feeding the fetus- on interrogating the notion of maternal-fetal conflict (1997)

8/11/2019 Feeding the Fetus- On Interrogating the Notion of Maternal-fetal Conflict (1997)

1/23

Feeding the Fetus: On Interrogating the Notion of Maternal-Fetal ConflictAuthor(s): Susan Markens, C. H. Browner and Nancy PressSource: Feminist Studies, Vol. 23, No. 2, Feminists and Fetuses (Summer, 1997), pp. 351-372Published by: Feminist Studies, Inc.Stable URL: http://www.jstor.org/stable/3178404.

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2/23

FIK

:DING

THE

FETUS:

ON

INTERtROGATING

THE'1

OTION

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

complicatedpregnancy

and

possible poor

birth

outcome.

Recollection

of

a

Recently

Pregnant

Woman:

"Isaid 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.3At 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

ndeed,

in

the

beginning

of this

century,

U.S.

Feminist

Studies

23,

no. 2

(summer 1997).

?

1997

by

Feminist

Studies,

Inc.

351

This content downloaded from 141.213.236.110 on Tue, 22 Oct 2013 01:53:03 AMAll use subject toJSTOR Terms and Conditions
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3/23


4/23

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

fromthe health

of the woman

to the

health

of

the fetus.16 ssues

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"

exual

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.19Our

argument

is

that

pregnancy

has

always

been controlled: what

changes

is

353



5/23

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 recommendationsby 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



6/23

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

nterviews

of one and a half

to four

hours

in

duration were conducted

in

informants' own

homes or

at the HMO.Tapes were transcribed and subjectedto 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

e

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



7/23

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

n

the discussion

of our

findings,

therefore,

we

do

not differentiate

among subgroups

of

informants.In fact, the lack of variation amonggroupsdemon-

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

urthermore,

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



8/23

Susan

Markens,

.H.

Browner,

nd

Nancy

ress

FINDINGS

I've eaten a lot healthier.

I

used to be

a

hamburger-fries-

shakes

person,

nachos,

any

kind of

junk

food here was.

I

was into it. We'd

go

out to eat almost

every

night

and

it

was

always burgers

or steaks

or barbecueor a

couple

of

beers. And now it's

salad,

it's what has iron ....

I've

eaten a lot healthier oodswith this

pregnancy.

-Pregnant

woman

Prenatal educationand the context

of healthy eating.

The wom-

en

in

our

study

were both concernedwith 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.27At the HMO where we

collected

data,

this care

in-

cludeda one-timeonly three-hourprenatal 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"

oods,

an

exercise

which

delighted

the

women

in at-

tendance,

particularly

those

who

got

the

"bad,"

ut

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 becomingpregnant, 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 llow

you

to

357



9/23

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'llbe

pleased

if

you

can

get

three

servings.

.

.").

Some educators

preferred

to

personify

the

fetus,

with

admonishments

like "Eat ots 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 connectingyou ... 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

s 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 coveredin class.

Lay

self-carebooks 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"

n

different

popular

sources),

there

is consensus on

certain

general

principles-for example,

the intake of

sugar,

salt,

and

fat should

be

limited;

"fast" oods

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 reportedthat they made changes in

their diets because of their

pregnancy

in

accommodation

o 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



10/23


11/23

Susan

Markens,

C.H.

Browner,

and

Nancy

Press

something

in

my

mouth

I'm

always thinking

the

baby's goingto 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:"BecauseI 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 comfortableabout

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/babyto

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



12/23


13/23

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

n

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"

oods

(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 alcoholduringher pregnancyin the followingway: "I'vehad

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



14/23

Susan

Markens,

C.H.

Browner,

and

Nancy

Press

specific

foods

they

eat that

they

know

are considered

problem-

atic,

rarely

is the

"perfect"

iet 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. Forpregnantwomen 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"ntake

and/or

increasing

the

consumption

of

"good"

oods. 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"

tems

she still

consumes is a

dramatic

example

of how

pregnant

women

accept

maternal

responsibility

for their

fetus/baby

in

a

363



15/23


16/23


17/23

Susan

Markens,

C.H.

Browner,

and

Nancy

Press

for Tina Herrera:

"I

try

to eat the

servings

[recommended

n

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.36Our

argument

here is that

regardless

of whether

women

follow biomedical

advice,

they

are

generally

aware of

what

they

"should" e

eating

in

biomedical

terms.

This medical

knowledge,

in

conjunction

with embodied

knowledge,

is often

used to evaluate

how

"good"

r "bad"

hey

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"

ractice

by engaging

in

other

"good"

ractices.

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" abits

(i.e.,

eliminating junk

food,

caffeine, alcohol,

etc.,

from

their

diets)

and/or

decreasing

the amount they smokedwhile pregnant.Laura Givens'sstrat-

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"

ehavior

of

dietary

intake:

"I

am

a

smoker,

I

smoke about

three

cigarettes

a

day

and

I'm

not

giving

them

up

366



18/23


19/23

Susan

Markens,

C.H.

Browner,

and

Nancy

Press

we

posed

in

this

article

is,

How do

pregnant

women

experiencethis

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

nterests-women

experience

it

as

both.

As

such,

"conflict" s

something

which

emerges

in

particular

women, in particularpregnancies,and in particularcontexts.

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

ife-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



20/23


21/23

Susan

Markens,

C.H.

Browner,

and

Nancy

Press

Christine

Morton,

"UltrasoundBabies and Their

Imaginary Counterparts:

Women's

Experienceof 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-ScientificConstruction

of

Fetal

Personhood,"

in

Off-Centre:

eminism 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," rigi-

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'sConstitution-

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:

deology

and Technology n PatriarchalSociety(New York:W.W.Norton, 1989).

8.

See Daniels.

9.

Wendy

Chavkin,

"Womenand the Fetus: The Social Construction

of

Conflict,"

n

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 n 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 Womenas 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,"

n

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,"

n

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, WesternCulture, and the Body (Berkeley:

University

of California

Press,

1993);

Kim

Chernin,

The

Obsession:

Reflections

on

the

Tyrannyof

Slenderness

(New

York:

Harper

&

Row, 1981);

and

Mimi

Nichter and

Nancy

Vuckovic,

"Fat Talk:

Body

Image among

Adolescent

Girls,"

n

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



22/23

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 JacquelynLitt, "MoreMedical-

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 BrooksGardner,"TheSocial Constructionof Pregnancyand 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 nd

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

he

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,"

or

an

ac-

count of

pregnant

women's

personification

of the fetus and an

attempt

to

reconcep-

tualize

"fetal

personhood"

rom

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

n

the

Body:

A

Cultural

Analysis of

Reproduction

(Boston:

Beacon

Press, 1987);

Rayna

Rapp, "Accounting

for

Amniocentesis,"

n

Knowledge,

Power,

and Practice:

The

Anthropology

of

Medi-

cine and

EverydayLife,

ed.

Shirley

Lindenbaumand

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,

"TheoreticalConsiderations 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 GroundedTheory Analysis,"Social Science and Medicine 38

(1994):

351-61.

27. Thomas P.

McDonaldand Andrew

Coburn,

"Predictors f 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).

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feeding the fetus- on interrogating the notion of maternal-fetal conflict (1997)

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