Ordinary Insanity, page 10
Another woman, pregnant with her third child, mentioned to an OB at her practice that she’d like her four-year-old daughter to be present at the birth. The OB, she told me, closed the door and harangued her for more than half an hour about the insanity of this decision. “This is a medical procedure,” the OB said, as if my friend were a child imagining fairy tales and not a mother who’d already given birth twice. “You could go into cardiac arrest on the operating table. Do you want your daughter to see that?” The woman made a list of all the risks the OB had tried to scare her with: tearing, hemorrhaging, her daughter being traumatized by witnessing “blood and fluids,” her daughter being traumatized by seeing her mother naked, her daughter reporting the experience to all of her friends at school and traumatizing other children, her daughter seeing the baby covered in vernix and fluid and being disgusted and unable to bond with the baby.
In a formal letter of complaint to the hospital, my friend pointed out that the risk of a woman going into cardiac arrest during labor is less than .001 percent, and the risk of severe postpartum hemorrhage is approximately 1 percent. The four-year-old daughter’s witnessing birth, witnessing her baby brother’s first breaths in the world, might have become one of the whole family’s most powerful shared memories. My friend, passionate about women’s rights and about making women’s lives visible, cares deeply about sharing with her daughter the epic significance and struggle of birth, but the OB did not seem to care about this. She cared about the remote possibilities of disaster that she blew up to larger-than-life dimensions. She cared about zero risk.
The women doctors, anthropologists, and bioethicists of the Obstetrics and Gynecology Risk Research Group point out, “It is the physician’s obligation not to eliminate risk, but to help patients weigh risk, benefit, and potential harm, informed by best scientific evidence and guided by a patient-centered ethic.” But this obligation, otherwise in evidence in patient-doctor relationships—as doctors try to help patients decide whether or not to go on certain medications, for example, or whether or not to undergo certain procedures—vanishes in the context of pregnancy.
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The room where my daughter Elena had her checkups at our pediatrician’s office had a poster tacked to the door of a baby sleeping next to a giant butcher knife. “Every week in Ohio, three babies die in unsafe sleep environments,” it announced. This statistic is presumably derived from the number of sleep-related deaths per year in Ohio; in 2015, 471 infants died sleeping in areas considered unsafe. These areas could include adult beds and couches as well as car seats and playpens. Over half of these infants were born prematurely; a quarter were born before twenty-four weeks. This means that around 240 full-term infants died in unsafe sleep situations throughout the year, or about .1 percent of all infants born that year. Still, our pediatrician told us that co-sleeping is “extremely dangerous.”
I pointed out that I’d done my research and set up my bed specifically for co-sleeping—a firm mattress, no blankets or pillows or toys, not even my husband—and that both the baby and I slept much better this way. I pointed out I wasn’t using drugs or getting drunk or smoking. I pointed out studies that showed that sleep-related deaths are actually much lower in countries like Japan where co-sleeping is the norm and that co-sleeping has long been the norm around the world. She insisted I was endangering my baby’s life.
I didn’t point out that many co-sleeping deaths happen precisely because of the fear-mongering in the United States around sleep: exhausted parents, too frightened to co-sleep, keep trying to get their baby down in a crib or bassinet until, finally, groggy and overwhelmed and unable to think clearly, they pull the baby into bed with them or fall asleep in the rocking chair. The U.S. obsession with safety can have an effect opposite to its intentions: by stoking parental misery, it ultimately creates dangerous environments for children.
In a rare mood of defiance, I continued to co-sleep and did so without guilt for the first several years of my daughter’s life. By the time Elena was two months old I was getting decent sleep. By the time she was four or five months old, she was going to sleep at a fairly regular hour and sleeping “through the night,” albeit with the help of breastfeeding on demand, which was easy enough when I was lying right next to her in bed. This single point of defiance on my part against the medical establishment may have spared me some anxiety at this vulnerable postpartum moment, and in fact those first six months after Elena was born were some of the most achingly beautiful ones of my life. Some of the wisest decisions I made as a parent stemmed from a direct disobedience of fear-stoked cultural norms.
In 2018, when my daughter was three, NPR published an article titled, “Is Sleeping with Your Baby as Dangerous as Doctors Say?” The answer was no; the risks had been grossly inflated. The piece notes all the warnings from the American Academy of Pediatrics—no parent should ever co-sleep at any time—and then cites the actual statistics, which show that the risk of death from SIDS while co-sleeping is 1 in 16,400; for comparison, the risk of being struck by lightning is 1 in 13,000. It highlights what I discovered in my own research: the studies on co-sleeping have failed to discriminate between many different types of co-sleeping, including situations in which the mother is drunk or has been smoking, situations in which mother and infant are sleeping on a huge overstuffed couch or chair, situations involving premature infants sleeping under blankets, and situations in which infants born at term sleep on stripped-down mats with breastfeeding mothers.
This conflation of circumstances denies mothers and babies significant benefits and arguably confers harm. Co-sleeping provides measurable benefits for the child: sleep studies have shown that a breastfeeding mother creates a little nook for her baby in the bed, regulating its heartbeat and breathing, calming it throughout the night.
In this case, a pattern can be seen that governs almost all of women’s choices in the context of reproduction: a minimal risk, which can be made almost nonexistent with the right precautions, is exaggerated and applied equally to all women and all babies, with the explanation that women will not be able to parse any differences in risk by themselves and so must be counseled to avoid a situation entirely. Meanwhile, this extreme interpretation of risk can actually damage mothers and babies in subtler, more insidious ways, not so easily measured by science, or which science is not particularly interested in measuring.
4
The Risks Not Taken
One way Jamie measured normal versus pathological was by asking friends and colleagues. She went through a spell where she was obsessed with the news stories about people leaving their children in hot cars. She could not stop thinking about her husband leaving her son in the car. So she asked her boss, “Is it normal that every time I pull in my driveway, I have a pit in my stomach that I’m gonna look in my husband’s car and my son’s gonna be there?”
“No,” her boss said, “that’s not normal.”
But in the end, it didn’t matter: she was sick to her stomach every time she pulled in the driveway anyway. She mentioned this particular fear once to her psychiatrist and he said, “Zoloft could help that,” but she’d already been on Zoloft and it hadn’t done anything for the anxiety. She didn’t want to be on it again. So she just endured the anxiety, the way people endure drought or rain or frost.
Jamie became ultra-vigilant about hoodies. Her mother would buy her son adorable, expensive little shirts with hoods and Jamie would say, “Thank you so much, that’s great!” and hang them in her son’s closet and never let him wear them. The babysitter would put him in an outfit with a hood and immediately, Jamie would take him out of it, saying, “It’s too hot for that.”
“I had excuses for everything,” she told me. It is possible to get really, really good at excuses. It is possible to squander almost all of one’s creative resources on inventing them. Still, after a while, excuses grow threadbare: people start to glimpse the madness like the swirly sheen of a pearl.
“Why are you taking him out of his clothes?” friends would ask Jamie.
“It’s a safety thing,” she’d reply, like it was plain and simple, and they’d push, and then she’d feel trapped, because she knew she couldn’t fully explain without sounding, well, crazy, and on some level she knew it was crazy. Listening to Jamie’s story part of me thought, Wow, that’s crazy, and then another part of me was instantly ashamed, because I realized that yep, that was probably crazy, and that it was the exact same kind of crazy I am, only the details of my craziness differ: I might not let my daughter touch fences. Garden hoses. A restaurant crayon. My kind of crazy was as finely tuned and all-consuming, just of a slightly different species. Surely there are women who will read about mine and Jamie’s and think, That’s nuts! And then they will go home and sterilize every one of their children’s toys, or Google the health effects of sodium benzoate until their eyes are bleary, or lock all of their electric cords in a hidden compartment. It is so easy to feel smug about another person’s crazy—wow, really?—and at the same time remain completely, blindly enthralled to one’s own.
One day, Jamie was walking by a playground near her house when she noticed a sign: it had a drawing of a hoodie with strings, and it displayed a warning about hoods getting caught in playground equipment. She was ecstatic—her anxiety was not crazy! She took a picture and sent it to everyone she knew and said, Look, hoods are a threat! To this day, she does not let her six-year-old son wear hoods.
Jamie tells me: “When I say it out loud I know it’s ridiculous, but it’s no skin off my back to not put him in a hood, so why not?” Why risk it?
Jamie used the refrain I hear over and over from pregnant women, and that I only paid attention to once my OCD therapist pointed out how frequently I myself recite it: “Why take the risk?” Most of these gestures are fairly small. How long does it take to pack some extra Benadryl? To cut off a hood? To wash a child’s hand? How hard is it to forgo an iced tea? A salmon roll? A beer? Such a small detour is an extra five minutes, a little bit of diverted attention. Until one day, a woman sits down and makes a list of them all, the way I did in the therapist’s office in downtown Pittsburgh, and discovers that there are not enough lines on the page for every act of prevention or protection performed in the name of risk avoidance every single day.
Why risk it? The question is rhetorical; no respectable mother has to answer it. The rhetorical givenness doesn’t start to seep out of it until one asks it over and over and over: why wear this, why eat that, why try this, why go there, why drive, why fly, why, and then the repetition becomes so wearying that it is possible to see how this refrain grinds a life down to its smallest, saddest incarnation, to a hard little kernel of fear.
I have discovered that it is possible to live a life in a frantic, zigzagging scramble, dodging risk after risk, all creative energy and vitality funneled into a pages-long litany of tedious, precautionary acts. The amount of attention that can be poured into such rituals is stunning and tragic. But there is no reward for the mother who says, Fuck this, I’m going to take the risk.
The paradigm of zero reproductive risk is most glaring in the context of drinking. Most of those who provide women with care—even supposedly crunchy, establishment-wary midwives—recommend total abstinence from alcohol in pregnancy. No issue better illuminates the problematic ethics of negotiating reproductive risk than the question of safe alcohol use, and more specifically, the fear of fetal alcohol syndrome (FAS).
In her extraordinary book Conceiving Risk, Bearing Responsibility, sociologist Elizabeth Armstrong tells the story of how FAS first came to light as a rare birth defect, gradually took hold of public and medical imagination, and eventually became “demedicalized,” transitioning from a clinical diagnosis affecting a subset of severely alcoholic women into a social and moral issue that threatened all babies.
Armstrong first looks at the history of beliefs about alcohol and pregnancy, which have swung wildly from grave warnings about alcohol’s danger to claims of its benefit to the fetus. Into the nineteenth century, Armstrong explains, it was believed that children were indelibly marked by the moment of conception. The parents’ state at that fateful moment would shape the child’s personality and health. Thus, parents who were drunk while conceiving children would produce offspring “wont to be fond of wine.” Both parents were seen as responsible here. A passage in Plato’s Laws stated that “when drunk, a man is clumsy and bad at sowing seed, and is thus likely to beget unstable and untrusty offspring, crooked in form and character.” The state of drunkenness—sloppy, sickly, morally suspect—would somehow seep into the child’s soul.
For most of recent history in the West, it was believed that the quality of a man’s sperm—rather than a woman’s egg, health, or pregnancy—determined the heartiness of a child. In the late nineteenth century, the sperm’s mystical life force was referred to as the “germ plasm”: scientists posited that via the germ plasm, a certain set of essential qualities or characteristics were passed on from generation to generation. Doctors warned that alcohol could poison the germ plasm, affecting not only an individual child but the whole stock of a race. Worries about alcohol became implicated in eugenics. Armstrong quotes one early-twentieth-century doctor declaring that alcohol use would result in the “wholesale poisoning of civilized and semi-civilized races.”
At the same time, in the opening decades of the twentieth century, a contingent of eugenicists began to promote the idea that alcohol was actually a “fool-killer”; drunkenness would weed out degenerates and “weak stock” and breed temperance in successive generations. Those exposed to alcohol in utero would develop immunity to it, as if it were a type of vaccine. This theory was based on the dubious observation that so-called civilized races—“Jews, Greeks, Italians, South Frenchmen, Spaniards, and Portuguese”—had drunk abundantly for centuries and remained relatively sane and peaceful. As one American eugenicist put it, “the enlightened nations are the inebriate nations.”
The medical consensus veered back toward the adverse impact of alcohol in pregnancy when women began campaigning for suffrage and higher education. Medicine, writes Armstrong, “functions as a form of social control”; when anxiety rises about women defying traditional norms—entering male-dominated spheres of work or study; engaging in political activism; refusing to have children or having them later—medicine can step in to act as a corrective, reinforcing women’s “natural” role as selfless, sacrificing mothers.
In the late Victorian era, doctors speculated that alcohol, carried in maternal blood, might act as a poison on the fetus in pregnancy. Certain studies on alcoholics suggested that the children of incarcerated alcoholic women—who were forbidden from drinking in prison—fared better than the children of those who were free and drank to excess in pregnancy. But more powerful than the findings of these studies was the growing belief that pregnancy was a period of risk and significance, and that the mother, more than the father, held responsibility for a child’s health. Just as women were fighting to break free of the bonds of Victorian social norms, they were reminded that they were the “divinely appointed guardian[s]” of not only their own pregnancies, but of society.
Then, in the relatively freewheeling 1920s, when women’s new rights had settled in and become familiar, the social tide shifted again. Drinking in the 1930s and ’40s and into mid-century was seen as fashionable, and women increasingly drank at the same rates as men. Temperance was prudish, passé. Meanwhile, older epidemiological studies were revealed as outdated and flawed, and the medical establishment rejected the notion of alcohol as a teratogen. In 1942 the editors of the Journal of the American Medical Association wrote, “In human beings it is difficult to prove that alcohol has a deleterious effect on babies in utero, even when large amounts are taken.” Armstrong cites a 1942 book by two researchers at Yale’s Center of Alcohol Studies, the country’s leading research institution on alcoholism, deriding the notion that alcohol was a poison, calling it a “social condiment” and insisting that there was “no acceptable evidence” of alcohol’s having any effect on the fetus. Doctors’ main concern about pregnant women’s alcohol consumption was excessive weight gain. A 1953 Clinical Obstetrics textbook warned, “Probably the most serious effect of drinking these beverages comes from the calories they, and the hors d’oeuvres which usually accompany them, carry.”
In fact, doctors were forcibly intoxicating women in order to prevent and stall preterm labor. This procedure, developed in the 1970s by a doctor whose wife went into labor in her seventh month of pregnancy, involved the intravenous application of pure alcohol, getting women so blitzed that “they smelled like a fruitcake.” Armstrong details nurses’ complaints of outrageously drunk mothers lashed to their beds. Some women received this treatment regularly for months. At mid-century, and until the late 1970s and early 1980s, doctors were as confident about alcohol’s innocuousness as doctors today are of its harm.
In 1973 and 1974, a group of doctors at the University of Washington School of Medicine in Seattle published a series of articles in The Lancet. These articles described a pattern of birth defects in children born to chronic alcoholic mothers, and introduced a new diagnostic classification for these defects: fetal alcohol syndrome. The articles were based on eleven case reports, all taken from non-controlled, retrospective studies, but they would form the basis of a new understanding of alcohol use in pregnancy that would radically alter women’s lives.
