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:
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Thalidomide babies: Birth defects caused by a drug to avoid morning sickness;
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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
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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!
Radical Doula 
You are so absolutely right! In addition to what you’ve said about finding things out slowly by trial and error, the fact is that if something has not been rigorously scientifically tested on pregnant women and is used anyway (I’m thinking of things like pitocin and epidurals), then the reality is that all women who receive the medication or procedure are essentially non-consenting patients to an experimental procedure or medication. It is presumed or assumed safe, but without these tests (random, double-blind, or however else they are to be controlled), it is nearly impossible to assess the true risk, except in retrospect. Most mothers and most babies will survive birth regardless of what happens during labor or birth. Figuring out whether something is riskier to the mother or baby than not doing it, is difficult because most people survive birth, so the incidence of something happening can only be tested by a large study with thousands of participants. It’s just easier to start using a procedure or medication without proper testing and see if it works. Only if it is disastrous a lot of the time (such as with thalidomide) will it quickly be removed; otherwise, even if proven ineffective most of the time (like continuous electronic fetal monitoring, episiotomies, witholding food and water from laboring women, requiring IVs for all women, not allowing laboring women to get out of bed….) it will likely remain the status quo.
Kathy
womantowomancbe.wordpress.com
Exactly Kathy–that’s a great way to put it, that women birthing in the hospital are unwitting and nonconsenting participants in non-scientific medical trials. So frustrating–maternal and fetal death should NOT be the only things that prove an intervention to be harmful.
Oh and dont forget—
Early cord clamping that deprives the baby of its own blood.
Pure Oxygen that blinded babies.
How about that NO drugs are deemed safe including the drug cytotec given to induce labor and has killed a lot of babies and moms.
or the numerous vaginal exams that just cause infections?
Or that C-sections are hurting more and more moms in the long run?
or that So many of the prenatal testing is worthless and can be harmful…
i could go on and on.. but as a homebirth midwife i try to empower women to take back their births..and refuse to allow the fucking men-drs to manipulate them anymore.
so I take it you dont like retrospective studies as evidence.
Thats fine, so what alternative are you proposing? Are you suggesting we start randomized controlled trials on pregnant women? Because thats the ONLY WAY to get the data you need to prove these things one way or the other.
Retrospective studies, despite their flaws, are better than nothing. So unless you got an alternative, I dont understand your argument.
And it is women and babies who suffer. My son was recetnly stillborn for no apparent reason, and nobody is researching this? They don’t even bother to have accurate reliable numbers of stillbirths in the US, although it is 10 times more common than SIDS. How will we ever reduce the rates of stillbirth, premature birth, all of the unknowns with this trial and error bullshit where it takes decades to figure out all the fuck ups. As a scientist, I’m just frustrated with the lack of funding, the lack of knowledge, and I think you hit the informed consent thing right on the head. You are sooooooooooooo right.