Pregnant women are still being patronised, blamed for our bodies failings, and made to feel guilty about our choices
I spent one third of 2015 about 120 days on bed rest. I moved only to visit a hospital or doctors office, where I was scrutinised and presented with a list of concrete and potential deficiencies. There was certainly something wrong with my cervix, likely something wrong with my hormone levels, probably something wrong with my placenta, and possibly something wrong with my babys heart. Every time I was examined which was constantly a new potential problem surfaced. Having already lost two pregnancies, I was overcome by the looming possibility of catastrophe. I refused to prepare for anything more than a week in advance, as if hope were interchangeable with hubris and therefore deserving of punishment.
Throughout the pregnancy, I was grimly enthusiastic about suggestions, tests, and treatments convinced that the more I endured, the more likely I would be to bring a baby home. I injected progesterone; sustained weekly ultrasounds; underwent a special MRI scan. I attended my appointments with the obstetrician, the maternal-foetal-medicine specialist and the foetal cardiologist. Most of all, I tried not to move. I believed that stillness might give me the best chance of giving birth to a healthy infant. Also, a sense of self-preservation urged me: if I were the most careful patient, then I would not have to blame myself were a tragedy to occur. Lying flat at home, I was in a dull, perpetual panic.
That panic ended two years ago, replaced by the more welcome panic of how to care for a baby. After so much dread, not a single could-go-wrong went wrong. I will never know if the precautions helped, or if everything was fine all along. My daughter, born healthy at full term, is a toddler now, and this, the spring of 2018, is the season of my fourth pregnancy.
Four pregnancies: two losses over two years, followed by one little girl, followed by one baby, currently inside, who occupies a tentative place between a pregnancy and a living child. I assess her week by week: if she were born today, she may never take a breath; if she were born today, she would soon die; if she were born today, she might even live. Yet, for months, Ive been seeing her face, formed and shifting, on a black-and-white screen, beamed out from within me. At the least, she is and has long been decidedly present.
As soon as my now-two-year-old daughter was placed, hollering, on my chest, the bitter struggle to have her receded in my mind. But now that struggle has come back clearly, because it is repeating: specialists, scans, injections, constraints, doomsday scenarios, cautionary tales. But this new pregnancy, which began 18 months later, is occurring in a different setting, in the context of #MeToo. What once seemed like bad behaviour that women were expected to bear has been revealed as oppressive, grotesque and often criminal. Pregnancy and birth experiences do not exist outside the greater culture, but firmly within, along an ugly, interminable continuum.
I entered my recent pregnancy, which began with my personal tradition of early bleeding and confusion, during the Trump presidency, a couple of months before the Harvey Weinstein allegations. My obstetrician, a feminist who skilfully guided me through my pregnancy in 2015, recommended that I see a specialist. She didnt know much about him, except that he had a high success rate with complicated pregnancies. He used aggressive techniques, but shed heard he saved babies.
I went to the specialist for a series of intricate scans. I had 38 vials of blood taken at once; my arm ran out. The specialist diagnosed me with a mild clotting disorder. According to him, it meant that my placenta could be compromised; without treatment, it might not provide the baby enough nourishment. Or then again, it might, as it had before, with my daughter. Thats the tricky thing about pregnancy: nobody knows. If you werent so privileged, if the equipment werent so advanced, you may never learn that something about you doesnt fit the many textbook requirements, yet you may have a robust little baby anyway. Or you might lose that baby and remain mystified as to why.
Once diagnosed, I was instructed to inject a blood thinner into my stomach every day. I was also prescribed progesterone, though my levels were only on the lower end of normal, placed on pelvic rest no sex for six months and scanned every two weeks. I was still mobile, and could continue with my daily life, so I felt lucky. Or that is what I told myself. To conceive my daughter, Id spent years undergoing minor surgeries, miscarriages, fertility treatments. I figured any subsequent conception would be a similarly long, painful journey. Just in case, when I stopped breastfeeding, I visited my obstetrician to discuss birth control. Six weeks later, I was staring at a plus sign on a stick. My husband and I had been sloppy just once, but as any idiot teen knows, once is enough.
The timing wasnt ideal. Beneath a thick veneer of gratefulness, I felt a guilty, unspoken regret. In what I considered the selfish recesses of my mind, I longed to be free. The path to parenthood, as it unfolded, had been invasive and constant, shocking in its intensity, grief-inducing, medicalised and without pleasure until my girl was born. Then I felt that I belonged to her. We were physically attached to each other, breathing the same pocket of air, and it had taken me more than a year to begin working in earnest again. After so long, I finally had autonomy over my own body and then, before I knew it, someone was residing within me. But that tiny resident was the priority, I told myself. I wouldnt dare tempt the universe with complaints.
At my 20-week check, the ultrasound technician informed me that, while my baby was in perfect condition, my cervix – the portion of the uterus that stands between the baby and the world – was shortening prematurely, the condition that had caused me much grief two years earlier. The official diagnosis is incompetent cervix. In a competent female body, the cervix stays long and closed until full term, and then dilates. But in an incompetent female body, the buffoonish cervix can shorten and open early, allowing a baby to tumble out. The incompetent cervix joins a number of curious obstetric diagnoses: the inhospitable uterus, hostile uterus, hostile cervical mucus, blighted ovum. Meanwhile, men experience premature ejaculation and not inadequate testicles; erectile dysfunction, but never a futile penis. They exhibit problems, but their anatomy is not defined as lacking. Pregnant women over 35 are of advanced maternal age, just a slight improvement over the previous term, only recently defunct: elderly. Those who have suffered more than two miscarriages are known as habitual aborters. We experience spontaneous abortions. A bad habit, that impetuous self-aborting: if only we had the selfcontrol to stop.
The specialist entered the exam room and inspected the images of my bungling cervix. He would perform a cervical stitch the next day, in an emergency surgery. My obstetrician had performed a similar intervention during my prior pregnancy, but she wanted a specialist to do it this time. Sitting on the examination table, I remembered my previous experience with bed rest. My obstetrician had steadfastly declined to order it, but another doctor had encouraged me to move very little and, terrified and vigilant, I decided to obey him. I recalled how, isolated and dull, I had worked half-heartedly on the edits of a book Id spent four years researching and writing. Then, I had stayed with my mother in a building with an elevator near the hospital. Now, I was living in a third-floor walk-up with a dog, a toddler, a babysitter on the payroll and deadlines to meet. The specialist appeared unmoved by the logistics of my life. I asked what I could expect in terms of physical activity and continuing with work. He did not answer, but told me to stay still for 24 hours.
The next day, I was wheeled into an operating room, where a male anaesthesiologist commented repeatedly on a tattoo on my back and then grappled, mumbling, to insert a needle into my spine, just above my bare ass; general anaesthesia is bad for a baby, so I would be awake during the procedure. My feet and legs went dead. I was manipulated into a most undignified position, a sort of naked traction. A coterie of male medical professionals took to fixing my most intimate parts.
Later, my husband told me he knew how I must have felt. No, I said. Imagine that over the course of your lifetime a flock of people, many of them women, have prodded, inspected and peered at your nether regions. Usually annually. Sometimes weekly and sometimes, while sighing in exasperation, shaking their heads in disappointment, or nodding approvingly. Imagine, then, that for the second time in as many years a few of these women hung your legs up while you were fully conscious and sewed up your balls. My husband, a shade of pale grey, muttered that I was right: he couldnt relate.
As instructed, I didnt leave the house that week. I took a cocktail of drugs. They made me sick, but, according to the specialist, they were good for my uterus. But they might be bad for the baby. But if I didnt take them, and the baby were born early, that would be worse for her: disabling, fatal. I stopped trying to assess the situation. I wondered if I would lose the baby because of either my flawed body or my poor choices or for no discernible reason at all. I also wondered about other things: if I would get to take a walk, pursue a lead for a story, keep up contacts, honour contracts.
At my next appointment, I learned that the baby was thriving and the surgery had been successful. Nothing was guaranteed the situation could change silently and abruptly but this was good news. The specialist nodded and seemed satisfied as he inspected the ultrasound images of my insides once rebellious, but now pliant and deferential. Before he left the room, I asked again about the restrictions on my job and movement.
You care only about your work, he said, suddenly raising his voice. Youre pressuring me.
I am not a woman who shies away from conflict and have never once been mistaken for a people-pleaser. But had this interaction occurred two years earlier, I would have experienced a furtive rush of fear, convinced that I was at the mans mercy. For the sake of my baby, I would have told myself, I would do well to yield, to calm him, to agree, to defuse and then to go home and privately rage, feeling young and dumb and female. But now I saw the situation from the outside, through the lens of the feminist uprising that saturated the news. From this view, a woman was sitting on the examination table, the specialist standing before her. He was up, she was down. He was the expert, she the civilian. He had recently been elbow-deep inside her. Each time they met, only one of them was carrying a baby they could lose. And only one of them was wearing pants.
I want to know how my medical situation will affect my professional life, I said, not sweetly, and looking him straight in the eye. You told me that we would assess it this week. I want to know what to expect.
What can you expect? he said, irritated. Fine, you can expect to be on bed rest for the rest of this pregnancy.
This was punishment, I felt, for pushing back: four months confinement.
Bed rest is not widespread protocol. It is, in fact, highly controversial. Some medical experts have deemed it ineffective, unsupported by data and risky: it can cause blood clots, muscle atrophy, depression, the loss of a job or money. The American College of Obstetricians and Gynecologists cautions against it in most cases. Many argue that its an old-fashioned recommendation made when the stubborn mystery of female biology asserts itself. Doctors and patients want a solution, and bed rest allows them to prescribe and undergo something, rather than face the disconcerting reality of the unknown.
Then again, millions of women and doctors across the world have sworn by bed rest for centuries. They consider it a tried-and-true method to keeping a baby in. They have seen it work. To give your child a better chance, you simply have to stop your life for a few months. Can you really resist? I knew about this controversy, so when the specialist insisted that bed rest was imperative, I wanted him to justify himself. I reminded myself that if I felt inferior to this man, it was only because he wished it to be so, not because it was true. I asked again for him to explain his reasoning.
He took another tack. Ive had people disregard me and they lose a baby theyve wanted for 10 years, he said. Because of an obsession with work.
A woman who wanted or needed to work, then, and in so doing defied his orders, could be said to have caused her babys death. It seemed to me that he chose to place blame on that woman to imply that she had caused her own loss, even when that loss may have been unavoidable. Though this man had made a successful business in womens health, I understood then that he didnt know a thing about the interior lives of women.
I left the clinic. I would have liked never to return. But here is the pregnant womans conundrum: we are not unto ourselves. We hold within us the beginnings of other people; were supposed to preserve our own independent humanity while growing new, dependent humanity. Its a hard balance to strike, and were led to believe any decision, mistake, slip of the mind, can have atrocious consequences. Were expected to subvert everything in our lives if necessary. Also, if not necessary.
The expectations placed upon women by the obstetric establishment especially if our pregnancies dont follow a perfect course, and often even when they do are presented as normal. The field of obstetrics requires women to enter into an absurd realm, or perhaps to simply remain within the absurd realm in which we already exist. Were subjected to methods that verge on Victorian: to remain prone, and in extreme cases tilted on a hospital bed at an angle for months at a time; to forgo work, pleasure, money; to allow painful interventions and invasive procedures; to agree to major abdominal surgery. Were told its for babys sake; anything other than blind acceptance is selfish at best, murderous at worst.
Theres no easy alternative. Decades ago, a group of midwives, frustrated that pregnancy was treated as a condition and women as incapable children, created an empowering birth ideology, encouraging women to be confident about their bodies life-giving abilities. Their devoted following has morphed into a movement, itself sometimes restrictive and dogmatic, in which women are encouraged to forgo pain medication during labour which doesnt hurt, some adherents claim, but is simply a series of powerful sensations. By following this approach, the midwives claim, a woman and her child can avoid a host of devastating health disorders, possibly caused by hospital interventions. While this can result in positive, liberating birth experiences for some, its not a safe or reasonable option for others, especially those with high-risk pregnancies or those who dont have access to properly trained midwives. Plus, some women just want the epidural.
Whatever approach you pick, there are rules, and any deviation can result in devastation. Pregnant women can ruin everything by eating sushi, ricotta or beansprouts; drinking wine or coffee; using toxic face cream; riding a bicycle; vacuuming; working a long shift; taking out the dog; sleeping on our backs; having sex; reaching climax. By caring for older kids or trying to make a living. By not having supportive partners, or enough money for babysitters, or helpful relatives. We can ruin it by being black, sick, poor, or rural all factors that make a pregnancy or labour more dangerous. By moving, or not moving, taking medicine, or refusing to take medicine. By giving birth in the hospital, or in the home. Stress is harmful. We should relax. A bath could help, but could also be perilous. I often wake at dawn, hand on stomach, feeling my baby shift. I dont know how to do right by her.
So many doctors deal in the fear surrounding pregnancy. They can impose terror upon their patients with their diagnoses, prognoses, protocols and regulations, handed down with meagre explanation, no personalisation and little consideration for the intricacies of a womans life. They are part of a system that should be tipped towards supporting a woman during a time of vulnerability, but instead removes her free will and constrains her, while making her responsible for almost any tragedy that may befall her or her baby.
Women now make up more than half of obstetrician-gynaecologists, but the field was designed and dominated by men for centuries. I dont need the specialist to know what it is to give birth, to be a woman, a mother. I dont need him to be relatable, comforting, permissive, protective or a pal, a dad, a god or saviour. I do need him to acknowledge my humanity while dispensing his expertise. I expect him, and his contemporaries, to be honest about the mysteries of pregnancy and birth honest with themselves and their patients.
For all the research and money poured into this realm of medicine, so much remains unknown, unknowable. One cannot compare two treatments of the same pregnancy, nor can one experiment on pregnant women. I cannot judge whether it is right, then, to approach complications in a pregnancy as aggressively as possible. I do know that medical restrictions can radically affect a womans life, and because of this, the choice of how to proceed should not be a doctors to enforce. A woman should be able to choose how to conduct herself, rather than do it under threat. She must not be asked to pay a ransom of her own movement and free will.
I went back to my obstetrician. After discussing my situation, she and I decided together that I would stop many of the specialists interventions. But I have still chosen to follow some of his recommendations. I administer my shots. I limit my movements when I can. But I wonder: am I erring on the side of caution, or on the side of fear?
During my last pregnancy, I didnt ruminate on how the way women are treated during birth is linked to a cultural idea that the female body must be subdued, immobilised and controlled, and if the owner of that body is good and magnanimous, if she is on her way to becoming a wonderful mother, she must capitulate to any demand placed upon her. I didnt wonder why, if growing a baby and giving her life is such a powerful act, the experience of doing so is profoundly disempowering. I didnt ponder structures or systems. I just wanted to meet my daughter.
Times were different then, even though it wasnt long ago. More women lived in a sort of collective denial, accepting the unacceptable. I was different, too. Im a mother now, and I could say Im thinking of my two-year-old, and of the better world she deserves. But, really, Im thinking these days of what I deserve, not as a mother or a pregnant woman, but just as a human being, at once apart from all of that and intimately one with it. Im thinking of how I should be treated, for the person that I was before I got pregnant, and the person I will be after I am pregnant. The person I have been all along.
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