Researching Pregnancy

Chapter 2 we raised various contrasting or paradoxical aspects of pregnancy and these have been integral to our discussion of each of the topics we have addressed. They have included the apparent invisibility of women, in favour of their unborn child, bound up in the discourses of containment and responsibility that we have discussed in relation to employment, diet and exercise in particular. Intertwined with this is the complex mapping of the natural process onto the dominant biomedical discourse, which focuses on the management of risk and the sanctioning of behaviours, inherent in the discussions of diet and exercise but also relevant to the work on cognition. These are further complicated by the persistent images and representations of pregnancy which refer to feminine stereotypes and call into question the suitability of women"s role in the public domain during their pregnancy. This contrasts with the very visibility of pregnancy outside the routine; in the examination of celebrity and pregnancy ut of place" we can see these various discourses operating to deliver uncertainty and making pregnancy outside very narrow boundaries open to the types of commentary and interference we have described.

Although the wording undoubtedly reects standard advice on how to address the media (i.e. not commenting directly on any particular individual), it is telling in the context of this topic that the obstetrician refers tthe mother" rather than to an individual pregnancy and person are separate ident.i.ties.

Whether celebrity pregnancy is out of place or acts to separate individuals from their embodied experience, both the themes identied here locate pregnancy squarely in the public domain, whether as a matter of personal and private choices or as a public matter for inspection and concern. Lupton"s (1999) idea of theweb of surveillance" provides a way of conceptualising both the issue of pregnancy and of celebrity and brings us back to our initial point of engagement with the issue of celebrity pregnancy. While Lupton is talking about the management and representation of risk, we can extend the notion of the web of surveillance more widely to the concept of celebrity, particularly women celebrities. By apparently being the embodiment of the range of femininity, celebrities only need pregnancy to complete the picture. Indeed, it is almost a compulsory rite of pa.s.sage (Longhurst, 2005). At the same time, the legitimisa-tion of commentary that accompanies lives lived in the public domain is a.n.a.logous to the spotlighting of individuals who become pregnant, together with those who fall outside the boundaries of good motherhood.

Concluding remarks Like all pregnant women, celebrities are not permitted to remain private, their lives are lived on the boundary of the private and the public; like women and women"s appearance more generally, their clothes, their weight, their hair, and their partners, every element of their appearance and life is subject to comment. Equally, at no other time in their lives are ordinary healthy women given more sustained attention than when they are pregnant; they become celebrities for the period of their pregnancy, as the cases of the atypical pregnancies ill.u.s.trated. Thus, they are all subject to sanction and intrusion into their private lives. For example, women report that people (often complete strangers) will touch them or their b.u.mp or ask questions that would at other times be off limits, or regarded as hara.s.sment. For celebrities, by contrast, this is routine and even deliberately sought. The risk for a celebrity of not partic.i.p.ating in the surveillance is that they lose some aspect of their public ident.i.ty. It could be argued that to some extent their private ident.i.ty is actually already invisible; paradoxically, pregnancy provides a means of remaining under public, or at least media, surveillance but creating a shift in the gaze from 141 the individual to their pregnancy, a disembodied event. Thus, what appears to be intrusive could almost be acceptable or even welcome. For women who are not celebrities, the public involvement may also be welcome, but it may be intrusive.

There are undoubtedly a number of other ways that the relationship between celebrity and pregnancy can be viewed which are well represented in the media images and articles. One of these is the way in which pregnancy may serve to normalise celebrity. Like everyone else, celebrities get pregnant and put on weight (at least temporarily) and they are subject to the same conicting advice. But while such apparent frailties could at some times compromise celebrity status in the media, during pregnancy they may actually strengthen an individual"s currency as a celebrity. A common comment about seeing celebrities in real life is how familiar they seem. The apparently shared experiences of pregnancy, with morning sickness and discomfort, may bring them closer to the viewer and thus further sustain public interest via the media.

Signicantly, the impact of pregnancy may also be to extend the intrusion and surveillance that is part of the coverage of celebrities" lives more generally and further legitimate a critical framing of activity in the context of all women"s public roles. When they are pregnant, celebrities" partic.i.p.ation in the changed behaviours required of women who are taking their responsibilities seriously can also be commented on; the potential for increased criticism and identication of bad mothering is high.



Whether pregnancy serves celebrities well or ill in visibility terms, it is clear that the same tone of concern pervades the coverage of pregnancy as that applied to routine, normal pregnancies and those we identied earlier as atypical and the concept of good (and bad) mothers is invoked. By looking at celebrity pregnancy, albeit briey, we hope to have demonstrated that the almost permanent visibility that keeps pregnancy in the public eye is in part the outcome of a complex web of surveillance that surrounds women as they go about their daily lives.

Note.1 The Magdalene Laundries were inst.i.tutions sponsored and maintained by the Catholic Church in Ireland for the incarceration of young women thought to have transgressed public morals, including unmarried mothers. With the legal consent of their fathers, they were imprisoned and made to work for no pay in laundries, where they were exploited and often abused. The laundries existed until the 1970s and the last one closed in 1996.

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8.EPILOGUE.

Is pregnancy special?

In this book our thesis has been that the perceptions and beliefs held about pregnancy, including by women themselves, have determined both the research carried out on pregnancy, from a number of different perspectives, and the outcomes of that research in terms of its impact. On its own, this is hardly a novel thesis. However, we would argue that what we have been able to show, by looking at pregnancy in relation to the daily experiences of women"s lives cognition, employment, diet and exercise is that it is crucial to see women"s responses to their pregnancy as one dimension of an ongoing life of commitments, relationships, att.i.tudes and expectations that goes beyond the pregnancy. Combining the different topics we have discussed, we have identied a number of common themes, including several familiar discourses of pregnancy. The very consistency of these themes across the domains highlights their potential impact on women"s lives during pregnancy. Furthermore, it raises the question as to whether pregnancy can be said to be special or whether it can be regarded as simply another facet of the well-doc.u.mented territory of people"s lives, particularly women"s lives, more generally.

Before considering what we mean by "special" in relation to pregnancy and pregnancy research, we will summarise some of the main issues arising from each chapter, review the themes and discuss the various research perspectives.

The picture that has emerged from our review of a range of research on each of the topics, together with our own ndings, is one of inconsistency; ndings are frequently conicting or contradictory. This means, as we have suggested in several chapters, that during pregnancy women have to work hard to a.s.sess what is relevant or helpful to their own circ.u.mstances. Advice or information that arises from a shifting ow of research evidence has to be weighed against their own experience and opportunities. However, the research is seldom explicit either in relation to how this might be achieved or in recognising that this is an inevitable concomitant of the mixed economy of information available through a variety of sources.

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In Chapter 2 we raised various contrasting or paradoxical aspects of pregnancy and these have been integral to our discussion of each of the topics we have addressed. They have included the apparent invisibility of women, in favour of their unborn child, bound up in the discourses of containment and responsibility that we have discussed in relation to employment, diet and exercise in particular. Intertwined with this is the complex mapping of the natural process onto the dominant biomedical discourse, which focuses on the management of risk and the sanctioning of behaviours, inherent in the discussions of diet and exercise but also relevant to the work on cognition. These are further complicated by the persistent images and representations of pregnancy which refer to feminine stereotypes and call into question the suitability of women"s role in the public domain during their pregnancy. This contrasts with the very visibility of pregnancy outside the routine; in the examination of celebrity and pregnancy ut of place" we can see these various discourses operating to deliver uncertainty and making pregnancy outside very narrow boundaries open to the types of commentary and interference we have described.

Finally, we would not want to represent women as complicit in these discourses and concerns, though it may be inc.u.mbent upon them to manage the uncertainty that has been created. It is important to represent women as proactive in their own surveillance; issues of agency and control are at the forefront of women"s own experiences, as our own research ndings on diet and exercise have indicated. Indeed, the individual responsibility for created risk is now the common experience of all, but not an entirely negative experience. As we and Bondas and Eriksson (2001) have suggested, women wish to take control, they no longer take their health for granted and try to change their behaviour. Whether this is regarded as the acceptance of the advice and information they receive will depend on women"s own perceptions of their experience.

In the light of these parallel and competing concerns and in summary of the various topics we have covered in the book, we would like to highlight the following issues.

We dealt at some length in Chapter 4 with the topic of pregnancy and employment. The reason for this was that employment can be said to be a backdrop against which the various cultural beliefs about pregnancy are dramatically enacted. While it is by no means the case that all women encounter negative treatment, certainly the extent of such treatment serves to ill.u.s.trate how much the stereotypes of femininity and women"s roles remain endemic even in apparently enlightened societies. Women most likely to experience problems at work during pregnancy are those who would encounter them at other times: women with low-paid, low-status, low security jobs. The evidence that such att.i.tudes hold sway across the spectrum of employment, however, conrms that pregnancy is constructed as problematic for all women, in keeping with the biomedical discourses.

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While women"s previous experience at work is sometimes referred to, their treatment in pregnancy is seen largely as exclusive to that state as a visible representation of the public beliefs and att.i.tudes commonly held, but usually unspoken. Pregnancy in this context sanctions a set of comments and behaviour which are in many cases mostly actually illegal. In this case, therefore, pregnancy is the means by which other people can express their resentments or resistance to women"s independence, choices and lifestyle, while women are held to account. Ironically, they are held to account in research, much of it outside the traditional sphere of psychology, which is concerned less with their own behaviour and more with pregnancy outcomes. Even within research which has taken a psychological approach, women have been marginalised in terms of their importance and women have been seen as pregnant rst and individual women second.

In contrast to the other topics we have explored, research on diet is unusual in taking account of different cultural beliefs in relation to food choices and dietary behaviour. Therefore this work appears to avoid some of the traditional criticism that research adopts a largely monocultural approach. Despite this, the research and its ndings are not necessarily helpful in contextualising dietary behaviour and do not tend to take account of the contexts of women"s lives at other times, such as before they were pregnant. The research ndings have again concentrated on the unusual rather than on the routine, at the same time reporting ambiguous or inconsistent information proposing the reduction or restriction of certain dietary items. This lends itself to uncertainty of response and makes the surveillance of women"s behaviour more likely, which in turn leads to the sanctions on women"s behaviour. Women are expected to behave responsibly in order to ensure a healthy outcome, with the emphasis on their role as provider and container.

As with research on employment and diet, the research on exercise and daily activity is generally undertaken from a perspective that attends primarily to the risks and dangers of such behaviour and leaves room for doubt and uncertainty. However, it does have a feature not present in some other areas, which is that it points to the potential physical and psychological benets of such behaviour. Nevertheless, we would argue that this is very much from a position whereby women"s behaviour is treated as problematic and sanctions are imposed. What is interesting is that women do not necessarily respond as might be expected to these sanctions, because of the need to balance the relative risks and dangers to their own health with those perceived as affecting their baby. Research in this instance has very often led directly to guidelines for practice, like research on dietary hazards and some on employment hazards, and thereby it has positioned women as responsible for pregnancy outcome and for their own health the rhetoric of accountability. However, as with diet, lay beliefs remain clearly located within another discourse, that of moderation and even indulgence.

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This, incidentally, could be seen as providing women either with an opportunity for agency, giving women a further role as educator of others, or as conforming to a stereotype of motherhood whereby family health and diet is a fundamental duty of care. If it is to be as a proactive agent of education, it should be the case that pregnant women who take up advice to sustain their exercise are also able to inuence public att.i.tudes and beliefs; put simply, if there are more pregnant women exercising in the gym, it becomes more normal or routine, and their own discomfort and that of others may be reduced. Whether this can be achieved is less clear, and the evidence on pregnancy discrimination at work suggests that it may not be, but clearly the opportunity could be said to exist. However, as with diet, the problem remains of how to change behaviour even when such changes are sought since research evidence is also interpretable in several inconsistent ways and women are able to adhere to advice and ignore it simultaneously.

By contrast with the preceding three topics, the study of cognition in pregnancy has been largely addressed from a psychological perspective.

Before feeling too smug about this, the work is largely indistinguishable from that done from any other perspective and indeed it resonates very strongly with the biomedical tradition, taking as it does failure and incapacity as the starting point rather than development and skill: pregnancy as debilitation. Despite the absence of convincing evidence of incapacity, the research does women a signicant disservice, affecting others" att.i.tudes to women"s abilities and performance, endorsing recourse by women and by others to the power of the physiology of the natural process. Research on cognition during pregnancy very rarely invites women to identify improvements or examines the strategies that they adopt to counter any perceived effects. Thus, the outcome of research on cognition is to conrm female stereotypes rather than to challenge them and this has a forward trajectory for women"s lives as mothers and parents in the public domain; only rarely are the skills of mult.i.tasking and divided attention, which are frequently required in home life, regarded as valuable attributes in the job market for example.

The overarching theme arising from all the material we have explored, including that on celebrity pregnancy and atypical pregnancies, is that research has been accomplished to deliver sanctions on women"s behaviour. Sanction carries a double meaning, that of a penalty for disobedience and of approval for obedience, both of which are applicable within the discourses of containment, responsibility and femininity that pervade public beliefs about pregnancy. In effect, the research evidence also countenances a status quo, with the additional expectation that women must be accountable through their vigilance.

Last, we turn to the concept of whether pregnancy is special. In the previous chapter, we concluded that pregnancy serves as a means by which 146 women can be subjected to increasing surveillance. We discussed how pregnancy can be regarded as a form of celebrity and how the combination of visibility as represented by celebrity and the additional visibility accorded to special forms of pregnancy outside the narrowly dened boundaries of "normal" can accentuate the culturally determined responses to pregnancy.

Our conclusion to that chapter was not that pregnancy was special in that sense, rather that it provided an instantiation of a number of available discourses usually only referred to obliquely. However, when looking at all the issues raised by the chapters together, the answer to the question is perhaps not as clear. The word special means that something is in some way distinctive or exceptional, that is, that it is for a particular purpose or of a particular kind. Pregnancy cannot be dened as special without reference to the aspect that is being considered. This is not to say that the meaning or signicance of pregnancy is relative, but rather that it is complex.

In a personal sense, for the women concerned and their families, pregnancy is special, it is something distinctive and exceptional. Furthermore, as we pointed out at the start, healthy women are accorded more attention during their pregnancies than at any other time in their lives thus far, and in this sense they feel special. From our point of view, however, the implication of such a designation of pregnancy as special engenders the discourses of containment that are implicit in such special treatment; as we have seen in the ndings from research on employment and exercise, these discourses can dominate the way that women are treated during their special time. In a biological sense, too, pregnancy could be said to be special, something additional to the ordinary and, as a necessary activity for the reproduction of the species, pregnancy has a particular, unique purpose.

If we look, however, at the way research has dealt with pregnancy, we could perhaps say that pregnancy is not special. As we concluded in Chapter 7, the visibility of pregnancy is a manifestation of persistent and negative discourses which surround women and women"s behaviour at all times. If we consider diet, for example, in pregnancy attention paid to diet and eating is surely only a version of the monitoring of behaviour that goes on all the time, through the commentary on women"s appearance and clothing whether they are Princess Diana, Madonna or the US Secretary of State. The research and consequent guidelines developed for exercise and physical activity in pregnancy similarly reinforce the opportunity to a.s.sess whether women are working hard enough to maintain their own or their children"s health, endorsing once again women"s responsibilities and accountability, in this case frequently prioritising their infants" health over their own. The ndings on cognition also point to the problematic nature of pregnancy and women"s potential disadvantage, and the need for pregnant women to be treated with caution. In these senses therefore, we would suggest that pregnancy is not special. Neither is pregnancy research 147 special in that it takes as its model one of failure and inappropriate behaviour rather than capacity and enhancement. But this may be more than a concern with surveillance of women"s current or potential status.

The focus on the risks and dangers of daily living is by no means exclusive to pregnancy. As Shulamit Reinharz (1999: 438) amusingly details, such warnings are everywhere: would like to get through a day without being a.s.saulted by warnings. I nd this barrage of dire information intrusive, pervasive and depressing" (Reinharz, 1999 cited in Gray et al., 2001: 438).

If everyone is subjected to this high degree of contradictory and wide-ranging warnings then pregnancy could not be said to be special as such, but only to be a time when additional concerns are added to the mix. The negotiation of relative risks and benets is managed by all of us in relation to the practicalities of our lives. On the other hand, precisely because of the foregrounding of the invisible the baby or the foetus perhaps pregnancy is special. The issues of choice appear more salient, the concept of the future more immediate and the visibility of the risk more critical. Thus, women are not just responding to prevailing beliefs and discourses but are being agents in their own destiny, in the course of which they may encounter setbacks or support, and thus pregnancy has the potential to provide women with an opportunity to develop the negotiation of their position with that expected of them.

As we suggested at the beginning of this book, pregnancy is a challenging topic for research. We were rst attracted to this area because it appeared to be a nexus for many of the issues and concerns with which we as psychologists engage. While this may be satisfactory at an intellectual level, what seems to us to be regrettable is that only rarely are women accorded the opportunity in research to demonstrate the negotiation of the various different elements of their lives inherent in the experience of pregnancy. Rather, all that we have discussed above only serves to reinforce the research perspectives, which draw on the biomedical, the psychological and what could loosely be called the sociocultural. In the context of the research we have explored and discussed, the biomedical perspective is one where what is at issue is a set of processes out of the individual"s control.

Furthermore, a cultural or social perspective is one which also seems to us to disenfranchise women during pregnancy since it would appear that an individual is only able to exercise personal preferences and control when these are achievable in the face of publicly held beliefs and expectations.

Perhaps surprisingly, one of the positive elements of the psychological perspective, even if it has not always been manifest in the work we have described here, is that the whole individual is the focus of study, and that research is seeking to explain normal behaviour in relation to underlying characteristics and a range of different experiences. This has also been considered one of the weaknesses of some traditional psychology with its emphasis on a psycho-biomedical approach by which means the focus of 148 study has been on the minutiae of individual elements of a process or function, and within which the work on pregnancy and cognition could be said to be located. Nevertheless, a psychological perspective on pregnancy is one which acknowledges the very complex set of factors likely to impact on a person"s behaviour or att.i.tudes. While we have only been able to point to a limited set of ndings using these kinds of approaches, including perhaps some of our own work, in the main we would argue that there is considerable potential for extension of the concept of the person into the research, as has been the case with qualitative approaches. So although pregnancy research has been open to the same problems of prevailing beliefs and expectations as other domains, there are areas which have provided signicant illumination of the experience. In this sense, we would suggest that the viewpoint we have taken on pregnancy, as psychologists, is also special.

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GLOSSARY.

Antenatal Refers to events and experiences happening or existing during pregnancy before birth and pertaining to or concerned with the health and wellbeing of women during pregnancy, hence antenatal care.

Maternity leave Period of time allowed off from work to have a baby; length varies according to country, e.g. from 14 weeks minimum to 52 weeks maximum in Europe; may be paid at more than minimum benet level.

Maternity pay Money paid to a woman while on maternity leave, comprising state-provided funds and for some employees money paid by their employer.

Multigravida A pregnant woman who has been pregnant before, but who has not necessarily given birth before.

Multiparous Having had more than one child; sometimes used to mean pregnant for a second or further time but having given birth to at least one child.

Perinatal Referring to the period around the very end of pregnancy, labour, delivery and childbirth, and including the period directly afterwards.

Postnatal and post partum Both terms refer to the period following birth.

Primagravida Term used for a woman pregnant for the rst time.

Primiparous A term meaning bearing a child for the rst time; sometimes used interchangeably with primagravida to mean pregnant for the rst time.

Trimester Obstetrically, pregnancy is considered to last for 40 weeks and to have three stages, each of about 14 weeks in length, referred to as the rst, second and third trimesters. Thus, the third trimester refers to the last three months of pregnancy. We have used the term to reect the detail of research studies and elsewhere, as a form of shorthand for early, middle or late pregnancy.

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