Livia Arndal Woods //
Last month, there was some popular coverage of a recent article in the medical journal Obstetrics and Gynecology. Nathan S. Fox, MD’s “Dos and Don’ts in Pregnancy: Truths and Myths” frames its intervention as evidence-based common-sense pregnancy-best-practices in an “age of the internet” in which women are “bombarded” with more information than they can handle. The popular coverage (“Good News! You CAN Eat Sushi When You’re Pregnant”) frames Fox’s intervention as a medical stamp of approval on living a little more like a human while growing a human. And sure, compared to recent CDC recommendations that “women wanting a pregnancy should be advised to stop drinking at the same time contraception is discontinued,” Fox’s “Do’s and Don’ts” offer women more doctor-approved agency in navigating pregnancy-related risks. Fox is certainly correct both that 1) the extra-medical Mom-o-sphere can amplify fear and anxiety (I offer you this experiment: Google “soft serve ice cream pregnant”) and that 2) minimizing risk to the fetus is a meaningful maternal and medical goal in many pregnancies. And medical management of reproduction has seen historically unprecedented – though regionally, economically, and racially uneven – reductions in maternal and fetal mortality rates.
I think we benefit from reading Fox’s “Do and Don’ts” in conversation with a complicated history of the medicalization of women’s reproductive bodies that has so often treated the kind of anecdotal, somatic, lay-female knowledge that now circulates online as both partial and excessive, useless and dangerous. I’ve already sketched out pieces of this history here, as has Alicia Andrzejewski. Over at Remedia, Anne Hubel recently offered a helpful primer on 19th century pregnancy and childbirth advice manuals and their role in on-going negotiations of doctors’ and women’s power over reproductive bodies.
In (very) short: bodies in general contain the unknowable, bodies that diverge from medical “norms” in particular (Abigail Jane Mack’s recent post here on “medical uncertainty” offers one helpful thinking through of this unknowability). The unknowability of reproductive bodies is particularly pointed. Though our medical access to these bodies has resolved some of the mystery (it’s got a heartbeat, it’s a boy, your risk of down syndrome is low, your placenta is posterior…) so much of fertility, pregnancy, childbirth, and the postpartum period remain beyond the scope of rational epistemologies. Medical concern about the circulation of “irrational” reproductive epistemologies, however, has spanned modern obstetrical history. William Smellie’s Treatise on the Theory and Practice of Midwifery (published from 1752–64, the dawn of modern obstetrics and gynecology) ascribes poor outcomes in pregnancy and childbirth to misinformed mothers disobedient of medical advice.
Thomas Bull’s 1837 Hints to Mothers for the Management of Health During the Period of Pregnancy and in the Lying-in-room emphasizes the importance of obedience to (male) medical authority for the literate middle and upper-middle class white British women increasingly seldom cared for in pregnancy and childbirth by female midwives. I want to consider a passage from Bull’s preface to Hints to Mothers in conversation with the abstract for Fox’s “Do’s and Don’ts” because I think we see in these sources – separated by 181 years and major social and medical shifts – a shared anxiety about that to which unregulated women’s minds might fall prey. Bull frames women’s unwillingness to sufficiently communicate with and be calmed by their “medical advisers” in opposition to a tendency toward receiving advice from “ignorant persons” and, thereby, succumbing to “ignorant” worries:
In the minds of married women, and especially in young females, those feelings of delicacy naturally and commendably exist which prevent a full disclosure of their circumstances, when they find it necessary to consult their medical advisers. To meet this difficulty, and also to counteract the ill-advised suggestions of ignorant persons during the period of confinement, is the chief object of the following pages.
…There are many little circumstances, too, in which it does not occur to seek for advice, of the nature and result of which she ought not to be ignorant. Young married women are especially liable to many needless, yet harassing fears, which it has been the anxious object of the author to remove, by showing that they have no foundation in truth. (Bull 3-4)
For Bull, the problem of feminine misinformation is one of an otherwise praiseworthy “delicacy” that disinclines “young females” to speak of their reproductive “circumstances” directly with their doctors. Combined with “the ill-advised suggestions of ignorant persons” who shall remain nameless, but whom we can safely assume to be female acquaintances, the result is “needless” anxiety that could be easily assuaged by “truth” that only the doctor can access and offer. Bull’s 1837 “ill-advised suggestions of ignorant persons” anticipates Fox’s 2018 internet “information and recommendations” that are “confusing at best and conflicting at worst:”
Pregnancy is a time of excitement and anxiety. The reality for pregnant women is that their actions could affect their pregnancies and their fetuses. As such, they need to know what they should and should not do to minimize risk and optimize outcomes. Whereas this advice used to come from doctors, a few books, and some family and friends, in the age of the internet, women are now bombarded with information and recommendations, which are often confusing at best and conflicting at worst. The objective of this review is to present current, evidence-based recommendations for some of the things that pregnant women should and should not routinely do during pregnancy.
The ”family and friends” from whom pregnancy advice “used to come” (in the good old days) and whom Bull felt it necessary to “counteract” has been replaced by the proliferation of online advice, but the concern remains similar: women will get unreliable and inconsistent information from other women rather than from “doctors [and] a few books” approved by doctors.
And it’s true, women WILL get unreliable and inconsistent advice from other women, both face-to-face and face-to-screen (please refer back to your Google results for “soft serve ice cream pregnant”). This advice will speak to extra-medical, pseudo-medical, spiritual, and/or embodied ways of approaching the unknowable. This advice will come in the form of and in response to anxiety, and this female anxiety and its expression will be framed as unwise while the anxiety of medical professionals about women’s anxieties will be framed as salutary. Women and their doctors are both generally doing their best to navigate uncertainty and anxiety and both often get things wrong, especially if we’re thinking of this as a narrative of medicalization that encompasses 200-plus years. I’m not advocating for replacing medical knowledge with the communal wisdom of the question and answer boards on thebump.com. I am, however, suggesting that leaving some room for the epistemologies of pregnancy and childbirth achieved through experience is a meaningful intervention in our traditions of medical hints to mothers.