By Sarah Elton
You wake from sleep (whew!—still on your left side), step over the pile of dog-eared reference books by the bed, shower, spread $30 anti-stretch-mark cream on your growing belly and slip into your low-rise skinny jeans. In the kitchen you swallow your prenatal vitamin, then reach for a carton of omega-3 eggs, taking a moment to blow a kiss at the 3-D ultrasound pic taped to the fridge. Before you leave for your pregnancy massage, there’s time to check your email to brush up on exactly how many grams your fetus likely weighs this week. It’s just an average day in an expectant mom’s life. Right?
It may seem that way, but modern science—together with evolving societal norms and expectations—has shaped pregnancy into something our ancestors might not recognize. Sure, the biology and mechanics are pretty much the same, but we now know so much more about our unborn babies than even those who had babies 30 years ago. We have tools—like ultrasound machines and Doppler stethoscopes—to further our already profound understanding, and gadgets that cater to our every whim—like pregnancy pillows to cushion our bulging waists and brain-stimulating music to play to our babes in utero. And we are obsessed with the whole process. We buy dozens of books on pregnancy, nutrition and baby care. We lurk in online forums to trade details with other moms-to-be. We memorize prenatal screening results, and blog about how we’re feeling.
To get a handle on just how much things have changed, let’s take a gander back to the year 1971. That’s when Canadians like Sandra Oh, Justin Trudeau, Jacques Villeneuve and Evelyn Lau and a bunch more of us were mere fetuses, squirming and kicking inside our mothers’ wombs.
1. TESTING GROUND
These days, if you think you may be pregnant—like the day after your period was due or even earlier, in some cases—you tread a well-worn path down the drugstore aisle to the shelf displaying the pregnancy tests. Then, you go home and pee on a little stick which measures your hormone levels. In as little as a minute, it tells you if you’re pregnant. This may be a ritual now, but back in the early ’70s, the home pregnancy test was just being developed. Chances are your mom didn’t know she was pregnant for more than a month after sperm met egg.
“In my day you missed two periods,” says Ellen Hodnett, mother of two and a professor in the faculty of nursing at the University of Toronto, “There would be other signs and you’d figure it out. It was a process of deduction.”
2. THIS DAY AND AGE
When my mom gave birth to me at age 27, she was the oldest first-time mom in the labour and delivery ward. Two years ago, when I had my daughter at 29, my doctor remarked on how young I was to be starting a family. This contrast reflects a major shift in childbearing that’s taken place over the last 30-odd years. In 1971, the average age of first-time moms in Canada was just 23 years old. These days, the majority of women are waiting until they’re well into their 30s to have kids. StatsCan results show that the greatest number of Canadian babies are now born to women between 30 and 34 years old.
3. FERTILE GROUNDS
Human infertility in Western countries is on the rise, and women are having a harder time conceiving than in the past. This is partly because we’re waiting longer to get pregnant. However, according to Kerry Bowman, an ethicist who specializes in reproductive issues at the University of Toronto, maternal age doesn’t fully explain this growing trend. “There seems to be other factors. But we don’t understand why,” he says. Some researchers hypothesize that environmental factors are to blame, but nothing is known for sure.
Thirty years ago, an infertile couple’s only option would have been adoption. Today, science offers couples a number of choices, including hyperovulation drugs that stimulate ovulation, intrauterine insemination with donor sperm, and in vitro fertilization (IVF)—the process in which an egg is extracted, fertilized with sperm in a petri dish to form an embryo, then implanted in the uterus. Because IVF success rates vary (not all embryos attach themselves to the uterine wall), Canadian doctors usually implant three embryos at a time. That explains the rise in multiple births and all those double and triple strollers jostling for a parking space at the playground.
Couples also have the option of making arrangements for a surrogate mother to carry an implanted embryo to term. This process has been regulated in Canada since 2004, when the government passed the Assisted Human Reproduction Act, making it illegal to pay a women to be a surrogate mother.
4. DR. WHO?
Chances are you were born in a hospital. Most likely, an obstetrician or a family doctor was present. Now, depending on where you live in Canada, expectant parents have more choice about who attends their baby’s birth than their parents did. In a handful of provinces, you can choose a midwife—a sage-femme in Quebec—who will “catch” your baby either at home or in the hospital. While there were practising midwives 30 years ago, it wasn’t until the 1990s and early 2000s that some provinces started funding and regulating the profession, making midwifery a more mainstream choice. That said, midwives are scarce in the Maritimes, Saskatchewan and in the north where the occupation isn’t regulated and therefore not covered by health care.
While the stereotype of a Birkenstock-clad woman delivering babies in a barn doesn’t apply, a midwife does offer a different approach. Whereas some doctors view pregnancy as a medical condition during which anything can go wrong, midwives see it as a natural process that doesn’t require intervention unless something goes wrong. This means that during labour the focus is on natural pain relief rather than an epidural and if possible, avoiding
surgical interventions like an episiotomy. While having a home birth is a popular choice today, your midwife can catch your baby at a hospital birth, too—and in some places, even order you an epidural. Should any problems arise that require an emergency C-section, a midwife will transfer care to an obstetrician.
5. SCREENING CALLS
These days, we possess an incredible amount of information about our unborn children. If we choose, we can know their gender, their likelihood of having one disease over another, and in some cases, we can peer at their chromosomes. We even get to see (albeit fuzzy, though sometimes 3-D) images of their little bodies swimming around. Our mothers knew only what they could deduce from our kicks and punches because it wasn’t until the late ’80s that ultrasound became routine. Now many women undergo integrated prenatal screening, comprised of two blood tests and an ultrasound, that determines the risk factor for irregularities like Down’s syndrome and neural tube defects.
While all this information may seem like a wonderful gift from science, it does raise some deep ethical issues for our time, says Bowman. Learning that a fetus has a certain genetic condition may leave the parents facing a difficult decision, he says. “That could be hell because what do you do?”
6. FIT PREGNANCY
What’s a pregnancy (at least a first pregnancy) without prenatal yoga, prenatal exercise class or aquafit? These days, there are umpteen different ways an expectant mom can keep her body fit for delivery (and afterwards). We know that keeping in shape is best for your baby. But when you were swimming around your mom’s tum, she was likely not encouraged to exercise. At the same time, though, the big focus was weight control. “The message was no more than 25 pounds,” says Hodnett. “Women gained more than that and they just felt guilty about it.”
Today, it’s not all about weight control and it can be okay to gain as much as 40 pounds during your pregnancy. “Lots of women gain that,” says Dr. Eva Purkey, a family physician who delivers babies in Kingston, Ont. But gaining too much weight might make your delivery a little tough and could mean you never lose it, she says. “If you’re really thin, aim for the maximum of 40 pounds. And if you’re overweight, aim for 20 to 25 pounds.”
7. FROM FASHION VICTIM TO VIXEN
Just look at any celebrity magazine featuring the latest Hollywood moms-to-be, and you’ll see how fashionable that bump can look. We might like to strut our stuff when we’re bulging with baby, but not long ago, pregnancy was a fashion nightmare. Think muumuus, smocks, tent dresses and overalls—anything that could hide your changing shape. “And horrible blue jeans that had stretchy jersey at the front,” remembers Jeanne Beker, host of Fashion Television and editor-in-chief of FQ magazine. “It was all about disguising your belly back then. Now it’s about showing it off.” And boy do we ever. Major clothing retailers now have maternity lines, and high-end maternity stores—where you can pick up a pair of Seven for All Mankind jeans that will see you to the delivery room—are as ubiquitous as designer strollers.
Beker looks at today’s generation with envy because she would have liked to show off her pregnant form in style. She remembers one particularly awful olive green-and-purple silk outfit she wore to an interview with Karl Lagerfeld when she was pregnant. “I was mortified,” she remembers. Luckily for her, after the interview, Lagerfeld gave her a black-and-white Chanel dress that fit beautifully.
8. LABOUR SUPPORT
You’ve waited at home bearing those contractions as long as you can manage before the long drive to the hospital. You make it to triage, and then on to the labour and delivery room. To help get through the long hours, many expectant moms hire a birth doula, a woman who offers support and coaching in natural pain-relief methods during labour.
But there weren’t any doulas in your mom’s day. They’ve existed in Canada only since the early to mid 1990s. And your mom’s generation was the first to have their husbands by their sides in the delivery room. (Your grandma may have laboured alone, visited occasionally by a nurse.)
When you were ready to be born, your mom would have been welcomed at the hospital by a nurse who would promptly shave off your mom’s pubic hair (yes, while she was having contractions). It was thought that removing the hair minimized infection (however, research later showed that it did the opposite, and eventually the procedure was stopped). After the shave came the routine enema. Aren’t you glad that some things change?
9. TIME OF DELIVERY
Things have really progressed here, from the technology and drugs to the policies that guide doctors through a birth. These days, if you haven’t gone into labour by 41 1/2 weeks’ gestation, then doctors will induce labour (that’s because the rates of fetal death rise at 42 weeks). Induction is much more common than it was when you were born because doctors are inducing their patients closer and closer to their due dates. Some hospitals will now even induce you on your due date, says Hodnett, the U of T Nursing professor.
But if your labour starts on its own, when you arrive at the hospital you may be hooked up to an electronic fetal monitor that keeps a paper record of both the baby’s heartbeat and the mother’s contractions so that doctors can get an initial read of the situation—though, in most cases, you don’t have to keep it on for the duration of your labour. While this technology has been around for a while, until the late 1970s it was used only for women with high-risk pregnancies. If the machine detects that the baby is in distress, then, depending on how things are progressing, an emergency Cesarean section may be ordered. And C-sections are being performed with increasing frequency. Fifteen per cent of babies were born this way in the 1970s; today, the rate hovers around 25 per cent. This number is slightly bolstered by those who are opting for a C-section because they see it as a convenient alternative to all that pain, pushing and unpredictability.
Also becoming more prevalent in the delivery room is the a synthetic form of the hormone oxytocin, which doctors will give you if they feel your labour is progressing too slowly. Some people in the profession, as well as advocates for women’s health, question whether or not the rising use of the hormone is necessary or good for moms. One American study of 7,000 women showed that two-thirds of women who had healthy, low-risk pregnancies were given oxytocin to speed things up.
10. HEY, BABY
When you were born, you were likely taken by a nurse to be cleaned and swaddled before being presented to your mom. Later you were whisked to the nursery for the duration of the hospital stay. There, nurses would change your diaper and bring you to your mother when they felt you needed to be fed. Now it’s only in an old movie that you’ll see babies lined up side by side in their Plexiglas bassinets. In many Canadian hospitals, if the birth has been without complications, mom or dad is allowed to cut the umbilical cord, and the baby ““ still covered in blood and vernix ““ is placed on the mother’s chest for the first feed. Then baby, mom and even dad stay together in the same room where nursing is done on demand. And the journey begins.
Sarah Elton is a Toronto journalist whose two-year-old daughter likes to ask pregnant women, “You have a baby in there?”