Women! In particular: pregnant women! Listen, because the Royal College of Obstetricians and Gynaecologists has an important public message about keeping baby safe and parts of it are quite complicated. Actually, for safety's sake, perhaps everybody should pay attention to the official advice, given the number of pregnant women who, as the RCOG points out, fail to grasp the responsibilities of this condition. Of course, it might be much better for society, which must provide for the pitiful results of maternal neglect, if such women could be prevented from ever becoming pregnant, but that must be a subject for a future scientific impact paper.
"The mother is the guardian of her baby's development and future health," is how experts introduce new advice entitled "Chemical Exposures During Pregnancy: Dealing with Potential, but Unproven, Risks to Child Health". Now, some of our more difficult pregnant mothers, spotting the word "unproven", have already thought it very clever to use long words like "alarmist", "patronising" and "irrational". They only embarrass themselves.
The scientists spell out the reasons why, for the punctilious guardian, no threat to her baby's development can ever be too unproven to be dismissed with confidence. "Any external influences on the baby predominantly come from the mother," the writers emphasise, in a section called "Mother as 'gatekeeper' of her baby's future health", adding with professional tact: "This important conceptual point may not be fully appreciated by many women that are pregnant."
Anyone who doubts the justice of the last remark needs only consider the huge numbers of pregnant women who, for instance, continue to work, when earlier studies have proved that foetal welfare dictates maternal rest and calm. How, if not by cognitive failure, can this be explained? Women probably do not want babies with abnormally small heads, yet this is the proven consequence for women who work more than 25 hours a week. Again, endocrinologists have shown how stressed mothers damage their own babies by flooding the womb with IQ-threatening levels of cortisol, with the most common source of stress being relationship problems with a partner. And yet, due to gatekeeper difficulties in understanding, innumerable foetuses are still being exposed to unhappy cohabitation.
If they were not afraid to appear, as is now being alleged, excessively interfering and paternalist, the authors of the new paper could justifiably urge pregnant women to remain quietly at home (supposing it is safe from harmful partners and loud noises) with the mobile phone switched off, for the duration of their pregnancy. As it is, they limit their advice to the more easily managed question of chemical exposure, noting the "increasing concern" about associations between chemicals and, say, "impairment of testicular development and reproductive function in males", where, however, none of these associations "infer causality, raising uncertainty".
The authors explain how chemicals "leach into food packaging and containers, including food and beverage cans", citing a US report that will surely alarm any pregnant woman who regularly eats (or, worse, ate) canned and packaged food, yet who might struggle to do otherwise. Of course, as the authors say: "One option is not to do anything. But, this may cause anxiety levels to rise which could be deleterious for mother and baby." "Could be"? And what anxiety levels? Are we talking a moment's hesitation before mother opens the tinned tomatoes, or a full-on Gwyneth Paltrow attack, resulting in the head circumference, for baby, of a gnat? Without relevant medical guidance, is the only responsible choice for a gatekeeper that of total compliance with the RCOG?
If this wilful obfuscation could, to use the jargon, be problematic for the kind of woman who already struggles conceptually (see above), it is calculated to have quite an impact on the vast numbers who already consume pregnancy literature and attend antenatal classes, and continually adjust their behaviour to alleviate, as far as possible, the inconvenience to the medical profession and risks to the foetus posed by gestation within the female body. If only our children could be incubated somewhere nicer.
In the circumstances, the RCOG can only hope to arouse potentially pathological levels of anxiety in baby's gatekeeper, then advise "such women to put 'safety first'". For which the scholarly term, say the authors, is the "precautionary approach". This means that pregnant women should stick to fresh food and shun, to summarise, along with plastic and tinned packaging, all cosmetics, new household items from cars to frying pans, domestic pesticides, paint, painkillers and, obviously, complementary health products. That this advice has already been modified by NHS Choices and rubbished bythe chief medical officer and Sense About Science cannot guarantee that guilty women will not, before long, endure the same preg-shaming difficulties if they are caught with glue or clingfilm at the checkout, as they did with cheese, when that threat was in vogue.
For the RCOG's supporters, who welcome medical warnings against endocrine disrupters, it must be frustrating that the precautionary approach is not extended yet more enthusiastically, to protect babies, children, adults too, from the contents of their homes. In fact, given the threats to their diets, even to their life prospects, that occur once babies have been born, you could argue that this project to raise awareness of the association between shrunken testes and handy reusable containers fails only in its dramatic lack of ambition. What is the point of an expectant mother cutting down on tinted moisturiser, and thereby stress, when the expectant father is, say, Boris Johnson?
In fairness to our health authorities, they would probably love to protect all children and adults from harm quite as much as they do the nation's foetuses, in that precious interval between non-abortion and birth. Young men, with their conceptual difficulties around drink and violence, are a particularly tempting cohort for the kinds of 1940s public information films that once urged responsible behaviour. Alas for public health, the only audience it remains permissible to instruct in this retro-paternalist manner is that composed of pregnant or would-be pregnant women. That recent, cautionary ad about waning fertility, depicting a revoltingly enceinte old woman, would never, otherwise, have seen the light.
Along with its conviction that "guardianship" correctly describes a woman's relationship with a foetus of her conception, the RCOG's batch of random prohibitions could only have emerged from a medical culture that, in this golden age of patient autonomy, routinely infantilises childbearing women – where "infant" is defined as mutinous halfwit. Alcohol is set at zero. Weight must be watched. Breastfeeding should last six months. The NHS hopes to introduce a carbon monoxide test that will expose what these recalcitrant incubators secretly know – whether or not they have been lying about smoking.
Even enthusiasts for the precautionary approach agree that, before it is adopted, all the risks should be put in perspective. Women who are pregnant may wonder if this important conceptual point is fully appreciated by the authors of "Chemical Exposures During Pregnancy: Dealing with Potential, but Unproven, Risks to Child Health".
