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Over the past few years a quiet revolution in obstetrics has begun.
After almost a century of passivity imposed by science, mothers-to-be are
seemingly being encouraged to take control. Pregnancy and childbirth handbooks
now flood the market, telling women how to take responsibility for the health
and safety of their child during pregnancy and labour, how to hold technology
at bay and achieve a ‘natural’ birth. The occasion need no longer be simply
an engagement between medical science and the fetus. Many hospitals now
ask prospective mothers what drugs and conditions they would prefer to give
birth under.

Such developments, though entirely welcome, nonetheless have a troubling
side, for with responsibility and control comes the potential for guilt.
Pregnancy advice books frequently play on the close association between
responsibility and guilt, producing an impossible check list of demands
which cannot but fail to make pregnant women feel inadequate. In this, contemporary
pregnancy handbooks are startlingly similar to those of the Victorian era.

Since the creation of the modern domestic ideal of the family in the
18th century, motherhood has formed a convenient focus of guilt. Maternity
has come to epitomise all that is natural – but equally, too, all that has
to be fiercely policed. The polarity abounds in today’s tabloids, where
the virtues of true motherhood are happily extolled amid attacks on women
who fall short of the ideal – teenage and single mothers, mothers who go
out to work, mothers who go on holiday and leave their children alone, women
who violate the realm of the natural by seeking to become mothers at an
unseemly age or who attempt the ultimate sacrilege of virgin birth.

The same contradictory anxieties surrounded motherhood in the Victorian
age, and nowhere were these more visible than in maternity handbooks. According
to William Buchan in his 19th-century Advice to Mothers, it was ‘little
short of intentional murder on the part of a weak, languid, nervous or deformed
woman to approach the marriage-bed’. The same book illustrated the dangers
of strong emotions during pregnancy with the case of a woman who flew into
a rage and gave birth to a child whose bowels had burst open. The Victorian
woman was firmly told that she had to preserve a ladylike calm during pregnancy.
Any failings would be registered on the child, whose temperament and physical
constitution would be ‘a legible transcript of the mother’s condition and
feelings during pregnancy’ (A Treatise on the Physiological and Moral Management
of Infants by Andrew Combe).

Contemporary handbooks espouse the same ideas but dignify them with
the label ‘intra-uterine bonding’. Britain might be lagging behind California
in providing educational classes for its fetuses, but the British mother
is being advised that ‘the bond created by a mother with her fetus will,
to a large extent, determine her future relationship with her child’ (The
Complete Handbook of Pregnancy, 1984, edited by Wendy Rose-Neil). Research,
this handbook claims, shows that old beliefs that maternal anxieties would
affect the fetus are correct: ‘it is now suggested, but not proved, that
a fetus can react to its mother’s emotions, such as love, fear, hate and
even to rejection or ambiguity.’ A mother who feels ambivalent about her
baby is far more likely to have a difficult birth and a child with physical
and behavioural problems: ‘Perhaps one reason for this could be that the
fetus can comprehend what his mother feels about him.’

Vague references to scientific research are interwoven with folk-belief
to produce a deeply threatening message: anxieties during pregnancy could
mark your child for life. As in the Victorian era the woman is placed in
a double bind. The alarmist prohibitions on anxiety necessarily engender
the very state of emotional agitation they are warning against.

Draughts of poison

Emotional tranquillity also features in advice about breast-feeding.
Again the Victorians have the edge in melodrama. Beeton’s Housewife’s Treasury
warned its readers that a mother who fretted would turn her baby’s food
into ‘draughts of poison’. Poison might have dropped out of the vocabulary
of 20th-century texts, but the equivalent arguments exist, focused now
on the ‘let-down reflex’. Virtually all handbooks now argue that breast-feeding
is only successful if the mother remains calm, happy and relaxed, otherwise
‘let-down’ will not occur and the baby will become frustrated and cross.
Although well-intentioned, the advice creates one more hurdle for the harassed
mother. If the child cries at the breast it is obviously her fault: she
has failed in the tranquillity stakes.

The call to return to the ‘natural,’ which underpins many contemporary
maternity manuals, represents a very double-edged weapon. While it can offer
a force of resistance against technological control, it can also function
as a reinstatement of traditional ideas of woman’s place within nature.
Thus the egregious Breast is Best (first published in 1978 but still very
much in circulation) does its level best to instil guilt in the working
mother. Mothers who return to work, we are told, might shroud their reasons
in economic excuses, but really they just want to preserve their self-image.
The real problem for contemporary society is that women are trying to behave
like men and are ‘loath to be female any more’.

Successful breast-feeding (code for women remaining at home) will only
occur ‘once we understand how a woman’s whole make-up revolves around her
hormones’. With this statement we are right back in the Victorian age when,
as one physician put it, woman was ‘less under the influence of the brain
than the uterine system’.

More recent manuals on breast-feeding are more measured in their arguments
than Breast is Best. Some are even written with the working mother in mind.
But the physical contortions suggested by such books tend to counteract
their overt message and to reinforce the equation between being ‘natural’
and remaining at home.

The advice given to the Victorian woman for health during pregnancy
offers a mirror image of our own manuals. She was to be careful to combine
exercise with rest and to judiciously control her eating. Then, as now,
she was told that childbirth would be ‘safe and free from danger’ as long
as she lived ‘according to nature’s laws’.

Unfortunately, nature’s laws seem to have been very hard to follow,
since too much or too little exercise, rest or food could equally well be
responsible for miscarriage or damage of the fetus. Throughout the manuals
it remains clear that the fault always lies with the woman for not maintaining
the requisite state of health. One handbook warned that an expectant mother
should follow to the letter every rule laid down by her physician for ‘by
one act of disobedience she may blast every hope of success’.

The rhetoric of blame is not quite so overt in modern manuals but is
often built into the organisation of the text. One American text opens with
a horrific list of the ways in which drink, drugs, sexual diseases and environmental
poisons can affect your child, and then offers, week by week of the pregnancy,
an analysis of ‘How your actions affect your baby’s development’. In common
with the Victorian texts, contemporary manuals tend to highlight the most
extreme views to be found in medicine.

The Victorians were greatly concerned with the evils of drink. They
regarded with horror the prospect that the ‘child-spirit sent by the hand
of God’ should appear on Earth ‘in human flesh, corrupt with the vices and
taint of the mother’. In today’s handbooks the ‘taint’ has become ‘fetal
alcohol syndrome’ and expectant mothers are warned that just one binge could
give it to their child (Miriam Stoppard, Pregnancy and Birth Book, 1985).

The St Michael Complete Book of Babycare takes worry about alcohol to
a further extreme, suggesting that both partners should abstain from all
alcohol for at least a hundred days before conception. The period of maternal
responsibility seems to retreat ever backwards, extending beyond even the
period of gestation. Even mothers who avoid such ‘vices’ are still prey
to highly disconcerting advice about food. Many manuals give graphic lists
of the deformities which can be caused by lack of particular vitamins in
the diet, so that every encounter with the fridge can become a self-torturing
exercise in damage control.

Smoking and drugs have now joined the Victorian list of vices to be
controlled. In Britain, control of the pregnant body has tended to rest
at the level of graphic warnings of fetal abnormalities in the handbooks.
But in America, lawyers are moving in. Using existing laws on child abuse
and drugs, some prosecutors have tried to bring pregnant women who drink,
take drugs, or even smoke to be brought under legal constraint – a constraint
usually applied only to the lower classes. From the 19th century onwards,
issues of reproduction have been infused with class anxieties. The Victorian
middle-class woman stood accused of following her own desires rather than
duty to the nation: her luxurious lifestyle led directly to infertility,
she was told, while all around the working classes were reproducing at an
alarming rate.

Equivalent fears are in operation today. Women’s magazines and the women’s
pages of the quality newspapers repeatedly run articles which warn the professional
working mother that if she puts career first she might find she has become
too old to reproduce. In America such rhetoric takes on both class and racial
overtones as the low birth rate of the white middle classes is contrasted
with the higher birth rates of Hispanics and Blacks.

Why should modern maternity manuals, ostensibly designed to help women
take control over their own lives, recycle views from the Victorian age
which ultimately have the opposite effect? It may be significant that the
Victorian preoccupation with personal control, both of the body and of social
and economic position (as in Samuel Smiles’s book Self-Help and the belief
that everyone could pull themselves up by their own bootstraps) arose precisely
at the time when the emergence of industrialisation was curtailing possibilities
for individual control.

Cult of the body

A similar pattern can be traced in our own time. The recent rise of
the cult of the body, with all the associated fitness industry, is contemporaneous
with the re-emergence of Victorian economic doctrines of self-help come
at a time when possibilities for individual control seem, in the face of
technological developments and multi-national capitalism, to be increasingly
under threat.

In the field of childbirth the teachings of the supporters of natural
childbirth have created a very welcome challenge to the dominance of medical
technology. We should be aware, however that to be allowed a birthing plan
in hospital is not to escape the larger framework of medical and social
regulation of childbirth.

The government’s recent acceptance of the proposals of the Winterton
report should make it easier for women to obtain home births. But would
such endorsement have been forthcoming if the proposals had not represented
a cost-cutting measure?

Within our complex society, the experience of pregnancy and childbirth
can never be confined to a simple and direct relationship between the expectant
mother and her body. ‘Natural’ is no longer a viable term: the whole experience
of pregnancy and childbirth, from the state of the food we consume to the
place of parturition, is dominated by factors outside our control. If we
accept the impossibility of a fully ‘natural’ childbirth, we can move one
step closer to casting off the burden of guilt which seems so indelibly
linked, both in the Victorian age and our own, with ideas of personal responsibility
and control.

Sally Shuttleworth is a lecturer in English at the University of Leeds.