The reproductive politics of second trimester pregnancy loss in England

Abstract

This thesis is a feminist examination of women’s experiences of second trimester pregnancy loss involving labour and birth in South West England. Drawing on ethnographic interviews with 31 women, it analyses second trimester pregnancy loss as a distinct phenomenon produced by the interaction of biomedical and governance discourses, and enacted on the bodies of pregnant women. Extending Franklin’s concept of foetal teleology (1991), it argues that prioritised discourses about second trimester pregnancy loss in England are underpinned by a teleological ontology of pregnancy, in which the reality of pregnancy is defined by its outcome of a separately living person. In the second trimester, a pregnancy ending because of foetal death, premature labour, or termination for foetal anomaly will almost never result in this outcome. This means that at an ontological level the foetal beings which emerge in the second trimester are conceptualised as a non-persons, the pregnancies which produced them are not ontologically ‘real’ pregnancies, the labours and births which resulted are insignificant, and the pregnant women who undergo those labours are not ‘real’ mothers. The thesis is a novel ethnographic account of the events and impact of second trimester pregnancy loss, and the consequences for reproductive politics of the teleological ontology of pregnancy it makes visible. In relation to biomedicine, it shows how diagnostic classification of the foetal body as being in the second trimester restricts women’s care options in the English NHS. In terms of governance, it shows how in second trimester loss parental choices and resource entitlements are determined by the ontological status of the foetal being. It shows how these prioritised discourses, and their ontological underpinnings, disrupt women’s ontological security (Giddens, 1991) by conflicting with embodied experience. And it shows how an alternative English kinship ontology of pregnancy which centres embodied personhood is agentially used by some women as resistance to the erasure of their gestational kin- and person-making work.