From the issue dated July 30, 1999

Making Babies With New Technologies

New books examine the evolving political status of the fetus

By PETER MONAGHAN

Becoming a baby is not what it used to be.

That was apparent to Monica J. Casper when she first attended a fetal operation.

There, among the cutting, clamping, and lots of blood, were two tiny feet protruding from a mother-to-be's uterus.

The surgeon sliced open the fetus, temporarily bundled its organs into a small bag, and attempted life-saving repairs. He replaced the fetus's organs, then the fetus; refilled the amniotic sac with saline solution; and finally stitched up the mother and placed her on antilabor medications.

After procedures such as that, which remain little-known but are increasingly common at hospitals at the University of California at San Francisco, Vanderbilt University, the University of Michigan, and elsewhere, the fetus ideally continues through gestation. (In only about a third of the operations, in fact, do the fetuses survive that far; the first operation Ms. Casper witnessed, in the early 1990s, was unsuccessful.)

Recalling that surgery, Ms. Casper, an assistant professor of sociology at the University of California at Santa Cruz, says: "I was surprised, not so much shocked, at what the fetus looks like. Particularly coming from a background of abortion politics – we all talk about the fetus, but most of us don't see fetuses unless they're in a jar on the street." She was struck by how "recognizable" the second-trimester fetus was, and by how much the surgeon had to cut the mother to get to it.

Ms. Casper describes the operation, and others like it, in The Making of the Unborn Patient: A Social Anatomy of Fetal Surgery (Rutgers University Press, 1998). Her book about what she calls "fetal politics" is part of a suddenly sizable literature in which researchers from across the humanities and social sciences are pondering the new ways that babies come into the world.

Along with a number of other writers, Ms. Casper contends that fetal surgery, like other innovations in reproductive science, "is proceeding rapidly ahead of careful reflection about what it means and without public debate about its consequences" – and, ultimately, about "what counts as personhood at the close of the twentieth century."

To be sure, "let's make a baby" need no longer be merely a euphemism or a come-on. Not in an era of fetal surgery, the marketing by sperm banks of designer "techno-semen," the manipulation of sperm and eggs in in-vitro fertilization, and overwhelming pressure on women to agree to imaging and monitoring machinery throughout pregnancy and childbirth.

On the horizon are technologies that will enable doctors to alter the genetic makeup of fetuses as early as a few days into their development. And the cloning of human beings appears increasingly possible.

Those are, Ms. Casper and other researchers acknowledge, "amazing accomplishments." They have been coming for some time. The first fetal surgeries, for example, occurred in the 1960s in New Zealand and Puerto Rico.

But she and other scholars do not blithely accept the new procedures as medical inevitabilities. The procedures have social causes, they insist, which include, in Ms. Casper's words, "the search for new health care markets, research trajectories within experimental medicine, the seductive allure of technology," and other forces, including "women's own desires for healthier babies."

In particular, many researchers have been interested in analyzing how the fetus has come to enjoy a new cultural and political status. It's an issue that, naturally, has attracted feminist scholars. "Our mothers and grandmothers say: 'We never thought about what it was or how it was growing. We were just waiting to greet it when it was born.' Those days are gone forever," says Lynn M. Morgan, an associate professor of anthropology at Mount Holyoke College. She is the co-editor, with Meredith W. Michaels, of a new collection of essays, Fetal Subjects, Feminist Positions (University of Pennsylvania Press).

Fetuses certainly are no longer hidden away in women's wombs until birth, but instead appear prominently in full color in popular magazines, medical journals, and motion pictures. Not to mention in black-and-white sonograms.

To what effect?

A momentous one, researchers such as Ms. Casper argue. In the new body of literature, a constant theme is that the fetus has become an entity somehow independent from the mother, with competing medical, legal, and cultural status.

The ultrasound image, several researchers observe, has become the first baby photo, fast-forwarding the bonding between parents and child-to-be.

But some scholars argue that public acceptance of the fetus as an independent entity has its roots in the well-established disparagement of women as childbearers.

Since its inception, obstetrics has questioned the capabilities of mothers and such non-technical experts on childbirth as midwives, write Robbie Davis-Floyd and Joseph Dumit in the introduction to Cyborg Babies: From Techno-Sex to Techo-Tots (Routledge, 1998). Doctors, they say, have portrayed the female reproductive tract as "a birthing machine" fit to be worked on only by skilled technicians – the obstetricians themselves. That view of the medical profession took hold in anthropology after Emily Martin's 1987 book, The Woman in the Body: A Cultural Analysis of Reproduction (Beacon).

Ms. Casper says reproductive technology has reinforced that attitude toward women. In fetal surgery, she says, fetuses are the focus, and women become defined as support technologies or intensive-care units. She recalls one fetal surgeon who referred to pregnant women as "the best heart-lung machine available." Even sonograms, she contends, move the focus to the fetus – and, in effect, "erase women."

From there, she suggests, it is not a huge leap to blaming women for the effects of their actions on fetuses – drinking while pregnant, for example – while ignoring, say, the effect of pollution on fetal development.

That "erasure," of course, has as much to do with the way birth is discussed as it does with how birth happens. Some of the new work on fetal technology is by scholars in the fields of rhetoric and communications. "Discourse and narrative, and how we tell the stories of birth, really support, sustain, and challenge our vision of what our bodies are like and capable of doing," says Mary M. Lay, a professor of rhetoric at the University of Minnesota.

These days, she notes, every mother-to-be is warned of at least some of the "thousands of risk factors" defined by medical experts – high blood pressure, age, or genetic history. Ms. Lay, with three others, has edited Body Talk: Rhetoric, Technology, Reproduction, due out this fall from the University of Wisconsin Press. "When we begin to talk about risk and safety, women begin to fear their bodies, and think they're not capable of going through the process of birth without the expectation of interventions," she says. "Many people don't realize that many women still choose to have home births."

In fact, the "process of childbearing has become technoscientific through and through," write Ms. Davis-Floyd and Mr. Dumit in Cyborg Babies. The editors, a research fellow at the University of Texas at Austin and an assistant professor of science, technology, and society at the Massachusetts Institute of Technology, respectively, argue that sonograms may be modern first photographs but they are also "gray blurs on the ultrasound screen" – technological representations that help create the baby as an inherently technological creature. Similarly, labor usually does not happen without machines – "the contractions both traced and mediated by the monitor, the baby's heartbeat a green line on a black screen."

With all the other kinds of technological interventions available, they say, the sum is this: "A primal, intrinsically embodied act that women themselves used to perform is turned into a series of technological procedures performed on them."

In essence, they suggest, babies have become cyborgs – fusions of organic life and technological systems. The cyborg concept is most commonly associated with the influential Donna J. Haraway, a professor of science studies and women's studies at the University of California at Santa Cruz, who famously stated in one of her books: "We are all cyborgs now."

That includes the fetus, she argued in her Modest_Witness@Second_Millennium.FemaleMan©_Meets_OncoMouse™ (Routledge, 1996), which includes a chapter on what she calls "the social-technical webs that constitute reproductive practice."

Those webs are tangled. Ms. Davis-Floyd and Mr. Dumit write of the need to look for "the fine line between 'mutilating' a natural process in a negative and destructive way and 'improving' or 'enhancing' it." They and other scholars have raised plenty of "mutilating" possibilities – the danger that humanity is embarking on unpredictable, potentially disastrous genetic paths; the rise of a "eugenics with a human mask," in Ms. Casper's phrase; and the specter of women being forced to undergo fetal surgery, just as some courts have ordered women to undergo Caesarean sections.

The new research also takes up such issues as: In the era of mix-and-match designer babies – where one woman may gestate the eggs of another, fertilized by the sperm of a man she may have never met but whom she has selected for his genetic contributions to her child's success – how should one define a parent? What should be the role of fathers and other partners in reproductive decisions? What becomes of kinship? In Cyborg Babies, Charis M. Cussins, an assistant professor of sociology and women's studies at the University of Illinois at Urbana-Champaign, argues that the new ways that conception occurs will force a reconfiguration of categories of kinship – blood versus non-blood relations, natural or biological versus social – that will require new words as well.

Especially tangled, perhaps, is the question of what reproductive technology means for the abortion controversy. Ms. Casper points out that fetal surgery was initially carried out in secrecy, precisely because surgeons feared that their work would be embroiled in abortion debates. As one surgeon pointed out, "when we're done with the operation, that fetus could still be legally aborted."

Ms. Casper says her advocacy of abortion rights has been strengthened by seeing that new technologies can make women's bodies even less private than they have been. But she does not oppose the new technologies out of hand. "When I started my project, in grad school, certainly I had some of those sentiments, about 'Oh, they're mucking around in reproduction once again,'" she says.

However, "it becomes much more complex. Who am I to come in and say this is bad for women, in all cases?"

A more fruitful tack, she believes, is to try to imagine "what fetal surgery would be like if it was done on behalf of women."

Ms. Davis-Floyd and Mr. Dumit agree that the new "cyborg technologies of birth" potentially can facilitate the setting up of non-traditional families, and a growing number of feminist scholars are interested in the role of the "new" fetus within feminist theory and practice. But Ms. Morgan, the co-editor of Fetal Subjects, Feminist Positions, says some feminist scholars don't want to acknowledge that the new fetus has succeeded in making claims for itself, and a greater claim on consideration in the debates. "We did talk to some feminists who said they preferred not to be involved in a collection that was going to take this point of view, because they want to insist that women, and women's reproductive and moral integrity, stay at the center of the debate," she says.

Introducing the collection, Ms. Morgan and her co-editor Ms. Michaels, a research associate in philosophy at Smith College, state: "To recuperate the fetus in feminist terms necessarily forces us into dangerous territory."

So it proves in the collection. Ms. Michaels, in her essay, argues that feminists will have to insist that women be granted "full capacity as social agents" and be permitted the same "prerogative to kill" that men often enjoy – in war and hunting, for example – on "what most consider reasonable grounds."

"If," she says, "as is now the case, increasing social autonomy is granted to the life-within-the-womb, then women's right to abortion must be seen as an instance of the right to kill those things whose invasion of one's life threatens its integrity."

Copyright © 1999 by The Chronicle of Higher Education