawing on a qualitative study conducted over a period of eight months between 2014 and 2015 at two fertility clinics in Delhi and two in Kolkata, India, this paper examines the experiences of the surrogates and the intended parents when faced with missed conceptions or failed conceptions during a surrogacy arrangement.ResultsWe argue that while the surrogate grieves the non-arrival of a ‘good news’ as an uncertain loss, the intended parents experience yet another, failure in addition to the losses they might have incurred during their previous fertility treatments. The body of the surrogate becomes a site of ‘a lost opportunity’. The surrogate embodies a loss in her quest to achieve social mobility and the intended parents experience a disembodied pregnancy loss. This very emotional experience stands in stark contrast to the conceptualisation of such failed attempts as non-events within the discourse of the surrogacy industry. The experience of loss of the intended parents is recognised but their grief is given no space. We argue that such ambiguity around the nature of losses resulting out of a missed or failed conception during surrogacy is an outcome of lack of interpersonal relationship between the surrogate and the intended parents.ConclusionsSince commercial surrogacy is a relational process, the only way in which the experiences of losses and failures of the actors at the preconception stage can be better addressed is through developing close sharing and understanding between each other through an ethics of care. Therefore, to nurture caring relationships, surrogacy needs to be understood as a moral commitment by –the surrogates and intended parents. To enable such a commitment, there is a need to reconsider the pre-defined and legally regulated professional duty of the doctors, agents and agencies. It cannot be a one-sided commitment, but has to have elements of mutuality. (shrink)

Introduction: Intimate Partner Violence (IPV) has unfavorable consequences for women as well as for newborn babies, which is very serious and preventable public health problem. It is believed to have an excessive occurrence in lives of women in South Asia. The objective of this study is to describe the prevalence, risk factors and consequences of IPV in Bangladesh. Methods: A scoping review was carried out based on the past 12 years of posted and gray literature about IPV in Bangladesh using (...) Arksey and O’Malley’s framework. Only the literature addressing abuses or violence in households or outside including physical, sexual or mental violence on the married woman in Bangladesh were taken into consideration for the study. Results: The overall prevalence of IPV in Bangladesh, the latest reviews of rates ranging from 15.5-82.7%.Most of the IPV in Bangladesh was based totally on the experience of legally married women. The main risk factors of IPV in Bangladesh were women being younger, from lower socioeconomic reputation, from lower academic attainment and lower education of husband, dowry, child marriage, perceived disobedience of wives, family conflict, children had recently been ill, and incapability of to furnish sexual satisfaction. Maternal depressive symptoms, signs of stress, anxiety and constraint to the better health of young children are the main consequences of IPV in Bangladesh. Besides, IPV causes unwanted pregnancy, pregnancy loss in the form of miscarriage, induced abortion, or stillbirth and termination of pregnancy in Bangladesh. Conclusions: Woman’s empowerment may reduce IPV and understanding attitudes towards IPV in cultural context could be crucial for developing interventions to reduce IPV and its consequences. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Full Collection of Personal NarrativesGianna O'Leary, Paul Hostovsky, Yilu Ma, Leo Almazan, Hilda Sanchez-Herrera, Marisa Rueda Will, Elaine Hsieh, Manuel Patiño, Felicity Ratway, Liliana Crane, Laisson DeSouza, Nilsa Ricci, Linda Pollack-Jackson, Kelley Cooper, Mateo Rutherford-Rojas, Rosa C. Moreno, Maja Milkowska-Shibata, Patricia Coronado, and Catalina Meyer• A Day in the Life of a Spanish Interpreter• Deaf Interpreter• "Call me Dr. XXX!"• Translating Care for the Voiceless Patient• Are We There (...) Yet? A Narrative of Firsthand Interpreter Experiences in the Medical Field and Insights to Aid Language Access Compliance• One Interpreter's Journey of Interpreting for Pregnancy Loss• More Than Words: Communicating for the Quality of Care• From Linguistic Bridge Builder to Aspiring Physician• Towards Language Justice: A Call to Identify and Overcome Structural Barriers• Voices in the Shadows: The Hidden Complexities of Being a Medical Interpreter• The Voice of Patients: The Exclusive Work of a Human Who Can Advocate• Don't Mute the Messenger• The Ramp and the Stop Sign• How Policies and Practices in Medical Settings Impact Communication Access with Deaf Patients and Caregivers• And When May I Cry? Juggling Emotions in Healthcare Interpreting• To Engage or Not to Engage: An Interpreter and a Mother's Need for Connection in the Cardiothoracic Unit• Witnessing Trauma: Emotional Challenges in Medical Interpretation• Being an Interpreter—Beyond Linguistics• 1-800-Quit-NowCopyright © 2024 Johns Hopkins University Press... (shrink)

This paper presents a case for the decriminalisation of abortion in Britain in light of the increasing investigations into people experiencing pregnancy loss and prosecutions of those suspected of illegal abortion. This growing enforcement of the criminal abortion offences has coincided with the legal change to allow the home use of abortion pills through telemedicine, and comes in the context of global backlash against abortion rights. Framing abortion as a necessary healthcare service and human right, this paper demonstrates (...) the harms caused by criminalisation and highlights how the law exacerbates socio-economic and other vulnerabilities. It is later illegal abortions that tend to be prosecuted, and while there are complex reasons as to why someone might require an abortion, the law prohibits abortion beyond 24 weeks except for narrow medical reasons, creating crisis situations for those that find themselves without legal access. Decriminalisation is necessary to move away from this culture of suspicion, hostility, and stigma that has been built around abortion. (shrink)

Why do humans menstruate while most mammals do not? Here, we present our answer to this long‐debated question, arguing that (i) menstruation occurs as a mechanistic consequence of hormone‐induced differentiation of the endometrium (referred to as spontaneous decidualization, or SD); (ii) SD evolved because of maternal–fetal conflict; and (iii) SD evolved by genetic assimilation of the decidualization reaction, which is induced by the fetus in non‐menstruating species. The idea that menstruation occurs as a consequence of SD has been proposed in (...) the past, but here we present a novel hypothesis on how SD evolved. We argue that decidualization became genetically stabilized in menstruating lineages, allowing females to prepare for pregnancy without any signal from the fetus. We present three models for the evolution of SD by genetic assimilation, based on recent advances in our understanding of the mechanisms of endometrial differentiation and implantation. Testing these models will ultimately shed light on the evolutionary significance of menstruation, as well as on the etiology of human reproductive disorders like endometriosis and recurrent pregnancy loss. (shrink)

Abortion remains a controversial topic, with pro-life and pro-choice advocates clashing fiercely. However, public polling demonstrates that the vast majority of the Western public holds a middle position: being in favour of abortion but not in all circumstances nor at any time. The intuitions held by the majority seem to imply a contradiction: two early foetuses at the same point in development have different moral statuses. Providing coherent philosophical grounding for this intuition has proved challenging. Solutions given by philosophers such (...) as Feinberg, Harman and Räsänen are complex and do not fully account for the lived experience of pregnancy loss. This article argues for a relational ontological construction of human personhood as the basis of foetal personhood. This approach takes seriously the literature of pregnancy loss and the lived experiences of pregnant persons. Focusing on the manner in which persons relate to early foetuses (especially pregnant persons), provides a coherent ground for distinct foetal value. Importantly, this approach is both simple and intuitive. Therefore, it can be more easily adopted by middle. To counter an implied equality of human relationality, the article argues for a clear hierarchy based on relational proximity that affirms pregnant persons? primary role in deciding the moral significance of foetal termination. (shrink)