Invisible labours: the reproductive politics of second trimester pregnancy loss in England

在英国，由于流产或胎儿畸形终止妊娠而导致的意外怀孕在历史上一直被边缘化，直到最近，这类事件才被更广泛地认为是潜在的重要医疗和社会经历。妊娠24周后的死产和妊娠12周前的早期流产事件越来越得到社会的认可，并且在英国开展了关于其社会影响的研究。相比之下，在怀孕的第二个三个月，即13周后，但在24周的法定胎儿生存能力之前，妊娠丢失在社会科学中尚未得到具体解决。因胎儿异常而终止妊娠也受到了有限的关注，有时被排除在妊娠“丢失”的类别之外。我的研究解决了自发或诱导形式的中期妊娠损失，这是在英国的NHS管理劳动和分娩，而不是手术，并经常涉及到与胎儿形成和可识别的人体相遇。我认为，中期流产是一种特殊的经历，与早期流产不同，因为胎儿身体的形成程度，分娩和分娩的潜在强度，以及许多女性开始将即将出生的婴儿视为一个特定的人。与此同时，妊娠中期流产与死产不同，因为法定生存能力的门槛通常意味着不允许进行民事登记，并且不承认由此带来的人格和亲属关系，以及产假等相关支持。这种介于两者之间的状况的后果体现在向妊娠中期妇女提供的保健服务中，这些妇女在分娩时往往得不到为妊娠后期妇女提供的支持，例如硬膜外镇痛或助产士协助。他们可能没有资格享受产后六周的检查，或心理上的丧亲支持。甚至有多少妇女经历过这样的经历也不得而知，因为在生存能力前自然流产的统计数据没有整理，只有在全国范围内报告了堕胎。我对英国女性在妊娠中期流产经历的研究，描述了许多人对这一经历本身的痛苦、英国国民保健服务体系（NHS）对这一事件的处理方式，以及随后的社会边缘化。它还描述了一些妇女如何抵制对发生在她们身上的事情的主流定义，并坚持认为她们的孩子是一个活着和死去的人。例如，妇女利用超声波图像、照片和火化灰烬等胎儿身体的证据来纪念婴儿的生与死。当她们声称自己是母亲并在其家庭中存在自己的婴儿时，她们也抵制将自己排除在民事登记的人制造和亲属制造特征之外。在这项ESRC奖学金中，我将出版一本学术书籍和期刊文章，并与相关的第三部门和议会团体建立关系。所有这些工作都将通过孕妇的经历解决英国的中期妊娠损失问题，包括胎儿死亡、非常早产和胎儿异常终止妊娠。通过这种方式，我的目标是提高边缘化生殖经历的可见度，优先考虑孕妇的经历，并关注人类生殖中未被充分研究的妊娠期。我的作品还描述了诸如“妊娠中期”和“胎儿生存能力”等社会和医疗类别如何产生特定类型的排斥，以及孕妇机构如何对这些问题提出异议，因此它解决了政治和生殖正义问题。在奖学金期间，我还将在这项工作的基础上发展生殖社会科学的未来研究，并准备向UKRI和Wellcome申请资助

The loss of a wanted pregnancy, through miscarriage or termination for foetal anomaly, has historically been marginalised in the UK, and it is only recently that such events have been more widely recognised as potentially significant medical and social experiences. Events of stillbirth, after 24 weeks' gestation, and early miscarriage, before 12 weeks' gestation, are increasingly socially acknowledged, and research about their social impacts has been carried out in the UK.By contrast, pregnancy loss in the second trimester of pregnancy, after 13 weeks but before legal foetal viability at 24 weeks, has not been specifically addressed in social science. Termination for foetal anomaly has also received limited attention and is sometimes excluded from the category of pregnancy 'loss'. My research addresses spontaneous or induced forms of second trimester loss, which are managed in the English NHS by labour and birth rather than surgically, and often involve encounters with the formed and recognisably human body of a foetal being. I argue that second trimester loss is a specific experience which is different to early losses because of the degree of formation of the foetal body, the potential intensity of the labour and birth, and the way many women have begun to consider the coming baby as a specific person. At the same time, second trimester loss is different from stillbirth because the threshold of legal viability usually means that civil registration is not permitted, and the recognition of personhood and kinship which this entails is withheld, along with associated support such as maternity leave.The consequences of this betwixt-and-between status are felt in the healthcare offered to women in the second trimester, who often undergo delivery without the support offered to women later in pregnancy, such as epidural pain relief or midwife assistance. They may not be entitled to the postnatal six week check, or psychological bereavement support. Even the number of women who go through this experience is not known because pre- viability spontaneous loss statistics are not collated, and only terminations are reported nationally.My research with women about their experiences of second trimester loss in England describes the distress many feel about the experience itself, the way it is managed in the English NHS, and the subsequent social marginalisation of the event. It also describes the ways in which some women resist the dominant definitions of what has happened to them and assert the personhood of their baby as a person who lived and died. For example, women use evidence of the foetal body such as ultrasound images, photos, and cremation ashes to memorialise the life and death of their baby. They also resist their exclusion from the person-making and kin-making features of civil registration when they assert their own motherhood and the existence of their baby within their family.In this ESRC fellowship I will produce an academic book and journal articles, and develop relationships with relevant third sector and parliamentary groups. All this work will address second trimester pregnancy loss in England, including foetal death, very premature labour, and termination for foetal anomaly, through the experiences of pregnant women. In this manner, I aim to increase the visibility of marginalised reproductive experiences, to prioritise the experiences of pregnant women, and to pay attention to the understudied period of gestation in human reproduction. My work also describes how social and medical categories such as the 'second trimester' and 'foetal viability' produce particular types of exclusion, and how these can be contested by the agency of pregnant women, and it therefore addresses questions of politics and reproductive justice.During the fellowship I will also build on this work to develop future research in the social science of reproduction and prepare grant applications to UKRI and Wellcome