Published in Overland Issue 235 Winter 2019 Feminism / Pregnancy The most natural thing Natalie Kon-yu I was eleven weeks through my first pregnancy when I checked myself into the psychiatric ward at Royal Melbourne Hospital. It was 4 am. I clutched the nurse’s hand as I walked through the door. Another nurse asked me, apologetically, to hand over my keys, my phone and my loose bobby pins that cluttered the corners of my bag. In this situation, apparently, even bobby pins could be weaponised. I remember begging the psych nurse to please, please stand by the bed until I went to sleep. He didn’t, and I didn’t sleep much. My body had been trembling for two weeks, and my leg-shaking was almost constant. I could hardly sleep, despite the exhaustion; I would drift off around 11 pm and wake at 2 am. I’d been having panic attacks, and had seen numerous GPs as a result of the fear clawing at my chest. Two days before I checked myself into the psych ward, my cousin realised that I might be going through a withdrawal from Endep, a drug I’d taken on and off for years for an injury in my lower back. I’d told my GP (whose website assured me that she was a specialist in obstetrics) as soon as I went off them, and she had said, fine, that should be fine. This only happened five years ago. It happened in a nice clinic in Melbourne’s pricey inner north. It happened in the era of mental-health plans, of increased talk about the horrors of postnatal depression. It happened in the age of the internet, in which information is easily googlable, even for GPs. It happened even though I am articulate, intelligent, feminist and forthright. But what I’ve learned through two pregnancies is that such incidents are not surprising. These things happen to women; they keep happening to women. I was in no way prepared for pregnancy – had not even considered the idea that pregnancy is something to prepare for. I had not thought about what Maggie Nelson labels ‘the capaciousness of pregnancy. The way a baby literally makes space where there wasn’t space before … the rearrangement of internal organs, the upward squeezing of the lungs.’ I imagined such things almost painlessly. After all, my mother had done it; my grandmothers had done it. How hard could it be? I am ashamed by this now, embarrassed by my naivety in buying the old cultural lie that accompanies anything that can be labelled ‘woman’s work’ – how hard can it be? But it’s not surprising. Pregnancy is, in our culture, an under-considered phenomenon. Philosophers Elselijn Kingma and Suki Finn point out the dearth of philosophical thought about pregnancy – what writer Chitra Ramaswamy terms ‘the curiously silenced story of how every single one of us began’. Part of this, I think, stems from the fact that, in our culture, we tend to focus on the foetus rather than the mother, because our culture values male babies more than the women who bear them. As a result, we subscribe to what Kingma and Finn define as the container model: the idea that the foetus is a separate being that resides within the maternal body. Consider how we mislabel a foetus as ‘a baby’ from the very beginning of pregnancy. The container model is the crux of every anti-abortion position – despite the fact that a foetus cannot live independently of the mother until about 24 weeks’ gestation; and, even then, there is an abundance of medical data that suggests that the longer the foetus resides within the maternal organism, the greater its chance of survival. Recent studies indicate that delaying the cutting of the cord after birth by up to two minutes gives the baby better blood volume, more iron, a higher birth weight and a lower risk of anaemia; reduces the risk of intraventricular haemorrhage and sepsis; and lessens the need for transfusions. This model underpins the world of Gilead in The Handmaid’s Tale, where fertile women are separated from their families and enslaved, forced to carry foetuses and birth children for commanders and their wives. It is reinforced by pregnancy websites divided into ‘How your baby’s growing’ and ‘How your life’s changing’ (what’s happening with ‘baby’ is invariably detailed before anything about the person reading the page). The language of these websites is condescending at best; advice is drop-fed in pastel hues, with pictures of a developing foetus placed beside pictures of peas, apples, mangoes so readers can understand its size in uncomplicated terms. Mums are always white, non-Indigenous, cisgendered, financially comfortable and clearly heterosexual. Dads are there, supportive but mostly absent. Pregnancy is mostly easy. The pregnancy tome What to Expect When You’re Expecting is over 400 pages, and only 18 pages are reserved for pregnancy illnesses like hyperemesis gravidarum (HG), pre-eclampisa and chorioamniotis. In these pages and spaces, pressure is on pregnant women to consider the foetus first in every decision she makes. Sociologist Elena Neiterman observes how ‘expectant mothers are responsible for learning the “do’s and don’ts” of pregnancy and for adopting behaviours that will ensure the safe development of their unborn children’. Even though there is very little a woman can do to make sure that her pregnancy goes to term. Rachel Cusk writes that, ‘the literature of pregnancy bristles with threats and the promise of reprisal, with ghoulish hints at the consequences of thoughtless actions … “When you raise your fork to your lips,” reads one book on the subject, “look at it and think, Is this the best bite I can give my baby? If the answer is no, put your fork down.”’ For Kingma and Finn, the container model is only one concept of pregnancy. A more useful way to think about pregnancy, they argue, is the parthood model. ‘In the case of pregnancy, the maternal organism is the whole, where the maternal organism has many sections, such as the maternal organism’s arms, legs, heart and lungs, etc. The foetus is simply one of those sections,’ they write in Aeon magazine. This may be a radical philosophical notion, but it seems to be a perfectly rational physiological one. As humans, we host various different kinds of organisms, chief among them viruses and bacteria that cause colds, flus and gastroenteritis. They can all be expelled from the body, but depend on the body for their survival. The parthood concept also exists in the way in which parents talk about their children: as a part of themselves. As a parent, I have used this kind of hyperbole; I also think that if something were to happen to my children, then I as a person would cease to function. I’d be hollowed, heartbroken. Should it be noted that Kingma and Finn are women? ‘The metaphysics of pregnancy matters,’ Finn writes, because it: lies within many of our surface values and disputes regarding pregnancy and the ethical questions that accompany it, which can be some of the most divisive social-value questions we face. Hence, the metaphysics of pregnancy relates importantly to issues of reproductive ethics, which demonstrates that doing philosophy is going to be a necessary first step to resolving such debates. If nothing else, then, rupturing the container model would allow for the pregnant woman to become central to issues pertaining to pregnancy. In a small study of forty-two women’s experiences of pregnancy, Neiterman notes that, for her respondents, the ‘difference between the amount of information provided during pregnancy and the lack thereof in the postpartum period was striking’, with one respondent noting that ‘after pregnancy, women are not needed anymore’. ‘There is no other time in a woman’s life when she is so supported and praised and helped and loved,’ Anne Enright writes of pregnancy. ‘Though perhaps it is not “she” who gets all the attention, but “they”; this peculiar, mutant, double self – motherandchild.’ I was nine weeks through my first pregnancy when my legs started shaking. After a week of trembling, nausea and insomnia, I asked my GP if the symptoms could be caused by pregnancy. No, she thought not. She then asked if I had tried listing the colours of the rainbow as I lay in bed. I gaped: I didn’t sleep, I was afraid to leave the house on my own, I didn’t like being by myself anymore. How to make her understand the gulf between the person I was used to being and the person I was becoming? I was desperate, I explained; I would consider getting an abortion if my mental and physical state was the result of pregnancy. She looked at me, blankly. I had a panic attack about an hour after my consultation and called my friend Miriam. In the clinic, Miriam was articulate, intelligent, feminist and forthright – all the things I no longer was. A senior GP came in to consult; he thought I should be hospitalised because I had expressed the desire to harm my unborn child. I shrank in my seat; Miriam blanched with outrage. What Miriam was reacting to, and what I couldn’t express for myself at that stage, was the way in which the foetus’ wellbeing was so obviously more important than mine. I was only nine weeks pregnant – no-one knew if the foetus was even viable. But already the foetus inside of me, the size of a kumquat according to babycenter.com, was the primary concern. In that GP clinic, the possibility of a possibly viable life took precedence to the adult woman patient. When I finally checked myself into the psych ward, I went because I feared for my own life. There, I learned that I had been medically mismanaged. Because I was pregnant, the doctor had been hesitant to prescribe me benzodiazepam, even though one of the side effects of the anti-anxiety medication she had prescribed was increased anxiety. She hadn’t wanted to take the risk of benzodiazepam for the baby – but she was willing to take it for me. This is something else we don’t talk about: the effects on mental health for pregnant women. There were an estimated 309,142 births in Australia in 2017, and, according to Perinatal Anxiety and Depression Australia (PANDA), ‘almost 100,000 expecting and new parents in Australia are struggling with perinatal depression or anxiety each year’. While the discourse of postnatal anxiety and depression has made its way into the mainstream, the idea of anxiety and depression during pregnancy is still taboo, and in direct contrast to the infantilising language of pregnancy provided by medical discourse or the glorious Earth-mother ideas about pregnancy and birth that centre on the miraculousness of new life. My baby was fine. It seems a miracle that she clung on through those traumatic days, but she did, and she was born healthy, robust and amazing. But it was a long time before I could face the idea of becoming pregnant again. Not only had I been through that trauma, which resulted in both perinatal anxiety and postnatal depression, but I’d also had HG for the duration of the pregnancy, which meant that I was nauseous and vomiting until the day I gave birth. I had HG through my second pregnancy as well. I threw up on the agapanthuses outside my bedroom window every morning from six weeks on. The condition is serious: medical researcher Marlena Fejzo describes women who ‘experience vomiting so violent that their retinas have detached, their ribs have fractured, their eardrums have burst, their esophagi have torn, their fingernails have fallen off and in rare cases, they can suffer from brain damage from malnutrition’. It is easy to see familiar patterns about women and the invisibility of their work emerging here. I find myself angry that our culture continues to think of pregnant women as containers, that this permeates the way in which we approach the care of pregnant women – both medically and psychologically. Pregnancy and conditions related to pregnancy (like postpartum depression) are highly embodied, experiential phenomena; but, for years, our medical, sociological and philosophical communities have been devoid of women experts, with women only entering the medical fields and the workforce proper post-Second World War. This means that much of our thinking about pregnancy has been informed by men. ‘Childbirth and motherhood are the anvil upon which sexual inequality was forged,’ writes Cusk, ‘and the women in our society whose responsibilities, expectations and experiences are like those of men are right to approach it with trepidation.’ I agree with Cusk, but I’d argue that women lose their agency as soon as they know they are pregnant. From that time on, the foetus (viable or unviable) comes first. The woman is lucky to be seen at all. Consider the strange idea that we expect women to keep their pregnancies secret for the first twelve weeks. This means that there are fatigued, ill women pretending that everything is fine while they sleep under their desks or in the cars at lunchtime and vomit in the toilets at work. For most women, early pregnancy is the most exhausting and physically gruelling time (except perhaps for the last few weeks of the third trimester), and the time when they most need help and understanding from friends, colleagues, family and employers. Before twelve weeks, of course, the chances of miscarriage are far higher; for some women, this is a deeply traumatic experience. ‘[T]here’s a social awkwardness about the subject,’ writes Monica Dux – but it’s a staggeringly common outcome of pregnancy, with about one in four women experiencing miscarriage. In Things I Didn’t Expect (When I Was Expecting), Dux describes a meeting she has with one expert, Professor Shaun Brennecke, who says that in the case of miscarriage, there is an usually ‘an underlying genetic abnormality, an abnormality which means that the foetus never really had a chance.’ He suggests that not much can be done to prevent miscarriages, that they are ‘a throw of the dice’ and that the human race would not exist if environmental factors had a significant impact on the success of a pregnancy. When I miscarried, I lay on my sofa for a fortnight, crying and cramping and watching Downton Abbey. I had no idea that miscarriages hurt, physically hurt, but they do. I felt the loss, and I grieved. But I felt lucky that I had miscarried early in the pregnancy, before an ultrasound, before I started thinking up names or wondering about the gender. When I miscarried, I found out that a lot of my friends had miscarried, too. All these women had been walking around with a secret sorrow. And it seems to me, again, that, at a time when women need help, understanding and support, they do not get it. If miscarriage is normal and common and a sign of the body acting naturally, then why is there a shroud of unspeakability and shame around it? Why aren’t we as a culture better equipped to deal with pregnancy loss and be more supportive of the women who go through it? Historian Daniela Blei notes that the silence around miscarriage is a relatively new phenomenon, tied to advances in the medical field – which another historian, Shannon Withycombe, has suggested have contributed to the idea that ‘every pregnancy is intended and every pregnancy is successful’ – as well as to the proliferation of anti-abortion debates pushed forward by (mostly) conservative male lawmakers. ‘By entangling pregnancy loss with abortion,’ Blei writes, ‘anti-abortion activists have seized on miscarriage as an opportunity to push the idea that life begins at conception, changing the stakes of the conversation.’ The lack of choice innate in miscarriage has become blurred with a woman’s right to choose to carry on with pregnancy. In both cases, the focus is on the loss of the foetus, rather than on the consequences for the woman – the sanctity of a possible life, rather than a real one. It is difficult not to be outraged by this. Difficult not to hold abortion up as definitive proof that we privilege the life of the foetus over that of the mother. ‘I loved my hard-won baby-to-be fiercely,’ writes Nelson in The Argonauts, ‘but I was in no way ready to bow out of this vale of tears for his survival. Nor do I think those who love me would have looked too kindly on such a decision – a decision that doctors elsewhere on the globe are mandated to make, and that the die-hard antiabortionists are going for here.’ Giving pregnant women full control of their bodies upsets the patriarchal balance of power that governs our culture. If we subscribed to the parthood model rather than the container model, then women could decide to end their pregnancies. They could make these life-and-death decisions for themselves. The actual life of the woman would be foremost in this decision, instead of being an afterthought to the possibility of a robust, healthy baby. Our culture doesn’t give women agency over their bodies – even though women know their bodies best. Recent studies have shown that women are less likely to die from a heart attack when they are being treated by a female physician. Brad Greenwood, Seth Carnahan and Laura Huang found that ‘female patients treated by male doctors were about 1.5 percentage points less likely to survive a heart attack than male patients in the care of female doctors’. Mortality rates for men and women were the same when treated by a female physician. Is it any wonder that women’s experiences are undermined and trivialised both by the medical profession and the culture around us? Is it any wonder that, when faced with a pregnant woman, medical professionals are able to zero in and say, the baby, the baby comes first? I remember the moment my obstetrician lifted my baby boy out from my stomach, and I saw him mottled from the combination of blood and amniotic fluid. His black hair was plastered to his head, and I thought, briefly, that he looked like my brother. I cried in relief and in recognition. Here he was, my baby. That moment, or rather those moments, are as pure a happiness as I’ve ever experienced. My second birth was much easier than my first – that one had resulted in an emergency caesarean because my daughter’s heart rate was dropping. She did not cry when they lifted her out, and those seconds between them taking her to the cart and me hearing her thin wail were the longest I had ever endured. But this time, I went into mild labour, the obstetrician met me at the hospital for the planned caesarean and my son was born. After he was checked over and pronounced perfectly healthy, the obstetrician asked me if I still wanted her to go ahead with the procedure. Yes, I told her, let’s do it. I’d made the decision early on in my second pregnancy, and my husband agreed – your body, your choice. I’d missed too much throughout my pregnancy; there were books I couldn’t read, conversations I didn’t have, papers and articles that I hadn’t been able to write. All of my relationships had suffered. I no longer felt like a good friend or partner or mother; my focus, all of it, went into getting through each nausea-laden day. I’d watch my husband take our daughter out, relieved that I’d get time to rest, but also envious of the time they were able to spend together, out there in the world. For nearly nine months, I’d been confined to the periphery of my own life, and I wanted to get back to its busy, bursting centre. I lay on that table in the room, and the obstetrician cut my tubes. I had two healthy children – the pigeon pair – and I considered this to be lucky beyond my wildest imaginings. While she performed the sterilisation, the other doctors and midwives tended to my baby, and brought him back for me to hold. And I remember both these things happening at once – my baby laying against my chest with me singing to him, and my fallopian tubes being severed so that this exact and exquisite thing, this holding of my new baby, would never ever happen again. These seemingly disparate ideas existed side by side in easy harmony. I was happy. I was done. This essay has been peer-reviewed. Read the rest of Overland 235 If you enjoyed this piece, buy the issue Or subscribe and receive four brilliant issues for a year Natalie Kon-yu Natalie Kon-Yu is a lecturer at Victoria University and has been published nationally and internationally. Most recently, she was a contributor to and co-editor of the collection #MeToo: Stories from the Australian Movement (2019). More by Natalie Kon-yu Overland is a not-for-profit magazine with a proud history of supporting writers, and publishing ideas and voices often excluded from other places. 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