Pregnancy Is an Uncomfortable Experience – Why Hasn’t Medical Science Made It Easier?
Research has excluded pregnant women from clinical trials — adding to cultural perceptions around pain and motherhood being natural allies.
Pregnancy is a major physiological change to the body. Its many symptoms range from back pain, increased urination frequency, trapped gas, all the way to morning sickness and even mental health conditions. And yet, the overwhelming narrative around pregnancies frames it as an uncomfortable experience that’s, on the whole, bearable. There are as many anecdotal remedies for the multitude of side-effects as there are pregnant individuals, as well as a laundry list of things to avoid, particularly for the fetus’ health — but these tend to be deeply flawed and are culture or location specific.
People might consider pregnancy a “natural” part of a woman’s life—it’s part and parcel with eventual marriage and motherhood. But when we look at the fact that there’s no cure for morning sickness, a common symptom, it raises the question of why science hasn’t paid attention yet. “There is not enough research on pregnancy, period,” Dr. Aaron Caughey, chair of the department of obstetrics and gynecology at Oregon Health Science University, told NPR. “During the first trimester of pregnancy, when pregnancy nausea is often the worst, is also the time for embryogenesis. Thus if you want to study a medication that could treat nausea in pregnancy, you would need to do many animal studies first to show that the effect on embryogenesis was nonexistent.” But of 13,000 studies on the subject, JAMA reviewers only found 35 to be robust.
Clinical trials for medications that can alleviate pains don’t include pregnant women, for fear of the potential harm to fetuses. A National Library of Medicine article showed that although this fear is valid in some instances, there is a greater danger in exclusion altogether. Some conditions require urgent intervention, like preeclampsia – a life-threatening pregnancy complication – but researchers say that investors shy away from focusing on it. “Probably most people think pregnancy is a time-limited experience, and therefore, because it lasts only nine months, we don’t need to invest that many resources in it — because it’ll be over soon,” Diana Bianchi, director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, told Washington Post. “But that’s really a fallacious idea. Pregnancy is a stress test for a woman.”
Full body pains, and abdominal cramps (to name a few) are other commonplace issues occurring with pregnancy where science has largely remained mum. The dangerous combination of a shortage of research and exclusion from trials has ensured that little to no approved drugs exist for common medical problems in pregnancy, as the “Healthy Mum, Healthy Baby, Healthy Future” report shows. “We need to mobilize … enthusiasm and investment towards pregnancy to develop effective medications because we’ve simply not been touching pregnancy,” Peter Brocklehurst, co-author of the study, told the Guardian. A “profound lack of research activity”, alongside outdated information and a fear of litigation have halted progress—within the past 40 years, only two new drugs have been approved for use during pregnancy. “We could make a massive difference in a relatively short space of time if there was sufficient investment and desire to do work in this field,” said Brocklehurst. In most societies, going child-free is the exception rather than the norm – making pregnancy a nearly ubiquitous experience, which in turn magnifies the dearth of research on its discomfort.
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There are cultural factors at play too. According to Julie Jomeen, professor of midwifery at Hull University, “[A]n important driver for some women is the desire to really feel the whole experience, to really be connected to that very primal experience of birth,” yet the fact remains that a birth with pain relief and medical or surgical interventions are not “an inferior outcome” for mother or child—this is more related to the “sociological discourse of good mothering”. In the 1960s and 70s, with the second wave of feminism, the natural birthing movement emerged. Paula Michaels, associate professor of history at Monash University explains that, “[F]eminists latched on to the idea of birth as a site for feminist empowerment and for liberating women’s bodies from the surveillance of male obstetricians.”
Besides the physical discomfort, pregnancy is also a vulnerable time for infectious diseases – with people more prone to developing serious Covid19 infections, as recent reports during the pandemic have shown. Bodily changes could be a factor: a new study to assess tuberculosis, HIV and diabetes among pregnant women has been launched at BJ Government Medical College. The team aims to understand “how changes in immunity due to pregnancy and Gestational Diabetes Mellitus (GDM) increase the risk of TB in pregnant and postpartum women,” principal investigator Dr Sanjaykumar Tambe told the Indian Express. According to Dr Vidya Mave, “[C]ombining and studying the impact of these diseases on each other fills an important knowledge gap around women, pregnancy, and risk of TB in India.” While studies like this seek to lessen the deficiencies in obstetric medicine, there is still a chasm, especially in regards to the pain women experience during pregnancy.
Then, there are the pre-existing health conditions and even disabilities that pregnant people deal with. For most drugs, clinical trials exclude pregnant women as a ‘vulnerable’ category – making their impact on pregnancies unclear. Many, therefore, have had to stop taking important medication, like psychotropic drugs, during pregnancies. In recent years, however, as further research is conducted and people recognise that extreme conditions like pregnancy can have a significant effect on mental health, evidence shows that most psychotropic drugs are safe for use in pregnancy, for mother and child.
Pregnancy itself has acute racial connotations—research has shown that maternal mortality is significantly higher among women of color compared to their white counterparts. Stress, for example, can cause an overproduction of cortisol, which is linked to comorbid cardiovascular diseases (CVD) and consequently, higher risk pregnancies and birthing complications. Doctors’ tendency to undervalue and underdiagnose their Black patients can lead to these CVD symptoms being ignored or overlooked. Dr Alicia D Bonaparte, co-editor of Birthing Justice: Black Women, Pregnancy, and Childbirth, cites institutional racism alongside classism, ageism, ableism, and heterosexism as contributors to these alarming statistics. “[C]hanging the way medical schooling addresses reproductive healthcare” can have a drastic impact, Bonaparte told the North Shore Moms.
Ultimately normalizing this process aligns with the cultural glorification of female pain. “Our societies have a high degree of importance that we place on maternal sacrifice, and a kind of martyrdom that does with being a mother,” University of Oslo philosophy professor Anna Smajdor told VICE. Apart from being highly inaccessible to a disproportionate number of women, an increasing number are voluntarily refusing painkillers during childbirth – let alone during pregnancy. Smajdor suggests that this attitude hints at a “social and moral currency attached to enduring the pain of birth without painkillers.”
Akankshya Bahinipaty writes about the intersection of gender, queerness, and race, especially in the South Asian context. Her background in political science and communication have shaped her past multimedia and broadcasting experience, and also her interest in current events.