When Bad Mothers Lose Good Babies: Understanding Fetal and Infant Mortality Case Reviews

Abstract

This article examines how the practices of the Fetal and Infant Mortality Review–Case Review Team (FIMR CRT) in “Florida City” constructs particular types of maternal and fetal subjects and how these narratives about fetal and infant death reflect particular discourses about “bad mothers” and “good babies.” I argue that the very methods of the Florida City FIMR committee structure the types of conversations and, in effect, judgments that can be made about women who experience a fetal or neonatal death. In addition, I examine how many of these ideas resonate with the discourses around fetal rights that pervade contemporary abortion politics in the United States.

Keywords:

• fetal death
• fetal rights
• infant death
• responsibility
• United States

Notes

1. 1. Because of the sensitive nature of CRT cases and the confidentiality involved in reviewing fetal and infant deaths, both the identity of the area of the CRT and many of the details of the cases have been obscured. Details important to understanding the particulars of the case are included, but in some cases details from multiple reviews were combined into one case to mask any identifying features and protect the integrity of the process.

2. 2. It is assumed that little intervention can be done in cases of fetal deaths before 20-weeks’ gestation, also considered ‘pre-viable.’

3. 3. Case privacy was integral to this process, and I have been very careful to disguise any identifying features of this CRT. There was much discussion about encouraging local hospitals and doctors to participate in the process, and privacy was central to this. FIMR reviews are not linked to legal issues in any way, and cases that were implicated in any malpractice lawsuits were not reviewed by this particular CRT.

4. 4. All women who show up in a local emergency room for delivery qualify for ‘presumptive Medicaid,’ a means for the State of Florida to cover the hospital costs for women who do not qualify for insurance or Medicaid because of immigration status.

5. 5. In an interesting twist, a ‘potential’ American citizen can prevent an undocumented pregnant woman from being deported, at least while she continues her pregnancy in the United States (see Casper and Morgan 2004).

6. 6. Feminist scholars such as Armstrong (2008) and Oaks (2001) have argued that narratives linking fetal harm to women’s use of alcohol and tobacco in pregnancy are fraught with moral imperatives around biomedical prescriptions for maternal behavior. With attention to this point, I specifically designate ‘heavy’ exposure to tobacco and alcohol as linked to poor birth outcomes.

Additional information

Notes on contributors

Lauren Fordyce

Lauren Fordyce is a lecturer at University of North Carolina at Chapel Hill. Her research examines technologies of risk in pregnancy among Haitian migrants living in South Florida.