“Mis-carriage”

Why the hyphen separating the two halves of that word? This week I’ve been musing, by necessity though not design, on the concept of “miscarriage.” From the OED:

mis-, prefix.
Germanic, Old English origin; prefixed to verbs with sense “badly,” “wrongly,” “perversely,” “mistakenly”

carriage, n.
Carrying or bearing from one place to another; conveyance.

Though today the term “miscarriage” is typically attached to pregnancy, really we could describe the improper conveyance of anything–physically, conceptually, politically–a “miscarriage.” Over time I know I have “mis-carried” a lot of things. However, the main reason for this focus is that on Wednesday this week I miscarried my first pregnancy. To cut a long story short, I went to the ER on the day before Thanksgiving; several ultrasounds and exams confirmed the pregnancy had ended; I had a D & C; I slept it off at home; I cooked the big holiday dinner the next day. This experience made me think about other abandoned, aborted, or misaligned projects or endeavors of mine, or of other folks. To risk the wrath of parents who say that nothing is like the experience of birthing or raising a child, bear with me for the sake of the metaphor.

For example, I’ve considered in the last few months what it means–what it really means–to follow a long-term project through to completion. After all, I have to write a dissertation, a project which at this point looks as though it will take at least two or three years. For many humanities scholars, it takes much longer to complete a Ph.D. I know some folks in my own department who have been there eight or nine years (not something I hope to do). Many humanities folks will discontinue their work at some point (I hesitate to use the phrase “drop out,” because that sounds too juvenile considering the very difficult pressures of adulthood and academia). I got to thinking of an abandoned dissertation or abandoned academic career as a “miscarriage” for several reasons. One, an academic project or career is kind of like a child of the mind, spirit, and even body. It takes form in one’s imagination; one can work hard on its development; one has dreams for its future. One tries to take all the necessary precautions and make all the necessary interventions for its success: attending conferences, applying for grants and scholarships, padding the CV with any professional development opportunity available, and so on. However, not all projects, nor all pregnancies, go on to completion. The relationship between ex-scholars and current academics can be a bit prickly at times: it seems that those who leave academia often find themselves defending their decision to condescending colleagues who say, “Oh, the academy’s not for everyone,” or a variation of, “Oh, decided you wanted to make money instead of doing new work?” and so on. This is a very unfair characterization of people who leave academia or who discontinue a scholarly project. It also does not recognize how common it is to leave academia after finding oneself unsatisfied there.

Similarly, as I’ve been perusing message boards dealing with identifying a miscarriage and dealing with the loss of a pregnancy, and as I’ve reflected on conversations with my own circle of family and friends, it seems that though miscarriage, especially in early pregnancy, is very common (I’ve been given figures ranging from 30% to 70% of all women have a miscarriage at some point), it is just. not. talked. about. The responses on the message boards are telling. A woman may feel ashamed that her body couldn’t do this one evolutionary thing correctly; a woman may feel guilty that something she did or didn’t do ended the pregnancy; a woman may feel obligated to put on a straight face and not admit to feeling deeply about the loss of an early pregnancy. Despite the relative abundance of miscarriages out there, they really don’t get much talk time. The same silence often follows–or is cultivated by–those who leave graduate study, or who leave a large project unfinished. The sense of shame–its cultural imposition–is prevalent, though to me shame should not enter into the equation.

For instance, as I called my family and told them the disappointing news that I had miscarried at 10 weeks, I was surprised to find that at least four women between my own relatives and my in-laws had also miscarried within the past two generations. Previously, I had known only of one relative’s experience. When I was in the ER waiting for ultrasounds and exams and medications and an operating room, two of my nurses told me they had had miscarriages as well as successful pregnancies. I kept thinking, “Why, if this is so common, does no one ever talk about it?” The cone of silence seems to be around early-term miscarriages moreso than later-term stillbirths. I think the uncertainty resulting from the limited sense one gets of an embryo or fetus in its early stages contributes to this cone of silence. If you haven’t seen an ultrasound, heard a heartbeat, or found out the sex of your baby, can you really become that emotionally attached? Yes, for some women–for instance, if repeated attempts or fertilization treatments have failed in the past, or if one is by disposition more emotionally attuned to the idea of a baby growing in there. However, that was not the case for me, which leaves me attempting to figure out if I’m a secret sociopath or if I’m simply a product of rational, academicky analysis.

What I mean is this: I was not emotionally attached to the fetus (or embryo…it’s still not clear at what stage the pregnancy self-aborted) because I was only 10 weeks along and had not yet had an ultrasound (I was supposed to have a first ultrasound next week). There wasn’t really time for me to feel yet like the pregnancy was REAL: my body wasn’t changing yet (except my boobs had already gotten bigger, which was awesome); I had almost no nausea; my other classic first-trimester symptoms were relatively low-key in comparison with some of my friends’ experiences. My spouse and I had told our parents the good news only days before we had to deliver the bad news. I was fortunate that my parents-in-law had traveled down to be with us for the holiday–I think they took the event of the miscarriage harder than I did, but they were very patient in the ER while waiting for news. We had originally planned to tell the rest of our families over the phone on Thanksgiving, and I now had to decide whether to drop the bad news. I decided that I did not want to continue the cultural sublimation of shame alongside miscarriage–shame through silence–so I told our various families.

I considered my own reaction and how I structured my conversations with my families: I decided to be the way I was. Resigned but not shamed; disappointed but not sad and certainly not devastated; irritated that my carefully-timed pregnancy got messed up. However, I omitted the part where I felt a little relieved because, although we decided years ago that we would have a child and we worked for several months to get pregnant, I’m still ambivalent on trading my independent adulthood and my skin elasticity for years of sleep deprivation. I value my own self, my marriage, and my career, so I don’t want my kiddo to be the tyrant of my life. I write that in the most loving way possible, but I often find that other women respond with some form of disgust or dismay when I mention it. Sigh.

Interestingly, everyone took the news in quite different ways (though I acknowledge it’s hard to gauge reactions over the phone): some, like my father with whom I purposely have little to no contact, seemed broken up; some directed attention to themselves and their own exploits; some were quietly sympathetic (these were the women whom I was just learning had had miscarriages too); none were shocked or weepy (or at least they had the courtesy to get off the phone first!). All were surprised that I was pregnant in the first place, though they should not have been surprised that I would hold in the news for so long. I thought waiting 10 weeks would get me out of the danger zone (ha). I also don’t like the thought of my extended circle thinking about my body in that way, or really thinking about my body at all, and I didn’t want to be the center of attention.

However, those personal reactions or desires clash with my other desire to help demystify and de-shame miscarriage. To do so, one must “own” the event–but how does one do that, really? It certainly doesn’t seem appropriate to take pride in the event, but it does seem appropriate to talk about it. Acknowledging that miscarriage exists and is very common is not enough; acknowledging that a range of emotional responses is good but still not enough. There must be some kind of balance struck between accommodating the range of women’s personal responses (from devastated to neutral or even relieved) and not secreting those responses or looking down on them. I was worried that my family may think I’m a secret sociopath for not being totally broken up after miscarrying my first pregnancy; now I’m resolved to help change those types of perceptions by making pregnancy neutrality a thing.

Postscript:
Because this all happened over Thanksgiving and there was a lot of football on TV, I also got to thinking of “mis-carrying” in the sports world, and how the idea of “fumbling” a ball, a play, a project, a dissertation, a fetus, etc. can give the impression of an accident. Since there’s no one to blame in a true accident, it might be useful to think of miscarriage as a biological accident, or an evolutionary accident, in which (in many cases) no one can be blamed. No blame means no shame for either the event or for the feelings which accompany it.

Post-postscript:
Evolutionarily speaking, a miscarriage is actually a pretty good thing. Many early-term miscarriages are the result of some genetic sequence being incompatible or incorrectly put-together which, if the fetus were carried to term, would likely result in birth defects or disability. These thoughts helped me not only rationalize the event but be relieved that it happened when it did. Better early than late.

What do scholarly women talk about?

Pile of books and painting of a mother and infant

Books or babies? Both, of course.

The other night, a sizeable group of women from my graduate program got together for “ladies’ night:” movies, desserts, and drinks. I baked a version of apfelkuchen, a German dessert which I’ve mentally filed under “mouthgasm.” The movies took a backseat to the banter. In addition to the normal party chitchat, many of the conversations addressed aspects of our graduate program, questions and concerns about advanced study in academia, and a healthy dose of grousing. So what, then, do scholarly women talk about?

Well, the Facebook invite read, in part:

“At some point, think of something that A) is worth celebrating, B ) is a point of contention, and/or C) is something you just think a group of smart and funny women should discuss. One or all, it doesn’t matter. We can anonymously (or not) consider any or all of these things at Ladies Night. Some examples might include:

     Does painting my nails make me look unprofessional? Does asking that question make me look unprofessional?

     I gave a kick-ass presentation last week on [x, y, z].

     How to deal with the patronizing ‘old white male’ syndrome.

     Proposing special-topics courses: to be contentious, or to not be contentious.”

I had to leave early, so I didn’t get a chance to engage in all the conversation, but until I left we were engaged in various topics such as course proposals, marriage proposals, gendered professional events, gendered superheroes, preparing for comprehensive exams, writing the dissertation prospectus, departmental gossip, and sports teams and activities. These are all pretty standard topics; at other women-only academic gatherings, I’ve noticed a pretty strong focus on having children during grad school or as a newly-minted assistant professor. At the risk of sounding like I’m relegating academic women to the dregs of archetypal femininity by using the word “gossip” or by reporting on a bunch of chicks talking about girly stuff like how their boyfriends proposed or how many babies they do or don’t want, I’d like to consider the value of such discussion in general.

It’s been well-documented and well-discussed that as one progresses up the academic ladder, one is less and less likely to find oneself surrounded by women. The lack of women in the higher levels of academia is due to many factors, all of which contribute to the problem of gender disparity at the core of higher education. One of the results for women at all levels of academia is “imposter syndrome” (which by no means limited to the academy; women in all professions and interests deal with this too). Part of feeling like one is unworthy of the challenges her career sets is not having a strong community in which to feel involved. Women are more successful when they are surrounded by supportive, successful women.

Of course, there’s a chicken-and-the-egg conundrum: how will women get to be more successful unless there are already a bunch of successful women to help them out? True, at this point in history there are many extraordinary female role models for academics, corporate people, politicians, scientists, artists, humanitarians, and so on. But it’s kind of hard to get Hillary Clinton or Oprah Winfrey to meet you for coffee after a harsh meeting with your grad advisor. Many universities and academic societies now have women’s caucuses, which is a great start. An even better start, however, is getting to know the women in one’s own department. In graduate school, we tend to end up far from friends and family, so those support networks are not as accessible. Moreover, many friends and family simply don’t understand the pressures, commitments, frustrations, and joys of graduate study, so what mental or emotional support they can offer is often not enough. I personally find it very difficult to construct new social-professional (I’ve been at my current institution for two and a half years and finally feel like I have department friends—damn my introversion!), but making the effort is worth it.

The danger here is making the misogynistic assumption that women always need to be around other women, because, you know, hormones and gossip and sharing recipes and talking about infants’ bowel movements. No; a woman needs to know that she is not the only one whose experience in her academic career has unjustly left her feeling inadequate. A woman needs to be able to express her anxieties in a safe space, which even now (in what we like to fantasize is the egalitarian 21st-century USA) is often still a female-dominated space.

In some ways each new crop of graduate student women has to reinvent the wheel by finding out for themselves the diverse challenges and barriers that academic women face. Some of those barriers are worth an eye roll—“My male students, who are mostly taller than me, keep looking down my cleavage when we talk”—and some are more insidious—“The department chair said that I can’t teach during the second half of my pregnancy because ‘What if I need to leave school suddenly?’.” Ladies, no one will make the institution better for women unless we do it ourselves. If the occasional “ladies’ night” can give us anything, it’s a forum for addressing these issues among like-minded people. It’s also a way to normalize women in academia, and to work towards changing the university system to retain more strong female talent.

Condition and Community

While many of my forthcoming blogs will be scholarly and analytical in nature, this one definitely advocates for certain choices. I do try to be fair and acknowledge that my choices are not for everyone or every situation.

Earlier this week I visited a local birthing center. A what? A birthing center is a private clinic in which midwives and nurses, not OB-GYNs, attend women for all prenatal care, the birth itself, and postnatal care. On the spectrum between home births and hospital births, birth centers fall right into the middle, and so may be a good choice for women who are not made overly nervous by the idea of giving birth, whose pregnancies have progressed normally and healthily, or who prefer a less clinical, less hospital-y atmosphere. This blog, therefore, will be about approaching pregnancy and birth in terms of “condition” and “community.”

Birthing Center suite vs. Hospital delivery suite

On the left is one of the birthing suites at the birthing center I visited. It includes an attached private bathroom with shower as well. On the right is one of the delivery suites from one of my local hospitals. It has a private bathroom too.

Modern midwives do much the same thing that OB-GYNs do, except they tend to “interfere” less in the pregnancy and birth.  That word “interfere” has a lot of negative connotations, but in the interests of analysis, I’ll attempt to make the term more neutral. Think of interference in terms of interventions (medical, physical, technological) versus observation. During prenatal care, interventions may be anything from multiple blood draws, genetic testing via amniotic fluid collection, multiple ultrasounds, and/ or a pelvic exam at every visit. During birth, interventions can range from inducing labor via Pitocin, to constant fetal monitoring (either external or internal), to episiotomy, to cesarean section. There are many other specific interventions as well, some even to the extent of not letting the pregnant woman eat or change positions while laboring. Of course, some interventions are definitely medically indicated in certain cases, and should thus not be shunned.

Birthing centers encourage laboring mothers to let their bodies work without medication during labor. Midwives are trained in pain management techniques such as massage, counterpressure, positional changes, movement, and water therapy; however, most birthing centers do have some chemical ways of assuaging pain, such as the synthetic narcotic Nubain or the use of nitrous oxide. Midwives will advocate for medical intervention a) when they deem it necessary, but b) not without the mother’s consent. Of course, doctors must in general have patient consent for any procedures as well, but the overall environment of a birthing center versus that of a hospital may sway a laboring mother to be more relaxed and in tune with what she actually needs. Studies have clearly shown a higher correlation between hospital births and optional interventions, whereas birthing centers perform fewer interventions but have the same fetal and maternal safety rates as hospitals. Mothers might worry about their newborn’s health in a birthing center, but these centers have standard resuscitation gear (oxygen tanks, masks, pumps), anti-hemorrhage drugs and equipment, and many other tools to help mothers or babies who need it. The midwife with whom I spoke at my birthing center visit said that they will not hesitate to transport (either via car or ambulance) a mother or baby in distress to the nearest hospital if it becomes necessary.

Typically, a midwife’s philosophy is that pregnancy and birth are a state of being, rather than a medical condition or illness. In other words, midwives tend to treat all pregnancies as healthy and normal, unless otherwise indicated. This is in contrast to the views–and indeed, the training–of many OB-GYNs, who tend to approach pregnancy and birth as a medical condition akin to illness. This is not to say that OB-GYNs are insensitive to a woman and approach her only as a sick patient: I have had several OB-GYNs assure me that they prefer as much of a hands-off, normative, non-interventionist approach as possible during pregnancy. However, OB-GYNs, being doctors, tend to rely more on instruments, statistics, drugs, procedures, and policies during their care. It doesn’t help that hospital OB-GYNs tend to have many patients and not much time for each one of them. During labor, the OB-GYN is called for only periodically and in the final moments to catch the baby; hospital nurses will be in and out of the room because they can rely on electronic monitoring to tell them when to see the mother. Conversely, a midwife tends to help the woman understand her own body and its cues, prioritizing and trusting the innate human ability to carry and birth a child. Additionally, birthing centers see many fewer patients than hospital delivery wards do. The center I visited hosts between three and ten births a week, and laboring women seldom overlap with each other. Due to this low volume, someone (the midwife and her nurses will rotate with each other) stays with the mother the entire time, unless she and her partner ask for some privacy.

It’s not only labor where the difference between a birthing center and a hospital becomes apparent. During prenatal care, a hospital and a birthing center typically meet with a mother about the same number of times: once a month until Week 32, then once every two weeks until Week 36, then once a week until delivery. At hospitals and OB-GYN offices, these prenatal meetings tend to function like a doctor’s visit: they are relatively short and take place in an exam room. Hospitals offer birthing and childcare classes, but they are separate from the prenatal healthcare visits. Many birthing centers, on the other hand, do what is known as “centering.” Centering is a monthly meeting of women who are due around the same time–perhaps within one or two months of each other–coupled with short health visits. For example, at the birth center I visited, each Centering meeting begins with a private health check between the midwife and each mother. This short checkup allows the woman to ask private or sensitive questions specific to her own concerns, and assures both the midwife and mother than the pregnancy is progressing normally. Then, the group of mothers are either led in a specific class (e.g. pain management techniques in labor; pre- and post-natal yoga; breastfeeding) or encouraged to ask general questions and converse about their impending motherhood. The Centering cohort remains the same, so women often form friendships, or can at least organize shared group-style child care. Though some women (myself included) may balk at the notion of sharing our (silly? stupid? strange?) questions, I realize that if I were to have a silly question, then someone else probably does too.

If we had to divide up the birthing experience into binary halves (which of course is never quite accurate or fair, but a line has to be drawn somewhere for the sake of ease), then hospitals and OB-GYNs tend to view pregnancy and birth as medical conditions, whereas birthing centers and midwives tend to view them through a community lens. Both professions agree that birthing is a natural process; they tend to disagree on how natural we should let it be. Some interventions may be medically indicated and would have the wholehearted backing of a midwife; some may be unnecessary from a medical standpoint; some may be necessary for the individual woman, for example if she is overwhelmed by pain during labor.

Personally, because I know how my own mind and heart work, I know I am more likely to be nervous in spaces with obvious medical accoutrements; with people going in and out of the room; with being surrounded by beeping machinery. Constant monitoring of anything (like the watched pot which never boils) makes me second-guess myself, and makes me anxious. Therefore, after all my personal research and after meeting with the midwives at a birthing center, I know that if my own pregnancy is normal and healthy, I’ll choose a birthing center wholeheartedly.

(P.S. Birthing center costs tend to be much lower than a hospital birth, because birthing centers don’t need to pay for a big building, lots of equipment, staff, anesthesiologists, surgeons, etc. Typically, women stay in a birthing center less than 24 hours, compared to 2-4 days in a hospital. I’m lucky to have good insurance that accepts birthing centers, and the total price I was quoted was $1165, including insurance coverage, for all prenatal care, staff, facilities, 20-week ultrasound, the birth itself, and a home visit two days after birth. An early ultrasound would run an additional $145; nitrous oxide during labor is $50 for 15 minutes or $200 for the whole run. Considering that I’ve had hospital prices quoted between $3000-$5000 [after insurance kicks in] for a healthy, normal vaginal birth, the price tag is another reason to consider a birthing center!)

Welcome!

Hello, and welcome to Bearing Scholarship, a blog about the intersections between the academic environment, scholarly work, graduate study, pregnancy, and parenting. I begin this blog for several reasons:

1. My dissertation explores the representations of pregnancy and birth in British literature between 1720-1830. My scholarly methodology, findings, interpretations, questions, and arguments are part of the larger conversation about the many childbearing issues facing modern women. Literary study, social and economic inquiry, medical texts, epistemology and aesthetic theory, and archival finds are all a part of this project.

2. The university system, from its graduate students to its tenured professors to its administrators, has recently drawn more and more scrutiny of the ways it responds to pregnant women or women with families. Childbearing women in academia often find themselves in a bureaucratic and professional mess when they must balance the seemingly-opposed demands of two halves of their lives, and the effect of childbearing on a tenure-track hopeful is demonstrably not good. These are things we must investigate in order to change.

3. I will explore, to an extent, the personal side of childbearing in academia. Looking through a subjective lens can help us balance all the abstract “theory,” or statistics, policies, and ideas, with some concrete “practice,” or the real effects of policies and ideas. What do graduate student mothers (and fathers) actually experience? How are they treated by their departments? Should a pregnant graduate student hold off on entering the job market until after she has delivered? Essentially, beyond OB-GYN visits and the travails of selecting a pediatrician, what additional institutional pressures and problems do pregnant or parental students and scholars face?

I must acknowledge the risk of creating a blog like this. These risks are purely professional, which will become apparent as I continue writing. Unfortunately, many job-search committees, whether consciously or not, are averse to hiring pregnant women or mothers. Many institutions have no policies, or only vague or unwritten policies, determining the status of such women during the tenure-track phase or during graduate study. As I am a graduate student who will face the (quite terrible) academic job market in a couple years, and as I am a woman of childbearing age who may become pregnant, I put my professional persona at risk of ridicule, refusal, or being ignored and marginalized. I risk becoming one of “those women” whose concentration on a mere biological process like birth apparently detracts from her humanistic scholarship. In order to mitigate this risk as much as possible, I am authoring this blog anonymously (at least until such time as I can assert my identity). For now, you’ll know me as “L.”

Why do I take this risk? To prove to skeptics that vigorous scholarly research, writing, pedagogy, and service can coexist quite well with the processes and requirements of pregnancy, birth, and parenting. Institutional and social change–continuing to open our minds and hearts, and stressing equality and opportunity despite differing circumstances–are necessary for female scholars to feel unconstrained by either biology or administration in the academy.