Too big, too young, too risky: How diagnosis of the foetal body determines trajectories of care for the pregnant woman in pre‐viability second trimester pregnancy loss

Abstract

Women in the English National Health Service facing pre-viability second trimester pregnancy loss through foetal death, premature labour or termination of pregnancy for foetal anomaly find themselves in a particular trajectory of care. This usually involves the requirement to labour and birth the foetal body and may involve undergoing feticide in cases of termination. Drawing on ethnographic research investigating women's experiences of second trimester pregnancy loss, I argue that the determining factor affecting care trajectories for the pregnant body is the biomedically diagnosed status of the foetal body. Foetal size, non-viability and the potential for live birth during terminations all structure the healthcare options for the woman facing pregnancy loss in the second trimester. As such, the diagnostic classification of the foetal body in the context of gestational time determines the medical care afforded to the pregnant body. This results in specific consequences for women, whose experiences of, and choices around, second trimester pregnancy loss are constrained by diagnostic and classificatory decisions around the status of the foetal being before legal viability.

Invisible Labours

“…Women also use traces and inscriptions from biomedicine itself to claim foetal personhood through evidence of the foetal body. The lay use of biomedically produced representations of the body of the foetal being within kinship and personhood discourses and practices has been described in other contexts (Roberts 2012, Han 2009, Middlemiss 2020, Taylor 1998, Kroløkke 2011, Keane 2009, including in the representation of the personhood of foetal beings in pregnancy loss (Keane 2009, Layne 2000. I develop these ideas here to argue that in the English context and in the second trimester, biomedical evidence is not simply a neutral 'proof' of personhood, but is used strategically and politically as a reverse discourse to claim personhood against the biomedicallegal ontology of no personhood before viability without separated life.…”

“…Experiences of the foetal being during pregnancy which are mediated through biomedical technology, particularly imaging, but also foetal Doppler listening, have been shown by feminist researchers to socially construct foetal personhoods whilst being presented as objective and neutral representations of scientific 'fact' (Duden 1993, Petchesky 1987, Hartouni 1997, Taylor 1998, Mitchell 2001, Howes-Mischel 2017, Middlemiss 2020. More recently, research in England has shown, however, that pregnant women are not passive in their responses to technologies which represent the foetus, and that these responses are not singular.…”

Employment leave for early pregnancy endings: A biopolitical reproductive governance analysis in England and Wales

“…We draw on research carried out for the first author's Sociology PhD, which identified differences in maternity leave entitlements in the specific circumstances of second‐trimester pregnancy loss (Middlemiss, 2021b) as well as the ongoing Early Pregnancy Endings and the Workplace project, a collaborative multiuniversity project led by The Open University, which investigates experiences of all pregnancy endings in the workplace before 24 weeks' gestation. Early Pregnancy Endings and the Workplace includes experiences of miscarriage, ectopic and molar pregnancy, and all forms of abortion.…”

“…Much of the extant social science literature on pregnancy loss and early endings, in the UK and further afield, concerns the experiences of women going through miscarriage, stillbirth, or abortion, especially in relation to marginalization in wider society and medical care (see, e.g., Bloomer et al., 2017, Earle et al., 2012, Frost et al., 2007, Hey et al., 1989, Kilshaw, 2020, Layne, 2003, Lovell, 1983, Middlemiss, 2022, Purcell, 2015, Shaw, 2014). The limited research on pregnancy endings and the workplace takes a similar approach (Boncori & Smith, 2019; Devlin et al., 2017).…”

“I Want to Bury It, Will You Join Me?”: The Use of Ritual in Prenatal Loss among Women in Catalonia, Spain in the Early 21st Century

“…Research on prenatal loss demonstrates that a jurisdiction's definition of viability can have an enormous impact on a person's experience of such losses. Middlemiss (2021) described the case of a woman in England who experienced two second-trimester losses, one three days before the medically and legally defined point of viability, and one two days after. In the first case, her loss was considered a miscarriage, a fact that prevented recording the child as a member of the family.…”