Because labor begins when the uterus is opened, women who endure the procedure early in the second trimester must be confined to bed rest on antilabor medications for the duration of the pregnancy. Newborns, who typically arrive early and always by Cesarean section, require additional treatment after birth and may still face lingering impairment. Finally, the surgery may jeopardize a woman's ability to carry subsequent pregnancies to term. For Casper, fetal surgery raises serious ethical questions about maternal sacrifice, the status of the fetus, and medical priorities. The ethical questions are enormous.
Fetal surgeons view the fetus as the patient, but does that mean the fetus is a person, asks Casper.
Despite the pressing questions surrounding fetal surgery, the procedure remains shrouded in secrecy at the few medical centers in the country that are performing it. Casper had to file Freedom of Information Act requests to obtain details about some of the 100 or so surgeries that had been performed at the hospital where she conducted her research, and she lost access to prospective and actual patients after surgeons gleaned the scope of her research. Casper asserts that the ethics of fetal surgery are being overlooked in the public arena, where a generally positive reception by the media is curbing the scope of the discussion. Casper's goal in writing her book was to avoid simplistic answers. When pressed, she says she favors preserving fetal surgery only in a context that protects the woman's rights as an independent patient and only if it can be made safer for both fetuses and the women who choose it.