Researching Pregnancy Part 5

Of course, it is always possible that women were reporting advice and information from health professionals and family or friends that was in line with their own preferred behaviour. There have been suggestions at various times that pregnancy may afford women the opportunity to avoid other life tasks (Artal and Gardin, 1991; Harris and Campbell, 1999). However, our examination of women's responses to advice does not suggest this and nor does work by Rodriguez et al. (2000) on psychosocial predictors of smoking and exercise, which suggests that the same factors predict exercise in pregnancy as predict health behaviours in general. Nevertheless, when we are discussing daily domestic and recreational activity rather than exercise, the women in the study certainly suggested that they were taking the opportunity to avoid doing things they had never liked very much, such as less housework, not going down into the cellar: t's a good excuse really'. Pregnancy can clearly be a time when various forms of advice give legitimacy to particular types of behaviour and pregnancy itself provides a buffer to unwanted activity. It remains to be seen whether the increasing emphasis on tness and exercise will lter through into the context of lay advice on pregnancy, given that existing research which sanctions activity and exercise would seem to make little difference to the cultural stereotypes of maternal responsibility and preparation.

It would be unfair on the women involved to give the impression that they all reduced their activity wherever they could. Although it was certainly the case that some of the women we talked to did relinquish activities, others continued to be active and took the opportunity of nishing paid work to do household jobs, such as preparing the home for the new baby, and tried to retain their social lives at the same time as taking care of themselves. Effectively we are talking about the way that different individual women negotiated the information and advice they received and the pressure they felt to conform to other people's expectations. In some cases, such negotiation involved adopting the behaviour that was expected of them, such as resting or doing less, while at the same time developing various coping strategies that allowed them to continue to 115 partic.i.p.ate, through, for example: carefully monitoring the consequences of their activities and giving them up if they did not feel comfortable; pacing themselves, by which they meant nding ways to complete a comparable level of activity to that prior to pregnancy, such as dividing it into shorter and shorter episodes (as discussed in Chapter 4); and by forward planning whereby the women considered what they were hoping to do, the context in which it would occur and the implications it might have either physically or socially. Then they would make a conscious decision whether or not to partic.i.p.ate. In this way the women we talked to were able throughout their pregnancy to do most of the things that they wanted to do but with some changes in the speed or location of these activities. In addition, for some other women, pregnancy did give them a licence to leave things to others.

It must also be acknowledged that numerous other factors may discourage women from maintaining their habitual daily activity pattern during pregnancy. Although outside inuences, including family and friends, often served to discourage physical activity in pregnancy, these women indicated that they themselves considered their behaviour to be appropriate during pregnancy t's obvious isn't it' and stated that at least part of their decision to change their activity, either at work or at home, had been their own choice, as much a result of their own personal preferences as it was a response to external expectation or information, activity advice or att.i.tude to healthy behaviours. Thus, for example, a high level of importance was attributed to rest and relaxation and a lower level of importance to physical activity. If a woman also believes that she rather than professionals or chance will determine the outcome, that is, a healthy baby, then the predominance of the highly visible recommendations of rest and the reduction of tiredness may also be regarded as a legitimate priority, whatever the apparent benets of exercise for good health in the longer term.

Concluding remarks There is no doubt, as the ACOG guidelines and all the evidence we have discussed conrm, that a certain amount and level of exercise is a good thing' in pregnancy for women, for labour and delivery and for a healthy baby. In addition, it has longer-term health benets. For the same reasons, maintaining an active lifestyle is also a good thing; even if it does not carry quite the same level of positive benets, it may be much easier to sustain over time. Advice is quite clear on the matter, wherever it is found, and it does address some aspects of daily lives as well as strenuous physical exercise. But, ironically, within the framework of supervision that surrounds pregnancy in the early twenty-rst century (Lupton, 1999), understanding how to behave in response to advice may actually become 116 increasingly difcult. There are competing demands to be met and negotiated by each pregnant woman. The biomedical discourses of pregnancy, in the ascendant with the advent of technologies of reproduction and replete with research evidence, place women as responsible for the pregnancy outcome. Thus, professional health advice, arising from research, exhorts necessary changes in behaviour or at least maintenance of an active lifestyle.

The professional advice gives permission for women to be active, as long as it is in the service of a healthy outcome. At the same time, lay discourses of pregnancy, while paying homage to the power of the professionals, have not yet taken account of the research evidence and place women within the stereotypical feminine role, lacking agency and control, unable to act on any advice but that of family and friends, who in turn have recourse to powerful cultural expectations. By this means, women are granted permission to be inactive in order to ensure healthy outcomes. Moreover, the advice itself is ambiguous. Physical activity is good but fraught with risks, thus caution needs to be exercised in order to prevent damage to themselves or the baby; by contrast, tiredness, a natural concomitant of pregnancy, has high visibility and women are given permission to take advantage of their pregnant role and moderate their behaviour.

7.PREGNANCY UNDER SURVEILLANCE.

In the preceding chapters we have explored how women may or may not change their behaviour during pregnancy. In some cases the changes are founded on information from research. The need to take action in accord-ance with advice can be seen as reasonable. However, it has been our contention that this message to change behaviour reects a number of a.s.sumptions about women's behaviour, their role as mothers and their responsibility to others. We would argue that this apparently reasonable set of requirements actually subjects women to a degree of oversight that could be described as a form of surveillance. In many ways this is integral to much of women's experience inasmuch as their appearance and behaviour are frequently subject to public scrutiny and criticism. This is particularly the case for women who are, for one reason or another, in the public eye. In this chapter we look at the way that pregnancy has been represented in the media and we focus on the images and representations of pregnancy and the pregnancy of public gures, in order to examine how the public sanctioning of behaviour is enacted.

Pregnancy in the public eye.

Pregnancy is highly visible. This visibility reects the ongoing public interest, is amply demonstrated by the comments made to women once their pregnancy is announced and includes extensive coverage of celebrity pregnancies in what is now a global media. Leaving aside the issue of celebrity for a moment, this visibility can partly be explained as inherent in the accompanying physical changes that occur over the nine months of pregnancy. However, in part and more recently, it is also because fashions for maternity clothing have made this change much more obvious, as Robyn Longhurst (2005: 438) points out in her paper on this topic: 'maternity wear has become maternity fashion' so-called 'b.u.mp chic'. A Danish anthro-pologist, Tove Engelhardt Matthia.s.sen, ill.u.s.trates this shift by highlighting the way that clothing has moved from veiling or hiding pregnancy, by the loose and shapeless garments worn by women in the twentieth century up to 118 the mid-1960s, to the current point where maternity fashion has become chic, through the use of stretch fabrics and the prevalence of tted women's clothing. Matthia.s.sen suggests that this is because n an era of sports and well-trained bodies you have to survive the bodily changes of pregnancies by being fashionable' (Matthia.s.sen, 2005: 5).

In addition to the visibility created by changes in fashion, we can think in terms of different kinds of visibility, since most women who become pregnant do not attract media attention. The rst type of visibility is that which arises from pregnancies that are considered atypical or abnormal because of their non-adherence to the standard images of pregnancy available to us. As discussed in Chapter 2, unusual or abnormal pregnancies which attract attention are typically a.s.sociated with specic individuals, and include single motherhood, especially where a partner may have died before conception; for example in the UK in 1999 Diane Blood applied to the courts for permission to use her dead husband's sperm for IVF. Other examples are: multiple pregnancies, especially where more than three babies are expected; very young (possibly too young) or teenage pregnancy (for example girls sitting their school exams); or the pregnancy of much older women, for example women who give birth at 58 and older following IVF. Other noteworthy examples are those resulting from new a.s.sisted conception technologies and also include surrogate pregnancies. The infrequency of these occurrences is what makes them visible or newsworthy. It also opens the door to signicant commentary on the women concerned and their behaviour. The commentary is then personalised and referenced with respect to the expected outcome, which is the baby. Thus, the gaze on women permits directed comment towards the pregnancy and clearly emphasises the metaphor of containment inherent within public concerns about pregnancy: 'your baby has grown since I last saw you'.

Second, pregnancy may be made visible because of some feature relating to the nature of the women themselves. In this category, we can place women in the public domain, such as celebrities, wives or partners of well-known or famous gures, such as Cherie Blair (the British Prime Minister's wife) or members of royal families, for example Princess Kiko of j.a.pan.

Thinking of visibility in this way allows us to explore the various aspects of the visibility of pregnancy in relation to the nature of the pregnancy and the nature of the individual. In both cases, we would argue, the nature of this visibility tends to prompt critical comment.

Furthermore, the increased understanding of the developmental signi- cance of the foetal experience in utero, which ranges from genetic and chromosomal effects to the potential toxins crossing the placenta, to the potential for inuencing intelligence and behaviour, has reinforced the pressure on all women to maintain a healthy lifestyle during pregnancy and preconception. The emphasis on containment provokes a plethora of advice to women on how to behave. As the previous chapters have ill.u.s.trated, 119 advice can be viewed as a means by which pregnant women are in effect held publicly accountable for their behaviour, and is recently demonstrated by the US federal guidelines asking women between the onset of menstruation and the menopause to treat themselves as 'pre-pregnant' at all times (Washington Post, 16 May 2006).

In the context of the medical/biological discourses of pregnancy this public accountability is perhaps hardly surprising. It has been happening for some time. Katherine Barker (Barker, 1998) ill.u.s.trates how the medicalisation of pregnancy was systematically introduced through a public health campaign in the US in the early part of the nineteenth century. By examining the content of a widely distributed manual developed at the time, Prenatal Care, she shows how pregnancy was conceptualised as a medically problematic state. Woollett and Marshall (1997) present a similar case through examples of this process in their a.n.a.lysis of publications on childbirth and our study of how employment is presented in these types of publications conrms the prevalence of the discourses of personal and public responsibility within a medical discourse of pregnancy (Gross and Pattison, 2001). Once pregnancy is dened as a medical event, its management is devolved to external and expert sources, which simultaneously draw women into the need to partic.i.p.ate in specialised procedures that a.s.sist in ensuring a healthy outcome. It can be argued that once it was removed from the exclusively domestic sphere of home where traditionally women were in control, pregnancy and pregnant women were accorded the increased visibility a.s.sociated with presence in the public domain.

In addition to the routine screening, monitoring, check-ups and the gamut of advice which make pregnancy public, there are a number of other ways that pregnancy is made publicly visible and open to scrutiny. One way that we can conceptualise this scrutiny is to examine how the atypical' pregnancies we identied in Chapter 1 and Chapter 2 are presented and to explore what it is that provokes such attention.

Atypical or abnormal pregnancies In order for a pregnancy to be newsworthy it must in some way be contrasted with what is considered to be normal pregnancy, which routinely receives little media attention although there is ongoing scrutiny in the medical domain. What is normal is obviously a statistical phenomenon. However, as the research by Linnell and Bredmar (1996) highlights and the overwhelming content of pregnancy and birth magazines regularly emphasises, what is normal as a pregnancy is as much determined by the outcome as by the process. Nevertheless, there are some ways that we can conceptualise what is generally understood as a normal pregnancy and this revolves around the notion of the Good Mother and its converse, the Bad Mother.

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While motherhood is highly valued in society, the attribution of that value being a good mother is largely restricted to pregnancy occurring within proscribed boundaries. Outside these boundaries, pregnancy may be seen as deviant. When the criteria of the Good Mother are met, she is accorded little attention. Conversely, women who fail to meet the criteria a.s.sociated with the Good Mother are accorded greater visibility, since being viewed as wanting in comparison brings with it automatic censure.

Thus, the Good Mother status can be bestowed upon women who are pregnant and married, or at the very least in a stable and usually heteros.e.xual relationship, who are of a certain age and who are willing to conform to the required changes in behaviour. Therefore, one potential form of bad mothering is pregnancy outside marriage, as shown by the examples of treatment at work cited in Chapter 4. Given that in 2005, gures from the UK's Ofce of National Statistics suggest that in Britain cohabiting couples equal or outnumber married couples, this places a large number of women who might become pregnant in a position where they will attract comment. The Eurostat (2004) gures also indicate that nearly half of births occurring in the UK are to non-married women. Outside the UK, Australia and the US also have high national rates of unmarried (rather than non-married) women, at 32 per cent and 30.6 per cent respectively (2004/05 gures). These gures in themselves contain the potential for shifting what is considered normal, though this has not typically been the response. Traditional family structures remain paramount. In addition to traditional family patterns, the legitimate childbearing years also clearly exclude girls under 16 and women over normal childbearing age (49). With the average age of rst pregnancy in some European countries at nearly 30 and in Australia at 30.6, these two groups of women, which also include teenage parents more generally, are considered to bebad mothers' and we discuss them in more detail below.

Moreover, it is also considered to be the norm that pregnancy is a positive and even uplifting experience, followed by an organised delivery and quick return to the pre-pregnancy state and appearance. So, good mothers are those who conform to the expectation of a blooming pregnancy, a healthy baby and a return to s.e.xy wife. Despite Jane Ussher's (1992) discussion of the tyranny of such an expectation in imposing on women the feelings of failure if they do not nd it so, only recently is it becoming acceptable to admit to not enjoying pregnancy or nding it hard.

Being a good mother also means enduring all the unpleasant (and sometimes life-threatening) side-effects of pregnancy with good spirits for the sake of the baby.

There are further a.s.sumptions made as part of being a good mother and this is that women will not have to give up their children for adoption and that loss of the pregnancy or infant is a source of serious distress and grief. The possibility of terminating a pregnancy for personal preference or 121 convenience is frowned upon, except in extreme cases of illness. By contrast, for those who are seen as bad mothers, pregnancy ending by termination, stillbirth or even neonatal death can be considered in some circ.u.mstances to be an appropriate outcome for women who fall outside the prescribed boundaries and adoption of children born to single women was the norm until very recently. As lms like The Magdalene Sisters, a ctional account of girls incarcerated in the Magdalene Laundries1 (directed by Peter Mullan, 2002), show us, treatment of young girls was sometimes alarmingly harsh, as their equation with the concept of the bad mother would permit.

Bad mothers are not accorded the same expectations as are extended to women identiable as good mothers. For bad mothers pregnancy can be automatically criticised as abnormal, as pathological and as unsuitable.

Thus, while pregnancy as a good mother attracts positive comment and interest, for women who fall outside the framework, pregnancy can attract criticism and worse, as the discussion in Chapter 4 of women's experiences in the workplace has shown, placing working mothers too as bad mothers in this a.n.a.lysis. Nevertheless, both good and bad mothers may be subject to the same judgements levelled at their appearance, status, beliefs and level of responsibility. In the following sections we examine these dimensions of good and bad mothering in more detail.

Pregnancy in older women In 1993, commentators were suggesting from population trends that by the end of the century (i.e. by 1999) 40 per cent of all births would be to women aged 30 or over and gures quoted earlier show that this point has already been reached in some countries. Even if conception and rst pregnancy are delayed until this time, women are frequently considered to be acting selshly by putting their own gratication rst, rather than acting responsibly, and certainly women who remain childless into their 30s often receive negative comments (Allen, 2005). One explanation for this disapproval may be something we raised in Chapter 1 the low birthrate and the perceived economic dangers of too few people to support public services and nance an increasingly ageing population. Another explanation is that older women in general are viewed as a h.o.m.ogeneous group; typically, women having rst children are aggregated with women having subsequent children, who are older simply of necessity precisely like the prediction of 1993. A further reason may be the power of stereotypes we have discussed in previous chapters. How old is too old depends of course on where the average is at any time and the prevailing expectations of women's other public roles, for example as workers or as parents. Women in contemporary society are expected to partic.i.p.ate in the public domain as 122 well as full their domestic or private roles and their willingness to accommodate public beliefs and expectations can, as we have seen, be extremely stressful.

Contrary to expectations, however, women who have their rst baby later in life are not all ruthless careerists, according to Julia Berryman and her co-authors (1995), who found that in their sample of 340 older mothers only 5 per cent of women had delayed pregnancy for career reasons. Nevertheless, women in their study reported that motherhood over 40 was often seen as inappropriate and that shock, horror and disgust were not uncommon reactions when they announced their pregnancy.

As advances in reproductive technology have enabled a small number of women, who might otherwise be expected to be going through the menopause (and beyond), to become pregnant, older women have attracted attention, almost as curiosities and as potentially bad mothers. The attention is a mixture of scientic pride and moral outrage. Coverage of very late (i.e. over 50) pregnancy is typically censorious and appears to reect pervasive political and societal beliefs that, while pregnancy in much older women may be technologically interesting, such pregnancy is somehow unsuitable, not normal, and strong sanctions may be applied to the individual, their lifestyle and their beliefs. Older women are considered to be irresponsible in becoming pregnant, and this criticism is levelled at the doctors too, for daring to cheat nature and rob the children of their rights to parents. George Monbiot wrote in The Guardian newspaper (25 January 2001: 29) an article ent.i.tled ur strange fear of older mothers', the rst line of which reads: 'No longer attractive to men, they're treated as an offence against nature'. Despite this alarming introduction, the article is in fact criticising negative coverage by other newspapers of announcements of a second pregnancy by a 61-year-old woman, and the birth of twins to another woman aged 56. In an oblique reference to the public perceptions of good and bad mothers, he goes on to say that 'to suggest that late births are unethical, we have rst to say whom they have wronged'.

The answer, we would suggest, is that it is public sensibility that has been wronged because of the expectation of what const.i.tutes the age of normal motherhood.

Where women already have other children, the announcement of a late pregnancy is often a cause of mirth and speculation rather than congratulations. Certainly, the woman's age and the age of any other children is a matter for comment, especially where there may be a large gap in age between the last child and the current pregnancy. As an example, when The Mirror newspaper announced Cherie Blair's pregnancy in November 1999 it had, below the main front-page headlineCherie is pregnant', the sentence (their underlining) 'She's having her fourth child at 45', a phrasing which manages to capture both the shock and amus.e.m.e.nt of being beyond normal childbearing age and late pregnancy and the potential age gap 123 between her existing children and the new baby. Interestingly, as the discussion on celebrities below also highlights, the images and coverage tread a ne line between dening Cherie Blair as either a good or a bad mother.

One effect of delaying rst childbirth is that women may encounter problems of conception; thus, pregnancy in older women may attract further disapproval because it brings together a number of categories of what we are calling abnormal pregnancies. Though statistics indicate that there are more multiple births to women over 35, this is partly explained by the increasing availability and take-up of a.s.sisted conception in this group, particularly the use of fertility drugs and the implantation of several embryos after IVF, which increase the likelihood of having multiple pregnancies. In addition, more fundamental fears of mortality are raised by the juxtaposition of the older woman and the fragility of the unborn baby.

This is emphasised through attention paid to potential risks to the woman's health and the future of the baby. Older mothers (medically those over 35 are considered elderly primigravida) may be presented as being irresponsible through the a.s.sociation with increased risk. There is evidence from the statistics on abnormalities that the incidence of certain defects increases with age, Down's syndrome being the most commonly known.

Other risks include miscarriage and both maternal and infant mortality.

Very recently, not only older mothers but older fathers have been found to increase risks of later problems in children born to older parents. Though statistics indicate that there are more multiple births to women over 35, this is partly explained by access to fertility treatments. In this way older women are visible as bad mothers not just because of their age, since they are expected to have given up on childbearing, but because of their mem-bership of multiple categories of atypical pregnancy. Lastly, pregnancy in older women also raises interesting questions about what const.i.tutes 'natural' in the context of pregnancy as a natural and biological event or process. Natural may be an archetypal element of the Good Mother here perhaps.

Interestingly too, there is a positive side to later parenting, which gets less coverage. At a primitive or mystical level, the appearance of new life in the context of an older parent can be rejuvenating and exciting. While it is undoubtedly true that it may be more tiring to have young children later in life, there may be other benets of delaying rst pregnancy, for example commitment to parenting, being in a better nancial position to support a child and the demands of family life, as well as living a healthier lifestyle.

Recent research has also suggested that having children later in life may actually benet women's health (Grundy and Toma.s.sini, 2005). These more positive elements tend not to feature in representations of older mothers although their absence is remarked upon repeatedly in another group of potentially bad mothers very young women.

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Younger and teenage mothers Despite the interest generated by pregnancy in older women, not least because of its risks, the greatest opprobrium, certainly in the UK and in the US, is reserved for teenage mothers. Why is this? As Bynner et al.

(2002) point out, it was once a common occurrence for women to be pregnant in their teens, but it is now constructed as a social problem. Part of the concern arises from the numbers. Figures suggest that the number of teenage pregnancies in the UK and the US is considerably higher than in some European countries, notably the Netherlands, and despite efforts to change behaviour it has reached an unprecedented rate. In 1997, the rate of teenage pregnancies among 15- to 19-year-olds was 30 per 1,000 in the UK and only 4 per 1,000 in the Netherlands. This discrepancy has continued to the present day. UK gures published in 2005 which relate to 2003 show that the number of teenage pregnancies in the 1517 age group was 42.1 per 1,000 and 8 per 1,000 for those aged 1315. The gures did go down, slowly, between 1998 and 2003 but they are certainly disturbing, particularly for the younger age group. US gures indicate the rate of births to 15- to 19-year-olds as 30 per 1,000 (US Census Bureau, 2005). However, though absolute numbers may be high, as Ann Phoenix pointed out in 1991, a distinction must be made between those adolescents who become pregnant during their school years and those who choose to become mothers during their teenage years beyond the age of compulsory schooling (in the UK this is 16 years). The subtlety of this argument is not well represented in the way that teenage pregnancy is made visible, whereby all adolescents, like all older women, are treated in the same way.

Sometimes, the tag 'school girl mums' is used to emphasise the extreme youth of the girls being featured. While concern centres on the numbers and the development of strategies to prevent teenage pregnancy, the possible reasons for the high rates of pregnancy in this group are less well understood.

Despite a relatively young average age of menarche (12 years 6 months in the UK and other European countries), there is increasing pressure for young people to remain at school, or extend their education elsewhere, in order to improve their future opportunities. Thus, there is a mismatch between biological maturity and the point of economic independence, which serves to highlight pregnancy as anomalous for this group, since they are not able to support themselves or a baby, thus marking them out as bad mothers. Of major concern is the likelihood that, once pregnant, adolescents will fall into a pattern of dependency on state benets, lowered educational expectations and reduced engagement in the labour market, all of which gives cause for public concern and grounds for public intervention in teenagers' access to contraception advice, s.e.x education or continued partic.i.p.ation in education or employment.

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Another signicant explanation for the very negative comments about young people's lives is that pregnancy is a clear representation of s.e.xuality.

Of course, this is also the case for older women who become pregnant, and it may be partly this symbolism that accounts for the very punitive att.i.tudes expressed in relation to pregnancy which offend public morals.

Pregnancy is normally a.s.sociated with adulthood, though whether it is becoming a mother that leads to maturity (adulthood) or whether motherhood is an outcome of being an adult is less clear, as Anne Woollett (1991) has pointed out. The concern surrounding teenage mothers can thus be regarded as arising from a proposition that pregnancy signals deviant childhood, particularly through the a.s.sociation of s.e.xuality with childhood rather than emerging adulthood.

Pregnancy is unlikely to be the intention behind most teenage s.e.xual relationships; rather, those who get pregnant may just be the unlucky ones.

Research by the Joseph Rowntree Foundation (2006) suggests that only a quarter of teenagers who become pregnant intend to have a baby. Others have suggested that pregnancy and motherhood may provide adolescent girls with a role in life, a role that is usually highly valued. In this case, the argument goes that the girls see no reason to delay motherhood (Ineichen, 1986; Ineichen et al., 1997). This would hardly be relevant to school-age mothers, however, and in their case there is a suggestion that teenagers who get pregnant subconsciously want to do so. This would scarcely seem to be an incentive to get pregnant given that the role is devalued. It is possible, however, that, on discovering the pregnancy, teenage mothers decide to keep the baby in order to full other psychological needs, to be loved. In Schoeld's (1994) study, some young mothers indicated that they received lots of attention while they were pregnant. At the same time, interestingly and as Phoenix (1991) also notes, as a teenage mother, they can enjoy child and adult status simultaneously, living at home and having their own mother look after them, and being able to identify themselves as a pregnant woman with a baby.

There is also an issue of choice. Moralistic arguments, following the public view of teenage pregnancy as a problem, can emphasise the need to terminate the pregnancy, often making use of arguments of inevitability of poor outcome, such as poor educational achievement and curtailment of ambition. Indeed, it would appear that in the UK on average about half of all teenage conceptions in 13- to 17-year-olds are terminated. In 2005 further legal challenges to young people's right to privacy in medical consultations were once again underway in England so that young women could not terminate a pregnancy without their parent's or carer's knowledge. This too has attracted media attention, some of which highlights the damage that would be done by such a shift in the nature of the consultation process and some of which endorses the imposition of parental control as a representation of moral values. Nevertheless, the visibility of 126 pregnancy in this age group remains as pregnancy out of place and the young women are seen as examples of bad mothers.

However, in terms of our public expectations and public representations of pregnancy, the status of adolescents as mothers is thus devalued by their entering adulthood at the wrong time. The ambiguous att.i.tude to teenage pregnancy is reected in the mixed responses to strategies to reduce pregnancies. Plans to improve s.e.x education offered in schools, especially for very young age groups, and to increase contraceptive advice or the availability of contraception to young people through schools or drop-in clinics in high street shops, are seen by pro-life and some religious organisations as promoting under-age s.e.x and encouraging the use of abortion as a contraceptive. Similarly, when an under-age mother continues in education and only stops to give birth before returning to her exams, the public response is that this is setting a bad example to other youngsters, putting education and under-age pregnancy in the same bracket (Grantham Journal, June 1998). Currently, plans by the UK government to make it a requirement that the police are alerted to any known under-age s.e.xual activity scarcely make it more likely that the young people involved will be able to seek appropriate advice. Furthermore, research could be said to be looking at this issue from a limited perspective. The evidence is strong that most young women who become pregnant in their teenage years are likely to have mothers who themselves were teenagers when they became pregnant. The cultural expectations within the communities and families are therefore likely to be very different from those of health educators and those concerned to break thecycle of disadvantage' perceived to arise from very young motherhood.

Teenage mothers who do not marry or cohabit with their partners go on to become members of another problem group, 'single mothers', a group which also falls foul of normal expectations of pregnancy and motherhood and attracts negative or condemnatory coverage. In fact, welfare-to-work programmes are specically designed to a.s.sist such young women in developing their skills rather than staying at home and looking after their children. This is despite an ongoing concern for the welfare of children and a decline in parenting skills; such is the contradictory nature of att.i.tudes and expectations of women. Newspapers highlight this inconsistency in their coverage: in a deliciously ironic article in the British newspaper, the News of the World, incredulity is expressed that asingle mum' could turn down an offer of marriage from the millionaire she was dating (News of the World, 24 January 1999). The public requirement is to take up opportunities that would reposition a single mother as a good mother at a stroke and is paramount in this case, even if in other circ.u.mstances she might be castigated for being agold-digger'. Thus, teenage or under-age pregnancy, which carries the double burden of being a single mother, provides a means by which surveillance may be maintained and repeated at 127 differing points in young women's lives; they become an object of future as well as current concern. This concern provides a rationale for continued interest and report.

The ideology whereby society denes teenage pregnancy as a problem is the means by which the private behaviour of s.e.xual relationships, pregnancy and motherhood are brought into the public domain and sustained by cultural images. There are other ways in which pregnancy becomes visible, because it does not conform to the normal expected pattern of behaviour expected of the good mother. This lack of conformity makes it inappropriate or irresponsible. These include hidden, surrogate and multiple pregnancies.

Hidden pregnancy In the context of the visibility of pregnancy, a hidden pregnancy would seem to be inadmissible. However, it is the visibility after the event that is of interest here, particularly in relation to concepts of good and bad mothers. Hidden pregnancy can take a number of forms. At its most extreme it can be a sign of a serious psychotic episode (Brockington, 1994); very often it involves infanticide, by killing or by neglect of the baby. It is hardly consistent with the rhetoric of good mothering. A headline which appeared in the Mirror newspaper in September 2005 'Mum nearly killed by hidden pregnancy' indicates how a pregnancy might be hidden. The woman involved had not considered herself likely to become pregnant, due to previous physical problems, and she and her partner were not planning to have children at the time. She had shown no symptoms of pregnancy, no physical changes, until suddenly she was taken ill and rushed to hospital, where it was discovered that she had pre-eclampsia. Her premature baby was delivered safely by caesarean section and both made a good recovery.

What is interesting about this particular story is that it turns the contained baby into the agent of the mother's negative experience rather than the defenceless recipient, which is how such hidden pregnancies are usually presented. For example, a CNN report (9 July 1998) of a case heard in the US in July 1998 concerned 'sweethearts Amy Grossberg and Brian Peterson' who received prison sentences for killing their baby son after he had been born in a motel room in 1996. In this case, the pregnancy had been disguised and kept from the young woman's parents and friends. This kind of hidden pregnancy is more common in adolescence, and may be coupled with poor understanding of the progress of pregnancy. At the same time, the pressure to deny the pregnancy because of the implications can apparently be strong enough to prevent the usual signs of pregnancy developing, so that the pregnancy is hidden not just from the public but from the woman herself. Once such cases come to court, however, their visibility is a.s.sured and the very environment in which the news comes into 128 the public domain is likely to determine the nature of the young people's treatment, both by the media and by the legal system.

The possibility of hidden pregnancy reecting a genuine unawareness of a physical state seems almost implausible, given the visibility of pregnancy and particularly, as we discussed in Chapter 2, at a time when the conrmation of a pregnancy can precede the typical indicators such as the rst missed period. However, awareness and recognition of symptoms will depend on the individual's perspective. Both those wanting to become pregnant and those concerned specically to avoid becoming pregnant will undoubtedly be highly alert to any changes, in the same way, we suggest, that somatic attributions are made by those reporting cognitive change for example. For those who have no reason to suspect a pregnancy or who have contraindications for pregnancy, for example absent or irregular menstrual cycles, then identifying symptoms may be a different matter, as the mother who was rushed to hospital herself suggested. In these cases, the woman really is unaware of her changed state, and this can persist up to labour, when women are brought into emergency wards with severe pain. Unawareness in this sense is clearly not the same as keeping the pregnancy secret.

Evidence from the teenage mothers in Schoeld's (1994) study suggests that girls kept their pregnancy secret in order to avoid causing problems at home. Because of the att.i.tudes to teenage pregnancy, several girls indicated that they knew that if they told anyone, their parents for example, they would almost certainly be forced to terminate the pregnancy. However, the research evidence that teenage mothers tend to be the daughters of teenage parents suggests that pressure for termination may only be true for a subset of the girls involved. By leaving it until it was too late to safely terminate the pregnancy this option was removed, and their choice was made.

Another reason given by the partic.i.p.ants in Schoeld's (1994) study to keep the pregnancy secret was to avoid admitting it to themselves and only when labour starts could they acknowledge what is happening and tell a parent. Even when it has been acknowledged at an earlier stage, treatment by health professionals is not always encouraging and rights offered to women of average childbearing age, such as being accompanied by a parent or partner during labour, were denied to the adolescents; they were effectively treated as bad mothers.

Finally, in this section, there has been a historic shift in the way that pregnancy is visible to others, alluded to above, and that is through the change in the way that maternity clothes have migrated from a form of veiling of pregnancy, to creating a pregnant silhouette as an object of desire. As Mathia.s.sen (2005) demonstrates in her paper, these changes reect changing times and customs in the treatment and expectations of pregnant women. However, it is a moot point whether the visibility created by the absence of disguise using smocks and loose clothing by the arrival of stretch fabrics has really allowed pregnant women more freedom.

129.

Paradoxically, as the preceding sections have demonstrated, it remains difcult to achieve the requirements of the good mother.

Before we go on to look at how celebrity pregnancy, the ultimately visible pregnancy, is treated in terms of public attention, there are two further examples of 'bad mothers' we would like to mention. These involve the combination of a.s.sisted conception and indeed gay parenting, which together create a potent focus for public comment.

Surrogate pregnancy Surrogacy has been portrayed in the public view as another example of bad mothering, as the following headline from 1988 attests: t's baby selling and it's wrong' (New York Times, 4 June 1988: 26). In November 2005 the South Korea Herald reported that the punishing of surrogate mothers had been made law. But aside from these outright condemnations, surrogacy is presented in an oddly ambivalent way. So, on the one hand, a devoted sister who offers to have a child for her childless sister may be seen as seless and generous. On the other hand, the idea of renting out a uterus, together with the possible fertilisation process that accompanies the conception, is viewed not only with distaste when it involves a nancial incentive, but also as being sordid and highly irresponsible. In 1999 there was news coverage of a British gay couple, who had just become fathers to twins born as the result of a surrogate pregnancy in the US: 'Gay couple pay for surrogate mother's twins' (The Guardian, 2 September 1999). The men were intending to adopt the children in order to become their legal parents and their case was ultimately successful. This was despite some very unsupportive responses provoked because they were gay, which drew, for example, on the risks of breaking the motherchild bond inherent in surrogacy and the needs of the children in terms of the natural parenting environment. This case refers explicitly to the notions of good mothers while, at the same time, surrogacy automatically invokes the metaphor of containment.

In another fascinating turn on the visibility of pregnancy, the way that surrogacy is dealt with includes commentary on the unsuitability of purchasing a womb to act as a vessel for the development of a baby that will be handed over to someone else. By referring to the concept of good mother, which includes the mother and child bond, the coverage unusually expresses concern about the wellbeing of the woman, and in particular this suggests that she will be psychologically affected by the loss of the baby. Research does not suggest that this is the case (Jadva et al., 2003). Despite the negative tone of the coverage, women report their involvement as a positive experience. Although it is indeed true that the baby will go home with someone else, the process is regarded as an opportunity to help others and thus women acting as surrogates can present themselves as good mothers, even if the public view is rather different. One way to explain the concern 130 over the surrogate mother's mental health is, of course, the reversion to female stereotypes in which emotionality and motherhood are key elements.

Surrogacy, however, can be regarded as disrupting the highly charged and prescribed motherbaby emotional relationship by allocating one essential component the antenatal experience to another person, though it does retain the important genetic link (van den Akker, 2000). This splitting is a calculated shift in the parenting relationship compared to the straightforward adoption of somebody else's child and raises anxieties of Orwell's 1984, clearly also undermining the concept of a natural process and of a good mother.

Multiple pregnancy The nal example of atypical or abnormal pregnancies which serve to highlight the visibility of many aspects of the experience of pregnancy and the way it is overseen is multiple pregnancy. This is where a woman is expecting more than one baby and usually more than three, which are considered rare but normal occurrences. Twins rarely attract attention and though triplets do occur without any a.s.sistive intervention negative comments are usually reserved for multiple pregnancies involving four or more babies. The Dionne quintuplets, born in 1934, were the rst to survive infancy and were displayed to the public in a theme park called Quintland by the authorities (www.nomotc.org). Multiple pregnancy attracts the same combination of the fascination for the technological developments, here surrounding the creation of a pregnancy outside the accepted method of biological reproduction, and the disapproval a.s.sociated with its execution, as has been discussed in relation to pregnancy in older women. An example is the case of Mandy Allwood, who in 1996 was pregnant with eight babies. Not only was this remarkable in itself, but she decided to sell her story to the newspapers, which attracted greater coverage and greater opportunities for disapproval. The phraseCash for babies' appeared in a number of newspapers including the Bolton Evening News, which also commented that 'her relationship does not appear to be stable'. She was not married to her partner and such a reference is clearly shorthand for Mandy Allwood is a bad mother. Tragically, the pregnancy did not proceed and all the babies had died by 19 weeks. Signicantly, however, coverage of the story centred more on disapproval of Mandy Allwood's apparently mercenary approach than on her personal story.

The case of Mandy Allwood and the focus on an individual and her pregnancy, which was discussed at length through the summer of 1996, brings us neatly to the topic of celebrity pregnancy, which forms the remainder of the chapter. In 1998, three well-known young women at the time were pregnant, two of the then Spice Girls band, Victoria Beckham 131 and Melanie Brown, and Melanie Blatt of All Saints. Concern was expressed by Family and Youth Concern (a pressure group) and by the British Pregnancy Advisory Service that teenagers would be inuenced by the message being given that t is ne to become pregnant'. The particular visibility of these women, who were in the music business already possibly regarded as slightly unsavoury together with the ambiguous marital status of two of them, identied them as potentially bad mothers; worse than this, they were unwittingly promoting such behaviour in others.

Visibility in the public sphere, particularly for women, carries with it an unspoken expectation of good behaviour. It is interesting to explore how this requirement for good behaviour is reected when such individuals become pregnant. In this case, because the well-known women were also young, they were tarred with the same critical comments as were their fan base they could not get it right. The second way of addressing the issue of visibility and of surveillance is to consider the representation of pregnancy of individuals who are already visible in the public domain for something that they do (i.e. the famous) rather than those who become visible because they are pregnant.

The already visible: pregnancy and celebrity Over the past twenty years, the press has seized on the pregnancy announcements by famous people; pictures of pregnant women abound.

Images of well-known gures from the world of entertainment, sport, royalty and even politics are now routinely captured in h.e.l.lo magazine and its worldwide equivalents. Increasingly, these images include pictures of celebrity pregnancies. Mandy Allwood appeared in one of the rst year's issues of OK magazine; Victoria Beckham and Melanie Brown appeared on the front cover of Now magazine in January 1999 and it is now almost impossible to avoid news of celebrities and their pregnancies. Indeed, Tyler (2001) and Longhurst (2005) reect on the role of celebrities in the growth of maternity fashion. It could almost be said that pregnancy itself has become something of a celebrity. The absolute visibility of the subject highlights how images of pregnancy can command public attention. In this section of the chapter, we explore how the fascination with images of pregnancy might also be seen as part of a more disturbing web of surveillance thrown over women's lives.

Images of pregnancy In their book Pregnant Pictures, Sandra Matthews and Laura Wexler (2000) state that at the start of their research they were concerned to identify the pregnant subject, having been prompted to begin their search by dismay at the shortage of images of such an important life event as 132 pregnancy in the public visual culture. However, once they had completed their research and the book was published in 2000 the situation had already changed dramatically. Since the early 1990s, when Vanity Fair magazine published a now famous picture of the lm actress Demi Moore, heavily pregnant, on its front cover, the apparent taboo against representing pregnancy in the public visual culture has relaxed; pregnancy has now become so visible it has even reached iconic status. The pose in the photograph of Demi Moore has been used frequently since then to picture other pregnant women, more and less famous, and such images are increasingly familiar and numerous, as the cover of this book suggests. As Matthews and Wexler doc.u.ment in their book, the change in visibility was in type as well as frequency; in particular they point to a shift from medico-instructional texts and instrumental forms of looking to iconic forms.

Signicantly, as we have discussed in relation to good and bad mothers, images that appear in the published media are not usually those of routine everyday pregnancies. Routine, normal pregnancies are usually presented in specialist publications or websites devoted to the topic, while pregnancies deemed unusual receive disproportionate and largely negatively nuanced attention. Instead, routine media images of pregnancy tend to be those of celebrities or other public gures. There are even specialist websites devoted to maintaining updated records of which celebrity is pregnant, by whom and when the baby is due.

Coverage of celebrities through both visual images and text is a major component of some publications' remit (e.g. Heat, h.e.l.lo, Now, OK and their equivalents globally) so that individuals' visibility is high. However, given the nature of coverage of pregnancy more generally in the media, it seems simplistic to a.s.sume that widespread coverage of celebrity pregnancy is merely an extension of the media's preoccupation with celebrity. Rather, it may represent a reactionary discourse of 'family'; or it may be a response to the power of female s.e.xuality evident in the pregnant form, making reference to representations of women as the archetypal Good Mother.

Alternatively, by referring to familiar stereotypes, such coverage may be a means of repositioning women in the role of mothers as uninterested in external events, as well as being irrational or highly emotional (Lemish and Barzel, 2000; Ussher, 1992) and centred around the home. Given that these discourses also surround pregnancy for all women, it is interesting to see whether the publicly visible pregnancies of celebrities are treated differently from those of less visible women, in relation to expectations of behaviour or advice.

Coverage of celebrity pregnancies also makes reference to the other categories of atypical pregnancy that we have discussed above. Jonathan Margolis in The Independent newspaper (10 August 2005) draws directly on these in a piece ent.i.tled 'Natal attraction', which highlights the signicance of pregnancy for celebrities: 'when cameras are trained on your 133 belly, pregnancy can be a career maker or shaker' (The Independent, 10 August 2005: 35). Within the article, he identies a series of styles or types of pregnancy and the stars a.s.sociated with these. For example, thedoctor defying' pregnancy of older actresses makes direct allusion to the issue of normal pregnancy age as well as the fertility rates discussed above: 'Normal women over 45 can consider a conception unusual. For celebrities, miracles begin at around 35 . . .' (op. cit.). He includes in this category Courteney c.o.x (Arquette), who was 39 when she nally became pregnant, and Holly Hunter whose rst pregnancy at 47 was with twins. He also identies thejust a bit' pregnancy, of Britney Spears, Reese Witherspoon and others. In this case, he is talking particularly about the value of news coverage that can be gained from speculation, some of which arises from apparent changes in weight or appearance. However, as we have discussed in Chapter 2, the possibility of early conrmation of pregnancy can also drive such speculation. A nal example from this collection of categories, particularly redolent of our discussions of women's behaviour in earlier chapters, is that of thescandalous pregnancy' (whether real or guessed at), such as that of Siena Millar or Elizabeth Hurley, where the paternity is uncertain and where behaviour such as smoking is considered unacceptable. This categorisation is clearly also drawing on the discourse of Good Mothers which we addressed in the earlier part of this chapter.

Celebrity In order to develop our argument, it is useful to digress slightly and clarify a denition of celebrity and of the psychological relevance of the concept in relation to a discussion of pregnancy. It is signicant that, as Giles (2000) points out, celebrity is essentially a media production and is largely a twentieth-century phenomenon. The distinction usually drawn between fame and celebrity is that celebrities are well known through the media for nothing in particular, whereas the truly famous are in some way deserving of individual recognition (Giles, op. cit.). Boorstin denes a celebrity as aperson who is known for his [sic] well-known-ness' (Boorstin, 1961: 57) and fame is clearly more than celebrity. Marshall (1997: 242) identies the celebrity as 'the public representation of individuality in contemporary culture'. Moreover, he equates the arrival of the celebrity phenomenon with the emergence of psychology as a discipline, which he criticises as reducing human activity to private personality and the inner life of the individual. What this serves to remind us is that the focus is squarely on individuals. In this context, therefore, the important issue is that the visibility is of the person and that this visibility pre-exists when an announcement of a pregnancy is reported or suspected. For celebrities and for the famous, the possibility of provoking comment is subsumed within their ident.i.ty as a celebrity, whatever their avowed desire for privacy. A 134 further point, following Marshall's concern about the role of psychology in creating a cult of the individual, is whether the dividing line between the personal and the public is so clearly drawn. As we have discussed elsewhere, for all women pregnancy offers a means by which the private is made public and there is publicly sanctioned access to the personal. Pregnancy can be regarded as a visible statement not only of women's fertility, femininity and heteros.e.xuality but also of masculinity and potency. Thus, it comes to signify fundamental gendering of social roles rather than individual experience.

Pregnancy, the individual and the body Unlike the often critical attention paid to atypical pregnancies discussed in the earlier part of this chapter, it might be supposed that women already visible in and through the media would attract positive comment, and at one level this is likely to be true. However, as the examples above indicate, these women are certainly not exempt from criticism. Being in the public eye itself invites and permits comment. Whether celebrities conform to the notion of good or bad mothers can be explored by looking beyond this to some other ways in which their pregnancy is represented. One possible way of exploring the phenomenon of attention to celebrity pregnancy that has already been referred to with respect to teenage pregnancies is to consider it as pregnancy ut of place'. For celebrities, this notion of ut of place'

could be seen as a celebration of the postmodern views of motherhood arising from the many options open to women supermodel, lmstar, mother, etc. However, as Susan Faludi pointed out in 1992, thehaving-it-all' culture has tended to result in the reinstatement of women as mothers and bearers of children as a means of reducing their visibility, rather than as extending it. The treatment of celebrity pregnancy might thus be a further example of such reduction of individuality to a more generalised 'mother'.

On what grounds might celebrity pregnancy be constructed as ut of place'? Is it that it conicts with the kind of activities and practices that are expected of celebrities? It is possible to think of celebrity and its attendant concerns with self-presentation as a form of work in itself, as, for example, in the following tag to an article about Julia Roberts' pregnancy with twins: 'Roberts will have to work overtime to keep up her glamorous image with the arrival of twins' (The Guardian, 9 June 2004: 15). If celebrity is a job, then, effectively, like other women with jobs, the expectation is that, once pregnant, women celebrities will have to work harder to prove that they are still as good as they were. Additionally, when they become pregnant, women doing this celebrity job are individually choosing to step outside the role they have previously inhabited, rather than accepting the one they are celebrated for. This is true of all women at 135 some point: for example when women are having a second or subsequent child and they have returned to work, having ostensibly relegated their fertility to another sphere. Nevertheless, their dual role as parent and worker is made visible in a way that may otherwise be maintained as hidden (Nippert-Eng, 1996). This way of characterising pregnancy as out of place is a.n.a.logous to teenage pregnancy, in that younger women have fewer competing roles until they become pregnant. It may, however, appear more instrumentally than conceptually out of place.

What is noteworthy about out-of-place pregnancies is that by disrupting routines or expectations they force a response from others, as we have seen before. The visibility of a pregnancy also determines the kinds of responses that emerge. In particular, such responses often involve the need to manage either some aspect of the pregnancy or some aspect of the pregnant person.

For example, medical management is the default, whether it is a routine or a technologically novel pregnancy, and includes promotion of health education and advice; in the case of teenage pregnancies the health advice may include termination of the pregnancy. If what out-of-place pregnancy accomplishes is the positioning of women in their role as mothers, rather than as celebrities (or otherwise competent individuals), they can then be accorded additional special status that highlights stereotypically feminine attributes. In doing this, the individual is simultaneously positioned as less competent and the justication for intervention or support is in place. It can work to the women's benet; our research on normal pregnancy (Clarke and Gross, 2004a, 2004b) suggests that women can exploit stereotypically feminine behaviours to reduce the demands on them to perform in all spheres, as discussed in Chapter 6. Harris and Campbell (1999) point to the way that pregnancy can provide a route out of employment for some women. In a similar way, pregnancy may represent an opportunity for celebrities to change other people's expectations of them (Page, 2003).

The nature of celebrity being what it is, celebrities are already subject to scrutiny and intrusion into their private lives; celebrity status involves being treated with care, if not respect. In this context, therefore, the visibility of pregnancy simply changes the focus of that expected care and may actually serve to reinforce the individual's own status and importance. A further example relating to Julia Roberts, concerning special arrangements made to accommodate her pregnancy during lming on location, serves as an ill.u.s.tration: Writers have had to rework the script to accommodate her pregnancy. . . . Another effect of her pregnancy is that she has had to frequently ask director Steven Soderbergh to halt shooting so that she can sit down and sip water during her bouts of nausea.

(London Evening Standard, 17 June 2004: 23) 136 This example can be read as stereotyping femininity, with male acceptance of her weakened condition, as well as the according of special treatment to her at work due to her being a celebrity (not always available to other women in the workplace).

However, we can also congure celebrity pregnancy as an atypical pregnancy because it demonstrates something inconvenient or unusual which draws public attention. As we suggested in discussing non-married teenage mothers, combining different forms of atypicality also attracts media attention. Here, the example of Cherie Blair is instructive. When her fourth pregnancy was announced in 1999, she was already well known for her role of political wife, mother and as a career barrister (Page, 2003), although she had kept a low prole in the media. As discussed above, she was also 45 years old. The announcement was covered in all the daily and weekend newspapers and created a suddenly expanded personal visibility for her as an archetype of the older mother, according to the Daily Telegraph newspaper (20 November 1999), as well as the epitome of the successful woman. Despite the Daily Telegraph's praise for her, there was also much reporting of how surprised and amazed Cherie was to nd herself pregnant, implying that for someone acting as a role model she had not prepared herself at her age to have become pregnant, and that she had been irresponsible by becoming pregnant when she already had older children and other commitments. The coverage also included reference to the possible risks of a late pregnancy. The Mirror newspaper offered her advice on how to minimise those risks: 'take all the tests like me and you will be ne' (Mirror, 19 November 1999: 6).

The notion of unplanned pregnancy resonates with the label of irrespon-sibility applied to teenage pregnancy and conception outside the boundaries of marriage, highlighting how, in order to partic.i.p.ate fully in the role of a good mother, celebrities also have to conform to appropriate criteria. A further example is the headline on Gwyneth Paltrow's pregnancy in an Australian gossip magazine: nside: Gwyn's shock pregnancy'

and a further strapline: 'Was it planned? Will Chris marry her? Will she cope?' (NW, 15 December 2003: 14). Speculation on the ability to cope emphasises the need to treat her carefully in her new condition and invites monitoring as a means of support. Such intrusion, we would argue, although commonplace for those in the public eye, nevertheless serves to diminish their signicance and potential threat, making these especially visible pregnancies available for external interventions.

As celebrity is largely in the