Our Mothers, Ourselves

I intended to begin with a personal admission. “I didn’t like being pregnant,” I was going to write, before describing the bodily discomforts (hypersalivation!) and psychic stresses (due date during finals!) I experienced while carrying my children. At the end of the review, I would loop back with a second admission: that reading journalist Angela Garbes’s Like a Mother actually made me want to be pregnant again.

But as I write these words, scores of migrant children are still separated from their parents, yet another police officer is charged in the homicide of an unarmed black boy, the United States has the highest maternal mortality rate in the developed world, unlicensed “crisis pregnancy centers” now have stronger free speech protections than medical professionals bound by antiabortion “informed consent” laws, and Supreme Court Justice Anthony Kennedy is retiring, ensuring greater challenges to Roe v. Wade. Whether or not I liked being pregnant is beside the point. How can anyone feel secure in the choice to bring new life into a country that is blatantly hostile to life and choice?

Like a Mother began as a 2015 article on breastfeeding that went viral.¹ Generically, it is many things: memoir, popular science, journalism. It is also a deeply political book that seamlessly blends anecdotes about topics like postpartum sex (“breast milk sprayed … like a fire hose”) with a robust defense of reproductive rights and critiques of American health care policy, from the lack of parental leave to inadequate insurance coverage for doula services. Not all of Garbes’s observations are new, but they are vital. We live in “a culture in which men hold nearly all of the legal and economic power … [and] whiteness is considered the norm and superior to other races and cultures; [and] an economic system that relies on, but does not adequately value, domestic work that is performed overwhelmingly by women.” Our government allocates woefully few resources for the well-being of parents and children. Our society devalues the knowledges of women and ignores women’s bodies, when it is not abusing them. J. Marion Sims, the 19th-century “father of modern gynecology,” practiced fistula repair on slave women without anesthesia. There are nearly five times as many studies of male sexual pleasure as there are of female sexual pain.² Women and minorities were not required to be included in NIH-funded clinical trials until 1993. A 2003 study found that 20–30 percent of women who give birth in America describe their experience as “traumatic.”³

What an insult it is, then, that the public discourse around pregnancy focuses on how women can “get their bodies back” and on manufactured “mommy wars” over things like pacifier usage. These are the conversations in which Like a Mother intervenes.

In pregnancy, then, as in life, the question is not how to tune out all avowals of expertise but rather to whom to give credence and when.

Garbes aims to create space for “diverse stories … about pregnancy and motherhood,” so that we “have a chance at understanding the experience, of making progress.” The book participates in the classic feminist project of enabling “the subaltern” to speak. However, reparative storytelling is only one part of Garbes’s tool kit. Did you know that breast milk contains pluripotent stem cells? Or that the placenta’s negotiation of the mother’s immune system is key to understanding organ transplantation? By amplifying feminist science, like Kristen Swanson’s research on caring at Seattle University, Katie Hinde’s work on breast milk at Arizona State University, and Susan Fisher’s work on the placenta at the University of California, San Francisco, Garbes demonstrates how important it is to support currently underfunded research into women’s health and bodies. By questioning the received wisdom of the medical establishment and the baby industry, Garbes returns knowledge to those who live it.

Throughout Like a Mother, Garbes challenges certain “experts,” from obstetricians who dismiss midwives, to writers of advice books and websites like What to Expect When You’re Expecting and BabyCenter.com. Almost all such resources “are written by doctors and mothers who present their opinions as definitive.” Their directive and judgmental tone leads readers to believe that there are right and wrong, black and white, decisions to be made, when in fact pregnancy and childbearing are gray areas of “imperfect choices.” The “messages we receive over and over are free of nuance, free of discussion,” Garbes writes, “information repackaged in the form of instructions,” the equivalent of abstinence-only sex education. These texts are also full of contradictions, whether about inducing labor or toddler naps. The contradictions are there because pregnancy is itself contradictory: “birth is both a normal, everyday occurrence and a significant medical event.” But even on top of that, these expert sources are rife with incomplete information.

As a mother of two, who should know better than to Google for baby advice but does anyway, I keep relearning this lesson. I learned it first when, nursing my oldest, I consulted the internet about a blocked milk duct. Heat or ice? Pressure or vibration? I suffered silently until I telephoned a lactation consultant who solved my problem in minutes. She then came to my home, watched me nurse, and diagnosed a problem I didn’t know I had. Observing that the optimal breastfeeding position is vertical, stomach to stomach, not horizontal (since the breast is not a bottle), she turned my hard-to-burp infant into one who burped herself. Garbes recounts many such instances in which the “advice … from average people who are giving birth and rearing children” trumps that of “medical professionals, online influences, and so-called experts.”

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“Test-Tube Babies” @40

By Lisa Forman Cody

To be clear: we are living in dangerously anti-expert times. As Craig Calhoun observes, the current president is “resolutely against knowledge.”⁴ Fake news drowns out researched reporting. Numerous individuals currently hold public offices for which they have no relevant education. Garbes is aware of this landscape, and Like a Mother doesn’t take issue with expertise as such. It queries whose expertise is valued. Garbes discusses the late 19th- and early 20th-century move from predominantly black “granny midwives” delivering babies to white male obstetricians wresting control of childbirth, an instructive case of how hard-won embodied knowledges can be displaced by cults of trendy information. By that same token, Garbes points out, advances in obstetrics like the Caesarean section have saved lives, just as formula has nourished babies for whom breast milk is not an option. In pregnancy, then, as in life, the question is not how to tune out all avowals of expertise but rather to whom to give credence and when.

Like a Mother unfolds in three cleverly but, to my mind, misleadingly titled sections: “One of You,” “Two of You,” and “A New You.” I say misleading because one of Garbes’s key arguments is that no one is “one” at all. Not only do we emerge reliant on our mothers’ bodies, but we also carry in our blood the DNA of our mothers and children, sometimes even siblings and foremothers. In the third trimester of pregnancy, over 6 percent of the DNA in a mother’s blood can be fetal. This phenomenon, known as fetomaternal microchimerism, “requires us to reconsider our concept of ‘self’ entirely. … We are never alone,” Garbes writes. “We are made up of others.”

A riveting chapter on the placenta also makes this point. An organ that nourishes the fetus, performs gas exchange, regulates temperature, eliminates waste, fights infections, and builds immunity, the placenta belongs to the endocrine systems of both mother and fetus, while 50 percent of its genetic material is paternal. The chapter “Mother’s Milk” further complicates prevailing notions of self by examining how breastfeeding literally enables “a private conversation between mother and child.” The baby’s saliva is taken into the mother’s nipple and its contents deciphered like a code that then directs the mother’s body “to adjust [the breast milk’s] immunological composition.” Breast milk is dynamic, adaptable, and communicative, even a record of life.

Like all good teachers, Garbes performs the enthusiasm that she hopes to incite as she describes these biological processes. Her prose is engaging and colloquial: “Time is the ultimate frenemy.” “Due dates are bullshit.” “I loved the idea that the gunk of my vagina … could be critical to a baby’s health.” That said, she never sacrifices accuracy for a one-liner. Garbes is also forthright about her experiences. A chapter is devoted to her daughter’s birth, which did not go according to birth plan, and another to the topic of miscarriage. She’s had two, and one abortion; I’ve had one of each.

Not only do we emerge reliant on our mothers’ bodies, but we also carry in our blood the DNA of our mothers and children, sometimes even siblings and foremothers.

Both miscarriage and abortion are incredibly common. (Studies estimate that 10 to 20 percent of known pregnancies end in miscarriage, and nearly 25 percent of American women will have an abortion by age 45.) Yet they are, oddly, still taboo subjects. This long-standing silence—and silencing—has had tremendously damaging effects on the public sphere, as unscientific information and ideological fearmongering take the place of women’s testimony.⁵ Garbes’s writing participates in a larger corrective movement to do justice to women’s experiences, a movement that includes Ali Wong’s comedy; Kiran Gandhi’s menstrual activism; the social media campaign #ShoutYourAbortion; Maggie Nelson’s memoir of queer pregnancy, The Argonauts; Kate Manne’s philosophical analysis of misogyny, Down Girl; and Lili Loofbourow’s writing on subjects like female sexual pain. Mainstream outlets are finally paying attention to the appalling US maternal mortality rate, by many accounts the worst in the developed world.⁶ This year, ProPublica and NPR’s series “Lost Mothers,” which covered topics like the disproportionately high maternal mortality of black women in America and health policies across states, was a Pulitzer finalist.⁷

I started Like a Mother a few weeks after having my second child and wished I could have read it years earlier. Had I taken in Garbes’s poetic description of the placenta (“meaty, like a juicy, raw pot roast … shimmering and bloody as a fresh wound … a carnal version of satellite photos of river deltas”), I would have looked more closely and reverently at mine. If I had been more knowledgeable about my body’s transformations in my first pregnancy, I might have prevented certain injuries in my second. When I had my first child, at a progressive Berkeley hospital, nobody mentioned the likelihood of abdominal muscles separating or the possible implications of cervical tearing. I’d never heard of postpartum incontinence until a yoga-teaching colleague confessed that after birthing her daughter, she couldn’t jump for fear of leaking urine.

It’s not just that we’re ignorant about these body traumas; in the United States, we are expected to “sacrifice and [suffer] … in silence.” There’s a whole chapter in Like a Mother about the neglected pelvic floor. “You probably know someone who has torn their ACL,” Garbes writes, indignant. “As part of their ACL recovery, patients are put on a program of physical therapy that includes multiple phases of exercises that can last up to six months. This is the standard care that the roughly two hundred thousand people receive who experience an ACL injury each year. There is no such standard protocol for the treatment of pelvic floor disorders, which affect up to 1.3 million of the 4 million American women who give birth annually.”

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Motherhood in the End Times

By Beth Blum

I had my second child at a birth center. After delivery, my midwife advised that I start physical therapy, even if I didn’t have any discernable problems. In the past weeks, I’ve shared what I’ve learned with my mother and aunt. Like Garbes, like me, they had ignored their postpartum challenges, assuming that “female pain [is] normal,”⁸ par for the maternal course.

I’m at an age when most of my peers are either pregnant, trying to get pregnant, or deciding whether to have children. Push past the commonplaces and the stories tumble out: hormone imbalance, polycystic ovarian syndrome, in vitro fertilization, incompetent cervix, placenta previa, placenta accreta, gestational diabetes, failed inductions, prodromal labor, breech inversions, partial epidurals, postpartum incontinence, third-degree perineal tears, stillbirth. Then there are the accounts of workplace discrimination and sexual harassment—all the ways that mothers, as Merve Emre writes, “are cordoned off from public life so that the visceral realities of motherhood—the disfigured bodies, the breasts leaking milk, the endless streams of piss and shit that emanate from babies … do not intrude upon the serious work of serious men.”⁹ These are not unique experiences. They are commonly negotiated problems overdue for public reckoning. Pregnancy may be a lesson in “surrender and submission,” but it is also an opportunity to connect with our bodies and reinvigorate the body politic around universally shared concerns. Whether or not you have children, you were once a child and, before that, a dependent infant. To quote Maggie Nelson: “You, reader, are alive today, reading this, because someone once adequately policed your mouth exploring.”¹⁰ Whether or not you are a mother, you were born of one, who is many.

It is no small irony that Like a Mother appears just as the possibilities for mothers in America are shrinking. Even as the public discourse on pregnancy progresses, reinvigorated domestic and global gag rules conspire to withhold information and lie about our bodies and health. Only the violently ignorant could wrest a breastfeeding child from its detained mother, outlaw abortion, or expect new parents to return to work in days.¹¹ Only those of us who “know and appreciate our bodies,” and are connected to “their inherent cycles and rhythms,” will be able to advocate for their—and our—worth. The stakes of not knowing couldn’t be higher. Garbes wants us to know.

This article was commissioned by Caitlin Zaloom.