By Victoria Adkins and Elizabeth Chloe Romanis.
Our paper Artificial Placentas, Pregnancy Loss & Loss-Sensitive Care discusses the concept of pregnancy loss without procreative loss: this is how we can recognise the experience of loss formerly pregnant individuals may feel when their pregnancy ends prematurely, even if their foetus/premature infant survives. After articulating and exploring this concept we use it to think about artificial placentas (technology on the horizon that is designed to continue gestation ex utero as an alternative to neonatal intensive care) and how care pathways may be developed for their use that are attentive to the needs of pregnant people. In drawing upon previous studies involving parents who have had infants cared for in neonatal intensive care units (NICU), we claim that the use of artificial placentas has the potential to exacerbate feelings of loss associated with the premature ending of a pregnancy. As a result, we argue that care pathways need to be attentive to the information provided to pregnant persons about artificial placentas, the language used, and the psychological support that may be needed for some pregnant people.
The idea for this paper originated from a participant quote from Dána-Ain Davis’ study in her book Reproductive Injustice: Racism, Pregnancy, and Premature Birth. In reflecting on their experience of premature birth in the US, the participant expressed how they felt the incubator was “doing their job” and referred to the shame they felt that their body did not carry the pregnancy to term. Reading the quote was so impactful and it was immediately shared by one of us to the other. This began an animated discussion about how pregnancy loss is so often bound up with the loss of the foetus or premature infant. Much less recognition is given to the singular loss associated with the premature ending of a pregnancy and how this affects people who have been pregnant. While, of course, the pregnancy loss we describe is not a universal experience, that pregnancy loss without procreative loss is practically invisible struck us as a further example of the way in which concern for the formerly pregnant person is always connected to what is or has happened to the infant.
Whilst not wanting to diminish the grief that is felt when a premature infant does not survive, in this paper we wanted to draw closer attention to the feelings of loss a formerly pregnant person may feel separate from the outcomes for the infant. Previous studies, such as those presented by Davis, illustrate that even when a premature infant does survive, the formerly pregnant person can be still processing and coping with the fact that they did not gestate to term. This led to us wanting to draw out the distinction between gestation and pregnancy that is explained in the paper and centre pregnancy as an experience of the pregnant person.
Use of an artificial placenta involves the premature ending of a pregnancy, and having seen how participants discussed their relationship with NICU incubators in other studies, we recognised that formerly pregnant persons could end up having complex relationships with this new technology. Although some authors reflecting on the design of the artificial placenta have turned their attention to incorporating stakeholder views into the development of an artificial placenta device, no discussion has yet focused on the specific experience of a pregnant person having to prematurely bring their pregnancy to an end in order to engage with technology. Therefore, in wanting to bring more focus to the experience of the pregnant person in relation to the use of artificial placentas, we felt the intervention our paper makes was necessary and important.
Beyond simply highlighting the potential of pregnancy loss being experienced with the use of artificial placentas, in our paper we also make suggestions as to how care pathways could be adapted to acknowledge and respond to this type of pregnancy loss. Our suggestions are not exhaustive, and we appreciate that there is scope for this to be explored in more depth. Of central importance to us is ensuring that care pathways are informed by those with prior experience of the premature ending of pregnancy as well as those that are closely involved in the design of the new technology. During 2024, we will be undertaking further empirical research with biomedical engineers, scientists, and people who have had infants cared for in NICU, drawing upon their views as to what features the technology should have and how it can be accessible to everyone. We are grateful to the Future of Human Reproduction programme at Lancaster University for the small grant awarded to undertake this work.
Authors: Victoria Adkins and Elizabeth Chloe Romanis
Victoria Adkins, University of Greenwich and Royal Holloway, University of London
Elizabeth Chloe Romanis, Durham University
Competing interests: None delcared