“I see that some of you are sitting with your legs crossed?” says the midwife – or asks, rather. Her inflection makes it a question. She scans the early pregnancy briefing’s female attendees – most of whom, indeed, have one knee resting on the other. A brief pause; then she smiles and shakes her head, a combination that positively radiates smug condescension. “Not when you’re pregnant,” she chides. “It could hurt your lower back.”
Just for a moment, the implied praise leaves me feeling superior: after all, I’m not sitting with my legs crossed, which surely means I win points of some sort. Then I come to my senses. I’m sitting that way by accident, not design, and anyway, I’m starting to feel suspicious of all this well-meaning but restrictive advice. Around me, the whole room rustles as twenty-odd women guiltily rearrange their limbs. We’re like children who’ve been told to sit up straight by the teacher: nobody wants to be seen as transgressive; everyone needs to look keen to learn. Yet what harm, really, could sitting with crossed legs do? Certainly, it won’t hurt our as-yet-too-premature-to-be-called-babies, and at absolute most, it’ll cause us a bit of discomfort – and admittedly, that’s a reasonable thing to want to bear in mind. But there’s a world of difference between telling us of a potential minor consequence and outright mandating that we never take the risk in the first place: the former is enlightening, while the latter is frankly censorious.
“Why take the risk?” is a phrase that crops up a lot with regard to pregnancy. Sure, there’s no proof that a glass of wine now and then could harm your baby, but why take the risk? In all probability, resting a laptop on your stomach won’t overheat your womb to the point of miscarriage, but why take the risk? It’s a question I’ve quickly learned to loathe for the pure and simple reason that it reeks of obsessive protectionism. Why risk cycling, or eating a few extra donuts when you crave them? Why risk jaywalking when you might get hit by a car? Why risk the odd cup of coffee with all the problems caffeine could cause?
Actually, though, caffeine intake can be a legitimate concern for pregnant women, as it’s been reported that a high caffeine intake can double your risk of miscarriage – but of course, that’s a meaningless statement unless you know what your risk of miscarriage actually is to begin with. And this can be an extremely difficult thing to pin down: reportedly, 30% of all pregnancies end in miscarriage – that’s one in three – but the statistic lowers to between 15% and 20% in instances where the pregnancy is confirmed. Or, to put it another way: the longer a pregnancy goes on, the lower the rate of miscarriage, meaning that the 10-15% difference can be accounted for by failed implantations – miscarriages that happen so staggeringly early in the process that the pregnancy itself was likely undetectable and which, rather than being dramatic events, are virtually indistinguishable from a woman’s normal period. That’s still a generic statistic, however – the presence of particular medical conditions or genetic histories puts some women at a higher than average risk of miscarriage, which in turn makes the overall statistic higher for everyone, regardless of their actual individual risk.
So what does that mean for your caffeine intake?
Ideally, it should imply the exercising of common sense on a case by case basis: your normal coffee intake is probably fine, but guzzling energy drinks likely isn’t (unless you’re not thrilled about being pregnant to begin with; in which case, there are myriad relevant organisations available to help) – but if you’re at a high risk of miscarriage and wanting to be super-careful, then it might be worth considering a no-caffeine policy for the duration of your pregnancy; or for the first trimester; or maybe not at all, if you’re already stressed and depressed and abstaining from a dozen other favourite things; or even if you just really, really need your morning latte. What I’m getting at is this: while it might seem more efficient in the short-term to condense all of the above into a simple, one-line bullet point about how caffeine can make you miscarry, the long-term consequence isn’t to inform pregnant women about their options, but to make us fearful of error. The devil is in the details – or in this case, the relevance. An occasional Coke won’t kill me, and I refuse to feel guilty about it.
Similarly, I’ve grown weary of being told that I can’t eat soft cheeses for fear of getting a listeriosis infection, which – yes – could cause pregnancy complications or even bring about miscarriage, but which is monumentally unlikely given how rare listeriosis actually is. It’s worth taking the time to unpack this one, given the vigour with which it’s assumed to be a true and, as a consequence, socially policed: while pregnant women are 20 times more likely to develop listeriosis than the rest of the population, the number of listeriosis cases reported for all of 2004 in the USA – including infections suffered by pregnant women, which make up 27% of all reported cases – was 753, at a rate of only 2-3 per million people. Which makes it a legitimately rare condition, even accounting for the extra vulnerability brought on by pregnancy – a vulnerability which isn’t even specific to listeriosis, by the way, but which is rather a consequence of having an overall weaker immune system, meaning that any old bacteria can cause more issues than usual. And while it’s true that listeriosis can have particularly nasty consequences for unborn babies (infected mothers aren’t at anywhere near the same risk, and in fact tend to experience only flu-like symptoms) the point is that you’d have to be spectacularly unlucky to contract it in the first place. Not a risk-taker, not irresponsible or foolhardy: unlucky. Listeriosis is a contaminant bacteria; outbreaks of it are tracked to the source, monitored, reported and contained the same way a sudden spread of E. coli would be. You’re not going to get it from a commercially well-known product.
The same sort of bad reputation applies to sushi and sashimi, too: while common wisdom assumes that raw fish is necessarily full of undesirable elements that could hurt a growing baby, the fact is that eating fish, whether raw or cooked, is actually extremely good during pregnancy. Sure, improperly frozen sashimi might contain parasitic worms, but that’s no more risk than you’d usually be taking, and the consequences are no more dire for pregnant women than they would be otherwise – and the same goes for eating other types of raw seafood. The only possible issue is with fish that has a high mercury content, like flake and tuna, and even then, the recommendation is to limit your servings, not avoid it entirely.
And yet we’re told to avoid it all – no cheese, no salmon, no unpasteurized yogurt, no alcohol, no barbecued meats (they might be undercooked and could therefore lead to a toxoplasmosis infection, which, as with listeriosis, is both bad for the baby and exceedingly rare); my sister-in-law was even told to avoid eating salad if she hadn’t seen it prepared herself, in case the ingredients were somehow contaminated – because why take the risk? Here’s why: because I’m an actual human being, not a womb with legs, and because maybe – just maybe! – the enjoyment I derive from eating a really nice wedge of blue cheese outweighs your need to make me afraid of rare bacteria and conditions which, if cited by any other member of the population as a reason for abstaining from the vast majority of delicious foods would have you peg them instantly as a paranoid hypochondriac. Never mind that once you eliminate meat, seafood, salads and a big whack of dairy, you’re pretty much left with carbohydrates, fats and sugars – that is to say, food which is high on energy but frequently low in nutritional value, and which all and sundry will judge you for eating too much of as vehemently as they’d judge you for eating Stilton (either because you’re seen to be putting on too much weight or because they assume you’re growing a child on nothing but cake and donuts and are therefore an irresponsible, undeserving mother – I mean, is it really so hard to ask that pregnant women all look a uniform size 8 except for the perfect beachball belly on front while subsisting entirely on hummus and carrot sticks? God.).
And this is what makes me angry: that facts which have been edited to the point of fearmongering are not only passed on to pregnant women as inviolate gospel, but lent weight as such by dint of being delivered in the same breath as legitimately useful, unambiguous and instantly applicable information, such as the fact that taking folic acid supplements both prior to conception and in early pregnancy can severely reduce the likelihood of a child developing neural tube defects, or that because the pregnancy hormones relaxin and oxytocin have set about making your joints looser, it’s much easier to tear or sprain your muscles during high-impact exercise. Not every piece of data can be safely converted into a soundbite; nor should it be.
But the reality is that, in this modern, oh-so-litigous society of ours, both doctors and manufacturers alike are terrified of being sued, either for failing to adequately warn their patients about possible risks or for producing a foodstuff which, for whatever reason, might cause that unfortunate one-in-a-million person to miscarry. Last month, for instance, I was at something of a low ebb, plagued not only by first-trimester nausea and the throbbing pain of an as-yet-unremoved wisdom tooth, but a horrific phlegmy cold foisted on me by my husband, the walking disease vector. (Seriously: the man cannot travel more than ten kilometers without catching something.) Almost in tears of pain due to my sore throat, I momentarily forgot the (again, sensible but occasionally misleading) pregnancy injunction on taking any medication that isn’t paracetamol and started gulping down Honey & Lemon Strepsils. It wasn’t until the next day, by which point I’d had about eight of them, that I noticed the warning on the packet saying they weren’t for pregnant women. Utterly panicked, I rang my GP to find out what damage I’d done – only to be told that, in actual fact, there was no danger at all; that the label was essentially a precaution on the offchance a pregnant woman did one day suffer some ill-effects. A legal safeguard, not an actual warning. I hung up the phone feeling drained and cross – but even so, I stopped taking the Strepsils, just in case.
In any number of ways, pregnancy makes you more vulnerable than usual. Physically, emotionally and chemically – to say nothing of all the other offshoot stresses that spring up around the process – your body is doing strange, frequently unprecedented things, many of which can be painful or unsettling. You are anxious. You are elated.You are busy. You are exhausted, short-tempered and probably about eighty thousand other emotions, at least seventy thousand of which you’re bound to obliviously inflict on your undeserving nearest and dearest because your self-awareness mechanisms are haywire, too. You are, in other words, extremely vulnerable to fear and manipulation, particularly as regards your child-to-be: fear about their development, fear of hurting them, fear of making a mistake. And in that context, giving pregnant women abbreviated, twisted information – however much easier a summary sheet might be to produce and distribute than an in-depth analysis – will inevitably contribute to their fears; and that’s really not good, either.
So: let’s all do our best to flesh out incomplete data where and when we find it, shall we? And in the mean time, I can get back to stuffing my face with camembert and donuts.
(And for those who are curious: yes. I may be a little bit pregnant.)