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

在英国，由于流产或因胎儿畸形而流产而失去通缉的怀孕，在历史上一直被边缘化，直到最近，此类事件才更广泛地被认为是潜在的重大医疗和社会经历。怀孕24周后的死产事件和怀孕12周前的早产事件越来越受到社会的承认，并在英国开展了关于其社会影响的研究。相比之下，社会科学没有具体讨论怀孕中期的妊娠损失，即怀孕13周后但在24周合法胎儿存活之前的怀孕损失。因胎儿异常而终止妊娠也得到了有限的关注，有时被排除在怀孕“丢失”的类别之外。我的研究针对的是自发性或诱发性的中期妊娠损失，在英国国民健康保险制度中，这些损失是通过分娩和分娩而不是手术来管理的，而且往往涉及到与胎儿形成的、可识别的人体的接触。我认为，中期妊娠损失是一种特定的经历，不同于早期的损失，因为胎儿身体的形成程度，潜在的分娩和分娩强度，以及许多妇女开始将即将到来的婴儿视为特定的人的方式。同时，中期妊娠损失与死产不同，因为合法生存能力的门槛通常意味着不允许进行民事登记，这意味着不承认人格和亲属关系，以及产假等相关支持。这种中间地位的后果体现在为中期妇女提供的医疗保健中，这些妇女往往在没有向怀孕后期妇女提供支持的情况下分娩，如硬膜外止痛或助产士援助。他们可能没有资格获得产后六周的检查，或心理上的丧亲支持。甚至有多少女性经历过这种经历也不得而知，因为存活前自发流产的统计数据没有整理，只有全国性的终止妊娠报告。我对英国中期妊娠丢失经历的研究描述了许多人对这种经历本身、英国国民健康保险制度的管理方式以及随后这一事件的社会边缘化的痛苦。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要定义，并主张她们的婴儿作为一个生和死的人的人格。例如，女性使用超声波图像、照片和火化骨灰等胎儿身体的证据来纪念她们婴儿的生死。当他们坚持自己的母亲身份和家庭中存在他们的婴儿时，他们也抵制将自己排除在民事登记的造人和造亲特征之外。在这个ESRC奖学金中，我将制作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发展关系。所有这些工作都将通过孕妇的经历来解决英格兰中期妊娠丢失的问题，包括胎儿死亡、早产和因胎儿畸形而终止妊娠。通过这种方式，我的目标是增加边缘化生育经验的能见度，优先考虑孕妇的经历，并关注人类生殖过程中研究不足的妊娠期。我的工作还描述了社会和医学类别，如‘中期妊娠’和‘胎儿存活’如何产生特定类型的排斥，以及这些如何可以被怀孕妇女机构质疑，因此它解决了政治和生殖正义的问题。在团契期间，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，并准备向英国国际扶轮基金会和惠康基金会的拨款申请

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