Midwives of the Revolution

Explorations, analysis, and reflections on women's health, midwifery, and politics from a feminist, marxist lens


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Transition

It has been so long since I have put anything in this space. So much has happened over the last year for reproductive rights, workers, immigrants, healthcare access, the political mood and movements, and my personal and professional life has not let me keep up with it here. Though I have had my best work-life balance of my professional life so far over this last year, I’ve had a hard time squeezing in time for writing about my experience or my thoughts about what’s happening in the world.

A lot of what is hard is that my dear mother has really been on my case about protecting my professional identity, and about being ever so careful about how I present myself on the Internet, in spite of my attempts to remain as anonymous as possible here. It’s incredibly hard, as someone who has so many damn opinions and for whom my profession is a major passion of my life, to figure out how much I can say about what I think about things, while preserving myself professionally. Are there enough disclaimers in the world to cover me and protect me from losing my job, or offending my clients, or not getting some job in the future? Probably not. So I hold a lot of ideas in my mind and wrestle with what is appropriate enough for me to put into print.

Hopefully this is.

Well, I’m doing it. I’m transitioning. A very welcome, but also a terrifying change, from intrapartum care only in the hospital to not only full scope (GYN and OB) care but to homebirth. I have been working over almost the entire last year mainly in a very large private academic medical center that I previously thought of only as my city’s “baby factory” because so, so many people deliver there. I have also been moonlighting in a similar role in a small Catholic community hospital in my neighborhood that primarily serves Black and Latinx patients. These were both very welcome changes from the major challenges I encountered at my previous position, and my life over the last year has allowed me to settle into a fairly reasonable routine that works well with my family and activist lives.

But now my dream job has started, and my world is being uprooted, but for the better.  in the most delightful ways. champagne

Why am I making this change? I’m giving up a 36 hour workweek with hardly any stress about my job, for being on call 20 days a month for a position that I care about deeply and find spiritually satisfying. I’m giving up about 100 miles a week in bike commuting (often schlepping my daughter on the bike trailer) for having to always be close to my car and driving all over a large metro area to I can get to labors and births in a timely manner. I’m giving up a position that allowed me to make a midwifery stamp and positively impact my patients during their labor, as I provide physician extender service as part of a resident team, for one in which I will partner with a team of midwives to develop relationships with our clients, who have invited us into our homes for the most intimate moments of childbearing. I’m giving up watching how the medicalization of childbirth, while “evidence-based” and in highly skilled and talented hands, so often leads to much higher rates of complications than one should see in otherwise healthy people, for a birth setting in which emergencies can still happen, and the operating room or assisted delivery or complicated resuscitation is still a 9-1-1 call away.

Sure, I’m giving up some personal comforts (and admittedly, proximity to emergency help), but I am leaping into what I am hoping will be a tremendous adventure that will train me to be so much more skilled in what I care about: normal birth with healthy people. It’s a tremendous honor to be seen for my skills and potential, and to have been chosen for this practice. There’s only one way to know if this is my perfect fit, and it’s to try! So, here’s to doing my best at trying!

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[Some] Breastfeeding Moms Can Now Do More!

There has been much jubilation this week in the women’s health and lactation (and tech) worlds this week as a brand new “smart” breast pump that will be hitting the market this Spring got the tech world excited at CES 2017. While the Scary Mommy blog and Association of Women’s Health, Obstetric, and Neonatal Nurses were beside themselves with joy over the new Willow breastpump, I believe a healthy dose of skepticism about this type of product is in order.

What’s the big idea? It’s quiet and discrete–you can wear it under your bra, it’s wireless, and it has some cool tech features. It’s being pitched as a way to multitask while pumping. Imagine easily commuting, going to the movies, making dinner, or cleaning the bathroom while pumping! Great for busy nursing parents, right?!

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Willow has a beautiful design,and if such technology was developed and made available in order to actually improve working parents’ lives, including, say, being a covered benefit under state Medicaid programs that would actually help working class and poor women meet their breastfeeding goals, that would be great! And, you know, if it came with gains for our side like the Fight for 15 movement is fighting for, it would be even more meaningful.

Don’t get me wrong–as a supporter of human milk for human babies and a former (and possibly future) pumping and working mama, I am for easing the burden of expressing milk when needed. For instance, as a nursing mama, I did bring my electric pump to the opening night of Star Wars: Force Awakens last year–went straight from clinic to the movies and plugged in during the previews and opening credits! This pump would have indeed made my expression of milk easier. The critique that follows is more about lower wage women than about professional workers such as myself that could likely afford the Willow. In regard to the Willow, we must consider the following not just about our own potential personal use of the pump but about what it represents.

  1. Moms are under pressure more than ever to Do More. You’ve heard that cute phrase “mother’s work is never done”? Or perhaps are familiar with the concept of the “second shift” of women* having two jobs–one (usually under-) paid at work, then going home to be mainly responsible for housework and childcare? With the devaluing of care and women’s work generally, nursing mamas are producing even more value for the economy by making food for their infants that doesn’t have to be paid for (unlike artificial milk for babies, which can be exorbitant but is paid for by programs like WIC). This product allows the pumping parent to Do More while pumping. Sure, that may be convenient and beneficial for many mamas struggling to feed their children, whether working outside of the home or not. However, it strikes me that this product is a symptom (not a creator) of the general societal expectation for mamas to be Super Mothers. In this time of neoliberalism and very few social resources that would actually help parents raise healthy children like, say, socialized high quality daycare/other childcare, postpartum in-home nurse care, excellent local public schools, accessible healthy food for families, walkable safe neighborhoods, paid maternity leave (for at least 12 months like a civilized county) etc.–mothers are still expected to Do Everything to raise healthy children by: breastfeeding in spite of all odds, prepare homemade meals for our kids every night, and sacrifice everything to be the right kind of mother who balances career and parenting. No such standards are ever applied to men/fathers because Sexism.
  2. willow-working-mom

    Ah, the working pumping mother! She’s so efficient and beautiful and productive! You hardly notice she’s a working mother! Makes you wonder if the manufacturer looked at the federal laws on pumping before launching this marketing campaign, or if they are directing it to capital. 

    Let’s be real. While mothers who can afford it (see point #3, below) would likely benefit from a pump like this to get more done at home–though most pumping moms I know do most of their pumping while at work, except exclusively pumping mamas–the real and direct beneficiary of products like Willow are the corporations that don’t really want to support their employees’ right to undisturbed pumping time on the job that is (for now) guaranteed under the Affordable Care Act. Makes you wonder if the creators of Willow have just been waiting for the ACA to be closer to repeal in order to promote this product. In every circle of breastfeeding parents I have been part of, there are constant questions about workers’ rights to pumping time. Many people resort to working through pumping time (though not as discretely as they would with the Willow) because it’s just not practical to take proper breaks to pump (I myself usually did charting while pumping because there’s always charting to be done, and the extra charting time lessened my time staying late). This will only get worse if nursing protections are lost with the almost inevitable upcoming ACA repeal. Bad news for maternal and child health–and workers’ rights. But here’s Willow, and ready to accommodate your upcoming loss of rights! Wouldn’t you like to see your midwife while they express milk for their child?! Or have your latte prepped by a properly productive multitasking discretely pumping barista? Or groceries rung up by a pumping cashier?

  3. Retailing at over $400, plus and astonishing $0.50 per single-use milk storage bag, Willow will be cost prohibitive to the vast majority of working mothers. For a product that will make it easier to make pumping parents work through their pumping session, the least capital could do is subsidize this product. In a rational world, corporations would be made to bear the burden of the cost of such a product, rather than consumers. Sure, eventually, Willow would benefit under the current ACA requirement for health insurance to provide lactation benefits. But until then–or after, if/when ACA is repealed under the next Administration–Willow will be a privilege of a small minority of wealthier professionals who can afford it. I wouldn’t consider Willow a “game-changer,” as it’s being touted, unless and until it is free to all pumping parents who need it in order to meet their breastfeeding goals.
  4. Finally, one question about this product that I’ve seen raised by lots of mamas on breastfeeding forums has to do with the actual science of milk production. Willow claims that it senses letdown and then switches to expression mode (not far off from Medela’s technology), but many pumping parents have expressed (um, sorry) concern that it can be hard to actually produce more milk while focusing on things other than nourishing the baby you love. That’s why many people don’t like pumping–you are always having to measure your output against your baby’s nutrition needs for the next day, and for many, the pressure of making enough makes this a stressful rather than satisfying process. The pressure many of us feel to pump enough in our stressful parenting and working lives does more harm for milk production than good. Some may feel better getting things done while pumping rather than staring at the pump as it fills up, but I question the physiologic good of hooking a mama up to a pump so she can be disconnected from the thing her body is doing (expressing milk) while her mind can be focused on doing something else. This seems to suggest that our nursing bodies are just machines for milk output. Most of the writing I’ve seen on increasing milk production (and I have ear a lot of it while struggling with it personally) suggests focusing your mind on your body and your baby–prety much the opposite of what Willow encourages. I am reminded of the pumping women in Mad Max: Fury Road, who I swear must have all been taking domperidone–making milk for the society and able to do little else. They needed Willow to up their capacity as contributors to the patriarchy!

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    Imagine a post-apocalyptic world with human milk a major source of sustenance and Willow at the ready to integrate pumping people into other productive endeavors!

  5. I hope the next phase of the women’s and reproductive justice movement will fight for paid maternity leave, and more collective solutions to infant nutrition and maternal health than are currently on offer under capitalism, and more specifically, neoliberalism. I hope we will be fighting for more leisure time for workers, so that we could start to imagine technology not to benefit the bosses and the war on women, but solutions for the common good and public health. Willow seems to me a symptom of a particularly American problem, whereas a society that actually values maternal-child health and in which mothers and workers actually have rights, would produce, say, workplace-based nurseries where nursing parents can feed their babies on demand and not be shackled to a pump during the workday at all. Or, say, hospital-grade pumps you could just hook up to (BYO parts), and more lactation lounges at your workplace or public locations like cafes, libraries, bars, etc. De-stigmatizing and promoting breastfeeding is not about individual decisions to nurse or breastfeeding in public, but must be part of changing the infrastructure of our society, and fighting sexism at every step, so that women’s reproductive work (pregnancy/parenting/nursing) can be separated from her life in a healthy, holistic way (yes, nursing parents and other mothers do need to get out of the house/be away from their nurslings sometimes).

    Some of these solutions exist in social democracies, and many of them have not yet been won anywhere, to my knowledge. Let’s not lower our horizons to hoping a product like Willow will lift busy nursing mamas from our drudgery, but use this as a way to vision a better way to integrate the needs of nursing dyads into society.

    *I am using “mother” and “mama” and “women here for linguistic ease. I do recognize that not all breastfeeding parents identify in these ways, and I seek to honor that in my writing. Most of the theoretical work about social reproduction and the second shift focuses on the care work of “women,”  and sexism has generally underpinned the war on mothers specifically. In the framework and sense of solidarity that I would like to put forward here, I do generally refer to women/mothers, because an attack on women and mothers generally underpins the war on parents of all genders, including gender non-conforming and trans* parents. I hope that as the movements for reproductive and gender justice grow in the coming years, they will help us develop more useful and inclusive language that helps capture the shared and also distinct experiences of sexism, misogyny, etc. of gendered oppression. And I hope you will read my piece with understanding and generosity toward my linguistic limits.


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Reflections on Birth and Immediate Postpartum Life

Well, this is now six months late…but I’m a new mom! And a full-time working nurse-midwife! I’m finally ready to dust off the keyboard and start blogging again! So, to kick it off, here’s a post I started right after the transformative experience of welcoming my baby into the world and finally polished off this week. It was fresh when the birth smells were deliciously enveloping my newborn, and fun to revisit now. Enjoy.

* * *

My daughter is now just over a week old. The heat of late summer has broken,  and the kids are back in school at the elementary school across the street. Her umbilical cord stump has just detached, and my bottom and other muscles are gradually returning to normal. I’m generally following the advice I so emphatically dish to my patients: sleep when baby sleeps. Now, I’m taking a breather and making note of what this whole birth thing was like.

Empowerment: I made labor and birth affirmations so I could hear my own midwife voice assuring me during challenging times. My partner drew on this principle several times during labor a few times by asking what I would say to a patient at that phase, when needing reassurance or guidance.

One of the inspirations I had in the week before birth was to make myself affirmations to look at when things got hard during labor. I had been thinking of turning to my friends who had had natural or home births and asking for advice I could use to prepare. While I did receive some good advice (both solicited and not) from such sources, it started to feel strange to me — after all, I’ve attended dozens of births as a student and as a certified nurse-midwife: I know what to expect! Granted, many of the births I’ve attended since beginning professional practice have been in a highly medicalized environment, and few of my patients choose unmedicated birth — fewer have the resources for prepared childbirth.

Yet, I knew the chief thing for me to be successful was not just hearing positive birth stories — and I have read and viewed many — and connecting with the friends and family who were there at my Blessingway, provided beads for my labor necklace, or who were lighting candles for me both near and across the country during my labor. Even having the best labor team possible — which I was fortunate to have — was not a guarantee that I would be okay. No, what I needed more than anything was to be able to hear it from the most authoritative voice I know, my own from my heart as a midwife and my own strength as a woman. For what good is a labor team if the mama isn’t the most willing and capable member?

Though I didn’t look too consciously at the pictures I created, they helped promote a good birth environment — my support team would recite the mantras I had written: Ya mero! Fierce mamas believe in you! You are going to get huge! Yes, yes you can. Trust your body, and so on…And more than anything, I was grateful for the opportunity to make them in the days I was “overdue” and making my nest and heart ready for my baby.

The days after birth, I kept reliving the experience. I was so exhausted and overwhelmed with love and sore in ways I never thought possible. Tears would flow every time I remembered how I felt when my little girl was wet and warm and just screaming her little head off, fresh out of the birth canal on my chest. I had heard and taught women about the “baby blues” on countless postpartum rounds. This was more like a spiritual high, of connection that nourished the parts of me that had been longing for this moment of readiness for years.

I also woke up this week in a panic, realizing that I am probably at high risk for postpartum depression. So I called up my doula, who had mentioned that she does placenta encapsulation, and I ordered up an edible form of the afterbirth to ward off the very real possibility of falling prey to the dark side of new mama life.

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Tree of life: placenta print

I had been hearing about placenta encapsulation for a few years, and knew it hadn’t been studied much. Searches in scientific literatures brings up little of substance, mostly concluding that more research needs to be done. But I also knew that loads of mamas and midwives swore by its powers. I had been planning to plant the placenta in the garden, but when I had a major panic thinking of returning to a very challenging work environment just 10 weeks after the birth, I thought why not give this a chance? Most mammals eat their placentas (seemingly more for survival reasons relating to evading predators), and the power of the oxytocin and progesterone gave me hope it would do more good than harm to try it out. So my lovely doula came over and picked up the placenta a couple days after the birth, and generously returned two days later with a beautiful jar of the capsules and extra home-made herbalist goodies.

In spite of my fears of impending depression, I mostly can’t help but think about how lucky I am to have experienced the birth I did, and how well this network of birth and postpartum support is setting up my little family for a bounty of love, patience, and joy. I had one of the most highly skilled midwives in my area at my birth, who worked with me through a fairly long labor and helped me achieve a normal birth. In almost any hospital, I am certain I would not have had such a nice outcome. Being denied freedom to move and oral nourishment, while being strapped into continuous monitors, I imagine my baby and I would have become very stressed, and a surgical birth would have likely ensued.

Since even before deciding I wanted to be a midwife, I knew home birth would be for me, and now having done it, I feel so strong and powerful as a mama, but also even more convinced of the importance of preserving normal, natural birth. At no point would drugs have helped my labor. At every point, my preparation and support team — my mother, partner, doula, and the midwife assistant — helped me more than any drugs normally administered during labor could. Every laboring woman deserves this type of set-up. How much better for me and my baby (therefore also for public health) that neither of us was too stressed physically during labor, so that we could have such a good, non-interventive birth?!

I know that not every laboring person desires unmedicated birth, but if given the tools and support, it seems many more might at least feel they could make that choice. It seems likely that this could be so helpful in lowering our national rates of surgical births, now more than a staggering one third of all births.

Yet birth is only the beginning. After bringing new life into the world, you have to keep sustaining it! And protecting it for many years!

People have asked me how pregnancy, and now how birth, has changed me as a midwife, but I think that piece, the postpartum and parenting piece has been the most humbling as a women’s healthcare provider. Now, I have pushed this baby out into the world, and now I am responsible for her. I am lucky that I have experience with babies and that I feel so confident in caring for her after this magical birth experience. But if it weren’t for my mother staying with us the first week, the meal train organized by other parent friends, and living in a supportive community, I don’t know I would feel capable of doing hardly anything this week! And I have mamas I care for who have hardly any such support — single mamas, teenage mamas, and mamas with unhelpful or unavailable families. It hardly makes sense to leave new moms alone as a society to figure out recovery from birth and caring for a vulnerable newborn baby.

And then there’s breastfeeding! What a major

BFing linocut

Image borrowed from Rachel Epp Buller’s book cover Have Milk Will Travel

commitment! And I knew it was something I wanted to do, and in fact had literally had dreams about for years. But then doing it is another thing all together. So far, so good. I love how it feels to snuggle this little person and I love how cool it is that my body is making the only food she needs now. I also love how my midwife and doula prepared me to deal with the pain in my nipples the first few days, with ointment, exposing them to air, and the homeopathic medicine. But again, how humbling to have worked with dozens of women to initiate the process immediately postpartum, and then realize how hard it is in real life to keep it up, all hours of the day and night. And a crying newborn. How much patience and calm it takes to keep on loving and caring for a needy newborn. No wonder, with such little support from friends, family, and healthcare providers, so few women in this country actually do commit to breastfeeding for any length of time.

I guess that’s it. Just sharing my thoughts on being a new and breastfeeding mama of a beautiful baby girl that I’m head over heels in love with! And of being a transformed midwife with a new appreciation for birth, the yoni, midwives, doulas, and mothers of all kind everywhere and of every time.

 


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A Day in the Life of a Still-Pregnant Midwife

Late August has arrived, and I have nearly completed 40 weeks of gestation. I wrapped up what Ina May Gaskin refers to as “outside” (paid or alienated) work last week, and all that remains is to rest and make final emotional and physical preparations for welcoming baby Popcorn into this world.

Though I have cared for hundreds of women through some stage of their pregnancy, birth, and postpartum needs, I find myself in awe of the experience in new ways. I am on the brink of one of the most incredible life changes I may have the opportunity to experience–though already participating in creating this life inside has already been remarkable.

Nourishing myself with favorite pregnancy snacks: fresh fruit, Greek yogurt with dates, and “uterus tea” in delicious early autumn air.

Now that I am feeling mostly recovered from a demanding final week on the job, sleeping many hours nightly, taking extended afternoon naps, and not quite having the energy to check off too much else from my to-do list, I find myself open to the possibilities of what comes next. I get to what I get to: today, the phone call to sort out my breast pump order (my very expensive PPO was apparently grandfathered in under ACA and is not required to cover this important benefit), getting the seasonal flu shot (out just in time to offer baby placental protection) while picking up wedding photos my partner and I finally got around to ordering to frame, and planning to prepare a favorite dish for dinner tonight (homemade ricotta and red onion marmalade pizza, perfect for a cool evening).

I am feeling loved and supported and grateful for the fabulous crew and cooperative body that has my back and believes in me and my body’s ability to bring this baby into the world in the comfort of my own home. Pregnancy has been easy so far–I haven’t experienced too many of the aches, pains, indigestion, swelling, emotional turmoil, and sleep troubles that many women suffer through. I hope this continues into the next stages. I  looking forward to lighting this candle, and knowing that the friends that participated in my Blessingway, who will be in Berlin or the Canary Islands and in the SF Bay Area will light their matching candles while they sit in vigil with my labor. I look forward to wearing this eccentric necklace comprised of beads from my friends and family near and far, which will also accompany me in my journey through labor and birth. I look forward to meeting my baby with my loving partner my my side, whenever the time is right.

This eccentric necklace is comprised of beads given me by friends and family, to be worn during labor and birth. The candle will be one of 6 lit during my labor around the globe. The bowl they sit in was a wedding gift from my grandmother.


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A Day in the Life of a Pregnant Midwife

A note to publish later… 

 Fridays are my on-call day. No scheduled clinic, just a day to take care of life, and catch up on some professional things, and, like all days, be ready to rush into the hospital if a patient is in labor.

Today, I woke up anxious from an bit of a nightmare I had the night before about completing an online course, deadline today, for renewing my Neonatal Resuscitation Program (NRP) certification. I prefer baby and nursing (breastfeeding, not my profession) dreams.

I had nothing else on the docket, and hadn’t even scheduled much else for the weekend, socially or politically, just worried about completing it.

NRP, unlike some other emergency resuscitation programs like Basic Life Support (BLS/CPR) or Advanced Cardiac Life Support, is almost always taught these days on a self-directed online course. 

For someone like myself, who has never been a labor and delivery room nurse, it’s a bit difficult learning the skills entirely from a book and DVD-ROM on my computer. It would be nice to put my hands on the “manikins” or instruments used for the program, before sitting for the “mega-code” portion of the certification. 

But no matter.

I spent the day alternating between my kitchen table, where I got teary-eyed looking at the simulated resuscitation videos (and completely overwhelmed by the premie section), and the living room, where I was playing music from my 2000’s record collection on the turntable with the new cartridge. In between Blackheart Procession and ventilating the baby’s lungs; the penultimate Sleater-Kinney album and intubation, I sipped my coffee and found that NRP wasn’t so hard after all. I was done by 5, certificate on PDF, ready to prove myself to the hospital NRP instructor.  

Then: baking inspiration! While my partner was on campus working on his dissertation and then heading for a social gathering, I munched on Dorie Greenspan’s oat-peanut chocolate crunchies and caught up on the third season of Call the Midwife, which I seem to have saved for just this moment. 

 If you are a pregnant midwife, I dare you to watch that show without weeping. It’s hard enough to do as a non-pregnant midwife. 

 I had planned to go to a political organizing meeting, but it was canceled. So I declined an invitation to a late-night jazz show — strict ten o’clock bedtime for me these days — and hunkered down for more nuns and secular nurses helping ladies and babies in post-war East End.

Just another day in the life of this expectant midwife. (Baby due late August 2015.)


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Getting ready!

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Spending this beautiful Sunday afternoon practicing surgical knots and perineal suturing. Took me a minute to remember how it works, but then it all came back to me. Next, rehearsing OB emergencies and mechanisms of delivery.

This week, I start attending deliveries! Looking forward to being there for my mamas inpatient, finally.


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The Loneliness of the First Trimester

On Thursday, I was pregnant. Seven weeks and six days of gestation. This was a very carefully timed, meticulously planned, and surprisingly quickly achieved pregnancy. On Thursday, I was happy. I had attended a meeting after work, hearing a report back from a protester that had been in the streets of Ferguson, Missouri, and analysis of police violence and the new phase in the struggle against American racism and police terrorism.

And then, I was bleeding.

I didn’t know, I couldn’t know, at first, if I would be the one in two women with first trimester bleeding, or the one in ten pregnant women overall, that would have a miscarriage, or spontaneous abortion. But I knew enough to identify that sign of bright red bleeding that doesn’t stop, when I had no risk factors for other causes of first trimester bleeding, meant I was losing this pregnancy. 

And so, by Friday, I wasn’t pregnant any more. 

And, since I’m not allowed to take any days off work until I’ve been at my job a complete six months (and I’m just three weeks shy of that), I went to work caring for women on Friday, while my uterus emptied. I felt myself bleeding while listening to a young mom’s baby’s heartbeat for the first time, celebrating with her and her beautiful partner. I patiently explained the speculum exam to a terrified young woman, and did a six-week postpartum checkup and got to coo over her gorgeous baby. I counseled an older woman on the risks and benefits of sterilization versus long-acting reversible contraception. I tried to have a normal day, when I wanted to be home, mourning. 

It’s only Saturday, and I’m still pretty devastated. I was supposed to attend my city’s SlutWalk protest, where a year ago, I had given a rousing speech tearing apart sexism. I wanted to be standing with my sisters and comrades in the streets. But more so, I need to heal.

***

I have been musing quietly about the loneliness of the first trimester since I peed on the stick weeks back and had the delightful moment of reading “pregnant” on the digital screen. The feeling was so different from the myriad other times in my life when I had taken the test in anguish — especially the one other time when I had a positive result, in midwifery school, and knew I was going to have an abortion. I was, this time, elated. 

But there is convention in our society to stay quiet about that positive pregnancy test until the second trimester, regardless of which choice we plan to make about the pregnancy. We know that people won’t really understand the complexity of our feelings about the pregnancy, and that we don’t want to tell everybody the bad news, if we end up needing or wanting an abortion, or if the pregnancy ends in a miscarriage. And so we tend to suffer through many discomforts of the first trimester, in silence.

I remember telling some of my comrades and friends what was going on, when I had the unplanned pregnancy years back. Because I am part of a community that embraces reproductive rights, I was fortunate that it was fairly easy for me to tell people at the time that I was planning an abortion, or that I was still dealing with some of the medical issues related to my abortion the few months after it started. I have since publicly spoken out about my abortion many times, working to de-stigmatize the experience that three in ten women will experience before the age of 45

Telling abortion or miscarriage stories can be a powerful way to break the silence. But it will take more than telling stories to break the stigma.

Telling abortion or miscarriage stories can be a powerful way to break the silence. But it will take more than telling stories to break the stigma. Art by Favianna Rodrigeuz, Just Seeds Cooperative

At that time, however, I didn’t talk openly about what was going on outside my activist network. But I did have a fellow midwife student classmate and friend who turned out to have an unplanned pregnancy at the exact same time as me. We turned to each other one day after class with our secrets: “I’m pregnant.” Neither of us felt good about it. We were both in the first of our two year program, and planned to go full time. There was no time for pregnancy, birth, and parenting, and both of us had partners that were full time graduate or professional school students. It was terrible timing. We each made different decisions, however. I ended my pregnancy, while she continued hers and is parenting this beautiful child, who is almost three now. 

The other difference between us was that none of our classmates knew that I was pregnant or had an abortion, while they eventually found out about hers, when she started showing and eventually had the baby during the program. We both knew that even in a midwifery program, people weren’t emotionally intelligent enough to deal with a sister midwife’s pregnancy to respond appropriately to our news. So we both kept quiet, attending class while coping with our own pregnancy challenges.

I have wondered sometimes if we would have felt that way if we were attending school in a more politicized or radical time, say at the height of second or third wave feminism. Interestingly, I was able to talk about it with my faculty and preceptors, who all had trained as midwives in more political times and were very accepting of my decision.

If a group of midwife students can’t be mature enough to be present with each other during pregnancy, who can be?

***

This time around, I spent much of the initial weeks of pregnancy being silently excited. I talked about it with few people: my mother, my partner, my nurse-midwife team, and one friend, whom I had asked to be my birth doula. It was strange not revealing the news when talking to friends and family about this big thing that was going on in my life. Many times, I wanted to tell more people. It was humbling to now be experiencing life as a “pregnant patient,” much as I had appreciated the experience of being the “abortion patient,” knowing that this would make me a more compassionate nurse-midwife.

And I continued with my life — bicycling, gardening, going to protests, working long hours, cleaning my house — while thinking about the little life growing inside me. Fantasizing about the home birth I expected to have in early April with the fabulous team of midwives I had chosen to care for me. Talking with my partner about changing the guest room into the baby room over the winter. Getting excited about the cousins our baby was going to have, given that my sister in law is pregnant with her second, and my brother and his wife might be trying to conceive soon. Planning with my partner how we were going to cleverly announce my pregnancy on Facebook and to friends in person. Looking forward to the excitement and congratulations we could expect from family, comrades, and friends. And trying to imagine what it would be like to meet that tiny creature my partner and I had created. 

***

I was starting in some ways to relish the privacy of the last couple of months. It has meant more time for introspection, self-care, and focus. I have needed that inner space to deal with some significant changes to my body and my changing life priorities. 

Like sobriety. I chose to stop drinking around the time that I believed I was ovulating, in the first cycle we tried to (and did) conceive. I genuinely enjoy beer, wine, and the occasional cocktail, but since beginning my new job for the last few months at my job, I had also relied on that delicious glass of wine after work to help me unwind. Being sober means having to actually face all the trauma I see at work, and process it in some other way. And this is a pretty drug- and alcohol- heavy society we live in, so not drinking or partaking in any drugs can be pretty challenging, socially and personally. I have loads of patients that aren’t able to cope with life without substances, and continue drinking and using (marijuana, mostly) during pregnancy. Like many women facing the prospect of complete sobriety for 40 weeks, I worried that I would be tempted to drink and felt guilty for even thinking it might be hard to stop.

Fortunately, I have felt pretty good about not drinking and have enjoyed the challenge of sobriety. But I also dreaded social situations in which I would normally be drinking, worried someone would ask why I am not having my customary glass (or three) of wine. What would I say if someone suggested I was not drinking because I was pregnant? Would I choose to tell them? Would I lie? Would I tell them I didn’t want to talk about it? Fortunately it never came up. (For the record, peeps: Don’t ever ask someone if they are pregnant! They will tell you if they want you to know!)

Another major chemical change occurred in my body as I prepared my body for pregnancy by weaning myself off the anti-depressant I had been taking the last few years. That drug had really helped me through some major difficulties the last few years, from completing my midwifery program, to facing my midwifery board certification, to an extended job search, to the major transition of this new and difficult job I eventually landed and accepted. I am fortunate that my depression is well enough managed, and I am stable enough to face stress without the help of this wonderful pharmaceutical product or alcohol. Mostly I owe that to years of therapy and yoga practice that have enabled me to access pretty decent coping skills, along with an extremely supportive partner. Nonetheless, it felt very difficult to stop drinking and to stop taking this antidepressant at the same time. In hindsight, I may have done it a little differently, but it worked out OK. 

Mainly, the changes in my body with the new pregnancy made me feel extremely vulnerable. I knew I had little control over if this pregnancy would continue successfully or not — knowing what I do about rates and causes of miscarriage. For the first few weeks, I could hardly believe I was really pregnant! Every trip to the bathroom, I feared seeing blood on the tissue paper. Every little tiny cramp or feeling in my pelvic area felt like it could be something wrong with the pregnancy. And since I only experienced momentary twinges of nausea, I looked forward to them, as proof that I was in fact pregnant. I caught myself looking at my breasts in the mirror and sometimes touching them to make sure they were really growing, and tender enough. Loads of women face extreme nausea and vomiting in the first trimester and are completely miserable, whether or not the pregnancy is desired or if she plans to continue it. I’m fortunate I was at least feeling well. 

And when the proof was there, out of nowhere — sustained bright red vaginal bleeding, cramping, and passing tissue — it was clear that it was all over, in a flash. One day, a pregnant patient, the next, a “miscarriage patient.” And I had to believe there was nothing I could have done differently. It wasn’t my fault. It just wan’t going to work out this time. 

***

These are some of the things we don’t talk about when we talk about pregnancy, planned or unplanned; desired, undesired, or ambivalent; spontaneously aborted, continued successfully, or electively aborted. These are some of the things we don’t talk about because we have internalized the messages of the war on women. This war psychically imposes a social and cultural expectation that all women naturally 1. want to become a mother and should embrace every chance at motherhood, no matter the circumstances; and 2. adjust and cope in a healthy way to the emotional and physical challenges of pregnancy. And if they don’t, there is something wrong, or even criminal in her thoughts or actions. Yes, lawmakers have proposed criminalizing miscarriage. Yes, every year, dozens of laws in every state of the United States are proposed and pass regulating women’s bodies and restricting abortion. Yes, laws primarily aimed at Black women  criminalize drug and alcohol use in pregnancy (see Dorothy Roberts’s Killing the Black Body).

Yes, this impacts popular opinion, and shapes how people–even and maybe especially women themselves–understand and talk about pregnancy, abortion, miscarriage, and motherhood. And mostly creates the circumstances for not understanding what it is to be pregnant, or how to empathize with a woman who is pregnant, or wants, does not want, or who cannot achieve pregnancy or parenting. 

***
I was grateful I was pregnant on Thursday, and still sad that I’m saying goodbye to that little embryo that I hoped would become a fetus and eventually the baby I would get to parent. I am nervous about what happens next. Will I be able to get pregnant again right away? What kind of loneliness and fear will I face the second time around? Will I make it past the eight week mark next time? Will my readers and friends respond compassionately to this post? 

I feel like I’m in a good enough place emotionally to be able to share my miscarriage story, alongside my abortion story. And like coming out about being queer, or about having had an abortion, I hope that by telling my story, I can contribute to de-stigmatizing something that our deeply misogynistic society doesn’t understand. 

But it takes more than being able to tell the story, for those of us for whom it is safe to do so, to change cultural values around pregnancy and sexuality. We have to end the war on women if we want to shift people’s consciousness and foster solidarity with the challenges people face during pregnancy and parenting. How could we do that? It means opposing every state/federal/local law and institutional policy that aims to decrease women’s bodily autonomy and impose control over women’s sexuality. It means being in solidarity against every form of sexual violence and coercion. It means fighting to end the New Jim Crow. It means demanding comprehensive sexual education for all children. It means standing up for a living wage, the right to union representation, and dignity on the job. It means building a movement for immigrant rights and to tear down the borders. It means calling for free quality childcare and the valuing of care work. 

Some of these things might seem far-fetched and maybe even only tangentially related to my story. Maybe you think I am coming out of left field?

But there used to be a saying in the women’s movement that really meant something, though it has ceased to bear any resemblance to its original meaning: “The personal is political.” In its best sense, it meant that our personal struggles as women or as women of color, weren’t ours alone, but a reflection, or a symptom, of the broader racism and sexism in society. In the era of neoliberalism, we are meant to see our problems as isolated from each other’s, and mostly as a reflection of our own personal weaknesses and inner failings.

More and more, however, I am seeing my personal struggles as intimately related to the structures of social oppression, and I’m tired of bearing them alone. When I fight against the war on women, or against the war on the poor, or the war on people of color, it’s personal. It’s deeply political, as well, but when I think about the circumstances of my reproduction, it’s also deeply personal. 

***

The last women’s movement, like the civil rights and Black Power movements, changed culture dramatically — but throughout my entire lifetime, the right wing has undertaken a sustained attack on the progress those movements made possible. It is my hope that we can build new social struggles from the ground up, that take up some of the demands I mentioned above, and more. Yet most of all, my hope and my argument is that the voices and demands of ordinary people as we struggle with our “personal” issues must be at the forefront of these movements — rather than the tepid Democratic Party politicians and NGO leaders who have been too afraid about upsetting the right wing that they have done nothing but compromise while our rights are under attack.

After all, it was- not well-meaning liberal politicians that made Roe v. Wade possible, but the fact that women took to the streets to tell their own stories about illegal abortion and forced sterilization. Those movements put women first — not the careers of politicians or career “activists.” Change happened, then, and it happens now, from the bottom, up. Or, as the late, great historian Howard Zinn put it, “What matters most is not who is sitting in the White House, but ‘who is sitting in’ — and who is marching outside the White House, pushing for change.” 

I don’t think the first trimester, or any part of pregnancy or parenting, has to be lonely. I know that people can develop deep empathy and solidarity with each other’s struggles — and we see a glimmer of that in every mass movement, from the revolution in Egypt to the capitol occupation in Wisconsin, to Occupy Wall Street, and even how people looked after each other in the immediate aftermath of Hurricane Katrina. We have to foster that in our communities as much as we can, but more so, we have to organize movements for reproductive justice that put the demands, voices, and strategies of ordinary women and other people who can get pregnant at the forefront.

Being part of those social movement traditions is what makes me feel a little less lonely as I grieve my lost pregnancy and look forward to the future.