Advancing the Dialogue about Reproductive Medicine

Scholar: Anne D Lyerly, MD, MA

Many contentious debates in healthcare involve reproductive medicine:  decisions about pregnancy and birth, contraception, embryonic stem cell research, and abortion.  Often such debates are polarized between two positions that fail to capture the viewpoints and experiences of those most affected – women and their partners.

Dr. Lyerly’s research has illuminated how women and men think about morally complex issues in reproductive medicine.

What is a “good birth”?  Debates among practitioners and policymakers have tended to focus on specific medical outcomes – for women and neonates – and to use frameworks that cast technology as presumptively good or bad.  The resulting discussions have been relatively narrow, highly polarized between medicine and midwifery, and have produced divergent policy options for containing cost and ensuring quality maternity care.  Often missing in the debate are the voices of women themselves, their views about what makes birth meaningful or valuable.

Dr. Lyerly and her team led the Good Birth Project, a three-year study investigating what childbearing women say constitutes a “good birth”.   They interviewed more than 100 diverse women and 30 maternity care providers. Women believed that in a good birth:

  • They have had a hand in shaping a process that is informed by things they value
  • They feel safe, secure, and in trustworthy hands
  • They feel meaningfully connected to loved ones, care providers, and of course the baby
  • Others respect them and their newborns, as well as birth as an important life event
  • They understand what is happening and why and gain wisdom by going through it

Taken together, women’s voices point to common ground for advocates and policymakers and help guide childbearing women who face increasingly complex maternity care options.

Dr. Lyerly has published her findings in the journal Social Science and Medicine and has recently completed a book, A Good Birth, to be published in August 2013 by the Penguin Group (source and source).  Weaving in her own experiences as both a mother and an obstetrician, she shows how considering the core elements of a good birth can help women, loved ones, and health care providers develop strategies to meet the physical and emotional needs of mothers and mothers-to-be, going well beyond standard birth plans and conversations. For instance, practitioners should not to treat birth as a mere medical event but acknowledge the ways that for many women birth is a human experience imbued with bodily and existential meaning. Further, there is more to good birth than meeting expectations or achieving a "normal" delivery or good medical outcome. And when measuring the quality of maternity care, women’s voices and preferences should play a prominent role.

Fertility patients think about embryos in different moral terms than those that have characterized the public debate.

Dr. Lyerly and her team also analyzed how fertility patients considering what to do with embryos remaining after fertility treatment.  She conducted a survey of more than 1000 fertility patients across the US with embryos they would not use to have a child. Despite debates over embryonic stem cell research, little was known about the views of fertility patients, who faced directly the moral complexities of embryo disposition.

Dr. Lyerly found that nearly 60% would donate embryos they did not need for their reproductive goals for stem cell research.   Far fewer were inclined to donate embryos to another couple trying to have a baby.  Her research also called into question the prevailing view that the most respectful and responsible thing to do with frozen embryos is to allow them a chance at life.  Rather, many fertility patients expressed a sense of deep moral responsibility to embryos that precluded allowing them to develop into children without their knowledge or participation.   This research was published in the journal Science (source).

Her research also highlighted important lessons for fertility care.  First, during informed consent discussions regarding freezing embryos, physicians should discuss with women the probability of leftover embryos, and the moral dilemmas that many patients face.  Second, because patients’ views about embryos evolved over time, it is important to revisit discussions about embryo disposition after childbearing is complete.  Third, patients cared very much how embryos were discarded and wanted processes for disposal that allowed them to acknowledge the inevitable loss that embryo disposition entails. 

Support from the Greenwall Foundation allowed Dr. Lyerly to advance the national dialogue about pressing issues for women’s health. 

In addition to her empirical research in bioethics, Dr. Lyerly has co-founded two major initiatives that address pressing issues in women’s health.  In 2006, she co-founded with Kennedy Institute of Ethics Director Maggie Little the Obstetrics and Gynecology Risk Research Group, an interdisciplinary group that analyzes the way that risk is perceived, managed, and understood in the context of pregnancy.  Their work has been published in several journals including the Hastings Center Report and Obstetrics and Gynecology (source  and source).  She also co-founded, with Professor Little and Berman Institute of Bioethics Director Ruth Faden the Second Wave Initiative (source) to advance the responsible inclusion in biomedical research of pregnant women, who are now largely excluded, in order to promote evidence-based care for women during pregnancy, an endeavor now supported by a grant from the National Institutes of Health.  Funding from the Greenwall Foundation has been critical in allowing Dr. Lyerly to develop the analytic skills and close collaborations that are fundamental to her work.