Hello, and welcome to FAB Gab. This is the podcast for the International Journal of feminist approaches to bioethics brought to you by Fab Network. My name is Kathryn MacKay. And today I'm joined by Anna Nelson, from University of Manchester to discuss her paper which is entitled, should delivery by partial angiogenesis be available on request of the pregnant person. And this appears in the latest volume of ijFab. Hi, Anna.
Yeah, nice to meet you.
Nice to meet you, too. Thanks for joining me on the podcast. I wonder if to get started. You could just give the listeners an elevator pitch summary of your paper.
Yeah, of course. So firstly, a little proviso to the elevator pitch what is partial ectogenesis Because I realized this is kind of a, a word that we throw around. It's a bit of a strange phrase. And so partial ectogenesis is a process whereby the fetus is extracted from the human womb, at the moment looks like kind of probably around the edge of viability, and is placed in artificial women external womb chamber, if you will, to continue at its gestation. And this differs from neonatal intensive care a little bit, as traditionally understood, because the fetus doesn't empty its lungs. So it doesn't need to have the capacity to breathe by itself or support mechanical ventilation, but rather its continued gestation almost outside the body. And at the moment, the technology that might allow this is kind of at lamb trial stage. So that's kind of where we're at as a bit of background. But the paper was specifically, and in that I kind of take a look at all the literature that exists about partial ectoGenesis, which has been kind of really rapidly growing in the past few years, I just slightly re frame the discussion around it, and, and frame partial ectoGenesis rather as this kind of technology or Neonatal Intensive Care alternative, I frame it as a mode of delivery. And the idea behind that to more fully center the pregnant person in the discussions about partial ectogenesis, because after all, it starts with a procedure on their body.
Right. And so it was kind of seeing that there was was it seeing that there was a sort of gap in the literature that motivated you to write this paper?
Yeah, so I kind of I think has talked about it in the paper, I characterize the different waves of literature. And I see this as part of like, a part of be of this more feminist move. That is mean, but I just thought there was space to expand a little bit, a little bit more, and it comes out of I'm doing a PhD application. So that's part of the motivation was that to find something to write about. And I was doing some other work around birth and kind of obstetric violence and vaginal exams of autonomy and birth. And those two kinds of things came together. And I thought, Oh, actually, maybe there's an angle here that's not been explored before.
super interesting. So um, I wonder if you can give us a few of the main points of your argument from the paper?
Yeah, absolutely. So as I kind of suggested, initially, the key central argument I'm trying to make is that partial ectogenesis could be seen as a mode of delivery. So I shifted the focus of the discussion centered on the birthing individual, rather than the technology in the idea that actually this extraction process from the human body, it's not particularly exciting, because it mimics quite closely though, is different from probably our understanding of a cesarean birth, so cesarean section. But despite not being a kind of sexy and interesting thing to talk about, it's really fundamental to what happens. And so that's one of the arguments is that we actually really focus on how the fetus gets out of the body and get into this artificial womb chamber. And and the second part of the argument, I suppose, is that this should actually, once clinically safely translated, this should be something that the pregnant people can request. And so this be a talk of like, we understand the discussion around requests is area and sections and the desire to remove medical gatekeeping there. So it comes from that idea that really, prima Fastow, we ought not to restrict choice in childbirth. And if this is safe, it's sufficiently analogous in certain ways to Syrian sections that really there doesn't seem to be a justification for imposing harsh medical restrictions on who could access this.
What are some of the reasons why people object to cesarean sections on request
Yeah, so they're kind of the, the rejection kind of centers around two points, I suppose. And one of them is risk. And it's an idea that actually it's it's riskier. The literature on that it's very muddled the, the use the literature and the statistics are used to support this idea that it's really risky, or it's much riskier to have a cesarean section, the statistics aren't separated into requests to zerion sections and plans, they're in sections, and emergency cesarean sections. So obviously, when we're in this kind of emergency situations, things are more risky because of the emergency. So it's actually not clear if you try and disaggregate those statistics, whether there is that same level of increased risk that talks about, and the second kind of focal point of, of the rejection is around and resource. And that. On one hand, particularly what we do with new technology might hold some weight, although I kind of look at it a bit more theoretical. So you can kind of do a little bit of, well, we're not thinking about the resource right now. But actually, when it comes to some serious sections, again, if you break it down, and you look at health a lot more holistically, that resource argument is shakier as well. Because, for example, the cost of people not getting a birthday want and finding that really difficult to deal with, if you factor in the cost of mental health care and support or the cost of dealing with some of the normal complications of vaginal birth that can really easily arise. It's not as clear cut as it might seem that it's super resource intensive.
I'm really interested in the the sort of risk part that you talk about. And so maybe we'll come back to that. But I wanted to ask you first about choice, because I think in the paper, you put a lot of emphasis on the birthing person's ability to choose the birth of they want, and you sort of emphasize the importance of having like a fully informed choice. And so yeah, I just wondered if you could speak to that a little bit and tell our listeners kind of your points of view on that one?
Yeah, I think that my emphasis might be quite informed I had just been doing, I did quite a lot of work around what was happening in the UK, when COVID hit with the choices that were removed from, from pregnant people in terms of really simple things about birthing partners, and even things like that. So that definitely could have thrust me into the mindset of choice. And choice around childbirth is quite tricky. Because there's there's kind of two sides to it. Obviously, people in the UK at least have a legally protected right to refuse any medical treatment, even during childbirth, no matter what are the consequences for themselves for the fetus. So that's a big kind of solid legal, right, but it's not, ness doesn't necessarily do his job, always as well as it could. But it becomes a bit trickier when we think about the access to choice to kind of choose particular modes of delivery of things, because you don't have a right to demand specific medical treatment. So it is I do realize when I'm dealing with this idea of choice, it's a bit messy in the middle, because where does your absolute right to choice stop, and this desire to have the best possible. But thing that I think needs to run through all of that, and I hope it comes out in the paper is that whatever is happening, needs to be happening on the basis of clear, clear information and, and reasonably non directive information and a broad spread of information. Because actually, from the literature that exists, what we see is that at times, people don't get access to information of decisions that are seen as kind of not normal or out with the norm. And that can really limit the ability to actually make these informed choices because you don't know what the alternatives are or could be.
So this does kind of bring us back to my question for you about risk a little bit. Because I think, I mean, I think it's really interesting the paper is the paper joins the literature, the why now literature on epigenesis that is well ahead of its time you know, we're doing bioethical work on a topic that is of major importance on a technology that is not yet usable, which is like the rarest situation to be in in bioethics. But so that makes it really interesting, but it also makes some of this kind of speculative. So I'm thinking Through the the paper, it's, it seems like the role of risk is a pretty big one in the paper. And that I guess there's a sort of it's not it's a you make it an explicit assumption that the procedure will be as safe as, say, a cesarean section or a vaginal delivery, which we know is not 100% safe. Yes. So I guess I kind of wondered, I mean, this is a bit of a rambling question way. But I think like, what's, what's your view on whether or not having that kind of intervention, a woman would have to have a much more intensive operation to have a fetus removed at this very early stage, and then to have it placed into the artificial womb? And I'm not even totally clear on what kinds of techniques would be involved there, we may need to invent techniques. What's your view on? You know, are those risks really comparable? Or is it a kind of for the sake of argument?
Yeah. I think that we can, I think, as you say, is speculative. And we can't know. And there's kind of two parts, I suppose to man. So if that's already assessed is that I think it's worth talking about it as if it's possible, even if it's not an even if actually, we get it a bit wrong. Because I think we have the opportunity now to frame the conversation in a way that really centers the birthing person, even if we're, you know, we're fantasizing a little bit too much. I think if we don't do this, we risk kind of leaving it to the other side. And actually, it's better to go a bit too far in our imaginations of what it could offer in terms of enhancing autonomy and centering the birthing person now and then reading it back in and then going too far the other way than having to try and catch up with the technology be like No, please focus on the birthing person. Because we know historically, that doesn't always go very well. And the second part is, I think that when we think about this idea of risk, and think it's really important to say even in my kind of, envisage the ideal of anyone could choose it if they wanted, we have to think about who would be choosing it. And why because lots and lots and lots of people would would wish to continue their pregnancy, either they'd feel that was right, or they enjoy the process of pregnancy and not not want to end that prematurely. So I think risk here is quite comparative, because we have to think about what would be going on to make someone feel that actually they'd like to do that. So maybe it's that pregnancy is really psychologically difficult, or the pregnancy is really physically difficult for them, different things like that. So I think that it's important, yes, it might always be too risky. This might be me being wildly optimistic, but also think it's important that we don't just balance risk against kind of physical health, but this holistic understanding of actually what's at stake for the person more broadly. And if they were to continue the pregnancy, maybe.
So I know that your focus in the paper is on the birthing person. And it seems really clear even from our conversation, that this is really where you want the focus to be. And I've also written on ectogenesis. And I also took the focus on women broadly conceived as not being cisgendered. But all women. And the thing that really made me wonder, and the thing that your paper really made me wonder, too, is what about the potential risks to the fetus? I wonder through all of this, if there's something to be said for the risks fetuses might face when taken out of female, uterine environment? Have you given that any thought?
Yeah, so I've not so specifically in my work, my work kind of, by nature of, I suppose, partly fitting into the project that I'm doing. And also just the way I've been thinking of it really does focus on this idea of kind of autonomy during birth. So that's more centered there. I think. I've been thinking more and more about it, as I've come to kind of, I think it's really false to create a dichotomy between fetal interests and maternal or birthing prison interests. I think there's a real relational entanglement there. And what I find really tricky, and I'm kind of thinking through at the moment, I suppose is recognizing and acknowledging looking at this kind of entanglement and the really kind of falseness of separating and maternal and fetal interests and putting them at cross paths with each Because that's not, I don't think an accurate way to think of it, but without, on the flip side, imposing an expectation that there's an entanglement and that actually, if you're if you're giving birth, surely, what you want must inherently be whatever is kind of best for fetus. What medicine, I suppose what medically looks best for it rather than that kind of holistic thing. So I, it's not something I've done work about, but it's something that constantly tried to get in my head is how it, how it all fits together. And of course, there is importance of fetal, fetal well being but I do think that sometimes within literature ride reproduction, what can get forgotten, and it is important is that at the time at which the birth occurs, in the UK, at least, the pregnant person is the only legal person and in lots of the cases here, that's what gets a little bit lost, I think. So that's, I suppose, an attempt to counterbalance that is why I've drawn it to the fore at the moment. Absolutely.
So did you have any particular challenges when you were writing this paper that you had
to overcome? Yeah, it's one of the first papers I've kind of written and written to be published. So it the challenge of just doing it and kind of knowing what to do and how to how to submit a paper, it seems so simple, but that thing's like wait, what's a cover letter? I don't know what to do with that. And I'm really lucky that I had some kind of wonderful friends and mentors, particularly Chloe romantics, Dr. Claudia remainers, who also writes and this was particularly helpful to me with that. But in terms of the writing process, the thing for me that was really challenging, I think, really was reining it in, quite excited by this area. And there was a whole other section in it that actually I think was my, like, favorite section. And my supervisor looked at it and said, well, that kind of that's a whole other paper, like, what's that doing at the end of this paper doesn't really make sense. And I thought I would just, I found it interesting. framing it into being like, this is one cohesive thought, and then we can can deal with other thoughts that are kind of attached later was probably actually the biggest challenge for me.
Yeah, that's relatable. I always try to put too much in mind too. Yeah. I'm really curious to know, before I asked you the final kind of wrap up question, really curious to know what the larger project is that this is a part of?
Yeah. So it's, it's my, my PhD, the whole thesis. And I think I changed the title so many times, though, but it's something it's a kind of thing. It's called new technology, old problems. So it's taking this idea of the way that there has been there continue to be difficulties with the laws ability to actually support autonomy during birth, and even in the way that it says it will. And so I'm looking at that issue of autonomy and birth and the laws in ability to protect it in practice. And then just thinking through if we were to introduce push that to Genesis against the background of where we're currently at. How will that Intersect with the current legal problems that exist? And therefore what can we take from the issues that currently exist forward into thinking about law and policy around partially its genesis to really try and introduce it, if it comes to pass, but to really try and ensure that if it were to be introduced the policy and law and kind of practice around it actually achieves its goal of being quite an autonomy supporting procedure, rather than just further eroding autonomy that is already slightly in trouble.
So if you had any takeaway messages, just from this paper itself, what would you hope that people
get from it? And I think I would hope that people get the kind of importance of centering birthing individuals in these discussions about new reproductive technologies, and also about really thinking through the justifications for limiting things. But you're also certainly more broadly, I think, we hope that people maybe get a sense that the way that we frame and the way that we talk about things really does matter, because that then goes on to form the basis of our discussion and then our policy and then maybe I lost so just carefully thinking about how we want to articulate and discuss and frame and push that Genesis and all new answers across all fields, I suppose. Hmm. Well, thank
you so much for speaking with me. And this has been really interesting. Thank you very much for having me. Oh, it's a pleasure. And also good luck with the end of this. Thank you. No problem. And thanks so much for listening to this episode of fat gab. You can find Anna's paper LinkedIn, this episode's notes along with the transcript. Fab gab is hosted and produced by me, Kathryn MacKay. You can find our other episodes on Spotify, radio, public anchor or wherever you get your podcasts of quality. Thanks again for listening. Bye