Pregnancy, then and now

I got back to work after my summer holidays to discover an absolute epidemic of pregnancy in our building, including three young women on the same floor as me. All three are at different stages – one with only a few weeks to go before Baby Day, one at around 20 weeks, and one around 9 weeks. They all sit together in a “pod” of 4 desks – the fourth woman is a grandmother who has stopped drinking the local water just as a precaution!

Discussions in the tea room centre around baby preparations and pregnancy comparisons, all three being first-time mums-to-be. This is endlessly fascinating to me as the biographer of a woman who had 10 children; the three pregnant women know about great-great grandma and are interested in comparing 1840s/1850s pregnancies with their own. They were hardly surprised when I looked at someone’s 9-week scan and commented that Sarah wouldn’t have had one of those, but they were surprised by some of the things I found in my latest research reading on the historical management of pregnancy and childbirth.

In the late eighteenth-century, pregnancy and childbirth were just beginning to be medicalised by doctors. It was greed, pure and simple. Upper class and aristocratic women were making it trendy to have an accoucheur, a male obstetrician, rather than a woman midwife. And doctors were keen to get into the baby business because it was easy money, all these rich women needing their help to pop out babies. Debate was intense as to whether the developing foetus was a separate entity from the mother before birth, and a view of the foetus as having separate rights from the mother was beginning to form – although most practitioners came down pragmatically on the side of the mother if pregnancy complications necessitated a choice between mother or baby.

The stethoscope was invented in 1819. In 1822, a young doctor had the inspiration of applying it to a pregnant belly, expecting to hear the “splashing” of the foetus in the amniotic fluid. To his great surprise, he heard a heartbeat instead, and is now credited with the discovery of the foetal heartbeat. I expect that midwives had probably discovered it long before this, but they were women, and thus didn’t count in the new world of scientific discovery. The foetal heartbeat soon became a significant tool in monitoring a pregnancy, within the bounds of modesty demanded by Victorian decorum.

Early medical intervention didn’t mean much beyond foetal monitoring and forceps deliveries. There was nothing like the wealth of information women have today, from books and medical pamphlets and websites, to scans, measurements and weigh-ins. What seems to have been traded for today’s information, and perhaps the security it provides, is modesty. Modern women usually say that after the first baby, they’ve got no modesty left. Notwithstanding today’s bikinis, low-cut tops, TV nudity and casual sex, today’s pregnant women have to deal with a variety of professionals peering at their nether parts under high illumination on numerous occasions. Great-great grandma, on the other hand, dressed modestly, especially when pregnant, and was unlikely to have experienced any stranger’s hand on her bits, and possibly not even her husband’s. Accepted procedure for the rare physical examination was for the pregnant woman to lie fully dressed on her side with her knees drawn up to her chest, while the doctor, carefully avoiding eye contact, rummaged under layers of garments, and literally groped his way through the examination working by touch alone.

Historically, women couldn’t be sure they were pregnant until around 4 months – the quickening, literally coming to life, as the baby’s first movements were felt. For first-time mums, even then they couldn’t be sure, having not experienced the sensations before. The cessation of periods wasn’t a reliable indicator. Unlike today’s hormone-regulated menstrual cycles, these women may not have even had a period at the time of first pregnancy. And later pregnancies might not be detected by women who spent the majority of their lives pregnant and breast-feeding – the menstrual cycle simply didn’t settle down into a regular pattern.

Technical and medical issues aside, possibly the most striking difference between Sarah’s child-bearing, and that of the young women I work with, is in the matter of choice. It’s not just that today’s young mums can chose whether or not to have children; they can (to a point) choose when, and how many. For Sarah, children were the inevitable outcome of marriage, and while breast-feeding might help to space them out a bit, the average nineteenth-century fertile woman would bear eight children. Sarah had ten live births; we don’t know whether she had any failed pregnancies. Most women today choose fewer children, at wider-spaced intervals. Choosing when to start “trying for a family” (not a phrase that Sarah would ever have heard) now means a myriad of decisions – the ability to support a child, impact on careers, future child-care options, even just feeling ready to have a child. Once the decision to go forth and procreate has been made, and assuming fertility isn’t a problem, that’s just the start of the choices : to know the gender or not; when to stop working; disposables or cloth nappies; home birth or hospital; epidural, or not, or even an elective Caesarian; birth plans and positions and which family and friends will attend; video or just photos; when to go back to work, and if early, bottle-feeding or expressing or having the baby brought into work for feeds; crèche or in-home child-care? Clothes, bedding, nursery decorations, toys, cot, baby capsule, car seats, wipes – the expense mounts up as well.

The choices may be bewildering to modern women navigating their way through first pregnancies; to great-great grandma they would be incomprehensible. She got pregnant when she got pregnant, had the baby when the baby was ready to come, survived or not depending largely on luck and her own strength, breast-fed and used cloth nappies, took care of the rest of the family, had the next baby when the time came, and with good fortune raised most of her children to adulthood. She dressed to hide her pregnancy as much as possible, keeping her corset on until she couldn’t do it up any more; she didn’t flaunt her belly and discuss the details with everyone she met – even her parents back in England might not know of the pregnancy until the birth was announced. She wouldn’t have gone out much in public in the latter stages of pregnancy, and she certainly wouldn’t have had a photo of herself taken while pregnant (let alone a video of the actual delivery!)

The one choice that Sarah had which today’s women don’t, was whether or not to involve the medical profession in her pregnancy. That choice was personal (and possibly economic), barring emergencies – she could have chosen to keep her pregnancy to herself until delivery, and then given birth with the help of a midwife, or friend or neighbour. She didn’t have to have a doctor and a raft of pre-natal checks. Nowadays, it’s nigh on impossible to have a baby without the involvement of the medical profession – and although most women wouldn’t have it any other way, there are always some who want to keep delivery as natural as possible and with the least amount of intervention – and they usually have to fight to achieve this.

Given the choice, would Sarah have traded her modesty and dignity and privacy for information about her own health and the baby’s progress? Would she have wanted the security provided by today’s very low maternal and infant mortality? I think it’s very likely that she would. Would she have wanted the choice of how many children she would bear, and when, and all the other choices and decisions that follow? That’s harder to know because it’s harder to separate from the culture and conventions of her time, her upbringing, her view of the world and her place in it. But if you could show her a scan of her growing baby, I think she’d react just the same as the young mums at work – with wonder and awe and amazement at seeing into the secret world of the tiny clench-fisted creature curled safe inside her.