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21 December 2015

The alarmist and contradictory advice pregnant women have to navigate could be dangerous

A recent study suggesting pregnant women shouldn't take SSRIs (antidepressant medication) is just the latest in scare stories that could harm future mothers.

By glosswitch Glosswitch

My knee-jerk response to reports like these is “fuck off.” So researchers have discovered that taking SSRI-type antidepressants during pregnancy “could double the risk of autism in toddlers”. Or that “sedentary lifestyle while pregnant may harm unborn baby”. Or that women who are obese before becoming pregnant “are at TWICE the risk of their baby dying in infancy” (the Daily Mail’s capitals, not mine). Fuck off, fuck off, fuck off.

Don’t get me wrong: I don’t necessarily disbelieve the research. Nor do I deny that it offers potential benefits to women and children. I’m just really sick of pregnant women being told, not what to do, but that everything they are doing already is wrong (moreover, I’m sick of them being told this by articles illustrated by photos of pregnant women who don’t have heads).

Take this one, for instance. “Pregnant women with diabetes could risk harming their babies with the medication they take.” While it’s nice to see pregnant women granted agency for once, it’s a shame this is only in order to blame them for their terrible “being ill and receiving treatment” ways. The article includes not one, but four headless pregnant woman shots, helpfully reminding us that one cannot gestate and be a full human being at one and the same time. While the advice being offered is for medical professionals (“doctors and nurses must review medications taken by diabetic women who want to become pregnant”), the overall tone is one that says “pregnant women! Stop fucking up!”

I know that to some this will sound like an over-reaction. Nevertheless, it seems to me that the policing of pregnant women’s bodies has reached such extremes that one cannot be too careful. One only need look at the US, where the imprisonment of pregnant women for “endangerment of a child” is increasing at an alarming rate. The very idea that because of the choices they make, pregnant women can put the lives and welfare of those not yet born at risk, is politically dangerous. My gut reaction is to shut down all debate: my body, my choice. If I need to take SSRIs while pregnant – and I have, all three times – then I will.

And yet, deep down, I know that – sigh – it’s a bit more complicated than that. “My body, my choice” works perfectly well for defending a woman’s desire to have an abortion (since no one else can be pregnant for her, no one else should get to decide).

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But it seems to me that the “ownership = choice” model breaks down when the outcome of your pregnancy will be an independent life that is not yours to live. In an age that encourages us to thrive on catchy slogans and moral absolutes (“keep your politics out of my uterus”) the pregnancies with which one chooses to continue remain hard to categorise. I have always felt that what is beneath my skin is my own, but didn’t I owe something to the people my foetuses became?

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It’s all a bit messy, and women are not safe when things get messy. Ordinarily we need to defend our physical boundaries like highly-trained border guards, constantly wary lest the next man treats us as some hole that one might just “accidentally” fall into. Patriarchy, like Freud, views those without penises as porous, unstable, empty receptacles to be filled. For me, feminism is very much about saying “no, this is where I start and you end”. But how can one say that to the foetus who inevitably becomes his or her own person?

Pregnant women do something amazing: they create life. But in doing so they also have the power to ruin it. Throw yourself downstairs when your foetus is at 25 weeks gestation. Down a bottle of Chardonnay every night for nine months. It can be that easy to wreck the hopes and happiness of other people before they’ve drawn their first breath. I’m not saying any woman would want to do this, but she could.

As a pregnant woman, I sometimes had the equivalent of that feeling you get when you’re standing near the edge of a high building and an inner voice says “you could jump, you know”. You could really mess with that foetus’s chances, you know. What’s more, you sometimes suspect it would be a relief to do so. Give up the fight against being a bad influence when you know that one way or another, you will do harm.

One can argue that taking antidepressants while pregnant is not the same as necking bottles of wine. I would agree. Still, I find it hard to look at this week’s autism headlines without feeling that the only way I can cope is to mistrust it all. I cannot demonstrate beyond reasonable doubt that the medication I took did more good than harm. I don’t know what impact my depression would have had without it. I don’t know whether taking it has affected my sons.

The headlines tell me nothing about my personal weighing-up of the pros and cons, and fill me with self-doubt. The conclusion reached by my doctor and midwife – “the most healthy thing for a baby is a healthy mother” – does not help. It sounds too much of a cliché and besides, aren’t they thereby implying that my health only matters if it’s good for the baby, too? What if that wasn’t the case? Who then gets to make that call and what motivates them?

The trouble with pregnancy, as Barbara Katz Rothman points out, is that it is not like anything else:

“The liberal argument, the fairness argument, the equal rights argument, these all begin to break down when we look at women who are, or are becoming, mothers. A woman lawyer is exactly the same as a man lawyer. A woman cop is just the same as a man cop. And a pregnant woman is just the same as … well, as, uh, … It’s like disability, right? Or like serving in the army? Pregnancy is just exactly like pregnancy. There is nothing else quite like it. That statement is not glorification or mystification. It is a statement of fact.”

This is a problem for any feminist approach that prioritises individuality, bodily autonomy and agency. Pregnancy just doesn’t work that way. It is a process. It is not just about your body, but someone else’s body, not now, but in the very near future.

We need to find a way of engaging with this that does not then open the floodgates to more demands placed on the female body. We need to say “this is an exceptional experience”. Yet at the same time we need to protect vulnerable women from the insistence that they put their foetus first. We need a new rhetoric that focuses not on ownership and choice, but on power and process.

Of course, I am aware this does not answer the pregnant woman’s immediate question: is it okay for me to take this drug, now? Or: how much does my own need for x count against my future child’s need for y? I don’t think there are any clear answers. Certainly, whatever you do, you will find ways to blame any bad thing that happens to your future child on something you did at some point. But if pregnant women are to be able to make informed decisions, there has to be an environment in which they can feel safe in their own bodies. Otherwise, like me, they will look at the headlines and just not want to know.