The New York Times had an article yesterday about a recently released study that claims that caffeine can double the risk of miscarriage. This is just another study to throw on the pile of “you’re going to harm your baby if” studies.

Research on pregnant women is a difficult issue. As it stands, due to ethics guidelines and a strict Institutional Review Board policy it’s very difficult to get permission to do studies on pregnant women. They are placed into the same special category as minors and incarcerated people–they are considered unable to give consent.

Now there are a few reasons why this might be. Minors are not considered capable of giving consent because of their age–it’s difficult to involve them in medical studies, particularly things like clinical trials, and their parents usually have to consent for them. People in prison are not allowed to give consent because of the history of abuses they have faced at the hands of medical research–it is also likely that they might feel coerced because of their incarceration. I think the most likely reason pregnant women aren’t considered able to give consent really lies in the ideas of fetal personhood–the unborn child she is carrying can’t give consent, therefore she can’t. That takes us down a slippery slope that most reproductive rights advocates are afraid of because it gives the fetus rights.

But what does this all mean for pregnant women and birthing mothers? What it means is that the research on pregnancy and obstretrical practices is not all that scientific. The studies can’t be set up in the rigorous ways they traditionally are. There can’t be control groups, you simply can’t test things out the way you normally do. Which means that studies like this one rely on data from women who are making their own decisions about how much caffeine to intake, so there are a lot of variable that are hard to factor out.

But most importantly what it means is that obstetrical technologies are used anecdotally. No one can run a study on the effects of pitocin in labor, except to look back at cases that already happened and try to compare. Same thing with epidurals, with fetal monitors, with cytotec. So instead doctors learn the hard way, and the SLOW way, by trial and error. But at whose expense? Just looking at the short obstetric history we see a lot of these mistakes:

1. Thalidomide babies: Birth defects caused by a drug to avoid morning sickness;
2. Twilight sleep: a drug used in the 1950s which erased all memory of childbirth but resulted in women being restrained and having rages and fits, in addition to affects on the baby
3. Episiotomies: It was once believed that cutting the perineum (skin and tissue between the vagina and anus) was preferrable to natural tearing. After a lot of years of routine episiotomies, they figured out that women were more likely to have really serious tears (and all sorts of other nasty problems) as a result of the episiotomy, and that natural tearing (with its jagged edges) healed faster.

Feel free to add your own to the list in the comments!