Our next speaker is Dr Philippa Ramsey.

Dr Ramsey is an obstetrician and gynaecologist

who has been in practice for 20 years.

Her speciality is obstetric and gynaecological ultrasound

and prenatal diagnosis of fetal abnormalities.

She's a visiting medical officer

at Royal Prince Alfred Hospital and Sydney Adventist Hospital

and she lectures in obstetrics and gynaecology

at the University of Sydney.

Philippa is an examiner in obstetric and gynaecological ultrasound

for the Royal Australia and New Zealand College of O and G

and she also runs a busy private practice

called Ultrasound Care at Newtown, Randwick, St Leonards and Wahroonga.

Welcome Philippa.

[applause and footsteps]

If you choose that…

Where do we have Philippa's—?

[inaudible]

Removable.

This one?

Yep. Just check that.

[inaudible]

OK, great.

[footsteps]

[cough in audience]

Thank you everybody for coming tonight.

I'm really heartened by the level of interest

in this really important topic.

And I want to thank you for inviting me to speak

except I have to admit that I haven't been invited to speak

I volunteered to speak because I feel so strongly about this.

So, uh, how do I go down?

So first of all I want to pay due respect

to those who have been the victims of crime

and to those who've lost their babies or miscarried their pregnancies

and who are still mourning them.

This talk is not about that.

I want to talk about the issues I have

with the proposed fetal personhood laws

and how it would change maternity provision

in this state and how it would impact

upon obstetricians and midwives

and the patients we look after.

So, I'll start with the small things.

First of all, I really disagree with the terminology.

Obstetricians and midwives are completely unanimous

about the words embryo, fetus and baby.

We call— we use embryo up until 10 weeks gestation,

which is 8 weeks of fetal development.

We use fetus after that, from 10 weeks until birth.

And after that until one year of age

we call the baby a baby.

And, uh, too, I've got to say,

obstetricians and midwives agree with that,

embryologists agree with that,

and even Wikipedia agrees with that.

[laughter]

So, uh, to rename the fetus an unborn baby

is really messing with our heads.

So the proposed law calls this, sorry, an "unborn child" from 20 weeks gestation on.

And I guess it's going to be a fetus before that.

But uh, this new label "unborn child" really messes with my head.

I think that the milestones of birth and death

are really clear and really unambiguous.

But if we rename the ch— the fetus to be

an "unborn child" it's as silly as

calling a newborn baby a "born fetus".

Or deciding that from now on

I want to be known as a "live corpse".

[laughter]

I just think it's, uh,

ridiculous and it just confuses, uh,

it confuses the issue.

But I understand the reason behind the new label.

Uh, because obviously, the phrase "unborn child"

is an elevation in status.

It's a promotion from fetus.

And this new label implies that this fetus

warrants the status of parenthood,

sorry, personhood, as if it's independent of the pregnant woman,

as if it's separate from the pregnant woman.

And I can promise you,

I've been an obstetrician for a long time,

and I can promise you that a fetus is

not independent and separate from the pregnant woman.

And I want to talk about three issues:

of pregnant women's lifestyles,

pregnant women's right to consent

to medical or surgical treatment for fetal conditions,

and the issues again of termination of pregnancy.

Just look at the picture.

The fetus is not independent

and separate from the pregnant woman.

And research shows that 1 in 7 Australian women

keeps smoking during pregnancy,

even though their health carers explain to them

that it is not good for the fetus,

that it causes fetal interuterine growth restriction,

that it increases the risk of stillbirth and neonatal problems,

even with all the knowledge in the world,

1 in 7 Australian women keeps smoking during pregnancy

because they are addicted.

And what about pregnant women who are addicted to illict drugs?

Or addicted to alcohol?

What about the pregnant woman who still

eats sushi and salami and pre-mixed salad

even though we advise them not to.

I can see you out there.

[laughter]

We know that this food might or could possibly harm the fetus

and still, it's not that easy.

We don't universally stop all behaviours

which could adversely affect the fetus

when we're pregnant.

Even though it may be a very wanted pregnancy

and a beloved fetus and beloved baby.

So if there is an adverse outcome,

the proposed law labels it, you know,

harming the fetus, grievous bodily harm to the unborn baby.

And it would be a criminal act under the proposed legislation,

except for a tiny exception,

and that is that it's OK for the pregnant woman to do it.

And when it comes to fetal procedures,

the fetus is clearly not independent and separate

from the pregnant woman.

Under those blue drapes

there are living breathing anaethetised women

who are allowing their body to be operating upon and traversed

to benefit their fetus.

Not to benefit them.

So if a paediatrician or a husband

wants a Caesearan section for this fetus

it has to be through the body of that pregnant woman.

So it would be great if fetal rights were

completely independent of women's rights.

And I love this graph, which I found on the Internet,

that shows the ideal situation.

Wouldn't it be great if the pregnant woman

had 100% of all of her pre-pregnant rights

continuing right through the pregnancy

despite the fact that some would like

to give the fetus the rights of personhood

in the third trimester or any time after 20 weeks gestation.

That the rights of the fetus should increase with gestational age.

But unfortunately this graph is

uh, a dream.

If a fetus has personhood, it has rights

equal to those of the pregnant woman

so for example if a paediatrician was advocating for the fetus

he may recommend that the obstetrician

perform a procedure on the fetus.

But as I've mentioned, it has to be via

the pregnant woman's body.

If the pregnant woman listens to all of the medical advice

and considers all of the evidence

and considers the impact on the fetus

and considers the impact on herself

and decides she doesn't want this procedure,

whose rights are going to be preeminent?

This fetus may want an operation on itself

or someone advocating for this so-called person

might want an operation on the fetus

um, but it has to be done through the mother.

So in reality if the fetus's rights increase

after 20 weeks gestation because it's been elevated to personhood

then by definition the mother's rights

to say no to these things

which may be beneficial for the fetus

by definition the mother's rights have to decrease.

But I feel that women must have the right

to choose what will or won't be done to their body.

Women must be the gatekeepers of their own body.

I mean we have been struggling for that for centuries.

And many women in many countries

are still not the gatekeepers of their own body.

They are still subject to rape in marriage, as an example.

And it's not illegal.

So I don't think we can get away from the fact

that conferring personhood on a fetus

impacts on the rights of the pregnant woman over her own body.

So what about when a pregnant woman

has a fetus who's found to have a lethal abnormality?

An abnormality that is going to lead to the death of that fetus,

either as a fetal demise in utero, a stillbirth,

or a fetal death during labour or soon after labour.

Or a pregnant woman whose fetus has a major fetal abnormality.

I counsel lots of women and their partners

in this situation every week.

And unfortunately there are really only two options.

The option to continue the pregnancy

or the option to terminate the pregnancy.

Fetal medicine has come a long way

but— and it's certainly come a long way with diagnostic tricks.

So we are now very good at diagnosing

all sorts of fetal abnormalities and

we know most of the prognoses for most of them.

But unfortunately fetal medicine hasn't

progressed to the stage where

some sort of fancy in utero treatment

is going to save lots of lives

or relieve lots of suffering.

There are actually very few fetal interventions

for major fetal abnormalities

and most of the lethal fetal abnormalities

are still lethal.