Not everything that comes from the birth parts of a woman is a human being.
Wilhelm Gottfried von Ploucquet
German physician, 1788
This quote is used by the historian Barbara Duden to contrast eighteenth century understandings of pregnancy with those held today. Before the involvement of medical professionals and monitoring, Duden argues that a pregnancy did not become a fact until it ended in the birth of a child. Those pregnancies that ended too soon were not seen as ‘true’ pregnancies, and the entity lost was not understood as human but as a ‘false fruit’ or ‘mole’.
In the UK, science and technology now heavily shape our understandings of gestation. Today it seems unimaginable that prior to birth the being within would not be considered ‘human’. Embryologists have studied the developmental changes taking place from conception to birth, and illustrated these in sequential diagrams of foetal growth. These encourage us to map out a future for the hoped-for baby as soon as a pregnancy is confirmed. Expectant families can see inside the womb using ultrasound and recognise the grainy figure as a ‘baby’, equating it with the tiny human that will be bathed and fed in several months’ time. These ways of understanding pregnancy shape practices and emotions of those who are pregnant and their families, with imaginings of the future child beginning with a positive pregnancy test. Clothing and toys are purchased and parties held to celebrate the child, not yet visible but nonetheless felt as present. The loss of a baby during pregnancy can have powerful impacts on families, as they grieve for a child that was never held but had nevertheless become part of their family.
These understandings of pregnancy as oriented towards its anticipated endpoint – the birth of a baby – can shape experiences of pregnancy in a positive way, bringing joy and excitement. However, they can also mean that when pregnancy does not end in birth as anticipated, such experiences can be seen as less valuable, as failed or even silenced. This can become more pronounced in pregnancies where that which is lost does not conform to our understandings of what it is to be human. Examples are anembryonic pregnancies (‘blighted ovum’), where a placenta and sac form but an embryo does not, and molar pregnancies, where the placenta develops abnormally preventing foetal development. In these cases, women can undergo signs and symptoms of pregnancy such as a positive test, growing belly and nausea, without a foetal presence.
These conditions trouble contemporary understandings of what it means to be pregnant, which so often focus on its endpoint. In the absence of a developing foetus they force us to reflect on all that pregnancy entails beyond the growth of a new human. For example, from their very beginning multiple forms of gestation provoke hormonal shifts, changes to the circulatory, metabolic and immune systems, and generate an entirely new organ: the placenta. These experiences, coupled with anticipations for a future child, powerfully shape the social worlds of pregnant people and their families.
In my Wellcome Trust-funded project (October 2020-October 2023) I will consider experiences of pregnancy beyond the birth of a baby through research on molar pregnancies and other gestational trophoblastic diseases. I will interview those affected by molar pregnancies and observe clinical practice to study how these pregnancies are valued and cared for. Aligning with iHuman’s work, the condition is prompting me to reflect on how the (future) human comes into being during pregnancy, even in its absence, and how scientific practice and clinical management shape such experiences for those affected and their families. You can read out more about my work, and find me on Twitter.
Further reading
Duden, B. (1993) Disembodying Women: Perspectives on Pregnancy and the Unborn. Cambridge, MA; Harvard University Press.
Franklin, S. (1991) `Fetal Fascinations: New Dimensions of the Medical-Scientific Construction of Fetal Personhood', in S. Franklin , C. Lury and J. Stacey (eds) Off-Centre: Feminism and Cultural Studies. London: Harper Collins, pp. 190-205.
