Aimee Middlemiss

Dr Aimee Middlemiss

Department: Sociology, Philosophy and Anthropology
Discipline: Sociology and Philosophy
Research Centre/Unit: Egenis

Project Summary

The reproductive politics of second trimester pregnancy loss in England

Awarded July 2021

This thesis is a feminist examination of women’s experiences of second trimester pregnancy loss involving labour and birth in South West England. Drawing on ethnographic interviews with 31 women, it analyses second trimester pregnancy loss as a distinct phenomenon produced by the interaction of biomedical and governance discourses, and enacted on the bodies of pregnant women. Extending Franklin’s concept of foetal teleology (1991), it argues that prioritised discourses about second trimester pregnancy loss in England are underpinned by a teleological ontology of pregnancy, in which the reality of pregnancy is defined by its outcome of a separately living person. In the second trimester, a pregnancy ending because of foetal death, premature labour, or termination for foetal anomaly will almost never result in this outcome. This means that at an ontological level the foetal beings which emerge in the second trimester are conceptualised as a non-persons, the pregnancies which produced them are not ontologically ‘real’ pregnancies, the labours and births which resulted are insignificant, and the pregnant women who undergo those labours are not ‘real’ mothers.

The thesis is a novel ethnographic account of the events and impact of second trimester pregnancy loss, and the consequences for reproductive politics of the teleological ontology of pregnancy it makes visible. In relation to biomedicine, it shows how diagnostic classification of the foetal body as being in the second trimester restricts women’s care options in the English NHS. In terms of governance, it shows how in second trimester loss parental choices and resource entitlements are determined by the ontological status of the foetal being. It shows how these prioritised discourses, and their ontological underpinnings, disrupt women’s ontological security (Giddens, 1991) by conflicting with embodied experience. And it shows how an alternative English kinship ontology of pregnancy which centres embodied personhood is agentially used by some women as resistance to the erasure of their gestational kin and person-making work.

Publications:

Middlemiss, A L (2021) Too big, too young, too risky: How diagnosis of the foetal body determines trajectories of care for the pregnant woman in pre-viability second trimester pregnancy loss. Sociology of Health and Illness. Online First. Open Access at doi.org/10.1111/1467-9566.13404.

Middlemiss, A L (2020) Pregnancy remains, infant remains, or the corpse of a child? The incoherent governance of the dead foetal body in England. Mortality. Open Access at: doi.org/10.1080/13576275.2020.1787365

Conference Papers:

Middlemiss, A L 2021 2021 Kinship time and the dead foetal person. Centre for Death and Society Annual Conference, 11th June 2021.

Middlemiss, A L 2019 'When it's happened, come and get me': the marginalization of Second Trimester pregnancy loss in English healthcare. Presented at: XI AFIN International Conference: Towards Reproductive (In)justice? Mobilities, technologies, labourings and decisions. Granada, Spain. 6 September 2019.

Middlemiss, A L 2019 The researcher as interdisciplinary agent: Feminist research into second trimester pregnancy loss in England. Presented at: Sociology Philosophy and Anthropology PGR Conference: Making SPAce, 16 May 2019.

Middlemiss, A L, 2019 Who counts as a mother, and what counts as a baby? Challenging discourses around Second Trimester pregnancy loss in England.  Presented at: BSA Annual Conference: Challenging Social Hierarchies and Inequalities, 25 April 2019

Middlemiss, A L, 2018 How medical and legal discourse in England puts the foetal body at the centre of pregnancy. Presented at: BSA Human Reproduction Study Group Annual Conference: Reproduction and the law: transformations, responsibilities and uncertainties in the 21st Century, 24 May 2018

Other talks:

Middlemiss, A L, 2021 Resistance and agency in second trimester pre-viability pregnancy loss, Open Thanatology Group, Open University, 24th November 2021.

Middlemiss, A L, 2020 Beyond obstetric violence: the medical care of women experiencing second trimester pregnancy loss as ontological boundary work. Presented at: Health Medicine and Agency Network, CRASSH, University of Cambridge, 11 February 2020.

Middlemiss, A L, 2018 Pre-24 weeks pregnancy loss: Some sociocultural, ethical, and legal considerations of birth registration. Presented to the UK Department of Health Pregnancy Loss Review Advisory Board, 19th June 2018.
 

Supervisory Team

Dr Katharine Tyler, Anthropology.

Dr Naomi Hawkins, Law.

formerly: Professor Susan Kelly, Sociology.

Wider Research Interests

Previous Projects:

‘Knowing they’re there’: Pregnant women’s use of Doppler ultrasound devices to listen to the foetal heart at home.

Foetal Doppler technology, used in midwifery and obstetrics to assess the presence and rate of a foetal heartbeat, is now widely commercially available in the UK. This project was an exploration of how and why pregnant women use the technology in a domestic setting, drawing on qualitative interviews with women in Cornwall and submitted as part of my MRes in Science and Technology Studies at the University of Exeter, 2017.

Developing Akrich’s concept of de-scription, the study found the Doppler as a technology has a script which is both strong enough, open enough, and compatible enough with other cultural ideas to be translatable to the domestic setting. The auto-auscultation allowed by the scripting of the Doppler situates its use within literature related to self-tracking practices, and the study found the Doppler is used in an attempt to manage risk in the precarious medicalised pregnancy in which women are established as responsible for foetal outcomes. However, women also re-script the technology when they use the domestic foetal Doppler to enhance their embodied experience of pregnancy, and to create and manage intimate social relationships, including those between the coming child and family and friends, in acts of agency which challenge the medicalisation of pregnancy.

The study concluded with some recommendations for policy change regarding advice on domestic foetal Doppler use, especially in relation to calls to ban the devices for home use, and on foetal listening by midwives

Publications:

Middlemiss, A. L. (2020) ‘It Felt like the Longest Time of my Life’: Using Foetal Dopplers at Home to Manage Anxiety about Miscarriage. In Kilshaw, S and Borg, K (Eds) Navigating miscarriage: Social, medical and conceptual perspectives (pp 160-183). Oxford, New York: Berghahn. https://www.berghahnbooks.com/title/KilshawNavigating

Conference Papers and other talks:

Middlemiss, A L 2021 Market solutions, moral panic, and managing privatised anxiety in the home use of fetal Dopplers. BPAS Centre for Reproductive Research and Communication, 8th November 2021. Invited online talk and panel discussion at the event ‘Autonomy, trust and surveillance – the role of technology in reproductive healthcare.’


Middlemiss, A L, 2017 The domestic foetal Doppler at the borders of pregnancy: How listening to the foetal heartbeat at home both reifies and challenges the medicalisation of pregnancy. SWDTP Conference 2017 - Research in a Changing World: Critical Encounters, Wednesday 8th November

Authored Publications/Reports

Middlemiss, A L (2017) How some methodologies of participation fail to address the problem of the political relationship between researcher and researched in the social sciences., TOR The Open Review of the Social Sciences, 3, 7-11

Aimee Middlemiss (2016) #SaveAnthropologyAlevel: the campaign which tried to retain anthropology in British schools. , Teaching Anthropology, Vol 6 (2016): A-level Anthropology: A retrospective , 15-19

Aimee Middlemiss (13th March 2018) The Fetal Dopplers Bill is based on limited evidence about pregnant women’s use of the device, LSE British Politics and Policy Blog