The road to parenthood is littered with advice and criticism. A burgeoning bump is an invitation for all manner of questions and commentary. For example, strangers will ask whether the pregnancy was planned, family members will comment on how long it took for the couple to get pregnant, and everyone will offer advice regarding everything from whether a woman should have an epidural to when the baby should have his first bath. Are you having an occasional glass of wine? Are you staying away from soft cheeses? Will you breastfeed? Will you breastfeed in public? When will you wean? Are you co-sleeping? Bedsharing? Cloth diapering? Is your infant getting tummy time? Are you reading to him? Are you giving her fruits or teasing her with ice cream?
These types of questions (and more) contribute to an inordinate amount of noise driving new families in different directions. A study published in Pediatrics finds that mothers of infants receive advice from doctors, birth hospital nurses, family and the media, and the inconsistency of the information they receive regarding general recommendations is the only consistency to be found. Generational differences about sleep positioning practices and breastfeeding, as well as beliefs about the efficacy of vaccinations all contribute to a mixed bag of parenting advice that new parents have to decipher from family members and the media. The study suggests that as new parents face the unique challenges of caring for a newborn, they're not receiving the support they need from their health advisors to follow evidence-based recommendations from public health groups. So despite the noise, there are important aspects of pregnancy that we're not talking about and these omissions are culturally problematic. This information void creates the sense of an ideal pregnancy that few actually experience.
When Duchess Kate delivered Princess Charlotte earlier this year, she appeared for a post-maternity photo-op looking like, well, a Duchess. Her hair and make-up had been done, her clothing was impeccable, and as some commentators pointed out, Charlotte's blanket was draped in such a way as to artfully hide the new mom's post-baby belly. The Internet was floored. Many commenters rushed to dismiss her appearance as something only a celebrity could expect, while some admitted jealousy, and  others expressed pity that a mother would have to assume normalcy so soon after giving birth. The consensus from bystanders was that this was not a general experience, and it stood in contrast to some elements of Kate Middleton's appearance following the birth of Prince George. In that instance, while she was still well-dressed, her slight post-natal bump was not as carefully camouflaged and the blogosphere had celebrated this small admission of what real women's bodies look like post-pregnancy.
The buzz that happened around Kate and both of her post-pregnancy appearances are significant in terms of a larger experience of pregnancy. The commentary on her physical appearance adds to the current public discourse on the expectations--both real and perceived--to shed pregnancy weight as quickly as possible and resume participation on one's pre-pregnancy life to the fullest extent possible. This includes fitting into pre-pregnancy clothing and returning to work sometimes before a woman's body has fully healed. In the United States, it's almost as if there is a cultural push to pretend that pregnancy doesn't happen, particularly as in many places common courtesy, such as offering a pregnant woman a seat on public transportation, is lacking. In fact, the treatment of pregnant women can spur vehement debates between those who choose to remain childless or otherwise feel that the election of this state of life creates an unwarranted sense of entitlement and those who have lived through this experience in some aspect. The question of paid maternity leave in the United States fits into these debates, as does a growing public discourse about the appropriateness of children's behavior in public places. These issues challenge a commercially manufactured sense of "normal" that romanticizes the state of being childless, and consequently leaves little room for accommodations that may infringe upon the celebrated freedoms that are perceived to be associated with this choice.
This rush to return to normalcy highlights the things that we aren't talking about when it comes to pregnancy. Miscarriages, gestational diabetes, and pregnancy-related hypertension are real issues that women may encounter during the course of their pregnancy but aren't issues that are widely discussed unless they arise during the course of a pregnancy. However, these issues do exist:
  • Approximately half of all fertilized eggs are spontaneously aborted before a woman knows she is pregnant. And among women who know they are pregnant, the miscarriage rate is between 15%-20%.
  • Gestational diabetes can affect up to 14% of pregnancies in the United States.
  • Six to eight percent of pregnant women experience issues with hypertension.

Additionally, Cesarean births and postpartum depression/paranoia are riddled with stigma. Rather than encouraging open discussions that may highlight support networks for women who have fertility challenges or difficulties during or after their pregnancy, a culture of shame persists that works to establish these experiences as unusual. Normal presently does not include complications, but it can and should. By not talking about these occurrences in public forums, these issues seem isolated. They can then be linked to individual actions instead of being recognized as independent medical conditions. As this sort of identification takes root, the individual may hesitate to seek help because they perceive social blame will be placed on their shoulders.

The Mommy Blog phenomenon is working to change some of this, but these experiences can be hidden amidst other narratives. Information and experiences are more freely shared in online birth forums (e.g., Baby Center, The Bump, What to Expect). Members can connect with each other based on their due date or find a group with a shared experience. This can be helpful for pregnant women with a new diagnosis of gestational diabetes or post-natal hypertension. But it also helps with more common concerns as well. There are a lot of "Is this normal"-type questions, and the answers can help reassure women who won't or can't get answers within their social circles. This seems like a great thing, and it is, but these forums also reiterate popular opinions and biases. As a result, co-sleeping and breastfeeding can become hot button topics. So women who may hold alternative or modified views of these practices may be ostracized by the online community. That means the transfer of evidence-based recommendations can fail in this medium because the engagement is one-sided.
Furthermore, the forum members are not equipped to deal with issues like postpartum depression or paranoia. At best, if a member expresses these feelings, others can suggest she reach out to her doctor or offer to visit. But there isn't a way to force a member to get help. And it's easier to admit that something isn't right online among strangers whom you may never meet than in real life where you may be judged by loved ones.
Changing the cultural perception of pregnancy has to start with the health care providers. Researchers suggest that the inconsistency in the messaging that patients receive from their health care providers may come about due to a lack of knowledge about the recommendations, an awareness of controversy surrounding the recommendation, or disagreement with the recommendation. But more concerning, some health professionals may choose to avoid the topic or conversation during busy times in the practice. But health care providers may represent the best means of issuing consistent messaging and a standardized experience. Realistically, medical practices will determine the tone they want to take with their clients: conservative doctors may order more tests and ask more questions, and sadly, insurance may also be a factor in the type of care a patient receives. However, the dangers presented when people don't seek help because they are ashamed can be far reaching. In this instance, it may impact an otherwise healthy pregnancy, lead to self harm, or the harm of an infant or child.
Family and media represent the largest sources of information for pregnant women. Family beliefs may be the hardest to change but health care providers may prove to be a source of empowerment for women who need to counter advice that goes against mainstream guidelines and recommendations. Health care providers are in the best position to talk to new parents about how guidelines can be modified safely to suit their family. As it stands, guidelines and recommendations may be ignored because they are presented as a one-size fits all mandate. However, this overlooks specific cultural beliefs and individual family needs. Changing the idea that pregnancy and children are an inconvenience means encouraging women and new parents to talk about their experiences. We have to dismantle the existing definition of normal to include less than perfect circumstances.
Staci R. Eisenberg, Megan H. Bair-Merritt, Eve R. Colson, Timothy C. Heeren, Nicole L. Geller, and Michael J. Corwin. Maternal Report of Advice Received for Infant CarePediatrics, July 2015 DOI:10.1542/peds.2015-0551
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