Like a Mother: A Feminist Journey Through the Science and Culture of Pregnancy

by Angela Garbes

But the answers to my questions couldn’t be found at the doctor’s office, either. That’s because so much about female bodies—though they play the most crucial role in the continuation of our species—remains mysterious. We still haven’t even managed to figure out what exactly triggers labor—the physical process by which every single human is brought into the world. The lack of understanding and knowledge of women’s biology has had cruel and damaging consequences when it comes to pregnancy and childbirth.

Without solid data about the impact of drugs, both prescription and nonprescription, on a fetus, pregnant women’s consumption is highly regulated and restricted, which can feel infantilizing and oppressive.

And how the cells of our children, whether we carry them to term or not, live on in our bodies for a lifetime.

When we don’t know and appreciate our bodies—when we feel disconnected from their inherent cycles and rhythms—our power, rights, and choices are more easily taken away from us. This disembodiment is part of what makes it possible for a male elected official in 2016—without shame, second thought, or consequence—to say of pregnant women, “I understand that they feel like it is their body. I feel like it is separate—what I call them is, is you’re a host.”3

As with so many other subjects, most dominant discussions, scientific studies, and representations of pregnancy do very little to acknowledge the incredible range of experiences.

Yes, we get facts and guidelines from our doctors, midwives, and nurses, but we only see these care providers every few weeks and, typically, for less than thirty minutes per visit. There’s a lot more time—and questions, big and small—that make up the daily experience of pregnancy. And so, increasingly, we turn to websites, books, online forums, and social media. There is no shortage of pregnancy advice out there, and all of it can be summoned to our screens in a matter of seconds.

The messages, which come quickly, one after the other, tell us to trust doctors but also to be skeptical. To trust birth and be open to its unpredictability, but also be scared because you might die. They say it is okay to let your baby cry it out at night, she won’t remember in the morning, but also be aware that her body will be flooded with the stress hormone cortisol and her unconscious will learn that you, her mother, are willing to abandon her when she needs you the most.

the indispensable authority on these topics. In his 1894 book The Care and Feeding of Children, Dr. Luther Emmett Holt advised against relying on women’s wisdom and experience, warning that “instinct and maternal love are too often assumed to be a sufficient guide for a mother.”2 His words paved the way for physicians to set the rules mothers would be expected to follow.

Williams found that many professors felt both unprepared to teach obstetrics and unqualified to deal with obstetrical emergencies. One man, who lectured on the subject, confessed that he had never actually attended a live birth. Instead of conceding that doctors might have something to learn from midwives, Williams doubled down on his agenda, insisting that the profession be eradicated. Midwives were dangerous.

Sims developed his technique through years of surgical experimentation performed exclusively on a dozen enslaved women, without the use of anesthesia. Their owners brought these women to Sims, only three of whom—Anarcha, Betsey, and Lucy—were named in his records. Slaves were considered property and, as such, the women were never paid for their participation. Only after mastering his technique (he operated on Anarcha thirteen times) did Sims repair the fistulas of white women, all with anesthesia.6

For all the talk of “empowered birth,” in American society mothers and expectant mothers have far less power than we should. Everything we do is measured against an impossible standard of what we ought to do, what is “best.” Variation is seen not simply for what it is, biological and cultural variety, but as a deviation from what is perceived as normal.

There is no right or wrong way to be pregnant, to become a mother, to make a family. There is only one way—your way, which will inevitably be filled with tears, mistakes, doubt, but also joy, relief, triumph, and love.

To the world, your changing shape signals that you are a pregnant person first and yourself second. You become a repository for other people’s hastily blurted thoughts, a blank screen for them to project their hopes, fears, beliefs, and instructions.

a man passing by won’t offer to help you, but he will ask, “Whoa, you sure you should be doing that?”

Lying on the back didn’t become the preferred position until the seventeenth century, when French king Louis XIV, a bit of a voyeur who enjoyed watching childbirth from behind a curtain, commissioned the construction of a special viewing table so he could get the best angle possible.1

Roman historian Pliny the Elder wrote: “Contact with [menstrual blood] turns new wine sour, crops touched by it become barren, grafts die, seeds in gardens are dried up, the fruit of trees falls off, the bright surface of mirrors in which it is merely reflected is dimmed, the edge of steel and the gleam of ivory are dulled, hives of bees die, even bronze and iron are at once seized by rust, and a horrible smell fills the air.”3

For many years the placenta was commonly referred to as afterbirth, which tells you exactly how we’ve regarded it: as an afterthought. Yes, the placenta is delivered after the baby is delivered, but it’s the organ that precedes the second set of organs growing in your body. Because we don’t often pay it the attention it’s due, most of us don’t know that at any given moment, 20 percent of our blood is traveling through the placenta, keeping our future child or children nourished. We don’t hear about its remarkable immunity work, fighting off and eliminating pathogens while also allowing antibodies that exist in a mother’s body to pass through

Fisher and other scientists are investigating how the placenta convinces a mother’s immune system to accept itself and the fetus. If we can understand how it prevents her body from rejecting them, we may be able to better understand how to prevent organ rejection in transplant patients.

Two and a half decades later, women are still underrepresented in medical research. While heart disease is the leading cause of death among women in the United States, for example, less than one-third of cardiovascular clinical trial subjects are female.

And so pregnant people don’t hear much about their placentas. We hear virtually nothing about this hybrid interface tethered to two people, keeping them separate but connected. We don’t hear about this remarkable organ that is the site of the first communication and cooperation between mother and child, but also their first conflicts and negotiations. We fail to understand how this conduit connects the present, past, and future, and how its influence can be felt through all these places in time.

“It’s a transition, part of living and dying. Every single day, your body is sloughing off fluids and cells that may be harmful to you. With miscarriage, you are entering a very natural process. The body is wise. It recognizes a pregnancy that could never be carried to term.”

Though it was created specifically to care for women who had experienced pregnancy loss, Swanson’s Theory of Caring has since been adopted as a model for general nursing and patient-driven care at hospitals around the country. I wonder what else we might learn simply by listening to women.

Miscarriage helped me understand that we become mothers not, as books and websites tell us, when our babies reach the size of an avocado or butternut squash but simply when we declare ourselves so.

“In every other wealthy country, and many less affluent ones, maternal mortality rates have been falling,” a 2017 ProPublica investigation found. “But in the U.S., maternal deaths increased from 2000 to 2014.”9

A full-term placenta holds about six ounces of a fetus’s blood, which is about half of a newborn’s blood volume. The infant needs that blood to be in its body when it makes its way to the outside. So how does it get into the baby’s body in time for it to be born? The mighty uterus and its contractions, which squeeze the placenta, force blood through the umbilical vein and into the fetus. As the uterus steadily increases the pressure it places on the placenta, the organ continues to shrink, and the amount of blood inside the fetus grows until it has what it needs to take its first breath and utter its first cry outside its mother’s body.13 The contractions we must endure—for hours, sometimes days—do so much more than cause pain.

This book has taught me so much. Loving it.

My baby, in its attempts to get out of my body, was wreaking havoc on it, literally getting in the way of my being able to perform the most basic of functions. If it wouldn’t let me pee in peace, what wouldn’t it block, crawl, drag, and pull with it on its way out?

looked at me, his eyes filling with tears, and said, “Are you sure? I know how much you wanted to have the vaginal birth. I know you can do it.” He was doing exactly what I had asked him to do. To remind me of what I wanted, to be held accountable to myself. It broke me a little to hear him say it. What he didn’t know, and what I had unconsciously come to realize, was that I was already a different person.

I could look back and think about the ways my body disappointed me—and I did, a few times. But whenever I went down that road, I found that it was a dead-end street that made me feel terrible. Hating my body remains a waste of time. At some point, just for the purpose of survival, I chose, deliberately, to focus on all the things my body did right, what it did so well on my behalf. Everything it tried to do.

One woman who had severe back pain throughout her entire labor spoke at length about the nurse who stayed on after her shift was done to be there for the delivery and how, after she gave birth, the same nurse gave her a back rub.

Simkin realized then that it was not the physical act of birth itself that held the most potent memories for women, but the way they were cared for before, during, and after birth.

But there is also another profound effect of labor support that can be summarized without any obstetric and clinical terms: Women with support have less negative feelings about childbirth. They are happier.7

These positive results are sometimes referred to as “the doula effect.” While many nurses provide great care for their patients, favorable outcomes are higher when a woman is supported by someone she chooses herself, and when that person reports to no one but her.

“Why can’t we guarantee that a woman always feels well cared for?” Penny Simkin asked at one point during our conversation. “All we need is a human being. And she doesn’t have to be a rocket scientist.”

Amid the sexualized images of breasts that abound in our culture, it can be hard to remember this. But breasts exist for babies first—any adult enjoyment or appreciation is secondary.

(Upon lactating, many women, myself included, are surprised to discover that there is not just one hole in the nipple, but six or seven.)

Christians are taught that Jesus Christ once turned water into wine. Around the world, women’s bodies perform a similar miracle, every hour, every day.

The nutritional and immunological components of breast milk change every day, according to the specific, individual needs of a baby.

According to Hinde, when a baby suckles at its mother’s breast, a vacuum is created. Within that vacuum, the infant’s saliva is sucked back into the mother’s nipple, where receptors in her mammary gland decipher it.8 This “baby spit backwash,” as she delightfully described it, contains signals, information about the baby’s immune system—including any infections it may be fighting. Everything scientists know about physiology indicates that this baby backwash is one of the ways that breast milk is able to adjust its immunological composition.

The love I had for my baby felt more like all-consuming, irrational, romantic love than I would like to admit: the falling for, obsessiveness, and the fuzzy-chested, dizzying joy of getting to know her. And then there was the physical attachment that, while overwhelming and draining, was also somewhat addictive and unquenchable.

If you were to ask a group of new parents how they’re adjusting to their new reality, you’d be met with answers ranging from elation to anxiety. But among those responses, there would more than likely be a few suggestions of a sense of loss—over their old selves, their old lives. According to a study conducted at the University of California–Davis, parenthood delivers a serious blow to the self-esteem of both women and men.2

How is self-esteem defined or measured? The psychologists who conducted this study correlated adult self-esteem with being good at what we do—mastering a set of skills, many of which are related to the work we do. The arrival of a baby gives us a whole new, arguably more important, job: parenting. And parenting, no matter how much we read up or prepare ourselves for it, is chaotic, trial-by-fire-type work.

“After the baby, I was doing just an adequate job, and I hated it,” she said. “Becoming someone who does things acceptably well, but not notably well, is really hard on me.”

Researchers found that couples who didn’t discuss parenting chores and who is in charge of which task—“unexpressed and incongruent role expectations”—had more negative feelings about their relationships. In contrast, having similar beliefs about the need to share tasks—and being clear about who is responsible for what—helped couples maintain a happier relationship amid the chaotic banality of early parenthood.

We rely on our pelvic floor for closure and control—to pee and poop and, perhaps more important, not to pee and poop until the time and location are right. We need these parts to be able to relax, too, so that when we crave stimulation and sex, we can open ourselves to these things. The pelvic floor is both an essential guardian and gateway, yet we are taught virtually nothing about its anatomy or function.

Preparing for childbirth without ever hearing about your levator ani muscle and pudendal nerve is like training for a marathon without hearing about your hamstrings or IT band.

Additionally, there is pressure for new moms to get back out there instead of “lying in.” In modern America, a woman at rest is often a woman effectively removed from the world—not working, not earning money, and falling behind. We’ve managed to turn a necessity of life into a liability.

Just one postpartum appointment focused on the pelvis could save money and time for both mothers and physicians down the road. Armed with a few personally prescribed exercises, women could begin dealing with problems that, left unaddressed, could lead to incontinence, chronic back pain, and other conditions that will eventually require treatment.

It is easy for mothers to focus our attention away from our own needs and onto those of our tiny, helpless babies—after all, they will only be this young once. But we will never be this young again, either.

That last sentence was so profound for me. I’ve heard the former a million times: “they will only be this young once.” But so will we. 👏

Maybe the reason we don’t tell women about the ways their bodies will change after they give birth is because, quite simply, health-care providers don’t know. They’ve been trained to prioritize the health of newborn babies but not newly born mothers.

A decade and a half later, scientists at the University of Alberta looked for fetal microchimerism in the brains of fifty-nine women following their deaths. Each of these women had given birth to a son. The scientists detected male DNA in 63 percent of the women’s brains and in multiple regions throughout them. The oldest subject was ninety-four years old, meaning her son’s cells had lived in her body for most of her life.3 Our children are, quite literally, frequent and widespread residents of our brains.