Pregnancy, Fear, and Conformity
Last fall, while in the midst of a severe head cold and four months pregnant, I emailed my obstetrician: “can I take Sudafed?” Within the hour he responded with “no sudafed until after 20 weeks if at all — concern is gastroschisis.” After Googling “gastroschisis” (a birth defect in the abdominal wall of the fetus so that the intestines or even the stomach and liver can stick outside of the body), I agreed that this did not sound like something I wanted to encourage. I dutifully bought a neti pot instead and suffered through a week of bad sleep, sinus pain, and constant nose blowing.
However, perhaps led by my training as a historian of medicine, I did not rely upon my obstetrician’s words as gospel truth and began a Googling crusade to find other points of view on the subject. WebMD told me that Sudafed was safe, while babymed.com warned that pseudophedrine “should only be offered to pregnant women with a ‘risk/benefit’ discussion, preferably with their doctor.”
If you’re trying to find the “right” answer about what is or isn’t safe during pregnancy, internet searches are a quick road to frustration, but these searches provide a unique glimpse into broader social and cultural fears about pregnancy and reproduction. If you haven’t experienced this frustration of seeking out “expert” advice for yourself, take a look at Tracie Egan Morrissey’s humorous and dizzying survey of the literature in her Jezebel article “How to Have the Best Pregnancy Ever.”
Being pregnant in the age of big data can be overwhelming, to say the least. Any and all questions about this individual and private experience can be answered in seconds by a large and public collective. In a continuation of the increasingly public nature of pregnancy in twentieth-century America, one woman’s experiences can now be held up as a warning or an encouragement to millions of others. Nowhere is this clearer than in researching the “proper” or “safe” medications to take while pregnant. But we should not think that these warnings are new, or that they are a result of our ability to access a wide range of opinions online. Over the past one hundred years of medicalized prenatal health care, advice about what a woman should or should not put into her pregnant body has flourished and continuously altered, reflecting not only advances in technology and pharmaceuticals, but also broader social concerns about reproduction.
At the dawning of the twentieth century, federal programs, medical experts, and countless authors of popular marriage and health guides expressed their fears about maternal and infant mortality, in part as a reaction to the changing demographics of the country. Immigrants streaming onto the shores of the U.S. at the time had recently transformed from predominantly northern and western European groups to largely southern and eastern European peoples. President Theodore Roosevelt coined the phrase “race suicide” to describe the new fear many Americans felt: that these new, very different populations (including African Americans who were also moving north to escape Jim Crow laws) were reproducing at a higher rate than the more “valued” white, Protestant, middle-class American families.
One way to stem race suicide was to make sure the “right” infants survived to adulthood through sweeping federal programs targeting the prenatal health of middle-class families as the saviors of the country. Compelled by the statistic that 300,000 babies younger than one year died in 1912, the newly formed federal Children’s Bureau published a guide on prenatal health care in 1915. The pamphlet, soon becoming the government’s best-selling publication, informed readers on proper diet, dress, skin care, and exercise for pregnant women, but also warned against medications. For example, for the pregnant woman troubled by her bowels, the Bureau recommended a paste of prunes, senna, and molasses over resorting to purgative medicines.1
By the 1960s, federal and medical leaders were less concerned with infant mortality (which had dropped from about 100 deaths per 1,000 live births in 1915 to less than 30), but no less worried about the dangers drugs posed to the pregnant body. Instead of relying upon a discourse of infant death and racial suicide, popular discussions now mirrored the simultaneous hopes and fears of science in cold-war America. After the public release of penicillin in the 1940s, and the instantaneous heralding of it as the latest wonder drug, American medicine seemed ready to solve any problem, whether it was cancer or morning sickness.
In 1962, the drug thalidomide began to make news. This pharmaceutical, originally prescribed in the late 1950s primarily as a sedative, soon became popular among European doctors as a treatment for morning sickness. By the early 1960s, medical communities began linking the drug to tens of thousands of infants born with phocomelia, or malformation of the limbs. While thalidomide was never officially approved in the U.S., many American women took the drug obtained from European sources, and many more read about the frightening effects through popular media, like Life magazine, which detailed the story of “5,000 deformed babies.” The message was clear – if you take the wrong drug during pregnancy, your child will be dramatically and visibly abnormal.
Pregnant women in the 1960s lived in a world in which the drugs and chemicals they ingested could result in children who were described more like characters out of science fiction — the Life magazine article reported that the affected children had “seal limbs.” In the early twenty-first century, our fears are differently chronicled, reflecting the shifting social concerns about future Americans. What makes the news is no longer nuclear bombs, or the picture of a pregnancy gone wrong, resulting in physical deformity. Scanning through the countless online forums for pregnant women’s discussions about their personal experiences, and anxieties, it is quickly clear that we don’t even really fear birth defects like gastroschisis. Instead, the prevailing fears today are invisible. In the collective minds of the news media, pharmaceutical ads, and probably many reproducing couples, the new fear is that you will mess up your child in utero, but not know it upon birth. Your child will look “normal,” but months or years later you will realize that what you ate, drank, or took for your congested sinuses had dramatically negative effects.
Another Google search, this time on “allergy medication pregnancy,” unveiled these new fears with surprising clarity. While the resulting links bombarded me with contradictory advice and views on the popular medications Claritin and Zyrtec from “experts,” what intrigued me the most was how mothers who posted on discussion boards and forums articulated the “proof” of their children’s normality. A word that came up again and again in these reports was “smart.” People alleged that the intelligence of their children proved the safety of the medication. Mirroring increasing studies and interest in autism, ADHD, and other intellectual and behavioral issues, the dangers of medications during pregnancy have taken on new meanings. These online remarks also reflect larger discussions of the science behind mother blaming — a practice that dates back at least to the early twentieth century and will probably continue despite a recent Nature article that ordered “don’t blame the mothers.”
One particular entry sparked my interest, however, and kept me wondering for days. A mother disclosed that she had taken Zyrtec during both of her pregnancies, but wanted to assure other pregnant women who were suffering debilitating symptoms that this medication was ok. Her proof? Her two “lovely and intelligent” children: a daughter who is “smart and helpful” and a son who “is all boy.” I realized then that pregnancy fears of the twenty-first century not only involve hidden intellectual and behavioral issues, but also reflect growing gender anxieties.
Today we still worry about maternal effects on fetal bodies, but more particularly on fetal minds and fetal gender. While I understand the mother’s post as using “all boy” as a signifier of health, I can’t help but wonder, what does “all boy” mean? And how would this proof work in the negative? Would someone recommend against using allergy medication if a son played with dolls? Wore pink skirts? Was “helpful”? As Lesley Larkin insightfully asks, in an age of supposedly greater gender equality and when most mothers express less sex preference when pregnant, why do we as a society continue to prioritize knowing “boy or girl” (as clear and distinct categories) both before and after birth?2 Should we see the growing interest of “clear” gendering as a reaction to the supposed increased acceptance of Americans who identify as gay, transgender, intersex, or queer?
In the end, I took neither Sudafed nor Zyrtec, and my son was born, at least according to all the medical experts he has seen in his short life, “normal.” Of course, we are not off the hook yet. I’ve been asked if I’m worried about autism, given that my husband and I are of “advanced” age, and I am getting used to the first question any stranger asks about my infant being “girl or boy?” Soon my son will face his own anxieties and be asked to conform to new generational ideas of “normal.” How much will my actions during pregnancy be to blame for what he will confront? Which reminds me, I need to go Google “breastfeeding and Zantac.”
Janet L. Golden. Message in a Bottle: The Making of Fetal Alcohol Syndrome. Cambridge: Harvard University Press, 2005.
Richard A. Meckel. Save the Babies: American Public Health Reform and the Prevention of Infant Mortality, 1850-1929. Baltimore: Johns Hopkins University Press, 1990.
Leslie J. Reagan. Dangerous Pregnancies: Mothers, Disabilities, and Abortion in Modern America. Berkeley: University of California Press, 2010.
Shannon Withycombe is an Associate Professor of history at the University of New Mexico and author of Lost: Miscarriage in Nineteenth-Century America. Her current research explores the development of prenatal health care in the early twentieth-century United States and the anti-Black biology constructed in the science and statistics that upheld the movement to "save the babies."