The women I know do a lot. They run companies, they write books, they chase their toddlers around the house, sometimes all at the same time. They wouldn’t dream of making important decisions — what job to take, what house to buy, what school to send their kids to — without doing the research and thinking it through.
And yet when it comes to pregnancy, these same women often passively accept the conventional wisdom. They microwave their deli meats and switch to decaf. They avoid rare steak, and they do whatever kind of prenatal testing their doctor suggests. Pregnancy is among the most important and meaningful experiences many of us will ever have, and yet we are not asking the questions, not looking for the real facts about it, not participating in the major decisions.
Ladies, we need to lean in to our pregnancies too.
It’s not just our fault. Being pregnant sometimes seems like being a child again. Everyone has an opinion. Waiters remove your wine glass as soon as you sit down at a restaurant, and look disapprovingly if you ask to have it returned. An older woman in line at Starbucks once said to me, “I hope that’s decaf coffee in there!” (It wasn’t.)
When I was pregnant, it was enormously important to me to make the right choices, but I just wasn’t comfortable assuming those choices were the ones dictated by the “rules.” As an economist by training, I was used to making decisions by getting all the data, and then combining it with an understanding of the pluses and minuses of a choice for me personally. This isn’t how pregnancy seemed to operate, but it’s how it should work.
Consider prenatal testing. When I talked about this with my doctor, she gave me the standard recommendation for a woman of my age (31), which was to do a nuchal scan and a blood test that screened for two hormones linked to chromosomal abnormalities. When I pushed to understand more about how this worked and the tradeoffs I might face, most of what I got was reassurance that everything would be fine, and a vague suggestion that doing more screening than recommended would be crazy.
It’s true that there is a high likelihood that the testing will go well and all will be fine. But let’s not gloss over what the purpose is. The goal of this testing is to determine if your fetus has a chromosomal problem (Down syndrome is the most common).
If you don’t test, you live with the (small but not zero) risk of having a child with a developmental disability. If you test and find you are carrying a fetus with a chromosomal issue, you face a decision about whether to continue the pregnancy. At the same time, more-invasive forms of this testing carry a risk of miscarriage, so you have to weigh any benefits of the test against the risk of losing a healthy pregnancy. One challenge was that the standard books didn’t really provide me with the numbers I needed on risks and benefits. But, much more important, I ultimately realized that a key issue was to evaluate how I, personally, compared the risk of a miscarriage of a healthy baby to the risk of a developmentally delayed child.
This wasn’t an easy or especially comforting thing to think about, but it is the central issue. Glossing over it (What to Expect When You’re Expecting says, “The best reason for prenatal diagnosis is the reassurance it almost always brings”) does a disservice to women. Yes, being pregnant brings a lot of anxiety (wait until you get to parenting!), but that doesn’t mean we should put our heads in the sand.
This decision loomed large at the start of my pregnancy, but it was accompanied by all kinds of others later. Whether to have labor induced, whether to get an epidural, should I have a home birth, and on and on. And then there were the smaller, everyday decisions — the coffee, alcohol, deli meats, exercise, hair dye. But instead of the latest research findings, the pregnancy books give us either nonnegotiable rules or vague platitudes without acknowledging a wide range of personal preferences and values. With a few exceptions (smoking, for example, which my research did reaffirm in all cases was bad), different women are likely to make different decisions based on the same evidence — and all of those decisions can be right.
At the end of my pregnancy, my desk was littered with medical papers, and my computer full of decisionmaking spreadsheets. My friends came to me with questions. I didn’t have all the answers for them, but I did have a way to help them make these decisions on their own. If only their doctors and guidebooks had done the same.