The Perceptions of Pregnancy blog, like the Researchers’ Network, aims to reach beyond boundaries and borders, and to facilitate an international and interdisciplinary conversation on pregnancy and its associated bodily and emotional experiences from the medieval to the modern. Today’s post is contributed by Dr Salim Al-Gailani of the University of Cambridge, co-editor of a special issue of Studies in History and Philosophy of Biological and Biomedical Sciences.
Around 1900, few pregnant women in Western Europe or North America had any contact with a medical practitioner before going into labour. By the end the twentieth century, the hospitalisation of childbirth, the legalisation of abortion and a host of biomedical technologies from the Pill and IVF to obstetric ultrasound and prenatal diagnosis had dramatically extended the reach of science and medicine into human reproduction. A special issue of Studies in History and Philosophy of Biological and Biomedical Sciences published this month reflects on the social, medical and technological shifts that have shaped the experience and understanding of pregnancy since the turn of the twentieth century.
Originating in a workshop held in Cambridge in 2012, the special issue is edited by Dr Salim Al-Gailani (University of Cambridge) and Dr Angela Davis (University of Warwick). The workshop stemmed from the observation that, despite a wealth of historical, sociological and anthropological writing on reproductive health and healthcare, we have a relatively insecure grasp of profound transformations in the science and management of pregnancy in recent modernity. There has been an overall tendency to focus on professional struggles over childbirth, especially between obstetricians and midwives, and the development of state policy, particularly around the expansion of hospital-based maternity care and the legal status of abortion. There remains much to explore.
This year marks the thirtieth anniversary of British feminist sociologist Ann Oakley’s influential 1984 book The Captured Womb: A History of the Medical Care of Pregnant Women. Drawing on wider critiques of the ‘medicalisation’ of everyday life, Oakley described the development of antenatal care and modern obstetrical interventions as strategies for the ‘social control of women’ by the medical profession on behalf of the state.[i] Feminist historical accounts of obstetric power such as Oakley’s were challenged in subsequent scholarship, particularly the social history of medicine. Part of a wider move to recover patient agency, historians have criticized Oakley for privileging a top-down social control model that portrayed women as inert victims of the medical profession, and underplaying the tensions between official policy and the practice of maternity care at the local level.[ii] Nevertheless, The Captured Womb remains one of the only historical studies to look beyond childbirth to consider the management of pregnancy in all its aspects. By drawing attention to such issues as the history of health advice to expectant mothers, debates over maternal and child welfare, the place of technology in obstetric care, the visibility of the fetus in medicine and public culture and the activism of maternity consumer groups, Oakley set the agenda for much subsequent social scientific writing in this area.
The articles in ‘Transforming Pregnancy Since 1900’ pick up and develop these themes, also highlighting many previously neglected topics. Jesse Olszynko-Gryn’s (open access) essay explores the expansion of laboratory pregnancy testing as a routine practice in the early twentieth century, providing insight into a remarkably little researched diagnostic technology. Surveying shifting understandings of pregnancy loss in Britain, Rosemary Elliot observes continuities between early twentieth-century concern with miscarriage as a public health problem and discourses of fetal personhood in the present day. In an (open access) article drawing on oral history interviews, Angela Davis studies the interplay between narratives of pregnancy and birth and narratives of war in the accounts of maternity by women of the wartime generation. Tatjana Buklijas relates how heightened interest in food and nutrition during and immediately after World War Two produced new concerns with fetal growth and development within medicine, biochemistry, physiology and agriculture. My own (open access) article analyses the history of preconceptional and prenatal vitamin supplementation in late twentieth-century Britain. Ilana Löwy describes how the development of new technologies of prenatal diagnosis has contributed to the ‘irresistible rise of the visible fetus’ as the focus of medical attention. Finally, Aryn Martin and Kelly revisit the thalidomide tragedy as a starting point for their history of the ‘placental barrier’ concept.
Collectively, the articles aim to contribute to ongoing reassessments of the medicalisation of reproduction. Historians now tend to see medicalisation less in terms of the nefarious collaboration of experts and state authority imposed from above, but rather as a complex and unpredictable process whose causes and effects must be analysed rather than assumed.[iii] Examining relations among pregnant women and medical professionals—from biomedical researchers and laboratory technicians, to family doctors and genetic counsellors—, the broader healthcare industries and lay groups, this special issue stresses the value of bringing into view the networks of individuals, institutions and technologies that have made and remade understandings of pregnancy since 1900.
About the Author:
Salim Al-Gailani is a postdoctoral Research and Teaching Associate at the Department of History and Philosophy of Science, University of Cambridge, where he is part of the Wellcome Trust-funded ‘Generation to Reproduction’ project. His research has explored the histories of anatomy, obstetrics and public health since around 1900, with his current project focusing on the making of folic acid as a technology of pregnancy in the late twentieth century.
[i] The Captured Womb: A History of the Medical Care of Pregnant Women (Oxford: Basil Blackwell, 1984), 250-274.
[ii] For instance, Janet Greenlees and Linda Bryder, Western maternity and medicine, 1880–1990 (London: Pickering and Chatto), 2-6.
[iii] Andrea Tone, ‘Medicalizing Reproduction: The Pill and Home Pregnancy Test’, Journal of Sex Research 49 (2012), 319-327.