The Making of the Unborn Patient: A Social Anatomy of Fetal Surgery

It is now possible for physicians to recognize that a pregnant woman's foetus is facing life-threatening problems, perform surgery on the foetus, and if it survives, return it to the woman's uterus to finish gestation. Although foetal surgery has existed in various forms for three decades, it is only just beginning to capture the public's imagination. These still largely experimental procedures raise all types of medical, political and ethical questions. Who is the patient? What are the technical difficulties involved in foetal surgery? How do reproductive politics seep into the operating room, and how do medical definitions and meanings flow out of medicine and into other social spheres? How are ethical issues defined in this practice and who defines them? Is foetal surgery the kind of medicine we want? What is involved in reframing foetal surgery as a women's health issue, rather than simply a paediatric concern? In this ethnographic study of the social, cultural and historical aspects of foetal surgery, Monica Casper addresses these questions. ""The Making of the Unborn Patient"" examines two important and connected events of the second half of the 20th century: the emergence of foetal surgery as a new medical specialty and the debut of the unborn patient. Drawing on a wide range of sources, Casper shows how biomedical work has intersected with reproductive politics for three decades to generate new cultural meanings of foetuses, women and medicine itself. Since its inception, foetal surgery has been controversial both inside and outside of medicine precisely because it transgresses a number of boundaries, challenging our most cherished assumptions about pregnancy, maternal sacrifice, foetal life and death, and the limits of technology. Like many other medical innovations, especially those at the beginnings and ends of human life, foetal surgery is proceeding rapidly but without careful reflection about what it means and without public debate about its consequences. Foetal surgery is risky, expensive and fraught with peril for both women and their foetuses. This book offers a critical social and cultural analysis of this nascent yet significant innovation in biomedicine. Analyzing original data, Casper explores early foetal surgery efforts and the emergence of the unborn patient in the 1960s. She examines several related practices, including foetal physiology, diagnostic technologies, animal experimentation, and foetal wound healing research, and the ways in which they have shaped foetal surgery. She presents ethnographic data collected at one of the premier US foetal treatment facilities, offering a behind-the-scenes look at the various kinds of work involved in operating on human foetuses. She also examines the many ethical dilemmas involved in research on human subjects in experimental foetal surgery. Perhaps most significantly, the book draws attention to the many ways in which foetal surgery affects women's health.