The Body Still Isn’t A Temple: On Pregnancy and the Cult of Purity
It took me about two months of throwing up almost every day before I asked for a prescription for a completely safe and very effective medication to ease my nausea. And I have great insurance through my employer.
At my 12-week prenatal appointment, my midwife explained that she recommends trying holistic treatments first. And everyone had been telling me that my symptoms would disappear at the start of the second trimester anyway.
That didn’t happen, and holistic treatments (which pretty much means eating differently) were getting expensive. When I thought watermelon helped, I bought a lot of watermelon, then threw up red. Blackberries? Yogurt? Something would seem to work, I would fill the fridge with it, and then it would, painfully, stop working. There were other costs, too, in my ability to work, or really do anything. Two months is a long time to feel shitty all day.
Decades ago, Diclegis was marketed as Benedictin. By either name, it’s a combination of an antihistamine and a form of vitamin B6. The drug worked so well from the time it was introduced in 1956, and was prescribed so widely, that by pure statistical chance, some women taking it also, unrelatedly, had babies with birth defects. Some of them sued the company that made the drug. Studies showed no correlation, and both ingredients were known to be safe.The FDA lists the drug as Category A during pregnancy, which is the safest possible rating. This means, “Controlled studies show no risk or find no evidence of harm.” A very few drugs make the Category A cut, mostly because pregnant woman are typically excluded from controlled studies. The drug company, knowing full well that it was safe, decided it wasn’t worth the cost of defending it and took it off the market in 1983.
It took THIRTY YEARS for another company to change the name to Diclegis and sell the drug again.
For this gross, decades-long lapse in safe and effective care, I don’t blame the women who brought the lawsuits, or even the lawyers who hoped to profit from their cases. I blame the insistent cultural message that, when something bad happens to a baby, it must be the mother’s fault. She’s selfish. She wants to eat a regular meal without vomiting. She wants the lacerations in her throat to heal. She wants to live her life, do her job, and give birth to a healthy baby.
It should go without saying that it’s not selfish to hope to digest your food, which—bonus!—results in passing essential nutrients to your developing baby.
Before this pregnancy, I had another pregnancy that ended almost before it began, so early that its end was almost definitely the result of some kind of uncontrollable chromosomal unviability. TL;DR, I don’t blame myself for my miscarriage.
And yet, when I told a new acquaintance about the loss at a party, she urgently recommended that I adopt a vegan diet (or is the term now “vegan lifestyle?”). In her mind, eating animal products may very well have ended my pregnancy. Which is bullshit. Which I told her. She did not recant. Our conversation ended.
I feel itchy whenever someone says to be careful or mindful or whatever about what you “put into your body,” as if these heaps of blood and meat are sacred vessels that mustn’t admit the impure. As if we should be in awe. As if we have dominion over them. My memory isn’t so short that I’ve forgotten the origins of “your body is a temple.” Remember? It’s about shaming women for wanting to have sex with anyone besides their future husbands, for any reason besides conceiving a child. It’s a patriarchal, violent metaphor.
And now it’s being regurgitated by the “clean eating” devotees.
Eating in a way that’s “clean” isn’t much of a leap from being “clean.” Which means there are clean people and unclean people. Does this sound familiar? It’s the basis of so much racist—and genocidal—propaganda.
When you’re pregnant, people will tell you with doubtlessly good intentions that whatever goes in you, goes in the baby, whether it’s smoke or kale or whiskey or pills.
At first, I accepted this at face value. It sounds right. And while I don’t blame myself for my previous miscarriage, I was scared witless that I would have another one, and wanted to do whatever I could do to minimize the risks, especially during the vulnerable first trimester.
Then I read Expecting Better by Emily Oster. While the tagline says, “Why the Conventional Pregnancy Wisdom is Wrong—And What You Really Need to Know,” the book is really more about making personal choices based on the most reliable studies and your own priorities. As an economist, Oster emphasizes the importance of knowledge-based decision making, pointing out several times that she and other pregnant friends made opposite choices (like whether to have an epidural or whether to eat deli meat) based on the same evidence.
I would recommend this book to anyone, pregnant or not, since we are all navigating a sea of medical advice, health news, and diet orthodoxy. We are googling our symptoms, we are scaring ourselves out of eating what we like and finding endless new recipes for foods we don’t like, we are sharing our sacred bits of anecdotal evidence, hoarding other people’s success stories, desperately searching for the Gospel of Health. What will keep us safe (or at least thin).
Some varieties of insight from Expecting Better, with widely applicable lessons in bold and pregnancy-specific examples following:
- Correlation does not mean causation. Caffeine intake is linked to early (first-trimester) miscarriage. True. But an absence of first-trimester nausea/vomiting is also, unrelatedly, linked to miscarriage. Nauseated women don’t typically want coffee, at all. There aren’t any studies that reliably untangle the question of whether women who drink lots of coffee have more miscarriages because of the coffee, or whether they drink lots of coffee because they aren’t sick to their stomachs and disgusted by coffee. Oster found no evidence that drinking up to 4 cups of coffee per day caused problems, and even for more than 4 cups, the results are mixed.
- Medical advice is overly general. Pregnant women are told to avoid eating cold deli meat because of the risk of listeria. Listeria is very bad for the unborn baby. But listeria is also very rare, and it’s really only deli turkey that has ever been the cause of a listeria outbreak, so there’s no real reason to worry about deli ham or soppressata or roast beef. (Incidentally, frozen vegetables and cantaloupe have also caused listeria outbreaks, and nobody tells pregnant women not to eat those foods.)
- Evaluating risks depends on your priorities. Epidurals are the most common pain relief medication administered during labor. Epidurals sometimes cause complications that make healing from labor more difficult and painful. For the most part, the baby will be fine whether you have one or not, so this is more about the comfort and preferences of the mother. For some women, it’s more important to reduce pain during labor, so they choose the epidural. For other women, besides the other attractions of an unmedicated birth, it’s more important to minimize complications of recovering from labor, so they forgo it. Neither is right or wrong.
- Some risks are riskier than others. Gaining less than the recommended amount of weight during pregnancy causes lower-than-average birth weight, and gaining more than what’s recommended causes higher-than-average birth weight. But Oster found that lower-than-average birth weight is much more dangerous than higher-than-average birth weight—yet almost all the warnings out there, from the internet and Oster’s own doctors, concern gaining too much weight. Which is backwards.
- Cocaine complicates things. Studies that indicated a link between light to moderate drinking and birth defects were flawed in a kind of ridiculous way: the women who drank were also more likely to do coke. The researchers don’t know whether alcohol or cocaine was really responsible for the problems. And you can’t, ethically, do a controlled study that requires half the pregnant women to drink alcohol.
There’s also a part about whether you really have to avoid changing the cat litter, but we’re not telling my husband about that one.
As for the idea that the baby is subject to everything the mother ingests? It’s just not that accurate. Some drugs are too big (in molecular weight) to cross the placenta. An example is insulin, which is the first-line treatment for pregnant women with diabetes. Untreated maternal diabetes puts both the mother and the baby at great risk. But I bet you money that a pregnant woman with diabetes has been shamed for taking insulin and told she can control the disease purely through diet.
Women are often given the blanket advice to avoid medications during pregnancy if possible. The “if possible” is important, since the benefits often far outweigh the risks, but, speaking personally at least, “avoid” rings a lot louder in a pregnant woman’s ears.
Pregnant women have higher blood volume, a weakened immune system, a rapid influx of mind-and-body-altering hormones, and growing uteruses that squish and push other organs around. And we’re shamed about seeking treatment for any of it because it might harm the baby.
I’m not immune. Yesterday, after two weeks of feeling much better on Diclegis, I didn’t take it out of a wild hope that I would be like the 95% of pregnant women who report that their nausea disappears on its own by week 16 (usually before). And I puked. Today, I’m back on Diclegis.
I tried to go without because I can’t fully shake the idea, so entrenched in our culture, that it’s better not to take medication, not because it could pose a risk to my child, but because it’s somehow more pure and natural. More clean.
This is a dangerous ideology, every bit as unscientific and anti-woman as the notion that “if it’s a legitimate rape, the woman’s body has ways to try to shut that whole thing down.” And it dovetails all too well with the campaign against healthcare access. Why go to the doctor? Just eat better and exercise! And if you eat a bunch of processed food, and you get sick, why should I foot the bill?
This is not an argument against holistic wellness or looking beyond Western medicine and the typical American diet to treat illness or maintain good health. Far from it. Choosing a vegan or grain-free diet clearly works for a lot of people to address inflammation or digestive issues or even flare-ups of diseases like MS. I’ve certainly suffered the fiery hell of taking too many antibiotics to treat a recurring urinary tract infection.
And I believe in listening to your own body and its wisdom, not because it’s holy, but because it’s yours. Everyone’s body is different, and you can pay attention to yours in a way that a doctor can’t. If anything, Oster’s book is an argument against taking everything your doctor says at face value.
At the same time, health is not determined by diet alone, or even diet and exercise. We don’t have that much control, and our bodies are astoundingly complicated. If they were simple (a close cousin of pure), we could build machines to carry embryos to full term.
We’re all susceptible to some magical thinking, and that’s not entirely a bad thing. My best friend in college decided to stop chemotherapy after multiple rounds of treatment left her depleted and enervated (and her family financially strapped). She said that daily shots of wheatgrass, which she grew herself, would strengthen her a lot more effectively than anything the hospital did. The truth was, chemo wasn’t really working, and she was going to die regardless. It was only a help and a comfort for her to believe that she could eat something to prolong her life, and to claim a little agency as she confronted her mortality.
The problem is when we start to believe we’re somehow more ethical, more clean, more pure when we use coconut oil instead of olive oil. Or when we see taking antidepressants as a failure to fight depression naturally. Sure, exercise helps to elevate mood, but you have to feel motivated to exercise in the first place.
The body still isn’t a temple. We aren’t going to defile it by eating a couple Cheetos any more than we are by entertaining some premarital peen. Eat right, however you make sense of that, but don’t tell me it’s more righteous than how I eat.
Photo by Grumpy-Puddin
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