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 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)

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)

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)

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)

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)

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 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)

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)

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)

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)

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)

Opponents of abortion are often described as ‘inconsistent’ (hypocrites) in terms of their beliefs, actions and/or priorities. They are alleged to do too little to combat spontaneous abortion, they should be adopting cryopreserved embryos with greater frequency and so on. These types of arguments—which we call ‘inconsistency arguments’—conform to a common pattern. Each specifies what consistent opponents of abortion would do (or believe), asserts that they fail to act (or believe) accordingly and concludes that they are inconsistent. Here, we show (...) that inconsistency arguments fail en masse. In short, inconsistency arguments typically face four problems. First, they usually fail to account for diversity among opponents of abortion. Second, they rely on inferences about consistency based on isolated beliefs shared by some opponents of abortion (and these inferences often do not survive once we consider other beliefs opponents of abortion tend to hold). Third, inconsistency arguments usually ignore the diverse ways in which opponents of abortion might act on their beliefs. Fourth, inconsistency arguments criticise groups of people without threatening their beliefs (eg, that abortion is immoral). Setting these problems aside, even supposing inconsistency arguments are successful, they hardly matter. In fact, in the two best-case scenarios—where inconsistency arguments succeed—they either encourage millions of people to make the world a (much) worse place (from the critic’s perspective) or promote epistemically and morally irresponsible practices. We conclude that a more valuable discussion would be had by focusing on the arguments made by opponents of abortion rather than opponents themselves. (shrink)

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)

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)

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)

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)

IntroductionGlobally, 15% of adolescents give birth before turning 18, leading to considerable personal, social, and medical impacts on adolescents and to the general society.ObjectiveThis study aimed at exploring and comparing three psychological attributes between parents and teachers for the phenomena.Method672 teachers and 690 parents participated in the study.ResultsThe results indicated a significant mean difference between parents and teachers on empathy, attribution of blame, and feelings of responsibility. Except for attribution of blame, parents’ mean scores of other variables were higher than (...) that of teachers.DiscussionTeachers’ higher attribution of blame to pregnant adolescents and lower empathetic concern raises a prominent concern over students’ healthy environment at school.ConclusionUnderstanding social feelings about responsibilities over adolescents’ general health is very essential, especially for fighting against the problem of early pregnancy. (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 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 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)

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)

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)

Early parental loss or trauma has been proposed by some as a significant factor in the adoption of atheist, non-theist, or irreligious worldviews. Relevant empirical data, however, have been limited, impressionistic, methodologically questionable, or limited to historically prominent figures. Survey data from the GSS and a study of affirmatively non-theistic and irreligious secular group affiliates in the U.S. do not provide evidence of disproportionately high rates of early parental loss among individuals who describe themselves as “atheist” (...) or “anti-religious,” reject belief in God, or express strong anger about religion. Loss of a parent or other loved may play a role in turns toward, as well as away from, God and religion for some. There is also evidence of comparatively high rates of parental loss in the lives of historically prominent figures, both religious and non-religious. Present results, however, do not support the hypothesis that early loss is a disproportionately frequent experience in the lives of atheistic or irreligious people. (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)

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)

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)

In order to survive, the developing conceptus must interrupt the normal ovarian cycle of the mother and extend the production of progesterone by the corpus luteum. An unusual Type 1 interferon (IFN), related structurally to the IFN–α molecule and produced in massive amounts for only a few days by the first epithelium (trophectoderm) of the preimplantation conceptus, has been implicated as the antiluteolytic agent in sheep and cattle. IFN‐a therapy during this critical period can also improve pregnancy success in (...) sheep. It remains unclear, however, whether the trophoblast IFN have specialized biological properties or whether they are unique merely in the timing, magnitude and site of their expression. (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)

In lieu of an abstract, here is a brief excerpt of the content:Journey to WellnessRoberta PriceI should preface this by saying that as a child and early teen years I was lean, well within my weight range for my height of 5’3”. I was physically active as a snow skier, swimmer, hiker and biker. I started running in high school until I got pregnant at the age of 17 in 1988, but even then, my family and I had a (...) gym membership and I worked out with a trainer until my belly got too big and complications from pre–eclampsia forced me to bed rest the last four weeks of my pregnancy. I gained about 80 pounds, mostly water, during this time. Post pregnancy, I lost all my weight and resumed my active lifestyle of walking etc. It wasn’t until I got married in 1990 that I found my weight creeping up on me, slowly, every year. I was still active with three kids and a husband by then, but bad eating habits and cheap carbohydrates were not my friend.My efforts to return to leanness started a few years ago, about 2006. At that point, I weighed at least 200 pounds and I was not happy. Everyone knows the best way to lose weight is to exercise and watch what you eat, so I start daily walks. While walking I started having problems with my legs going numb to the point that I could not feel my feet hit the ground. At first I thought this feeling was due to a pinched nerve as a result of a single–vehicle car accident I was in earlier that year. Some days my legs would not bother me while walking and other days only a few steps would bring on the numbness. Also, I was susceptible to feelings of panic and a racing heart beat. My doctor at the time never once mentioned my weight being an issue. The nurse would write my weight on the chart, I would cringe as I waited for the lecture from my doctor about my weight to start. It never did. It was a strange, sort of “non–issue” with him as I had three kids so I was fat from that. My physician just said, “Lose the weight, I have no idea what is causing the numbness in your legs.”Fast forward to 2011, I am now under the care of a chiropractor in hopes of relieving the numbness that is happening all too frequently now. An ultrasound of my veins showed good blood flow so that ruled out a circulation issue. The chiropractor prescribed physical therapy to help ease my lower back pain hoping that would relieve the nerves I thought were pinched. I was prescribed high blood pressure medication by my doctor, with adverse side effects such as a nagging cough that would not go away—no matter how much cough medicine I consumed. It was during these sessions with my physical therapist that I was able to lose 10 pounds.There is a lot of self–talk in the life of an overweight or obese person. Everyday I woke up, knowing I had to lose weight. Every single time I looked in any mirror or saw any photo (which I was careful to be the photographer and not a subject as denial had become my best and worst friend). It was the subject of many a late night conversation with my husband, whom by the way, at his worst weight was 30 pounds over his preferred height to weight ratio. Not a single doctor I saw previous to this offered any hope for weight loss other than to shove a piece of paper at me telling me to eat these “healthy foods” listed. Since I was the family chef and chief purchaser of food, I was buying and eating vegetables, fruit, whole grains, and attempting to cut down on the processed foods—although, we were heavy eaters of potatoes, pastas, bagels, pizzas and other high carbohydrate foods. Over the years, [End Page 112] the most weight I had lost “counting calories” or portioning out “slow carbs” over “fast carbs” only afforded me a 15 pound loss, to be gained... (shrink)

The concept of “Time” seems to play out differently at various phases of our lives: In our teens and twenties, we experience the luxury of youth; we may feel invincible or even indomitable. Generally, we feel our whole lives are ahead of us, and we “take” time to enjoy, explore and experience our world. Concurrently, our physiology also goes through the phases of childhood, adolescence, puberty and into adulthood, or the “reproductive years”; and ultimately (for women) through menopause and “ageing”, (...) or, the “non- reproductive years”. In this paper I will submit, on what I believe, is the obligation of the health care community to disseminate information early to their patients. This might ensure that the choices that people make in specific phases of their lives are educated and informed choices. Early education would be invaluable if backed up by the benefit of research that already exists, some of it presented in this paper. If this research was to be made available, say, on a patient’s first visit to a gynaecologist, (presumably in their late teens, early twenties), to start the education process, I believe many patients could benefit from it. (shrink)

Based on a qualitative study of 48 teenage mothers living in the Denver metropolitan area, this research examines the loss of multiple attachments, including mothers, siblings, and other extended family members and friends, among African American and Latina girls who become young mothers. Through life history narratives, this article explores the isolating effects of teen motherhood on the relational world of young mothers and the transition to “forced autonomy” that emerges out of the relationship strains in the teen mothers’ (...) lives. Faced with ruptures in significant childhood attachments and strains in the mother–daughter bond, young mothers develop strategies of accommodation to cope with the disruptions to connectivity and the demands of forced autonomy that are the result of early motherhood. These findings are interpreted through the frame of self-in-relation theory as this theoretical perspective has been informed by the scholarship on race and ethnicity. In reengaging the discourse on race, class, and gender, our findings contribute to the field in a number of significant and related ways: first, through an investigation into relationship loss and repair among teen mothers; second, by addressing the conditions under which teen mothers gain acceptance in their families; and third, in applying self-in-relation theory to the experience of adolescent girls of color whose relational lives are disrupted by the stigma and adversity of teen motherhood. (shrink)

This paper critically evaluates current conceptions of pregnancy as a possession of either mother or infant. In opposition to the more common stance that marks birth as the beginning of intercorporeality and perception, pregnancy is instead phenomenologically delineated as a chiasmic relationship between mother and her pre‐infant from a Merleau‐Pontian perspective. This paper maintains that during pregnancy a mother‐to‐be and her pre‐infant are deepened and modified through their intertwining.

This paper critically evaluates current conceptions of pregnancy as a possession of either mother or infant. In opposition to the more common stance that marks birth as the beginning of intercorporeality and perception, pregnancy is instead phenomenologically delineated as a chiasmic relationship between mother and her pre‐infant from a Merleau‐Pontian perspective. This paper maintains that during pregnancy a mother‐to‐be and her pre‐infant are deepened and modified through their intertwining.

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)

Postural instability and balance impairment are disabling symptoms in patients with acute unilateral peripheral vestibular hypofunction. Vestibular rehabilitation is known to improve the vestibular compensation process, but its effect on posture recovery remains poorly understood, little is known about when VR must be done, and whether the degree of vestibular loss matters is uncertain. We analyzed posture control under static and dynamic postural tasks performed in different visual conditions [eye open ; eyes closed ; and optokinetic stimulation] using dynamic (...) posturography. Non-linear analyses of the postural performance were performed in two groups of patients with UVH subjected to the same VR program based on the unidirectional rotation paradigm and performed either early or later after vertigo attack. Distribution of the angular horizontal vestibulo-ocular reflex gain values recorded on the hypofunction side before rehabilitation differentiated two distinct sub-groups with aVOR gains below or above 0.20. The postural performance of the four sub-groups of patients with UVH tested before VR showed significantly altered postural parameters compared with healthy controls. Greater instability, higher energy to control posture, larger sway without feedback corrections, and lower time of automatic control of posture were observed in static conditions. The four sub-groups recovered near-normal postural performance after VR in the EO and EC conditions, but still exhibited altered postural performance with optokinetic stimulation. In dynamic posturography conditions and before VR, the percentage of patients able to perform the postural tasks with EC and optokinetic stimulation was significantly lower in the two sub-groups with aVOR gain <0.20. After VR, the improvement of the postural parameters depended on the stage of rehabilitation and the degree of vestibular hypofunction. The best balance function recovery was found in the sub-group with early VR and pre-rehabilitation aVOR gain above 0.20, the worst in the sub-group with late rehabilitation and aVOR gain below 0.20. These differences were seen when the vestibular input remains the main sensory cue to control balance, that is, on unstable support without vision or altered visual motion cues. These findings extend to dynamic balance recovery the crucial roles of early rehabilitation and degree of vestibular hypofunction which we have already highlighted for vestibulo-ocular reflex recovery. (shrink)

Le développement d’un droit de regard des institutions collectives sur les corps gestants et surtout d’une injonction à « se savoir et se faire savoir » enceinte remonte au xvie siècle au moins. Or la reconnaissance d’un état de grossesse et sa datation ont toujours constitué une double incertitude, face à laquelle divers procédés d’observation corporelle ont été mis en œuvre au cours des siècles. L’article aborde cette question dans le temps long (de l’époque moderne à la fin du xxe (...) siècle) en comparant les modalités et les enjeux pratiques de la détection des grossesses dans un certain nombre de situations d’ordre médico-légal : affaires d’infanticide (datant surtout du xixe siècle), lutte contre l’avortement (fin xixe-milieu xxe siècle), dossiers administratifs relatifs au non-versement d’allocations prénatales (1945-1970). Cette histoire de la socialisation de la gestation permet d’identifier les jeux d’expertise, de médiations et de négociations auprès de femmes enceintes se disant non informées de leur propre état et propose une histoire sociale du doute, de la corporéité et de la conscience de soi. (shrink)

Many accounts of the morality of abortion assume that early fetuses must all have or lack moral status in virtue of developmental features that they share. Our actual attitudes toward early fetuses don’t reflect this all-or-nothing assumption: early fetuses can elicit feelings of joy, love, indifference, or distress. If we start with the assumption that our attitudes toward fetuses reflect a real difference in their moral status, then we need an account of fetal moral status that can (...) explain that difference. I argue that we can have or lack relational obligations to early fetuses in light of our own activities or choices, independent of the fetus’s own features or properties. Those relational obligations make the early fetus morally considerable to the persons who stand in a moral relation to it. Pregnant persons (and other participants in the procreative process) can come to have relational obligations to an early fetus just in virtue of their own decision to create a person, either by intentionally getting pregnant or by deciding to continue a pregnancy. That decision not only makes it appropriate for them to care about the fetus, but it also generates obligations to the fetus that they didn’t have before that decision. (shrink)

The aim of the study was verifying, whether speech development is conditioned by a preterm birth, multiple pregnancy or pregnancy complicated with TTTS. We examined 52 preterm children, 15 of which were born after a single pregnancy and 42 after a multiple pregnancy. 23 children came from a pregnancy complicated by TTTS. The average age of the subjects was 32.5 months. The research methods used in our study were as follows: analysis of medical documentation, a (...) structured clinical interview and psychological conversation. Speech development of a child was assessed using BSID-III. An analysis of the results we obtained showed that there was a lower level of EC in the TTTS children in comparison to multiple-birth children without TTTS and single-birth children. We also found statistically significant relations between the EC scores and gender, age at the time of testing, disability, gestational age, birth weight. (shrink)