On being pre-pregnant
I’ve been pre-pregnant for years. At first I was really good about it. For about a year, I made sure all of my meals were healthy, for nonexistent baby. I didn’t drink – easy, because I don’t like the taste of any drink I’ve yet tried – avoided caffeine, used OTC medications only rarely and under duress. I ditched the ibuprofen for my joints, in case it might hurt nonexistent baby, and I took antihistamines for my allergies maybe once every few months; otherwise I just put up with allergies. And every day I took the prenatal vitamin horse pill. Because I had trouble swallowing these, I got a mortar and pestle and ground one up each morning. I had a book on avoiding morning sickness, and practiced my favorite “supposed to get rid of morning sickness” recipes, so that I’d be ready, when nonexistent baby was conceived. And every day I charted my temperature, so that I would know exactly when I was supposed to be fertile, and, should I get pregnant, know within days when my period was overdue.
Now I’m bargain basement style pre-pregnant. I take folic acid, and, well, that’s just about it. OK, I also take iron and calcium, but that’s for me, not for nonexistent baby. I try to eat reasonably healthy and exercise, but again, that’s for me. I freely eat things that nonexistent baby isn’t supposed to be exposed to, such as soft cheeses and sushi. There’s only so much you can give up for a baby who stubbornly persists in refusing to show up.
I mention these things because of the Washington Post story on pre-pregnancy reporting that
New federal guidelines ask all females capable of conceiving a baby to treat themselves — and to be treated by the health care system — as pre-pregnant, regardless of whether they plan to get pregnant anytime soon.
Among other things, this means all women between first menstrual period and menopause should take folic acid supplements, refrain from smoking, maintain a healthy weight and keep chronic conditions such as asthma and diabetes under control.
Jessica of Feministing is appalled
The vessel will make sure to treat its uterus and surrounding matter with care for the preparation of the all-mighty fetus. The vessel puts the lotion in the basket.
Sorry, I’m all for being healthy–but I’d like to think of myself as bit more than a potential baby-carrier.
Jill of Feministe and Amanda Marcotte of Pandagon concur, with some interesting discussion ensuing in Jill’s comments section as to exactly what precautions do and don’t make sense (yes to folic acid, no to worrying excessively about changing the kitty litter) for women who could wind up having a child if their birth control fails. Amanda looks up the actual CDC report
Assume you’re pregnant all the time, ladies, because we’re just a few Supreme Court decisions away from when you will be. As Rebecca Traister notes, treating all women like they’re always pregnant or always about to be smells quite a bit like just more of that social control BushCo is so fond of. …
But since the article mentions that the guidelines come from the CDC and since I know that the CDC tends not to be really horrible about putting out punitive guidelines that resemble social control more than actual pragmatic health advice, I dug up the article for myself. (Okay, I got Auguste to do it.) The guidelines are a little less breathless with excitement over a brand new chance to control women and discriminate against us than this article implies. They suggest that doctors treating women talk about health care in terms of their own health but also in regards to their reproductive future. The actual article very firmly suggests, and the WaPo skims over this point, that the big recommendation is to emphasize the importance of planning your pregnancies to women.
…
So why did the WaPo misrepresent this report? Hell, they don’t even mention how important birth control is to this entire project except in passing at the bottom of the article. I think it’s because it’s a political hot potato to openly admit that the two most important steps towards reducing the infant mortality rate and improving the health of newborns in general is to get health care to every woman and to empower women with the knowledge and tools they need to get pregnant only when they want to.
I’m going to jump back, though, to the question of what level of pre-pregnancy planning makes sense for women who, unlike me, are in the position of having sex while using birth control to avoid getting pregnant, but who might, after all, wind up having a child if the birth control fails. There are several categories of “pre-pregnant” concerns here:
1) Stuff which is a big benefit to potential baby, not a particularly big immediate benefit to the woman, but also not especially high cost to the woman. And I’m talking here about folic acid, which really belongs in its own category. It makes a big difference to your baby’s chance of getting neural tube defects, it starts providing you a benefit if you get enough of it shortly before you actually get pregnant, it’s cheap, easy, and does you no harm, but if, say, you’re a nun and planning never to have sex in your life, or if, say, you’re had your tubes tied and are really never, ever going to have kids, then you’re probably getting enough in your diet for you, not for baby. Given that half of all pregnancies in the US are unintended (and overlooking for the moment any debate about why half of all pregnancies are unintended), you can see why it might be useful to have nearly every woman of childbearing age getting that extra folic acid. And, in fact, I’ve read discussion of how to do that, by, for example, supplementing stuff that people are already eating with folic acid. Anyway, if there’s any chance you might wind up having a baby in the near future, even if getting to that point would require a birth control failure, I for one think the benefits of folic acid outweigh the costs.
2) Stuff that’s good both for your health and for the health of potential baby, like that asthma and diabetes control that the WaPo article mentions. Here, the question is, what motivates you? If you’re hoping to have a baby really soon, and if you find it far more motivating to keep yourself in shape for potential baby, then, by all means, get that blood sugar under control for the baby. If, on the other hand, you don’t much care about potential baby, and are using three different methods of birth control to avoid potential baby, then, you know, keeping your blood sugar under control so you don’t need any amputations will also do just fine.
3) Stuff which is largely mythical. Yes, you can get toxoplasmosis from cat litter, but you’ve probably already been exposed (and it’s only a problem if you’re first exposed during pregnancy), and in any case it’s only a risk of you both have a cat that goes outdoors and don’t change the kitty litter every day. So, this wouldn’t be at the top of my list of things women should avoid during their entire reproductive life. Though, if your husband’s willing to always change the kitty litter for this reason, I won’t interfere.
4) Stuff which, mythical or not, is just too darn much trouble to do for your entire reproductive life. In my case, avoiding sushi and brie is on this list. (I’d put toxoplasmosis in this category, too, if the only solution offered were to get rid of the cat. But since you can also make your car an indoor cat, change the kitty litter every day, get someone else to change the kitty litter, or wear gloves while changing the kitty litter, it’s not like avoiding new exposure to toxoplasmosis is an impossible burden here. If you’re really worried about it.) Give me an actual pregnancy, and I’m willing to be paranoid. Till then, I’ll keep my soft cheese and raw salmon.
UPDATE: AIDS Combat Zone urges progressive and feminist bloggers to Hold Your Fire! about the CDC report, and explains how it is actually about empowering women, giving poor women greater access to health care, etc.
In a nutshell, it has four goals:
1) improve the knowledge and attitudes and behaviors of men and women related to preconception health;
2) assure that all women of childbearing age in the United States receive preconception care services (i.e., evidence-based risk screening, health promotion, and interventions) that will enable them to enter pregnancy in optimal health;
3) reduce risks indicated by a previous adverse pregnancy outcome through interventions during the interconception period, which can prevent or minimize health problems for a mother and her future children; and
4) reduce the disparities in adverse pregnancy outcomes.
Those goals have prompted 10 recommendations:
1) individual responsibility across the lifespan,
2) consumer awareness,
3) preventive visits,
4) interventions for identified risks,
5) interconception care,
6) prepregnancy checkup,
7) health insurance coverage for women with low incomes,
public health programs and strategies,
9) research,
10) monitoring improvements.
Interesting that the Washington Post article phrased things to emphasize the “individual responsibility across the lifespan” part more than the business about health insurance coverage for women with low incomes and public health programs and strategies. AIDS Combat Zone also links to a lot of progressive bloggers who are discussing the article.