The first time I was pregnant, I wanted to know precisely Everything. I read every book, every article, every FAQ page and advice column and interview I could find on “how to be pregnant,” and I’m sure I don’t need to tell you: it could have been a full-time job.
In the twenty-first century, there is an absolutely daunting amount of information available about pregnancy, prenatal care, childbirth, and beyond. Women didn’t always have so much information at their fingertips — and let me be very clear, I’m grateful to have it — but the democratization of information has also come at a price, because merely sifting through the advice out there, much less trying to make sense of it or apply it to your own life, can be utterly paralyzing.
I’ll tell you: I may have tried to read it all, but no one could. And no matter how much I read, I still felt like I was groping around in the dark.
Two years later, with my then one-year-old toddling around in the bathroom behind me, I found myself staring down at another positive pregnancy test, and I decided to take a different tack.
Namely, I decided to ask some different questions.
Where I had once asked: can I/should I/am I allowed to [fill in the blank: eat this, do that, go there, wear this, try that], I let my mind wander further upstream. At my prenatal appointments, I began to wonder how doctors decided to set the standard visit schedule in the first place. Each evening, when I dutifully swallowed my horse pill of a prenatal vitamin, I began to question what was in it, and why it was the very first item we pregnant women are expected to attend to. Instead of asking how many pounds it was advisable for me to gain, and at what rate, I wanted to know why.
As my pregnancy progressed, my questions may have shifted, but my curiosity grew with my belly. I decided to chronicle what I discovered, and the result is my recent book, Carrying On: Another School of Thought on Pregnancy and Health.
Every month during my pregnancy, I zeroed in on the question at the forefront of my mind, and I researched it as far as I could:
- In my first trimester, I was hung up on prenatal vitamins, morning sickness, and my growing body, so I researched when and why women began taking prenatal vitamins, the many and varied ways in which women and doctors have tried to resolve morning sickness over the years, and how medicine came to devise formal prenatal weight gain guidelines.
- In my second trimester, I thought about what I ate, what I could see on every ultrasound scan, and what my body was capable of — I researched how nutritional counsel to pregnant women has shifted from generation to generation, the onset and rapid adoption of prenatal ultrasounds, and the haphazard development of prenatal exercise guidelines.
- In my last trimester, I daydreamed of a good night’s sleep, wondered what my second birth would be like, and when labor would finally, finally begin — I dug into the research on sleep and pregnancy, and the history of birth plans, the history of induction.
I did not, as it were, develop neat and tidy answers to the classic pregnancy questions (can I…?). Instead, I learned that the modern prenatal care delivery system in this country is hardly the preordained enterprise many of us believe it to be. We were never destined to see our obstetricians however many times; it was not inevitable that we glimpse our unborn children at regularly scheduled prenatal ultrasounds; before there were scales, “pounds gained” was not a consideration; and though it is often taken as such, the act of making a birth plan need not be a political statement.
I should say, by the way, that I am no scientific dissident. I love science; I love medicine. I may be a skeptic, but I very much believe in the benefits and importance of prenatal care. Given that evidence shows women without access to prenatal care are five times more likely to die from pregnancy-related causes than women who receive prenatal care, how could I not?
Though much has changed in prenatal care, some things haven’t — the existing prenatal appointment schedule, for example, derives from one set forth in 1929 — and the system is the result of decades of decisions, cultural shifts, and overlaid ideologies. It is a medical system, yes, but it is not impermeable to the world around it.
We pregnant women exist within that system, including all of its many merits and its shortcomings. My book Carrying On tracks the emergence and expansion of that system, but it also explores the mounting body of evidence that has, in most ways (until very recently), afforded American women greater control over childbearing. Because it’s ironic, isn’t it, that our collective efforts to learn more about pregnancy, to better know and understand it, have contributed to imposing newfound expectations — from within and without — on women?
Over the course of history, our ideas and ideals surrounding pregnancy have been fluid as a river, shaped always by the terrain configuring its course. This book was my attempt to map the riverbank, to understand the winding waterways of prenatal care, to find stable footing and to walk my own path. I hope something in it helps you to find yours.