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First Month: Discovery
For us, how did it start?
In an improbable place. My husband and I were surprised ourselves at our surroundings: in Italy, in a farmhouse outside of Todi, a Renaissance town made of stone the color of baked bread.
We felt in those surroundings a bit like Twain's Connecticut Yankees in King Arthur's court—except that in this case the court was a wedding celebration of a friend of ours whose fiancee was the doyenne of a certain group of druggie glitterati.
The wedding preparations that we watched from the sidelines involved a ragtag carnival of New York's disaffected, pale young people with dark sunglasses who populated the edges of the art world. The old sweetness of the beds of lavender and dusty thyme, and the bending olive trees, made strange contrast with the lounging, cattily gossiping bone-thin hangers-on to the wedding party. Everyone seemed still sweaty from the plane trip and acrid-smelling from too many Marlboro Lights.
Behind the small veranda where we sat, louche ex-models were making pasta in the kitchen, dressed in black bikinis and the white high-heeled hiking boots that were having a brief vogue. They were chopping fresh basil on a century-old slab of white, gray-veined marble. The groom, a rakish young attorney, paced the sloping lawn where the ceremony would be held, looking pleased and scared.
During a lull in the conversation, I gazed at my coffee and then at the line of the distant hills. A guest at the wedding, a part-time photographer or a gallery employee or a curator, with lank overprocessed blond hair and sharp features-a woman who had said nothing remarkable in my hearing for threedays-suddenly leaned over toward me. She looked with a surprising compassion into my eyes and, still smoking ravenously, said, with absolute conviction:
"You're pregnant."
Was this some sort of conversation starter? Was this the New Age ramblings of someone who did not have much to say without resorting to the faux intuitive?
Nonetheless, something was going on. Was my cycle disturbed by travel? By the rich food we'd been eating? By the medicine I was taking to ease a sore knee?
When I went to wash my face some time later, my eyes in the mirror looked like nothing I'd ever seen before: yellowish and blurred, as if I were drunk. It must have been that which the wedding guest had seen. I thought maybe this had been caused by too much red Montepulciano wine, by jet lag, by anything, I half-prayed, but that thing.
After the pied-piper band scattered to make its way back across the ocean to Soho, my husband and I stayed on for a week to see a little of the country. But even as I waited, day by day, the question always at the back of my consciousness as we went sightseeing or napped in our high, white-plastered rooms, I felt something indisputable: a sickness in my gut. It was a kind of nausea that was entirely new to me: it had a richness to it, as if I had gotten sick by ingesting pure gold. If a mountain of sweets had been touched by Midas, I felt, that's what I had in my belly.
Ordinarily, when I've had scares, I've felt panic. This time, though, I felt far away from it. Every time I realized I could indeed be pregnant, I experienced, in spite of myself, a little thrill of joy.
We were in Perugina, the town of candy. There were whole streets devoted to varieties of one kind of nougat made from an ancient recipe. And still I felt that sick sweetness, surrounded by sweetness.
We asked a pleasant young woman pharmacist for a pregnancy kit. She leaned over very patiently and showed us the instructions in Italian, a language we did not understand at all: "Questa . . ." she said, speaking as if to a two-year-old and pointing at a picture of the strip with one line, "SI. Questa. . . ." she said, pointing to a picture of the strip with two lines: "NO." I recall a sense of absolute peace coming over me as we left with the packet in a small brown bag; a sense of fatalism; something that people in my cohort scarcely ever feel—a sense of events moving beyond one's control.
What will happen will happen, was something like the thought. Or even: What will happen has already happened.
When we found out for sure, we were in a neighboring town, a smaller one. The town was built up around a dark, cool bath that a medieval woman saint used to swim in.
We found out and gazed at one another—"in wild surmise." Then we reacted very differently. My husband needed to go for a run—and think; and I needed to sit still and not think. Male and female, after our first amazement, we reacted spontaneously, like different elements.
I went out to sit by myself, perfectly, uncharacteristically becalmed.
I sat on an old stone bench looking out over a deep, green, shadowy valley that the sun had saturated for days without number. My first thought was this: Thank God I have traveled a lot in my life when I was young.
Because now I will have to sit still.
For who knows how long.
* * *
For fifteen years birth control had never failed me; and then, when my heart and body longed for a baby, when I was newly married, when it was finally safe—birth control failed me. Was this baby "planned"? Technology did not plan this pregnancy; indeed, technology planned against it. It seemed my heart planned it. Like many women I would hear from later, I had the strong intuition that will and longing had somehow altered chemistry; that mother love, the mother wish, had created a different alchemy, more powerful than the alchemy of the lab or the product trial.
We returned to Washington, D.C., where we were living in a small apartment in an old leafy neighborhood. I soon lost the quiet confidence I had briefly felt, newly pregnant on a bench in the Italian sun. Being home meant that I was inducted into a medical system that had very clear expectations of me—but little room for me to negotiate my expectations of it.
I visited a highly respected practice and endured a brisk, efficient pelvic exam with a cold-handed ob-gyn. His focus on me (or, I should say, "me," since his attention seemed focused on an interchangeable "it") was entirely waist-down. I felt slightly irrational for being bothered by his manner. Clearly I was in good medical hands. Did it really matter that the man did not look me in the eye? Did it matter that the doctor, a heavyset fellow with a middle-European accent, had reminded me of Helmut Kohl attending impatiently to a routine briefing? When we left, I had the sad, sinking feeling of someone trying to summon the energy to do something creative within a rigid regime.
A few weeks later I met another of the obstetricians in the practice. The obstetricians rotated their duties. I wondered at the reason for this—did it help them to keep a professional distance? Was that good?
I was glad to know that this one would be a woman. I had a lot of questions to ask. I had just finished reading Jessica Mitford's The American Way of Birth, a terrifying expose of medical intrusiveness in the birthing profession: soaring C-section rates, needless forceps intervention, routine epidurals and episiotomies, the technique of forcing the labor into a preordained bell curve-all practices that were performed far less frequently in Europe, and Europe had better outcomes.
My obstetrician that day was a glamorous woman with perfectly coifed suburban hair, a tennis-toned figure, and an office full of gleaming French Provioncial furniture. Her husband was a powerful local developer; I had seen their picture in the society pages. She gazed at me as if she were the president of a one-woman bank and I was a high-risk loan applicant. My husband and I sat opposite her mighty desk, petitioning.
She said curtly that I could go ahead and ask my questions.
"Can you tell me what the C-section rate for our hospital is?" I asked politely, respectful and curious.
She looked uncomfortable. "I think it's about thirty per cent, but that figure is misleading. A number of those C-sections are high-risk. Since the hospital gets the difficult cases, you can't judge from the number with any accuracy."
I had read that this was a standard response, one of many that made it hard for parents to judge C-section probabilities of any given hospital for themselves. I tried another tack:
"What about the rate for this OB-GYN practice?"
She flushed. "Maybe nineteen percent. I'm not exactly certain. But all of the C-sections we perform are done for a good reason, you can rest assured."
"Is there any way for us to find the figures? Does the practice keep records?" In my innocence, I thought perhaps she didn't understand where she could find the data I was requesting. I had not yet done the kind of reading that I would do long afterwards, so I did not yet know that an ideological war was being waged over births in mainstream hospitals. I did not know that these seemingly innocent questions of mine were, to my obstetrician and virtually everyone else in the medical profession I would encounter on the way to the birth, part of a minefield of litigation, politics, vested interests, money, and beliefs about who holds the power over the delivery room. I thought I was asking about a biological process. More fool me.
"Believe me," she replied heatedly, like a politician on message, "an OB-GYN at this practice is only going to recommend a C-section if it is the medically called-for solution to a problem."
"Okay . . . , " I said, taking a silent step back at her defensiveness. I saw I was going to get nowhere further with that question.
"Well . . . what is the rate of epidurals?" I continued.
At this she laughed at me outright, an angry laugh. A note of casual contempt for my naivete filtered through her otherwise well-bred, well-modulated voice. "Everyone wants an epidural. You may think you can do without an epidural, but my dear, one good contraction and you will be begging for the injection like virtually everyone else." Her contempt astonished me.
"So epidurals are routine in this practice? I've read that some nurse-midwife practices find that they only need epidurals in about 60 per cent of the first births."
"I didn't say they were routine," she snapped. "I said everyone wants one, and we are not about to go against that preference. Just about every woman here gets an epidural block." I did not yet understand why she sounded like a politician under scrutiny.
"What about the episiotomy rate?" I pressed on, feeling extremely uncomfortable.
"Again, I don't have numbers, but it is part of the standard of care at this practice to give episiotomies just about every time."
"I read that in Europe, the episiotomy rate ranges from three to six per cent." Jessica Mitford had given the reason for this low number: European practitioners avoided the need for episiotomies by using a gentle massage of the perineal area; some used olive oil. A Belizean midwife whom I would listen to years later would explain that a steady application of warm oil on the perineum allowed her to deliver over eight hundred women without anesthetic in the rain forest, without even one of them tearing. It was hard for me to imagine the woman in front of me massaging anyone's perineum, let alone with a condiment.
"That can't be right. Your information is no good, I've never heard of that."
I was slowly getting angry, as well as feeling humiliated and diminished. Not only was she dismissing my questions without addressing them, she seemed to be dismissing my right to ask. She was acting as if it were irrational of me to request hard empirical information. But the doctor held my baby's well-being in her hands; and I, thoroughly infantilized by this new relationship of dependency, said nothing. Why should her professional status suddenly strip me of my lifelong assumption that a woman has a right to know? I wondered. Yet I felt intimidated.
"We do episiotomies on everyone," she continued, the air in the room thick with her impatience with me. "Especially for first births. We do them because it is easier to mend a straight, sterile cut than—" and here she fixed me with a glare—"a ragged, bloody-edged tear." She paused and spat out with barely contained hostility: "Some tears extend all the way from the vagina into . . . the anus."
And that did, indeed, shut me up.
As I would eventually find out, the glossy, efficient practice, and the medical establishment behind it, had a vested interest in not telling me any of this. What I did not know at that time was my first gynecologist's assumption of high medical intervention—one that a first-rate Washington practice takes for granted—is part of a dangerous standard of care that is unique to America. My friends and I and the women I would later interview as a way to find insight into the trauma of my first birth experience were all prepped and directed into this self-same journey with the self-same landmarks. Yet each of us was encouraged to think—and indeed did believe—that this was our unique birth experience, with hardships unique to our babies and ourselves.
But when you listen to women talk about birth, their horror stories about the medical profession are about something deeper and more fundamental than too much intervention; the thread that unites many is a telling, subtle, but distinctive lack of compassion.
My friend Yasmin, who lived upstairs, was five months ahead of me, vastly pregnant when I was still just queasy and struggling to get into my clothes. When I confided in her my qualms about my icy gynecologist, she told me about a similar experience. Early in her pregnancy, she had called her GYN about spotting. She got back one of those enraging, condescending, What-To-Expect kinds of answers: "It's nothing, it's nothing—but nonetheless, don't do any physical activity."
The OB-GYN's answer to Yasmin's question about spotting had only confused her further and, scared, she had begun to cry.
"Oh . . ." her OB-GYN had said, with ill-disguised horror. "You're upset."
Another new mother told me that after she had delivered twins through C-section, her doctor had come in to check the scar. She had gained fifty pounds because of a nausea that had restricted her food choices and was feeling self-conscious about it. The doctor checked the incision, explained that the incision was called "a bikini cut," and then went on to say that she didn't have to worry about it because she wouldn't be a candidate for a bikini anytime soon.
Copyright 2001 by Naomi Wolf
