Why "What to Expect" Will Make You Crazy

If you're thinking about having a baby any time soon, you may already be too late. That's the message of What to Expect Before You're Expecting, the latest in the wildly popular What to Expect [2] series. Like its companion volumes [3] and website, this What to Expect is designed to alleviate women's anxiety about pregnancy and early motherhood. But in order to ease anxiety, it must first create it. It's never too soon, apparently, to start worrying about your children.

According to What to Expect Before You're Expecting [4], a woman should start planning her pregnancy at least three months—even a year—before she gets pregnant. What with the lifestyle overhaul that conception may require—eliminating drugs and alcohol of course, but also lowering her BMI (that’s body-mass index) and starting a vitamin and exercise regimen while simultaneously reducing her stress level—she probably should have started strategizing the moment she set eyes on the father-to-be. Maybe even before. When it comes to conception, planning is out; pre-planning is in.

As someone who has tracked my cycles, taken multiple ovulation tests, even searched fruitlessly for "ferns" in ovulation saliva tests, I understand all too well the anxieties this book is meant to address. I'm now six months pregnant with my second child. I'm sympathetic to the women who aren't as lucky as I am. No doubt the What to Expect editors are tapping into very real anxiety that stems from research about advanced maternal age (at least among certain socioeconomic groups) and other factors that affect fertility and the chances of birth defects [5]. But for a woman who is already worried, this book will only turn her into her most neurotic self, which can’t, after all, be so healthy. "A book like this is organized around anxiety,” Georgetown bioethicist Maggie Little told Time magazine. “It would take a normal person and make her crazy."

The premise of What to Expect Before You're Expecting is not just optimizing the chances of conception, but "optimizing pregnancy outcome," as Yale obstetrician Charles J. Lockwood explains in the foreword. “Healthier moms and healthier dads can create healthier pregnancies and healthier babies," the book argues, and backs its claims with research from a slew of experts and organizations. But the book "tends to blur the line between important and well-established risks," Little points out, "and small or merely theoretical risk for which there is absolutely no evidence," such as coloring your hair, or the condition of your teeth.

What to Expect Before also takes preconception to a whole new level, making it seem like a lifestyle overhaul, or a full-time job. What happened to the joy of pregnancy—and for that matter, the sex that creates it? The decision to have a baby is rightly considered one of the most profound decisions in a woman’s (and a man’s) life. What to Expect Before reduces it to something akin to choosing a mortgage or buying a car: a consequential choice but not necessarily a sacred one. By treating conception (and pre-conception) as an occupation, a duty—and mind you, one it admits is “pretty female-centric”—baby-making (aka, sex) just becomes another “to-do” on an ever-growing list.

There are planning worksheets and an extensive array of no-nos that a woman should commit to memory—from tanning beds and acne treatments to excessive use of cell phones and BlackBerrys (which your partner, it suggests, ought to keep in a jacket pocket or holster rather than in his pants, where they might damage "those jewels"). Their proof? Unnamed “researchers” who “speculate that the electromagnetic radiation from a cell phone alters sperm cells As for your actual job, well, beware, as it “can contribute to fertility difficulties,” no matter what it is you do, if it is “extremely stressful.” Yet the book itself is chock full of stress-inducing tips that would make even the most Type-A woman feel like a slacker: "Over the course of 7 days, write down everything you eat (including the amount and approximate calorie count) ... Note in the diary the number of portions you consume in each category on each day. Once your chart is complete you'll be able to figure out where your eating habits are—and where they need to be to boost your baby-making profile.” After this kind of weekend, work will feel like a vacation.

Take the simple act of sleep: "Not spending enough time in the sack can step up stress, too, which can also undermine your fertility," the book warns. "Plus, if you're charting your basal body temperature, you need adequate, consistent slumber to get the best results." How to combat this pernicious problem? Well, it’s sort of complicated: "Nap when you can, turn in early, and stay in bed late (unless you're charting, in which case it's better to maintain regular nod-off and wake-up times)—with the goal of catching 6 to 9 hours of shut-eye per night." With all this to ponder and plan, no wonder you can't sleep!

There is already evidence that the sexless American marriage is becoming an epidemic. According to one recent study, 20 million American couples are in sexless marriages. But of course the book anticipates this objection, with—what else?—a catalog of ideas that “will keep your relationship on track—even when you’re tracking your monthly cycle, tracking your BBT [that’s basal body temperature], tracking your cervical mucus, and tracking your sex life.”

Like the other What to Expect volumes, the book is filled with cutesy advice that reads like something out of a fifth-grade film strip, or an episode of the Newlywed Game [6]: "Take your Sperm to a Movie … did you know that watching a sexy movie right before you do the baby dance may actually help you conceive faster?" The “baby dance?” Isn’t that something I saw on Dora the Explorer [7]? The Joy of Sex [8] may have had its excesses, but at least it was pitched to adults, and recognized that making babies is a serious undertaking.

What to Expect Before is not alone in its field. There are numerous books in this category, [9] a magazine devoted to healthy conception [10], even a website that offers “booty call” ovulation alerts [11] to be sent to your phone. This publishing phenomenon has helped fuel the Era of the Anxious Pregnancy. Today's mother-to-be (and potential mother-to-be) has been prepped and warned about the dangers of everything from hot tubs to sushi, albacore tuna and deli meat. [12]

The anxious-pregnancy industry has helped spawn a culture in which women feel an outsized responsibility for the health of their children — even before they are born. A recent article in Vogue offers the story of Gina Fromm, a 38-year-old woman from Columbus, Ohio, who was so worried about harming her unborn child that "she took only cold showers (to avoid overheating the baby), avoided yogurt (too much bacteria), and incinerated her chicken (to kill any lurking salmonella)." For her panic attacks, she took Paxil. Her son was born with a heart defect she suspects is related to the drug.

It is a heartbreaking story, and regardless of whether Fromm's hunches are correct, she blames herself for what happened to her son: "This person that I would have done anything to protect—how could I have harmed him?" she asks. It’s a vicious cycle. Women are always worried and always quick to blame themselves. Then, when something happens, the only reasonable lesson to draw is that they weren’t worried enough.

Such stories highlight the phenomenon political scientist Joan B. Wolf calls "total motherhood," [13] in which every decision a mother makes is weighed as a tradeoff between her desires and a child's needs. "Total motherhood" places undue obligations on mothers "to be experts in everything their children might encounter, to become lay pediatricians, psychologists, consumer products-safety inspectors, toxicologists, educators, and more." The message of What to Expect When You're Expecting, she argues, embodies this new mother-child equation. During pregnancy, "producing a 'perfect' infant," she explains, quoting sociologist Deborah Lupton, "is seen to be at least partly a result of the woman's ability to exert control over her body and engage in self-sacrifice for the sake of her fetus."

If you really are having trouble getting pregnant, see a doctor. Otherwise, take your sperm—and yourself—to a movie. Who knows, maybe afterward, you’ll get lucky.