Taking up space - pregnancy in public

Pregnancy takes up space – physically, internal organs have to adjust to allow expansion of the uterus over the nine-month period and a woman's increasing abdomen means that she literally occupies more air space than before. Fashion too contributes to this physical occupation of space, whether by disguising the bump with billowing maternity smocks or by making a visible statement via the marvels of Lycra (Matthiasson, 2005; Tyler, 2001). On the other hand, psychologically, the nature of the relationship between the internal and external experiences, the interactions between pregnancy and space(s), are complicated. I want to explore briefly these real and intangible but publically visible spaces of pregnancy and propose that there has been a change in the way that pregnancy occupies them in both the public and private spheres.

Key to this consideration of space is the simultaneous experiencing of the outer and inner realities of pregnancy. The space within, the real, pleasurable, though sometimes strange and even alien, internal physical sensations of being pregnant seldom feature in the typical information about pregnancy, which tends to focus on facts about bodily changes and fetal development. Nevertheless, feminist writers have been concerned with the individual phenomena of changes in embodied experience and the nature of subjectivity and consciousness at this time. Specifically with respect to the psychological impact on subjectivity of the physical experience of pregnancy, Iris Marion Young (1990) points out that pregnancy creates uncertainties about what is within the body, the self, and what is outside and separate. She describes her own experience of her insides as being both the 'space of another' and her own body, in which the pre-pregnant body image is still present. These two subjectivities are visible in psychological research: most pregnant women are typically reasonably happy with their changing body shape and size and the freedom from cultural norms for feminine beauty (Clark et al., 2009; Duncombe et al., 2008; Wiles, 1994), but this does not prevent them from wanting to look good (Longhurst, 2005) or from feeling that they are losing control of their bodies.

One of the physical changes taking place is the increasing abdominal bulk, creating not only the external manifestation of the pregnancy, but also an internally experienced shifting centre of gravity that alters the sense of self in space and in relation to the environment. Young (1990) describes the difficulty of manoeuvring the pregnant body, rather than the coexisting pre-pregnant one, through turnstiles or openings, and the necessary reappraisal of both the internal and external experiences of space. This is not just a practical adjustment, for example changing clothing or sitting positions at work (Pattison & Gross, 1996; Gross & Pattison, 2007; Morrissey, 1998). The constant possession of the body by another being alters and determines the rhythms and patterns of daily experience beyond the physical, affecting thoughts, dreams, eating and sleeping (Raphael-Leff, 1993). With the shifted thinking that these changes prompt, the woman is taking on the role of carer for the internal 'other', and discourses of responsible motherhood draw on the metaphor of containment.

The metaphor of containment locates the woman as 'fleshy incubator' (Bordo, 1993, p.84) and impacts on the expanded pregnancy space by privileging the subjectivity of the fetus, something emphasised by technologies; certainly, sophisticated ultrasound scanning makes the fetus appear more like a person not only to the mother but more widely. The cultural prevalence of the metaphor is obvious from images of pregnancy (see Matthews & Wexler, 2000). A quick internet search for 'pregnant women' produced 7.2m images, many of these of naked pregnant stomachs, rather than women, or of women cradling their stomach. The metaphor of containment also resources a biomedical discourse, which emphasises pregnancy outcome and personal responsibility for the internal, rather than women's experiences. It has been argued that this prevailing discourse pathologises pregnancy and female functioning more generally (Ussher, 2006), placing women at the mercy of external forces, even forces with good intentions. The argument is complex, and the issue here is the way the metaphor alters the relative spaces of the internal and the external pregnant body. Pregnant women clearly have a vested interest in the outcome and thus engage willingly with the discourse of risk avoidance and self-management, taking up the self-surveillance and personal policing inherent in the protective role (Miller, 2005). Lankshear et al. (2005) report that the ability to identify and quantify risk was used to justify interventions both by health professionals and by women themselves. But Bordo (1993) reminds us that shifting the internal subjectivity from self to baby can alienate women from their own embodied experience, and justifies the surveillance and closer external monitoring of women's bodies and lifestyles, including sanctioning of behaviours, the debate on fetal rights and even court judgements on pregnant women (see Seymour, 2000). Thus, the space within has also moved into the external public domain, and this conceptual change of space can also be considered to reflect a change of the places of pregnancy, effectively according pregnancy, if not necessarily women, more space.

Pregnancy care has been relocated from the private, domestic sphere to the public sphere, partially in an attempt to improve maternal and infant mortality rates. Management became increasingly medicalised, and located in hospitals during the 20th century (Hanson, 2004; Oakley, 1984). The relocation represented a change in control over women's bodies, and a curtailing of personal embodied space, while increasing the public spaces and control of pregnancy. Belated recognition of the effects of lack of control resulted in efforts to transform hospital spaces into more homely settings for delivery and postnatal care, and to improve antenatal services to provide a personalised, individual experience where women's choices are respected (Department of Health, 1993; NICE, 2008).

The focus on women has occurred within the context of low birthrates (certainly in Europe), making individual women relatively unfamiliar with pregnancy and each pregnancy arguably more precious. This unfamiliarity, and the personal investment in a pregnancy, coupled with a culture of risk intolerance, endorse both personal and public surveillance, and the role of expert others to confirm the normality of the process (Gross & Pattison, 2007; Lupton, 1999). While technology promises apparent certainty and control, uncertainty remains and, as the substantial research on decision-making and risk confirms, disentangling the personal relevance of information arising from many sources becomes a considerable task (Beck, 1992). Getting pregnancy right in both public and private spaces depends on giving sufficient attention – space – to the ranking of different risks and personal choices.

In an acknowledged climate of self-care and consistent with the containment discourse, individual responsibility for the hazards has increased. There is a range of sources of information and advice about potential risks. Official evidence arising from biomedical and epidemiological research is often provided through midwives and GPs and published documents (e.g. The Pregnancy Book: Department of Health 2009). Other information, sometimes sensationalised in the media, includes that available through magazines, books and most recently on the internet, where hundreds of websites in effect mirror the mix of official and unofficial advice available through more traditional sources. There are specific guidelines on diet, alcohol or substance use, exercise and working, as well as recommendations for lifestyle and behaviour. Very often, the subjectivity of the fetus predominates, with pregnancy outcome at stake rather than women's well-being, or personal relevance. Women have to weigh up the advice and the risks and relate them to their own situation. The complexity of this task may be one explanation for findings that women report giving up things that correspond with pregnancy advice but that actually they did not previously do, such as heavy lifting at work (Clarke et al., 2004), or foods they did not eat (Pattison & Bhagrath, 2004). The task can be compounded by the contradictory nature of the advice itself; for example the current advice on alcohol consumption (NICE, 2008) recommends abstinence, but this advice is unhelpfully combined with a suggestion that small quantities may do no harm.

Interpreting this publicly available advice is not the sole preserve of pregnant women and health professionals. Clearly, pregnancy is a personal, social and cultural event located in the public as much as the private domain.  Shared engagement with pregnancy is visible through comment and advice from family, friends and work colleagues (Clarke et al., 2004), many of whom may be able to enter more closely into the internal spaces of pregnancy discussed earlier, and some of whom may offer advice that contradicts that given by professionals (St Clair & Anderson, 1989).  Comments and advice can also come from strangers who have the same access to public information, and such access takes advantage of the metaphor of containment and can lead directly to the constraining of individual women's behaviour. In April 2009 newspapers reported an incident where a pregnant woman was ordered out of a pub for sipping from a friend's glass of lager on the grounds that staff were protecting the health of her unborn baby (The Express, Mail, Mirror, Telegraph & Times, 1 April 2009). Whatever the truth of the story, this example seems to demonstrate an extension of public control of personal space almost unique to pregnancy, sometimes more typically, if no more appropriately, marked by patting a woman's pregnant stomach.

The proliferation of advice on what to do and what not to do in pregnancy, and the implied lack of trust in the embodied experience, would appear to represent a significant incorporation of pregnancy itself into public space, permitting such interference in real encounters as is also evidenced by the way that women already in the public eye are treated more generally. The relentless attention paid to women's appearance, behaviour and lifestyle in gossip magazines and websites given over to 'celebrities' includes, of course, commentary on celebrity pregnancy, whether potential or actual. Speculation focuses on slight increases in size or style of clothing, highlighting how signs of potentially occupied space increase the visibility of pregnancy even before it is a reality. Once a pregnancy is confirmed and externally visible, women's behaviour is monitored by these various media as closely as by health professionals, with greater critical comment and advice on what is considered suitable behaviour. Certain celebrities have attracted greater vilification than others, especially where pre-pregnancy behaviour was reported as shocking or inappropriate, for example, Britney Spears. 

In a sense, celebrities could be described as vectors for particular styles and forms of advice and surveillance, and as well as taking up additional space (literally, column inches) as individuals once they are pregnant, they provide a reflection of how pregnancy should or should not be done in the public domain, offering yet another source of risk to be negotiated by pregnant women. Celebrities also highlight the possibility of other forms of embodied subjectivities, pregnant selves who do not change their appearance and remain apparently slim before and after the birth and perhaps contributing to some women feeling dissatisfied with their bodies (Clark et al., 2009).

Medical, reproductive and communication technologies have all provided opportunities to expand the visibility of the internal and increase the public location and visibility of pregnancy. In addition, and most recently perhaps, the need to fill media space, either with advice or with celebrities, has contributed to some of the changes in the public space taken up by pregnancy. Whether or not this contributes to confidence in women's embodied experience of pregnancy remains unexplored.

Harriet Gross
is Professor of Psychology at the University of Lincoln
[email protected]

References

Beck, U. (1992). The risk society: Towards a new modernity. London: Sage.Bordo, S. (1993). Unbearable weight. Berkeley, CA: University of California Press.Clark, A., Skouteris, H., Wertheim, E.H. et al. (2009). The relationship between depression and body satisfaction across pregnancy and the postpartum. Journal of Health Psychology, 14, 27–35.Clarke, P.E., Gross, H. & Rousham, E.K. (2004). Women's behaviour, beliefs and information sources about physical exercise in pregnancy. Midwifery: An international journal, 20, 133–141.Department of Health (1993). Changing childbirth (The Cumberlege Report). London: HMSO.Department of Health (2009). The pregnancy book. London: Author. [Available as PDF from http://bit.ly/czhhBB]Duncombe, D., Wertheim, E.H., Skouteris, H. et al. (2008). How well do women adapt to changes in their body size and shape across the course of pregnancy. Journal of Health Psychology, 13, 503–515.Gross, H. & Pattison, H. (2007). Sanctioning pregnancy: A psychological perspective on the paradoxes and culture of research. London: Routledge.Hanson, C. (2004). A cultural history of pregnancy. Basingstoke: Palgrave.
Lankshear, G., Ettore, E. & Mason, D. (2005). Decision-making, uncertainty and risk: Exploring the complexity of work processes in NHS delivery suites. Health Risk & Society, 7, 361–377.
Longhurst, R. (2005). (Ad)dressing pregnancy bodies in New Zealand. Gender, Place & Culture, 12, 433–466.
Lupton, D. (1999). Risk. London: Routledge.
Matthews, S. & Wexler, L. (2000). Pregnant pictures. New York: Routledge.
Matthiasson, T.E. (2005, 26–28 October). From hidden pregnancy to chic maternity fashion. Paper presented at the Interdisciplinary Conference of Fashion and Dress Cultures at Danish Museum of Arts and Design, Copenhagen.
Morrissey, S.J. (1998). Work place
design recommendations for the pregnant worker. International Journal of Industrial Ergonomics, 21, 383–395.
Miller, T. (2005). Making sense of motherhood: A narrative approach. Cambridge: Cambridge University Press.
NICE/National Collaborating Centre for Women's and Children's Health (2008). CG62 Antenatal care: Routine care for the healthy pregnant woman. London: NICE.
Oakley, A. (1984). The captured womb: A history of the medical care of pregnant women. Oxford: Blackwell.
Pattison, H. & Bhagrath, J. (2004). Dietary change during pregnancy. Journal of Reproductive & Infant Psychology, 22, 242.
Pattison, H. & Gross, H. (1996). Pregnancy, work and women's wellbeing: A review. Work & Stress, 10, 72–87.
Raphael-Leff, J.(1993). Pregnancy:
The inside story. London: Sheldon Press.
Seymour, J. (2000). Childbirth and the law. Oxford: Oxford University Press.
St Clair, P.A. & Anderson, N.A. (1989). Social network advice during pregnancy: Myths, misinformation and sound counsel. Birth, 16, 103–107. (Retrieved online 24 May 2009 DOI: 10.1111/j.1523-536X.1989.tb00876.x)
Tyler, I. (2001). Celebrity, pregnancy and subjectivity. In S. Ahmed & J. Stacey (Eds.) Thinking through the skin (pp.69–83). London: Routledge.
Ussher, J. (2006). Managing the monstrous feminine. London: Routledge.
Wiles, R. (1994). I'm not fat, I'm pregnant. In S. Wilkinson & C. Kitzinger (Eds.) Women and health (pp.33–48). London: Taylor & Francis.
Young, I.M. (1990). Pregnant embodiment. In I.M.Young, Throwing like a girl and other essays in feminist philosophy and social theory (pp.160–175). Bloomington, IN: Indiana University Press.