Pre-Pregnant

I am getting married in the summer, so I am trying to get in as many doctors appointments as possible before then. While discussing this with my mother, we had the following conversation:

Mom: When you see your doctor, ask her about putting you on prenatal vitamins.

Me: . . . Why?

Mom: In case you get pregnant.

Me: I'm not planning on having kids for at least a couple of years.

Mom: But just in case.

Me: I'm on the Pill.

Mom: It's what they're recommending now, for all women who are sexually active, just in case.

Me: I really disagree with that reasoning.

Mom: You never know. Your Aunt X got pregnant with her son Y while she was using a diaphragm.

Though she is well meaning, my mother puts me between a rock and a hard place. If I don't go on prenatal vitamins, I must be a baby-hating monster. If I do go on the vitamins, I am contributing to a mindset where women's needs are pushed aside in favor of the needs of a fetus--a theoretical, non-existent fetus that I am doing everything to prevent.

Her recommendation is part of a growing trend in medicine. In 2006, a group of medical organizations released federal guidelines asking all women capable of conceiving "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." They wrote these guidelines on the grounds that half of all pregnancies are unplanned. If early prenatal care is better for preventing birth defects, then surely beginning it before the pregnancy starts is the best possible scenario. Some of the things they ask sexually active women do include:

• Take folic acid supplements or prenatal vitamins
• Stop smoking and avoid alcohol
• Maintain a healthy weight
• Keep chronic conditions under control
• Make sure vaccinations are up to date
• Avoid contact with lead-based paints and cat feces
• Avoid workplace hazards

These guidelines sound innocuous enough. Most of them are good guidelines for any adult, male or female, who wants to maintain a healthy lifestyle. I certainly agree that a woman should take prenatal vitamins and follow the other guidelines if she is actively trying to conceive. I have no problem with a doctor asking a female patient if she is planning on getting pregnant within the next year, and discussing the guidelines with her if she responds in the affirmative. I support healthy pregnancies and healthy babies.

The problem comes when the label of "pre-pregnant," and the guidelines that follow, are applied to every single woman at every single moment, without regard for the woman's health or autonomy. It leaves no room for a woman's actual level of sexual activity or her sexual orientation. It does not factor in whether the woman actually wants to get pregnant or the steps she's taking to prevent unwanted pregnancy. I've read stories of women who were writhing in pain in the emergency room, but were delayed medical care because they had to wait on the results of a hospital-administered pregnancy test. Women have been denied medication on the grounds that they are women of child-bearing years and the best medication available is one that can cause birth defects. In some of the stories I read, the only way the women were able to get the care they needed in a prompt manner was to say, "I am on birth control and if I am pregnant, I will have an abortion." Women's health care is being detrimentally effected in favor of the health of non-existent pregnancies. This treads very close to the worldview of the anti-choice movement. The "pre-pregnant" woman is just a vessel, with no needs unto herself and no worth other than her future childbearing ability.

Besides the way it complicates health care for women, the "pre-pregnant" guidelines can also have legal ramifications. What begins as a "guideline" can easily morph into an "obligation," which can eventually become law. There are already proposed laws and creatively interpreted laws in many parts of the country that limit the actions of pregnant women. Some past incidents include:

• In 2006, an Arkansas state representative proposed a law in his state legislature that would ban pregnant women from smoking.
• In Alabama, 35 women have been arrested for "chemical endangerment of a child" because they tested positive for drugs immediately after giving birth. Most of the babies were healthy and full term. Of the babies that did not survive, none of their causes of death were attributed to drugs. The original law was meant to apply to people who allow children to be around meth labs.
• In 2010, a pregnant Iowa woman was arrested for "attempted feticide" after falling down a flight of stairs and admitting to a health care official that she was originally ambivalent about keeping the pregnancy.
• In March 2010, the Utah state legislature passed a law that would allow up to a life sentence for a woman who has a miscarriage or stillbirth as a result of "reckless" behavior. After criticism erupted around the country, they changed the law to remove the word "reckless," but would still allow for the prosecution of women who commit "knowing" acts that can result in miscarriage or stillbirth.

If the medical establishment automatically assumes all women to be pregnant until proven not, such laws can inhibit the freedom of all women. They even open the possibility of more laws. Can all women be barred from smoking or drinking alcohol? Can women be denied drivers licenses, on the grounds that they might crash and harm a theoretical fetus? Can women be pushed out of certain occupations with "workplace hazards" that harm fetuses? Can women be forced to diet if they are overweight? This sounds like a situation out of 1984 or The Handmaids Tale, but it isn't so far fetched for women who are currently in jail for supposedly harming their pregnancies.

Even without the laws, these guidelines leave women open to judgement from the very medical professionals who are supposed to help them. Women, especially those with substance abuse issues, might avoid medical help out of fear that they will be accused of harming a potential pregnancy. (Note that in the above scenarios, women were reported to the police by health care workers.) These guidelines also ignore the class issues involved with women's health. Many women are unable to afford medical care for themselves, let alone prenatal vitamins for a non-existant pregnancy. They lack the time and money to eat healthy and exercise. They are in a position where they can't quit jobs that have "workplace hazards." These factors need attention so that women can become healthy for their own sake.

When I go to the doctor, I want my doctor to think about what is best for my health. With the "pre-pregnant" guidelines, the attention is no longer on me, but rather on a role I'm expected to fulfill. While I want what's best for my future children (again, when I decide to have them), it cannot come at the cost of the health, autonomy, and desires of women in general. Incidentally, if my mom wanted to scare me with the dangers of not taking prenatal vitamins immediately, she picked a bad example. My Aunt X's son Y grew up to be a doctor.