Inspecting expectations

Bonnie J Rough

July 18, 2018
Angela Garbes will be appearing tonight, July 18, 2018 at 7:00pm, at Third Place Books in Seward Park to talk about her book.

As a kid, I watched enough Disney movies to make myself pine for a frilly white wedding so darn young that I had too much time to overcorrect. By the time I got engaged in my mid-twenties, I was in backlash against the wedding industry. Instead of buying Martha Stewart’s wedding guide, I searched out an early prototype of today’s vast array of alternative planners. Similarly, when my husband and I were expecting our first baby, the skeptic in me knew there was probably also a childbirth industry to beware.

Yet, as if pulled by gravity, I made the ritual visit to my local bookshop to buy the thickest books first: Heidi Murkoff’s What to Expect When You’re Expecting and the Searses’ The Baby Book. But the big pregnancy and childbirth guides—especially What to Expect—were only fun the way reading the encyclopedia is fun. When one or the other did get voicey and adopt a stance, they came across as weirdly untrustworthy. Whose truths were these?

I found my way quickly to other reading, particularly Ina May Gaskin’s Ina May’s Guide to Childbirth (2003), Henci Goer’s The Thinking Woman’s Guide to a Better Birth, Pam England’s Birthing from Within and Penny Simkin’s The Birth Partner. From these books, I gained perspective. There is science, there is history, there is Western medicine, there is profit and cost and liability, there are unknowns, and yet those of us who stubbornly hate to be told what to do still have some choices. A pregnant person, I was learning, could have more bodily autonomy and more agency and more wisdom than any bestselling pat-her-on-the-head-and-send-her-to-the-OB tome could seem to safely suggest.

At that time, I lived in a large middle-American city with no out-of-hospital birth centers. That meant I could either plan for a conventional hospital birth where even with a midwifery group my chance of having a cesarean section would run higher than the World Health Organization recommended, or I could plan to give birth at home. I chose the hospital.

Then, thirty-two weeks into my pregnancy, I changed my mind. I hired a homebirth midwife, installed an inflatable fish-cartoon kiddie pool in my basement, ordered a kit of the necessary medical supplies, set out some candles, and felt better about things. It was important to me, for my own reasons, to have every chance to propel myself into motherhood under my own bodily power, as independently as possible.

But this was not to be. On that day more than a decade ago, I labored in my pool, working through great big contractions and barfing cheerfully into a stainless bowl, exclaiming about the palatability of puke with no beer in it. When it was almost time to push, my midwife checked my cervical dilation and felt for my baby’s head. But, she realized as I watched her expression change, this was no head. It was a bottom. My baby was breech, and we’d all missed it.

“What does this mean?” I asked.

“It means we call an ambulance, and you’ll go to the hospital, and since they don’t do vaginal breech deliveries, you’ll most likely have a cesarean.”

And so it was.

The only thing that made me feel better about my surgery, in the drugged and tearful days that followed, was the certainty that we’d had a medical emergency: my cesarean section had saved my life, my precious new daughter’s life, or possibly both of our lives.

But that was another illusion. I soon learned that neither my baby nor I had faced any inherent danger. No one at the hospital had been trained in vaginal breech delivery; that was the danger of attempting it. Similarly, the contract I’d signed with my midwife excluded breech homebirth; that was the reason to call 911. When I asked my midwife what we would have done if I’d begun pushing before we discovered the breech, she shrugged and said, “We would have delivered her.”

As difficult as that was for me to hear, it was something I needed to know and examine.

If I’d been reading to gently disabuse myself of hysterical Hollywood notions of labor before having my baby, I went in for a full-blown reckoning afterward. I educated myself about breech vaginal delivery, including the fact that it was required training and common practice in other countries with better birth outcomes. So, what else were we doing at odds with the evidence—and at odds with what is still good about ancient birth wisdom?

I interviewed birth workers and went to conferences and workshops about maternity care. I watched a stream of birth documentaries, from Ricki Lake and Abby Epstein's The Business of Being Born and More Business of Being Born to Debra Pascali-Bonaro’s Orgasmic Birth. I went through doula training and began supporting births in hospitals and homes. I observed a cesarean section, notebook in hand, flexing my knees to keep from fainting off the stool a surgical nurse had given me to stand on.

And I read. I took in Gaskin’s early book Spiritual Midwifery (1977) and later manifesto Birth Matters (2011). I collected the works of Michel Odent, the pioneering French obstetrician who has written about things as radical as the effects of childbirth practices on the future of our species, and things as overlooked as love and how we learn it. I discovered the roots of how misogyny colors childbirth and manipulates female reproductive health from Naomi Wolf’s Misconceptions (2001), Tina Cassidy’s Birth (2006), Jennifer Block’s Pushed (2007), Marsden Wagner’s Born in the U.S.A. (2006), and especially the bizarre, fascinating pamphlet Witches, Midwives, and Nurses: A History of Women Healers (1973) by Barbara Ehrenreich and Deirdre English. In the historical archives of a university medical library, I copied fragile folio pages from centuries-old midwifery and gynecological texts, marveling both at how far we’ve come and how stuck we remain.

In the 1970s, Gaskin and her contemporaries picked up our birth-books canon where Grantly Dick-Read left off with Childbirth Without Fear in the 1940s, telling us that birth didn’t have to be a traumatic, drugged, hallucinatory experience but could be exultant in its spontaneous form. By the 2000s US childbirth had gone through both a back-to-natural renaissance and a new backlash toward over-medicalization. We have not recovered from this, with an egregious c-section rate and shocking maternal mortality for a developed country, although the American College of Obstetricians and Gynecologists pendulum of health care recommendations is swinging again, albeit slowly, toward safer practices already proven in other countries.

After my postpartum deep-dive for everything I wanted to know that no one had told me, I could place my cesarean section into a cultural, historical, and scientific context that allowed me to accept it for what it was to me—deeply disappointing—and to move on. But in my own search for lifelines as a white, middle-class, straight, married, cisgender woman with decent health coverage and flexible work, I didn’t think about who my answers left out.

That’s what makes Angela Garbes’ new book, Like a Mother: A Feminist Journey through the Science and Culture of Pregnancy such an essential, timely contribution to our long canon of feminist criticism of American pregnancy, birth, and maternity care.

In the way What to Expect only purports to do, Garbes has written an everyperson’s companion to pregnancy, birth, and early parenthood. She broadens the spotlight, illuminating more than only the “average” (white, cis, resourced) mother represented in mainstream pregnancy references. Pregnant people who are transgender or non-binary, as well as mothers of color, women with sexual trauma, people with addiction, and those who birth and raise their babies without a co-parent, all will find their experiences acknowledged and honored in Like a Mother. And, thanks to the reassuring way Like A Mother occupies the very real gray area in the false dichotomy of “natural” versus medical childbirth, mothers with the gamut of pregnancy, birth, and postpartum experiences will find themselves here too.

“The vast majority of resources on pregnancy and motherhood direct our eyes and minds to issues that don’t actually matter in the grand scheme of things,” Garbes writes. “There is no right or wrong way to be pregnant, to become a mother, to make a family.” What matters is not how a person gives birth, but how that person feels about it later—and that comes down not to technique, but to how well the mother is cared for, body, mind, and spirit, through some of life’s most formidable passages. That doesn’t mean we push away choices. It does mean we resist, in our own individual ways, “options” grown on greed, arrogance, untruth, and the very bodies of disenfranchised mothers and babies.

Certainly shelf references can support family health in good ways, but their authoritative staying power can also reinforce a dangerous status quo: We Americans have the worst maternal health statistics in the developed world, particularly for poor women and Black women.

So while What to Expect gets to stay the same, the resources we need most—the “what you actually want and deserve to know but nobody tells you” offerings—demand renewal. Because of this, look-behind-the-curtain pregnancy and childbirth books can be essential bellwethers that show us the ways in which we’re waking up as a society—or still need to. This is something evergreen reference books can only accomplish by their glaring failures: for example, failures to be inclusive, or failures to be critical of the medical-industrial complex. It’s something Garbes herself knows, as a cis Filipina American and outspoken LGBTQ+ ally. “Our resources have yet to catch up to our reality,” she writes, “putting the onus on their audience—the audience they should be serving—to adjust to outdated information.” As an example, she quotes a disclaimer about family diversity from the latest edition of What to Expect: “Please mentally edit out any phrase that doesn’t fit and replace it with one that’s right for you and your loving family.”

Layered throughout Like a Mother is the essential critique that racism, gender discrimination, and social shaming also hurt pregnant people and their families. Garbes wants us to pay attention to the language we use, to the assumptions we make, to the racial and gender bias inherent in the medical science and system we rely upon.

Yet Garbes brings more to the table than only the point that US maternity care is lacking; she is here also to remind us that people who give birth are still in need of significant care—medical, physical, and emotional—afterward.

In quoting a scientific study on childbirth, Garbes remarks upon the researchers’ tone, calling it “honest and detached” in a way she “could only ever aspire to.” But this is in great part her feat in Like a Mother. By picking her battles and choosing an intersectional, inclusive stance in her demand for better care—and lacing it together with authentic emotion and surefooted storytelling, she makes room for many ways of being pregnant, birthing, and parenting, pushing us only to demand that they become more safe, equitable, and just.

Although this is deadly serious business, Like a Mother offers no shortage of fun and fascination. Garbes ultimately assembles a curio cabinet of illustrative examples and wonderfully horrible facts. On one shelf are those things no one tells a first-time mom (after you give birth to your baby, you have to do it again for your placenta; also, early parenthood is punishing: “new parents should be regarded like endurance athletes or hard laborers”). On another are those things that, perhaps until now, few people outside the birth world know (a baby passing through a vagina absorbs beneficial microbes to jump-start its own healthy gut flora. And that legs-splayed, on-your-back lithotomy position good for vaginal exams and extra painful childbirth? We may have a famed voyeur, French King Louis XIV, to thank for the stirrups.)

She moves from the questions many of us have even before we get pregnant (how much alcohol really can I safely drink in pregnancy?) to the questions few of us think to ask until it’s the middle of the night and we’re weary with infant care and the answers just aren’t Googlable (ok so my milk changes to meet my baby’s nutritional and immune needs, but how do my breasts know the kid has a cold?) to the questions we might never ask at all, for the lamentable reason that our own postpartum bodies fall in priority somewhere beneath bleaching out the diaper pail and it doesn’t occur to us that the physical injuries of giving birth, whether vaginally or surgically, are real and common enough to have solutions—and that we’re actually worthy of such care. (Which physical therapist in my community can restore order to my pelvic floor and make it so I can hula-hoop again without causing pain in my hips or pee in my pants?)

Garbes, a journalist, is a serious thinker with the ability to observe and question even from the depths of life’s most boggy moments—and it doesn’t get hazier than labor land. She never strains to entertain and she’s not goofy, but she is damn funny, offering well-placed, halt-reading belly laughs. It’s the rare nonfiction writer who can describe a sex scene with her husband with unforgettable slapstick and absolute necessity.

The audience Like a Mother holds closest is that cohort still looking ahead to pregnancy, labor, birth, and new parenthood—or those who have recently made passage and are beginning to question and process. I’m not part of this audience anymore. But I was in that place once, and Like a Mother both brought me back and nudged me onward.

Garbes guides the reader through basics: what a placenta does; how nipples are more sprinkler than spout; and why “due dates are bullshit.” But going deeper she makes no bones about the perplexing, terrifying ways our bodies can simultaneously betray and save us. “It is okay to touch yourself,” she writes plainly in an arresting moment of direct address. “In fact, it may help you approach birth—and everything else that follows—with less fear, more strength.”

Books in this review:
  • Like A Mother
    by Angela Garbes
    Harper Wave
    May 29, 2018
    256 pages
    Provided by publisher
    Buy on IndieBound

About the writer

Bonnie J Rough is the author of Beyond Birds and Bees: Bringing Home a New Message to Our Kids About Sex, Love, and Equality (8/21/2018); The Girls, Alone, selected by Amazon as one of the Best Kindle Singles of 2015; and the memoir Carrier: Untangling the Danger in My DNA, winner of a Minnesota Book Award. She lives in Seattle.

Follow Bonnie J Rough on Twitter: @BonnieJRough

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