The Zero Trimester. Miranda R. Waggoner
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few years, my thinking on this topic has been enriched by conversations with Elizabeth A. Armstrong, Angela Creager, Cynthia Daniels, Kathleen Ferraro, Kathleen Gerson, Chris Gillespie, Larry Greil, Carole Joffe, Kelly Joyce, Martine Lappé, Emily Mann, Christine Morton, Lynn Paltrow, Jennifer Reich, Deana Rohlinger, Lindsay Stevens, and Shirley Tilghman.
A version of Chapter 6 previously was published as “Cultivating the Maternal Future: Public Health and the Prepregnant Self,” in Signs: Journal of Women in Culture and Society 40(4) (2015): 939–62. Several paragraphs throughout the text were previously included in “Motherhood Preconceived: The Emergence of the Preconception Health and Health Care Initiative,” published in Journal of Health Politics, Policy and Law 38 (2013): 345–71. Thanks to the University of Chicago Press and Duke University Press, respectively, for reprint permission.
While researching and writing this book, I benefited from generous institutional and financial support from Brandeis University, Princeton University, the University of Virginia, Florida State University, the National Science Foundation, the National Institutes of Health, the Andrew Mellon Foundation, and the Eastern Sociological Society. Alexandra Turner, Hena Wadhwa, and Harry Barbee provided helpful research assistance at various stages of this project, and Heidi Muir was a delight to work with during the interview transcription process. Judy Hanley, Cheryl Hansen, Kay Bennett, and Nancy Cannuli also provided critical help with technical and administrative concerns at different moments in this project’s trajectory. Naomi Schneider, my editor at the University of California Press, buoyed me with her thoughtful patience and consistent support for this project. Renée Donovan and Nicholle Robertson were considerably helpful during the production process. And Gabriela Whitefield’s heartwarming and steady friendship during this time has been more vital than she knows.
I have been fortunate to spend time in multiple academic institutions over the past decade and a half, and throughout my time in each location, I received crucial support from colleagues and friends that sustained me in significant ways. When I was an undergraduate at the University of Texas, Christine Williams inspired me to pursue a career in sociology, and I also thank Marc Musick, Sharmila Rudrappa, and Gideon Sjoberg for their indispensable support during my time in Austin. During my years at Brandeis, Ashley Rondini, Ken Sun, Vanessa Muñoz, Tom Mackie, Meredith Bergey, Amanda Gengler, Sonja Jacob, Dana Zarhin, Giusi Chiri, Erin Rehel, Maia Hurley, and Nelli Garton were all brilliant friends to have as I began to traverse the world of academia. Special thanks are in order for Liz Chiarello who made my time at Princeton infinitely more humorous and intellectually stimulating than I could have imagined. Also at Princeton, I treasured my chats with Fah Vasunilashorn, and James Trussell provided steadfast support along the way, for which I remain very grateful. Michaela DeSoucey and Sarah Thébaud have been consistently lovely sources of friendship and wisdom—on topics sociological and maternal—since the day we met in New Jersey. From the University of Virginia, I thank Jeff Olick, Charlotte Patterson, Katya Makarova, and Corinne Field for their support. I feel privileged to have written the final version of this manuscript while among my wonderful and engaging colleagues at Florida State University.
My parents, John and Linda Waggoner, have provided support I cannot possibly recount, as it has been abundant and every day. They championed my educational path and intellectual pursuits from the very beginning, regularly took care of my young son so that I could work, consistently served as a sounding board for life and career questions, helpfully read chapters and listened to my arguments, and provided much emotional and gastronomical sustenance during the years of this project. Needless to say, I am deeply grateful. I also want to thank my grandparents, David and Leta Andrews, for being so inspirational and loving, and my late grandparents, Weldon and Adelle Waggoner, whom I miss dearly.
Finally, I end with a happy and wholehearted thanks to my husband, Sven Kranz, and our son, Anton—both came into my life during this work and brought love and joys unforeseeable and indescribable. Cliché, of course, because it’s true: there are no words.
1Someday, Now
PRECONCEIVING RISK AND MATERNAL
RESPONSIBILITY
Having a healthy pregnancy is no longer contingent on being pregnant in the first place. In February 2016, the federal Centers for Disease Control and Prevention (CDC) released a statement urging women of reproductive age to avoid alcohol if they were not using birth control, lest they harm a pregnancy that might or might not be present. The idea was vast: the CDC indicated that about 3 million American women were putting potential pregnancies at risk, but any woman between 15 and 44 years old was defined as “pre-pregnant,” thus targeting, in effect, about 61 million American women.1 This measure attracted considerable social commentary and ridicule,2 but it hardly represented a new idea in public health. In 1981, Surgeon General Edward Brandt issued a warning that women “considering pregnancy” should refrain from alcoholic beverages.3 Since 1992, Kentucky has required bars to post warnings that drinking alcohol prior to conception can cause birth defects4 when, in fact, it cannot. The idea of pre-pregnancy health promotion surged after 2006, when the CDC released a report recommending improvement of the pre-conception health and health care of U.S. women of childbearing age.5 Alcohol was just one of many pre-pregnancy risk factors listed in this report, and public health warnings issued since 2006 have not been limited to drinking.
In late 2012, for instance, Texas initiated a public-awareness campaign, called Someday Starts Now, for improving the health of the state’s babies. In television spots, young women performed everyday activities—chatting with friends, exercising—accompanied by a looming bubble box filled not with dialogue, but rather with numbers indicating a long-in-the-future baby’s due date, sometimes years away. This approach had the visual effect of dangling future motherhood above the women’s heads. The campaign’s associated website stated, “your health today is important—and even more important to the baby you might have someday.”6 The text further offered: “If there’s a baby in your future, even if it’s months or years from now, today matters. Take control. Stop smoking, eat right and exercise and do something about your stress.”7 After seeing this television spot, one blogger wrote, “Texas is Reminding Me I’m Just a Baby Vessel Again.”8
The CDC and Texas campaigns represent but two illustrations of a growing tendency in medicine and public health to mark the beginning of healthy and responsible motherhood not at the birth or adoption of a child, not during pregnancy or at conception, but rather at an earlier point in time: pre-pregnancy. Similarly, in its recommendations for healthy pregnancy behavior, the March of Dimes—a national organization committed to improving birth outcomes in America—points directly to the three months prior to conception, claiming that a proper pregnancy today should actually last twelve months.9
These public health statements are jarring. Perhaps because of the invariant biological fact that a typical human pregnancy lasts about nine months, it is disconcerting to read that it instead should be thought of as a lengthier process. Given feminist progress over the past half century, the thought of women of reproductive age as primarily mothers-in-waiting seems problematic.10 Also given that the focus on pregnancy health for more than a century has been on pregnancy behaviors, the thought of focusing on health behaviors prior to pregnancy is astounding. At the same time, these public-health assertions are somewhat expected. The sentiment that healthy babies stem from fit, responsible women echoes age-old societal preoccupations with women’s bodies, behaviors, and reproductive outcomes. Anticipating and hedging future risk is reflective of our contemporary age of risk aversion and individualized responsibility for health. Concerns about the health of future generations have long manifested in cultural and political anxieties around family planning, fetal health, and women’s roles in society.
Pre-pregnancy care is a framework that emerged as the new panacea for ensuring healthy pregnancies and healthy infants in the United States in the twenty-first century. It now is a dominant medical and cultural schema for reducing risks to healthy pregnancies, and it includes prescriptions for both health care and self-care. To have good pre-pregnancy health is to render pregnancy less risky, the thinking goes, and might improve the overall health of women, children, and society. What is emphasized, then, in contemporary health discourse