UC Santa Cruz

In the past several decades, thousands of pregnant and postpartum women have been arrested, detained, or otherwise deprived of liberty after doctors or nurses made reports to law enforcement alleging fetal harm (Goodwin, 2020; Pregnancy Justice, 2023). The rise of “fetal personhood” legislation, which expands existing homicide, child abuse, and drug-related statutes to include fetuses as potential victims, together with policies requiring healthcare providers to document substance-exposed pregnancies, are largely responsible for the criminalization of pregnancy conduct. Due to racialized, classed, and gendered expectations of “good” mothers, stigma toward substance use, and heightened surveillance in public hospitals, low-income women and women of color are disproportionately vulnerable to drug testing, child welfare reporting, and arrests (Paltrow & Flavin, 2013; Bach, 2022). To better understand the processes through which healthcare settings serve as sites of gendered regulation and punishment, my dissertation examined how obstetric nurses negotiate professional duties with ethical responsibilities to patients. Through interviews with 11 nurses, the goals of this study were to: (1) gain a deeper understanding of nurses’ attitudes toward maternal-fetal conflicts (e.g., maternal substance use, declining medical advice, pregnancy termination), beliefs about pregnancy “risks” and how these beliefs inform attributions for adverse birth outcomes; (2) investigate how nurses’ constructions of motherhood are informed by intersecting race, class, and gender stereotypes; (3) examine how nurses balance fiduciary duties to pregnant patients with legal obligations to report suspected fetal health risks; and (4) assess nurses’ support for and opposition to the criminalization of pregnancy. Utilizing discursive analytic frameworks, I identified four overarching discourses that were leveraged to construct substance using women as “bad” mothers and legitimize violations of privacy and autonomy: (1) good mothers prioritize their children above all else (e.g., “You can’t mother well if you’re self-centered”); (2) good mothers comply with medical authority (“She just kept refusing, refusing, refusing what was being recommended”); (3) institutional surveillance and coercion are acceptable ways of managing pregnancy and labor risks (e.g., “If we suspect, we just send it in to be tested”); and (4) maternal substance use necessitates family separations and other consequences (“The baby doesn’t even need a shot at going home with mom”). Although participants widely shared their compassion for patients/clients struggling with addiction, many also accepted nonconsensual drug screening and child welfare reporting as routine aspects of their jobs. Central to these perspectives is the assumption that unborn children need “protecting” from their mothers. Implications of these findings, study limitations, and recommendations for disrupting the “healthcare to prison pipeline” are discussed.