Seeing the Baby

Since the 1970s, Americans have developed a ritual around obstetric ultrasound, in which expectant parents get to “see the baby” and bond with their expected child while the sonographer conducts a medical check-up as a component of routine prenatal care. This ritual initially emerged in the context of a scan at eighteen to twenty weeks of gestation, when pregnancies are mostly secure. In recent years, this ritual has begun to be performed at an earlier eight-week scan in many pregnancies. This means that many women discover an unviable pregnancy at a moment when they expect a bonding ritual, and miscarriages are made more poignant and difficult.

Detecting the Baby

In the nineteenth century, physicians developed new ways to detect pregnancy, as they sought visible and palpable pregnancy signs that allowed a physician to make a diagnosis independent of a woman’s testimony about her symptoms. In the twentieth century demand for pregnancy diagnosis increased as more women sought formal prenatal care and took on new responsibilities for self-care during pregnancy. The first pregnancy lab test was introduced in 1927 and improved over the decades, and a home pregnancy test reached the American market in 1978. Since then, the tests, which measure human chorionic gonadotrophin (hCG) in maternal urine, have become a ubiquitous part of planned pregnancies, and have gotten increasingly sensitive. This means that women increasingly use them to detect very early pregnancies, many of which are not viable.

Imagining the Baby

Since the 1960s, public debates about abortion have powerfully shaped how Americans think about pregnancy and miscarriage. Activists have staked out “pro-life” and “pro-choice” positions, neither of which provides comfort to a woman who has chosen to become pregnant but then miscarries the pregnancy. Pro-life activists have argued that embryos are babies from conception, and when they are lost, deserve to be mourned as such, and miscarriage support literature often draws upon pro-life language and imagery. The reality of frequent early miscarriages has been little recognized in the abortion debates.

Taking Care of the Baby

Beginning in the early nineteenth century, as Americans began to emphasize mothers’ roles in nurturing and raising children rather than conceiving and bearing them, pregnancy was increasingly regarded as burdensome, dangerous, and potentially worthy of medical attention. In the late nineteenth century medical advice writers began to give women elaborate instructions for caring for their future children in utero and using scientific images of embryos and fetuses to urge women to appreciate and value the developing child. The instructions and the embryonic images became standard features of modern prenatal care. Over the course of the twentieth and early twenty-first centuries, instructions to pregnant women across a range of media, including websites and pregnancy apps, became increasingly elaborate and guilt inducing, at the same time that a stream of embryonic images urged maternal bonding as a way to encourage women to feel responsible for their future children’s well-being.

Bonding with the Baby

Over the course of the nineteenth century and into the twentieth, parents gradually focused less on the patriarchal, religious, and economic duties and benefits of parenthood and more on developing loving relationships with children. This change in sentiment took place before modern medicine and public health would seem to justify it. Infants continued to perish at appalling rates even as parents came to mourn their losses with more evident anguish and less fatalistic resignation. Public health and medicine finally caught up during the twentieth century, as infant mortality rates decreased substantially. Over the generations, traditional economic and religious justifications for parenting diminished, and parents focused increasingly on their emotional relationship with their children. In the late twentieth and twenty-first century, the emotional focus of parenting continued to intensify. It also expanded into the months before birth, where it would clash with the biological reality of frequent early pregnancy loss.

Childbearing in Colonial America

Colonial American women experienced pregnancy in an era when life was always uncertain, the faithful were expected to trust God and submit to fate, and women were celebrated and respected for the bounty of their wombs. Childbearing could be exhausting and difficult, but children came when they came, and the process was largely regarded as inevitable and simply part of the natural and religious order of things. Early and abrupt endings, too, were part of the God-given order. Pregnancies came frequently and were regarded as tenuous until late in gestation. In an era when families frequently lost infants and children to infectious disease, early pregnancy losses received little attention.

Conclusion

There are a number of possible reforms that could improve pregnancy experiences and make miscarriages less distressing. These reforms include rethinking childbearing metaphors that have emerged out of the history described in this book, and pushing back on marketers, public health advocates, parenting experts, anti-abortion activists, and others who encourage expectant parents to become attached to pregnancies in their early weeks, while the chance of miscarriage is high. This conclusion proposes that accepting the inevitable imperfections of childbearing, including miscarriages, makes room for parents to appreciate the benefits of modern childbearing culture that have emerged from the historical shifts of the past 250 years.

Buying for the Baby

During the nineteenth century Americans increasingly bought rather than made their material possessions, and in the early twentieth century a robust market for baby and children’s goods emerged, via department stores and mail order catalogs such as the Sears catalog. In the mid-twentieth century marketers grew increasingly sophisticated and increasingly regarded expectant parents as a lucrative market, heeding the advice of market researchers such as Ernest Dichter. By the early twenty-first-century marketers could purchase first-trimester marketing lists reaped from online due date predictors, and a great deal of advertising was aimed at pregnant women at an early stage of pregnancy, when miscarriage is likely.

Introduction

Miscarriage is a common phenomenon and a natural part of healthy women’s childbearing: about 20 percent of pregnancies spontaneously miscarry, mostly in the early months of gestation. In the past, early miscarriages were generally taken in stride as long as a woman eventually had the family she wanted. Today they are often mourned as the loss of a child. Diverse social, cultural, medical, and technological changes of the past 250 years have reshaped pregnancy experiences in America, misleading couples into expecting perfect pregnancies and provoking great distress when pregnancies fail.

Planning the Baby

The American Revolution brought with it not just a visionary new form of government but also the radical new sensibility that individuals might reasonably strive to have control over their fate. Women began to imagine smaller families and to make explicit plans to limit the size of their families. This shift in intention came long before any meaningful innovations in contraceptive technology or knowledge. During the nineteenth century, couples used crude means—withdrawal, douching, abortion, and abstinence—to carry out their newfound intentions to become the masters of their reproductive destiny. In the twentieth century, modern birth control made fine-grained control of fertility more practical, and couples’ expectations and intentions ramped up accordingly. This new intention to control fertility, realized with ever-greater precision using sophisticated new modes of contraception, eventually resulted in an unrealistic expectation of near-perfect control of conception and pregnancy outcomes.