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BEHAVIORAL RISKS IN PREGNANCY

Many physiologic conditions make pregnancy dangerous to the mother and the baby. Most of these, such as diabetes, are intrinsic and, except for compliance issues, beyond the control of the woman. Some, such as alcoholism or cocaine use, are behavioral problems with substantial voluntary components. An unfortunate nexus of the medical efforts to improve prenatal health and the political debate on whether the fetus is a person deserving independent protection is the pregnant woman who engages in activities that might harm her fetus. Such women have been subjected to forced medical care, including cesarean sections, and to incarceration in prison.

Debates over the legality and even the usefulness of coercive policies aimed at pregnant women have obscured the issues in managing high-risk pregnancies. There is vast gulf between a physician seeking to have a woman treated against her will and the much more common problem of helping a patient understand the risks and benefits of various behaviors and medical care alternatives. In general, physicians providing personal health services should not attempt to force unwanted medical care on their pregnant patients. The AMA's position is illustrative.

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