What Else to Expect When You’re Expecting

Last Christmas our parish hall displayed a Nativity painting by a local artist, showing a dark-haired woman in a wheelchair holding an infant, with a man in hospital scrubs standing solicitously behind them. The scene was instantly recognizable to anyone who has had a baby in this country in the last few decades. It was a typical hospital birth: the just-delivered mother bonding with her newborn, the father outfitted as birth assistant. Here was Madonna as primipara, what doctors call a woman delivering her firstborn.

It is, of course, nothing new for artists to interpret the Incarnation in contemporary settings. Still, the picture is revealing. Presumably it made sense to the artist to portray history’s most important birth this way because the image so comports with our current impressions of what childbirth looks like. Indeed, we take for granted the doctor-and-hospital trappings of childbearing, even though our way of having babies is comparatively new and unusual in world-historical terms. While medicine provides great benefits for the health of both mothers and children, elements of this system might give us pause, particularly as technological and market imperatives redefine the experience of pregnancy.

Like so many other spheres of life, having a baby is now a matter of choice. Contraception lets women choose whether to bear a child at all. Legal abortion lets them choose not to have one already conceived. Social and career considerations encourage that babies be timed appropriately. To be sure, there are plenty of “unplanned” pregnancies, yet even that figure of speech reinforces the norm that having a baby is something one elects to do. Because pregnancy is no longer a taken-for-granted part of female adulthood but a highly deliberate act, women tend to view it as an epochal undertaking to be done right.

Though some expectant mothers choose midwives and birth centers to assist them in this goal, the majority still sees two lines on a home pregnancy test as a prompt to call the OB. Why? To begin with, we view doctors as the experts competent to help insure that pregnancy has a good outcome: a healthy baby. But something else, less easy to articulate, also drives women faithfully to prenatal appointments. In part, it is that doctors ratify mothers’ perception that what is happening to their bodies and babies is amazing, deserving special attention and honor.

Doctors now can tell—and show—us what is happening inside the womb, and their interpretation of pregnancy is the one we recognize as authoritative. Physicians tell women what to expect, and lo, those things often come to pass. They forewarn that skin may itch and noses bleed and teeth become more subject to decay, and then patients observe those things happening. Pregnant women master medical jargon to describe themselves, attributing discomforts and development to hormones like hCG and estrogen and oxytocin, counting days in gestational weeks, and when labor comes, reporting progress in terms of effacement percentage and dilation (expressed in precise metric measure). Adopting this terminology is a way for women to mark this remarkable period in life. It seems to deserve a special language, and we really have no other such vocabulary in which to describe it. There is something to this. It is one way of demarcating these nine months as distinct from the rest of life, when the only soul a woman carries around in her body is her own.

Yet in the role of enhancing the experience and appreciation of pregnancy, medicine is limited. Maternity patients look for more from their doctors than simply information that such-and-such side effects accompany gestation, or even simply why, in physical terms, these things happen. While Doppler heartbeat monitors and ultrasound apparatus can reveal what used to be veiled in flesh, plenty is left mysterious. Madonna can be passed off as primipara in a painting because women today recognize childbirth as a medical event, but they have known all along that it is a spiritual one. Exactly because this is such a sensitive time can women imagine parallels between the Virgin Mother and their own childbearing. Pregnancy practically cries out for spiritual reflection, so obvious is it that the giving over of one’s body to new life reveals deep meaning, beyond explanations articulated by biochemistry.

If pregnancy were experienced only in the abdomen, there might be little else to explain. But being pregnant is not just about the big belly. Pregnancy manifests itself throughout the body: making one sick at the smell of hamburgers, or dizzy or disoriented at unlikely times; making ankles swell and feet expand so normal shoes don’t fit; inscribing evidence of itself all over the skin, from dark splotches on the face to little tears wherever the body stretches thin, to the dark line, the linea nigra, that descends from the navel and bisects the belly. The mind does not stand aloof either, as pregnancy raises anxieties, generates unsettling dreams, makes the memory fuzzy—or, as one guidebook puts it, prompts the mother to address “unresolved problems or other ‘baggage’ that was never properly unloaded.” Finding herself at once bearing fruit and going to seed, a woman might reasonably request theological counsel.

Scores of books in print bear witness to this need, though they are not very good at filling it. For Christians there are expectant-mother devotionals, and for the public at large there is no shortage of sentimental or new-agey meditations. Both sorts of books tend to offer diffuse and insubstantial reflections about the cuddly one-to-be. And bestselling manuals like What to Expect When You’re Expecting just present medical information in layman’s language.

Clinical definitions tell a woman a lot about what is happening to her but do not give her much help in connecting these events with any larger scheme of meaning. Medicine might happily concede the point on the grounds that spiritualizing pregnancy falls outside its job description. Now that women look primarily to doctors for explication of pregnancy, though, it is not entirely clear where else they might look. And there are deeper concerns that proceed from our practice of entrusting pregnancy to medicine. We have learned to expect doctors to provide a healthy baby. That way of thinking, however, can encourage both doctors and patients to do things they should not in order to get a healthy baby.

Prenatal care includes batteries of tests—blood pressure, blood sugar, weight gain, and so forth—aimed to check whether mother and child are progressing normally. Tests for genetic abnormalities are now offered alongside these. For mothers in their thirties, alpha-fetoprotein screens and amniocentesis are on their way to becoming standard. Even when no one forces her decision, the very fact of genetic screening pressures a woman to have the tests and, if defects are detected, to consider ending the pregnancy. Childbearing is so founded on choice, and medicine so firmly established as the means to a good outcome, that a “quality-assurance” mentality can be hard to avoid altogether.

Related dilemmas, and even harder ones, arise in cases of infertility, when desire for children may lead couples to seek a baby through some of the mind-boggling techniques now available. Beyond in vitro fertilization of the parents’ own sperm and egg come variations with donated or contracted sperm, egg, or uterus; sperm sorting to get a child of a preferred sex; preimplantation genetic diagnosis to develop stronger embryos and sort out weaker ones; even cytoplasmic transfer of cellular material from another woman’s egg to the hopeful mother’s ovum, to make the latter more robust while maintaining that genetic material passed to the fetus is still (mostly) the mother’s own.

These methods—let alone cloning and other genetic manipulations currently under research—might seem like sci-fi fantasies to the average pregnant woman, remote from her experience. But so firmly are we in the habit of expecting medicine and technology to improve baby-making that we may be predisposed to take up whatever researchers offer us. High-tech intervention is already such a part of normal pregnancy that new, ethically questionable methods of screening and engineering could blend easily into the prenatal program that women now view as routine. In the face of reproductive breakthroughs, even couples who favor making babies at home might be won over. Why trust the health and well-being of one’s child to sex when there is so much at stake? Technologies that seem unsavory in the abstract can seem more palatable if they stand to benefit (or help create) one’s own children.

American women who become pregnant are likely to find themselves caught between two contradictory cultural impulses. On the one hand, women are edging away from standard hospital procedures in search of more natural births. Critics from feminists to anthropologists to midwifery advocates have faulted the assembly-line quality or even “patriarchal” domination of hospital delivery. Conscious of the market, many hospitals now advertise homey looking “birthing suites,” big tubs for water labor, and beds fitted with squatting bars. Yet even as trends pull delivery toward a more natural sphere, women consign enormous aspects of the childbearing process to technology, especially when there is trouble conceiving. In a culture that practically worships reproductive choice, prenatal care is one of the few contexts where pregnancy is accorded the respect it deserves. But pregnancy can be acutely vulnerable in that very same context, when destruction of human life appears as a sanitized, standard procedure.

Of course, all this is not to insist that childbirth be removed from the realm of medicine. But Christian communities, drawing on both Scripture and tradition, should foster ways of thinking about pregnancy beyond the clinical narrative. Reviving the language of procreation is a way to begin. Instead of casting pregnancy primarily as a partnership between physicians and patients, procreation calls mothers and fathers into cooperation “with the Creator in the marvelous task of giving life to a new human being,” in the words of Pope John Paul II. A woman undertaking such a task is doing more than following prescriptions to watch her diet and exercise; she is embarked on a discipline with its own kind of fasting, abstinence, and sometimes even suffering. Faithfulness in the process matters, not just the outcome.

The process brings instruction in motherhood even before the baby is born, making plain the frailty of the body, the profound overlap of human life, and the limits on our ability to determine our own offspring. This last lesson may be most critical, given the age we inhabit. Learning to honor a child as a created human life, entrusted in sickness and in health, can lead parents out of the creeping temptation of expecting only perfect babies.

Reflecting deeply on the meaning of “normal” pregnancy may help us speak more wisely about the potential perils of pregnancy directed by biotechnology. The fact that Jesus saw fit to liken the Apostles’ reaction to his death and resurrection to a mother’s grief and joy in birth suggests that men and women both would profit from thinking well about childbearing.

Agnes R. Howard teaches at Gordon College in Wenham, Massachusetts.

Image by Mart Production, in the public domain. Image cropped.