1On Being and Not Being Pregnant
Pregnancy tests remain memorable only if you don’t take too many. If you buy them in bulk packages and test and retest, each result loses its power to shock and awe. After more than a few pregnancies that don’t come to term, you forget which test you took where. Were you at home? Alone? Was your partner watching the wand alongside you as its color changed and a line or two came into view? Was that second line clearly visible, or did it appear as a faint haze of pink that you scrutinized for hours? All I can say for certain about my first pregnancy test is that two pink lines slowly materialized before my eyes and that my sense of what those lines meant was not yet what it would become.
Evan and I had moved to New York City a month before I took that test. I did not yet have a doctor. Or a dentist, or a hairstylist, or a favorite bar in the city. I hadn’t yet learned how to take a crosstown bus or switch from the local to the express train. I didn’t know which museums offered free admission after 5 p.m. or where to get a cheap lunch. The city was a Minotaur’s maze that seemed to block access at every point of entry. I found a gynecologist’s office through my insurance provider and tried to book an appointment. They could only see me a month from now. Wouldn’t that be late? No, they said, that’s a normal time to wait to see if the pregnancy is viable.
Viable. The word, uttered by an impatient receptionist, was my first introduction to the precarious and sometimes hostile landscape of early pregnancy. When I took that first pregnancy test, it all seemed straightforward. You sat on the toilet seat and held the magic wand under a stream of urine. It was better, I would learn, if you had to pee just the right amount. The test itself was as straightforward as possible. Depending on the brand, you would simply wait for a plus or minus, one or two lines, pregnant or not pregnant. These binary options didn’t allow for the possibility that one might be just a little bit pregnant—that a tiny clump of cells would do their best to generate a spark of life but, in the end, they didn’t have all the right information. These cells might manage far enough along to create two pink lines, but then they would break up, falling away as bloody detritus: the same mess experienced every month, but this time with the poignancy of lost potential.
When bleeding appeared before the scheduled doctor’s visit, I called the office and was told that it was most likely a “chemical pregnancy.”
Should I be seen by someone?
No. As a first-time patient, there was no cutting the line. It wasn’t an emergency.
The bluntness with which these words were delivered stung. For the receptionist on the phone, this was run-of-the-mill. Not all pregnancies are built to last, I would learn.
People move to New York City for many reasons. Ambition, adventure, fame. Sinatra sang a song about it. Evan had gotten a job here and if we wanted to have a child together, I’d need to move too. We were looking down the barrel of our thirties. Time was running out. So we moved, we tried, and it all proved rather complicated.
* * *
I KNOW A guy who works in advertising. I’ve known him since middle school when he asked me to a dance organized by a Jewish youth organization. The dance was in Bloomfield Hills, outside of Detroit, and I remember standing in a crowd of teenagers I didn’t know, cold in my spaghetti strap semiformal dress and awkward in my semi-Jewishness. In the years since that dance, I’d kept up with him and watched over social media as he transformed himself from a husky thirteen-year-old in a yarmulke to a sleek advertiser in San Francisco. He worked for an agency that was known for cheeky, irreverent advertisements. My favorite thing that he posted on social media from that time, when we were both in our twenties, was a television ad for a Clearblue Easy home pregnancy test. The ad is shot like a scene from Star Trek, with a white pregnancy test slowly coasting through black space. The music recalls the slow crescendo of 2001: A Space Odyssey. A deep male voice intones the ad’s catchphrase: “The most advanced piece of technology that you will ever pee on.”1
I watched the ad on my friend’s social media feed, but I rarely saw it on the air after that. At the time, I was neck-deep in graduate work in English literature, and my focus shifted to the blue screen of my computer and the pile of books that I needed to read. But I never forgot the ad. It goes against the basic logic of home pregnancy test advertisements, with their emphasis on joyous couples celebrating positive results. These ads want you to focus on the happy consequences of a positive test that reveals a sought-after pregnancy. In the Clearblue Easy ad, we don’t see any people at all and the results of the test are inconsequential. The focus is on the test itself as a technological marvel. Like a spacecraft from a science-fictional universe. I love that final punch line. It’s advanced technology that we pee on. High tech meets lowbrow.
The first laboratory test for pregnancy, the Aschheim-Zondek (A-Z) test, was invented by Jewish-German scientists in 1927 to detect the hormone that is now known as human chorionic gonadotrophin (hCG).2 The placenta produces hCG, which is secreted after the embryo implants itself into the lining of the uterus. This hormone stimulates a cyst on the ovary called the corpus luteum to produce progesterone, which is essential for maintaining the pregnancy. As the pregnancy advances, the placenta will begin to produce progesterone itself. But in the early days, a blast of hCG is needed to help the embryo along before the placenta can take over. This is why hCG is an important indicator of an early pregnancy, before an ultrasound would be able to visually capture an image of the embryo.
The A-Z test required five immature lab mice. Each mouse was injected with the patient’s urine twice a day for three days, after which they were killed, dissected, and scanned for signs of ovulation, which would not have otherwise occurred in such young mice. If any of the mice had ovulated, the patient was diagnosed pregnant. It was not far off from a sacrificial offering.3 Five mice for one pregnancy. Later versions of the test used rabbits. In the TV show Mad Men, the advertising executive Roger asks his former lover Joan whether she’s had a “rabbit test” to know if she’s pregnant. Because of the difficulty and expense of animal testing, A-Z tests were used only in extreme cases, often when a woman was ill and doctors needed to determine whether she might be experiencing a rough early pregnancy.
From the grisly origins of the rabbit test came a series of innovations that led to the home pregnancy test. In the U.S., the FDA approved the home pregnancy test in 1976 and aggressive marketing for the first devices began in 1978. The e.p.t Early Pregnancy Test tapped into the emancipatory rhetoric of the feminist movement to promise customers “a private little revolution any woman can easily buy at her drugstore.”4 It also introduced the idea of at-home diagnostics; as historian Sarah A. Leavitt observes, “home testing was an unusual occurrence for most Americans, who probably counted the thermometer as their only home diagnostic tool.”5 No longer relegated to the specialized domain of white lab coats, pregnancy tests brought advanced medical technology into the home. Early tests, unlike the sleek modern versions, did not hide their origins in the laboratory. They consisted of elaborate test tubes and droppers like a child’s first lab kit. Users needed to follow nine intricate steps to get the results they sought.6 With the shrinking and streamlining of the pregnancy test over the years, the devices have become more efficient to use. Now you can buy them in packs of ten or more to use as early as a week after ovulation. They are packaged like a set of disposable razors, meant to be used as often as possible and thrown away.
* * *
EVEN AFTER MOVING to New York City for my husband’s job, I was occasionally staggered by the sheer conventionality of my decision. We had spent the previous three years accommodating my job. I was hired as an assistant professor of English literature at a public university in Atlanta that was excited about supporting my work as a young, energetic teacher and researcher. The job was a major coup coming three years after the financial collapse of 2008, when universities were slashing tenure-track positions left and right. The runner-up for the position was an Ivy League PhD who double majored in English and computer science and was fluent in a handful of languages. Getting the job fell somewhere between miracle and cosmic joke. The faculty were warm and inviting, but they were disappointed to learn that I was married to another energetic teacher and researcher. Even worse, his energetic teaching and researching was in precisely the field they were least interested in expanding. Their disappointment registered on their faces at cocktail parties and welcome dinners. Evan and I had started dating as graduate students in the same PhD program in English at the University of Texas. Although I was a year ahead of him in the program, we had met on equal footing—both students, both bright enough, both painfully aware of our points of weakness. But pursuing careers in the same field meant that we would always have to balance on a swinging teeter-totter of prestige and insecurity. One plus sign for another minus sign. My two lines for his one, or vice versa. There were so few jobs and our fields were so specialized that it was unlikely we would ever find positions in the same city.
With good grace, Evan spent those years as a trailing spouse, applying for the jobs he could find and hoping one would land him in the same region. We lived on my salary and the small income that he brought in from adjunct work. And then, unexpectedly, he landed the job. The shiny, big job in his field that everyone wondered who would get. The kind of job that got you talked about at conferences. The kind that stirred up professional animosity and made people rethink their previous dismissals of your intelligence, aptitude, and fitness. It was the kind of job you didn’t turn down. The unwritten rules of scarcity and prestige governing our profession demanded acceptance.
I had wrenching discussions with friends and family about whether to live apart or resign from my job. My dissertation advisor—a wittily acerbic British expat living in Texas—described it as my “Elinor or Marianne” predicament. She was referring to the two main characters of Jane Austen’s Sense and Sensibility. The elder sister, Elinor, is reasonable to a fault, while the younger sister, Marianne, is romantic and impetuous. One is all head and the other all heart. While both sisters face trials, Austen goes to astonishing lengths to punish Marianne, whose raptures push her just nearly over the brink of polite society and almost lead to her death. Did it have to be a choice between the two extremes? I wanted to argue that we’re all a little bit Elinor and a little bit Marianne. Wasn’t that, after all, what made the novel so appealing? But, like the binary options of the pregnancy test, I could be only one or the other. Choosing to move with Evan would make me a Marianne and, as such, I should be prepared to suffer.
I did the thing that everyone said was unthinkable, and I resigned from my university position. Suddenly, I was the trailing spouse. I was offered a one-year visiting position at the university-one-does-not-turn-down. I taught my classes, met with students, presented papers, signed a contract for my first book. The position would end at the end of the year and I wanted to see if there was any possibility of extending the time. There was not. Universities-one-cannot-turn-down, it seems, did not offer open-ended positions to trailing spouses, especially ones who were trailing from southern public universities. One senior faculty member in the department sat down with me to discuss my professional options. She was brimming with advice about going back on the job market. The challenge, she said, was how to spin this decision to leave a tenure-track job. This disastrous decision, she implied. How could I describe this choice without making it seem so “wifey”? It would be one thing if you were pregnant, she went on, but it will be hard to explain leaving such a job for a husband.
And so that little clump of cells, before they had a chance to be anything more than a chemical spark that lit up a pregnancy detector, was already a missed opportunity to justify my decisions.
* * *
I BLAME MY father, a urologist, for my fascination with the role of urine in the sacred rituals of twenty-first-century pregnancy. Prominently displayed in his office is a framed print of a medieval physician wielding a matula—a glass flask used to visually examine urine samples. Uroscopy, the study of urine, is one of the oldest branches of European medicine and involved a physician inspecting a patient’s urine to determine the nature of an illness. Sometimes they would taste it to detect sweetness or acidity. The diagnostic skills of ancient “piss prophets,” as they were known, included pregnancy detection. The use of urine to detect pregnancy was not limited to Europe. Much earlier, in ancient Egypt, papyrus manuscripts from 1350 B.C. describe urine tests to detect early pregnancy. Two bags were prepared—one with barley seeds and one with wheat—upon which a woman would urinate every day. If the barley grew, it would be a boy. If the grain grew, it would be a girl. If neither bag germinated, the woman was declared not pregnant. This test and later versions operated through an analogy between a woman’s fecundity and the germination of seeds.7 It would be easy to write off such a test as unsophisticated in comparison to modern technology, and yet, when later physicians replicated the test, they found it could predict early pregnancy 75 percent of the time.8 It seems that estrogen can stimulate the growth of seeds; the grain and barley responded to the elevated level of estrogen in pregnant women’s urine.9 The Egyptian papyrus had a curious afterlife—the reference to “grain” was mistranslated by a German physician as “needle” and sixteenth-century women were instructed to place sewing needles in their urine; later, an English physician again mistranslated the “needles” as “nettles” and Englishwomen were soon peeing on the leaves of the nettle plant and looking for red spots to appear.10 One thing these early tests tell us is that there is nothing new in the desire to confirm a pregnancy as early as possible with some form of outside verification. I wonder about how these tests would have provided a different way of imaging a pregnancy. A flowering shaft of grain; an oxidizing needle; red spots on a nettle plant. These tests are all different ways of making a pregnancy visible to the outside world. Without them, pregnancy was a private feeling—a somatic experience known only to the woman herself; she might guess she was pregnant from her morning sickness or tenderness in her breasts, or she could wait for the “quickening” of the pregnancy, the first signs of movement in the womb. Yet, these feelings did not count as diagnostic proof. Seeing is believing, after all.
While urine tests have long been a form of early verification for women who think they might be pregnant, they are far less accurate and informative than blood tests. This is an old family conflict for me. My father might have been a urologist, but his father—my grandfather—was a hematologist. They had a difficult relationship. My grandfather was a dominating personality whose sense of humor could easily slide into ridicule. A first-generation American, he was born to Yiddish-speaking parents from western Russia. He had witnessed the horrors of Auschwitz as a medical officer in World War II and had attended the Nuremberg trials. Deeply intellectual, he did not suffer fools or extend much grace to those who fell beneath his contempt. He worked in private practice, seeing patients in Buffalo, New York, long after his eyesight and health had given out on him. My father, on the other hand, has always been lighter and easier with a loving, if slightly feisty, nature and a willingness to change his mind. I tend to anthropomorphize blood and urine in this way: one dark and deep, the other light and insightful. The battle lines were firmly established in my family tree.
Although it feels like taking sides, blood wins out over urine when it comes to pregnancy detection. In 1972, Judith Vaitukaitis developed a test that did not require animals to determine the presence of hCG. She began her work studying the hormone in order to detect certain forms of cancer, but the implications for pregnancy testing soon became apparent.11 The blood test that she developed, though it led directly to the manufacturing of commercial pregnancy tests, was much more sophisticated than the urine test we use at home. It could make more specific claims about a pregnancy beyond a simple yes or no. This test revealed the levels of hCG in the blood (not just its presence), to show whether there might be a complicating factor, such as ectopic pregnancy, in which the egg has implanted outside of the uterus.12 In the case of an ectopic pregnancy, the urine test would tell you that you are pregnant, but a blood test would reveal that the pregnancy is most likely not viable. What you experienced as a plus sign should have really been a plus with an asterisk—a pregnancy with a difference.
When Vaitukaitis published her findings, she said that this new test “will permit earlier diagnosis of pregnancy, which, in turn, would permit earlier therapeutic intervention if desired.”13 The knowledge of a pregnancy, enabled by a pregnancy test, meant very little if there were not actionable consequences to this knowledge driven by therapeutic needs and individual desires. The adjective “therapeutic” is doing a lot of work here. By emphasizing the therapeutic nature of any possible intervention, Vaitukaitis and her coauthors tacitly acknowledged cultural anxieties about the motives for intervening in a pregnancy. Early debates about the home pregnancy test focused on what women would do with this newfound knowledge about early pregnancy. Should women be trusted with this information? Would there be more abortions as a consequence? From a doctor’s point of view, diagnosing a pregnancy early allowed for quicker responses to complicated cases in early pregnancy, again including the ectopic variety, where the life of the mother may be at risk. In many cases, therapeutic intervention meant abortion. A year after Vaitukaitis described the possibilities for therapeutic interventions generated by home pregnancy tests, the U.S. Supreme Court maintained the legal right to abortion in the case of Roe v. Wade (1973). Pregnancy tests and legalized abortion in the U.S. share a timeline—information about when a pregnancy started went hand in hand with the right to make decisions about what to do about it.
From these tangled roots, pregnancy testing and the U.S. abortion debates have influenced the experience of miscarriage in America. Historian Lara Freidenfelds argues that home pregnancy tests coupled with the heated rhetoric of the pro-abortion and anti-abortion movements in America have increased the poignancy of miscarriage for many women. Early testing alerts women to pregnancies long before previous generations of women would have known they were pregnant, at a precarious stage when miscarriage is very likely: about 30 percent of detectable pregnancies are lost, most often in the early weeks.14 In a culture in which anti-abortion advocates push sentimental images of life in the womb, which women are meant to protect as a sacred principle, and pro-choice advocates emphasize the control that women should exert over their choice to be pregnant or not, miscarriage stands, in Freidenfelds’s words, as “a silent repudiation to both sides” or “a denial of life and choice at the same time.”15 The at-home pregnancy test is a preliminary step that precedes the highly medicalized experience of twenty-first-century pregnancy, but it is an essential one that allows for therapeutic intervention and that shapes attitudes toward pregnancy. It gives the illusion of certainty and the expectation of control with a graphic, highly visual image of a pregnancy confirmed.
* * *
STANDING ON A sandy beach in James Joyce’s imagined Dublin, Stephen Dedalus thinks these words to no one but himself: “The ineluctable modality of the visible.”16 I’ve taught this passage of Ulysses many times and each time I have to look up two words in the dictionary—“ineluctable,” “modality.” What is he trying to say about vision, visibility, seeing? To be ineluctable is to be inescapable. The connotation is negative—you want to get away from something but cannot. And what about modality? That which relates to a mode or style or manner, but not the substance of the thing itself. So, the ineluctable modality of the visible, glossed in inelegant descriptive prose, means: we cannot escape the style of what we see. Or, that which is visible is known to us only through its style, not its essential nature.
Seeing a pregnancy through an at-home test, for instance. We buy it over the counter at the drugstore (it is a commercially available medical supply); it is often white and comes individually packaged (surgically clean); and it is shaped like a wand (magic!). Once we’ve peed on it, we wait a few minutes and something is revealed to us. A plus or minus, one line or two. Once we see those symbols, we cannot escape them. They are the manner through which we first see and know ourselves as pregnant. And yet, what did we really see? We saw a binary response to the presence of hCG in our urine. In the case of a positive response, we did not really see confirmation of a baby—the essence that those two lines claim to represent—though it feels like we did. There is something mirage-like about an early pregnancy. It is there and not there, existing only incompletely in the mind and in the body.
I held on to the common superstition against telling people I was pregnant before fifteen weeks. And yet, people had a way of knowing. During one pregnancy, I spilled the secret myself—telling Miranda that I was pregnant as we sat outside on a beautiful sunny fall day at the Met Cloisters, surrounded by medieval art. Miranda had been my closest colleague in Atlanta and leaving her was one of the hardest parts of my decision to go. She was a quick-witted know-it-all who was fierce in her loyalties and convictions. Hers was an alpha personality that hid a deeper vulnerability. She reminded me of my mother. We’d come to the Cloisters, nestled at the top of a rocky cliff overlooking the Hudson River, to find a particular sculpture of the Virgin Mary. Miranda specialized in literature of the American South and wanted to find this sculpture because it was especially beloved by Flannery O’Connor, who sought it out repeatedly when she lived in New York City, far from her home in Georgia and hungry for a familiar companion.
After an hour of searching, we were still not sure which sculpture O’Connor would have visited. Was it the one with the soft smile whose child playfully tugged at her mantle, or the rosy-cheeked one who was missing her arms? There were so many Virgin Mothers. My current, distinctively less immaculate conception had been confirmed by a doctor just the week before, and I was not planning to tell Miranda during our outing, but a morning spent submerged in the iconography of pregnancy loosened my tongue. I couldn’t take my eyes off the paintings of the Annunciation. In these works, the artists were depicting a divine form of early pregnancy detection. The archangel Gabriel visits the Virgin Mary to announce that she is pregnant just as the Holy Ghost arrives to make it so. I stood in front of one of the most famous iterations of the Annunciation, Robert Campin’s Mérode Altarpiece, a fifteenth-century Dutch triptych. In this version of the Annunciation, Mary sits in a domestic space, leaning against a bench and absorbed in the book that she is reading. She doesn’t notice Gabriel kneeling on the other side of the table about to deliver the news. Meanwhile, above Gabriel’s head a minuscule white figure—the Holy Ghost, who appears like a tiny homunculus—dives through the window on a sunbeam, carrying a cross and cruising with high velocity straight toward Mary. To know she is pregnant is to be told by Gabriel and, perhaps at the same moment, to experience a collision with the Holy Ghost. On the left side of the triptych, a wealthy Dutch couple, the artist’s patrons, kneel and observe, while on the right side, the carpenter Joseph plies his trade, not knowing what Mary will soon know. This altarpiece catches its figures in a strange moment between knowing and not knowing, between not being pregnant and being pregnant.
Miranda had guessed I was pregnant before I told her.
But how?
She couldn’t say. There was something about the way I was behaving. An air of mystery she hadn’t seen before.
Copyright © 2024 by Emily C. Bloom
