Erosion of the rights of pregnant women: In the interest of fetal well-being

Abstract

T he current interest in fetal well-being has been generated by the hope that the striking advances made in the health care of women during childbearing could be followed by similar improvements in the health of their fetuses. From the end of World War II, maternal mortality has declined dramatically in the United States and other developed countries because of medical progress in controlling the major causes of illness and death in pregnant women, ie, blood loss, infection, and toxemia of pregnancy. Antibiotics, modern blood banking, surgical technology, and improved living conditions made these improvements in outcome possible. The better outcomes for women naturally improved the lot of their fetuses, but there have remained many fetal conditions that were not affected by this indirect approach via improvements in maternal health. With the pregnant woman's health and safety largely secure, medical attention has been more intensively focused on trying to improve the outlook for the fetus directly by making fetal evaluation and, at times, therapy a part of obstetrical care. In addition, it was hoped to improve fetal outcome by reducing unhealthy habits and lifestyles of pregnant women, such as smoking and alcohol consumption, which have an adverse effect on fetal health. Advances in prenatal diagnosis, surveillance, and treatment in the last 25 years have made it possible to consider approaches to fetal problems in utero. Ultrasound, amniocentesis, and fetal surgery have allowed access to the fetus while it is still in the womb. This access to the fetus, however, has been at the expense of invasive procedures through the pregnant woman who must consent for the procedures not only for her unborn child but for herself as well. It was also discovered that common practices of everyday life could have a devastating impact on pregnancy and the fetus. Thus smoking during pregnancy was noted to cause prematurity and low birth weight. Alcohol consumption has resulted in infants with physical and mental problems, appropriately labeled fetal alcohol syndrome. Street drugs have more recently © 1990 by The Jacobs Institute of Women's Health 1049-3867/90/53.50