Full Genetic Sequencing for Fetuses and Motherfucking Ethics

[Contents: ableism, eliminationist rhetoric, fat hate]

I briefly mentioned this article on Twitter yesterday: What Fetal Genome Screening Could Mean For Babies And Parents. That's a donotlink link, by the way. The article was published in Scientific American.

I'm not even sure I can adequately express how deeply I'm disturbed and frankly disgusted by the attitudes expressed by the scientists in the article. The first few commenters are even worse.

Basically, some bioethicists at Brigham & Women's Hospital in Boston, MA have published in The New England Journal of Medicine that YUP, parents should be able to get this with appropriate genetic counseling services.

That in and of itself isn't necessarily so bad, although "genetic counseling" leaves open a big door and there's lots of variation as to what it includes and entails. Then you get in to their reasons for arguing this. The big one cited is "Parents may emphasize diet and exercise more for a child at heightened risk of diabetes, for instance."

BECAUSE YES, SINGLING OUT A KID FOR DIFFERENT TREATMENT FROM DAY ONE FOR A DISEASE THEY DON'T HAVE BUT MIGHT GET IS SUCH A GREAT FUCKING IDEA, FOLKS.

I just... look. If you are different as a kid already, that's hard enough. Kids who have illnesses that require treatment, like special diet plans, medication, or other treatments visible in public, are incredibly stigmatized on a routine basis. And while the article makes the point that genetics do not guarantee a disease, this argument for fetal full genome sequencing completely ignores that. It's arguing you should treat your kid differently on the basis that they MIGHT get a disease (a disease we associate with OMG OBESITY, by the way - I don't think THAT'S a mistake), marking them from early childhood on as someone who's less than, someone to be pitied, mocked, someone who's impure.

The rest of the article is from some other scientist all dismissive of "perfect baby quest" concerns, and all "WELL IF PARENTS WANT IT THEY SHOULD GET IT". Which is a shitty, shitty argument. "Well I want it" is no basis for a solid ethical decision. And her reasons for dismissing ethical dilemmas about the potential for parents terminating a pregnancy because they found out they fetus' eyes would be brown instead of blue, for instance, is "well not everyone would get it". Which doesn't eliminate the ethical problems at all! And there's a brief mention of "well fetuses can't consent", but it doesn't even remotely touch on what the ethics are of having your genetics on record before you're even born, much less consent. Can you imagine insurance companies with that information, for starters?

Then you get to the comments, and the first few are so deeply ableist and eliminationist, jesus fucking fuck. They straight up say there are no ethical problems with this, and raising a child with an illness or disability is not loving. "That's the unethical thing", one person says. You'd be a bad parent to not get it is strongly implied, because giving birth to a kid with a disease is abusive.

Yes folks, someone argues that it's unethical for people with disabilities to even be born.

I... holy shit. This person thinks I shouldn't have been born.  This person thinks that my kid shouldn't be born, because I opted for absolutely zero genetic testing or screening. This person thinks that a whole fucking bunch of people I know shouldn't have been born, because they weren't born "perfect".

Holy. Fuckball. Shit.

So yeah, you're damn right I disagree.

I absolutely think there is an ethical debate to be had here.

In some respects, this is a debate many pregnant people and their partners have. The Man and I had a discussion about it, although in our case the discussion was short. While full genetic sequencing was not offered to us, we were offered other testing, including a nuchal translucency scan, a quad scan, chorionic villi sampling, and more. We turned them all down. Part of that, honestly, is because The Kid is at low risk of developing anything those are testing for. The bigger part of it is that even if The Kid did have something that was being tested for, such as trisomy 21 (better known as Down syndrome), we wouldn't do anything about it. We wouldn't terminate the pregnancy. We'd have The Kid, and we'd love them, and raise them the best we could. The Plan would not change.

We did get the "standard" anatomy scan between 18-24 weeks. If that had discovered that The Kid had a condition wherein there was no way they would survive to term or outside my uterus, at that point we would have terminated. If that had discovered Trisomy 18 (also known as Edwards syndrome), where the majority of fetuses die before birth, and approximately 8% of those who are born survive past the first year, that would have prompted more conversation, although we likely would choose to continue the pregnancy anyway, with monitoring.

Those are our decisions. (And shoutout to my midwife and OB who are 100% supportive of them.) And yet this commenter thinks those are unethical. Wow.

But if you think that if a fetus has a disease, or a potential for a disease down the road - because let's be real, 99% of what fetal genome sequencing would find would be the potential for a disease - then that fetus shouldn't be born, where do you draw the line? Obesity is considered a disease - should fetuses with higher risk of obesity not be born? Ehlers-Danlos? What about my Hashimoto's? What about schizophrenia? Cancer? Does it matter what kind of cancer? Diabetes? Does it make a difference if it's Type 1 or Type 2?

Because here's the thing - we all get sick. Each and every one of us. Every single one of us carries within us the potential for a whole host of things, from heart disease to cancer to fuck all knows what else. And genetics are not a guarantee of disease. We don't even know which genes are tied to which conditions, in most cases, much less how the complex interplay between genetics and environment determines who gets what and when. We just cannot predict, outside of a few things diagnosable in utero, what any fetus will get in their life after they're born.

Moreover, we rank diseases and disabilities. I've already done it a few times in just this piece. I think most if not all of us have that sort of internal ranking. "Well Hashimoto's is bad and an autoimmune disease, but it's not thyroid cancer" is another one I have. I also think that our wider society's rankings of disease and disability go beyond their treatability, the pain and suffering they cause, their risk of death, etc. and gets way in to aesthetics. See also, obesity is considered a disease. As I mentioned earlier, I don't think it's a mistake that "diabetes" was the example given by the bioethicist arguing for fetal genomic sequencing. We perceive Type 2 diabetes as preventable, as well as caused by obesity - which we also consider preventable. It's one of the diseases where society really likes to blame the person for getting it.

And to use that potential of disease or disability as a screener to determine which fetuses should be born or not is so abhorrent. Even if they do have the potential for something that's really scary, that's not a guarantee. Conflating giving birth to a fetus with the genetic potential for something you don't like with abusing that child, or with a death sentence, is mendacious as fucking hell, not to mention unethical.

Finally, the idea of health at every cost comes out here. As if we owe it to ourselves, to society, to our children, to be absolutely healthy. To do everything we can to be healthy. And let's be real, it's a real narrow definition of healthy that's always used here, and it absolutely includes "not fat". It also doesn't include "uses a wheelchair", "has a mental illness", or "has a chronic disease that limits their activity". We're all supposed to be thin, preferably white, happy, active, totally able-bodied people. Anyone outside those parameters need not apply.

Fuck that.

Fuck that narrow definition of health, and fuck anyone who thinks I owe fitting in to that definition to them or to "society". And fuck anyone who thinks that as a presumptive parent, I owe it to anyone for my children to fit that narrow, ableist, racist, hateful mold. Fuck the entire idea that if you and your body and mind are less than "perfectly healthy", that you shouldn't be here. Fuck that fuck that fuck that.

Shit Fat Pregnant People Get Told: The What (Not) To Eat Edition

[contents: diet talk, disordered eating, medical, food restrictions, fat hate]

Everyone and their mother has advice on what to eat when you're pregnant. It's in every book, every provider I've seen so far (and I've been rotating among people in the practice, so that's three so far) has told me what (not) to eat. Random strangers give you advice. Seriously. EVERYONE.

Some of this advice falls under "what to do for morning sickness", which... is another topic entirely and so annoying. I'll probably cover that at some other point. What I wanted to talk about is the recommendations you get for your "pregnancy diet".

A lot of the books and sites you read are.. yeah, okay. The "YAY YOU'RE PREGNANT HERE'S THE INFORMATION ABOUT THE HOSPITAL" book I got at my first midwife appointment has this type of recommendation. Eat a variety of foods, heavier on the fruits and veg, try to get some stuff with calcium and protein, etc. and so on. Fairly reasonable so far as it goes, even if it does completely ignore people who have varied needs or dietary restrictions, and completely ignores folks for whom regular food is not a thing.

In fact, all of these recommendations are like that, whether the generalized ones you read in the books, or the ones most doctors and midwives will tell you to your face. On food stamps? No room for that here. Limited income? Food desert? No time to cook (or no energy to cook)? WHATEVER. These recommendations don't give a shit about your "problems". In fact, my care providers have never tried to see if I'm food insecure, beyond a single question on the intake questionnaire (which was FIVE PAGES LONG and had NO ROOM TO ACTUALLY ANSWER QUESTIONS) about if I were worried in any way about "money". Not actually about food or housing, just "money".  And with one line to try to cram an answer in. An answer you're giving to someone you haven't met yet and aren't sure you can trust. Super.

So yeah. Then you get to the stuff that's said to you in specific. In theory, these should be better! They're coming, usually, from people who know you, some of whom know your medical history in detail! HAHAHAHAH WHAT A FUNNY JOKE. These examples are all drawn from what I've been told so far. Please share your own in comments!

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Try to get some protein and a fruit or vegetable together at every meal.

On the scale of 1 to "are you trying to kill me", this is like a three, at least for me. The explanation was that fruits and veg are good for you, and having some protein with it would make sure that your blood sugar was more even and you stayed full longer. Which... the staying full longer is, yes, straight-up diet language. On the other hand, when you get nauseated as hell when you start getting hungry, not getting hungry after twenty minutes is a definite feature.

The blood sugar thing, I'm not entirely sure if that was "you're fat so you'll get the diabeetus", or just general good advice. I do know from past experience that if my blood sugar drops, bad things happen. If you've ever heard the term "hangry", yeah. THAT. So things that can help me not get to hangry are always appreciated. (Interestingly, this happens approximately not at all now that my thyroid is being treated. So many interesting things that I just took as my normal seem to be turning to be "nope your thyroid was fucked".) But there is some research showing that you'll probably be in a better mood, and overall feel better, if you're not riding a blood sugar roller coaster. So... yeah okay.

Fruits and veg, I'm one of the people for whom those sorts of things are really good. I know people for whom fruits and veg in general, or extra fruit and veg, would be absolutely detrimental to their health. From fucking up your potassium levels, to aggravating things like ulcerative colitis, fruits and vegetables are not actually good for everyone! Sure, many people benefit from the whole "five a day" thing that has been a feature of US public health campaigns for years (recently replaced with "More Matters")... but not even CLOSE to everyone. Turns out people are individuals! SHOCKING I KNOW.

But what makes this really less annoying for me was the "try to". Because it signals to me that this recommendation is coming from someone who understands that eating "perfectly", whatever that even is, is really not an attainable or reasonable goal. And that if I reported that I hadn't done this more often than I did, the follow up would more likely be a gentle reminder along the lines of "well keep trying", rather than straight-up fat shame. It's really the only recommendation I've gotten that has even a hint of awareness that everyone is different.

Eat a small meal every two hours.

You hear this in dieting, you hear this sometimes in HAES, and WOOOO I heard it in pregnancy. Some of the thinking behind this one is the same as the previous recommendation - try not to ride a blood sugar roller coaster. Some of this is to hopefully prevent nausea - which is less useful when both eating and not eating make you nauseated as hell, as happened to me the first, oh, three months or so, but it's a nice thought.

But this ignores the fact that sometimes you're really just legitimately not hungry, and that is okay too! When trying to unlearn disordered eating patterns, it can be incredibly helpful to present food to yourself on a schedule. And even then, it's okay if you're not actually hungry at that time. Eating well isn't about adhering to a strict schedule, or limiting food intake, or restricting in any way, it's about meeting your body's actual needs. Eating a meal every two hours, no ifs ands or buts, is not actually a way to do that.

At this point though, this has become extremely practical for me, because I just cannot fit much food in my stomach. I can be super fucking hungry! And then I take like SIX BITES AND I'M FULL. It's intensely frustrating. If you follow me on Twitter you'll occasionally see me post things like "and for second dinner", because I eat... and then I need to eat again two hours later. It is so frustrating for me right now.

But again, that's me... it's common in pregnancy, especially later on after the uterus has grown significantly, for the pressure this exerts on one's internal organs to make it more difficult to eat. Not guaranteed though. And eating every two hours isn't always the best plan for everyone. Even for me, where this does work pretty well, it varies day by day, as well as by time of day (I tend to be way hungrier in the evening). So again, shocker, PEOPLE ARE INDIVIDUALS. Not that this is reflected in most advice.

Avoid white foods.

This shit alternately makes me laugh and seethe. This was from the same midwife who told me to "only gain 10 pounds". When she said this to me, I nearly blurted out "so... white meat chicken, pork, navy beans, apples, cauliflower... right?" I then thought "so... are you telling me I should be eating the things that in the US we stereotypically associate with Black people? Or I should be eating only Indian food? What?"

I mean it's just a bullshit recommendation on its face.

Usually when you see this what it means is "eat whole wheat bread, not white bread, eat brown rice instead of white rice, avoid potatoes and starchy things" etc. and so on. The rationale is usually OH REFINED FLOUR HAS NO NUTRITIONAL VALUE AND WHOLE GRAINS HAVE FIBER AND MICRONUTRIENTS.

Look.

There is literally no food that has zero nutritional value. I will repeat that. THERE IS LITERALLY NO FOOD THAT HAS NO NUTRITIONAL VALUE.

Literally none.

I mean, did you know you can get 10% of your RDA of iron from a serving of potato chips? And that anemia is ridiculously common in pregnancy, so it's important to get plenty of iron? Seriously. Potato chips have iron in them. Lots of things do. Every single food you could possibly eat has some nutritional value, both in terms of calories (which, you need calories, they are literally units of fuel), and vitamins/minerals. Every. Single. Food.

Additionally, a non-specific recommendation like this to NOT eat foods, to avoid an entire category of foods (even a category as loosely defined as "white foods") can be incredibly dangerous. I've talked about eating disorders and disordered eating before - blanket recommendations to avoid foods can be incredibly triggering for folks in those situations. Additionally, when a recommendation is based not on nutritional needs, but, as I have to figure in this case, the fear of the FAT and the DIABETES, it's not actually helpful, and can in fact be very harmful. Furthermore, the entire idea behind this is based in the notion that some foods are not "real" foods or are "OMG POISON" which... ugh, I don't even have the words for the contempt I have for those ideas. They're straight up diet culture and fat hate. And usually some racism and classism mixed in for good measure.

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So yeah. That's what I've heard so far. Mostly a bunch of one-size-fits-all, based-in-diet-culture-and-fat-hate, utter crap.

In the mean time, I'm working on eating when I'm hungry, and satisfying what I'm hungry for. Because I need to eat.

Perfect Pregnant Bellies

[contents: body image, fat hate, racism, ableism, trans hate]

So when I say the words "perfect pregnant belly", what do you think of?

Is it something like this?

Chances are, it is. The epitome of "perfect pregnant belly" belongs to a white woman, relatively small-framed, who looks like she has a basketball for a belly. It has smooth, firm skin, no stretch marks in sight, certainly no extra fat anywhere to be seen. And that's what's in that picture.

When you google "perfect pregnant belly", images like that one are an AWFUL lot of what comes up. There's more variety than I was expecting - some people showing their C-section scars, some with stretch marks, some with henna. I had to scroll some to find someone with dark skin though, and there was only one. All the rest were light skinned. 90% or thereabouts were headless pictures.

What I didn't see were any pregnant bellies that looked like mine.

Sure, I'm a (very pale-skinned, although it's funny how not being "how are you alive" anemic has changed that) white woman. So I saw lots of skin tones like mine, which is typical for media. White and light-skinned folks are way, way over-represented, thanks racism. But I didn't see any fat pregnant bellies in that search. I didn't see any bellies on people who have big thighs like me, and arm fat that hangs below their triceps like me, who had stretch marks on their bellies and breasts long before they were pregnant, like me.

I didn't see any pictures of people who have dark body hair on their arms and legs and lower abdomens like me. I didn't see any pictures of people whose breasts were never "perky" or "firm", but pretty much always looked like a cantaloupe in a sock, like me. I didn't see pictures of pregnant bellies on people who have what their mothers call, not unkindly, "junk in the trunk" like me, with dimpled flesh and back fat and jiggliness all over, like me.

And that's just like me. There's way more things that aren't represented in that "perfect pregnant belly" imagery we get.

That's deliberate.

People will try to tell you that the kind of bodies you see most often represented aren't the result of deliberate choice, that it's all just "how these things work" and nobody is really at fault and it just happens, like the world is a fucking vacuum and culture has no influence on this sort of thing. They're full of shit. The fact that "perfect" is attached to thin white cis able-bodied people with no visible "flaws" is not an accident. It's not an accident in modeling, it's not an accident on tv, it's not an accident in pregnancy. It's not an accident ANYWHERE.

Racism is not an accident. Fat hate is not an accident. Trans hate is not an accident. Ableism is not an accident. What society tells you is "perfect" is not a fucking accident.

And fuck all of that.

Because you know what? My fat pregnant belly IS perfect. It's MINE. There's A FETUS GROWING IN THERE. All of a sudden two weeks ago I saw myself in profile in the mirror and went HOLY SHIT, I LOOK PREGNANT. This is a very wanted pregnancy for me, and that was EXCITING. No, I don't have that "smuggling a basketball look", and I almost certainly never will. But what I DO have, is MY pregnant belly. And MY pregnant belly is fucking perfect.

You know what? If you are pregnant and want to be, and you have a pregnant belly? YOUR PREGNANT BELLY IS PERFECT TOO.