When I gave birth by scheduled caesarean section last year, a surgical drape made a blank screen in front of my eyes. My arms were strapped, crucifix-style, to a gurney, and I was numb from the sternum down. I could move only my head, so I turned to look at the window of the operating room, whited out by a late-winter snowstorm. There, I discovered, I could see the doctors and nurses gathered around the mound of my belly. When the obstetrician pulled my baby from my body, my first sight of him was in that window's reflection, pale and ethereal. After nine months of wondering what this child would be like, it was fitting that my earliest glimpse would look this way—half imagined and half real, not unlike the shadowy ultrasound images that seemed as much a prod to the imagination as a literal picture.
What I did on the morning my son was born was what we all do when we think about fetuses: We project our wishes, fantasies, and fears onto these unborn, unseen beings. That's the argument made by author Sarah Dubow in a provocative new book, Ourselves Unborn: A History of the Fetus in Modern America. Dubow, an assistant professor of history at Williams College, contends that "the meanings ascribed to the fetus from the late nineteenth century through the early twenty-first century have had more to do with social values and political circumstances than with biology or theology." The enigmatic opacity of the pregnant belly, Dubow notes, has made it the perfect foil for any number of collective concerns, from anxieties about the economy to fears about national security to unease about the changing roles of women. Tracing the shape of the "protean fetus" over the past 150 years, Dubow sets out to demonstrate that its shifting forms tell us more about the tenor of the times than about the fetus itself.
She presents some intriguing evidence. Dubow begins her study in the late 19th century, when concerns about the way an emerging industrial economy was challenging the traditional order led "prenatal culturists" to exhort women to instill values and character while their offspring were still in the womb. Charles Bayer, author of a book about the importance of such "maternal impressions," warned in 1897 that "the money-making mania seems to be increasing" and attributed this phenomenon to the thoughts and feelings of pregnant women. "Our theory is that the prospective mother, who overhears the exciting stories of the day's success in making money on the Board of Trade, which engrosses the mind of husband, father, or brother, and the plans which are formed for a further accumulation of wealth in her hearing, necessarily influences the mentality of the unborn child," he wrote. Worries about "pauperism, feeblemindedness, alcoholism, prostitution, rebelliousness, and criminality" continued into the 20th century, Dubow observes, leading some to embrace eugenics and others to champion the importance of prenatal influences and "the right to be well-born."
As the United States entered the Cold War, concern shifted to the fragility of the American psyche, now understood in psychoanalytic terms but still believed to be the pregnant woman's responsibility. At the annual meeting of the American Medical Association in 1953, Dubow tells us, Dr. William S. Kroger led a session on "prenatal neurosis": "A new baby may be destined to be a neurotic child if his mother was the victim of disturbed feelings during the months before birth," he reported. Kroger attributed gestational conditions like preeclampsia and even miscarriage to the expectant woman's mental state and to the effects of "the stress of modern living."
The 1973 Roe v. Wade decision legalizing abortion inaugurated another era for the fetus as foil, this time as a backdrop for clashes over feminism. As women entered the workforce in greater numbers, "fetal protection policies" were put in place, with industry posing as the guardian of fetuses' well-being while pregnant women, especially those in well-paid technical and industrial jobs, were cast as avaricious and uncaring careerists—as "women who want to hurt their fetuses for a slightly higher wage," in the words of a Court of Appeals judge who allowed such a policy to stand. In the 1970s and 1980s, pregnant women—especially those who were poor or black—were increasingly portrayed as pleasure-seeking hedonists who cared little about their fetuses, a dynamic on lurid display during the panic over a putative epidemic of "crack babies."
Dubow concludes with a look at the 1990s and 2000s, when reaction against women's increased autonomy assumed a softer, gentler guise. Conservative commentators began voicing concern about the psychological harm experienced by women who terminate their pregnancies and about the physical pain experienced by a fetus during an abortion. (I should note that Dubow cites, but does not discuss, an article I wrote about fetal pain for The New YorkTimes Magazine in 2008.)
Dubow is no doubt correct that the fetus has served as an especially accommodating vessel for a succession of social problems, and she does an admirably thorough job of identifying the links between such issues and our attitudes toward pregnancy. But there's a curious omission in her book: the actual, physical fetus itself. Indeed, Dubow appears to believe that no such being exists. "A fetus in 1870 is not the same thing as a fetus in 1930, which is not the same thing as a fetus in 1970, which is not the same thing as a fetus in 2010," she writes. Well, yes, it is the same thing. Or, rather: If a fetus in 2010 is a different thing from a fetus in 1870—better nourished but more stressed, say; less polluted by coal, but more contaminated by bisphenol A—then it has been made different by material forces about which Dubow, in her discussion of the shifting "meanings" and "interpretations" of the fetus, has little to say.
Ourselves Unborn does not address the way tangible influences, such as nutrition and exposures to pollutants and other chemicals, have shaped the fetus and its image in modern times. The midcentury tragedies of thalidomide and diethylstilbestrol (or DES),for example—two drugs given to pregnant women that caused agonizing damage to their offspring—shocked the medical profession and the population at large out of the comfortable assumption that the fetus was sealed away in the womb, impervious to harm. Whether we perceive the fetus as fragile or invulnerable, inert or active, benign or parasitic would seem to be at least as dependent on evidence from its physical being as on the airier stuff of cultural discourse, but on this subject Dubow is silent.
More surprisingly, she also neglects to examine the way that scientific and medical advances have changed the fetus's body, as well as the way we think and feel about it. For Dubow, science is simply another stage on which we enact our fantasies and anxieties. Describing the pioneering work of the early embryologists Wilhelm His and Franklin Paine Mall, she is interested in science not as a process of genuine discovery but as an elaborately theatrical performance: "The painstaking and laborious process by which His and Mall materialized embryos—obtaining them, sectioning them, staining them, classifying them, fixing them in paraffin for slides—illustrates the complex steps through which the modern embryo was not discovered, but was constituted and produced through Progressive-Era technologies and assumptions," she writes. In this book the fetus is always "constituted" and "produced," "constructed" and "represented"—never conceived or born, nurtured or harmed.
And the fetus is never understood in an objectively more accurate fashion than we understood it before. Yet that has been the story of science and the fetus in modern times: a steady expansion of our knowledge about the prenatal period, one that has accelerated markedly in the last few decades. To take just one example, consider the folic acid supplements now recommended to all women of childbearing age. We can dissect the cultural iconography of these little white pills and analyze the symbolic meaning of adding it to the nation's food supply—but we must also acknowledge the fact that this essential vitamin has prevented thousands of devastating birth defects like spina bifida since British epidemiologist Nicholas Wald first tested its use in pregnant women in 1983. To be sure, science deserves its share of cultural criticism; indeed, Dubow offers many sobering examples of science, or pseudo-science, used to buttress pre-existing biases and hierarchies. But she doesn't give enough credence to the capacity of science to tell us something we didn't already know.
The authority we're willing to grant science when it speaks about the fetus is an especially salient matter now, as an emerging field known as the developmental origins of health and disease begins to reshape once again our understanding of the fetus, the pregnant woman, and the relation between them. This burgeoning science has amassed considerable evidence that our health and well-being throughout life are significantly affected by the conditions we experienced in the womb. Dubow doesn't address this fledgling discipline in Ourselves Unborn, but one imagines that she would view it as just another tale we're told about the fetus, one ripe with possibilities for coercion and blame directed at pregnant women.
That would indeed be part of the truth. The interpretation of DOHaD findings, and perhaps even the science itself, is inevitably colored by our society's current preoccupations: with reducing risk, with maintaining social status, with producing the "perfect" child. But it is also true that science can often hold itself above the fray long enough to generate new knowledge, knowledge which in time alters our attitudes along with our bodies. There's a reason we accord science such outsized authority: Imperfect though it may be, it makes things happen, and sometimes it makes things better. A fetus is an idea, but it's also a physical being, describable and understandable in scientific terms—and one that becomes, when the screen is at last removed, a baby.