Pregnancy is a common enough state of being, but if you stop and think about it, it is a unique state of existence- whether on physiological, philosophical or legal level.
I have wanted to blog about pregnancy for a while now- on the rights and responsibilities of a pregnant woman-as a pediatrician, and as woman who is ‘pro choice’ in the American sense of the word.
On Abortion Rights:
I fully support the right of a woman to terminate her pregnancy upto the period of viability. The age of viability is a medically determined goal-post that keeps shifting (it was 28 weeks a while ago, in certain countries it is 20, in some 22) and denotes the ability of the fetus to survive outside the uterus (with appropriate medical support).
I however do not agree with extending the right to terminate a pregnancy beyond the period of viability- even when the ‘rights’ of the potential human are non existent upto the actual birth. I cannot articulate why exactly I feel this way- morality perhaps?
It goes without saying that late terminations should be permitted when the life/health of the woman is at stake, or when the termination is sought for humane reasons- like birth defects which are fatal or incurable.
On harmful choices made before the baby is born–
This includes smoking, drinking and substance abuse during pregnancy. All of these affect the fetus inside the woman, during its development inside the uterus and also its life once it is born. While I believe women should not be subjected to excessive ‘policing’ while pregnant, I have seen first hand the disadvantages some babies are born with, and this informs my views on this issue.
I think appropriate support should be extended towards women in order for them to make better choices and modify their harmful behaviour antenatally. Still, I think children born with disabilities/disadvantages resulting from maternal alcohol/smoking/substance use should be able to sue their mothers in court.
A landmark claim in the UK is currently being filed to determine if compensation can be claimed from a woman (on behalf of her child) for drinking heavily during pregnancy, causing her child to be born with developmental problems.Obviously, fetuses do not (and should not) have rights, but children do, and all children were once fetuses, so it will be interesting to see if the law can ‘punish’ a woman for ‘poisoning’ her child when he was a fetus.
On choices made during labour:
I’m conflicted on this. Sure, it is the woman’s right to choose et al, but most obstetric decision making in labour is anyway centred first on the woman, and only switches to fetus-centered mode if there is no additional risk to her.
I’ve attended lots of deliveries as a pediatrician to resuscitate babies who were born in suboptimal condition BECAUSE the mother made an anti-cesarean choice in a desire to go ‘all natural’. In the quest for ‘autonomy’ over her method of delivery, I’ve seen a woman’s baby end up severely disabled for life- and it was heartbreaking and enraging, to me, as the baby’s doctor to know that the baby would have ended completely and totally FINE , if not for the C-section refusal.
Decision making goes hand in hand with taking responsibility for that decision, and while I’m sure there is a lot of guilt and horror on a woman’s part when avoidable damage is caused by her decision, the fact remains that it is primarily the child who has to live (or die) with the consequences of that decision.
I’m not sure how I feel about seeing such children also empowered to take their mothers to court over cases where multiple healthcare professionals advise strongly against/for an intervention and are over-ruled by the woman in question. I’m worried how punitive it can potentially become. I think holding the woman legally liable in unwarranted because the intent to harm is absent- that happens collaterally.
I must clarify that these stances of mine are applicable only to normal pregnancies- and if there is any threat to the woman’s health from pregnancy or labour at any point, right up until the baby is physically outside her body, she (the woman) should come first, no matter what.