Lying in bed the other night, drifting off to sleep thinking of holidays and cookie traditions and solstice eclipses, I jerked alert with a sudden, horrible realization: I have not been taking B vitamins. And without B vitamins — folate/folic acid in particular –, babies get neural tube defects. It’s Science. Everyone knows this. And once one knows one is pregnant, it’s really too late, because it’s most critical in those very first weeks, when the neural tube is first being formed. And for whatever reason, I, though trying to conceive, had completely forgotten about this Most Vital Fact and have neglected to take any form of prenatal combination vitamin or folic acid substitute and so I have doomed1 my child to cleft palate, or spina bifida, or, my nightmare when I was on a drug with a significant increase in NTDs, anencephaly.
Except that’s not true.
The truth is that a maternal diet low in folate (found primarily in leafy greens) is associated with an increase of neural tube defects noticeable on a population scale, enough so that in the USA we enrich nearly all grain products with folic acid2. The truth is that even without supplementation, the risk of NTDs are still really quite low. There’s also decent evidence that we piss away most of the content of artificial, pressed-together single-dose multivitamins. So for most people, especially those with halfway decent diets who do not regularly suffer from starvation or malnutrition, skipping vitamin supplementation is a pretty safe choice.
Except that’s not true, either. Hear me out.
The risk for choosing to avoid supplementation — or any other prenatal practice dictated as standard by society — isn’t, primarily, physical or nutritional: it’s social and emotional. The risk isn’t that one will have a child with a neural tube defect (which, even with food- or supplement-based folate intake far exceeding the ridiculously low minimums set by the FDA, is entirely possible) or other “imperfection”, the risk is that one will have a child with an atypicality and be blamed for not doing everything possible to prevent it.
The risk is that one will spend an entire pregnancy obsessing and worrying over what one “ought” to have done better, taken more of, eaten less of. The risk is that one will blame oneself for the rest of one’s life should it happen. The risk is that one will live with a constant refrain of “What if?” running in the back of their brains, never ceasing, never slowing, never backing down in the face of reason or rationality or science or practical assessment of odds because what if. What if something’s wrong because I didn’t take vitamins, did drink a beer, ate too much tuna? What if I could have prevented this condition/disease/disability/death if I had only done this differently, better, not at all? What if, what if, what if?
When we have taken all precautions — based in science and fact, or superstition and “everyone knows”3, or some muddled combination thereof — that are deemed appropriate by our society, well then, things just happen sometimes, and though still at risk for the whispers (or outright statements) that we must have done something wrong, we also often get sympathy (or pity) and are assured of our inculpability. But if we didn’t? Ah, then, we are at fault, inescapably, unforgivably. Then it — our baby born brainless, our newborn unable to nurse, our child needing yet another surgery — obviously wouldn’t have happened if only we had done better/more/what we were supposed to.
And so we take our vitamins, get the tests, avoid soft cheeses4 and deli meats, and pray nothing goes wrong and we will not be victim to the unbearable blame.
Appendix, or Apologia: Of course there are good reasons for some of our prenatal precautions, and there is almost always at least some seed of reality behind each of them (except the all-soft-cheeses here in the USA — that one I’m fully willing to mock). I’m hardly arguing against ignoring all precautions, or saying that people only follow them out of preemptive defense. We each take the information we have and perform absolutely brilliant feats of risk-benefit calculations on it, and make the best decisions out of the choices available to us given the resources we have. My point is not that pregnant people are sheep, or prenatal precautions are entirely pointless, for there are Prenatal Do Nots that I indeed do not do5, and some proscriptions I proverbially thumb my nose at6, and some precautions — the folate — that I wish I had done. My point7 rather is that fears, not so much of the risk but of the social repercussions of bypassing expected precautions, are absolutely included in our calculations. And sometimes, when we deviate, they keep us up at night.
- Because having any form of physical variation such as spina bifida is of course automatically DOOOOOOOM. For the unfamiliar, this footnote is sarcasm. ↩
- Why we don’t instead, say, make leafy greens — and vegetables generally — more accessible to everyone who wants them is a rather different rant. ↩
- And oh, how often one masquerades as the other! ↩
- Despite all USian cheeses being required to be pasteurized or aged sufficiently that risks of listeria are considered nonexistent; some soft cheeses somewhere in the world aren’t, and so have an astronomically small risk of carrying pathogens, and so best to avoid all soft cheeses everywhere, obviously. ↩
- Such as deep abdominal work — when not a part of Maya Abdominal Massage — which is really a bummer because my psoas needed some lovin’ this week and didn’t get it. ↩
- Oh holiday homemade eggnog with raw eggs and a dash of rum, how I adore thee! ↩
- In this post, because oh will there ever be more posts on pregnancy and kyriarchy and social pressures and the arbitrary nature of Western pregnancy and birth, should this currently-seed-size collection of cells stick around for the entire ride. ↩