There’s this Old Testament story about a locust plague that I used to think of often, in my early twenties. Israel’s gone polytheistic on her theistic deity, and, by the time His punishment has taken full effect, the food’s gone. Wine’s dry. Lights are out. And, everything is full of dead, insect bodies.

“Yet even now!” a little known prophet by the name of Joel would recount Jah’s word to his wayward countrymen, “return to me with all your heart…and I will restore to you the years that the swarming locust has eaten” (Joel 2:25).

The years that PTSD ate up my life like a swarm of angry, green vermin, I used to imagine myself—small, in a blue dress—in Bible school, before the rape and rage and confusion, before the depression and years of drunken, tear-filled debauchery, and wish that I could hang my whole life on that, “even now.”

“The spirit and soul are the body and brain, which are destructible,” Ta-Nehisi writes to his son in his book, Between the World and Me. “That is precisely why they are so precious.”

I had been living with PTSD for the better part of 9 years when I started craving bacon and cottage cheese hard enough for my husband to start buying it in bulk. By the time I took a pregnancy test, the doctor said I was 8 weeks along — and showed me my baby like a tiny, kidney bean tucked away in the corner of my yolk sac.

At week 12, I found out that he did, in fact, have working kidneys, and I cried at the three inch, tiny human inside me, with the beating, butterfly heart. For a body that had returned to episodes of violence over and over and over again, it was the first time in my adult life that I was producing something — anything — that might be restorative, and I could feel the change. My breasts softened. My anger subsided. And, I started obsessively googling studies that showed pregnancy could improve PTSD.

Then, at week 26, when my baby was as big as a head of kale, a technician at Mt Sinai hit me — and him — with her blue gel wand, so she could see his stomach chambers. He jumped. And I froze — silent. Like so many times before.

When she left the room, my husband said, “We can tell them it’s not OK to do that without asking.”

“I will,” I said. But I wouldn’t. And I couldn’t.

Maladaptive: that’s what my therapist calls it. In studies with rats — which boast a close neurological match to humans — scientists have found that a pregnant rat will experience an almost complete rewiring of her brain circuitry before giving birth. By the time her babies are born, she’s bolder, sharper and more efficient, capturing her cricket prey at four times the speed of non-mom rats.

Even a rat addicted to cocaine can get straight in order to take care of her young. But put her in a cage with an aggressive, sexually charged older male rat, leave him to have his way with her, and she’ll come out at a loss. Her associative learning will suffer. Her stress hormones will spike. She’ll struggle to express maternal behaviors.

While our society fights for the recognition of a woman’s right to efficacy over her body, Sharon Dekel, principal investigator at Massachusetts General Hospital, is developing a deeper understanding of what happens if we don’t give women that recognition. Her focus is on the potential negative consequences for a women in childbirth, and, afterward, on another demographic entirely: her children.

In a 2018 study of 685 postpartum women, her research team found that women who suffer from PTSD can have difficulty bonding with their babies — a symptom with the potential to undermine aspects of child development.  

A pregnant rat will experience an almost complete rewiring of her brain circuitry before giving birth—bolder, sharper and more efficient, she can capture her cricket prey at four times the speed of non-mom rats.
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PTSD was a mystery to us before 1975, when, 479,000 cases showed up, all at once. We’d diagnose it just five years later, in 1980, and, eventually uncover one million lifetime PTSD cases from Vietnam. Later, we’d call it a “growing epidemic.”Almost 40 years later, there are as many estimated rape and assault victims as there are veterans alive in the United States, and 94% of them show signs of PTSD.

These women are at a higher risk of developing further mental disorders as a result of birth, according to Dekel. With nearly 4 million women giving birth each year, and up to 12% of them developing postpartum (PP) PTSD, PP-PTSD may be the most substantial, silent societal cost to the American woman’s loss of efficacy that we’ve ever seen.

There’s a whole lot we can’t control. We can’t go back in time and turn the tide of America’s rape epidemic. We can’t control whether a woman is young, whether there’s real risk to her baby, or whether or not it is her first pregnancy (all factors that also drive increased risk).

But in control itself we may find a solution.

Dekel’s studies show that one deciding factor with the potential to positively or negatively override almost everything else in a woman’s situation is her perception of whether or not she feels that she maintained efficacy over the birth process.

Providers would need to consider all the factors influencing her choices to create an environment where a woman is truly in charge, according to Ruth A. Wittmann-Price, an Assistant Professor in the Department of Nursing and Health at DeSales University.

In a 2004 theory entitled, “Emancipation in decision-making in women’s health care,” she purports that a woman is almost always influenced by her own empowerment and personal knowledge in a situation, the social norms that exist around her, whether or not she has opportunity for reflection and if she is operating within a flexible environment.

To develop decision science without discussion of oppression and an emancipation process in the humanistic care of women, Wittmann-Price points out, would be to deny obvious barriers to shared decision-making. And my own emancipation began with the realization that I wasn’t ready to assert myself.

In the weeks that followed, while my nursery sat full of unpacked boxes, my husband and I focused our preparation on my mental well being. In the process, I learned that my experience of assault had taught me everything I needed to know. My requests would not be honored. My consent would be assumed. The power dynamics over me would be strong. I’d feel lesser, possibly even guilty for saying what I needed. It was up to me to change that narrative, even when my brain insisted otherwise.

There are all kinds of pre-existing factors that may influence how you react to a high-stress situation, according to Jim Hopper, PhD, a nationally recognized expert on psychological trauma. It starts with what he calls the hardwired, evolutionary stuff, that can predispose reflexive responses. Then, there’s your prior learning history, your childhood, how you dealt with aggressive and dominant people growing up, socialization and habit based prior learning.

In an environment like birth, they have the power to influence everything. The day I went into labor, they were all there — the reflex, the learning history, the socialization and the knee jerk responses. But in the small, sacred space between my disorder and identity, I found enough dissonance to use my voice. Through it, I developed my three most poignant memories of that day.

The most powerful is when I met my son — perfect, and purple, with a head full of thick, black hair. I had been pushing for three hours when his head and left shoulder finally ripped through my episiotomy, and I pulled the rest of him out of me and into my arms.

I love you. I love you. I love you. And I had never felt a love like that.

The second was labor hour eight, when I called out our epidural safe word: pineapple. My husband I had developed it based on a mutual understanding that in order to try for a non-medicated birth, I’d need to yell for an epidural without actually meaning it. Under no circumstances was he to agree to giving me one, unless I said the word.

We’d tossed around other words: pumpernickel (too long), coffee (too common), and watermelon (too much red puke in my recent past). Ultimately, pineapple it was.

Pineapple: put a needle of ropivacaine hydrochloride in my god damn spine, and do it now.

I’d said my safe word three times, and requested she turn the pitocin off twice, by the time my midwife, buried in the corner in a rousing game of Tetris, slowly said, “I think we’re here to have a baby, and we don’t want to slow things down.” But I knew my brain, and my body. The pain of pitocin-induced contractions was driving me toward a place I couldn’t go again. A place where the world would go dark, and I’d be on my back, in pain, submitting to someone else again.

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By the time she reluctantly, slowly, moved across the room, and did what I asked, I’d involved advocates. My husband and doula, who had spent hours of deep conversation understanding my trauma cues, concerns and triggers, knew when to ensure I got results.

“Get her an epidural, now,” I heard him say.

“Turn the pitocin off — she’s asked you multiple times,” my Doula added.

“She can contract on her own. Let her do it.”

When I heard the beep of the machine turning off behind me, the pain I was feeling, six hours into hard contractions, didn’t improve in the least. Mentally, however, I was back in charge. And somewhere, deep inside me, I felt like the most powerful woman alive.

“But to let the baby out,” writes Maggie Nelson in The Argonauts, “you have to be willing to go to pieces.” And pushing my son out put me past the brink of what I thought was physically possible.

I was told I’d get a second wind — some kind of strength I didn’t expect, especially when I saw the top of his head. But I didn’t feel anything except panic. I was going to pass out. I needed to puke. I couldn’t find the strength to push.

I have had the power siphoned from my body like a balloon blown up and let go. I have spent years picking my way with the gullied parts of me, where it no longer exists.

But I have never been more palpably aware of the power in, and over, my body than on floor 3M at Brooklyn hospital, on my back, minutes before midnight, when my midwife told me to stop breathing.

She said it like I had no other option: breathe, or birth a baby.

You’re not working hard enough (while pulling on the inside of my labia).

It’s been too long (while checking her watch).

You just don’t seem to want this (looking at me).

Poor kid, he’s got such a headache (looking at him).

I argued—on my back—insisting I needed air. Needed more time. Needed help.

Inside, feeling like I’d failed—like I didn’t love him enough to get him out. Like all the other women in the world knew how to give birth, but not me.

Human memory is a sensory experience, writes Bessel van der Kolk, a Boston-based psychiatrist noted for his research in the area of post-traumatic stress. And when a nurse grabbed my foot, I wasn’t in the delivery room anymore.

I was 21. And, someone else had their hand on my foot. Someone else was tucking it under their arm. And, someone else was telling me to be quiet, while they had their way with me, in ways I’d been trying to forget ever since.

Sexual assault is horrific in its own right. But it should be understood in the broader context of what causes long-term trauma in the body, which typically has two things in common: loss of empowerment and loss of human connection—i.e. being treated as an object—according to Hopper.

Inside I felt like I’d failed—like I didn’t love him enough to get him out. Like all the other women in the world knew how to give birth, but not me.
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I felt both, in that moment. But I did what I wished I would have done, the first time. I yelled.

Get away from my foot, get my husband now, kind of yelling.

Don’t fucking touch me. I’ll push when I’m ready.

My bed a bailey, my partner and doula standing citadels, we enforced my requests.

I breathed.

I slept.

When I woke up, I ran my own fingers around my baby’s temporal bone, and noticed there something in my perineum that wouldn’t move — something that had it taunt and hard, like a rock, and not budging.

“Just cut me,” I said.

“You have room.”

“No I don’t. Do it.”

I had no way of seeing that my son’s hand was against his face, blocking his head from coming further than I’d pushed it, but that’s exactly how I would deliver him, an hour later, suckling his knuckles, heartbeat steady, on his path through my birth canal.

“I didn’t realize!” my midwife would call out. But somewhere, in the place that exists only between a woman and her body, I’d know that I did. And that I’d done what I wanted, midwives and naturalists, birth advocates and medical advisors be damned.

While there’s no concrete proof that my assertion of self in my birth kept me—a woman with almost all the risk factors of PP-PTSD—safe, Dekel points out that her studies show that a woman’s positive appraisal of her birth experience may have more to do with her mental health than the experience itself.

She’s encouraged by the fact that woman today are being screened for depression during pregnancy and postpartum, but notes we need to do more.

“Currently I don’t know of any program that focuses on empowering mothers or women prior to giving birth or postpartum,” she says. “There’s nothing routinely implemented to screen women at risk for developing PP-PTSD.”

Her hope is to that alongside others, her team can develop a more holistic approach to obstetrical care that integrates a better kind of team collaboration between psychiatry, psychology and OB department.

I still sometimes wake up in the middle of the night, mid-flashback of myself like a rat locked in a cage, while someone else has their way with me. I struggle with confusion. I wonder about efficiency. Like many women who have been sexually assaulted, I struggled at first with feeling like breastfeeding was a hostile take-over of my body.

A single sound or stirring from my son can cut through all that. Suddenly, my confusion is gone. And, in its place, a connection that feels as natural as breathing.   

I have another flashback that comes to me, increasingly often, in that place. In it, I see my husband’s teary face, looking at me, looking at my son.

“Look what you did!” he says.

“I’m just going to stitch you up,” the midwife adds, from somewhere beneath me.

I don’t have to close my eyes to feel the warmth of my son breathing on me, after that. Or, to feel the warp and weft of the needle, putting back together parts of me I used to believe were broken for good.

As a Black, non-binary femme who, while pregnant, intended to raise a “gender creative” child after birth, many of my concerns as a parent-to-be weren’t—not surprising, but disheartening nonetheless—addressed in the traditional parenting books I read about, was gifted or purchased.

I had countless romanticized ideas about the experience of pregnancy combined with feelings of paranoia regarding things that could go wrong, anxiety about how I’d cope with the upcoming changes while in recovery for an eating disorder, and general curiosity about what it meant to be pregnant. Due to health reasons, I’d been warned by doctors that my pregnancy would be high-risk and I had to take special precautions to ensure that myself and the baby would be healthy and safe.

Given the alarming statistics and data regarding Black maternal health in the U.S. (according to the CDC, Black woman are three to four times more likely than non-Hispanic white women to die as a result of giving birth as just one concern), I was riddled with worry at the potential for problems. Thankfully, I had a solid support system primarily in the form of an understanding and loving partner who supported me fully. Still, I hoped to find a sense of community or even a small village of people who could relate to my journey as a pregnant person and soon-to-be mom.

I started my pregnancy on Medicaid, enrolled in my final semester of undergraduate studies as a returning student, battling hyperemesis gravidarum—a severe form of vomiting and nausea vomiting—and hoping to have a doula-assisted home water birth. Fast forward eight months to an unexpected hospital birth, after over a day of excruciating but lovingly-supported labor at home, and an earlier-than-planned transition into motherhood.

Despite the last minute drastic changes to my birth plan, any sense of preparedness I had while birthing—and upon returning home with my newborn—was fostered and instilled in me not by any of the conventional pregnancy and parenting books I eagerly devoured early on in my pregnancy, but by a source not available to most prior generations of parents: social media-based forums and pages. I was gifted so many books and out of curiosity and fear of the unknown I read each one cover-to-cover.

I mostly read them with my future doula work in mind, gathering tools and information I could possibly need given the diversity of possible clients in my area. For me personally, though, the book just didn’t help for my unique journey as much as I hoped they would. They lacked the intersectional analyses of different issued related to pregnancy and birth I longed for.

During my pregnancy I experienced racism at my OB office at nearly every visit; I finally stopped going around 35 weeks. Each time I went I wished I had the confidence to advocate for myself and my child. Thankfully, my partner and I were honest and open with each other every step of the way so during moments of stress he would support me. Further, he would respectfully advocate for me if I was on the verge of a breakdown.

The levels of discomfort felt by my partner and I subsequently lead to crippling anxiety. Primarily for me. We would unpack the visits together because the racism we experienced was blatant but we decided to hang in there for as long as possible given the risks of my pregnancy. When we did stop going, though, if we needed help we sought the help of midwives, doulas, and nurse relatives for guidance. As a doula myself, I felt confident in my ability to seek the help of a new doctor if need be or to find other forms of professional, medical help.

Racism During Prenatal Visits isn’t a topic covered in any of the popular pregnancy books so I scoured the internet for people who could relate beyond peer-reviewed articles and academic texts about the intersections between institutional racism and the medical industrial complex. Sure I read those as well, but I wanted personal stories and honest narratives written by other pregnant people with relatable transparency.

There were other issues I yearned to talk with other pregnant people that the popular texts simply didn’t begin to broach: dealing with misgendering as a non-binary femme, choosing a parenting style that no one else in your family takes seriously or will most likely criticize, opting to raise gender creative children, planning for a home water birth with a doula in New York City, coping with body image issues as someone in recovery from bulimia, issues regarding receiving different physical exams during pregnancy as a survivor of sexual assault and rape, addressing intergenerational trauma as a soon-to-be Black mother. The list went on and on (and on) but luckily I eventually found exactly what I was looking for.

About halfway through my pregnancy I saw a shared post on Facebook that led me to a private group for pregnant people suffering from hyperemesis gravidarum. This was the first space I felt I could be open and honest about my experiences because the thousands of other people in the group could genuinely relate to me and I didn’t have to worry about suggestions for ginger or crackers. They, too, knew the struggle of wanting to take just a sip of water only to have your body reject it. Not eating for days, vomiting more than ten times a day, emergency room visits.

There were other issues I yearned to talk with other pregnant people that the popular texts simply didn’t begin to broach like theintergenerational trauma as a soon-to-be Black mother.
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Having found a sense of real community and understanding in that group I began to search for more solace, more solidarity. In time I was a member of about ten different groups that focused on the issues I was dealing with. I would discuss different topics everyday and eventually I made close bonds with people around the world by becoming friends on Facebook, texting, and following each other’s journeys on Instagram. Everything I couldn’t find and would never find in traditional parenting books I found online at all hours of the day.

Something that most traditional parenting books leave out are the effects that structural, institutional, and systemic forces have on lived experiences. Race, class, gender (or the lack thereof), nation of origin, disability, sexual orientation, region, and so much more impact our lives in ways that make experiences like pregnancy and childbirth truly unique.

Our bodies alone, and their differences and histories, make pregnancy and childbirth a unique experience, but so do things like the food we have access to, the way we are perceived by others, the type of insurance we have (if we have insurance at all) whether or not we work, whether or not we have a partner or partners, implicit biases medical professionals have toward us based on our race—there is so much silenced and overlooked.

But thanks to the internet, there are online spaces for people with shared experiences to connect, bond, and offer each other support. I’m thankful I found those spaces because they made my journey feel less helpless and made me feel less alone. I didn’t feel silent, I felt understood. My experience wasn’t erased. I, and thousands of others, could be seen and heard in those spaces.

Those spaces helped me see that for some pregnant people and parents, or people considering starting that journey, the most helpful guides to turn to for advice, useful information, and necessary guidance won’t be found on your local bookstore shelf (or online shopping cart). Instead, it’ll be found on social media, most likely Instagram or Facebook. And while we all navigate these journeys in our own way, if you’re like me and enjoy a sense of community with others who genuinely understand you, then I highly recommend you find an online space you consider safe.

Our bodies alone — their differences and histories, make pregnancy and childbirth a unique experience and there is so much silenced and overlooked.
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Sometimes you can’t always turn to family and sometimes the books won’t have answers to your questions. If you go into these spaces knowing you can learn, as a supplement to whatever level of professional and medical advice from doctors or other specialists you seek out, then your journey as a pregnant person or parent can be deeply enlightened and maybe, just maybe, less stressful.

It’s comforting to know that you’re not alone and it’s empowering to feel affirmed. Online communities offer that and I’m grateful I found them during such a major transitional and transformative time of my life.

Study after study has shown that when women make more than men, women generally don’t want to marry them. And maybe they should want to marry them, but they don’t. Over big populations this causes a drop in marriage, a spike in out-of-wedlock births and all the familiar disasters that inevitably follow. More drug and alcohol abuse, higher incarceration rates, fewer families formed in the next generation.

– Tucker Carlson

My first thought when I saw this quote pop up on Twitter was “Tucker Carlson said something shitty, that tracks.” That’s Tucker Carlson’s job; to say nonsense in a way that sounds reasonable. I don’t give Carlson too much thought. He’s a conspiracy grifter who learned how to tie a Windsor knot after losing his job at CNN on account of being intellectually bested by a puppet. But, because he can string sentences together with grammatical (if not factual) clarity, he gets to be on TV and treated as a “serious thinker.” His recent series “War on Men” a vapid monument to meninist insecurity of which he is an architect, has mostly been laughed off, and rightly so. But part of his remarks last week sent a chill down my spine: he tied the rise of women in power to the socioeconomic fear around population drops. And I thought to myself “it’s coming.”

How do you know when a lie is going to get traction? If you told me at the beginning of Barack Obama’s presidency that three years later there would still be media coverage about whether or not he was born in the United States, I wouldn’t have believed you. Why? Because it was a stupid, racist, theory devoid of fact. I was naive to social pendulum swings that follow a shift in power ownership, and the lies that drive them.

This has been a pretty good year for women, insomuch that life in a hellscape can be good. There are more women in positions of power than ever before. Conversations are happening between women and between men and women, realistic conversations about what a society built on the pillars of patriarchy and white supremacy does to a culture. And while it’s been uplifting and encouraging, I’ve kept my eye out for the pendulum swing, nervous about missing it before it hits me squarely in the jaw.

How do you know when a lie is going to get traction?
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It hasn’t been easy for those looking for a way to push back against women (well at least not as easy as it has traditionally been). Yes, Brett Kavanaugh was confirmed to the Supreme Court, but the support for Dr. Blasey Ford and outrage surrounding his confirmation was overwhelming. The amplification of angry voices from women across the country, united in their exasperation with patriarchal dictates, was visceral. Collective anger begets organized and energized movements, and action follows.

Attempts to pit Rep. “Don’t hate me cause you ain’t me”, Ocasio-Cortez against House Speaker, “Do not characterize the strength I bring to this meeting” Pelosi have largely failed because both women refused to take the bait and instead focused on issues. Calls for civility after the Red Hen incident were met with an annoyed eye roll from anyone seeing children in cages on the nightly news. Even the recent faux pearl-clutching about Rep. Rashida Tlaib use of the word “motherfucker” faced a ton backlash and garnered almost no censuring from Democrats, except Sen. Joe Manchin (also the only Democrat to vote yes for Kavanaugh’s confirmation) and who the fuck cares what he thinks.  

With what seems like a strong female army at the helm of the resistance, and a smart social media presence pushing back against antiquated stereotypes, what is the response going to be? I tried to filter out any nonsense and focus only on things that I believed would have traction. Late in 2017, I filed something away in my brain that sounded so close to the justification for a quick march towards Gilead I was surprised someone said it out loud:

“This is going to be the new economic challenge for America: people. Baby boomers are retiring — I did my part, but we need to have higher birth rates in this country” – Paul Ryan, Former Speaker of the House

That’s right, ladies. The newest economic downfall is going to be all your selfish fault for not reproducing. (Sorry, I meant white ladies — but more on that in a moment). The problem with Ryan’s statement is that it’s not technically incorrect. Birthrates in the United States are the lowest they have been in three decades, according to the latest numbers from the Center for Disease Control. It’s also well below the replacement population rate. With elderly dependents outnumbering people in the workforce, the financial system will take a hit, and the structure of the economy currently has not adapted to social changes in the last several decades.

Also a “serious thinker,” but one with legislative power, Paul Ryan could helped the economy adapt. Instead, Ryan suggested he “did [his] part” because his wife had four children, putting their family above the national average in terms of birthrate. Because Paul Ryan doesn’t want to use the many tools at his disposal to address realities of parenthood and why cost is a preventative factor in having children, he wants to blame people not having babies for a weak economy.

And that, I believe, is the angle from which the weight of the pendulum will be pushed back. It has everything. It takes a complicated issue and boils the solution down to three words: Have More Babies. It places the blame squarely on a certain type of woman. You know, those ambitious bitches who don’t value family, who insist on having jobs or not getting married or using contraception. Now not being pregnant isn’t just a rejection of the duties of being a woman, it’s a rejection of civic duty. Suddenly, all these women in Congress would be better serving their country if they shut up and got pregnant. It has a nice socio-economic nativist ring to it. Have more babies! For America! Well, not all of you.

It takes a complicated issue and boils the solution down to three words: Have More Babies.
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Make absolutely no mistake, when Paul Ryan, Tucker Carlson, and every other conservative pundit talk about women needing to have more babies they mean white women having white babies. The maternal mortality rate for Black women is over thirty percent higher than it is for white women, and yet there is no War on Pregnant Black Women chyron on any Fox News Broadcast. The birth rate for first-generation Americans is higher than the generations that follow, but the White House insists that the crisis at the border is all of the brown families that want to become citizens.

Let’s take a look at why people may not be having babies. We don’t have policies to that to ease the financial burden of having children, like federal paid maternity leave, or policies that require large corporations to make childcare available to their employees. The cost of decent education is a preventative factor for people looking to expand their families, and people of birthing age are drowning in student debt. And the wage gap means women fear further financial punishment for choosing to have children. There also isn’t a smart pathway to citizenship, considering first-generation Americans are likely to have higher birth rates than second or third. Though we know how these pundits feel about immigrant children.

There’s also the issue of choice. Many people just don’t want kids, whether it’s because of their carbon footprint or their other priorities or just because parenthood has never appealed to them. Access to abortion is precarious, but it exists. Women can use contraception. The social stigmas around being child-free are beginning to be challenged. But instead of devoting resources to the issues facing those who want to have children, or working to create an economy that doesn’t rely on an ever-increasing birth rate, conservatives can conveniently blame it all on women.

Not everyone has the luxury of Rep. Steve King, using the world’s least funhouse mirror to mimic the credo of white nationalist David Lane. Or the overtly racist platform of family separation architect and (alleged) childhood glue eater Stephen Miller. No, some will need to take a more thoughtful approach when pushing back on a progressive movement.

Take a kernel of data, create a crisis around it, and make someone responsible for it. And if you’re smart, lay some groundwork first. Target the person you want to be held responsible and ask if they’re “likable” or “genuine.” Chip away first at their credibility and then at their intentions, while slowly introducing the crisis. Wait for others to start parroting your concerns about your target. And then, at the right moment, release the manufactured hysteria and watch the pendulum swing.

Shortly after Nicole Bennett was sent to prison in 2012 at the Century Regional Detention Facility in Lynwood, CA, she discovered she was pregnant. Like nearly every pregnant woman in prison in the United States, Bennett was kept with the general prison population throughout her pregnancy aside from monthly hospital visits and giving birth.

“When my daughter was born in April 2012, she was born with pneumonia and taken straight to the NICU (neonatal intensive care unit),” Bennett told me in an interview. “They sent me back to the jail the next morning.” She was shackled during 22 hours of labor. “A correctional officer let me spend five minutes with her in the NICU, but that’s all the time I was allowed to have.”

Throughout her pregnancy, Bennett wasn’t allowed to see the two ultrasounds she was given to monitor the baby, she struggled getting in and out of her assigned bottom bunk, and wasn’t reunited with her baby until a year after she was released from prison and regained custody in 2014—even as her daughter was in the NICU for two weeks with feeding tubes and labeled, “failure to thrive.”

“There was a good chance my daughter wasn’t going to make it,” Bennett added. Despite her newborn daughter’s poor health, she remained separated throughout the recovery. “I think programs for pregnant women in jail should be expanded and offered to everyone—or we should open one of the closed prison facilities and devote it just to pregnant women so the mothers can spend time with their newborns and have that bonding time.”

A correctional officer let me spend five minutes with her in the NICU, but that’s all the time I was allowed to have.
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A new bill proposed in the House of Representatives on September 13—the Pregnant Women in Custody Act of 2018—seeks to reform this culture within the United States Prison System where pregnant women in prison are poorly treated, often kept in shackles, denied adequate healthcare, and separated from their babies once they are born.

“Rep. Mia Love (R-UT) and I thought if we did a bill around pregnancy during incarceration it would be an opportunity to raise everyone’s understanding that there are pregnant women in prison, and it would be a way to unify all the women in the house,” said Rep. Karen Bass (D-CA), who co-authored the bill with Rep. Katherine Clark (D-MA), and Rep. Mia Love (R-UT).

“Needless to say, gender is a primary issue happening in the capitol as we speak, so this is an opportunity to come around on a gender issue that is really not controversial.”

The bill seeks to develop a national standard of care in federal prisons for pregnant women and provide incentives for state prison systems to adhere to the same standards, which include providing adequate healthcare, prohibiting restrictive housing, and the use of shackles on pregnant women.

“We incarcerate a lot of parents, we incarcerate women who are pregnant and when they give birth in prison, those babies are turned over to the foster system, or if they are lucky enough they go to kinship care if they have family,” ACLU National Prison Project Deputy Director Amy Fettig told me. “The lasting impacts of being separated from your child or being separated from your parent are burdens that communities in the country really bear and by and large they are poor communities of color.”

Mass incarceration in the United States widely impacts women, and criminal justice reforms often ignore reducing women prison populations in favor of men. Since 2009, women prison populations in 35 states have either grown faster than men prison populations—increased while men’s prison population has decreased—or declined at lower rates than men.

133 women are incarcerated per 100,000 people, the highest rate of incarceration in the world. According to the Prison Policy Initiative, though only four percent of the women in the world live in the United States, more than 30 percent of the global women prison population are in U.S. prisons.

An estimated 219,000 women are currently incarcerated in the U.S. Prison system, but the Department of Justice hasn’t collected any data in regards to pregnancies within this population. The Pregnant Women in Custody Act of 2018 would require the Department of Justice to begin to collect data on pregnant women in prison.

The lasting impacts of being separated from your child or being separated from your parent are burdens largely born by poor communities of color.
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In lieu of this lack of data, Dr. Carolyn Beth Sufrin at Johns Hopkins University started the PIPS (Pregnancy in Prison Statistics) project to collect recent data on pregnant women in prison. Twenty-two state prison systems, six jails, and three departments of juvenile justice have reported statistics to the project, which are currently under peer review. The project’s results will likely be released in early 2019.

“There are pregnant women who are in prisons and jails across the country,”  Dr. Sufrin said. “That’s the main point the PIPS project is shedding light on. Until this project, we haven’t had any idea how many women are pregnant. Part of this reflects the notion these women are categorically neglected, forgotten about, and the fact we have no systemic data on them reflects that.”

Without any data, Dr. Sufrin argued, it’s difficult to diagnose problems within the systems and develop solutions. “If we want to understand the scope of this problem and what the needs are, having data is essential,” she added.

Though there are a few prison programs in the United States that provide nurseries and opportunities for women prisoners to spend time with their babies after birth, Dr. Sufrin noted these programs aren’t a solution to the mass incarceration of women in general. Rather, they are necessary under the current system as criminal justice reform advocates push toward a broader vision of what the prison system should look like.

“Most of the women in the U.S. have been charged with nonviolent offenses, and most of them don’t necessarily need to be in custody and this is true for pregnant people,” Dr. Sufrin continued.

“They’ve been born into terrible circumstances, struggle with poverty, addiction, being victims of sexual and physical abuse, and prison is just part of that pathway. The bigger picture is thinking about alternatives to incarceration for pregnant people in the criminal legal system and instead being managed in the community. We can cultivate compassion and openness for alternatives for these women so they and their children can live better lives.”

Under the current system, Dr. Sufrin cited the need to ensure pregnant women behind bars are getting the social support and healthcare they need while working to achieve a broader vision in how pregnant women in prison are broadly treated.

Women are categorically neglected, forgotten about, and the fact we have no systemic data on pregnancy in prison reflects that.
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Lynne Paltrow, the Executive Director and Founder of the National Advocates for Pregnant Women, agreed with the notion that pregnant women should not be kept in prison custody, as the idea of using the prison system to address health and social welfare issues is a rampant perpetuator of mass incarceration in the United States.

“We don’t believe the government should be about separating families, whether its on the border, through child welfare or through incarceration,” Paltrow told me in an interview. “We need to stop criminalizing and incarcerating women in the extraordinary way we do in the United States. A very large percentage of women in prison are mothers and we shouldn’t be locking them up in the first place.”

The first time I remember wanting to be a mom was when my little sister was born, 12 days before my sixth birthday. The first time we took her out I carried her around proudly and called her “my baby.” Not “my sister” or “my baby sister,” “my baby.”

Since then, I’ve known, without a single doubt, that I wanted to be a mother. I’ve loved the children I’ve cared for as a childcare provider, but I’ve known that the love I had for each of them would pale in comparison to the love I would have for my own child. I’ve loved many people, but I know none of them have been my one true love; my one true love will be my child.

On May 25, I took two pregnancy tests, and they both turned positive. Those two tests sat on my bathroom counter, and every time I saw them, they confirmed that my one true love was alive inside me. But just days after finding out I was pregnant, my OB told me she was concerned about an ectopic pregnancy because I’d had surgery on my reproductive organs to treat endometriosis only two months earlier. She ordered some tests and while waiting for the results, I decided to take another pregnancy test, just to be sure. But that test only showed one line: not pregnant.

Heartbreak isn’t a strong enough word to describe the agony I felt sitting on the bathroom floor staring at that negative pregnancy test. I cried the way that mothers do in movies when they lose their children—a kind of crying that I always thought was exaggerated for dramatic effect. For five weeks my baby was alive inside of me. Part of me. When my baby died I felt the absence inside of me, like a piece of of me was suddenly gone.

On The Fear Of Pregnancy Loss In The First Trimester
theestablishment.co

I want to be clear that this is my individual experience of pregnancy and pregnancy loss. We all have different opinions about when a pregnancy constitutes a life, and all those opinions are valid. The moment I knew I was pregnant, I became immediately attached to that life. This does not happen for all women and that is completely fine. Each experience is different. This one is mine.

In my grief-addled brain, I desperately tried to make sense of what had happened, and only two explanations seemed to fit: either this was all part of some universal plan that I didn’t understand, or my body, which had failed me so many times already, had failed again.

A lot of what people said in their attempts to comfort me was along the lines of the “universal plan” explanation. Most people don’t know what to say when confronted with the enormity of someone else’s grief, so they resort to cliches like “everything happens for a reason” and “nothing happens in God’s world by mistake” and “on the other side of every struggle is a lesson.”

Either this was all part of some universal plan that I didn’t understand, or my body, which had failed me so many times already, had failed again.
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When I was struggling in the past, I found cliches like this comforting. But when faced with the loss of a child, they sounded hollow and cruel. How could there be some kind of lesson in this loss? What purpose could a higher power have for taking a baby from me? How could there be beauty on the other side of this?

I was forced to reexamine my beliefs on a higher power and the universe, and I came to the conclusion that I don’t believe in a higher power or a universe that would take my baby as part of some greater plan or to teach me a lesson about resilience or least of all to punish me for my past sins. And without an external force to blame for doing this to me, all that I was left with was the conclusion that my body had done this to me. My body had rejected a baby that it somehow couldn’t support.

My body was an easy target for my anger and hatred and pain because I was so accustomed to hating my body. I can’t really remember a time when I was comfortable in my body. What I do remember is the constant battle I waged against my body and the battle I felt my body had waged against me.

The Criminalization of Miscarriage Makes Me Fear My Eating Disorder
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When I got my period, my body and I very quickly became enemies. The flood of hormones brought crippling depression. I started to gain weight, which is completely normal during puberty, but I compounded this weight gain by overeating to cope with the depression that had turned my world monochromatic. Within a few years of getting my period I was “the fat kid” and got bullied relentlessly.

A couple of years after my period began, I started showing symptoms of what would be diagnosed, 12 years later, as endometriosis. Every month my cramps were so painful that I could barely move, sometimes so painful that I would vomit. I would bleed so heavily that I had to change my tampon between every class. The weeks surrounding my period would bring awful GI problems that left me running to the bathroom as often as I could.

By the time I was in high school, it was clear to me that this fat, malfunctioning body which tortured me all the time was my enemy. So, I started on my quest to tame the wild body that made me feel so out of control, to make it more acceptable. What started as a “diet and exercise plan” quickly morphed into an eating disorder that would rule my life for the next 12 years. It was easy to punish a body that made me feel so awful, physically and emotionally. I believed it was what my body deserved.

My body was an easy target for my anger and hatred and pain because I was so accustomed to hating my body.
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When I finally got into treatment for my eating disorder, I was ready to make peace with my body, but I wasn’t prepared for what that would entail. When I stopped using eating disorder behaviors I gained a lot of weight. Suddenly, I was the fat kid again, and I hated my body more than I ever had, even before the eating disorder ever started.

I was confronted with the fact that my body, when it is healthy, is an overweight body. I can force my body to be thin by depriving it and pushing it beyond its limits and punishing it constantly, but when I am kind to my body and feed it when it needs to be fed and move it only as much as it wants to move, my body wants to be fat. And that’s when I decided that, if I was ever going to be happy again, I had to accept my fat body exactly as it was. Which was exactly as hard as it sounded.

I found a really good therapist who helped me see the connection between my core beliefs that I was broken and not good enough and not worthy of love and the way that I treated my myself. And how my belief that I deserved bad things and that they were my fault meant I’d never be free from them.

Over the course of several months, I used eating disorder behaviors less, and finally, I stopped. I started hiking and doing yoga—activities that allowed me to be present in my body and see what my body was capable of doing. Slowly, I began to view my body as a vessel for my experiences in the world rather than a symbol of my value to the world.

Eventually, I didn’t really think about my body that much at all. I could walk by a mirror and look or not look, and if I did look it wouldn’t ruin my day. That was my version of accepting my body.

Acceptance was as far as I’d gotten before I got pregnant. Being pregnant was the first time I’d ever really felt at home in my body, completely okay with my body. I’d wanted to be pregnant my whole life, and when I finally was, everything felt right. This body I had hated for years was no longer my enemy.

But just as quickly as the peace was made, it was shattered. When I miscarried I felt betrayed by my body. Betrayed by a body whose reproductive system had never worked quite right. A body that was my prison while it suffered through a chronic illness. A body that had just gone through surgery to remove endometriosis so I could get pregnant. A body that I had never really liked in the first place, no matter how thin I got. A body which I had beaten and starved and mistreated for years. A body that had given me a baby and then taken it away.

I wondered how could I continue to live in my body, a body that apparently hated me as much as I hated it. Why else would it give me the one thing I wanted more than anything and then take it away?

In the aftermath of my miscarriage, I wanted to hurt my body as much as it had hurt me. But to my surprise, I found that I couldn’t. There were days where the grief was so overwhelming that I forgot to eat, but when I purposely tried to restrict or force myself to exercise when I didn’t want to, it didn’t provide the sense of relief or control that it used to. There have been times when intrusive thoughts about self harm have taken over my brain, but I couldn’t bring myself to actually act on them.

In the aftermath of my miscarriage, I wanted to hurt my body as much as it had hurt me. But to my surprise, I found that I couldn’t.
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No matter how angry I am at this body that has betrayed me, no matter how much I hate it for taking my baby from me, I can’t hurt it anymore. I’ve learned to value my body and myself too much to cause myself harm.

I’m beginning to understand that the anger and hatred I’ve been directing at my body is misplaced. When grief is too excruciating, it’s much easier to turn to more accessible emotions and direct them at something more concrete than the abstract experience of loss. It’s much easier to assign blame to my faulty body than it is to accept that my miscarriage just happened—that there isn’t any reason or explanation. But doing what’s easy and rationalizing away grief doesn’t allow healing.

I’m starting to engage in the much more difficult process of accepting and forgiving rather than blaming and harming. I know it’s going to be a long process, but by now, my body can handle it.

Content warning: discussion of suicidal ideation

Throughout my teens I was adamant I didn’t want children. I thought they were annoying, sticky money pits who had no business being near me. I was a sad and corny teen. Now, I’m 30. I’m still sad, but I’m not broke, and I have a husband. My feelings on the child situation have changed. I’m more open to it now. I think it was a combination of seeing other people with kids and, as I’ve gotten older, having more love to give — or something. I didn’t have the most stable childhood (or adulthood, for that matter), but I’m now in a position where I could give a kid a good and not-at-all toxic upbringing. I’m not desperate to have a baby — not that there’s anything wrong with that — but I’d love to try.

I traipsed off to therapy, excited to discuss starting a family. I’d only talked about it with my husband, and my therapist would be the only other person who’d know. Lucky her! I readied myself for all her joy and delight. I’d seen it before with my friends. They’d start with a goofy grin on their face and say something like, “We’ve stopped using birth control.” This would be followed by gasps and tiny squeals of glee: “You’re trying for a baby! We’re so happy for you!”

The Maternal Instinct Is A Myth And We’ve Got The Science To Prove It
theestablishment.co

With the same goofy grin that I’d seen from my friends, I proudly announced to my therapist that I wanted to start a family. She smiled, looked me dead in the eye, and said, “If you want to have a baby, you need to tell me around three months before you start trying.”

Ah, just how I dreamed it would be!

I have bipolar II, which means I experience frequent episodes of severe depression with a smattering of hypomania. Therefore, I need a longer lead-time to process and plan for the mental and physical changes that occur during pregnancy. I’d heard of postpartum depression, and I’d heard of people developing depression during pregnancy, but I haven’t heard anything about what happens when you’re already depressed and want to have a baby. But with that one decision — to try for a baby — my depression shifted to pre-prenatal depression.

The prevalence of mental illness cannot be overstated. One in six Americanssuffer from a mental illness, millions of whom are depressed — and according to an analysis carried out by a clinical psychologist at Oxford University, women are 40% more likely than men to develop mental health conditions.

With the one decision to try for a baby, my depression shifted to pre-prenatal depression.
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So it seemed odd that there’s not more out there about getting pregnant whiledepressed. The few stories I found scared the shit out of me. (One article was ominously titled, “Scary News For People Who Get Pregnant While Depressed.”) And, unfortunately, there’s no clear list of guidelines for depressed women who want to become moms.

As Bay Area psychiatrist Jill Armbrust explained to me, the plans for treating a person with depression who wants to get pregnant are the same as those for anyone who’s becoming depressed. “The difference being there would be more focus on and care put on the side effects of various medications.” This takes a lot of time and careful planning. “One usually starts with about six months of psychotherapy if you have that kind of luxury,” Armbrust advised.

The guidelines that do exist center on medication, of which I take a range to keep my mind intact, namely lithium, Latuda, trazodone, lorazepam, and clonazepam. I’d be a whole lot worse without them, and — with absolutely the intention of sounding dramatic — I may even be dead.

But it turns out these pills don’t mix well with pregnancy. My therapist advised weaning off the meds completely. My first thought was simply, “No.” I didn’t want to think about who I would be without medication. I tried to kill myself without medication. My brain flooded with questions: How could I create a new life when I’ve wanted to end my own? Will I turn into a monster? Should people like me even have children?

I found myself asking that last question a lot. Given my history of depression and suicide, was it safe or even fair for me to have kids? I wondered if there were any circumstances where therapists advised people against getting pregnant.

There are, though, as Armbrust explained, “It’s tremendously variable because of the stigma that even some practitioners carry.” While there’s no absolute answer to this, Armbrust suggests the only two reasons she’d advise against pregnancy: when the woman had unstable psychosis or an untreated substance abuse problem. She went on to say that she believes women with schizophrenia, bipolar, and depression — like me — are all candidates to be very good mothers.

I am fortunate enough to have a therapist, and (thanks to my husband) health insurance. Having a baby while depressed was going to be hard but not impossible.

So we began.

Confusion

My therapist said we would start by lowering the doses of my lithium, trazodone, and Latuda. However, I had to stop taking lorazepam or clonazepam, since both have been recognized by the U.S. Food and Drug Administration as drugs with “positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans.” The U.S. agency calls these Category D drugs, with Category A being the safest for pregnant women and X being a total no-go. But since I didn’t take lorazepam or clonazepam every day, I didn’t think that would be too bad.

The one I was worried about most was lithium. Lithium was the one that tied the room together. At the time of talking to my therapist, lithium was category C, the third of the five categories, so I could potentially keep taking it at low doses even if I did become pregnant.

My therapist assured me we’d get through it together and that she’d be monitoring me closely. She suggested I see an OBGYN and see what they thought. About a month later I was booked to see a nurse practitioner where I had a pap smear and a ton of questions. It isn’t common practice for an OBGYN to screen for depression at this stage, though Armbrust says this would be hugely beneficial, given that postpartum depression is so common. But when it comes to pre-prenatal depression, “It’s still considered stigmatized in a separate area of expertise.” Most of the time you have to volunteer the information yourself.

Given my history of depression and suicide, was it safe or even fair for me to have kids?
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I told the nurse about my psychiatric history, and that I was trying for a baby. Before I could ask her any questions, she stopped me: “Do not start trying until you are completely off your medication.”

“Even lithium?” I spluttered. She furrowed her brow, left the room to check. Three minutes later she came back. “Even lithium.”

My therapist was confused. “Even lithium?” she asked me. I nodded, and when she opened her laptop to check, she nodded, too. “It’s changed to a category D” — just like lorazepam or clonazepam.

This was the first of many conflicting pieces of information I would come across in my mentally ill quest to become pregnant. Distressed that no one had a clear-cut answer, I turned to the one place I knew would be even worse, though it seemed to be also the place where my doctors were getting their information: the internet.

LUV 2 B ONLINE

Here in the murky depths of online pregnancy forums is where I found other people with mental illnesses who were as equally as confused as me. Though there were still no clear answers, it was strangely comforting. Up until now, I’d been speaking to medical professionals who discussed coming off medication as though it were a procedure. However, in the forums I found people who were talking about it in terms to which I could relate. These were people who lived with schizophrenia, bipolar, PTSD, and depression. There were those who felt guilty about continuing to take medication and those who were OK with it. There were some who’d stopped taking their medication, had a bad episode, and had to go back on. And there were those who stayed off meds for their whole pregnancy but went back on after the baby was born. One thing was for sure, nobody had the “right” answer because the “right” answer is whatever works for you.

These conversations turned from medication to general feelings. Women talked about how they felt ashamed of feeling depressed when they should be happy and grateful that they managed to get pregnant in the first place. They talked about how they wrestled with their emotions on the inside and the judgment cast upon them from the outside. The judgment on the outside being other moms in the forum telling them they’re bad mothers for taking medication. It happens all the time and is not exclusive to pregnant mothers with a mental illness. If you’ve ever been on a parenting or pregnancy forum, you’ll know that, while they can offer solace and support, they’re also diabolical whirlpools of toxicity designed to drag you down into a complex sewer system of self-righteousness and unconstructive criticism.

Fear-Mongering Among New Mothers Is A Profitable Business
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“So why even go on them?!” I hear you cry. Great question — but avoiding them is easier said than done, especially when forums are one of the only places I could go to read about other pregnant peoples’ struggle with mental illness (and I’m a sucker for shame). Even though pregnancy forums are bustling hellscapes, they’re (ironically) the only places some us can go to discuss “taboo” subjects such as mental illness.

It’s Not You, It’s Me

I decided the “right” answer for me was to come off all my medication before trying for a baby, including the lower-risk ones. After three months of careful planning and monitoring, I was entirely med-free for the first time in five years, when I’d tried to commit suicide. The few other times since then when I came off certain medications because I convinced myself I didn’t need to be on them, I experienced particularly bad depressive and hypomanic episodes, at one point landing myself back in the hospital.

Before, I didn’t tell anyone when I went off medication and decided to go cold turkey, which isn’t ideal. This time, it felt different. I had my therapist monitoring me closely. Still, being off meds contained all the terror of a manic episode without the mania, like walking a tightrope over the Grand Canyon with no safety net.

For the first time in five years, I started to feel — but not in a good way. I’d become so accustomed to my moods being regulated; it was like I had two bouncers standing in front of my mind, letting thoughts and feelings come in at a steady pace. Now the bouncers were gone, and everyone started to rush into the club and fuck shit up. I was overwhelmed and began to isolate myself. I talked to my husband, my therapist, a couple of friends, and a whole bunch of strangers on the internet. I retreated into the pregnancy forums where I could be among women who were going through the same thing as me. Out of everyone, the forums is where I felt the most comfortable. I didn’t feel like I was burdening people with my “issues,” I didn’t feel like I was boring anyone with my constant questions, but most importantly, I didn’t feel alone. I’d tried talking to other people, but with all these unsupervised feelings, it was hard not to get upset or angry.

On The Fear Of Pregnancy Loss During The First Trimester
theestablishment.co

When it comes to your pregnancy, everyone you meet is an expert on you and your body. You tell people you’re trying, and immediately they’re all, “You’ve got plenty of time,” or “Relax, it can take up to a year.” As with everything in life, if I want your opinion, I’ll ask for it, but please know I’ll never ask because I never want it. I knew getting pregnant could take a while. Sometimes it happens instantly, other times it can take years. Either way, the wait can be excruciating. And when you’re flying solo without your antipsychotic medication, the wait becomes dangerous.

Every day I’d wake up and wonder if today were the day I’d lose it. I hoped I wouldn’t have to be hospitalized again. I begged my mind not to have an episode. For me, getting pregnant wasn’t a race against time, it was a race against mind.

After only a couple of months, I felt unstable. I started to feel sad. Not depressed, just sad. I assumed this was part of my unregulated moods, but the sadness lingered. Before long, I felt myself sliding into dangerous territory. The sorrow had morphed into depression, and without any medication to block it, the depression began to pick up speed. I still wanted to have a baby, I just didn’t know if I would be around to have it. I talked with my therapist, and we decided to give it one more month before I went back on the meds. One more month would make it three months total of being off meds, and whether I became pregnant or not, I felt proud I’d made it this far. Those three months were both terrifying and challenging, but nothing prepared me for what happened next. I got pregnant.

Uncomfortably Numb

Even without a mental illness, pregnancy can mess with your head. There’s the hormones, nausea, and the ever-changing body, which can be hard to process for anyone. But here I was, with no control over my body or mind. Everything started happening so quickly. I felt as though I was losing myself. I was happy and grateful we’d managed to get pregnant in a relatively short amount of time, but I was also depressed and disconnected. I remember staring blankly at the eight-week ultrasound. I knew I should be feeling something, but it just wasn’t happening. It was like I was experiencing phantom feelings. I’d already disassociated from the pregnancy, a pregnancy I wanted and planned. I started to experience a familiar numbness, the same numbness that enveloped me for the first 20 years of my life. I couldn’t even feel shame anymore.

Just like pregnancy, everybody experiences mental illness differently. And while I am fortunate enough to have a therapist, health insurance, and an OBGYN, the only person who was going to come up with the “right” answer was me. I’m now four months along and still off medication. Things aren’t perfect. (Is any pregnancy?) I still struggle with depression, and managing without meds does not mean I’m “cured.” I will always have bipolar, and anxiety, and PTSD, but there are things I can do to lessen the mental strain while I’m pregnant.

Just like pregnancy, everybody experiences mental illness differently.
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I continue to work hard at therapy. I try to eat healthily and exercise as much as I can. And I’m starting to increase my social support system beyond the confines of the internet, which has been daunting, but it’s helping a lot. And although I feel good now, I don’t take for granted that it could all change.

I want to be clear: Nothing can or will replace my medication. Even now, going back on medication is still an option, and once the baby is born, the plan is to start taking them again. The most important thing is my health. If I’m not healthy, then there was no way this baby could be either. I considered starting back on a low dosage of lithium, but I before I made that decision, I wanted to work on my mental health one last time. Again, I do not judge anyone who continues or goes back to their medication. If that’s what’s best for them, then that’s the right decision.

These are just things that help me personally, but who knows, it all may change. I’m taking it one day at a time. That’s the way it is with depression. There’s no cure; there’s just what works for you, for now.

Getting pregnant wasn’t a race against time, it was a race against mind.

Kewei Hu / Unsplash

Content warning: discussion of suicidal ideation

Throughout my teens I was adamant I didn’t want children. I thought they were annoying, sticky money pits who had no business being near me. I was a sad and corny teen. Now, I’m 30. I’m still sad, but I’m not broke, and I have a husband. My feelings on the child situation have changed. I’m more open to it now. I think it was a combination of seeing other people with kids and, as I’ve gotten older, having more love to give — or something. I didn’t have the most stable childhood (or adulthood, for that matter), but I’m now in a position where I could give a kid a good and not-at-all toxic upbringing. I’m not desperate to have a baby — not that there’s anything wrong with that — but I’d love to try.

I traipsed off to therapy, excited to discuss starting a family. I’d only talked about it with my husband, and my therapist would be the only other person who’d know. Lucky her! I readied myself for all her joy and delight. I’d seen it before with my friends. They’d start with a goofy grin on their face and say something like, “We’ve stopped using birth control.” This would be followed by gasps and tiny squeals of glee: “You’re trying for a baby! We’re so happy for you!”

The Maternal Instinct Is A Myth And We’ve Got The Science To Prove It

With the same goofy grin that I’d seen from my friends, I proudly announced to my therapist that I wanted to start a family. She smiled, looked me dead in the eye, and said, “If you want to have a baby, you need to tell me around three months before you start trying.”

Ah, just how I dreamed it would be!

I have bipolar II, which means I experience frequent episodes of severe depression with a smattering of hypomania. Therefore, I need a longer lead-time to process and plan for the mental and physical changes that occur during pregnancy. I’d heard of postpartum depression, and I’d heard of people developing depression during pregnancy, but I haven’t heard anything about what happens when you’re already depressed and want to have a baby. But with that one decision — to try for a baby — my depression shifted to pre-prenatal depression.

The prevalence of mental illness cannot be overstated. One in six Americans suffer from a mental illness, millions of whom are depressed — and according to an analysis carried out by a clinical psychologist at Oxford University, women are 40% more likely than men to develop mental health conditions.

With the one decision to try for a baby, my depression shifted to pre-prenatal depression.

So it seemed odd that there’s not more out there about getting pregnant while depressed. The few stories I found scared the shit out of me. (One article was ominously titled, “Scary News For People Who Get Pregnant While Depressed.”) And, unfortunately, there’s no clear list of guidelines for depressed women who want to become moms.

As Bay Area psychiatrist Jill Armbrust explained to me, the plans for treating a person with depression who wants to get pregnant are the same as those for anyone who’s becoming depressed. “The difference being there would be more focus on and care put on the side effects of various medications.” This takes a lot of time and careful planning. “One usually starts with about six months of psychotherapy if you have that kind of luxury,” Armbrust advised.

The guidelines that do exist center on medication, of which I take a range to keep my mind intact, namely lithium, Latuda, trazodone, lorazepam, and clonazepam. I’d be a whole lot worse without them, and — with absolutely the intention of sounding dramatic — I may even be dead.

But it turns out these pills don’t mix well with pregnancy. My therapist advised weaning off the meds completely. My first thought was simply, “No.” I didn’t want to think about who I would be without medication. I tried to kill myself without medication. My brain flooded with questions: How could I create a new life when I’ve wanted to end my own? Will I turn into a monster? Should people like me even have children?

I found myself asking that last question a lot. Given my history of depression and suicide, was it safe or even fair for me to have kids? I wondered if there were any circumstances where therapists advised people against getting pregnant.

There are, though, as Armbrust explained, “It’s tremendously variable because of the stigma that even some practitioners carry.” While there’s no absolute answer to this, Armbrust suggests the only two reasons she’d advise against pregnancy: when the woman had unstable psychosis or an untreated substance abuse problem. She went on to say that she believes women with schizophrenia, bipolar, and depression — like me — are all candidates to be very good mothers.

I am fortunate enough to have a therapist, and (thanks to my husband) health insurance. Having a baby while depressed was going to be hard but not impossible.

So we began.

Confusion

My therapist said we would start by lowering the doses of my lithium, trazodone, and Latuda. However, I had to stop taking lorazepam or clonazepam, since both have been recognized by the U.S. Food and Drug Administration as drugs with “positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans.” The U.S. agency calls these Category D drugs, with Category A being the safest for pregnant women and X being a total no-go. But since I didn’t take lorazepam or clonazepam every day, I didn’t think that would be too bad.

The one I was worried about most was lithium. Lithium was the one that tied the room together. At the time of talking to my therapist, lithium was category C, the third of the five categories, so I could potentially keep taking it at low doses even if I did become pregnant.

My therapist assured me we’d get through it together and that she’d be monitoring me closely. She suggested I see an OBGYN and see what they thought. About a month later I was booked to see a nurse practitioner where I had a pap smear and a ton of questions. It isn’t common practice for an OBGYN to screen for depression at this stage, though Armbrust says this would be hugely beneficial, given that postpartum depression is so common. But when it comes to pre-prenatal depression, “It’s still considered stigmatized in a separate area of expertise.” Most of the time you have to volunteer the information yourself.

Given my history of depression and suicide, was it safe or even fair for me to have kids?

I told the nurse about my psychiatric history, and that I was trying for a baby. Before I could ask her any questions, she stopped me: “Do not start trying until you are completely off your medication.”

“Even lithium?” I spluttered. She furrowed her brow, left the room to check. Three minutes later she came back. “Even lithium.”

My therapist was confused. “Even lithium?” she asked me. I nodded, and when she opened her laptop to check, she nodded, too. “It’s changed to a category D” — just like lorazepam or clonazepam.

This was the first of many conflicting pieces of information I would come across in my mentally ill quest to become pregnant. Distressed that no one had a clear-cut answer, I turned to the one place I knew would be even worse, though it seemed to be also the place where my doctors were getting their information: the internet.

LUV 2 B ONLINE

Here in the murky depths of online pregnancy forums is where I found other people with mental illnesses who were as equally as confused as me. Though there were still no clear answers, it was strangely comforting. Up until now, I’d been speaking to medical professionals who discussed coming off medication as though it were a procedure. However, in the forums I found people who were talking about it in terms to which I could relate. These were people who lived with schizophrenia, bipolar, PTSD, and depression. There were those who felt guilty about continuing to take medication and those who were OK with it. There were some who’d stopped taking their medication, had a bad episode, and had to go back on. And there were those who stayed off meds for their whole pregnancy but went back on after the baby was born. One thing was for sure, nobody had the “right” answer because the “right” answer is whatever works for you.

These conversations turned from medication to general feelings. Women talked about how they felt ashamed of feeling depressed when they should be happy and grateful that they managed to get pregnant in the first place. They talked about how they wrestled with their emotions on the inside and the judgment cast upon them from the outside. The judgment on the outside being other moms in the forum telling them they’re bad mothers for taking medication. It happens all the time and is not exclusive to pregnant mothers with a mental illness. If you’ve ever been on a parenting or pregnancy forum, you’ll know that, while they can offer solace and support, they’re also diabolical whirlpools of toxicity designed to drag you down into a complex sewer system of self-righteousness and unconstructive criticism.

Fear-Mongering Among New Mothers Is A Profitable Business

“So why even go on them?!” I hear you cry. Great question — but avoiding them is easier said than done, especially when forums are one of the only places I could go to read about other pregnant peoples’ struggle with mental illness (and I’m a sucker for shame). Even though pregnancy forums are bustling hellscapes, they’re (ironically) the only places some us can go to discuss “taboo” subjects such as mental illness.

It’s Not You, It’s Me

I decided the “right” answer for me was to come off all my medication before trying for a baby, including the lower-risk ones. After three months of careful planning and monitoring, I was entirely med-free for the first time in five years, when I’d tried to commit suicide. The few other times since then when I came off certain medications because I convinced myself I didn’t need to be on them, I experienced particularly bad depressive and hypomanic episodes, at one point landing myself back in the hospital.

Before, I didn’t tell anyone when I went off medication and decided to go cold turkey, which isn’t ideal. This time, it felt different. I had my therapist monitoring me closely. Still, being off meds contained all the terror of a manic episode without the mania, like walking a tightrope over the Grand Canyon with no safety net.

For the first time in five years, I started to feel — but not in a good way. I’d become so accustomed to my moods being regulated; it was like I had two bouncers standing in front of my mind, letting thoughts and feelings come in at a steady pace. Now the bouncers were gone, and everyone started to rush into the club and fuck shit up. I was overwhelmed and began to isolate myself. I talked to my husband, my therapist, a couple of friends, and a whole bunch of strangers on the internet. I retreated into the pregnancy forums where I could be among women who were going through the same thing as me. Out of everyone, the forums is where I felt the most comfortable. I didn’t feel like I was burdening people with my “issues,” I didn’t feel like I was boring anyone with my constant questions, but most importantly, I didn’t feel alone. I’d tried talking to other people, but with all these unsupervised feelings, it was hard not to get upset or angry.

On The Fear Of Pregnancy Loss During The First Trimester

When it comes to your pregnancy, everyone you meet is an expert on you and your body. You tell people you’re trying, and immediately they’re all, “You’ve got plenty of time,” or “Relax, it can take up to a year.” As with everything in life, if I want your opinion, I’ll ask for it, but please know I’ll never ask because I never want it. I knew getting pregnant could take a while. Sometimes it happens instantly, other times it can take years. Either way, the wait can be excruciating. And when you’re flying solo without your antipsychotic medication, the wait becomes dangerous.

Every day I’d wake up and wonder if today were the day I’d lose it. I hoped I wouldn’t have to be hospitalized again. I begged my mind not to have an episode. For me, getting pregnant wasn’t a race against time, it was a race against mind.

After only a couple of months, I felt unstable. I started to feel sad. Not depressed, just sad. I assumed this was part of my unregulated moods, but the sadness lingered. Before long, I felt myself sliding into dangerous territory. The sorrow had morphed into depression, and without any medication to block it, the depression began to pick up speed. I still wanted to have a baby, I just didn’t know if I would be around to have it. I talked with my therapist, and we decided to give it one more month before I went back on the meds. One more month would make it three months total of being off meds, and whether I became pregnant or not, I felt proud I’d made it this far. Those three months were both terrifying and challenging, but nothing prepared me for what happened next. I got pregnant.

Uncomfortably Numb

Even without a mental illness, pregnancy can mess with your head. There’s the hormones, nausea, and the ever-changing body, which can be hard to process for anyone. But here I was, with no control over my body or mind. Everything started happening so quickly. I felt as though I was losing myself. I was happy and grateful we’d managed to get pregnant in a relatively short amount of time, but I was also depressed and disconnected. I remember staring blankly at the eight-week ultrasound. I knew I should be feeling something, but it just wasn’t happening. It was like I was experiencing phantom feelings. I’d already disassociated from the pregnancy, a pregnancy I wanted and planned. I started to experience a familiar numbness, the same numbness that enveloped me for the first 20 years of my life. I couldn’t even feel shame anymore.

Just like pregnancy, everybody experiences mental illness differently. And while I am fortunate enough to have a therapist, health insurance, and an OBGYN, the only person who was going to come up with the “right” answer was me. I’m now four months along and still off medication. Things aren’t perfect. (Is any pregnancy?) I still struggle with depression, and managing without meds does not mean I’m “cured.” I will always have bipolar, and anxiety, and PTSD, but there are things I can do to lessen the mental strain while I’m pregnant.

Just like pregnancy, everybody experiences mental illness differently.

I continue to work hard at therapy. I try to eat healthily and exercise as much as I can. And I’m starting to increase my social support system beyond the confines of the internet, which has been daunting, but it’s helping a lot. And although I feel good now, I don’t take for granted that it could all change.

I want to be clear: Nothing can or will replace my medication. Even now, going back on medication is still an option, and once the baby is born, the plan is to start taking them again. The most important thing is my health. If I’m not healthy, then there was no way this baby could be either. I considered starting back on a low dosage of lithium, but I before I made that decision, I wanted to work on my mental health one last time. Again, I do not judge anyone who continues or goes back to their medication. If that’s what’s best for them, then that’s the right decision.

These are just things that help me personally, but who knows, it all may change. I’m taking it one day at a time. That’s the way it is with depression. There’s no cure; there’s just what works for you, for now.

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]]> https://theestablishment.co/how-the-medical-community-is-pushing-invasive-procedures-on-women-who-miscarry-b2946fe28d3c/ Tue, 27 Mar 2018 21:07:02 +0000 https://theestablishment.co/?p=2615 Read more]]> Patients have many treatment options after a miscarriage — so why do doctors keep using the most invasive one?

“Your baby has no heartbeat.”

I stared at the doctor in shock, my eyes instantly stinging with tears as his words sunk in.

I looked back and forth from the devastated look on my husband’s face to the sonogram screen, silently pleading for that tiny little black and white flicker to suddenly appear, unable to believe this was really happening.

How could the baby, who was developing so well for the last nine weeks, just be gone?

Within moments of hearing those devastating words, I was told I would have to have a D&C, that this was my only treatment option.

Ten to twenty-five percent of all pregnancies end in miscarriage. In some cases a woman may wait and see if the body naturally expels the tissue, but this is not a viable or recommended option for many people. This is when a dilation and curettage (D&C) may be needed. A D&C is a surgical procedure, typically done in the first trimester, to remove tissue from inside your uterus after a miscarriage. The patient is placed under general anesthesia — or, in very rare cases, under heavy sedation — while the procedure is done. (There is also a D&E procedure that removes tissue and also requires anesthesia, but this is typically used after the first trimester.)

The Pregnancy Loss Cards That Say ‘It’s Okay To Scream’
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Historically, the D&C has been the dominant treatment method for people after a miscarriage, and it has generally been considered safe — and for some, it may be necessary. But there is an increased risk of complications whenever anesthesia is used, due to potential reactions to the medication and resulting breathing problems. And for those who already have a history of reacting unfavorably to anesthesia, this can add additional complications.

Recent studies have also found that there may be more risks to a D&C than previously thought. Researchers from the European Society of Human Reproduction and Embryology analyzed 21 different studies on D&Cs and discovered that the procedure is connected with a 29% greater chance of preterm birth (defined as birth occurring before 37 weeks) and a 69% greater chance of very preterm birth (less than 32 weeks) in a future pregnancy. This study of almost 2 million women also found the risk of prematurity was even higher in women with several previous D&Cs.

This is not intended to cause alarm in women who have already had a D&C, or to endorse one procedure over another — but patients should always be advised of every option available to them, not just the standard D&C.

Manual vacuum aspiration (MVA), for instance, is a safe treatment option in an early miscarriage. In this procedure the cervix is numbed and tissue is removed with a hand-held device (MVA) or a small electric device (referred to as an EVA). The procedure lasts, at most, 10 minutes. The patient remains completely awake and alert the whole time, and it is now the recommended method of treatment for early miscarriages by the World Health Organization. The Journal of American Science also reports that the MVA is effective, less time consuming, and less costly, and since it doesn’t require general anesthesia, the risk of complications is less than a D&C.

Patients should always be advised of every option available to them, not just the standard D&C.
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Another study published in The International Journal of Obstetric and Gynecology reports that the MVA is “an alternative to the standard surgical curettage, performed under local anesthetic. It is a safe, and possibly cost-effective procedure, with advantages for both the patient and the health-care system.”

There is also a medication option where a patient is given misoprostol, a drug that causes the tissue to pass. Patients take the pills at home and often have to follow up with their doctor afterwards to ensure the procedure was effective.

I was not informed of these other options after my own miscarriage by any provider, including my doctor, a highly-regarded physician in New York City, and the staff at the surgical center. As a clinician that has worked in a medical setting, and with patients who have miscarried, I was already aware that other options to the D&C existed, but none of my providers discussed these with me. At one point I was even told by staff at the center that “if you have a miscarriage then you have to get a D&C.”

When I met with the “counselor,” employed by the surgical center to speak with patients before they see the doctor to inform them of treatment options and review consent forms, they only brought the information and consent forms for the D&C and said nothing about the MVA or the option to take misoprostol at home.

I continued to refuse the D&C. Having had difficulty with anesthesia in the past, I saw no need to have this if it wasn’t absolutely necessary, and finally, after going through multiple staff members and supervisors, I was given the proper consent forms for an MVA and was taken to one of the on-duty doctors who confirmed that an MVA is an applicable treatment option in an early miscarriage.

In speaking with many other women who have also been in this situation, they too shared stories of not being informed that there were other options, and many told me they had never been told that the MVA procedure even existed.

Fear-Mongering Among New Mothers Is A Profitable Business
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There are compelling reasons why patients might not be getting a full picture of their options after a miscarriage, the location of where the procedure is performed being one. Many D&Cs continue to be performed in hospital operating rooms, despite the advances in miscarriage management, and even though, with the exception of certain complicated cases, there is no longer a medical need that necessitates a patient going to the hospital after a miscarriage for a D&C.

This is often due to physician preference rather than what the patient wants. Studies have shown that medical providers’ attitudes toward newer treatment have remained stagnant, that many physicians still utilize the older D&C method and still prefer to treat pregnancy loss in the hospital operating room, according to research published by the Guttmacher Institute and the National Institutes of Health.

Even if a D&C is the right treatment option for a woman, it isn’t medically necessary for this to be done in the hospital and it can be performed in other medical settings, such as a surgical center or a private doctors office. Requiring people to go to the hospital OR (operating room) often adds significant stress, time, and cost to an already painful situation.

New York City-based physicians, Drs. Priypa Praditpa and Anne R. Davis, concluded in at 2015 study, “Manual vacuum aspiration: A safe and effective treatment for early miscarriage,” that the MVA is not only a safe procedure, but that “for too long, patients have blamed themselves for a miscarriage and physicians have relied on the D&C in the OR. Changes in the culture surrounding miscarriage are long overdue.”

At one point I was even told by staff at the center that ‘if you have a miscarriage then you have to get a D&C.’
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The financial aspect to the D&C likely plays a role and provides an incentive to which procedure doctors perform and where they perform it. Providers can bill insurance companies at a higher rate once anesthesia is administered and even more so if it is done in a hospital. Anesthesiologists typically bill at a base rate and then at each 15-minute interval while the patient is under their care.

Both the MVA and the medication option are considerably less expensive than a D&C, with the average cost of an MVA being less than half the cost of a D&C in the OR — $968 for the MVA, compared to $1,965 for the D&C, according to Praditpa and Davis’s research. The Healthcare Bluebook also lists the “fair” billable price for a provider to charge for a D&C as $2,728, though that can go all the way up to $6,820.

For uninsured women, the cost of a D&C can be staggering; though prices vary depending on provider and location, they often range from $4,000 to $9,000. Insured women have also reported exorbitant out-of-pocket expenses after a D&C, ranging from several hundred dollars to well over a thousand depending on their individual insurance plans. This further skews the incentive for medical providers to offer more economical treatment options.

But it’s not just about money or location. A miscarriage is already an emotional and painful time and it is every woman’s right to know all of their treatment options so they, not the medical staff or office billing manager, can make the best decision for their body — a decision based not on increasing profit or perpetuating unnecessary medical procedures, but on their individual needs.

By The Bad Advisor

“Today is my dad’s birthday. We all forgot . . . again.

I have asked him numerous times to just provide a reminder. I always give everyone a heads-up before my birthday — it’s a courtesy as everyone is so busy nowadays.

So I got a midday ‘joking’ email about how no one wished him a happy birthday. I feel guilty, but this could all be avoided if he just gave his forgetful family a little warning instead of playing this game every year. Thoughts?”

—From “I Forgot . . . Again” via Carolyn Hax, Washington Post, 6 February 2018

Dear I Forgot,

If only there were some mechanism by which we could visually measure the annual passage of time, broken up into smaller increments — say, 12 allotments of, I don’t know, 30 days or so? — that would enable us to mark important occasions such that we could plan for them before the very moment of their occurrence. What a wonder that would be! Instead, we will simply have to rely on each individual person to remember indefinitely and exhaustively which of life’s milestones are important to which people and how far ahead those people need to be apprised of the coming anniversary of the aforementioned milestones, literally the only way to have any knowledge whatsoever of the day that anything happens, ever. It’s a shame that your father is personally holding you and the rest of the world back from developing another system of measuring time, but obviously he just loves this great annual game!

Bad Advice On Employing A Sexual Harasser To Teach Your Child

“My son, Steven, and daughter-in-law, Julia, are expecting their first child and our first grandchild next month. I had what I thought was a good relationship with Julia, but I find myself devastated. Julia has decided only Steven and her mother will be allowed in the delivery room when she gives birth. I was stunned and hurt by the unfairness of the decision and tried to plead with her and my son, but Julia says she ‘wouldn’t feel comfortable’ with me there. I reminded her that I was a nurse for 40 years, so there is nothing I haven’t seen. I’ve tried to reason with Steven, but he seems to be afraid of angering Julia and will not help. I called Julia’s parents and asked them to please reason with their daughter, but they brusquely and rather rudely got off the phone. I’ve felt nothing but heartache since learning I would be banned from the delivery room. Steven told me I could wait outside and I would be let in after Julia and the baby are cleaned up and ‘presentable.’ Meanwhile, Julia’s mother will be able to witness our grandchild coming into the world. It is so unfair.

I’ve always been close to my son, but I no longer feel valued. I cannot bring myself to speak to Julia. I’m being treated like a second-class grandmother even though I’ve never been anything but supportive and helpful. How can I get them to see how unfair and cruel their decision is?”

— From “Second Class Grandma” via “Dear Prudence,” Slate, 5 February 2018

Dear Second Class Grandma,

Who can call herself “Grandma” who has not personally witnessed, with her own grandmotherly eyes, the progressive dilation of the cervix that is to produce the wee babe she will know as grandchild? What charlatan would take the name “Grandma” if she failed to be within 36 inches of the crowning blood-soaked noggin of her spawn’s spawn? Since the dawn of time, all grandmothers have been within spraying distance of errantly projectile afterbirth, and you and only you are being excluded in this way. It is appalling that your son thinks so little of you that he does not long for his mother to be as close as possible to his wife’s naked, heaving body as she produces this child for you. After all, you are a nurse!

Pregnancy looks beautiful on many women, but obviously it has turned Julia into a self-absorbed cow who believes she should have full control over who surrounds her during one of the most intense and potentially vulnerable moments of her life. Would that she weren’t so selfishly preoccupied with her own meaningless bullshit surrounding bringing a human life into the world and instead could see the incredible opportunity she has to show her respect for you, in the form of her whole entire vagina. Alas, this egotistical woman can’t see past the end of her own baby-nourishing bellybutton to the person at the center of this new family: You.

The only recourse now is to take this over Steven and Julia’s self-obsessed heads to the doctor or administrator in charge of hospital policy and confirm that there’s no rule against having two children in the delivery room.

“I’d like your opinion on a relationship question — but not the typical kind that you get. It’s about the relationship between Americans and British royalty.

Why is it that so many Americans, especially women, are obsessed with those British royals? We fought a war to throw off the oppression of privileged people like them. A couple of decades later, they sent their army to attack us and burn much of our capital. I have no problem with our being friendly to the British people, but monarchy reeks of slavery and imperialism. What do you think? Personally, I blame Walt Disney!”

—From “Paul in Sonora” via “Dear Annie,” Creators.com, 18 February 2018

Dear Paul,

Women are dim-witted fools who will cotton on to anything shiny because they are too dumb to know the difference between fantasy and reality. (Men, of course, would never indulge such an interest because they are very smart and their use of Axe body spray creates a kind of herd immunity to the manipulations of late capitalism.) Sadly in the case of British royalty, American women’s wholesale dipshittery in the face of anything wearing a hoop skirt and a crown also results in a widespread lack of patriotism, making American women an especially degenerate class of traitors to this great country, where slavery and colonization never had a home, and where everyone has always had exactly the same rights and exactly the same access to those rights forever.

I worry that there is an overabundance of focus on sperm donation to queer parents, and not enough on the folks raising the children.

flickr / m anima

By Katherine DM Clover

Queer women, and other LGBTQIA folk with uteruses? We’ve been making babies for a long time. But making those babies isn’t always easy, in part because of one tiny cell: the spermatozoa. While many straight people (though certainly not all) have all the basic ingredients to grow a new human right within their relationship, many (though certainly not all) queer people need to look a little farther for all of the components.

For those of us with uteruses looking to carry pregnancies, that often means using a sperm donor.

I’m a queer woman, married to a non-binary person who was assigned female at birth, so when we decided to have a kid together we knew we were going to need sperm. Our child is a toddler now, and when folks ask about our family (and they ask a lot) I’m usually very open and honest about our arrangement. Partly I do this for my kid’s sake — I don’t want him to grow up getting the idea that the way he came to be is a dirty secret — but I also have no problem being the person who educates people about the realities of queer reproduction.

Lately I’ve noticed something, though. People are really interested in our kid’s sperm donor (who just happens to be trans). And people think it was really really nice of them to give us that sperm. Sometimes it almost feels like a jumping off point to a larger conversation, which is all about how giving and amazing the people are who donate sperm to needy ladies like me. To hear people talk about it, sperm donors are brave and inspiring heroes, doing something selfless to aid others on their way protracted path to parenthood.

Don’t get me wrong. I’m really glad we were able to get sperm when we needed it, and I certainly said thank you. But the overemphasis on sperm donors in the world of queer parenting is starting to make me uncomfortable. When there are so many queer folks working so hard to raise kids, why is there so much focus on the people (mostly men) who donated the sperm? Sperm is undeniably an important part of bringing a human child into the world, but so are many other things. I worry that there is an overabundance of focus on sperm donation, and less on the folks raising the children.

Sperm donation, at its core, is a pretty simple concept. Forgive me for getting all sex-ed on you, but to make a fetus (that can grow into a baby) you need a sperm and an egg. If you need more info, I recommend What Makes A Baby, by Cory Silverberg (my kid loves that book). Some people want to have children, but don’t have sperm. In those cases, donated sperm (either from a friend who makes sperm, or purchased from a sperm bank) can be used to fertilize an egg or eggs. Depending on the specific circumstances for all involved, conception might take place in a clinic, at a doctor’s office, or even at home (and no, most of us didn’t have sex with our sperm donors).

A person absolutely doesn’t have to be gay or queer to need or use a sperm donor, but it’s pretty common among queer women. In this essay, that’s mostly what we’re talking about.

For the uninitiated, there are two main types of sperm donors: known donors and unknown donors. Known donors are typically people you know (just like it sounds like), and they agree to do you a solid by giving you some sperm. The other option is the unknown donor, which means that you are purchasing sperm from a sperm bank, and you don’t know the person who donated. It’s generally understood that unknown donors are legally simpler (and therefore safer) and known donors are a murky legal area. Many banks also offer a third option, which is an unknown donor who agrees to have their contact information eventually released to any children they help create. For many parents, this seems like a nice compromise. All of those options are equally valid ways to make a family.

How Can The Queerest Generation (Ever) Still Believe In Gender Roles?

Oh, and almost all the sperm donors at sperm banks in the United States are straight, cisgender men. Just like gay men don’t get to donate blood in the United States, they aren’t able to anonymously donate sperm. Which means that when we talk about sperm donors in general, and their awesome generosity that leads them to selflessly part with their sperm, we’re mostly talking about straight dudes. And if they donated through a sperm bank, they were financially compensated. Whether or not that compensation was fair for the amount of time and inconvenience demanded is another matter, and in truth, it seems like donating sperm is not all that sweet a deal. However, many kinds of labor pay poorly, yet few low wage jobs comes with the “selfless hero” label.

So why are these heterosexual men who were paid to masturbate without lube the heroes of the queer parenting world? Well, I think the way we talk about men who part with their genetic material reflects a lot about our own culture — and our culture is infused with patriarchy at almost every level.

Our culture sees men who give up their sperm as giving up something fundamental and important, and that something is paternity. On some level, we still see fatherhood as biological, and we still see fathers as patriarchs. We see this ideology manifest in various subtle forms, like the way that “to father” as a verb means to get somebody pregnant, but “to mother” always includes the physical and emotional labor of parenting.

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It’s there in the fact that westerners originally assumed the soul of a new child was literally contained in the father’s semen. And even though we now know that the sperm and egg are equally important, much of our reproductive education still anthropomorphizes sperm cells. Sperm tends to be seen as active, competitive, willful, and goal-oriented…in contrast to eggs, which are usually portrayed as passive receptors. As far as the patriarchy is concerned, men have a biological right to control their children, and to give away a single spermatozoa is to relinquish that right over a potential child.

How brave, how noble.

This hyper-focus on the supposed sacrifice made by sperm donors is insulting to the people doing the actual labor of making, birthing, and raising children. Queer parents themselves face an incredible number of hurdles at almost each step of our parenting journey, and we deserve credit for the enormous amount of work we do.

Planning for and trying to conceive is work. Carrying a pregnancy is work. Giving birth is work. Caring for a newborn is a hell of a lot of work, as is caring for a child of pretty much every age. On top of that, we often deal with social stigma and a host of other issues related to our marginalized identities (which can be amplified if we are multiply marginalized). All of this is labor that deserves recognition, and is not performed by sperm donors.

Sperm tends to be seen as active, competitive, willful, and goal-oriented — in contrast to eggs, which are usually portrayed as passive receptors.

It isn’t that donating sperm isn’t a nice thing to do, it absolutely is. Rather, the issue is that the level of praise and admiration seems a little outsized. The people (predominantly men, though our particular sperm donor happens to be trans) who donate sperm are absolutely giving part of themselves away, and that’s an act of generosity that matters.

But we need to be very clear here: They aren’t sacrificing a limb or a vital organ — they’re donating individual cells, which their bodies readily and easily replenish in case they need more. And yet, our culture insists on elevating this act and the people behind it, while ignoring the labor of queer parents.

Even in the world of queer moms, it seems, we can’t escape the far reaches of patriarchal bullshit.

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