When Elizabeth Mitchell Armstrong asked her audience at the Fillius Events Barn on Monday to formulate a mental image of a fetus, everyone imagined one of two images—either the monochromatic projection of a fetus from an ultrasound or a more lifelike rendering of a fetus in utero, such as the iconic image that graced the April, 1965 cover of Life magazine.
Conspicuously absent from the audience’s imaginations of the fetus was the vessel, that is, the pregnant woman. The notion that a fetus exists as its own person, separate in identity from its mother, is a relatively new one in the history of obstetrics and has profound implications today in the treatment of pregnant women. Armstrong, associate professor of sociology and public affairs at Princeton University, argued that the contemporary definition of fetal personhood has far-reaching, oftentimes debilitating consequences for pregnant women. Armstrong’s presentation was part of the 2010-11 Levitt Center Speaker Series on Inequality and Equity.
Armstrong thinks that, because there are so many dualities and contradictions inherent in modern-day social conceptions of pregnancy, pregnancy is difficult and the relationship between mother and fetus is hard to understand. Armstrong enumerated some of these paradoxes—pregnancy is the only normal, healthy condition that can be fatal; pregnancy is simultaneously a miraculous event and a rather mundane one that has happened to humans billions of times before; it is often outwardly celebrated while it can be a source of great stress for a mother and father.
These dualities, Armstrong said, complicate discussions of pregnancy and fetal development. There was, though, a time when society held a more prevalent, less convoluted conceptualization of the pregnant body.
Armstrong showed several images of the fetus from medical texts in the 16th century. All of the images were alike in their portrayal of the fetus, not as its own entity, but as a component inside the body of its mother. Armstrong contrasted these images with images of fetuses from modern textbooks, all of which have a fetus in the foreground with the pregnant body altogether missing.
While the images themselves may be insignificant, what they represent is a paradigm shift in obstetric medicine that can be attributed to the replacement of the female midwife by the trained, male physician. With the invention of tools like forceps to assist birthing women and eventual technologies such as ultrasound imaging and amniocentesis (prenatal diagnosis of chromosomal abnormalities), the fetus began to emerge in medical literature as a second patient, in addition to the mother. In short, obstetrics (from the Latin obstare, “to stand by) originally emerged to manage the risk that a fetus posed to women in childbirth, but expanded its professional mandate at the end of the 19th century to include the wellbeing of the fetus.
This paradigm shift can be traced quantitatively by the appearance of fetal health as major topics in medical literature. “The unborn patient” was first described in 1969, and the first mention of “fetal personhood” came in 1978. In 1980 was the first court-ordered cesarean section and in 1987, the Washington, D.C. Circuit Court’s In re A.C. ruling became the first major court case to attempt to tackle questions regarding rights of pregnant women and their unborn fetuses.
While there are no federal laws that establish fetal personhood, the dominant social discourse often deals with fetuses as people with individual rights separate from their mothers’. While the implications of this assertion are explicitly apparent in the abortion debate, there are other ways in which pregnant women are affected that get less mainstream attention but are no less pressing, argued Armstrong.
Punitive approaches to substance abuse, increasing occurrences of cesarean sections from doctors trying to free themselves from malpractice lawsuits, and a status quo in which pregnant women’s actions are subject to severe scrutiny by not only medical professionals but also the public, all are symptoms of the changing status of the fetus as an individual.