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Polemics and Pregnancy: A Response to Arguments About Ethical Obstetrical Care

In a somewhat polemic style, Charles (2011) suggests that the American Congress of Obstetricians and Gynecologists (ACOG) may endorse certain obstetric practices that inadvertently contribute to the problem of violence against women. Using examples of physician response to alcohol during pregnancy and court-ordered medical treatment, Charles argues that some obstetric practices bear a “disturbing likeness” to the attitudes of abusive men in coercively controlling women’s behavior through manipulation, intimidation, and violence. We agree that violence against women is a significant global health issue. However, there are two elements of Charles’s paper that require further exploration. First is her contention that advice to pregnant women is based on oppressive gender norms rather than sound evidence. Second is the contention that misogynistic, male obstetricians dominate and abuse the helpless women in their care. It is around these two issues that we frame this response. Taking first the issue of alcohol advice during pregnancy, Charles’s principal argument is that despite ambiguities in evidence regarding actual fetal risks, obstetricians have recommended complete abstinence. She supports the stance of Lyerly and colleagues (2009, 35), who argue that there has been a retreat from evidence-based advice to a mantra of “better safe than sorry.” Charles refers to a press release in which ACOG strongly urged women “not to ignore the public health warnings associated with consuming alcohol while pregnant” (ACOG 2008, 1). In this, the ACOG reiterated its long-standing position that no amount of alcohol consumption can be considered safe. Charles argues that this abstinence-only approach is paternalistic and reflects a regulation of pregnant women’s behavior. Thus, instead of giving women accurate, evidence-based information and allowing them to make an informed decision, obstetricians intentionally overstate the risks of alcohol and coercively control women’s behavior. From this she concludes that the abstinence-only campaign holds parallels to the tactics used by abusive men. It is the case that ACOG’s position on abstinence does not align with the stance of other organizations. For example in the United Kingdom, following a review of available evidence, the National Collaborating Centre for Women’s and Children’s Health (2008) advises that although there is