Friday, October 29, 2010;
How the Nine Months Before Birth Shape the Rest of Our Lives
By Annie Murphy Paul
Free Press. 306 pp. $26
It makes perfect sense that a pregnant science writer would find herself wondering about the science of pregnancy. Annie Murphy Paul tied the nine-month journey of gestation to investigation, looking most particularly at what is being learned and studied and understood about the consequences of what happens during pregnancy. She looked at some often-told stories, like concerns about drugs and their effects on the developing fetus; at some recent headlines, like the ones about the toxic substance BPA used in plastics and more general alarms about environmental toxins; and at newer and less familiar stories, like the effects of maternal depression and maternal stress on fetal development.
And as she tells those stories, she tries to chronicle her pregnancy, to describe some of the emotional impact of learning - and worrying - about whether she is doing the right thing for the child that is to come.
For the most part, she manages the very tricky act of balancing science writer - with a fair-minded attention to the ambiguities and complexities of research - and pregnant mother - with a certain tendency to lyricism, sentimentality and a wry awareness that her perspective has shifted. When she attends a scientific meeting, she describes scientists looking at her with surprise, "as if a whale had shown up at a conference of marine biologists" (and in the humor and the double meaning there, you see the science writer looking for illustrative images). "At those same meetings," she goes on, "held in gray hotel conference rooms under fluorescent lights, my eyes were probably the only ones to prick with tears when ultrasound images of fetuses or recorded wails of newborns punctuated the presentation of research findings." And these observations of perspective and change give weight (oh dear, now I'm doing it) to her emphasis on the idea that pregnancy itself needs to be viewed as a developmental stage.
This developmental stage she compares at several points to adolescence: It is a transitional state, swayed by a unique set of hormonal influences, subject to a variety of imperatives and stresses.
Among other topics, she considers modern medicine in its heroic and not-so-heroic moments and reminds us that expertise and received wisdom do indeed change with time and new evidence. " 'No, smoking and alcoholic drinks have no effect on a newborn baby,' chided a news bulletin distributed by a medical society in 1954. Calling such ideas 'superstitions' and 'old wives' tales,' it concluded with a wag of the finger, 'Listen to your doctor instead of sewing circle fantasy.' "
Paul is honorable about examining the scientific, social and moral complexities of her subject. She takes on what I think is the biggest question: When we consider our profoundly increased understanding of the importance of the prenatal period and its long-standing effects on health, development, personality and intelligence, does this understanding bring us closer to determinism? Are we, in fact, in danger of giving up on young children and losing faith in their plasticity? That is to say, if we begin to view children as perhaps already "damaged" by the time they are born, already destined for one problem or another, will we stop exploring - and supporting - all the efforts that can improve their lives outside the uterus? "The theory of fetal origins ought to contribute complexity, not reduce it," Paul writes; "if we take care in how we think about prenatal influences, they may add another layer to our understanding of who we are and how we got to be this way."
In fact, many of these issues of prenatal influences and prenatal origins lead to complexities; pursuing the question of stress on the mother and its effect on the fetus, for example, leads to studies of the aftermath of pregnancy in a time of catastrophe. She describes researchers studying women who were pregnant during wars or famines or natural disasters and who deliver infants who have higher rates of prematurity and low birth weight or grow into children with higher incidences of mental illness. But she also looks at research which suggests that moderate amounts of stress during pregnancy are associated with children who perform better on developmental tests. Similarly, the question of drug safety during pregnancy is full of complexity: "Spooked by nightmares like thalidomide and DES, pharmaceutical companies have avoided developing or testing drugs for pregnant women," leading to a "so-called drug drought in maternal medicine."
In considering all these influences, Paul comes back again and again to the emotions of the pregnant mother, to the desperate desire to keep the developing fetus safe, to the guilt with which pregnant women torture themselves, and to the difficult lesson that, in the adventure of creating life, not everything can be controlled. "When I speak to researchers," she writes, "even those who've been working in this field for decades, I'm struck by how mysterious the fetus remains to them: it's a creature more rumored than real, encountered only in shadowy glimpses and amplified rumbles."
Perri Klass, M.D., is a professor of journalism and pediatrics at New York University and author of "Treatment Kind and Fair: Letters to a Young Doctor."