NYC's pregnancy discrimination law is a sign of the demise of the bubble-wrap approach to pregnancy.

Why Women, and Doctors, Are Turning Away From The Bubble-Wrap Approach to Pregnancy

Why Women, and Doctors, Are Turning Away From The Bubble-Wrap Approach to Pregnancy

The XX Factor
What Women Really Think
May 11 2016 5:30 PM

Why Women, and Doctors, Are Turning Away From The Bubble-Wrap Approach to Pregnancy

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A woman in her third trimester enjoying a well-deserved glass of wine.

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Last week, the New York City Commission on Human Rights announced a new set of guidelines to prevent discrimination against pregnant women. Among them are requirements that protect pregnant women in the workplace by “[r]equiring employers to accommodate reasonable requests from employees related to pregnancy, childbirth, or a related medical condition” and “[r]equiring employers to initiate and engage in a  ‘cooperative dialogue’ ” with pregnant employees who need accommodations. The guidelines also aim to prevent pregnancy discrimination in the public sphere, including one stipulation that bars and restaurants can’t deny pregnant women entry into their establishments or refuse to serve them a drink.

This right to drink, the part of the guidance that has earned the most headlines, is hardly the most pressing matter for women suffering from pregnancy discrimination. Surely losing one’s job (or having one’s hours reduced) as punishment for being pregnant is far more damaging than being denied a beer or two.

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Still, the inclusion of this right to drink is remarkable as a symbolic gesture, one suggesting that our paternalistic, overly cautious attitude towards pregnant women might, despite some recent, inane recommendations, be slowly fading. “While covered entities may attempt to justify certain categorical exclusions based on maternal or fetal safety, using safety as a pretext for discrimination or as a way to reinforce traditional gender norms or stereotypes is unlawful,” reads the new guidance. In other words, just because a bartender or a boss has good intentions—intentions that are often rooted in outdated research—they don’t have the right to tell pregnant women what to do.

In an October 2014 story for Cosmopolitan, journalist Michele Ruiz looked into why college-educated, employed women in their 30s are more likely to drink during pregnancy than other demographics and surmised that it’s because this group is more likely to challenge the conventional, and inaccurate, wisdom that drinking while pregnant is never OK. This is an accurate description of what I saw when my friends and I got pregnant and navigated the litany of prohibitions. The vast majority of us decided we were comfortable enjoying a glass of wine or beer, and these libations were universally doctor-approved. Indeed, nearly every pregnant women I’ve ever known has told me how (and everyone uses this phrase) “laid back” their OB-GYN is on most lifestyle choices, including the consumption of alcohol and caffeine. When I asked a few friends about this while researching this piece, they said everyone they knew also had a “laid back” OB-GYN. I’ve begun to suspect that it isn’t so much that we all have especially chill doctors, but that doctors have started to change the way they speak to pregnant women.

According to Sarah Horvath, an OB-GYN and the current Gellhaus Fellow at American Congress of Obstetricians and Gynecologists, doctors today are much more in tune with the reality that being pregnant doesn’t strip a woman of her capacity to reason. “The goal has become to give the patient as much information as possible while respecting her autonomy to make a decision,” Horvath said. “There has, and will continue to be, a decided shift over the last couple of decades from paternalism to autonomy in the doctor-patient relationship. This is true in medicine in general, but nowhere do we see it more than in pregnancy and reproductive medicine.” She explained that while the official line in the medical community continues to be to advise pregnant women against drinking, many doctors believe the right thing to do is to explain the full picture to their patients and let them decide for themselves. The full picture includes the facts that while a little bit of alcohol doesn’t appear to do any harm, a lot of alcohol does, and nobody knows where exactly the line between a little and a lot lies.

Emily Oster, author of Expecting Better, a book that takes aim at conventional, often fear-mongering pregnancy advice, said that she suspects that enthusiasm for a more relaxed approach to pregnancy is rooted in a growing resistance against the culture of overparenting. “I think we are seeing some pushback to this idea that all desires of parents must be subsumed by the desires and needs of their children. This thinking bleeds into pregnancy: one should not do the things one enjoys, and should suffer for the good of your kid,” said Oster (an occasional Slate contributor). I agree, though I also suspect that birth reform advocates may have contributed to pregnant women’s sense of agency, with their constant messaging that women should be feel empowered to make their own decisions during pregnancy and childbirth.

Oster also added that, as Ruiz pointed out out, this less bubble-wrapped attitude to pregnancy is more common among educated, wealthier women. She said many of the OB-GYNs she spoke with about her book explained that they were more likely to present the full, complex picture regarding pregnancy prohibitions to women who they believed were capable of grasping it. “It’s often a privilege to be offered a more relaxed approach,” Oster said.

Still, a less paternalistic culture towards pregnant women, even one that starts among privileged women, can benefit less educated, less wealthy women as well. Dina Bakst, co-founder and co-president of A Better Balance, a legal advocacy organization, pointed out that while the consequences experienced by a minimum-wage earner being discriminated at work are much graver than those experienced by a high-income worker being discriminated against at a bar, they are motivated by a similar mindset.

“By including guidelines for the workplace as well as public spaces, the commission is showing how they are motivated by the same paternalistic assumptions, assumptions that need to be rooted out,” Bakst said. “The bottom line is, women should be able to dictate what their needs are, what they are capable of handling, wherever they are.”