Feeding The Fetus - On Interrogating The Notion of Maternal-Fetal Conflict (1997)

Feeding the Fetus: On Interrogating the Notion of Maternal-Fetal Conflict
Author(s): Susan Markens, C. H. Browner and Nancy Press

Source: Feminist Studies, Vol. 23, No. 2, Feminists and Fetuses (Summer, 1997), pp. 351-372
Published by: Feminist Studies, Inc.
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FIK
I
:DING THE FETUS:
ON INTERtROGATING THE'1 NOTION OF
MATERNAL-FETAL CONFLICT
SUSAN
MARKENS,
C.H.
BROWNER,
and NANCY PRESS
TV Commercial:
Scene one: A woman is in labor. She is in
pain. Hospital
staff and medical
equipment
surround her.
Something
is
wrong;
there are
complications.
The
laboring
woman wonders
why
this is
happening,
what went
wrong?
Scene two: Flashback. A
pregnant
woman
(the
one we
just
saw in
labor)
is
at a
party.
She is
having
a
good
time. She's
drinking
alcohol.
Implicit Message:
This woman's
drinking during pregnancy
caused the
complicated pregnancy
and
possible poor
birth outcome.
Recollection of a
Recently Pregnant
Woman:
"I said to
M,
'We need to
go
for coffee sometime and catch
up;
we haven't
talked in such a
long
time.' M
replied:
'You can't have
coffee; you
can have
juice."'
From commercials and friends to
warnings
in restaurants and
remarks
by complete strangers,
U.S.
pregnant
women are con-
stantly
reminded that
they
need to
manage
and control them-
selves
during pregnancy.
The invariant
message
is that what
they do,
and to an even
greater
extent what
they consume,
can
directly
affect the fetus
growing
inside them.' Connected to
these trends are recent advances in
reproductive technology,
from
prenatal diagnosis
to fetal heartbeat
monitors,
which
have
brought
to the
foreground
concern for the fetus as
patient
and as a
person.2
In
particular,
visual access to the fetus af-
forded
by
the use of ultrasound has
promoted
the
image
of the
unborn fetus as a
separate
individual.3 At its
extreme,
a notion
of "fetal
rights"
is
produced by
this
perspective
of a
pregnant
woman and her fetus as distinct
beings.4
Historically,
the interests of woman and fetus have not been
seen as
separate.5 Indeed,
in the
beginning
of this
century,
U.S.
Feminist Studies
23,
no. 2
(summer 1997).
? 1997
by
Feminist
Studies,
Inc.
351
Susan
Markens,
C.H.
Browner,
and
Nancy
Press
courts did not
grant
the fetus
any rights
until it was born-
alive.6
Yet,
the
emergence
of "fetal
rights"
is not
solely
attribut-
able to
technological
innovation.
Technology
is used and devel-
oped
in
particular
social and
political
contexts. In
particular,
the rise of anti-abortion rhetoric since Roe v. Wade has been a
crucial factor in the creation of "fetal
rights."
In their
fight
against
a woman's
right
to an
abortion,
anti-abortion activists
have had to
argue
for fetal interests-interests which are nec-
essarily
construed as in conflict with that of the
pregnant
woman.7 At the same
time,
the
perception
of the
potential
for
maternal-fetal conflict in
pregnancy
has led to other disturb-
ing
trends-court-ordered
cesareans, prosecution
of women for
"fetal
abuse,"
and
workplace
restrictions on fertile women.8
Although
feminist
scholarship
has focused needed attention
on the
dangers
of a fetal
rights
discourse for women's
repro-
ductive freedom in
particular
and women's
rights
in
general,9
there has been little
empirical
work that examines women's
embodied
experience
of
pregnancy
with
regard
to the
light
it
could cast on the issue of maternal-fetal conflict.'0 In this arti-
cle,
we
analyze
the
prenatal dietary practices
of a
group
of
pregnant
U.S. women for what
they
reveal about the women's
understandings
of their
relationship
and
responsibilities
to
their fetuses.
Although
dietary
preferences might
seem incon-
sequential
to the
politics
of fetal
rights
and the construct of
maternal-fetal
conflict,
an
analysis
of these
preferences
can
provide
rich
insight
into how women's own concerns
shape
the
concrete
ways they
accommodate to
pregnancy.
The
"feeding" practices
of
pregnant
women focus attention
at the
symbolic
and real connection between woman and fetus.
It is also
precisely
within this connection that both
lay
and
medical discourses
give
women
responsibility
for and control
over fetal
development.
In
fact, regardless
of their level of med-
ical
knowledge, cross-culturally
and
throughout time," preg-
nant women and others around them have often
expressed
a
concern for diet. The
eating practices
of
pregnant
women are
therefore an
important
domain in which to elicit whether and
when
pregnant
women see their fetuses as
separate
or in
oppo-
sition to them and when
they
see them as
merged.
We
argue
that the
contemporary
self-control of women's di-
etary
habits
during
their
pregnancies
is the result of two in-
352
Susan
Markens,
C.H.
Browner,
and
Nancy
Press
tersecting processes. First,
women enter their
pregnancies
al-
ready
immersed in issues of
weight
control and
health.l2
Al-
though
women's
eating practices during pregnancy
are often
centered around concern for the health of the
fetus,
their de-
gree
of accommodation to
prenatal dietary
changes
is also the
result of this
generalized
concern most U.S. women have with
the
amount,
as well as the
quality,
of their food intake and its
affect on their
health, body shape, general well-being,
and self-
esteem.
Second,
maternal
responsibilities
have
expanded
from
the care and nurturance of children and childhood socializa-
tion to the
monitoring
of
childbirth, pregnancy,
and into the
prepregnancy period.13
This in turn feeds into
pregnant
wom-
en's often
exaggerated
concern over diet and nutrition.
Even as
sharply growing
numbers of women are
balancing
the demands of
paid employment
and
family,'4
women as
mothers are
increasingly expected
to subordinate their own
needs to their children's.15 With
regard
to
pregnant women,
this
expansion
of maternal
responsibilities
to the
gestational
period signals
a shift in the focus of
pregnancy
from the health
of the woman to the health of the fetus.16 Issues
surrounding
diet and maternal
responsibilities
come
together
to make
pregnancy
a
period
in which women's behavior has become
subject
to
growing monitoring
and control.
In this
context,
it is
important
that we
put
the
contempo-
rary expectations
of
pregnant
women in historical
perspective.
When
focusing
on the effects of the recent fetal
politics
dis-
course on the behavior of
pregnant women,
we must not as-
sume that
pregnant
women have
only recently
been held re-
sponsible
for birth outcome. For
example, throughout
the Mid-
dle
Ages,
women in
Europe
were believed to affect the
appear-
ance of their
offspring simply by
what
they gazed
at
during
conception
or
during pregnancy.l7 Similarly,
in the nineteenth-
century
United States it was believed that "unnatural" sexual
intercourse, fright,
or
cravings
could affect the
fetus, causing
babies to be born with
markings, tumors,
and
deformities.l8
Al-
though
such cause-and-effect
relationships might
seem far-
fetched to us
now,
we cannot
easily
dismiss the various
ways
pregnant women, through
their behavior and
activity,
have
been held accountable for birth outcome.19 Our
argument
is
that
pregnancy
has
always
been controlled: what
changes
is
353
Susan
Markens,
C.H.
Browner,
and
Nancy
Press
how and
by
whom. Present
expectations
of
pregnant
women
are
keyed
to the
large
role biomedicine has in
determining
the
appropriateness
of their behavior as medical institutions
play
a
strong
and
growing
social control function in twentieth cen-
tury
U.S.
society
more
broadly.20
It is
through
examining
how
pregnant
women
negotiate
is-
sues over food and
eating
that we
hope
to shed
light
on the
work
pregnant
women do in
"feeding
the fetus"2' while at the
same time
attending
to their own concerns and desires about
body image, weight control,
and
self-indulgences.
It is
impor-
tant that feminist
scholarship recognize
that women's activities
are also based in
part
on their own
interests,
for to do other-
wise leads us closer
conceptually
to a construct of motherhood
based
entirely
on selflessness.22 We
explore pregnant
women's
understandings
of and
changes
in
prenatal
diets in order to dis-
cover the
degree
of normalization and internalization of a med-
ically managed pregnancy
in the United States.
Through
analysis
of
pregnancy diets,
we examine how women
negotiate
the
conflicting
demands of enhanced
responsibility
for fetal
outcome with their embodied
experience
of the
separateness
and
interdependence
of woman-fetus. Our
findings suggest
that feminists must further
interrogate
the construct of mater-
nal-fetal conflict to account for the
complex
and sometimes con-
tradictory ways
women
experience
their
pregnancies.23
In the
following
section we describe our data and methodol-
ogy. Next,
we
analyze
pregnant
women's
degree
of accommo-
dation to
dietary prenatal
recommendations
by exploring
the
complex strategies
women
pursue
in order to
satisfy
what
they
perceive
to be the sometimes
conflicting
needs of their fetus
and themselves. In our final
section,
we look at the
develop-
ment of the
concept
of maternal-fetal conflict and
integrate
our
empirical findings
with feminist
analyses
that examine
the
danger
that a
unitary
construction of maternal-fetal rela-
tions
poses
to the
reproductive autonomy
of women.
DATA AND METHODOLOGY
Our data are based on interviews with 138
pregnant
women
who were enrolled in
prenatal
care at one of five branches of a
health maintenance
organization
(HMO)
located in southern
354
Susan
Markens,
C.H.
Browner,
and
Nancy
Press
California. We were
broadly
interested in women's self-care
during pregnancy
and in how
they incorporated
biomedical
prenatal
advice into their
previously existing
self-care rou-
tines. In
gathering data, therefore, particular
attention was
paid
not
only
to the
changes pregnant
women made in their
lives due to
pregnancy
but also to the sources of the informa-
tion on which these
changes
were based.
Semistructured,
open-ended, tape-recorded
interviews of one and a half to four
hours in duration were conducted in informants' own homes or
at the HMO.
Tapes
were transcribed and
subjected
to content
analysis.
In
addition,
we observed twelve
prenatal
education
classes at the five HMO branches. The HMO offers all
preg-
nant clients a three-hour
prenatal
education
class,
which re-
views the
physiological
and
psychological changes
associated
with
pregnancy,
describes the nature of the
prenatal
care the
HMO will
provide,
and
gives
the HMO's recommendations for
diet, exercise, weight gain,
and rest.
We were
particularly
interested in how
ethnicity
and social
class
might shape
women's attitudes toward
prenatal
care and
their self-care
practices during pregnancy.
To
explore
such dif-
ference,
we stratified our
sample along
ethnic and class di-
mensions.
Sixty-eight percent
of those interviewed were Euro-
pean American,
and 32
percent
were Mexican American
(i.e.,
born in the United States to
parents
of Mexican
ancestry
or
immigrated
to the United States
by
the
age
of
ten).
These two
groups
were chosen because
they demographically
dominate in
California. The women
ranged
in
age
from
eighteen
to
thirty-
five
(mean
=
26.6,
s.d. =
4.5)
and
already
had zero to six chil-
dren
(mean
=
1.3,
s.d. =
1.04).
Self-reported
median household
income was
$30,000
to
$35,999, although
24
percent
had in-
comes below
$15,000
and 15
percent
had incomes over
$50,000.
Most of our informants had
completed high school,
al-
though
19
percent
had
not; only
14
percent
had earned a bach-
elor's
degree
or more.
Because other researchers have found that
ethnicity
and so-
cial class
shape
attitudes toward
prenatal
care and women's
self-care
practices during pregnancy,24
we
expected
to find sim-
ilar
patterns.
This did not
prove
to be the case with our sam-
ple.
We found no
significant
differences
by ethnicity
or social
class in the women's attitudes toward
prenatal
care or their
355
Susan
Markens,
C.H.
Browner,
and
Nancy
Press
prenatal
care
practices.
Ellen Lazarus
reported
similar results
from her research on Puerto Rican and
European
American
obstetrical
patients
at a U.S.
inner-city hospital.
She found
that "the Puerto Rican and white women held similar beliefs
about
pregnancy
and
birth, managed
these events in a similar
fashion,
and behaved
similarly
in their clinical
interactions,
despite
the fact that the Puerto Rican women maintained a
strong, separate
cultural
identity."25
In the discussion of our
findings, therefore,
we do not differentiate
among subgroups
of
informants. In
fact,
the lack of variation
among groups
demon-
strates the
degree
to which the norms of biomedicine have
been internalized
by
women of diverse
backgrounds
and be-
liefs
living
in the United States.
The extent to which our
findings
are
generalizable may
be
limited
by
the fact that all the women in our
study
were med-
ically
classified as low-risk when
they began prenatal
care and
the fact that
they
were
patients
at an HMO where there
may
be a
greater emphasis
on
patient
education than at other
kinds of
facilities,
such as
public
clinics.26
Furthermore,
as this
study
is concerned with the extent to which
physician-provid-
ed
prenatal
care is
playing
a role in the
self-management
of
low-risk
pregnancy,
a
question
to be asked is whether the in-
terview
process
itself was
part
of and contributed to the
very
processes
we
sought
to examine. For
instance,
did
asking preg-
nant women about their diets elicit
particular culturally
ac-
ceptable responses, particularly
because we recruited our in-
formants
through prenatal
care facilities?
Although
we ac-
knowledge
that our data are
reported
accounts and not neces-
sarily
actual
behavior,
we believe our informants
provided gen-
erally
truthful
responses.
Evidence of this comes from the
depth
and detail of women's
responses
to our
questions
and
the fact that most
reported
that
they
did not
fully comply
with
biomedical
prenatal
recommendations at all times. Additional-
ly,
we
argue
that accounts are what matters in as much as we
are interested in women's
agency
and therefore their
interpre-
tation of events.
356
Susan
Markens,
C.H.
Browner,
and
Nancy
Press
FINDINGS
I've eaten a lot healthier. I used to be a
hamburger-fries-
shakes
person, nachos, any
kind of
junk
food there was. I
was into it. We'd
go
out to eat almost
every night
and it
was
always burgers
or steaks or barbecue or a
couple
of
beers. And now it's
salad,
it's what has iron .... I've
eaten a lot healthier foods with this
pregnancy.
-Pregnant
woman
Prenatal education and the context
of healthy eating.
The wom-
en in our
study
were both concerned with and articulate about
dietary
issues. This leads to the
question
of how
pregnant
women know what foods
they
are
supposed
to eat and which
they
are
supposed
to avoid. Formal
prenatal
care
played
a
part.
All our
informants,
like the vast
majority
of
pregnant
women,
enrolled in
pregnancy
care
during
their first tri-
mester.27 At the HMO where we collected
data,
this care in-
cluded a one-time
only
three-hour
prenatal
education class.
In the
prenatal
classes we
observed,
the women were met
with a vast and often
confusing array
of
information,
offered
either in
generic
form or as
individually
tailored recommenda-
tions. Diet was
emphasized
more than
any
other
subject
dur-
ing
all twelve
prenatal
classes we observed. The
topic
also
evoked more
interest, questions,
and animated discussion from
the women in attendance. In a
typical class,
a dietician indicat-
ed which foods would make a fetus
healthy
and recommended
first foods for the
baby
to eat. With the aid of multicolored
charts,
the educator described the basic food
groups
and ex-
plained
which foods were
calorically
low, moderate,
and
high.
She then distributed
plastic portions
of
commonly
eaten
"good"
and "bad"
foods,
an exercise which
delighted
the women in at-
tendance, particularly
those who
got
the
"bad,"
but
clearly
de-
sired
ones,
such as cakes and
hamburgers.
Women were re-
quired
to fill out charts
indicating
their
prepregnancy weight,
weekly weight gain
since
becoming
pregnant,
and current eat-
ing habits;
and
they
were asked
many questions
about their
own
daily
food intake.
Although
class content and format varied little from one
HMO branch to the
next,
health educators' tone when dis-
cussing
diet
ranged
from
paternalistic (e.g.,
"We'll allow
you
to
357
Susan
Markens,
C.H.
Browner,
and
Nancy
Press
eat more of
this, this,
and this. . ." and "I let
my pregnant
dia-
betics. .
.")
to
cajoling (e.g.,
"I'll be
pleased
if
you
can
get
three
servings.
.
.").
Some educators
preferred
to
personify
the
fetus,
with admonishments like "Eat lots of fruits and
vegetables;
ba-
bies love fruits and
vegetables."
But
despite
variation in
ap-
proach,
most had the common
goal
of
making
women aware
that there was a direct and close
relationship
between mater-
nal intake and fetal
development.
Said one: "The
placenta
should not be
thought
of as a barrier between
you
and the
baby, only
as as lifeline
connecting you
... so
anything you put
in
your mouth, anything you smoke, anything you
snort
up
your
nose will
go
to the
baby."
Another
insisted,
"Before
putting anything
in
your mouth, you
ask
yourself:
'What is this
going
to do to
my baby?'"
The women in our
study
also had
ready
access to
multiple
written sources of
dietary
advise.
Nearly
one-fourth of the
HMOs own a
ninety-six-page publication "Preparing
for a
Healthy Baby"
that is devoted to the
subject, reiterating
the
information covered in class.
Lay
self-care books on
pregnancy
invariably
include one or more
chapters
on diet. The authors of
the
best-selling general
book on
pregnancy
in the United
States-and the one most often mentioned
by
our informants-
What to
Expect
When You're
Expecting,
also
published
a com-
panion volume,
What to Eat When You're
Expecting, despite
the fact that their
general
book devotes considerable attention
to the
subject.28 Although
the details of
dietary
recommenda-
tions
vary
in
ways
that can be
confusing (e.g.,
recommenda-
tions for
legumes
and whole
grains range
from four to seven
"servings"
in different
popular sources),
there is consensus on
certain
general principles-for example,
the intake of
sugar,
salt,
and fat should be
limited;
"fast" foods should be
avoided;
calcium is vital to fetal
development. Overall, then,
a
signifi-
cant
portion
of the
prenatal
classes we
observed,
as well as
popular
written
materials,
were devoted to this issue of diet
and
weight
control. It is not
surprising, therefore,
to find that
most women in our
study reported
that
they
made
changes
in
their diets because of their
pregnancy
in accommodation to bio-
medical
prenatal
recommendations.
Yet,
the women's
reported
diets
during pregnancy
were as
much a condition of the
larger
context of the
accepted general
358
Susan
Markens,
C.H.
Browner,
and
Nancy
Press
nutritional
knowledge
as
they
were based on advice from
pre-
natal classes. For
instance,
when asked who told them to make
specific
or overall
dietary changes during
their
pregnancy,
our
informants
frequently responded
that it was "common sense"
or
something they
were aware of before
pregnancy.
As Martha
Evans 29
stated, "Well,
I was aware of it even for
nonpregnant
people; you
know that those are the
things
to watch ...." Simi-
larly,
Jeannette Fullerton
provided
more detailed
examples
of
appropriate
and
inappropriate
foods to eat: "You've
grown up
with the
knowledge
of what's
good
for
you
and what's not. You
know that a Snickers and a coke
[are bad].
I
automatically
know that. I would think that it would be better to have more
a
protein/vitamin-type
meal than a
sugar
fix."
The extent and limits
of
maternal
responsibility. Acting
to as-
sure the welfare of the
fetus/baby
was a
globalized preoccupa-
tion in the minds of those interviewed. Asked
why
she made
changes
to her
diet, Daphne
Potter described how she believed
that the
responsibilities
of motherhood
begin
with
pregnancy:
"[I]t makes me feel more
responsible. Right
off the bat I'm al-
ready being
a mother. Granted I'm the
baby's
mother but the
baby's
not here
yet,
but I still feel
responsible
and I still feel
the care is
necessary."
This
type
of
preoccupation provided
a
generic
rationale for the
dietary practices
women described. A
typical response
to the
question
of
why
women made
specific
dietary changes was,
"'Cause it's
healthy
for the
baby."
In ac-
cepting
a
relationship
between their
eating
habits and the de-
velopment
of their
fetus/baby,
these women
acknowledged
and
accepted
maternal
responsibility
for fetal outcome. As Eliza-
beth
Meyers explained
in
discussing
her
pregnancy diet,
"The
healthier
you are,
the healthier
your baby's going
to be."
For
some,
this
acceptance
of maternal
responsibility
meant a
pregnant
woman tailored her diet to
place
the
fetus's/baby's
needs above her own desires. As Trisha
Phelps
stated:
"[W]hat
I eat the
baby
eats ...
[I'm
always]
thinking
of the
baby
and
not
my cravings." Indeed,
so imbued with
meaning
were the
women's
eating
behaviors
during pregnancy
that the
consump-
tion of food was sometimes articulated as
deriving
from the fe-
tus's/baby's preference
for
"good"
food items.
Judy
Brewster de-
scribed the
relationship
in the
following way:
"[I'm
eating]
ba-
sically
what's
good
for the
baby.
Because
every
time I
put
359
Susan
Markens,
C.H.
Browner,
and
Nancy
Press
something
in
my
mouth I'm
always thinking
the
baby's going
to like it." This
type
of
explanation signifies
that some
preg-
nant women do
regard
the fetus as a
person
with its own likes
and
dislikes, separate
from the woman herself.
At the same
time,
women's
eating strategies during preg-
nancy
were not
solely
derived from concerns over fetal out-
come. Women also looked to the effects of their
prenatal
diet on
their own health and bodies. Lisa Stevens was
pragmatic
about her own needs and
concerns,
over and above those of her
fetus/baby:
"Because I want a
healthy baby
for
one;
[and]
for
yourself,
it's not
just
for the
baby
... to
prevent myself
from
being
in
danger.
You have the chance to become diabetic while
you're pregnant-and
toxemia." Lisa Stevens articulates a
posi-
tion in which the focus of her activities
during pregnancy
is as
much for the health of the woman as for that of the
fetus/baby.
Pregnant
women are
simultaneously
concerned with how
preg-
nancy
affects both their own
body
and their fetus.
Dietary
practices
reveal this inherent tension as described below.
When women articulated their own
needs,
it was often in
connection with their concerns about
obesity
and
weight
con-
trol. Anna Gomez's
response
as to
why
she was
eating
certain
foods
during
her
pregnancy
demonstrates how a woman's con-
cern over her
fetus/baby
can mask
underlying
concerns
regard-
ing
her own health and
body.
Just because
you
hear so much about that's what the
baby needs,
the
baby
needs all this
good
food and don't eat too
much,
don't
put
too much
weight
on. And I'm real self-conscious about not
getting
fat . . .
getting
stretch
marks,
and I
always
think the less
you put
on the
better,
the better
your
chances of not
having
this
problem,
not
having
the varicose veins. And I'm
not comfortable about
being heavy.
The
language
used
by
Anna Gomez illustrates how
pregnant
women do not
separate
their own "needs" and health concerns
from those of their
fetus/baby. Pregnant
women
implicitly,
and
explicitly, recognize
that fetal outcome is
intricately
tied to
their own
well-being.
Rachel Miller
expressed
such a senti-
ment
quite directly by linking
the health of her
fetus/baby
to
her level of stress: "I'm not a
big
soda
drinker,
so I don't have
that
problem
[of drinking
too
much].
If I want one I'm
going
to
have
one,
because I think it's better to make me
happy
at this
point
... instead of
being
stressed."
360
Susan
Markens,
C.H.
Browner,
and
Nancy
Press
The awareness of and attention to their own
interests,
on
the
part
of
Stevens, Gomez,
and
Miller, suggests
the
dangers
of
simplistically equating
women's assertions of their own needs
as
necessarily
in
antagonism
to the "needs" of the
fetus/baby.3
What does this
complex relationship
between the
perceived
"needs" of the woman and her
fetus/baby
mean in
light
of our
findings
that our informants were
preoccupied
with the control
of food intake
during pregnancy, particularly
as it related to
fetal outcome? Their
accounts,
described in more detail
later,
suggest
that
pregnant
women's diet modifications
during preg-
nancy
are
constantly
under
negotiation
as
specific practices
are
weighed against
the
pregnant
women's
wants, desires, needs,
and
perceptions
of overall health.
What, then,
are the
eating
strategies
women
pursue
to ensure the health of their fetus/
baby
while
simultaneously attending
to their own concerns?
Accommodation and control: The
eating strategies of preg-
nant women.
Many
of the women we interviewed
distinguish
between the activities of
feeding
their
fetus/baby
what it
"needs"
(e.g., milk, vegetables)
and
feeding
themselves what
they
like
(e.g., "junk
food").
This
type
of
analytical
(and
practi-
cal)
distinction in terms of "who" a
pregnant
woman was
eating
for at
any particular point
in time allowed women to
satisfy
a
range
of
prenatal dietary
recommendations for the
fetus,
while
also
eating
for themselves when
they
felt the desire or need.
For
example,
Diana
Rodriguez
described her
pregnancy
diet as
"better" than usual but also admitted to her
"indulgences."
I
try
to eat better. I'm like most
people-junk
food. I'm a
go-er
so I
stop
at 7-
11,
I
stop
at Taco
Bell,
but I
try
to drink more milk. I'm not a meat
person
but I make an effort to eat some meat once in awhile.... To me food is not
a
priority.
... So now I make more effort to have milk in the
morning,
maybe
milk before I
go
to bed. I have some kind of meat in the
day,
eat
plenty
of
vegetables,
but I still sneak in the
junk.
Similarly,
Paula Adams
gave
this
response:
"More
milk,
more
vegetables.
You're not
going
to
get
me off
my potato chips.
Even
though they say
it's not
good
for
you,
I like
chips
so I still
eat those."
Thus, although
this
group
of
pregnant
women can be charac-
terized as both concerned about the fetus and aware of medical
advice,
we found that
very
few women were
fully compliant
with all medical advice.
Instead,
we discovered a
range
of ac-
361
Susan
Markens,
C.H.
Browner,
and
Nancy
Press
commodation existed in which each individual woman
negoti-
ated the demands of her
life-style,
her needs and
desires,
and
concern about the
fetus/baby.31
In
doing so,
these women devel-
oped prenatal
diets and routines that satisfied their desire for
a
healthy pregnancy
but didn't
put
what each
pregnant
wom-
an considered an undue burden on herself
Yet,
the fact that
most women modified their diets in at least some
way
for the
fetus indicates the
degree
to which the
pregnant
women in our
study accepted responsibility
for
"feeding
the fetus." That
is,
rarely
did
they challenge
the notion of
primary
maternal re-
sponsibility
for the outcome of the
pregnancy
and the health of
the
fetus/baby
when in
reality
a host of other factors from
poverty
and male
genetic contribution,
to environment and
workplace influences,
also
play
a role in fetal outcome.32
Women
negotiated
their
pregnancy
diets
by employing
two
types
of
strategies
which were not
necessarily mutually
exclu-
sive. The first involved
changes
in the
degree
of intake. This
meant
increasing
the intake of
"good"
foods
(e.g., vegetables
and
milk)
and/or
decreasing-or eliminating-the
intake of "bad"
foods
(e.g., caffeine, alcohol,
chocolate).
For
instance, "cutting
down" was a common
practice
and easier than the elimination
of a
customary
substance. This could mean
reducing
the con-
sumption
of a
particular
item that was still used on a
regular
(i.e., daily)
basis.
Sandra
Bassinger:
I drink less sodas. I used to drink a lot....
Interviewer: How
many
a week would
you say?
Sandra
Bassinger:
.. .I would drink like two or three a
day.
But
now I
only drink,
if one a
day.
Interviewer: But because
you're pregnant you're only
drinking
one a
day?
Sandra
Bassinger:
Yeah.
This
strategy
of
changes
in the
degree
of intake could also in-
clude the
irregular
and reduced
consumption
of a
particular
item that
prior
to
pregnancy
would have been used more often.
For
instance,
Rachel Miller described her limited
consumption
of alcohol
during
her
pregnancy
in the
following way:
"I've had
maybe
a
six-pack
of beer in this whole
pregnancy....
If
you
have too much of
it,
then I think it's
going
to be bad for the
kid.... I sometimes
get
a taste for it and I'll have a beer."
What these
responses
indicate are that
although pregnant
women are aware of and do
attempt
to
modify
the amount of
362
Susan
Markens,
C.H.
Browner,
and
Nancy
Press
specific
foods
they
eat that
they
know are considered
problem-
atic, rarely
is the
"perfect"
diet in the view of the HMO and the
women achieved.
Yet, by selecting
the amount and
type
of food
consumed,
women
actively
and
consciously attempt
to balance
their own and what
they perceive
to be their
fetus's/baby's
needs. In
"cutting down," pregnant
women seem to be
comply-
ing
with biomedical
proscriptions by accepting responsibility
for
ensuring
a
healthy baby,
but
they
are
doing
so in a
way
which makes sense in terms of the realities in which
they
live
their lives. For
pregnant
women in our
study,
a suitable strate-
gy
was moderation of
specific
food items.
The other
strategy pregnant
women
employed
was to
(ex)change
the kind of intake. This
strategy
entailed
balancing
or
negating
some "bad"
dietary
intake
by decreasing
or elimi-
nating
another "bad" intake and/or
increasing
the
consumption
of
"good"
foods. For
instance,
caffeine was a substance most
women felt
they
should avoid.
Yet, many
women
complained
that so
many everyday products
contain caffeine that to elimi-
nate it
completely
seemed
impossible. They justified
their in-
ability
to wean themselves
completely
from such caffeine-rich
items as
soda, chocolate,
and tea
by asserting
that it was bal-
anced
against
(or
even
negated by)
the
positive
effects of
eating
well otherwise and/or
forgoing
coffee. Maria Sanchez's
descrip-
tion of the
changes
she made while
pregnant, along
with the
practices
she has not
altered,
illustrates how
pregnant
women
attend to certain needs/desires.
I eat more of chocolate ... I don't
drink;
I
stopped smoking
when I
got
pregnant.
Because before that I was
going
out to
night
clubs and
going
out
and I would drink and I would smoke and whatever. I
just
avoid
being
in
those
places
and I don't smoke or
anything.
It's not
right/good
for the
baby.
That's about
it,
I'm
just
into now a lot of
junk
food.... I drink a lot of
soda,
that's one
thing
I have. I don't drink
coffee,
but I drink a lot of
soda;
that's
caffeine,
I think the doctors mentioned that's not
very good
for
you
but I
have to have soda
everyday.
Sometimes what was
actually
done "for the fetus"
might
seem
minor,
but these
practices
further indicate the
degree
to
which
pregnant
women have come to
accept
that
they
have to
change something
about their
dietary practices
in
response
to
pregnancy.
Bonnie Brown's
honesty
about all the "bad" items
she still consumes is a dramatic
example
of how
pregnant
women
accept
maternal
responsibility
for their
fetus/baby
in a
363
Susan
Markens,
C.H.
Browner,
and
Nancy
Press
variety
of
ways.
Unfortunately
I eat
just
the same. I don't limit
my
intake of
sugar
or
fats,
or like I know I should ... [I drink]
several
cups
of coffee a
day,
I eat all the
chocolate I want
and, no,
I don't
try
to limit
my
caffeine intake. I drink a lot
of iced tea. And I drink sodas with caffeine and
sugar
in them.... I do take
prenatal
vitamin
supplements....
I knew that I was
going
to be
pregnant
when I was and so I had
actually gone
out and
bought prenatal
vitamins at
[a
drug
store].
Before I even
got pregnant
I started
taking
them.
This
weighing
or
balancing
of different
types
of
dietary
items
was a common
practice among
the
pregnant
women in our
sample. They acknowledged
their "bad
habits,"
whether small
or
large,
but
they
often
counterposed
their
indulgence(s)
with
all the
positive things they
were
doing
for the
fetus/baby.
In
other
words, regardless
of how few
changes
a woman made in
her diet
during
a
pregnancy,
most women saw themselves at
least to some extent
actively engaged
in
managing
fetal out-
come. For
instance, although perhaps quite
modest in her de-
gree
of accommodation Bonnie Brown is still
representative
of
the
general strategy
of
"balancing"
fetal and maternal
dietary
needs in her
practice
of
taking prenatal
vitamins before even
becoming pregnant.
In
sum,
we find
degrees
of accommodation exist in which the
women in our
study engaged
in a
variety
of
balancing strategies
with
regard
to
dietary
recommendations.
Yet,
most did make
some
changes
for the duration of their
pregnancies.
This indi-
cates the extent to which the discourse on maternal
responsibil-
ity
and the
purported
effects of
prenatal
diets affect the control
to which women
subject
their own
pregnant
bodies. The
ques-
tion, then,
is what
type
of factors account for the
dietary
changes
women did and did not make
during
their
pregnancies?
Drawing
the line. It is clear from our interviews that there
were limits to which a woman would
"sacrifice,"
yet it varied
where each woman "drew the line." For
some, making per-
ceived
changes
would
require
more effort or resolve than the
woman was
willing
or able to make.33 For
instance,
Bonnie
Brown,
the woman who took
prenatal
vitamins but made no
changes
to her
diet,
had this to
say
about
why
she did not alter
her diet
upon becoming pregnant:
"I think it would be a
good
364
Susan
Markens,
C.H.
Browner,
and
Nancy
Press
thing
if I would
change,
but it would
just
be an overall life-
style
change
which
up
to now I've been
undisciplined
to make."
And she adds: "I love to cook and I
just
cook the
way
I've al-
ways
known how to cook."
Furthermore,
the amount of
change
needed for the
"perfect"
prenatal diet, although
not
determinant,
did seem to
play
a
significant
role in how close women came to
achieving
it. That
is, many
of the "less than
perfect"
women made more
dietary
changes for their fetuses/babies than some women who had
been
eating
"well"
prior
to
pregnancy.
This is because women
who claimed to be
"healthy"
eaters before
pregnancy,
like Jan
Avery,
felt there was little
they
had to do to accommodate their
dietary
habits to biomedical
proscriptions
once
pregnant:
"No
[regarding
making
any changes
in her
diet].
My
husband and I
believe in
eating right,
and our food
budget
is
probably
more
than our friends that have five
children;
we
just
eat well all
the time."
Jan
Avery's response
illuminates the different
meaning
ac-
commodation can have when diverse
starting points
are taken
into consideration.
Furthermore,
her reference to a food
budget
also
highlights
how the standards used to evaluate women's
compliance
to biomedical
authority
can be
quite
class biased.34
For
instance,
class affected what diets could be
achieved,
as
Jennifer Hart's
explanation
of her
pregnancy
diet reveals: "One
thing,
I don't have a lot of
money,
that's one
thing,
so I
try
to
eat what's on
sale,
what's
cheap-you got
to do what
you got
to
do." This
example
illustrates that class affects
how,
but not nec-
essarily that,
women
attempt
to follow biomedical
proscriptions
by actively managing
their
pregnancies
via their diets.
In
general,
the lack of accommodation to
prenatal dietary
recommendations existed in the context of what women will
and can do for their fetuses/babies. In addition to
class,
time
was another
important
consideration that could affect the de-
gree
to which a woman made
changes
to her
dietary
practices,
particularly
when a woman
already
had children. This factor
was relevant to Rhonda Bennett's
pregnancy
diet: "I have to
admit,
this
pregnancy
I've been not
quite
as much the
perfect
mother
[laughs]
'cause-I don't know-I don't have more time."35
Eating
in
restaurants,
in
addition,
affected the
strategies
women
employed
and their
degree
of
accommodation,
as it did
365
Susan
Markens,
C.H.
Browner,
and
Nancy
Press
for Tina Herrera: "I
try
to eat the
servings
[recommended
in
the HMO's
literature],
but it also
depends
too on what we're
doing.
If we're
busy
and we have to
go
out then it's kind of hard
to watch
your
diet when
you
have to eat
out,
but I
try
to."
Our interviews show that women are not uninformed and
unreflective social actors. To the
contrary, they
have
strongly
internalized the norms of biomedical
knowledge regarding
proper
nutrition. This is not to
say
that
knowledge
of medical
proscriptions explains everything pregnant
women choose to
eat or not to eat.
Elsewhere,
we
argue
that women's "embod-
ied"
knowledge (e.g., cravings, nausea, quickening)
also
plays
an
important
role in how
pregnant
women
manage
their
preg-
nancies.36 Our
argument
here is that
regardless
of whether
women follow biomedical
advice, they
are
generally
aware of
what
they
"should" be
eating
in biomedical terms. This medical
knowledge,
in
conjunction
with embodied
knowledge,
is often
used to evaluate how
"good"
or "bad"
they
think their overall
and/or
specific eating practices
are.
When those interviewed
ignored prenatal
recommendations
it was done because other life circumstances were more com-
pelling.37 Indeed,
in no interview did we find a woman who
thought
she was
actually engaging
in a
practice
that she felt
would
negatively
affect fetal outcome. If a behavior was re-
garded
as
threatening,
either the woman
changed it,
or she at-
tempted
to cancel out or balance the effects of a "bad"
practice
by engaging
in other
"good" practices.
This was true
regardless
of whether the behavior was considered "low" or
"high"
risk
from a biomedical
perspective.
For
instance, many
women in our
sample
who were smokers
continued to smoke
throughout
their
pregnancies.
These wom-
en were concerned about the effects of their habit on the
fetus/baby, yet
this did not
prompt
them to
quit. Instead,
as
with
eating practices,
women
attempted
to
negate
the effects of
smoking by cutting
all other "bad" habits
(i.e., eliminating junk
food, caffeine, alcohol, etc.,
from their
diets)
and/or
decreasing
the amount
they
smoked while
pregnant.
Laura Givens's strat-
egy
for
smoking
illustrates the
way
in which a
high-risk
behav-
ior is
approached very similarly
to the accommodations made
to the "low-risk" behavior of
dietary
intake: "I am a
smoker,
I
smoke about three
cigarettes
a
day
and I'm not
giving
them
up!
366
Susan
Markens,
C.H.
Browner,
and
Nancy
Press
..
I've cut back from like not
quite
a
pack
to three a
day.
And
sometimes I don't even smoke three a
day.
That's
my
limit."38
Other evidence to
support
the fact that these women are not
unreflective social actors is seen in their reasons for occasional
"cheating."
These reasons were often well
thought out, weighed
against
the
alternatives,
and even
approved
of
by
their
physi-
cians.
Cathy
Martin's
experience
and her
reasoning
are illumi-
nating:
"I
try
to
stay away
from that
[fat],
and saccharin and
coffee. I do have an occasional
cup
of
coffee,
because it
helps
with the headaches that I
have,
and
my
doctor said that that
was
O.K.,
and alcohol I don't
drink,
I don't
smoke,
so ...."
That
Cathy
Martin's
physician approved
her occasional
cup
of coffee illuminates two
important aspects
of the
dietary
stra-
tegies pregnant
women
pursue. First,
women's
prenatal
di-
etary adjustments
can
simply
be seen as
overcompliance
with
vague
recommendations. This was
particularly
true for caf-
feine.39
Second,
women's
noncompliance,
where
they
"drew the
line,"
was more than
just asserting
their own
"needs,"
as
they
often
sought
and received
physician approval
for the activities
in
question.
That
is, pregnant
women receive
contradictory
and inconsistent information
regarding
what
practices they
should or should not
engage
in.
They
are
told,
for
instance,
not
to consume alcohol and
caffeine, yet
their
physicians
will at
times
give
them
permission
to
occasionally indulge.
This un-
certainty
is
compounded
when the
pregnant
woman is aware
of the inconclusive medical research
findings regarding prena-
tal recommendations.40
Ironically,
it is this
uncertainty
which
helps explain
women's inconsistent accommodation to biomed-
ical
authority
while
verbally asserting
its
importance.
CONCLUSIONS
The
image
of the
pregnant
woman and fetus in conflict with
each other has been
critiqued by
feminist scholars in as much
as it
incorrectly
assumes the two can be
separate.41
Rosalind
Pollack
Petchesky
calls this the
"viability" myth-the
false sense
of the fetus as autonomous from rather than
dependent upon
the
pregnant
woman.42
According
to
Cynthia
R.
Daniels,
the
concept
of "fetal
rights"
is
misleading
in that it
ignores
that the
woman's and the fetus's health are
inseparable.43The question
367
Susan
Markens,
C.H.
Browner,
and
Nancy
Press
we
posed
in this article
is,
How do
pregnant
women
experience
this
relationship
via their
dietary practices?
Our data
suggest
that the woman-fetus
relationship,
as
presently
conceived
by
the
pregnant
women in our
study,
is
very
fluid. These women viewed the fetus as sometimes
merged,
sometimes
separate
from themselves. That
is,
it is in-
correct to envision the fetus either in conflict with its mother
or with
complementary
interests-women
experience
it as both.
As
such,
"conflict" is
something
which
emerges
in
particular
women,
in
particular pregnancies,
and in
particular
contexts.
The women in our
study
all were
actively managing
their
pregnancies
through
their diets. The
high degree
of accommo-
dation we found is
significant
in as much as it indicates the ex-
tent to which women's
reproductive
behavior
during pregnancy
is
already subject
to much
control, by
others and
by
them-
selves.
Still,
our
findings suggest
that the woman-fetus rela-
tionship
is
complex.
The construct of maternal-fetal conflict in
which the interests of the fetus are assumed to conflict with
those of the woman does not
accurately capture
the
percep-
tions and activities of the
pregnant
women in this
study.
We
argue
that
pregnant
women
actively negotiate
a
complex
web
of
intersecting
demands.
They
are accountable to and influ-
enced
by
biomedical
proscriptions
and related discourses of
maternal
responsibility.
At the same time
they
attend to their
own desires for a
healthy baby,
as well as their own health and
perceptions
of what will enhance their
well-being,
which
may
or
may
not be in conflict with biomedical notions.
Finally,
their
dietary strategies
are
pursued
within the constraints of
time,
money,
and an accustomed
life-style.
This is not to
say
that these women's accounts of
pregnancy
are unaffected
by
debates over maternal-fetal conflict. To take
these women's
experiences
as unmediated
by contemporary
re-
productive politics
would essentialize
gender experience.4
In
other
words,
the
pregnancy
concerns and accounts of
pregnan-
cy-related
behavior of the women in our
study
arise from their
embodied
experience
of
pregnancy; yet,
their
interpretations
and reactions to their
pregnancies
cannot be
placed
outside
prevailing gender
relations in a
society
marked
by
advanced
capitalism.
In
particular,
these
pregnant
women's
dietary
strategies
are
very
much a
product
of the
strong
role of medical
368
Susan
Markens,
C.H.
Browner,
and
Nancy
Press
institutions and biomedicine in U.S.
society.
As historical work
on the
body
has
shown,
how
physiological processes
are under-
stood and
experienced
is
very
much a
product
of
prevailing
ideas and medical
knowledge.45
Our
argument
is that the
significant
degree
of accommoda-
tion to clinical advice
by
these
pregnant
women illuminates
the extent to which the medical
management
of
pregnancy
has
been normalized.
Furthermore,
this normalization indicates
acceptance
of the
growing emphasis
on the exclusive or
nearly
exclusive role of maternal
responsibility
for fetal outcome. In-
deed,
the focus on diet is indicative of the extreme individual-
ism in American culture and medicine. In their account of
their
pregnancy diets,
these women
accept
and
participate
in
the individual
(i.e.,
maternal)
accountability
for birth outcome.
Their
willingness
to accommodate to the
proliferating
dis-
course on maternal
dietary responsibility
contrasts
sharply
with the
reality
of
poverty
and environmental hazards that
feminist activists and other health advocates
argue
are more
significant
in
explaining pregnancy
outcomes.46 At the same
time,
women's accommodation to clinical
dietary
advice is in-
consistent,
as is the advice itself. It is the
range
of accommoda-
tion
strategies pursued by pregnant women,
and the
complexi-
ty
of the woman-fetus
relationship,
which make a
unitary
con-
struct of maternal-fetal conflict
simplistic, reductionistic,
and
misconceived.
NOTES
This research was
supported
in
part by
NICHD Grant HD-11944 and
grants
from
the Academic Center and the Chicano Studies Research Center at the
University
of
California at Los
Angeles.
The authors would like to thank
Stephanie Browner,
Elaine
Gerber,
Laura
Gomez, Lynn Morgan,
Christine
Morton,
and the Feminist
Studies reviewers for their
thoughtful
feedback and criticism.
1.
Pregnant
women are not the
only
ones who receive these
messages.
For
instance,
liquor labels, billboards,
and commercials are an admonition to all fertile women.
Furthermore,
men and others often hear these
messages
as
permission
to exhort
pregnant
women.
2. The choice of nomenclature with these issues has definite
political implications.
We
deliberately
use the term "fetus" when we write of the
entity growing
inside a
pregnant
woman in our
analysis. Yet,
we also
respect
the
complex ways
in which
pregnant
women themselves conceive of and describe it.
Consequently,
we do use
the term
"fetus/baby"
when we make use of
pregnant
women's own accounts. For a
criticism of feminists'
problematic acceptance
and
embracing
of the term
"fetus,"
see
369
Susan
Markens,
C.H.
Browner, and
Nancy
Press
Christine Morton, "Ultrasound Babies and Their
Imaginary Counterparts:
Women's
Experience
of Fetal Visualization and Movements"
(unpublished manuscript,
in au-
thor's files).
3. Barbara Duden, Disembodying
Women:
Perspectives
on
Pregnancy
and the Un-
born
(Cambridge:
Harvard
University Press, 1993); Sarah Franklin, "Fetal Fascina-
tions: New Dimensions to the Medical-Scientific Construction of Fetal Personhood,"
in
Off-Centre:
Feminism and Cultural Studies, ed. Sarah Franklin, Celia
Lury,
and
Jackie
Stacey (London: Harper/Collins, 1991), 190-205; Rosalind Pollack
Petchesky,
"Fetal
Images:
The Power of Visual Culture in the Politics of
Reproduction," origi-
nally published
in Feminist Studies 13
(summer 1987): 263-92, reprinted
in
Repro-
ductive
Technologies: Gender, Motherhood, and Medicine, ed. Michelle Stanworth
(Minneapolis: University
of Minnesota Press, 1987), 57-80.
4. Franklin; Janet
Gallagher,
"Pre-Natal Invasions and Interventions: What's
Wrong
with Fetal
Rights,"
Harvard Women's Law Journal 10
(spring 1987): 9;
Dawn
Johnsen, "The Creation of Fetal
Rights:
Conflicts with Women's Constitution-
al
Rights
to
Liberty, Privacy,
and
Equal Protection,"
Yale Law Journal 95
(January
1986): 599-625.
5.
Gallagher;
Johnsen.
6.
Cynthia
R. Daniels, At Women's
Expense:
State Power and the Politics
of
Fetal
Rights (Cambridge:
Harvard
University Press, 1993),
11.
7. See Daniels; Franklin; Rosalind Pollack
Petchesky,
Abortion and Woman's
Choice: The State, Sexuality,
and
Reproductive
Freedom (Boston: Northeastern Uni-
versity Press, 1990);
and Barbara Katz Rothman, Recreating
Motherhood:
Ideology
and
Technology
in Patriarchal
Society (New York: W.W. Norton, 1989).
8. See Daniels.
9.
Wendy Chavkin,
"Women and the Fetus: The Social Construction of
Conflict,"
in
The Criminalization
of
a Woman's
Body,
ed. Clarice Feinman
(New York: Haworth
Press, 1992), 193-202; Gallagher; Johnsen; Petchesky,
Abortion and Woman's
Choice; Rothman.
10. See Carol
Bigwood, "Renaturalizing
the
Body (with the
Help
of Merleau-
Ponty)," Hypatia
6 (fall 1991): 54-73;
and Iris Marion
Young, "Pregnant
Embodi-
ment:
Subjectivity
and Alienation," Journal
of
Medicine and
Philosophy
9
(February
1984): 45-62, for their
personal
and
philosophical
accounts of
pregnancy.
Their work
describes the embodied
experience
of
pregnancy
from these authors'
perspectives,
but there are few
published laywomen's
accounts of low-risk
pregnancy experience.
See Christine Morton, "Relations in Utero: A
Study
of the Social
Experience
of
Preg-
nancy (master's thesis, University
of California at Los
Angeles, 1993).
11. Sheila
Kitzinger,
Ourselves as Mothers: The Universal
Experience of
Mother-
hood
(Reading,
Mass.:
Addison-Wesley Press, 1995),
and Women as Mothers (New
York:
Vintage, 1978); and
Joyce
E.
Thompson,
Linda V.
Walsh, and Irwin R.
Merkatz,
"The
History
of Prenatal Care: Cultural, Social, and Medical Contexts,"
in
New
Perspectives
on Prenatal Care, ed. Irwin R. Merkatz and
Joyce
E.
Thompson
(New
York:
Elsevier, 1990),
9-30.
12. Sandra Lee
Bartky, "Foucault, Femininity,
and the Modernization of Patriar-
chal
Power,"
in Feminism and Foucault:
Reflections
on Resistance, ed. Irene Dia-
mond and Lee
Quinby (Boston: Northeastern
University Press, 1988), 61-86;
Susan
Bordo, Unbearable
Weight: Feminism, Western
Culture,
and the Body (Berkeley:
University
of California
Press, 1993);
Kim
Chernin, The Obsession:
Reflections
on
the
Tyranny of
Slenderness (New York:
Harper
& Row, 1981); and Mimi Nichter and
Nancy Vuckovic, "Fat Talk:
Body Image among
Adolescent
Girls,"
in
Many
Mirrors:
Body Image
and Social Relations, ed. Nicole Sault (New Brunswick,
N.J.:
Rutgers
University Press, 1994), 109-31.
13. Robert C. Cefalo and
Merry-K Moos, Preconceptional
Health Promotion: A Prac-
tical Guide
(Rockville,
Md.:
Aspen Publications, 1988); Jacquelyn Litt,
"Pediatrics
370
Susan
Markens,
C.H.
Browner,
and
Nancy
Press
and the
Development
of Middle-Class
Motherhood,"
Research in the
Sociology of
Health Care 10
(1993): 161-73;
Maureen McNeil and
Jacquelyn Litt,
"More Medical-
izing
of Mothers: Foetal Alcohol
Syndrome
in the U.S.A. and Related
Develop-
ments,"
in Private Risks and Public
Dangers,
ed. Sue Scott et al.
(Brookfield,
Vt:
Ashgate, 1992),
112-32.
14. See U.S. Bureau of the
Census,
Current
Population Reports, Households,
Fami-
lies,
and Children: A
Thirty-Year Perspective (Washington,
D.C.:
GPO, 1992),
28-29.
15. Jennifer
Terry,
"The
Body
Invaded: Medical Surveillance of Women as
Repro-
ducers,"
Socialist Review 19
(July-September
1989):
13-43.
16.
Duden, Disembodying Women, passim.
17. Marie H6elne
Huet,
Monstrous
Imagination (Cambridge:
Harvard
University
Press, 1993).
18. Carol Brooks
Gardner,
"The Social Construction of
Pregnancy
and Fetal Devel-
opment:
Notes on a
Nineteenth-Century
Rhetoric of
Endangerment" (unpublished
manuscript,
in author's file).
19. More
recently,
some
pregnant
women started
listening
to classical music be-
cause of research that claimed the fetus could hear while in utero.
20. Peter Conrad and J.W.
Schneider,
Deviance and Medicalization: From Badness
to Sickness
(St.
Louis: C.V.
Mosby, 1980);
Peter
Conrad,
"Medicalization and Social
Control,"
Annual Review
of Sociology
18
(1992): 209-32; Irving
Kenneth
Zola,
"Medi-
cine as an Institution of Social
Control," Sociological
Review 20 (November 1972):
487-504.
21. We
adapt
this
phrase
from
Marjorie
L.
DeVault, Feeding
the
Family:
The Social
Organization of Caring
as Gendered Work
(Chicago: University
of
Chicago Press,
1991),
who uses the
concept
of
"feeding
the
family"
to
highlight
the effort and skill
behind the "invisible" work done
mainly by
women in
providing
sustenance for a
family.
22. Daniels discusses the
problem
of "selfless motherhood."
23. See
Morton,
"Ultrasound Babies and Their
Imaginary Counterparts,"
for an ac-
count of
pregnant
women's
personification
of the fetus and an
attempt
to
reconcep-
tualize "fetal
personhood"
from a feminist
perspective.
24.
Margarita Artschwager Kay, "Mexican,
Mexican
American,
and Chicana Child-
birth,"
in Twice a
Minority:
Mexican American
Women,
ed.
Margarita
Melville (St.
Louis: C.V.
Mosby, 1980), 52-65;
Ellen S.
Lazarus,
"What Do Women Want? Issues
of
Choice, Control,
and Class in
Pregnancy
and
Childbirth,"
Medical
Anthropology
Quarterly
8 (March 1994): 25-46; Emily Martin,
The Woman in the
Body:
A Cultural
Analysis of Reproduction
(Boston: Beacon
Press, 1987); Rayna Rapp, "Accounting
for
Amniocentesis,"
in
Knowledge, Power,
and Practice: The
Anthropology
of Medi-
cine and
Everyday Life,
ed.
Shirley
Lindenbaum and
Margaret
Lock
(Berkeley:
Uni-
versity
of California
Press, 1993), 55-76;
Edward
Spicer, ed.,
Ethnic Medicine in the
Southwest
(Tucson:
University
of Arizona
Press, 1977).
25. Ellen S.
Lazarus,
"Theoretical Considerations for the
Study
of the Doctor-Pa-
tient
Relationship: Implications
of a Perinatal
Study,"
Medical
Anthropology Quar-
terly
2
(March 1988): 34-58.
26. For an
analysis
of how
high-risk
women
(e.g., drug
addicts)
respond
to
pregnan-
cy,
see
Margaret
H.
Kearney, Sheigla Murphy,
and Marsha
Rosenbaum, "Mothering
on Crack Cocaine: A Grounded
Theory Analysis,"
Social Science and Medicine 38
(1994): 351-61.
27. Thomas P. McDonald and Andrew
Coburn,
"Predictors of Prenatal Care Utiliza-
tion,"
Social Science and Medicine 27
(1988):
167-72.
28. Arlene
Eisenberg,
Heidi E.
Murkoff,
and Sandee E.
Hathaway,
What to
Expect
When You're
Expecting
(New
York: Workman
Press, 1991),
and What to Eat When
You're
Expecting
(New York: Workman
Press, 1986).
371
Susan
Markens,
C.H.
Browner,
and
Nancy
Press
29. All names have been
changed
to
protect
the identities of our informants.
30.
Chavkin; Lynn Morgan,
"Fetal
Relationality
in Feminist
Philosophy:
An An-
thropological Critique," Hypatia
11
(summer 1996): 47-70.
31. Robin
Root,
C.H.
Browner,
and
Nancy Press, "Foucault, Feminism,
and the
Pregnant Body" (unpublished manuscript
in author's files).
32.
Chavkin;
Daniels.
33. C.H. Browner and
Nancy Press,
"The Production of Authoritative
Knowledge
in
American Prenatal
Care,"
Medical
Anthropology Quarterly
10 (June 1996):
141-56.
34. Also
troubling
is the
finding
that
poor
and
minority
women are
disproportion-
ately prosecuted
for fetal
neglect.
See
Daniels;
Chavkin. For similar
findings
re-
garding
sentence
discrepancies
for
perinatal endangerment,
see Anna
Lowenhaupt
Tsing,
"Monster Stories: Women
Charged
with Perinatal
Endangerment,"
in Uncer-
tain Terms:
Negotiating
Gender in American
Culture,
ed.
Faye Ginsburg
and Anna
Tsing
(Boston:
Beacon
Press, 1990),
282-99.
35. It should be noted that Rhonda Bennett refers to her status as
mother, and,
concomitantly,
her maternal
responsibilities,
as
they pertain
to her
pregnancy
rela-
tionship
to her
fetus/baby.
36. Browner and Press.
37. Linda M. Hunt et
al., "Compliance
and the Patient's
Perspective: Controlling
Symptoms
in
Everyday Life," Culture, Medicine,
and
Psychiatry
13
(September
1989):
315-34.
38. Further research is needed to
explore
the difference between
pregnant
women's
practices
which are believed to
actively
harm the fetus
(e.g., smoking,
use of
alcohol,
drugs,
coffee) and women's
practices
of
passively
not
doing everything possible
to
"grow"
the fetus
(e.g.,
not
eating enough
of recommended food
items).
39. The
special
concern with caffeine
may
be its association with
drugs
and the
clear
anti-drug
rhetoric within
popular
culture. This concern with
drugs
is
particu-
larly strong
in relation to the habits of
pregnant
women.
Indeed,
it was the
phenom-
enon of "crack babies" that drew much
public
attention to and concern over the
"negligence"
of
pregnant
women. See Laura
Gomez, Processing
and
Managing
So-
cial Problems: The Institutionalization
of Pregnant
Women's
Drug
Use in the Cali-
fornia Legislature
and Criminal Justice
System
(Ph.D. diss.,
Stanford
University,
1994).
40. Ian
Chalmers, Murray Enkin,
and Marc J.N.C.
Keirse, eds., Pregnancy,
vol. 1 of
Effective
Care in
Pregnancy
and Childbirth (Oxford:
Oxford
University Press, 1989).
41. For a
review,
see
Morgan.
42.
Petchesky,
Abortion and Woman's Choice.
43.
Daniels,
137.
44. Susan
Markens,
"The Problematic of
'Experience':
A Political and Cultural Cri-
tique
of
PMS,"
Gender &
Society
10
(February
1996):
42-58.
45. Barbara
Duden,
The Woman beneath the Skin: A Doctor's Patients in
Eigh-
teenth-Century Germany (Cambridge:
Harvard
University Press, 1991);
Thomas
Laqueur, Making
Sex:
Body
and Gender
from
the Greeks to Freud
(Cambridge:
Har-
vard
University Press, 1990).
46. We would like to thank
Rayna Rapp
for
bringing
our attention to this
point.
372

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