Episode 51 SN: Race, Identity & Motherhood: Naomi’s story

Today’s guest, like many of us, encountered some unexpected twists and turns at the delivery that were challenging to manage in the moment. But the focus of the story she shares today is about race and identity–she gives us a sense of what it’s like to live in the world both as a daughter who doesn’t resemble her father, and as a mother who doesn’t superficially look like her son…what assumptions people make and share and what these assumptions suggest about how we define motherhood.

You can find Strength of Soul, here

More of Naomi’s work: The Hidden Curriculum and Rethinking Race in the United States

Audio Transcript

Paulette: Hi welcome to war stories from the womb

I’m your host Paulette Kamenecka. I’m an economist and a writer and the mother of two girls. 

Today’s guest, like many of us, encountered some unexpected twists and turns at the delivery that were challenging to manage in the moment. But the focus of the story she shares today is about race and identity–she gives us a sense of what it’s like to live in the world both as a daughter who doesn’t resemble her father, and as a mother who doesn’t superficially look like her son…what assumptions people make and share and what these assumptions suggest about how we define motherhood.

Let’s get to her inspiring story

Hi, thanks so much for coming on the show. Can you introduce yourself and tell us where you’re from? 

Naomi: Absolutely. Thank you, Paulette, for having me. My name is Naomi Rachel Enright and I am based in Brooklyn, New York.

P: Oh, wow. That’s lucky. Brooklyn’s like the place to be.

N: It’s a pretty cool place. I must say. I do love it. I love it. My son is being raised here was born here too. I do love it. And I love New York in general. Like I grew up in New York, in Brooklyn and the Bronx, actually, I went to high school in Manhattan. So I am a New Yorker through and through for sure.

P: Wow. So we’re here to talk about family so before we’re talking about the family you created let’s talk about the family you came from. 

N: Okay. 

P: So why don’t you tell us Do you have any siblings?

N: I do. I have one older brother. His name is Nikki and he is six and a half years older than me and also lives in New York. So that’s that we’re both still here. Yeah. And so

P: you have kind of an interesting story of your family moving here. Why don’t you tell us a little bit about that? Because I want to get a sense of whether the context you came from affected the context you thought you wanted.

N: Oh, wow. Okay. Yeah, no, that’s a great question. So I was raised in New York, as I said, but I was born in the La Paz Bolivia by chance actually, my father had a job there for two years. And so I was born there and spent the first 10 months of my life there and I am, ability and citizen but my origins are Jewish American on my father’s side. My paternal grandfather came to Ellis Island in 1910, from Russia. And my paternal grandmother was the daughter of Lithuanian immigrants. I mean, I think, you know, sort of the borders have changed over the course of time and so I’m sure maybe that you know, it’s like modern day Poland. What do I know but Eastern European, and my mother is from Guiaquil Ecuador, and did not come to this country until age 19. She came here on a scholarship at Tulane University. So she left at age 19 for that. And my father, my mother met through the Peace Corps. Actually, my father was a Peace Corps volunteer. He was teaching English and he was teaching English in Guiaquil, and my mother was one of his students. And so that’s how they met and fell in love. And were married for 44 years, I suppose. And my brother actually was born in Guiaquil. They had thought they would live in Ecuador. They were there for a few years before my brother was born. And then they came about the time they left Bolivia so he was about 10. months, I think as well. And then my mother jokes that she’s like a salmon because the salmon returns to its birthplace right to have its children. She wanted us born if not in Ecuador than in South America. But looking by birth, yeah, she was like this will do. So that’s my origins, you know, sort of ethnic, you know, familial origins, or

P: I know from your book that having an American father and Ecuadorian mother those two backgrounds together, played an important role in your life, and we’ll get into that. But on a more basic level, did you know that you would want a child?  Did you think I’m going to have a family?

N: Yes, it’s funny that you asked that because when I was expecting my son, and I’m the mother of one child, in his first almost year of life my father was we told me that I had been preparing for motherhood since I was about five he would joke because I did I always wanted to have children. I always thought a lot about becoming a mother, wanting children how I would raise them. I used to in fact as a little girl, I would name my kids so I have these list of things for my future unborn children. So it was definitely a want of mine, you know, a desire of mine. And I think that you know, there was some truth with my father said it wasn’t a preparation, a lifelong and I’m also an educator. And so I work with children of all ages for many, many years, you know, nearly 20 years and I have a way with kids I relate very well to children, and I relate well to actually a wide range of ages…I always had some younger cousins I would take care of and use or pretend they were my babies. I have a, my youngest first cousin, I actually named him and so, you know, I felt this real, you know, sort of very connected to him. I always joke that he was my first baby, which my son does not like he’s like, actually, I’m your first baby and your only baby. So yeah, so motherhood was definitely something I wished for. And I’m very, very lucky and happy that that I achieved it. I am a mom.

(4:45) &P: Yeah, amazing. So before you got pregnant, what did you imagine pregnancy to be like?

N: Wow. It’s funny, you know, because I think that a part of me always thought of pregnancy sort of in the abstract, and I did not think of what the reality of being pregnant and and bringing a child for a lifeforce would, would be like. I remember clearly sort of the first inkling that I was pregnant, and I had, you know, sort of cramping that was out of the timeline of when I would be having cramping. And I remember thinking, Wait a second. That’s strange, right. And I had actually been my parents also sitting over there for some reason. And so the next morning I texted my husband, I said, you know, I had this strange cramping and it woke me up in the middle the night and he said he instantly thought she’s pregnant and he was like, she’s definitely pregnant. So he had the first inkling that I was, despite my having the physical sensation, he, he was really convinced that that was the, the, you know, my our child or future child making his presence known.

P: And that’s a testament to your abstract notion of pregnancy,

N: I guess. Exactly. That was like, I don’t know what that is. But But yeah, and so then it was confirmed within I guess, about two weeks from that. And my pregnancy itself was quite healthy and easy. I remember my hair looked great. I felt really great. So I would say my son was good for my curls when I was pregnant. And I was thrilled and excited. But as the pregnancy became closer and closer to the actual birth story, I remember feeling very nervous and very scared and you know, sort of this realization that you know, this is not abstract anymore. You know, this is going to happen, I’m going to give birth to a human being and I was terrified. And I ended up having a very, you know, not really complicated but it was it was a tough story because I went into labor

P: let’s go slowly here. Yeah. So tell us how how are we know today’s the day that you’re gonna go into labor like what what happens that day?

N: Well, that’s funny. Yeah, that’s part of sort of, you know, you know, the best laid plans, right. I remember packing my bag for the hospital and, you know, having it ready for whatever, two weeks or so in advance of my due date. My due date was November 24 2010. And so I had it packed and I had my novel, I had my lollipops, you know, I was like, Oh, this would be great. Thinking I was going to like to have some resort. And I remember that on was it it would have been I actually tried to have labor pains on the 24th. And so on the due date, and it looked like I might go into labor. And my husband, it was all like, you know, ready to he was like, alright, you know, we’re gonna go and we call the doctor and then it stopped. And so, you know, it’s an essence post labor and I was deeply distressed by that. I remember I was very upset because I had felt like oh, you know, this is it. You know, we’re ready. We’re gonna go we’re gonna have his kid. And it was not to be and I remember I texted uh, one of my best friends was pregnant as well and expecting very close to my date as well. And I told her and I was like off I’m so annoyed, right this this kid does not want to get out. And she said, we looked that way. It looks like he wants to see in the belly and you know he was expecting a boy. And I said, as long as he’s not past December 1, I was like, You better be born at least within a week. I said, and so you know, that week went by and that Monday before the first time where I had acupuncture, you know, sort of like get things rolling. And then that Tuesday the 30th it really started to get in motion and surgical contraction in this sort of thing out this is really going to happen you’d like we’re close you know maybe was even the mountain the night actually Monday night it was Tuesday went to the doctor you know as waddling along could barely walk, you know, huge It was huge. And I’m a fairly small statue you know, I’m not even five three and I had this huge belly and I was for waddling along and in a lot of pain I remember I love sciatic pain because of the weights and so my back hurt and I couldn’t walk I was so so uncomfortable. And went to the doctor and they said you know I think your close so you can go to the hospital and so are they actually said you can go like have a like a bite and then go to the hospital. And my doctor was of course in a realm of you know, in the neighborhood of doctor or you know, as my son was born in what was then Brooklyn Methodist Hospital, and my doctor was just about two blocks away from there. And then we went up to some diner and my in laws were in town and so my in laws and my husband and I went to have to food sort of you know, it was like, let’s have food and see what happens, you know, then we’ll take her in and sort of leisurely to the hospital. And I couldn’t hold on the food and I was not well and they all were like you know what, I think we just need to go to the hospital. We walked the block and a half or so that it was to the hospital. And I remember I remember sort of the you know, the wailing and the pain and really immediately asking for an epidural and I had I had not what I would want one I have I had totally the whole pregnancy tradition which is natural law. You know, I can do this, you know, women, you hear me roar. And

P: I hear some Brooklyn in there, 

N: did you but all of that went out the window. Right? As soon as it really came you know the pain was there and the contractions and the reality was setting in what was to come I immediately was like, give me all the drugs. And of course, you don’t get that right away. And so I had to wait to whatnot. But I remember when they gave me the the epidural and I remember immediately calming down and being like, Oh, this is a really nice room. We’re gonna get the show on the road. So it’s a very funny switch of energy and behavior. And we really thought that it would come you know, fairly soon right that I would have like contractions I would dilate and I would give birth and we’d have this baby in our arms and be shorter lives as parents and as a family of three. But oh, that actually was not the case and I dilated to eight centimeters and I ended up I remember they had to give me I was GBS positive, I remember. 

P: Yeah. 

N: And I remember that when I for that I needed to be given antibiotics, right so they wouldn’t affect the baby. And I developed a fever from the antibiotics. It’s so funny to be remembering all this right? Because it’s so so long ago really in this way it was over a decade ago. But it’s so vivid, right? It’s like I remembered as if it were yesterday. I tried to use the case ready for any transformative experience. And so I did I developed a fever, and there was a horrible, horrible storm. I remember that night there was this rainstorm, and the wind was howling and there was the rain was hitting the window. And I have all these very vivid memories of the contraction and so looking at the different points in the room. I had my different points there. I’m of the doctor and my husband everybody told me to focus on as the contractions came. And I remember one of those points was the window and so I would see the rain and I would see the branches and it looked very ominous, frankly, you know, look very scary to me. And I was like This is terrifying. Like I don’t know what is about to happen and I’m so nervous.

P: I’m not sure you want to give birth on a dark and stormy night.

N: Exactly. I was like this is not making me feel good. And of course with a fever you feel awful anyway, right? Like I had the muscle aches. I mean, it was just awful. And I don’t know my doctor I loved loved, loved my doctor, you know, I felt like he was almost like an uncle. You know, he just adored him. And he was so kind to me and so good to me. And he was a jokester a little bit, you know, they’re a funny and this is with him, you know who make me laugh and he was very funny and light hearted and warm. And so I had this very comfortable rapport with him. And I remember he said to me, you know, Naomi, I think that you’re gonna have to have a C section. And I thought he was kidding, because he’d always been funny, right? So I started to laugh. And he was completely the most serious I’ve ever seen him and he said, No, Naomi, I’m serious. It’s like we have to get this baby out, and you’re not dilating and you’re feverish, and you’re delirious because I had barely slept. And so he’s like, you’re gonna have to have a C section. And I was very upset by that, because I had always throughout the pregnancy said as long as it’s not a C section, I don’t want a C section. And so I was deeply distressed to realize that I would, in fact be giving birth via C Section.

P: Some people have overlaid feelings about the C section beyond that it’s a surgery and that there’s recovery, but that it means something about the birth. Is there any of that going on or you just don’t

N: that was 100% What was going on? For me it felt like then I hadn’t done my job I hadn’t followed through a you know, as like the woman who gives birth vaginally and I was just very upset. You know, I felt kind of like, but that’s not what I’m supposed to do. Right? I’m supposed to give birth vaginally and I’m very upset by this. So it was entirely about the narrative of what is the quote unquote, right way to give birth. 

So yeah, so that’s what it was. And of course, I was frightened of the surgery. I was and knowing that the recovery would be alongside caring for a newborn. So that was there. But I would say the overriding feeling was certainly you know, sort of that societal narrative and societal pressure of the right or wrong way to to give birth or to have a child period right to become a mother and so yeah, and so I remember I was very upset by it, and he had to really calm me, you know, they were like, listen, like you need to, you know, like you need to get this baby out and we need you to be in a good place as well right for you physically as as well as emotionally. And so you know, eventually was like, Okay, right, I guess this is this is how I’m gonna give birth right? 

And I remember, you know, wheeling me into the room preparing the whole scene, the curtain ray in front of me and my husband has scrubs and of course, my husband hadn’t slept at all either, you know, he was delirious as well. Not feverish, but he was delirious and about to become a father and so for him was also you know, this is a latch, right, and we’re not even parents yet. And I remember in the operating room, being very cognizant of not seeing what was happening, and being very frustrated by that, you know, so very sort of divorced from my own birth story. You know, I sort of felt like am I even here, right? Because the curtain was in front of me, and I couldn’t see anything. And I could only make out certain things either by what I saw or what I heard more of what I heard them saw.

P:  let me ask you a question about that. So I see section two before they put up a curtain I was like, You’re not gonna make me watch right. I don’t want to. I don’t want to see the woman sawed in half. That’s, that’s not my game. But people have said that they sometimes surgeons allowed like to have a mirror on the other side so you can see what’s happening. I wonder if that was an option for you or

N: no, that was never brought up that was never offered and I don’t think I would have necessarily wanted that per se. For me, it was more about not seeing the action of the doctor, you know, and the nurses and my husband, you know, that was more of the frustrating part to me. You know, I felt sort of alone despite having all these people surrounding me. And that bothered me, right and I remember when they finally did get my son out and I heard his cries. I said, my baby, my baby, that’s my baby. I want to see my baby. And I had to wait, you know, because of course, you know, they have to cut the cord and you do the weight and all that stuff. And so it felt to me like a lifetime. I was like, I hear this baby who I’ve been trying for the last 41 weeks, and I want that baby. I was like, give me the baby. And I couldn’t hold him of course, right? Because it’s a C section. And so my husband, he brought him you know, all wrapped up and clean. And I kissed him and I remember thinking he was the most gorgeous thing I’d ever laid eyes on that he was just precious precious. And I was then wheeled away which right I had to go to the recovery room. And that also was upsetting. I was like so I just kissed this baby who is in a world now thanks to my body and my husband, you know, and I’m not happy that I can’t be with him. And I’ll never forget that as they were really getting out. There were nurses wheeling, of course, right the gurney and they were having a conversation. But at one point I thought they were talking to me and they said to me like how are you? And I started to answer and then within moments I realized they weren’t talking to me I was like I’m actually not really here. Like no one’s talking to me was also sort of, you know, this kind of alienating isolating experience and in the recovery room. The first person I talked to on the phone beside of course. My husband of course, who was in the room with me was my cousin and my cousin is my first cousin. He’s the son of my mom’s sister, my aunt, and we grew up together. And I consider my brother, right for me I really feel that I have two older brothers and I adore him and so I always remember that he was the first person I got to talk to after becoming a mom and for him who is my older brother in essence right and has seen me grow up for him. He says you know, I can’t believe my little cousin’s a mom and remember, he was like, that’s crazy. So you know that that conversation sort of sense you know that wow life is really about to change, like it has changed. It’s about to become very different. And so I was in there and I couldn’t have water I had to do is chew my ice cubes which also aggravated me I was like I am thirsty. Like I want water and my baby. And I don’t know how many hours later it was you my son was born I think at 1:36pm and I didn’t see him till I guess like 730 or eight o’clock at night, something like that.

P: wow

N:  Maybe it was early and it was like 630 but it was you know significant chunk of time. And they’re you know when I finally got to see him and hold him in the room was just phenomenal. And my husband were watching the video and I said to him in my arms I said you grew nice and strong in there because he grew he was eight pounds and 21 inches you know he was he was a very sturdy he was a strong baby’s born with muscle you know, it’s like you were like doing like push ups or something because he was so strong and so healthy. And so Did you know In retrospect, of course it took many years to come to peace with this but I in retrospect it was absolutely right call for me to have that C section. But it was a very hard way to to become a mom and to then navigate feels initial days and weeks and even months, perhaps even years of motherhood. 

Yeah,

P: I have to say we have some similarities in our story. We both had C sections. Yeah. And a lot of the things that you described, I’ve never focused on in my own story, and you’re totally right. All that stuff is really alienating and it’s so weird to be wheeled to the recovery room. Just like you after the C section I was alone, but everything that unfolded after your C section is strange. I understand that the nurses can talk to their colleagues during work. But it’s strange to have that conversation literally right over you and ignore you in the process.

N: precisely

P: the lack of interaction sounds industrial, really just contrary to the spirit of what you’d expect after birth. Why was there such a long period before you got to eight your son?

N: I’m not sure I have a feeling perhaps had to do with having been ill right having had a fever and not having slept and maybe they thought they right from time. 

P: that makes sense

N: But it was a it was like I’m not going to sleep like Are you joking, right? I was like I still want to see my baby. So that’s not going to happen, right? I didn’t sleep at all. You know, all I did was talk to my cousin and sort of you know, count the hours until I got to see and hold my child but I think that was the thinking the thinking was you know this woman needs to rest on before we really thrust her into the the ring.

P: for so many women that that last piece does not happen. It doesn’t people don’t dilate. Fully. Exactly. What would you do? Right?

N: Exactly. No, it’s that’s actually a really good point. Because I remember you know, my family saying to me, and you know me if this had been another time or another context, there you or your son would have been in danger, right? I mean, and that really also helped me to come to peace with with a C section as well. But I remember even people you know, even people initially in those first couple of weeks and whatnot, you know, saying like telling you their own birth stories in a way that I was like, I’m not really interested in your story right now. Right because I just went through it yesterday. Right? And it was traumatic on a number of levels. And I remember that upsetting me, right that people should be like, Oh, for me, it was so simply and I went in and I went out I had a baby. And I was like awesome for you. Right? Bully for you. Right? Because that’s just not what you say to, in my opinion to to any woman who’s just given birth like it’s actually about your story. It’s not right. It’s like in that moment, it is that mother and her baby and and that journey that they took to reach that point. And and so that was also upsetting to me in those first couple of weeks. I had more than one person you know, and I get it to I get like we want to reminisce you remember, especially now right now that’s years later like it, it’s so vivid, I get it right. I get that, you know, this is a transform experience that all parents remember and want to share and share. But I think you know, timing is everything. And so that was rough too. Yeah,

P: I agree. I do think it’s like traveling to a place that people who haven’t been there, just have no idea what it looks and feels like. That’s right. It’s just it’s a really hard thing to translate into language just like just like the pain of delivery, right? Like you imagined like, you know, I’ve hurt myself before and I’ve toughed it out like this is a pain that kind of defies defies analogy, right? It’s not like anything else. So it’s really hard to kind of get there. 

P: Now that we’ve heard about your experience, I’d like to talk about how you’ve written about your experience. I don’t know if you’ve written more than one book, but you’ve written strength and soul. Is that the name of the book? That’s probably my one and only look at, which is super interesting. Take on your well, maybe I’ll let you describe it. So can you describe it?

N: Sure. Yes. So So interestingly, so you know, I describe my ethnic background, right Jewish father and Ecuadorian mother, and And so growing up there were lots of questions about like, my family, a lot of assumptions made a lot of othering you know, is that your real dad? Are you adopted, you don’t look like him this kind of thing. And so I was grew up with this way of people sort of making an oddity out of my family. And it’s always it was something that I think sparked a lifelong interest in examining identity and and racism and understanding the ways that we conceptualize of ourselves and of the world around us, and of history, and the assumptions we make and how that’s connected to to systemic racism.

P: So when we start, let me stop you there for a second because this is totally relevant to your story. So I read that beginning piece of your book about people asking you on the playground is that your dad when he comes up to you and how people treated you differently when it was just your dad and you and your brother versus all of you? Yeah, and I’m wondering how that I mean, that lives in your head. So how does that affect your thinking about I’m going to start my own family?

N: That’s a really great question. It’s interesting because my husband is white. My husband is of Irish and German origin. Grew up in the Midwest grew up in Ohio. And when I you know, when he and I became serious, and you know, certainly after we were engaged in married, and planning a family, letting a child let’s just say because we were already family, I had more than one person for sure. There were my father’s saying, you know, if you have a kid or kids, they’ll more than likely look white, right because adults my husband is white, and you are largely European in your heritage, right, and your ancestry. I mean, I’m brown skin, but I’m got a lot of European running through my veins. And so there was sort of this, you know, sort of this question, you know, what would this kid look like, you know, what would our kids or kid look like? And I remember when I was pregnant, thinking, like this, these can be light skinned, like there’s no denying in my head, and more than likely this child will be light skinned. So it’s really prepared for that possibility and more than like pure reality. And I remember once having a dream a very vivid dream, not too long before giving birth around the summer, I don’t know. And it was a sort of a golden skinned baby with, like, sort of caramel eyes and like, just very golden hair, you know, and I remember thinking, the urge, you know, maybe like that kind of maybe it’s my baby like, maybe that’s gonna look like my kid. And the truth is, I wasn’t far off because my son completely looks completely white American. There’s no one who would ever look at my son and think that he’s a brown skinned mother, and an even darker skinned grandmother and dark skinned biological family members. 

No one would ever think it and so as soon as he was born, I looked at him I was like, wow, really? This kid is way lighter than even I expected. Right? I was like, I was kind of prepared for me to be light skinned, but this light skinned you know, I mean, he looked completely white. And I remember thinking even in the hospital room, like hmm, you know, it’s gonna be interesting right to be in the world with him. A little did I know just how interesting and how challenging and exhausting frankly, it would be right to navigate motherhood with a child that most people do not associate with me. And many people discard me as he’s not afraid to discard the possibility that I could be his his mother. And that was very painful for me. Because growing up it was hard. You know, I hated when people ask me those questions. I my brother, in fact, looks just like our father. I mean, I used to joke that my brother was our father dipped in milk chocolate. It’s my father’s face. Like he is my father’s you know sort of doppelganger, really, and I look less physically like my dad, but I certainly have shared physical traits of my father. And what made it even more challenging, sadly, is that my father right to my white parent, and just falling ill soon after my son was born, you know, he fell ill in January 2011. And I was very convinced it was very serious. And, frankly, the family didn’t really believe me. And they were like, Well, you’re a new mom. You know, you’re not sleeping like you tend to be a very a worrier. I’ve always been a worrier. This is true. And so they kind of thought I was over blowing things, and they were like, oh, Naomi, he’ll be fine. He’s fine.

But I was like knowing that right was like he’s losing weight. He’s not giving him an appetite. This is not the father. I know. Right. My father always been very healthy a good eater, you know, Walker. So I was just deeply, deeply concerned from that point from January 2011. And over the course of that year, which is the course of the first year of my son’s life, my father was dying. He was dying at year and we did not receive confirmation of that until September

P: oh wow

N: September 2000. Let him I thought it was diagnosed with stage four pancreatic cancer which we know is different. Right? And he died November 29 2011. And so the very day a year before that I had gone for acupuncture. I’m beginning to you know, begin the journey of of giving life and having a challenge becoming a mother my father died and left this world and was deeply traumatic, deeply traumatic, because not only was I close to my dad, we were the best of friends, but I lost the connection, the context in essence, the physical context or contextualization, I should say for my son from my side of the family. And so when when I’m out in the world, my mother would think goodness is alive and well. People are just scratching their heads. They’re like, how did this happen? Right because my mother looks to the naked eye people think she’s black American. People look at me and think I’m Latina, or Middle Eastern. Maybe when people look at my son, I think he’s white. And so we are three generations of the same family. And yet, right and so there’s this real fatigue, you know, and being out in the world and even with my husband and son, you know, people often just or I can just tell you, you know, they’re looking back and forth and sort of trying to figure out, you know, what’s the connection here? You know, that’s the mom, you know, I’m gonna people that actually voice these things. It’s not just that I can tell by expression and because I have a lifelong experience with people staring and wondering. They have voiced it you know, I’ve been asked how long I’ve looked after him. 

P: Oh, my God. 

N: And this is from, you know, when he was relieved, I mean, now it’s different because he is, I’ve raised my son, you know, we’ve raised our son to have a very clear understanding of the way through the assumptions that people will make about us, and how those are always a reflection of their reality. Right? Like, what they know what they want, they think they know, and not of us, which was how I was raised. I was raised to know that the questions people pose to me, were not a reflection of me. And I always felt very empowered by that. And so I think that because of that intentionality, and my parents raising of me and my brother, I was prepared to be my son’s mother. That’s what I always say. I always say to be my parents daughter prepared me to be my son’s mother. Because I was you know, super heavy armor you know, I had the armor to be able to handle the questions you have to handle the the comments, and although you know, I’m not no one is made of of iron, and so it was very painful for me often and it was particularly painful because I didn’t have my dad and so I don’t have my dad. And so it was Yeah, and my son has my father’s eyes. And so that’s another thing that’s interesting is that people are very struck by his eyes. His eyes are really striking they are he has a blue green eyes that change with the light or what he’s wearing. And so they’re really a beautiful shade. And he also it’s interesting, because it has its shape of my mother’s eyes, and so they’re almond shaped. And they’re really striking, right? Because you don’t tend to see that shape without that color. But people always say that, you know, people are like, Oh my God, he’s got the most beautiful eyes. And I have to often be like, yeah, they’re my dad’s eyes, right? And so I’m always sort of reminded of his absence, you know, in those interactions, and people often assume he’s got his dad’s like, oh, he must have his father’s, which is always actually kind of annoyed me. 

Because, right the assumption is, there’s no way that can come from you. So when I wrote this, you know, my book is is an examination of the contrast in the assumptions that were made about me with my mother and father, particularly my father, versus the assumptions made about me as a mother. And so as a mother, I’m assumed to be his nanny, his caretaker. And then growing up it was assumed that my father had adopted me. And I think there’s a lot of that’s a loaded, loaded assumptions. Because they are sort of attached to privilege and power and inequity really, right. And so I was just fascinated. I was like, Wait a second, you know, there’s something here right that there’s this huge contrast and was a suit about the same person me in the roles that I hold with these two people, one who gave me life and one whose life I brought forth, right, it was like this is fascinating. 

And of course, it also sort of coincided with my lifelong interest in examining these issues. And I’ve also worked in around this all my life, too. I was a language teacher and in my Spanish teacher and in my language classroom, we were talking about identity a lot about culture. And all of this has just been a lifelong passion of mine. And so, you know, then having a child and sort of being given this, the huge responsibility of raising a person which is just in and of itself, a huge responsibility, preparing them for the world, and then visa vie all these issues. And then of course, you know, the wrench of my father’s death, you know, sort of the twists, you know, my father having died so early on in my child’s life, and in my journey as a mother, right, like that was so, so painful for me very traumatic, very traumatic and remains a source of pain for me, you know, I think I will always be sad about it. I will always feel that absence but luckily, because of my, my writing, really, I write a lot about loss as well. And Strength of soul is also born out of that loss as well. And so I feel like you know, language for me has always been a healer. And when I’m able to write about my father and my journey as a mother, I find each and every time it feels like balm for my soul, and it’s also a gift for my son, I feel, you know, I feel like I’m giving my father to my son. My son really sort of has a sense of who he was. 

And my son has a sense of who he is right? My son knows that despite how people see him, and the assumptions they make about him, right. People do not think that he’s bilingual. People do not think that his name is pronounced in Spanish. Or of course, they don’t think I’m his mom. He’s so so at this point. He’s 11. Now, you know, he’s just ready to take it all on, right. Like, knows who he is. And I’m feel that that’s totally because of the efforts on my husband and our families parts. And so I feel very proud of that. And I feel sort of empowered by that because it feels to me like you know, the outside exterior is not going to dictate for us, you know, who we are and how we feel basically, in the world.

P: It is a tricky thing that you’re describing. And I can imagine as a child was confusing for people to constantly asked about is this your father, and to question your role as your son’s mother, maybe suggesting that there’s something that’s not right or that doesn’t make sense about a mother who looks like you having a child who looks like your son. Maybe that’s what feels offensive.

N: I mean, I think that we make assumptions as human beings regardless right? And assumptions about everything assumptions about you know, belonging, about family about what language you might speak, you know, where you’re from, etc. And, you know, I feel like that’s just a human quality, right that we’re going to do that sometimes. However, I think there’s a distinction between assuming and acting on the assumption. Right, I That, to me was the fascinating part, particularly as a mom that people would voice these things to me I was like, really, you know, I’m like you like That’s why you should keep to yourself, right? Like, why would you ask that?

P: I’m always thinking, you know, I can hear you say that out loud.

N: Like you said out loud. Exactly, exactly. I mean, the thing is, over the course of my son’s life, I have learned how to handle it so so well, I have to say because initially, I would just get upset, you know, making the anger I would feel hurt. And I would you know, just not want to leave the house. You know, I hated those mom and baby groups. I hated them. Because for me, it was like, you’re all staring at me. Like I have no place here. And I could tell that you’re like, how did that happen? You know, how is she that kid’s mom? And then I’ve only spoken to my son in Spanish in essence since his birth, right and so there’s and that to me, it’s been a godsend. It is protection for me because even though Spanish is not a private language, particularly in New York City, it is our own little sort of secret in a way right? It’s like people do not expect the child to respond to me in Spanish and they certainly don’t expect him to be like mama, blah, blah. Blah, right. And to me that feels like yep, you know, you figure that out rarely let people sort of sit there and you know, sit with that right that makes me feel you know, sort of empowered and and happy. But you know, in the beginning wasn’t like that of course right? When he was pre verbal right when he was pre verbal is like, gosh, right? Like no one knows anything here. He can’t you know, also speak to them. But I have a memory two memories that stand out from when he was quite small. He was about three when I was asked how long I’d been looking after him. I remember I was on a train platform with him and someone asked me, you know, how long have you he’s so cute. How long have you been looking after him? And without missing a beat I said since he was in utero. 

P: Oh, that’s a great answer.

N: Thank you. Yes, I was pretty proud of myself. And she kind of blanched it was like, Oh, he’s yours? And said, yep. And she goes, Oh my god, I’m so sorry. You know, I was like, I mean, I guess you know, he’s really looked like you which is not true. He does not look at me look like me. Superficially, I always say, actually, he does not look like me. But for those who look beyond the surface, the child looks a lot like me, and particularly now that he’s older, but he has my lips. He has the shape of my eyes. He has my smile. He’s a lot of my gestures. And so it was like this kid is definitely looks like me, right? But people they just see, you know, his, his light skinned his late eyes and his light hair versus my dark skin, dark eyes and dark hair and they’re like, No way, right? 

But I remember she was you know, apologetic and then ended up saying, you know, well, you know, you’re very cute and gratulations and I was like, Thanks, you know, and so ended up being sort of a passive exchange, it could have gone very differently, right. And I was trying to spin those moments to become sort of a learning teachable moment, which to also take psychic energy like that’s a little tiring for me, but I’d rather that then it becomes sort of you know, contentious, but I have another memory where he was not much older. He while he was like four. We’re on the train. And someone was staring at us. And I think sort of gone by that point, even at that tender age, was accustomed to people looking at us. And he was in his little brain trying to, you know, be like, oh, like, what is the big deal? Like, what are you looking at? You know, and I remember, he pointed at me and then look back at the person and said, Mama, and I was like, My job here is done. Like, it felt so, so affirming. To me. I was like this, my child gets it really he gets that people are gonna question I’m going to disbelieve and he’s gonna let them know what time it is. And that was at four right and so now he’s 11. And he’s just, he just knows what’s up, you know, and it makes me feel it makes me feel really good. It does. Because it’s been a hard road

P: what a moment to feel seen right when you’re when your four year old is like schooling the other train riders.

N: Exactly, Mama.

P: That’s amazing. And he’s bilingual.

N: He is he’s a native speaker of both. Yes, he is.

P: I’m So jealous because he so do you still speak to him only in Spanish or nowadays?

N: Well, you It’s funny you asked that because more and more the older she gets, you know for for particularly when it’s all of us together. It’s going to be in English right? But just the other night you know, we were having a conversation all of us you know my husband and I and after it was a dinner agenda generally, you know, the always the three lesson to speak in English but then after dinner I remember I was doing the dishes or whatever. And he started to chat with me again in English. And I said sufficiente Anglais I was like enough English, right? I was like, massive, but I will order Caressa which means like, gives me a headache. And so I told him he was like, switch, right? And so he switched, right so I feel like for my relationship with him for our own dynamic. I prefer it in Spanish right? And I’ll speak to an English in with his daughter, my husband and with other family members or like, you know, with a friend this kind of thing, but the minute I can or we can I want it to be in Spanish. And I think that’s in part because I don’t want him to lose it. You know, I feel that if he’s not using if you will lose it like any other skill. And I also for me, it’s also sort of a the cocoon of it. You know, it feels very safe and warm to me, right? I mean, it was interesting to me because when I was pregnant and expecting my son, I would speak to him in Spanish in utero. And I remember being taken aback by this because I go back and forth seamlessly for me both languages exist in my brain and had my entire life. I was also a Spanish teacher, right? So it’s like these two languages are entirely both minor, right? But all of a sudden, there was something about motherhood or impending motherhood, or Spanish became what I wanted to use. And I realized quickly that it was because my own mother spoke to me in Spanish speaks to me in Spanish, and it’s my language. Of, of comfort, I guess. Right? It’s like it’s my language of comfort in my language of safety and protection. You know, I’m sure I have even some, you know, subconscious memories of being saying you too in Spanish, you know, are you being soothed in Spanish as as a baby and as a toddler and so that was very eye opening for me, you know, to realize like, wow, like this is this language is definitely more significant in that sense. And so I remember you know, I remember when speaking to him and uterine Spanish, my husband saying who are you talking to? And I said, our son

P: in your family where you were raised, your mother spoke Spanish, did your dad speak English?

N: It’s funny. My dad was bilingual. My dad did speak. Both. But in general, yes. In general. My relationship with my father was in English, and my relationship with my mother is in Spanish. And then when we were the four of us, or as my brother got older and left the house and it was the three of us, I would go back and forth, but generally for us, like at dinner time, even if it was for three of us, it would be Spanish actually, because my dad spoke it. My husband does not and so that’s why it’s not Spanish in those moments.

 I mean, my husband however, I will say, understands, I’d say like 90 to 95% of what is said. So like whatever I say to Sebastian, he will reiterate, right like your mother just said Go put on your shoes, whatever it is, right. So he understands. And I also always say that that my son would not be bilingual without my husband’s participation. Right. My husband’s agreement, right. My husband could have gotten in the way of it, you know, it could have been like, well, I don’t speak and I don’t want to not understand what my kid is saying, you know, he could have gone there. And he did not right I think he really understood how important was to me in Tripoli, given how the world receives us, right? He knows how that is for us. And I think sometimes it makes him feel saddened and frustrated, right? Because he knows it’s not as quote unquote, easy for me in the world with our son as it is for him. And so I think

P: I’m not sure I would quote unquote.

N: Well, I say up because I say, you know, there’s other ways it’s challenging to be a parent. Right? So it’s like, it’s hard for him in other ways, basically, but in this way, you’re right in this way. It is not hard for him at all. And so I think he really was like, You know what, our kid will be battling Well, you know, like, that’s an asset. It is. It is great that you want him to be really well. And here he is, right. And he you know, I mean, he even he told me recently they were reading a book about a Mexican American character. And so there’s a lot of Spanish in the book and the girl’s name and whatnot. And he said to me that he had corrected his teacher that that it wasn’t pronounced. He said, I told the teacher that we don’t say Gente, that the G is pronounced like an H. So it’s gente, which means people and I was just for me, it was just like, this beautiful, beautiful moment of him identifying so closely right with being a Spanish speaker and with being part Latin American, and saying we you know, he was like, you don’t say, right, I was like, Oh, my God, that is so beautiful, right? Because he gave me my son, you know, because of his presumption of whiteness has a very different reception in the world, you know, than I do from incidentally as a male as well. And so, I feel sometimes that he defies you know, all of these notions, you know, of who he is and, and that, to me, feels, you know, just just, it’s a celebration for me, because I think he needs to know all of who he is in order to, to, I think, to be more present in the world and to hopefully be more connected to people in the world. That’s That’s my thinking, you know, and that’s what’s behind the whole intentionality of his name and his and his bilingualism.

P: That’s super cool. Well, let me ask you a question. Looking like now that you know what, you know, looking back, is there anything you would you would have told younger you for this journey? 

N: Wow.

That’s a great question. I think the one thing I would have told the younger me is to be prepared for, for surprises, you know, to be prepared for the unexpected. I think that when I had been thinking about motherhood, and certainly when I was closer to my within reach, right when I was married and whatnot, and you know, planning it with my husband, I had this idea that I would raise my kid with both of my parents alive and well and their participation in their involvement and I didn’t quite imagine necessarily having a kid who looks so white and wouldn’t be assumed to be mine. And I was wrong on both counts. Right. I ended up having this child with his physical appearance, and losing my father and having to navigate this new normal and this the reality versus sort of the ideal that I had concocted in my brain. 

And so I think it would have helped me to know that the unexpected may happen. And I wish I could have been more prepared, I guess, in that sense. You know, I would have told my younger self she knows me like you don’t know what’s going to happen and be prepared for anything to happen basically, because he was he was a rude awakening to realize, like, Oh, this is gonna be a very different journey than what I expected. What I thought I would have and I think now certainly since losing my dad, and since you know, sort of having these immensely transformative experiences happen within a year of each other. I am now that person right now, I know not to think I know what’s going to come. Right. And like, actually, the only thing we know is that we don’t know what’s going to happen. Right. And I think that is actually healthy, sort of more of a protection in a way right? I mean, even with a pandemic, right. I mean, as devastating and as traumatic as it’s been, you know, in gradations, depending on what your personal story is, but I think it’s been globally traumatic, in a way I sort of was like, Okay, this is what we have to live with. Now. Right? This is what we have to deal with to roll with the punches over what they signify. So live in a global pandemic and wear masks and get vaccinated and do remote school and all these pieces. And I feel like my own tragic loss, kind of prepared me for that in a way you know, that tragedy will and may, you may or her and you have to find a way to integrate that tragedy and continue forward.

P: Yeah, that’s good advice for all of us. For younger you and for all of us now. 

N: That’s right. Yeah. 

P: Naomi thanks so much for sharing your story and I will put a link in the show notes to your book on Amazon.

N: Yes, a link to my book. And if you’d like I can also I can send you a couple of other links to other like through sites of of my work, and you could link those as well. I’m I’m very active on LinkedIn. So maybe that’s also linked if people wanted to connect or so I’ll send you those. I’ll send you more links for you to include in the in the episode.

P: Awesome. Thank you. So much.

N: Thank you, Paulette. This has been great.

Episode 50SN: A Pregnancy that Outran Scary Predictions: Lisa’s Story

Today’s guest has an interesting spin on the difference between her expectations for the pregnancy and birth and her experience going into pregnancy. She had a number of health conditions that lead to a lot of cautionary talks about the many things that could go awry. And then when she actually was pregnant, she more or less skated through a problem free pregnancy. So she’s left with feeling grateful to have outruns so many serious issues and sad about the fact that she didn’t get to enjoy what was basically a straightforward pregnancy because she was constantly on alert.

You can find Lisa’s writing here

PCOS

https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439
https://www.webmd.com/women/what-is-pcos
https://www.cdc.gov/diabetes/basics/pcos.html#:~:text=What%20is%20PCOS%3F,beyond%20the%20child%2Dbearing%20years.

Epilepsy
https://www.mayoclinic.org/diseases-conditions/epilepsy/symptoms-causes/syc-20350093

https://www.webmd.com/epilepsy/default.htm

Epilepsy and Pregnancy

https://www.cureepilepsy.org/webinars/epilepsy-pregnancy-contraception/
https://epilepsychicago.org/what-is-epilepsy/sudep/?gclid=Cj0KCQjwpcOTBhCZARIsAEAYLuU8fRCTSVMxWjho2b1pckFcUOEhXYtS6Nvros5kCvTJZgKhCcC3EUsaAncmEALw_wcB

Fetal Surgery for Spina Bifida

https://www.ucsfbenioffchildrens.org/clinics/fetal-treatment-center
https://www.ucsfbenioffchildrens.org/conditions/spina-bifida?campaignid=71700000085986996&adgroupid=58700007287088131&adgroup=FTC-NT+-+Conditions+-+Spina+Bifida&creative=537193062435&kwid=43700065426505077&matchtype=p&network=g&adposition=&target=&device=c&devicemodel=&feeditemid=&loc_physical_ms=9031971&loc_interest_ms=&targetid=kwd-803521056122&utm_source=GOOGLE&utm_medium=cpc&utm_campaign=FTC-NT+-+Conditions+All&utm_term=spina+bifida+fetus&&campaignid=14146813904&adgroupid=125672267659&adid=537193062435&gclid=Cj0KCQjwpcOTBhCZARIsAEAYLuVdDLyuSmXsok5GdMl3I_JALDEjLXlO00R2JNSHebSUzLG5DWzjA6QaAn3mEALw_wcB&gclsrc=aw.ds
https://www.chop.edu/treatments/fetal-surgery-spina-bifida/about

Pyloric Stenosis

https://my.clevelandclinic.org/health/diseases/4524-pyloric-stenosis-hps#:~:text=How%20common%20is%20pyloric%20stenosis,condition%20requiring%20surgery%20in%20infants.

Breastfeeding across the US

https://www.cdc.gov/breastfeeding/data/facts.html

Episode 49 SN: Choosing the Greatest Vulnerability: Jody’s Story

Today’s guest has a host of experiences when it comes to creating a family. She and her partner had their first child when she was 35. And when they tried to have another, things didn’t quite line up. And so she and her partner looked for adoption, something she’d always been interested in exploring, as she herself was adopted. She’d anticipated that her experience would draw her closer to her daughter, but what she hadn’t expected is that it also drew closer to her mother.

(cover art by Marvel Maring)

Find more of Jody’s writing here

And here is her forthcoming book, Under My Bed and Other Essays

Age at first birth in the US

https://www.nytimes.com/interactive/2018/08/04/upshot/up-birth-age-gap.html

https://www.cdc.gov/nchs/nsfg/key_statistics/b.htm

Advanced maternal age

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5683335/

https://academic.oup.com/humupd/article/24/3/267/4855813?login=true

Placenta previa

https://www.mayoclinic.org/diseases-conditions/placenta-previa/symptoms-causes/syc-20352768

https://medlineplus.gov/ency/article/000900.htm

Adoption statistics

https://pages.uoregon.edu/adoption/archive/MazaAT.htm

https://www.cdc.gov/nchs/data/vsus/nat74_1.pdf

https://en.wikipedia.org/wiki/Baby_Scoop_Era#:~:text=The%20Baby%20Scoop%20Era%20was,higher%20rate%20of%20newborn%20adoption.

https://adoptionnetwork.com/adoption-myths-facts/domestic-us-statistics/

https://pages.uoregon.edu/adoption/topics/adoptionstatistics.htm

Maternity homes/birth mothers

https://en.wikipedia.org/wiki/Rickie_Solinger

Primal wound

https://www.theatlantic.com/health/archive/2015/12/adoption-happily-ever-after-myth/418230/

https://marcyaxness.com/adoption-insight/primal-wound-separation-trauma/

Audio Transcript

Paulette: Hi, welcome to war stories from the womb. I’m your host, Paulette Kamenecka. I’m an economist and a writer and the mother of two girls. Today’s guest has a host of experiences when it comes to creating a family. She and her partner had their first child when she was 35. And when they tried to have another, things didn’t quite line up. And so she and her partner looked for adoption, something she’d always been interested in exploring, as she herself was adopted. She’d anticipated that her experience would draw her closer to her daughter, but what she hadn’t expected is that it also drew closer to her mother. After we spoke, I went back into the interview to include details about some of the things that came up.

Let’s get to this inspiring story. 

P: Hi, thanks so much for coming on the show. Can you introduce yourself and tell us where you’re from?

Jody: My name is Jody Keisner and I’m from Omaha, Nebraska.

P: Nice and Jody did you grow up with any siblings that you grew up with brothers and sisters?

J: I have one sister Debbie. She is she would tell you she is 13 months younger than me that’s important to her.

 P: You guys are close. So did you Did did growing up with a sister make you think oh I definitely want a family or was Did you know you wanted a family?

 

J: That is an interesting question because I had children later in life. I was pregnant with my first when I was 35 and all my friends were having children in their 20s or at least their early 30s. And I did not feel compelled to have children or to become a wife or to get married until I met my husband John. I met him when I was in grad school. And it is as they say it was like a biological clock. And this primal urge inside of me. After we were married. I had to have children. I mean I had to the thought of it started to consume me a little bit.

P: That’s totally interesting. I’m similarly situated in that I thought I wouldn’t get married and have kids and you know, here I am married with two kids. But I also started a little bit later although I feel like I should look it up 35 probably isn’t that old anymore. It may have been in your circle. 

J: Right? 

P: But I think that age at first birth is trending upwards. 

So I did go on look up the numbers. On average in the US the age at which people become mothers for the first time has increased between the year 2000 and 2016 The average across the US at 26. But the average for first time mothers is hirer in big cities and on the coast and it isn’t the interior. And our goal in New York Times cites the statistic that in 2018 in New York and San Francisco, the average age of first time mothers is 31 and 32. While in Todd County, South Dakota and Zapata County, Texas. It all happens a decade. Sooner at 20 and 21. One of the big drivers of this age gap is education. Women with college degrees have a child on average seven years later than those without.

J: Yes, and I read many articles on that when I was trying to get pregnant because my OB GYN said I was advanced maternal age. Yes, yeah. And I kind of took umbrage at that was like well, what does that mean?

 

P: So it is a totally unfortunate term and it is kind of vague, but when OBE is used terms like advanced maternal age, what they’re flagging is that reproductive machinery ages faster than the rest of our body. There are a number of theories that try to explain this process, including how we manage senescence cells are cells that no longer divide in reproductive organs and changes in immune function, because immune cell activity is critical to a healthy pregnancy. A consequence of this faster aging is that women in their 30s and 40s are more likely to experience pregnancy complications like miscarriage, low birth weight, preterm or post term delivery, and cesrean delivery. As we learn more about the aging process in general and what families and genes are intimately involved with aging Some researchers think we can expand the window of fertility. I linked One review article in the show notes. So check that out if you’re interested.

J: then I was looking at the average age of first pregnancy and it does seem like it’s trending upward especially on the coasts. I think here in the Midwest, it might still be 20s and 30s, early 30s But I do find comfort in that. 

P: Yeah, yeah, you are not alone. I know we’re going to talk about your second daughter. But the first one you got pregnant easily. What was that like?

J: We tried us they told us to I want to say it was about six months, and then they prescribed me Clomid. And she thought that perhaps I was ovulating late. And we got pregnant right away. The first Clomid pill and I had an early miscarriage eight weeks and I was devastated. I felt devastated. I had all the concerns. I think, you know, I’ve read that other mothers have which is what if I can’t get pregnant again? What if I can’t carry a pregnancy? We waited the requisite two months took Clomid again. got pregnant. My husband John said this one’s going to stick I just know it and that was Lily. 

P: Oh, lovely, lovely 

J: she’s eleven

P: Oh wow. And that pregnancy was more or less straightforward.

J: It was straightforward. I didn’t I did have a placenta pre varia. That corrected itself.

P: A quick word on placenta previa, our placenta develops inside the eaters with the baby and then placenta previa, the placenta is partially or totally blocking the cervix, which would frustrate a woman’s ability to give birth vaginally is described as quote common and happens in one and 200 pregnancies. For many women. That condition resolves as the uterus grows, and there’s more space between the placenta and the cervix. If it doesn’t resolve the solution is a C section. There are a bunch of risk factors including pregnancy in women who are 35 and older.

J: And I had the book What to Expect When You’re Expecting and of course in the back of that book, it’s like an index of everything that can go wrong. And I had I just couldn’t read that book. Because then I would analyze and diagnose everything that was happening. And really the pregnancy was very smooth. 

P: Good. good

J:  I enjoyed it a lot.

P: And then you Did you deliver the way that you wanted to deliver. Did you walk in with a birth plan or what did that look like?

J: Oh, I chickened out of the natural birth that I had planned with a doula. I was in labor for about two days. And you know, the first time they sent me the hospital sent us home. And then we went back and by the time I had been up for was it about 30 hours straight because I couldn’t sleep through the contractions. And I remember the nurse coming in and saying do you want pain relief? She didn’t say Do you want an epidural? She said do you want pain relief. I mean, I knew what she was asking. But in my birth plan, I was gonna say no to the epidural. But I could say yes to the so I had an epidural. I’m not disappointed. I don’t have regrets. The pregnancy was fine. Lily was whole, you know, she born with a whole head of dark hair and healthy and it just went really well.

P: Good. That’s lovely. I can’t decide how I had two C sections because I had you know, everything that could go wrong did go wrong. I mean, I knew I was having a C section. months before the baby was born because things were so fucked up. So I never had to brook this issue of what I take the epidural wouldn’t I take the epidural, but I’m ambivalent about people describing it as like brave or like you said I chickened out. I’m not I don’t I’m not sure how I feel about that. Because you chickened out because you took a medical a medical approach that’s available to you so you don’t have unbelievable pain like there is this. There is this glory around the suffering, which I can’t figure out what that’s I don’t know where that comes from. Maybe that’s crazy. Maybe it’s just broader culture. I don’t know where it’s from. 

J: no  and there’s so many theories on whether or not is truly empowering for women to give birth without any medical intervention or support, or if that’s all rooted in misogyny that we need to suffer that we need to so I’m glad I’m actually really glad you brought that up. I had so many friends who had experienced natural childbirth, and then had impressed upon me how liberating and empowering of an experience it was. And so I thought, well, this may be the only time in my life. I can experience my body doing this. And I was curious, but once I was in a certain amount of pain, I was no longer curious. And I knew I wanted to be more comfortable. And I had you know, I have no regrets about that. 

P: Yeah. 

J: And my Doula was wonderful. She wasn’t a hard ass. Like some of the doulas I had interviewed. They were really tough. And I knew Nope, I don’t I don’t want someone that’s not going to support me if I change my mind. It’s my body. I’m going to do what I want to do. But I’m glad you brought that up.

P: Also. I mean, maybe you would have done it if you hadn’t been awake for 30 hours before that, right? There’s so many so many factors that you can’t anticipate when you’re making that decision beforehand that when you’re in it, you’re like, This is nuts. Right?

I’ve interviewed midwives on the show before and one of them said, she’s seen obviously all kinds of births and that many of the women who don’t get drugs are so out of it when the baby is born, because they’re so just completely spent that they don’t actually get the moment everyone relishes about having the baby put on your chest right after the baby’s born and having that bonding moment because they’re just 

J: oh sure 

P: they’re just completely out of it. And so when it came to her own birth midwife said that she asked for an epidural, because I want to focus on and so it may be for these other woman they want to focus on the physical prowess of doing this really hard thing. Right. You know, everything is a trade off.

J: Oh, I think that’s fascinating that the midwife

P: totally This is so I mean, I hope you’re telling people this because,

J: right because there are pros and cons. It isn’t it isn’t one is better than the other necessarily depends on what you want from your experience. And when Lily was born, it was beautiful. John, my husband was crying and put Lily on my chest when she started. This is a little graphic but when she started crying, milk just started running down my front.

P: That’s kind of awesome. 

J: And it was awesome. It was all just awesome. Yeah, very cool. Well, good.

P: So I’m glad that all worked out. And then you have Lily and then How old is she before you decide we want another one?

J: Lily was three so she was just too old enough that I started to forget how brutal it is when they’re newborns because my friends had warned me about a lot of things with the labor itself. People use words like Oh, you’ll be exhausted. You’ll be tired. None of those words encapsulate how brutal it is in the beginning, when you’re up every hour with a newborn who either is or is not latching correctly, and your body is trying to heal from the labor and everything is new and you can’t just run to Walgreens when you want to because you have a newborn and so it took three years for me to forget that I had said no more children and when she was three, so I would have been 39 when we tried again and did have to see a specialist, a fertilization specialist. And I was told after we had tried, you don’t have enough eggs. This isn’t going to happen for you. We would have to use a donor egg and We didn’t want to throw more money at it at that point. 

And I’m adopted. My younger sisters, my parents biological child, but I was adopted. I was always interested in adopting a child John and I had spoken about it before we had gotten pregnant with Lily. And so we started talking about it again. And the process from when we started learning about adoption to when we had an adoption profile letter that a prospective birth mother could view was a year. It took a year because we went through the process of open adoption I was adopted in a closed adoption when records are sealed and the birth mother doesn’t know who has adopted her child. And the adoptive parents don’t know the birth mother’s identity. And the adoptee grows up without having any of that information.

P: Wow. So let me stop you here for a second and say that I don’t know anything about adoption. I’m going to ask questions because I don’t know anything. So do they still do closed adoptions now and how do you feel about the closed adoption?

J: Closed adoptions really used to only benefit adoption agencies because the school of thought at the time was the privacy is good for everyone. We’re protected. I was adopted in 1974, which was during the baby scoop era. 4 million babies were adopted domestically. 

P: Okay so to give you a little context here, the baby’s poop error that Jodie is talking about is a period that runs from the end of World War Two to the early 1970s. And as God suggests, a large number of children were adopted. This reflects a bunch of things limited access to birth control, higher birth rates, social pressure against being a single mother. According to the adoption History Project, roughly 50,000 children were adopted in 1944, rising to 175,000 in 1970. In 1974, there’s an estimated 138,000 adoptions, and for relative comparison, just over 3 million live births. So that’s something like 4%. These are rough estimates because the data is messy. Currently, one out of every 25 US families with children have an adopted child. According to the US Census, about half of these families have both biological and adoptive children. Today, almost 60 to 70% of domestic adoptions are open adoptions, which as you’ll hear more about from Jody means there’s a degree of openness and disclosure of information between the adoptive and birth parents regarding the adopted child.

J: This school of thought you know, culturally at the time was that being a single unwed mother was shameful. And so let’s let’s hide the shame away. Send the birth mother to a maternity home and then practice a closed adoption where we can pretend like it never happened. And I’m not going to say too much about my birth mother’s experience because that’s her her story but she was Catholic and her parents thought it was shameful. And she was told to never speak of me again. Now we know that’s really damaging. We know through research and the research psychologists have done as sociologists and etc, that even separating a baby from their birth mother is a trauma.

P: Again, to give a broader context here Ricky Solinger is a historian who wrote a book about adoption in the post war era which is linked in the show notes and her description of the type of maternity home that girls and women could be sent to gives a sense of that hardship. She writes maternity homes served a further stigmatize pregnant young women by removing them from their families, friends and neighbors. These quote homes could create an austere and frightening atmosphere for the birth mother whose freedom of movement was strictly curtailed. And then looking at the psychological costs of birth much more specifically, the adoption network Law Center in California notes that there’s rarely a public acknowledgement and friends and family of the birth parents may attempt to ignore the loss by pretending that nothing has happened. In some cases, the secrecy surrounding the pregnancy and adoption may make it difficult for birth parents to seek out and find support to grieve their loss. Also, the lack of formal rituals or ceremonies to mark this type of loss makes it more difficult to acknowledge the loss and acknowledge the grief as a normal process 

J: And so agencies started moving towards open adoption, where the birth mother and sometimes the birth father are involved in selecting the adoptive parents, and they agree on some manner of openness. Maybe that’s just letters, you just exchange letters, but maybe that’s visits, maybe that’s birthday parties, maybe that’s shared family holidays and something you negotiate throughout the child’s life. Because we know that’s better for the adoptee.

P: So it must be really interesting and informative. Having had the experience you had to then adopt the child because you have a sense of what it’s like for them.

J: I hope so I really hope I can guide Amelia. We adopted Amelia when she was three days old. She’s now almost five, her birthday is in March. I really hope that I can help her with some of those identity issues and some of that loss and grief that I grew up with. And she’s so young but she already has questions. She knows she’s adopted. We talked to her about it before she could even understand just so we would be comfortable talking about it and it would never be some she would never have a memory of this is when my parents sat me down and told me I was adopted. She would just grow up knowing

P: that already seems like a great strategy. And it’s good for you guys to practice before she’s aware. That’s super smart. talk for a minute about the letter. What’s the you said it took a year to put together your profile? What’s that process and what does that mean and how does that work?

J: So the adoption process it for us? We researched open agencies that practice open adoption. We liked the Nebraska children’s home their nonprofit. And we went to something called like an information meeting or probably there were 30 other couples and it’s a two hour meeting where they tell you this is what an open adoption looks like. And if you like what you hear you schedule an intake interview. This was another I think two hour meeting and we were asked all kinds of questions and some of those questions are poking and looking for a unresolved issues you might have that you need to address before you can adopt. So we were asked if we grieved our infertility. We were asked how we solved conflict. We were asked about relationships with extended family members all kinds of questions. Have we ever been to couples counseling? Had we ever contemplated divorce? And I don’t think they’re looking for reasons to say no, we’re not going to help you adopt a child. I think they’re, they’re making sure you have a strong foundation before you begin the process. And you know, maybe they would have had advice for us to seek out counseling or something if the intake interview had uncovered something. But after that step,

P: wait can ask the question about that. Sure. Since you have had your own biological child and now you’re in this world and how do we feel about the different burden placed on adoptive parents to have a child right no one’s asking you those questions when you’re when you make your own child in your bedroom. Or even if you go to IVF no one’s asking you those questions right that never comes up. But somehow when you land in this spot, it’s it’s a different thing. How do you feel about that?

J: Well, I think maybe it would be beneficial to children if all parents had to answer some of those questions before bringing a child into their home. I understand why it’s necessary because adoption is a process that is legally facilitated. You know, there are lawyers involved. There’s a caseworker involved. So it makes sense to me. It would come with all of this other’s stuff that you have to do. Because many people are responsible for this family that they’re put, you know, it’s not just John and I are responsible. We have a caseworker and agency and a lawyer and, and and the birth family and so that’s why all these other steps come in. We questioned it at times. You know, we talked about that. John and I did talk about that. That because you do have a caseworker that visits your home and that talked to our youngest child and we had to have letters of references from friends. And one of the questions asked them if they had ever observed John and I fight and how we handled it. Just a lot of investigating into your marriage.

P: it’s interesting because you also went the IVF route, and I needed help getting pregnant. And in that genre, right, you are inviting all these other people into the process, but because it’s at a different point in the process. The things that are being investigated are totally different. you’re creating this kind of bigger circle of people who are involved in the birth and life your child and I send pictures of my child to the cardiologist and the surgeon who helped her every year so like that feels like a bigger window but it just doesn’t include anything personal really. I mean, it’s like they’re looking for physical things, but there’s no you know, how do you manage conflict does not come up right? There’s no

J: but it’s so interesting that you brought that up because I hadn’t thought of that that with Lily. The help we needed was all related to my body and the physicality of baby making. And with Amelia it was all the emotional and mental. Yeah, components that go into parenthood. Yeah. Yeah, that’s, that’s really fascinating. It is not a very private process. However, when we were undergoing it, and we, you know, met with the caseworker, we had to do background checks. We read books, we took adoption education classes, was really involved process. We didn’t tell anybody. My friends who served as my references knew, and the people in the organization knew and my mother knew, but we didn’t tell anyone else kind of like when you’re trying to get pregnant if you don’t want everyone to know, because then they ask how’s it going? And we still tried to keep it private, even though in some ways it’s it’s impossible to keep it private because you’re working with all these people.

P: can totally see that. Yeah, but it’s a different circle, right. It’s not like your internet’s right your your this is like professional people. But once you get that letter together, what happens then and or do you do any searching or that’s all you do? You put it out there and then someone finds you.

J: Before you get to the letter, you fill out a questionnaire that requires a lot of soul searching that’s asking you questions about are you prepared to adopt a child who has, for instance, disability, and then it’s going to list the different kinds of disability? Are you prepared to adopt a child who is not the same race as you? And Nebraska Children’s Home took that really seriously? Because if you said yes, you had to talk about how are you going to make sure that this child’s cultural background and racial background is represented in your home and in their school and in your upbringing? 

And so after you fill out this really intense questionnaire, they have that information, and they take your adoption profile letter, and they’re only going to show it to birth mothers who match you. And you wait, and while you’re waiting, I think we were told 30% of us would be chosen in a given year and the 70% of us would not and while you’re waiting you attend these adoption education meetings that kind of feel like support groups for waiting couples to keep learning and talking about open adoption and what it looks like and and then you meet other couples who are also waiting for us. That was an additional six month wait. 

And then I was at work. I am a professor at a university. I teach creative writing and I was in my office getting ready to go to a class. Like it was literally 10 minutes before the class and I get a phone call. And I see that it’s Nebraska children’s home and I think Oh, our background checks are about to expire. And I’m nervous because John at this point is worried he’s aging out of new parenthood. He’s 45 I’m 42 And we’re like, How much longer are we going to wait before we decide This is our family of three. 

But that’s not what the woman on the phone asked. She starts telling me that baby has been born. And I stand up from my desk, you know, I was sitting down and I stood up and I was like, Is this happening? What’s happening? We had been told that a birth mother would pick us while she was pregnant and then we’d all meet and get to know start getting to know each other and talking about what that open adoption would look like. But the woman on the phone is telling me this baby is three days old. And the parents have chosen us and they want to close adoption. And can we come and get her right now?

P: Oh, my God, I have to tell you that all the hair on the back of my neck is standing up like I can’t. I can’t I mean it feels a lot like the call from the nurse from the infertility clinic about whether you’re pregnant or not. Right like just a but hugely accelerated because you’re pregnant. The baby’s born she’s here come get her

J; Exactly. We had three hours and come and get her because she was being released from the hospital and they were going to meet us at The Nebraska children’s home office and she was telling me some facts and things about the birth parents but honestly, I wasn’t hearing any of it. I saw later I’d written some of it down, but I didn’t even remember writing it down. As soon as she said we have this baby girl. She’s three days old. You know, I just started crying. And my body flooded with adrenaline. And I was thinking I don’t have diapers. I don’t have a crib. We don’t have food. We don’t you know, John’s parents don’t know. We we haven’t told anyone. And then she said you know call your husband because I was like yes, yes. Yes. You have to call your husband and then call me back at this number. 

P: that’s so funny You’re like What husband? 

J: Yes, it does. Yeah, I don’t care what he thinks. I’m coming to get our daughter. And I called John and he works construction and he was driving around in his white construction van. And he said, Is this happening? Is this really happening? I can’t believe this is happening. I have to pull over the side of the road 

And we both met at home and, and Well, first I had to find someone to teach my class. You know, it was a very bizarre conversation the next day with the chair of my department when I had to tell her that I had to take maternity leave immediately. But John and I met at home and, you know, kind of got ourselves together. We didn’t have a name. We had talked about boy names. We hadn’t decided on a girl name because we thought we might even do that with the birth parents. And he had told me that the birth mother loved Harry Potter.

So I did not want to name my daughter, Hermione 

P: Fair totally fair.

J: I googled on my phone, female characters and Harry Potter and we saw Amelia. She was a good witch. And I love the sound of that.

And that was Amelia and we went to the adoption agency and we met her daughter. 

P: That’s amazing and and the other twist here is that they want to close adoption after all these classes you’ve been to for an open adoption. 

J: Yes. 

P: So how did all that go? What do you have any say in that or? 

J: No, we don’t. They know who we are. You don’t hide any of that when you’re going through? This process. And so they know our full names. They probably know where we live. They’ve seen pictures of us. And for reasons that were undisclosed to us, they chose a closed adoption. I have written letters to them, that I send to the caseworker.

And she let them know that I had written these letters so far they have not asked for those letters. And I know Amelia at some point is going to want to know Yeah, you know that that consumed me during my teenage years. You know who I was really curious about my birth mother. And I know she’s gonna want to know and I’ve talked to our caseworker about this who’s a lovely woman. She said when when she’s older and she starts asking those questions. Why don’t you come and see me?

And obviously with DNA services being what they are. She can find them? 

P: Yeah, 

J: when she’s 18.

 

It will be easy for her.

But I would prefer that. Maybe before then we’re able to reach out. I know I’ve read a lot about adoption reunion stories and they don’t go they don’t always go the way they went on to Oprah or people magazines. 

P: I can imagine that it’s impossible. If you are looking for your birth mother, not to have some kind of fantasy

J: I did

P:  idea about what that’s like, right. It’s just that just is like a natural story you would tell yourself so that set such a high bar for the meeting. 

J: Yes. And especially they don’t want to be found.  So I’d much prefer we work with our caseworker and she contacts them and says, you know, look, she’s going to look for you. Eventually. Anyway. 

P: Yeah. 

J: Some some birth mothers do not want to be followed. So birth parents don’t want to be found. 

P: Yeah. So Emily is five right?didn’t you say she was five? 

J: Five at the end of March. 

P: Okay. So so we’re not in any, any. There’s no immediate risk that she’s going to run out to 23 and me and make it happen. 

J: Exactly. No. So that’s a long way off. She does. So children are so smart. And we have some books on adoption that we read when she wants to read them. But she has asked me questions sometimes. She establishes in our family she’ll say mommy is adopted.I’m adopted.

Daddy’s not adopted, Lily’s not adopted.

And she’s repeated that a few times. She has asked me where her birth mother is where her birth father is. Gosh, she was three I think when I was trying to show it to her explain it to her with her stuffed animals. This is your birth mother. This is me. This is you. You were in your birth mother’s tummy because she has asked was I in mommy’s tummy? 

P: Yeah.

J: And now I’m your forever mom. Or your heart mom?I’ve read in books, these phrases in books. So I’ve used them.

And there was a timer sitting in a room and I was explaining this to her and she looks so sad and I said it’s okay to be sad. And she got into my lap and she cried a little bit.

I believe babies feel this. I believe they feel this when they’re separated from their birth mom, how could they not?

P: A little more on this So in 2003, a book was published by Nancy Verrier, a therapist, adoption advocate and author and many people thought this book had the power to revolutionize the way we talk about adoption…she refers to adoption using the term relinquishment and she coined the phrase the primal wound, which she defines as, quote, physical, emotional, psychological and spiritual wound. Her argument is that the act of separating an infant from its birth mother creates trauma. The infant of the birth mother had been growing a bond over their 40 weeks together. The infant knows its mother through all the sensory relationships that exist between a mother and a fetus in utero, a sense of a heartbeat, voice and smell and to be removed from that even at a very early age creates trauma. This is not to say that kids who are adopted are victims. It’s just to recognize that something significant has been lost in this process. adoptees can love their adoptive parents and feel traumatized by their relinquishment and adoption. So the primary goal here is to acknowledge this fact. Marcy Axness, also therapist and author on the subject notes that abandonment and loss is imprinted on the unconscious mind and the biochemistry of those who have been separated from their biological mothers at birth. Part of why this is important is because culturally we tend to bury this truth. You focus on the adoption part of the transaction, but not the relinquishment part. And denying trauma exists doesn’t resolve it, especially given that trauma can have all kinds of downstream effects on development. There’s a link to a relatively recent article in The Atlantic on this topic in the shownotes.

J: We know from research they recognize their voice and recognize the heartbeat maybe the smell, how could they not feel that? So I do think Amelia feels that loss not every day. But I do think in that moment when we were in her room and she was asking me questions. She was sad about it. 

P: Yeah, I agree with you. It’s hard to imagine she doesn’t understand on some levels somewhere in her body about that. That connection, but I’m you know, I guess for her sake, I’m I’m very hopeful because at least you’re acknowledging it and you’re talking about it, which I can imagine was not a thing when you were three.

J: No, and when I would ask my mom about the other lady, as my mom said I would call her she would she would get upset. And she has said to me over the years I never thought of you as adopted. I’ve always thought of you as my own.

But I was adopted. I was hers but I also had a birth mother. And I didn’t want to make my mother cry. And if she would cry, she would be upset. And for a while, I felt like I can’t ask about it. I can’t I can’t talk about it. But my mother did help me when I was in high school and then later in college when I said Mom, I have to meet my birth mother. I have to at least try I need to know this piece of my identity. And where I come from. I have so many questions. And it was my mom who helped me 

P: that’s awesome. and I can imagine it makes a difference. 

J: it Makes makes a huge difference to have that support. And I think it’s definitely complicated for adoptive children and for adoptive parents and I thought because I was adopted I would slide so gracefully into this role of being an adoptive mom, that I wouldn’t feel jealous or threatened or confused or these things I had read about in these adoption narratives that adopted adoptive parents can feel but I didn’t feel all those fakes.

When we brought Amelia home, I did have some insecurities. I did wonder, who do you look like? Where did you come from? Who do you think I am? Do you know? I’m your mom? Do you feel like my daughter you know I had I went through all that which helped my mom and I you know grow closer because I talked to her about it.

So I did feel all those complications.

The kind of complicated love that accompanies of that kind of family making 

P: Yeah, I mean, none of it’s for free, right. There’s no There’s no easy path. I think to having children 

J: exactly 

P: anyway you can and so two things to say one is the do they look like you is such a powerful presence. So my two kids don’t look anything alike. i One on One looks like mini me. And when they were little and I would have them in the stroller, people will ask Are they both yours? 

Oh, that’s always fun all the time. You know, which I was like, this is such a weird why are you asking me this? You know? It’s a weird thing to say.

J: Amelia is whatever she feels her feelings toward her birth family and where she’s come from, and that journey for her is not mine. 

P: Yeah, 

J: you know, it’s hers. It’s going to be hers. And yeah, I know my mom had her own feelings about that. And and it at times was painful for her that I have and I’ve met my parents so I have this whole other world that she’s not a part of. 

I want to say something to the comment you made about people asking you if both your children were yours. Yeah. I can tell you adopted people hate those that the question and you know, it’s it’s probably a thing in every culture that people will comment on newborns. Oh, he looks so much like you. Oh, she’s got your nose. Oh, you know people used to tell my sister and I because we’re so close in age that we are we twins we looked so much like this commenting on resemblance is so common in our culture, and it does out you know, non traditional families that question like outcome, in some ways. I mean, you can lie when people say people will comment that don’t know on how much Amelia looks like John. They both have brown eyes and brown hair. But people that do know will also comment like almost as a way to assure reassure me they’ll say oh, she touched you looks so much like John she looks so much like your family you would never know. And, and that begs the question, Well, why would I never want people to know.

P: Agreed. What are you hiding? Thats wacky 

J:  Why can’t people know but then on the other hand, I find that question so invasive like someone asking you are they both yours? Why do they need to know that if they’re not in your inner circle that is so not any of their business? And what is it that they’re trying to get at? I just it’s such an interesting interesting phenomena. 

P: It totally is. And I agree, I don’t I don’t I don’t know what the source of that what the source of that curiosity is.

J: I’ve read a couple of theories about it. And I don’t go on too long, but I read something about it’s sort of rooted in our ancestors in the male need to affirm kinship and make sure the child was theirs. 

P:Yeah.

J: So that is rooted in that like it’s not the male man’s baby right? The baby looks like me.

 

P: Yes, it does seem primal to some degree or 

J: it’s outdated to now… families are made in so many different ways. 

P: Yeah. Yeah. Agreed. So that’s amazing. So 11 And five, so you’re pretty busy. 

J: Yes, very busy. I have a great relationship though.

They really enjoy that. Well. The young one adores the older one, of course and follows her around everywhere. 

P: Interestingly, also, maybe you would agree with this, that age gap is is kind of nice. And actually, you didn’t have a big age gap. So you had a totally different experience, but my I have a younger sister who’s eight years younger than me and when we were kids, we didn’t have that much in common, but she’s absolutely one of my best friends in adulthood. And I talked to her every day. You know, there’s no competition between 11 and five.

J: Right. Right, and they can have their own extracurriculars and their own friends and it doesn’t overlap in school the way it did for my sister. 

P: Yeah, 

J: and me. Yeah, that’s absolutely right. The competitiveness is not there. In the same way. 

P: Yeah, I’m assuming your sisters need to point out that she’s 13 months younger is some need to distinguish herself from you or differentiate or, you know, we’re not twins. 

J: Yeah. And when I would say, Well, this is my little sister, she would go not that little 13 months difference, kind of thing. So it absolutely was a way to like distinguish herself from me.

Yeah. Yeah. 

P: So that sounds lovely. I know you’ve written about this, but you’re I think we were talking earlier about. You’ve written a book and it somehow touches on this week. Tell us about the book. 

J: Yeah. So my book under my bed and other essays. It’s coming out September. First. 2022. And Amelia story is in the book. The origin story of the book is that when I was in my 20s, living alone for the first time, I had this nighttime ritual. I get home at night, and I raced around my apartment and check behind furniture, yank back the shower curtain and look under my bed. Because I felt like if I didn’t, there would be an intruder, serial killer or rapist waiting for me.

And I knew it was irrational and childlike.

But maybe not that irrational. So I started seeking out these origin, stories of my fear and other women’s fears and where they come from, and in the process of writing the book started writing about Mother fears, and even Body Body fears. But the book is ultimately about how we choose the greatest vulnerability of all which is to love and care for others. So Amelia story is in the book.

P: That’s very cool. What’s the name again? 

J: it’s under my bed and other essays, okay. And you have a website or what I do, okay? Should I say it? Sure. It’s www. Jodi. keener JODYKEI S N E R.com. 

P: Cool. And I assume you have more writing there? 

K: I do. Yeah, there’s some links to other essays. 

P: That is very cool. Thanks so much for coming and sharing your story and telling us all about this interesting and difficult process. 

J: Yeah, thank you for having me. It was a lot of fun.

P: Thanks so much to Jody for sharing her story. When I was looking into all the topics she introduced me to there was a lot of discussion of adoption being quote, the last taboo, because the profound disconnect between the public perception of adoption, which can only be discussed in terms of incredible luck for the child and generosity for the adults involved. And the way it’s experienced by adoptees, which seems more nuanced includes both trauma for the initial loss, and the glory we all hear about. So I sincerely appreciate that this story is being shared so we get more information about all this.

You can find links to the things that Jody and I discussed, including a link to her website, and Her most recent book, on the war stories from the womb. website at war stories from the room.com Thank you for listening. If you liked the show, feel free to share it with friends. We’ll be back soon. With another inspiring story.

Episode 48 SN: Making her Way through Preterm Labor & Surrogacy: Ariel’s Story

In today’s episode, my guest is a friend of mine shares her story. She comes up against a host of extremely difficult situations and challenges in her quest to have a child. Her story has some elements that many people will relate to preterm labor and issues with her cervix, and other issues with IVF and surrogacy that I think really showcase her resilience and strength and make the birth of her daughter a triumph we can all celebrate.

(painting pictured above: The Quest by Andy Davis)

Ariel’s book about her experience is called The Maternity Labyrinth, which you can find here.

Audio Transcript

Paulette: Hi Welcome to War Stories from the womb. I’m your host Paulette Kamenecka. I’m an economist and a writer and the mother of two girls. In today’s episode, my guest is a friend of mine shares her story. She comes up against a host of extremely difficult situations and challenges in her quest to have a child. Her story has some elements that many people will relate to preterm labor and issues with her cervix, and other issues with IVF and surrogacy that I think really showcase her resilience and strength and make the birth of her daughter a triumph we can all celebrate. In this conversation. I also include the insights of an MFM who’s doing amazing research about the cervix, and has the kind of bedside manner that sets the bar very high for doctors, I think gives patients an idea of what we should all be looking for in an OB. 

Let’s get to this inspiring story. 

I mentioned that today’s guest is a friend of mine, we’re in a writers group together, but I’m gonna walk her in just like I walked in everyone else so Hi, thanks for coming on the show. Can you introduce yourself Ariel and tell us where you’re from?

 

Ariel: My name is Ariel, and I am from New York City and now live in California.

 

P: Lovely. Thanks so much for coming on. I read the maternity labyrinth. I knew you have quite a story. There’s a lot going on. I mean, that’s a that’s a perfect title. It is. It is a tricky thing to make it through. Let’s start before the beginning. You have siblings, right?

 

A:  Yeah, I have two younger brothers.

 

P: Did you grow up thinking I definitely want a family. I want a big family. What were you thinking?

 

A: That’s good question. I guess I assumed I would have a family. I not necessarily big I think I probably assumed I have I don’t know two kids. I didn’t get married till I was in my mid 30s. So at that point, I think having a big family was less likely in my mind. But I mean, my mom had three super easy pregnancies, easy deliveries, no issues got pregnant easily. So I just assumed you know, it would have happened when it happened.

 

P: You’d walk into it kind of in a straightforward way like your mother. Yeah. around that age. I had my first kid of 32. So around that age, I feel like when people are starting to have kids and are you like aware of what’s going on with your friends, is anyone having a trickier time or it just that doesn’t have much resonance for you because in your own family, it went well. 

 

A: I definitely had some friends who had miscarriages in the first trimester. And I have one good friend from Boston who definitely had a really hard time. She had multiple miscarriages and they did IVF. So I had friends who had some fertility issues, and I definitely seen friends.

 With IVF. 

P: So it was somewhere in your universe, but you didn’t think it was on your path. And so now let’s start at the beginning. Remind me Was it easy to get pregnant? 

 

A: It was very easy to get pregnant. 

 

P: Okay, good. Okay, good.

 

 

A: So that was the what was so bizarre about it was like once I got pregnant that easily because I was worried I was in my mid 30s. So I thought, you know, maybe it’s not going to be as easy as it would have been a few years earlier. And I got pregnant easily. I thought, wow, this is this is gonna go fine.

 

P: And you found out with like, a home kit. Yeah, that’s fun. And that’s an exciting day in your house. 

 

A: Yeah, no, I was I remember being stunned, right. Frankly, my husband couldn’t believe it either. We really thought it would take at least you know, the good five months or whatever. And so I think it was like, second month I tested and there was it was it was fast and easy. 

 

P: Wow.  Well, that’s a good story. You know, I think all of us walk in thinking that’s how it’s gonna happen just because that’s the story you get when you’re a teenager. So I’m glad it was true for you and it’s true somewhere, and then that pregnancy develops and then I know that you run into trouble with that, but I’m not sure about the timing.

 

A: Yeah, so so everything was going smoothly. I had amnio everything was fine. I had the level two ultrasound and I can’t remember if it was around 20 weeks or something. Everything was great. And at that point, I thought you know, it’s gonna be smooth sailing from here on in because I sort of passed all these markers and I felt fine. And I was it was in 24 and a half weeks pregnant and I was just it was night I was just reading in bed and I went to the bathroom and a bloody clot came out. And so I tried to be rational and calm and I mean, I just felt fine and I wasn’t bleeding continuously. So I got all my trusty pregnancy books. And we’re in then about anything like that because it was way past miscarriage time. And so I wasn’t having contractions I felt fine. So I kind of sat and waited



P: Wait a minute, wait a minute…So this is I feel like I would hit the panic button immediately because 

 

A: Well, I think because it was at that point it was so it is it didn’t fit any bigger. Like I had no idea what like I was completely out of my mind that I could possibly be Miss Karen because it was I was 24 and a half weeks pregnant. I was six months pregnant. So like at that point, it’s not a miscarriage. 

 

P: Like it just no no, I agree. It’s I agree it just meeting is like enough to it’s not like I felt weird, right? It

 

A: it wasn’t like continuously bleeding. That’s what was strange. And then I think part of it may have just been the way I don’t know if the way I was raised but I generally I had never I’ve never heard that in my entire life has been in the hospital. The only sicknesses I’ve ever had are like you know, a cold what happened? Nothing. Like my I think my mom is sort of joke like she is the antithesis of the Jewish mother that she is like, she’s the type like if you tell her to do well, she’ll tell you to go shrug it off like not a worrier. We were not rewarded for sickness. It was sort of like go to school and get over it. So it was like the furthest thing from my mind. I’m generally I’m moderately athletic. I felt fine. So I could not imagine that something could be going wrong. And then I had like everything looked fine and all the tests. So I thought, you know, who knows? Then I started having contractions.

 

P: and you knew that they were contractions. You knew what they were? 

 

A: Well, I mean, again, I started rationalizing, thinking, Oh, they can be Braxton Hicks. It’s about the right time. And again, you know, looking at all my books and nothing made sense. And so I tried to go to sleep and it got worse like the contractions were bad. So I called my doctor the middle of the night and she said go to the hospital now. 

 

P: are you in NY for this?

 

A: No, I was in here in California, California. Okay. So she said, Go now and I’ll meet you there. And she told me later that she almost hesitated to tell me that because I sounded so calm, which is nice. I went to the hospital and I was in full labor. I mean they checked me out I was fully dilated. And I mean, they had to deliver the baby there was nothing they could do. Like once you’re dilated like that…so when the doctor arrived, they decided to do an emergency C section because 24 and a half weeks is a dicey time like there is a decent chance the baby could survive, but it’s not. Not not ideal, but I guess she wanted to do whatever she could to, you know, to see if the baby could learn if no vaginal delivery would not have

 

P: so vaginal deliveries like too much pressure on the baby.

 

A: So they did an emergency C section. And when the baby was born, I mean, she was crying like it was she was born alive and they took her immediately to the NICU. And basically she survived for three days and the thing that I believe develops last is the lungs. 

 

P: Yeah, 

 

A: so the lungs were just not and once that started with just sort of snowballed, like that affected with the brain and then there was bleeding and it’s like there was just no way.

 

P: Yeah, I mean, you it sounds like it was so out of the blue that you didn’t even get the chance to take steroids for a day or two or anything. Like that, because it happens so quickly. I’m So sorry.

 

A: You know, it was seriously like I mean, I’m even at the time I barely reacted because it was I couldn’t cry. It made no sense. It was surreal, truly. And, you know, no one could figure out what like they did. Test. There was no there were no genetic issues. There were no one could figure out why. So after that, 

 

P: something kicked off, Labor’s what that means, right, something 

 

A: Well, that’s interesting. So my professional medical theory. Yes, I mean, in my mind or the way it felt because I wasn’t doing anything. It wasn’t like I was running a marathon. I was seeing getting rejected, right. So in my mind, it felt like there was some chemical thing. Miss something not wired right. That told my body to go into labor at the wrong time. However, I did I went to see a high risk specialist and he said that I have an incompetent, incompetent cervix, not a diagnosis, I can name I really appreciate

 

P:  I was gonna say, in this community of writers, we have to come up with a different name That’s so dumb and and just why why in 2020 like 15 years ago, why?

 

A: It’s like an accusation…So anyway, but he said that it wasn’t definitive because you basically have to go into preterm labor twice for them to be sure of that and there was also like, again, my mom never had any problems. It does tend to be something that sometimes runs in families. I wasn’t particularly large. 

 

P: today. We’re lucky to have Dr. Filthy Rich on the show. She’s a professor at Intermountain Healthcare and adjunct at the University of Utah. And medical director of MFM, obstetrical ultrasound services. So I feel like the cervix is the unsung hero of pregnancy. And I think people don’t necessarily understand exactly what’s going on with their cervix. Maybe you can walk us through the role of the cervix in pregnancy.

 

Dr. Feltovich: So the cervix is just an amazing structure. That cervix is one of the critical pregnancy tissues that performs a diametrical opposite function during pregnancy it’s job for most of pregnancy is to remain long and firm and closed but for pregnancy to occur normally, and allow vaginal delivery at the end of it, it has to go completely opposite by the end of pregnancy. It has to be completely soft and completely dilate and open for normal events to happen and the same is true of the other reproductive tissues. The uterus needs to stay quiet and calm through most of pregnancy but at the end contract strongly for things to go normally, and the membranes also have to stay quiet and intact, and only like break open to allow the delivery at the end. And these structures are all talking to each other all the time. There’s a lot of evidence about, cellular communication between them. The problem is that it’s just such a remarkable transformation that these tissues undergo throughout pregnancy, that there’s just really not much known about it. Not nearly enough known about it. 

 

P: So let’s talk about Ariel. I’ve shared her story with you…and Of course after such a devastating outcome, We want to know why. Why did this happen? So the doctor she goes to see says that maybe she has an incompetent cervix, but it has to happen twice to get that diagnosis. I wonder she’s got no family history. She doesn’t have a high BMI. All the obvious things are not in play. So I’m wondering what the risk factors are for preterm labor. Do we think there’s some chemistry issue at play for spontaneous preterm labor with no obvious trigger?

 

Dr. Feltovich: So first of all, I’d like to react to the term incompetent cervix. I never use that term. I feel like it’s pejorative and it kind of Yeah, it is. And it it sort of imply some sort of personal blame on the patient and their own body or blame on their cervix or, you know, something else that just isn’t fair and isn’t correct. So, I actually use the term cervical dysfunction because there there are certain people whose for whatever reason, those reproductive tissues that are supposed to stay intact and strong and have the molecular scaffolding within them stay intact until the very end of pregnancy for some reason in some people that that isn’t the case. And there are, multiple different reasons for it. There are certain things that precipitate or increase the risk of preterm birth and a lot of it is sort of a chicken and an egg problem. So, bleeding can be both a symptom of cervical dilation. And for Ariel, it kind of sounds like that was the case because she had some, some bleeding and passage of sounds like some mucus and clot and then she had contractions right after that. But bleeding can also be the precipitator of events. So for instance, women who have bleeding during pregnancy, especially continued bleeding, heavy bleeding, bleeding, in the second trimester are at increased risk for preterm delivery, because there’s just something about that bleeding that that irritates tissues and sort of messes with their extracellular matrix, you know, the scaffolding and in the membranes and the cervix that that give it its, strength, it’s biome biomechanical properties, and it’s never clear which thing comes first. Right? It’s a real chicken and the egg thing. Same thing is true with another precipitator of preterm delivery, which is preterm rupture of membranes when that when that bag of water around the baby breaks too early. And same thing is true with cervical dysfunction where the cervical structure just kind of breaks down. So What’s tricky about this is that all three of those things have to happen, right? The cervix has to disappear become soft and dilate, the membranes have to break and the uterus has to contract in order for a fetus to deliver. And he more we learn about it, it seems like those things don’t need to happen in any particular order. So the cervix to go back to Ariel’s problem has long been thought of as the kind of gatekeeper of pregnancy and it is, you know, it’s like sort of the common denominator of all these processes, right. It’s sort of the final step, because you can be contracting, your water can be broken, and unless that cervix opens and shortens the fetus won’t deliver. So it’s kind of thought of as a gatekeeper. For a long time people thought the cervix was just sort of a bystander in the process of parturition, which means, you know, pregnancy and delivery. And then for a long time, people thought it was sort of controlling the event. And there are various different theories on that. The truth is, nobody really knows except that it is 100% clear that all of the pregnancy tissues are involved, and they are all chattering with each other all the time. One important thing for somebody like Ariel to know, is that two thirds of spontaneous preterm births are unexplained, two thirds of them and this is revealing of the real paucity of understanding we have about the process. Many women have zero antecedent history of anything going on until they’re minding their own business laying in bed one day and they pass a clot. So that is a very, very common story. And why this I think, is so complex, is that take Ariel story, she passed a clot and had some bleeding. 55 0% of women will have bleeding during pregnancy. You know, mostly during the first trimester spotting or you know, something like that. But the problem is that there’s this event that can herald a very serious outcome, like what happened to Ariel is also very normal in pregnancy. Same with contractions. You know, people talk about the Braxton Hicks contractions or many of us call those preterm uterine activity without preterm labor. And in fact, we understand so little about preterm birth and why it happens. That the diagnosis is actually retrospective, which means if someone’s having contractions, and I say 32 weeks, which is preterm 37 weeks is term 40 weeks or someone’s due date, but if someone’s having contractions at 32 weeks, I will tell them, you know, I don’t know if this is preterm labor or not. It depends on what happens if you have all these contractions and deliver before 37 weeks, it was preterm labor. If you have all these contractions and deliver at 37 plus zero or later, it wasn’t preterm labor.

 

So the picture is just so complex because all of the things that normally happen for a pregnancy to occur in the right way, which is cervix, changing contractions, breaking water, even bleeding is really normal. All of those things can also be completely abnormal and results in a traumatic outcome. So very, very complex. 



A: None of it really fit or made sense. 

 

P: Right.

 

A: So he basically said, you know, if I get pregnant again, they would do a squash community sewing up your cervix and put me on full bedrest.

 

P: How do we walk away from this and I can fully imagine that it cannot be processed in the moment, but now Is it is it 15 years old now? How long ago was this? 

 

A: This was 2002 

 

P: Okay, so 20 years ago, yeah, almost.

You would say it’s processed now or we just we don’t touch it.

 

A: It’s it’s pretty much processed. I mean, I mean, I think to some degree, you never get over something like this, but I 

 

P: agreed

 

A:  totally about it. I mean, I’d say at first I was just not like totally shocked. And I mean, we we decided we try again because the doctor said he thought it was I mean he couldn’t make any promises, obviously but he thought I had a cat remembered statistics, something like an 80 something percent chance of carrying to term or at least to a safe time. So this second time, it took me a little longer to get pregnant. I think it’s about seven months and then I got pregnant and then I did CDs because they can do it earlier than amnio and everything was fine and then did the start class and I think around 13 weeks, went on full bedrest

 

P: What are you doing in your life at this point? This is a huge thing to ask.

 

A: The timing worked out well because I was teaching and I had this or collage seriously the day after school ended in June sometime and then did not plan to return the following year and then was on bed rest we made arrangements which was complicated like the bed rest rules are just so weird because he wouldn’t give me definitive answers. Like we had a second story in our house or our bedroom was so I said, Well, can I go up the stairs to go to bed and he basically said once a day, like it seemed a little arbitrary. 

 

P: Yeah, 

 

A: so I basically hung out all day on a sofa and our den which was right next to the kitchen, and he told me I could get up to use the bathroom

 

P: one thing that’s frustrating about incompetent cervix is all you’re doing is naming the fact that your cervix open too early, but 1000 routes probably lead to that outcome. So I don’t know what you’ve identified at all except for the most obvious thing. So I’m wondering like how bedrest will resolve whatever force is confusing your cervix?

 

A: That’s an excellent question. Well, I believe they think it’s more of a structural issue, not a chemical one. So I think he saw it as putting less weight or pressure on the cervix. So you’re supposed to lie on your side, not even your back, which is mentally uncomfortable. Yeah. And basically just minimize the amount of weight and pressure you put on your cervix. I mean, I think there’s, this is a controversial treatment. I got a second opinion. I went to another expert in San Francisco and she said the same thing. I think it was almost like for lack of a better remedy. I mean, they just end fitness has bad side effects.

 

P: I took this issue of bedrest to Dr. Feltovich.

When you describe the complicated dance between the uterus and the cervix and the membrane and all the chemistry that must be going on to have those things communicate, it’s not I understand bedrest for that since we don’t know. We don’t know what’s causing the preterm labor. 

 

Dr. Feltovich: bedrest. Yeah, it does nothing. You’re exactly right. I mean, I think in in previous days, people recommended it because it makes sense that if you’re like laying there doing nothing, that things should be better. But in actuality, that is not the case. There’s tons and tons and tons of data to suggest that bed rest only results in an increase in blood clots differently than people. And it doesn’t. It doesn’t prevent preterm birth at all. I tell my patients, you know, you could be climbing Mount Everest or laying in bed and if your water’s gonna break, your water’s gonna break so, live your life and I think there’s an element of people including doctors feeling like if you suffer a little bit, chances are your outcome will be better and bed rest just precipitates anxiety makes people crazy, right? So I think there’s some element of that but in fact, the American College of Obstetricians and Gynaecologists completely agrees with you and two years ago, put out a publication that we call them practice bulletins for providers that said there’s no reason for bed rest. Stop it. Wow. Yeah, that there’s some role for bedrest in women with hypertensive disorders, you know, high blood pressure disorders, but not for prevention of preterm birth because it flat out doesn’t work. So I’m really glad you brought that up, because there’s still a lot of misinformation out there about bedrest.

 

P: I can’t remember in like, early 2000s I mean, you certainly didn’t have the internet stuff you have now right? I feel like Netflix was still like, send away the DVDs and get it back.

 

A: Yes, we did. But I did have Netflix was sending us I saw a lot of movies. And it was hard though. Yeah, my husband was working so like he would leave. Like all I had to do was basically just get it. I didn’t cook or anything. I had a couple of friends who’d come over but I mean it was it’s lonely. It’s also just physically uncomfortable to be like, you know, to lie in one position for hours on end. It’s awful.

 

P: And like you feel responsible like if only I lay the right way. Yeah, all worked out. Right. Which even though that doesn’t entirely make sense.

 

A: And then when I was monitored it also like the ultrasounds they would try to measure my cervix and through the ultrasound, and he would tell me things like it was always long and closed. Everything looks fabulous. And sometimes it was longer. I was like it’s growing. I mean, it was ridiculous. Like, the tests aren’t even accurate.

 

P: She said one thing that was frustrating is she had been going in to get her cervix measured, measured, measured, measured, and she was saying every time I got it measured it gave some different reading. And I understand that that measurement means that this is what your cervical length is in this very moment. But she was wondering how predictive that is.

 

A: It’s a little tricky, you know, measuring the cervix after somebody has had a sore claws like that’s a whole separate area. But if you think about just cervical length in general, it is the best biomarker that we have currently, for preterm birth prediction and a biomarker is a metric of discrete measurement that can’t be done in a standardized fashion that actually gives you information. So it is really the only biomarker we have for prediction of preterm birth, which makes what I’m about to say next, even more pathetic, which is that its predictive value is close to flipping a coin. So yeah, so there’s definitely there’s a very well established inverse relationship between the length of the cervix in the middle of pregnancy like between 16 and 24 weeks or so. And eventual timing of delivery. So that people that have a cervix, that is what we call short. And by the way, there are various definitions of short but the most accepted definition of 20 is 25 millimeters or less,

 

P: since everybody’s body is different. I wonder why you wouldn’t take a measurement of the 20 week and then make it a percentage. So

 

Dr. Feltovich: that has also been looked at, okay, and another definition of a short cervix is a cervix that is…What we work on is developing non invasive ultrasound waves called quantitative ultrasound to do things like measure how fast an ultrasound wave goes through a tissue, because that’s directly related to it softness. So I work with brilliant people at the University of Wisconsin Medical Physics Department, my main collaborators, Tim hall there and he’s a well established quantitative ultrasound physicist and we have so many brilliant during your faculty and trainees that we work with there and at Columbia and Duke University and we just have this big group of really invested caring people with brilliant minds turned on this problem or I’m just that person in the lab group that goes and says this is a terrible problem, please fix it. So what what all these people in our labs are coming up with is ways to look directly at properties like tissue stiffness and the structure like how organized is that sort of college and microstructure in the cervix in the membranes? And we have found that the cervix has a wide range of stiffness property and the length at the beginning of pregnancy does. These are small studies. Small studies, but it seems pretty clear that the normal sort of x changes in stiffness by about four to 6% per week, there is a predictable stiffness decrease in normal pregnancy. You’ve just said it makes so much more sense that you basically figure out where a particular person is starting and predict from there rather than just say, well, here’s this number that kind of fits most people. And eventually, we and many other people that are doing pregnancy research, hope that that’s the case hope that we can do modeling and sort of a precision approach to pregnancy.

 

A: Anyway, so that went on I was monitored heavily and the this time into my 23rd week of pregnancy. I then went to the bathroom and my waterpark and I mean this was with all that. So so again went to the hospital and at that point, I was like basically rolling my eyes because I obviously knew what was coming. And it also tells you that the tests they do like like the ultrasounds they measure your cervix like at that given moment. Yeah, this was a few days later. So yeah, it doesn’t it’s not predictive in any way. It’s just they see at that time,

 

P: I had a kind of wait and see aspect to my pregnancy too. And I kind of I kind of appreciate it, at least for today. I know that things are okay. Even though I could go home and it could all fall to pieces right? Did you have any comfort from the actual ultrasound in the moment or you were like this is worthless? 

 

A: Well, at the time, I believed that they were giving me good news. It was only after when I went into labor A few days later, which clearly showed that and then, at that point, I just felt like I had lost faith in sort of modern medicine and my body like I just felt like no one knows anything.

 

P: There’s a lot of unknown. So obviously your cervix doesn’t have to open for your water to break because you have a collage.

 

A: No, but I think it tore through part of it. Like I seriously like first for the stitches. Wow. Yeah. I mean, me and my cervix is highly like I don’t know, it also made me think like it has to be something chemical. Because I wasn’t doing anything. There was no weight on my Surface. Yeah. And I wasn’t like someone who was enormous when they were pregnant, like the baby was not huge. So it just made no sense and I mean, I haven’t seen multiple doctors since then and specialists and ask them about about like it being triggered by something chemical and they will roll their eyes and I’m not kidding. looked at me like I was asking an idiotic question. still contend that is not

 

P: Agreed. Agreed. That seems crazy that they’re not willing to at least entertain there might be something here we don’t know. Since bedrest is not the answer. So this seems very stressful. You know, when your water broke, there’s there you can’t they can’t maintain the pregnancy anymore right

 

A: now. Well, but I mean, it was awful. So what happened was so when my water broke, the umbilical cord came out as well. So that meant the baby could not survive. So they also did a vaginal delivery even though I was told in no uncertain terms by my doctor that it had to be a C section. It was a T cut. It would be dangerous to deliver any other way second time, but they said because the baby was so small it would not be a problem, which would turn out to be correct. So at least that delivery was easy. Because the C section was a nightmare too I was excruciatingly painful for six weeks. We can’t do much of anything. So this was easy in terms of the delivery part. But the baby was stillborn because the umbilical cord had come out…

T

 

P: Did you know it was the umbilical cord like did you find it and they found it Okay, good.

 

A: Yeah. So

 

P: So that seems again, unbelievably hard. And yeah,

 

A: it was also surreal in the I think because it was easy delivery. I mean, I came in, like in the early evening I can’t remember at dinner time and they I left the next morning in the hospital. And the only reason I stayed overnight is because it was essentially I mean, there was no like they said, I mean because there was no baby. Like, I could just go home I was fine, which was also crazy. Like, it’s just like, 

 

P: the whole thing is  crazy, and I’m guessing you’re on like labor and delivery work. 

 

A: Yeah. Which was awesome. Well, they were I do have to say Stanford’s credit, they both times they gave me my own room, but the C section. And that’s, they were I mean, they were very set for the C section. I was there for four days and they were very sensitive to the fact that they were not going to put me in a room with someone with a newborn. And this same time also I was just there overnight that they gave me my own room and I noticed they put something on the door I couldn’t see what it was it was some sign for the doctors or nurses making clear that there was no baby so like not to ask me awful questions. So So I at least they they seem to do that. Well.

 

P: Well good. I’m glad for that. And then I can imagine it’s are you thinking like we’re I guess we’re not going to have kids or we’ll adopt or like how do you what?

 

A: So at that point, well, when we talked to a doctor before I’d asked him about this and he said like if this didn’t work and he said there was another kind of cert clash I can’t remember they call it something else where they I can’t they saw you up like I don’t know if it’s like part of your universe. It’s a much more involved procedure. And you’re, like, again, risky, there was no way I was doing that. And I didn’t really have much faith in anything working at that point. At that point. We were talking adoption. And then my doctor had mentioned that she had had a patient who would use a surrogate. So she told me, you know, she contacted the patient and asked him it’s okay if I talked to her. So I talked to this patient and was willing to entertain and in my mind, I remember surrogacy when I grew up. I was a child, but I remember the very Mary Beth Whitehead case, and it was a huge thing in the news. And basically she carried the baby for another couple, but it was also her egg. And then when the baby was born, she wouldn’t give it up. Oh, this is what I remember, at least. The whole notion of surrogacy seemed insane to me. And that’s really all I knew about it was that story that I remembered.

 

P: But let me ask you a question about you knowing you I feel like you’re not someone who is super attached to the idea of pregnancy like it has to come from my body, right? You don’t care

about that? 

 

A: No, not really, but I definitely and at that point, it was clear like I had no problem getting pregnant. So that part I could do. It was the caring part I couldn’t do which is why surrogacy seemed like the perfect solution. Right? That’s why you couldn’t use our sperm and egg and someone else’s, basically. Yeah, but yeah, so that part I and I, my experience has been pregnant are so negative at this point, that was nothing like that. I was romanticizing accounting, but it still it made me very nervous. Like, you know, I don’t I didn’t know enough about it. I didn’t like my mind. I thought Who on earth would do this and I didn’t understand the legal issues. involved. So we looked into it and the person I talked to had a very positive experience both with her surrogate and the agency shoes. So I called the agency she had used in LA has, for whatever reason, many service agencies. We all seem to be there and I was really impressed with the people I talked to. And then we did look into adoption too. And I taught a cow for adoption in California is quite complicated, actually. Most of it’s done through private lawyers, not through agencies and I talked on lawyer who I really didn’t like very off putting so and then my husband was much more in favor of surrogacy than adoption. So we started kind of doing most of our research on in that direction. And so that was another very lengthy process.

 

P: It there’s no easy way to have a child right there’s no no easy path there. I guess unless you’re like 18 or something. I interviewed a midwife who was a surrogate. Her argument for why she wanted to be a surrogate was that I could do this pregnancy thing pretty easily. And it’s such an amazing thing to give to someone else. And I totally agree with that. And I was like, Oh, I guess if it were easy for me. I could see how that would be an attractive thing to like, make money on the side and do something for someone else. So I think it’s like attractive. If you find that person. It sounds like what the first person you work with. 

 

A: She was fabulous. Yeah, no, they were she was great. Like and that was true of like the people we talked to and interviewed with but they were lovely. They really they all had easy pregnancies. They like doing it. It was like a good deed they could do for someone else. They were mostly people who really cared about family. Yeah, the agency was great. They screen people. Well, I mean, it took a long time, you know, to match us all that. So the surrogate we worked with at first had four kids of her own two Singleton’s and twins, and she was just lovely, warm and like common sensical and just easy to deal with. They thought that I’d be a great candidate because I had no problem getting pregnant. They thought oh, this will be a snap. But meanwhile, also I was turning 40 And so like, who knows what was going on with my fertility at this point, it wasn’t going to be getting any better. So we did IVF. Basically, we ended up doing four rounds of IVF and each time I produced insane number of x for like a four year old, like, minimum of like 18 Like it’s like unheard of. 

 

P: I remember reading that and thinking holy crap. This is a I hear so many stories about people who do IVF and they end up with, you know, after day three or four when they form the embryo and they’ve checked it out they end up with like one or two. 

 

A: I always had a bunch of times and like obviously some of them were not good, but it was like that was not a problem and and then we got plenty of decent embryos each time. And each time the surrogate first was a two time shooting and pregnant third time she got pregnant with four quadruplets. And I was like, This is insane. It was like Octomom story.

 

P: That’s that seems scary. And in your book, I was like,

 

A: No, we couldn’t make this stuff up. It was crazy. The doctor was very aggressive to like he put in a ridiculous number of embryos each time because he kept perceiving me it was like he couldn’t fathom that. It wasn’t that I wasn’t there for fertility reasons. Yeah, we kept like putting in ridiculous amount of it was not good. So anyway, like before, basically we would go down each week with like her for the ultrasounds and each week was like then there was one less and finally the last week there were none and they had to do a DNC It was horrible.

 

P: So it was just sound like emotionally challenging in a totally different way. 

 

A: it was awful like, just like you’re sitting there staring at the screen because like no one’s knows what’s going to come and they ultrasound and you could like that time I would look at the doctor’s face as he was and you could tell he was horrified. And then I asked her around she didn’t get pregnant and then we decided we would try to use donor egg and see what happened with that, because the doctor kept blaming me in my ancient texts, that I had to be the problem and meanwhile, the one thing about our surrogate is she was very overweight. And and that is a factor. I mean, yeah. And I had asked about that when we first met her and my doctor didn’t think it would be a problem because she had had four kids no problem. So we then had to find an egg donor, which was another incredibly lengthy, crazy process. We did that and we had some great embryos and so they implanted a couple in our surrogate and she was pregnant, got pregnant, and they could tell two heartbeats, but one seemed pretty weak and the other same time. And then again, after a few weeks, the one that was weak, didn’t survive, but she didn’t miscarry. And then the second one was not looking so good, and then again on the ultrasound, not viable. So that was when we decided this is like I kept emailing him and saying, What is going on? And he kept proposing things like putting our surrogate on different medications that she Oh, I know what it was. She was pre diabetic, maybe. Like he wouldn’t just say this is not working out find a new surrogate. He went through that. I had to flat out say to him, if you knew what you knew today about our surrogate, would you recommend I work with her and he just wrote back? No. She told me this like two years ago,

 

P: totally. And there’s so much gray area that right

 

A: Yeah, and I’d say that particular placement we use that place because it was within a reasonable distance to our surrogate house. But it was kind of an Idea Factory. It was not. It was a private clinic. It was the office was always jam packed. You never got any you never felt like they cared about you. It wasn’t I don’t know. I mean, it sounds like there are a bunch of different considerations you have to keep in mind like ease of access for the service, right, which is important because you mean she had to go there quite a bit. So we then had to find a new surrogate which was also awful because I you know, we had become close and I felt terrible. I mean, I basically, you know, ruin two years of her life and you know, she had her own life and family as well, like it was terrible. So the agency found us a new surrogate who would carried like she seemed like a surefire bet she had carried twins full term. They were like a powerhouse for another couple years before. Plus she had had to have her own kids. So we used we had frozen embryos from the previous round. So we use that lb changed. Fertility Centers. Which was a huge, like, night and day. This was USC. The difference was amazing. Like, just at my intake, I guys spent two hours talking to the doctor. He was lovely like he it was just a very different experience. So she got pregnant on the first round. But nothing easiest thing on earth. And I mean, at this point, I was a nervous wreck and could not possibly believe in any control.

 

P: When I read the book, I was amazed by your tenacity because there’s so much hope put in every single attempt that anyone makes ever and to the IDF seems fairly grueling, right. There are a lot of aspects to that you taking drugs and the shots and all that stuff. And all of it is building building building to the implantation and then the next ultrasound and there’s so many points at which things can go right or things can go wrong and it’s just it’s a lot

 

A: I that’s interesting that you said tenacity, but I felt like I’d started something and you can’t finish like I was going to see this to the end of it killed me it was like I had people ask me that. I think one of my cousins said like, Why on earth are you doing this? And it was like I felt like I had something to fix. And I and it also just sort of snowballs. Like, once you get started, it’s like you can’t you almost can’t stop. Once we had the embryos. I’m like, well, we may as well use them.



P: And that’s totally true. But it’s not costless for you right? I can You can see that you’re when you read the book, like you’re suffering through all of this. On the one hand, I totally relate to the I’m going to see this thing through I’m this is my goal. I want a kid and this is how we’re going to do it. And on the other hand, it’s just, it’s like expensive, right in terms of emotional capital. 

 

A: Yeah, no, it was awful. I mean, I I would definitely say I not the same person. Right. Yeah. And yeah, I mean, it affected me in profound ways. Just like I mean, the whole pregnancy. I mean, seriously until our daughter was born. I did not believe that this was going to happen even after the first trimester when we were basically we were done with the fertility center like after three months. You then go on to your regular OB I still was not convinced this was gonna work. 

 

P: Oh, my God, I would have wrapped the surrogate and bubble wrap. 

 

A: Well, that’s the funny thing is like, first of all, she lived in LA and I live in Northern California. So we felt like I could monitor her noise in my place to do everything right. And she’s also she’s very low key easygoing, which I think is probably great, but for me, that’s inconceivable to me how you could be so relaxed. So it was hard for me to have to sort of let go and just trust her. It’s not like I know her well, but you know, everything was fine. And the irony of all this was that in the end, our daughter was a week late. Wow, that killed me severest.

 

P: So how. So how does all that work? Like how does it work for the bird? It sounds like you’re going down there fairly frequently for all the ultrasounds to be involved. Yeah, and et cetera, like you I needed a bunch of medical help to get pregnant and stay pregnant. And it’s, it’s so not what I pictured to involve all these people in my pregnancy. What it is like a different route to that same outcome. So how did it work for the birth? Like what’s the plan and

 

A: we made plans ahead like we knew we had visited the hospital with our surrogate ahead of time and the hospital and clearly worked with surrogacy before we were warned ahead of time to avoid certain hospitals, particularly Catholic ones who are not so okay with this. So we went down to LA. We were there for about a week we like we went down after her due date because her daughter said no way on earth is she ready yet or giving birth any day? So we stayed in a hotel and was pretty much waiting with our phones on all the time. Basically, when the doctor said he was inducing her, we then moved to a hotel like right next to the hospital, and she called us early in the morning and we went in and then he was born like two hours later. Wow, we were in the delivery room.

 

P: That’s awesome. That was gonna say is it’s weird to be late. This is her fourth pregnancy. Right. Kind of want to? Yeah, of course. But I’m glad that the birth was fairly straightforward. Yeah, no,

 

A: it was, I mean, easy fast. And her I mean, she said they did limit the number of people that could be in there. It was my husband. And I And then her mom, and that was it. And it was again great. They didn’t very they were very sensitive. You know that she had, you know, some like there’s some decorom there. My husband is not suiting like it was it was done very appropriately. As soon as our daughter was born, they handed her to me. It was they, they really did a great job. And then they we had a room in the hospital they gave us that’s awesome. I know. They were amazing. So we all stayed overnight and then the next day we drove back home to our house, with a baby. 

 

P: And a surrogate just says goodbye and that’s it. 

 

A: Yep. So she stayed overnight also, just to make sure she was okay. And she went back to her family and she was 15 minutes away from the hospital. But, you know, we’ve been in touch with her. You know, we sent pictures. It was surprisingly the surrogacy relationship worked out very well, like we were friendly and got along well, but I don’t think there was any indication that we were necessarily going to be best friends for life. But I think, you know, I think she wants to know that our daughter is fine and things are okay. And you know, that’s that’s really the extent of it.

 

P: I do think it’s probably surrogates are similar to NICU nurses, where it’s like special people who select into that work and so they’re able to have kind of the right kind of bond with someone who they who they give this gift to. 

 

A: Yeah, no, she, I mean, I’m forever grateful to her. She you know, what you’re in for life. And, and she, you know, she did a great job, like, there was, our daughter is healthy and fine. And so.

 

P: So that’s amazing. And you guys get home and what’s that like?

 

A: Well, that I mean, this is where we’re going to talk about how I feel like I’ve been profoundly changed like, I’m like, I think like my mom, I was never someone to get worried about sickness or anything like that. And then, like, that was a huge change. Like, my daughter would so much it’s like sneeze and I’d be ready to call 911 Just like I would assume the worst of everything just get much more nervous high strung about particularly things that I’ve never ever been like before.

 

P: Well, that totally makes sense, right? You’re you have had these shocks. So now you understand how things can go and that’s kind of that’s terrifying, right? It’s there’s no, that seems like a legitimate response to experience. 

 

A: Yeah, I would say though, it took years before I kind of realized, you know, she’s basically she’s likely to be okay. But that was a huge difference, I’d say are a huge impact that this had on me.

 

P: And did you guys take turns fingered at you know, when she was an infant, or how did all that go? 

 

 

A: I’d say why I couldn’t nurse and we’d looked into that it would have meant taking more hormones, which not doing any work, but because of that it meant my husband could get up for the night. That was quite nice. That’s super nice. And she was a huge baby. She was big and hearty because she was a week late also. So it meant like she generally slept better through the night faster, and she didn’t need to find a ton of weight fast. So that was also nice. That’s awesome.

 

P: I mean, you’ve had time to process all this stuff that has happened. What advice would you have given to younger Ariel? What would you tell her to have made her path any easier?

 

A: That’s a good question.

 

P: I mean, I think most people learn partially how you did through your own experience. With pregnancy. That is like a giving up of control. And I’m imagining while you’re talking about the surrogate, you have to give up control even more. It’s not even your body, right. It’s not, which is a hard thing to hard thing to do. 



A: I don’t know what advice I’d give. This isn’t advice, but expect the unexpected, which is kind of cynical, but I felt that I was cocky about my pregnancies but the first time but I after a certain point, I felt like what could go wrong? Yeah, like after I asked the first trimester and so it’s hard for me now like when I like even after shortly after that time, friends who were you know, more or less my age who got pregnant and they were just relaxed. And I had one friend, you know, she ran part of a marathon I had, like I was just thinking and they were very self confident and everything turned out fine. But I mean it’s still mystifies me like I still I’ve gotten less so now but at that time, like I would see women, you know, pregnant women, whatever at the gym or biking or doing and I just thought how and I assume with most of them, everything was fine, because I think my situation was also on the extreme end and it’s by no means common. Yeah, all combination of things. And it’s it’s also hard, like, people who don’t know what happened, ask them about pregnancy and I don’t want to give advice to anyone because, like I said, I just was I don’t want to scare people or horrify them again, it’s not what happened to me. It’s not typical by any means. So

 

P: I’m not sure what to do with the scary part. I mean, a lot of people talk about oh, I don’t want to talk about my preeclampsia because it will scare people and I’m not sure that’s the right frame only because it is what it is. This is what pregnancy looks like in all its many forms. It’s not all rainbows and butterflies. I think that’s a pervasive story, but not necessarily a pervasive experience.

 

A: Yeah, no, I think you’re right. I mean, it’s interesting, but in terms of when I was looking for agents for my book, and a lot of them would say things like it’s too much of a downer. People don’t want to read that they want you know, much more optimistic story.

 

 

P: I mean, I think your story is amazing that here you are with a 50 sheet 15 or 16 shall be predictive team soon. Yeah, like a you with a 15 year old. This is an amazing story. I think I you know, all the things that you went through, you know, show that it can be done.

 

A: At the same time. I remember people would ask me, which still shocks me shortly after she was born if I was gonna have another one. I’m not doing this because I also realized that it took five years basically to have one. Yeah. And I knew all the possible things that could go wrong. Doing this again, but people were stunned like they thought because I had a healthy child that somehow erased everything that had preceded it.

 

P: Yeah, or they can’t imagine what it felt like to do although the everything that came before. I think it’s an amazing story and amazing to have a teenager now. Right? 

 

Maybe because Ariel and I know each other. The end of the episode sort of got away from us. We started talking about things unrelated to pregnancy. So I’m gonna end this episode with two more insights from Dr. Feltovich about the culture around specific issues in women’s health. Everyone I’ve spoken with, patients and doctors suggests that they don’t like the term incompetent cervix and I’m wondering how we change the name. How does that happen?

 

Dr. Feltovich: These things happen slowly medicine is very, very, very slow to change. But I don’t hear the term incompetent as much as I used to, even though it’s in the ICR diagnostic codebook has it in there because it’s just it’s been a term for more than 100 years. Some people think it’s better to call it insufficient cervix. And I guess that’s slightly better, but I don’t like that one, either, because lots of tissues can function or dysfunction and it just seems kind of non pejorative. So how do we change that? I guess, like we change everything else, just talking about it and whenever we publish on it, talk about cervical dysfunction. We had a paper some collaborators and I a number of years ago in which we talked about how incompetent wasn’t the right term, and I guess we just slowly talk about it and speaking of talking about things, I think the culture around preterm delivery really needs to change again by talking and you know, sisters talking to sisters and friends and mothers and neighbors and, and talking on blogs. And podcasts. And you know, all of this because I think that one very common misperception

 

really needs to change again by talking and, you know, sisters talking to sisters and friends and mothers and neighbors and, and talking on blogs and podcasts and you know all of this because I think that one very common misperception that ties into terms like incompetent cervix is some sort of accountability for that. As if we as patients have any control or as if there’s something the matter with our bodies and you know, I don’t think I have ever in my multi decade career, done a consult on a patient with a history of preterm birth. Who has not cried when I’ve said and what part of this do you think is your fault or you know, what are the things coming up around the, you know, because they don’t talk about it. People are scared to say, What did I do? You know, so in my clinics, we just hit that nail on the head, we say, Okay, you’re gonna think you’d like like, let’s say Ariel had come to my clinic after her 23 weeks P prom, right? Yeah, I would say all right, you’re gonna think 100 things over the next few days. It’s just it’s the mind is a very, very busy place. And anxiety, and fear, are very, very strong emotions, and they kick things up in your brain, right? You can’t control them. And so we always talk about how there there are 100 things that are going to come up you know, like, that day when you’re throwing up and you’re like, oh my gosh, why did I want to be pregnant? This is awful. Or like, you know that those glasses of wine you had before you knew you’re pregnant, or you know what, whatever else it is, there’s the mind is just a very busy, active place. And let’s pick those things up. But none of them are true, because the truth is that you could be laying on the street doing meth cocaine, you know, like mainlining, crud your whole pregnancy and not have a preterm birth, like you could be really doing things that aren’t good for your body and not lined up with a preterm birth. So culpability is the word I was like. culpability. Yeah, they’re just there, isn’t that and so, a really important thing. That I hope people like you disseminate and communicate to people is that there really is no shame or blame in this. Doctors. Experts don’t even understand what causes it, but we know what doesn’t cause it. And what doesn’t cause it is women doing things wrong. Yeah. Yeah.

 

P: If only it were that easy, right. Then you just say, don’t walk downstairs.

 

Dr. Feltovich: Right. And that is exactly that is exactly what I tell people. I say. That’s exactly what I tell people. I’m like, I wish there was like, I wish I could say, Yeah, thing ABMC that’s what you did. So don’t do those again. Right? But they’re just there. There isn’t that. And so there’s a whole component of classy care. That’s not about the uterus at all, but it’s about self care. And self love, and gentleness and understanding around real uncertainty over biology. And, yeah, and really letting go, self judgment and the judgment of others.

 

P: such wise words to live by…Thanks again to Ariel for sharing her story. And thank you to Dr. Feltovich for teaching us what the current state of understanding is about preterm labor, and what the future might look like. If you liked the show. Feel free to like and subscribe and share it with friends. We’ll be back soon with another story of overcoming






 

Episode 47 SN: A Dilemma of What to Do with Frozen Embryos: Nicole’s story

If, in your attempts to start a family, you run into trouble getting pregnant you quickly learn about a thousand elements involved in the process of getting pregnant: hCG and estrogen and the uterine lining and if you are making use of IVF technology to get pregnant, a whole other set of elements enter the equation: the quality of eggs and sperm and if you are lucky embryos, and then, again, if you are lucky, the quality of the embryo after a few days of cell division, the blastocyst…and the list goes on and on. What today’s guest contends with, which I’m guessing is a common issue for most people who use IVF, is the question of what to do with the remaining frozen embryos. The power of their potential keeps her and her husband uncertain about their appropriate fate. 

You can find Nicole’s piece about this experience, Very Nice Blastocysts, here

Audio Transcript

Paulette: Hi Welcome to War Stories from the Womb. I’m your host Paulette Kamenecka. I’m an economist and a writer and the mother of two girls.

If, in your attempts to start a family, you run into trouble getting pregnant you quickly learn about a thousand elements involved in the process of getting pregnant: hCG and estrogen and the uterine lining and if you are making use of IVF technology to get pregnant, a whole other set of elements enter the equation: the quality of eggs and sperm and if you are lucky embryos, and then, again, if you are lucky, the quality of the embryo after a few days of cell division, the blastocyst…and the list goes on and on. What today’s guest contends with, which I’m guessing is a common issue for most people who use IVF, is the question of what to do with the remaining frozen embryos. The power of their potential keeps her and her husband uncertain about their appropriate fate.  

After we spoke I interviewed a reproductive endocrinologist from Yale, who also happens to have used IVF technology for her own pregnancy.  Although this is a very personal decision, She has some insight into the process and the difficult question of what to do with frozen embryos.

Let’s get to this story.

P:  Hi, thanks so much for coming on the show. Can you introduce yourself and tell us where you’re from? 

 

Nicole: Yeah, I’m Nicole graves Lipson, and I live right outside of Boston in Brookline, Massachusetts. 

 

P: Nice. Lovely. So sometimes in thinking about the families we create, it’s useful to think about the families we’ve come from. So Nicole, do you have any siblings? 

 

N: I do I have one brother. Yeah. 

 

P: And growing up to do you think I’m definitely having a family or I want to recreate this or

 

N: I always knew that I wanted to have a family and have children. I don’t think it was in a intense active way. But when I envisioned my future, family and children were always in it. 

 

P: Okay. Let’s get to the family then. Do you have two kids? 

 

N: I have Three, 

 

P: three kids. Okay. Yes. So was it easy to get pregnant? 

 

N: It was not at all easy to get pregnant. My husband and I were married for six years before we had our first child. I had assumed as I think a lot of women assume but it would once we decided to have a child that would be in a year, year and a half. or so before we would get pregnant at the most. And that did not pan out. And so we pretty quickly realized that we needed to turn to fertility treatments and assisted reproduction to help us out with our first 

 

P: so let me ask you about that before we get into that even more. We needed help as well. And I found that kind of shocking and awkward. And you know, once you invite more people into the process of creating a baby, it’s just it’s just not what we were kind of fed growing up. Right. That’s not your image of baby making. Were you equally kind of taken aback by that or did you just you thought this is Thank God this is here. 

 

N: I was taken aback by it. I think I think what was hard for me about it wasn’t so much that there was a stigma around it or anything like this. It was the feeling that for so many things in my life as a kind of driven, ambitious person. I’ve been able to control outcomes. If I worked hard enough, if I focused I could make a lot of the things that I wanted to happen happen. And it was hard for me to come to terms with the fact that there was nothing that my brain could do to help my husband and I create a baby. 

 

P: Oh, totally. And we briefly talked before we started taping about uncertainty. I have the exact same mindset and I thought well, I will just work super hard to make it happen. Yeah, that’s how it works. Right? Although I have come to reflect on that idea as naive. And maybe my sense of my control over all those things was less complete than I thought it was in the moment. 

 

N: Yeah, I think it’s really hard. To let go of that tendency. 

 

P: Yeah, 

 

N: I would still think about it all the time while I was going through the process, not only because there are elements of it that just make it very consuming, whether it’s yourself medications, or things like this, but I think I still had that feeling of if I put brainpower to this you know, if I think about it enough, you know, if I read enough online forums, you know if I know enough about this, if I do the process well enough meaning, you know if I give myself that injection, not at the no one at night or similar 659 But exactly at seven o’clock so I think it is really hard to give give up that control. Another that you’re doing in assisted reproduction. You are you are handing over control of this process to to medicine 

 

P: to someone else, right. You’re giving me a flashback of our I remember myself in a room practicing the injections on an orange did you have to do that? 

 

N: Oh, sounds actually familiar. And now that you know, you say it, I might have done that as well. A universal thing? 

 

P: Yeah, yeah. Okay, so So you realize you need help and what does that look like and how does that go? 

 

N: Doing some research and finding out you know, different well regarded fertility clinics here in my area that are many in the Boston area? 

 

P: Yeah. 

 

N: And so we were lucky in that regard, and then having a consultation with a couple people and going with the doctor who we felt comfortable with and and who we felt we would have a good shot with. 

 

P: you Did IVF right?

 

N:  Wasn’t that your before our first child? We did IUI. We did three rounds of uterine insemination and the third was successful. That’s it. 

 

P: That’s what I did you and that’s pretty gentle in terms of art, right? I imagined that I’d walk in there and they’d have like a turkey baster. Which is how they’re filling you with with the materials of life. 

 

N: Yeah. I think the hardest part of that experience for me was that on one of the inseminations there was like a good teaching hospital that I did. There were like, six residents in the room. Like one of them actually did the procedure and I was like, I’m not so sure about this. There you go again, with right like handing over control. 

 

P: Yes and uncertainty. For sure. I’ve definitely been in the teaching hospital setting where I’ve thought I mean, I should just sell tickets. I feel like I’m getting used here. So the first one is a success and how is that pregnancy 

 

N: that pregnancy we might end up working? We might end up going off on a tangent here at that pregnancy, with the exception of nausea. I was nauseous at the beginning of all of my pregnancies was wonderful until week. 28. I want to say when I went in for a routine ultrasound, and it was determined that my cervix was shortening which you might know means often that you’re near labor, put on immediate bedrest, so as I’m bedrest for you know, modified bed rest at home for many weeks until I got to be in my you know, 30 Something pregnant and 36 weeks pregnant or something like this and nothing had changed in my cervix and my my OB was like, this just must be your body’s physiology. And so I ended up being induced at 40 weeks after all of that. Oh, I think you’ve got you’ve talked about the rest of the show. I mean, that’s a whole other. 

 

P: It’s useful to know it’s so widespread.

 

N: It’s so widespread. I mean, I wrote about this in one of my other pieces, actually, I think that the turning to that as an option. is not something that would happen if men gave birth. I was the head of the English department at my school and I, one day I was the head of the department the next day, I was on my couch and you know, like 

 

P; crazy. 

 

N: Yeah, there’s a lot there. Like the assumption is is that somebody else is managing the finances somebody else is able to provide if there’s other children, you know, it’s yeah, there’s a lot a lot. 

 

P: that’s crazy. So you bed rest for a while and then how’s the delivery? 

 

N: That was all great. I agreed. 

 

P: Okay, good. So then how long between the first and the second? So I started to try to get pregnant again. I’m born with a second child like two years apart. That was our ideal. So I started to try to get pregnant in probably when my my first child was like 18 months or so. And, you know, I think we tried naturally for a while and but we didn’t want that to go on too long. And then we sort of marched through the different levels of intervention, right? So first, we did Clomid, and then we did IUI and eventually our fertility doctors suggested it was probably time to move on to IVF for this one. So that is what we did. Yeah.

 

P: and IVF is an entire project as I understand it. 

 

N: Yeah, at the beginning, it’s quite like IUI what you went through where you are injecting yourself with a follicle stimulating hormone over a series of weeks and then so you have to go into the clinic for regular ultrasounds to measure the size of the follicles, the egg follicles and how they’re growing and get regular blood tests to measure your estradiol levels. And so it is involved in the sense that you are making regular visits to your clinic or hospital for these interventions. 

 

And then it’s just obviously a lot of mental, a lot of mental energy. A lot is hinging during those weeks on, you know, the the call you get from the nurse at the clinic in the afternoon telling you how the follicles are growing or how many there are. I think the thing about the IVF process or or or really any intervention, fertility intervention I think is how it takes up so much space in your brain when you are going through it. I think that’s, to me that was harder than the actual injection of the shots or, or all of this it was how the sort of fixation on how things were going, how things were going to turn out sort of eclipsed the other things going on in my life at that time. That was hard.

 

P: Well, you are given a window into how intricate and complicated this process actually is. Because if you don’t get pregnant just by having sex one night then then that process is broken down into 45 separate steps where now you have all these other things to focus on and will the cells divide and what will they look like and you are being forced to examine and focus on all these details that you otherwise took for granted? What does not agree it seems understandable if that’s how it would go I remember waiting for the call. And when I was waiting for the call, I guess it was on like the edge of cell phones. So not everyone had a cell phone so you had to be home. 

 

N: Right? 

 

P: impossible to imagine. Now I can totally relate to how hard each and every step is, especially as we talked about with your interest in controlling things that you’ve previously controlled in. Your life and now it’s in someone else’s hands and I’m not sure about you, but I felt really responsible for all my numbers. Like all these numbers are being produced by my body even though I can’t do anything to change the FSH control 

 

N: that really resonates with me what you just said and I think there’s so much about fertility and childbirth and motherhood, especially early motherhood. For me there were so many things about it that made me feel for the first time that my body’s involuntary functionings were reflection of one moral character in some way like you know whether or not you can produce a baby easily whether or not you can breastfeed, right? No woman has any choice over whether or not breastfeeding comes easily for her or not. And yet in our culture, there seems to be such like a value just to health value placed on breastfeeding your infant but almost a moral value right and so it becomes this like morally laden thing. Can my breast produce breast milk for my child can I can I create a wonderful latch you know, between my child and me, these involuntary functionings that we don’t think about otherwise suddenly carry this moral ethical weight. 

 

P; yeah, those feelings are totally familiar, but it sounds like in this case the IVF works. 

 

N: the IVF works. Yes. And the first the first round of IVF work so we were very lucky in that regard. Yeah. 

 

P: And then the leash gets longer after the first trimester because now you’re freed from the fertility people. 

 

N: Yeah, absolutely freed from the fertility people. And just regular pregnant woman at this point. Yeah. 

 

P: how does that pregnancy go. 

 

N: Hey, I really loved being pregnant. I loved being pregnant. All three times that I eventually ended up pregnant. 

 

P: I’m glad that went smoothly. I read a piece that you wrote. It’s called 

 

N: very nice blastocyst, 

 

P: a very nice, very nice blastocyst. Is that with reference to the third pregnancy? Or where’s that in the lineup? 

 

N: That’s reference to the second pregnancy. 

 

P: Okay. So let’s talk about that because that was a beautiful piece that you wrote, In case and in it, you’re sort of contemplating what to do with the other embryos, right? 

 

N: Right. So what happened in that IVF cycle? 

 

P: To give a little background on a typical IVF cycle, I got in touch with a reproductive endocrinologist today, we are lucky enough to have Dr. Tanya Glenn a reproductive endocrinologist from Yale on you have a clinical practice and you’re an instructor at Yale as well. Is that right?

 

Dr. Glenn: clinical instructor The third year fellow, so I’m still in training, and we’ll be graduating in about four months.

 

P: Oh, exciting. Congratulations. Thank you. Thanks so much for coming on the show. Can you give us a quick walk through what the process is? Just so people who have you know exactly what’s happening

 

Dr. Glenn: so to IVF is when patients will take their medication determines what that means is there are natural hormones where your brain tells your ovaries each month and a patient that’s having regular monthly cycles to grow an egg, and usually our bodies when they can, okay. And in this case, we take over that brain to ovary signal by giving them hormones that they take through an injection. And this instead of just saying grow one egg, I’m telling the body girl lots of eggs. And then when they get enough large eggs, we call them follicles at that point because eggs are microscopic so I can’t see eggs themselves by say I see the home that they live in. And as the egg gets more mature, the home gets bigger. And so once that follicle gets to a certain size, we give them what we call a trigger shot. This kind of mimics our body’s natural hormone rush that causes the body to ovulate or release the egg then approximately 36 hours later, we do a procedure called an egg retrieval that includes a transvaginal ultrasound with a little needle in the end, or we actually go into the ovary and suck out the follicles or the eggs under ultrasound guidance. We would then give those eggs to the embryology lab. And let’s say someone is has a male partner or using donor sperm. And in that case, we would expose the eggs to the sperm. And then you know, watch them fertilize in the lab and then usually grow them to day five, sometimes day three if they’re lesser quality. At that point at day five, they’re called a blastocyst and a blastocyst can either be transferred back to a patient she desires to get pregnant in that cycle, or we freeze everything? And especially with patients who have let’s say a couple like they don’t just have one embryo they have five or six that say they want one place back but now with these other five, they’re going to freeze them. It’s called process called vitrification, which is Latin for making glass and they can transfer them in another cycle. And the purpose of that too, is that we know even for patients with you know less than 35 so peak fertility is actually in the mid 20s. But we can really see it go down at 35. And so even patients younger than 35, we only see about a 55% chance for live birth each time that you place an embryo back, so it’s not 100%. So it’s nice to have those I say something reserved in the bank. And so we know that the live birth rate after about three embryo transfers one each time is about 90%

 

N: I think I had 14 eggs that were extracted at the end of that cycle, maybe five or six fertilized normally and the doctors picked the very best two and this is interesting. I learned that embryos are graded like diamonds, it’s a similar grading system that diamonds have like clarity color. There’s a very similar grading system for embryos and so I from us process we had two beautiful sparkling high quality diamond embryos and so two of those were been implanted in my uterus and and that’s determined based on your your age and an algorithm you know, how old are you? How likely are you to have multiple babies? I would have welcomed twins if that had happened but it did not only one of the embryos implanted and that embryo turned into my son, who is now eight. 

 

P: That’s sort of amazing and you’re talking about feeling judged based on what your body does and but you’re literally your eggs are being judged. They’re like, 

 

N: Oh, I’m proud of my diamond embryos. Like it’s like my husband and I produce these diamonds. Absolutely. Like you’re sitting there I remember sitting on the on the hospital table with like the paper sheet over me being shown this photograph of the two embryos and Doctor explaining to me what made them so perfect. And you know, I was just I had, like my first glimmer of maternal pride in these little creatures that might become a child of mine. So, yes, and and then what they do is they they continue to let the remaining embryos that are in that petri dish, their cells continue to multiply and they watch them and the ones that continue to live on which means that they are in the strongest condition have the best hope of you know ever developing further they freeze and so after our IVF cycle, we had three frozen embryos left over should we ever want to use. 

 

P: So that becomes a little bit of a tricky question, right? What do you do with the embryos which I feels like it’s weighty? 

 

N: Yeah, so that’s the question that I explore in my essay, very nice blastocyst. Anyone who has had a child knows how all consuming it is to have an infant. And so you know, for for the first few months to a year of my son’s life. I’m breastfeeding I you know, I have his older sister at that point is a toddler age three. And so I’m a busy lady, with a lot going on, and not something I ever really thought about, you know, the embryos at that point. They were, you know, the IVF wasn’t that far behind us. You know, there wasn’t any question because my baby was so young that I was going to have another child anytime soon. Nor did my husband and I know if we wanted to have another child that was not something that we had planned for or discussed. We very much knew that. We wanted two children and not one we were very hopeful that we could have a second child after our first but beyond that, and never more children had never been a big factor in our thinking our planning we’d never gotten further mentally than into 

 

P: Yeah, and I can see because I also did not get pregnant easily. I know the drive and the focus, to make the babies and have it work. And that kind of overrides everything. So you don’t necessarily think about what’s going to happen to those embryos. You know, you’re so excited that you get pregnant when you’re when you get the call and you are pregnant and it’s going to work and you’re so focused on that. And so seemed like in your essay, you were saying that issue of these frozen embryos occupied a space in the back of your mind pretty continuously and sort of what to do with them. 

 

N: Right. So again, the saying earlier, the fixation on successful that getting a baby is so strong and so overwhelming. That I think it it pushes your brain away or pushed my brain away. I can say from thinking about other things, anything tangential and a future fallout from this experience. I wasn’t thinking about oh you know, is this going to be harmful to my ovaries in the long run to be stimulating them this way? Because I didn’t care. I just wanted this baby. You know, I didn’t care if you know there was heightened risk for ovarian cancer. I wanted this baby. 

 

P: people who use assisted system in production are pretty focused on getting pregnant. History really do we know if there are any long term consequences?

 

Dr Glenn: That’s a great question. I think that overall there has been some information looking at specific or mentally responsive cancers like breast cancer and IVF and one paper I know that I reviewed recently looked at maybe if there is a slight increase it was a Danish conference study that there might be a slight increased risk of breast cancer within the short amount of follow up time. However, when you looked at the risk, it was point 9% of the population versus 1.1% of the population. If there wasn’t a difference. It was incremental. I always have a caveat as well as that this is looking at a very homogenous population. It was a Danish cohort, how much does it apply to our own patients? And so there has been a certain studies looking at that if you look at something like egg donors, you know, we limit it to six cycles and so and it was actually not for the potential for increased risk for cancer, because looking at the increase of cumulative risk of doing something like stimulating your ovaries and going for an egg retrieval. So overall, it’s a risk for any kind of complications from an egg retrieval day. infection, bleeding damage to certain structures like your bowel and bladder is like less than point 1%. However, when you look at someone doing repetitive cycles over time that increases and so we just want to make sure we protect everyone. But overall it is it is a safe procedure. They take the each individual and say what are their risks and benefits knowing their history?

 

N: The same way did I know that there was a likelihood that my IVF cycle would result in frozen embryos? Yes, my husband and I were given among all the many piles of paperwork you have to sign when you when you do IVF there’s a form we had to sign even before embarking on IVF about storing frozen embryos because the clinic would store those in their own facility for up to three years. But beyond that, if you didn’t want them to be destroyed at that point, they would need to transfer them to an outside cryogenic facility. So all of this required paper work in advance and the clue to the fact that I just wasn’t giving them this topic. The brainspace that I probably should have before I embarked on IVF is that those papers I found those papers unsigned and unreturned after the IVF cycles, so there was something about those papers. You know, I remember reading them and thinking this is crazy. How can I be signing papers about genetic material that doesn’t exist that might not ever exist? Decisions for possible future genetic material and where I’m going to store it and it just seemed, it’s it was daunting paperwork and there was something almost like speculative about it. It just it was I didn’t want to look at it. I didn’t want to face it. I didn’t want to think about it. And I didn’t. 

 

P: Yeah, I mean, it almost seems overconfident to be like, where are you going to stash this haul? Like I don’t have anything yet. Right? 

 

N: Exactly. Like are you kidding me? I just want to have a baby. I don’t want to think about this doesn’t this doesn’t relate to me. And so obviously wasn’t a deliberate omission not to sign the papers, but I did find them unsigned later in my folder of IVF records. 

 

P: So one thing I wondered when I read your essay, because I don’t think you mentioned it to have this issue weigh on you. Do you have to think that those embryos are a life is that what is holding you up because I I’m not sure if I think of them as a life or not in the context of the abortion debate. Which is so polarizing and kind of flattens the arguments that can be made. I would say this is not a life… solely my opinion, and because I had so much trouble getting pregnant and with the pregnancies, the intricacy of all the things that have to happen. To turn that tiny ball of cells into a person gives me distance from them. 

 

N: Yeah, but I wonder what your feelings are about all that. I mean, maybe I’ll talk about the essay to get it that what was so interesting to me about going through this process, I’ll backtrack and I’ll just explain the predicament. I found myself. So after our son, you know was when he’s around two or so, you know, my husband and I did start to discuss are we done having babies, you know, do we want to have another baby and we weren’t sure. But the fact that we had these embryos felt like a strong nudge towards having another child I felt if we were on the fence for various reasons that it was that factor that tipped me over into wanting a third child. So we actually disagree with it. 

 

P: Let me stop you there. For a second is it that you went through this difficult procedure to get the embryos and so and so you should use them or it’s that these embryos represent a life and we should realize its potential? 

 

N: So little bit something in the in the middle, I think, 

 

P: Okay,

 

N: I think if we were just deciding whether to have a third child without factors, the embryos being involved, it would be a decision that had no if we decided not to have a third child. That decision would have no impact on anyone whatsoever. Only us right. But the fact that there were these embryos suddenly meant that that decision carried a lot more weight than it otherwise would have. We would actively have to do something not to have a third child. We would actively have to make the decision to destroy these embryos to not use them. Right and I do not think that embryos are life. Do think of them and this is where as a mother the issue became complicated for me. Our potential 

 

P: Yeah, agreed

 

N: they are read intial life. And so there is something very hard about letting go of potential. And I think especially if you’re a parent trained, you know to to love potential to look for potential to want to nurture potential. And so that was the meaning that these embryos started to take on for me and since we were on the fence about having a third child, I said I’ve got that nudged us towards yes having one. But then something happened to make things complicated, which is that once they got the process, going reconnected with our clinic, made an appointment for a baseline ultrasound, which is when they look at a do an ultrasound of your uterus to just see where it stands and what would need to be on what hormones would need to I would need to take to prepare the lining of my uterus for the implantation of one of those embryos.  once we’ve made all of those moves I got pregnant naturally.

 

P: of course you did…that’s how it works

 

N: which itself was a very wild experience after having worked very, very, very, very hard for my other two pregnancies to simply have a late period, have that moment of wondering, going buy the CVS and now on my way home from work, pee on the stick and be pregnant was like, writing my essay that it was as if all of a sudden somebody told me that my fingers could spin gold like that my body could do this was totally shocking and disorienting and wonderful.

 

P: especially when you see behind the curtain right now you understand the thing. Everything is amazing.

 

N: Absolutely. So that was wonderful and and that pregnancy went well and resulted in our in our daughter, but it did leave us then with this again, but the question of these embryos,

 

P: but I’m imagining it’s a slightly different question. Now that you have three kids right. Then you have to take into consideration the other three, right it’s

 

N: it was a pretty much out of the question. We were not going to have a fourth child for for many reasons. It’s just not feasible for our family. It was not something that we thought would be best for our family and so that left us with these embryos. And what my essay explores is sort of my shifting orientation to these embryos over the years because the truth is, I could not bring myself to make the call to our clinic to have them destroyed. And so their existence is something that I ignored that I I sort of willfully ignored for a long time. And you know, there would be moments when you know, I would think to myself, I can’t believe that I call myself a full grown adult when I am not taking responsibility for these embryos and making the choice to to have them destroy because I’m a writer, but it’s not hard to imagine like some of the like Apocalypse apocalyptic visions of like embryos out there in the world. And basically, I’d ceded all responsibility for our genetic material or potential, our potential but this potential that we’re responsible for to total strangers in a lab somewhere a couple miles from our house, but it’s a because it is so hidden and because these embryos are frozen in the they are unseen, right is what it is. They’re not a reality that you need to confront every day, right? You need to confront the reality of your children every day. You know, you need to prepare the meals you need to deal with whatever struggles and hardships come their way you need to attend to them but the embryos it’s very easy not to and truthfully way that I’ve since learned because I don’t know a whole lot about this at all, but the way that fertility clinics, deal with them. Also makes them sort of quite easy to ignore, because clinics are not particularly this. I shouldn’t speak for all clinics. I can speak for ours but my understanding is that this is pretty universal. They are not aggressive about getting their patients to make decisions about what to do with the embryos. I knew that that they were still at our original clinic I had never signed any papers authorizing them to be transferred anywhere. I you know, did wonder on occasion if they had been destroyed without my knowledge since they had been there longer than the three years. I did, you know, one day email our clinic because you know, and I write this and they they essay it wasn’t because I had some sort of resolve or I had come up with some sort of decision about them but I just I wanted to know if they were still actually around. Or if they had been destroyed. You know, there was a very lovely receptionist on the phone in the lab who basically was like, oh, no, they’re here if you want to transfer them. You just have to sign this paperwork. 

 

And there was nothing urgent about it, you know, whatsoever. And so it’s one of those like decisions that indecision that ends up happening because there’s no particular moment where anyone is putting a paper in front of you saying like this has to get done or else my relationship with these embryos began to take on almost strange, magical tenor and what I mean by that is no at first I sort of thought of them as a as Life rafts. I’m going to knock wood as I say this, but like God forbid should anything ever happen to our children there. There would be despair, there would be anguish, but there would be these embryos right so we could rebuild a biological family if tragedy befell ours. And then that over the years began to dissipate a little because you know my husband and I are getting older and as we got further and further from the baby stage, my my my youngest is now six returning to the baby stage seems it almost is harder and harder. Right? Like we are

 

P: totally understand what you’re saying by this kind of insurance policy. At the same time, my guess is I don’t know whether you’d be able to bridge that loss.

 

N: Yeah. t’s magical thinking and then it became more magical because it sort of more from like, well, these are sort of like an insurance policy to almost like superstition. If I destroy these embryos, something terrible is going to happen to my family. So there’s all of this kind of magical thinking bound up in them. You know, it’s just such an interesting juxtaposition when you think about like the rigid science that actually that actually created these embryos and then the the meanings that they that they take on and you know, during the IVF process, you know, as I said, I was fixated on the process resulting in a baby but the sort of thinking that I can do about these embryos now without that kind of urgent desire mixed in is I think about generations that came before my husband and me and our families. I think about all of the history in in that DNA, right? I think about I’ve read about in the essay, you know, my ancestors who my ancestors on my father’s side who escaped pogroms in Eastern Europe and you know, went through all sorts of turmoil to make it to the United States, right, and then lived in tenements Lower East Side and, you know, thinking about my grandmother and all of the fate and escapes that needed to take place for those embryos that are frozen to exist. And so all of these sort of meanings started to accrue and attach themselves to these embryos over the years. In a way that I never ever could have seen.

 

P: Once you start thinking about it as a family line, then there’s no way to extricate yourself from those from those embryos, right? You really only have like four choices, have them yourself, which you’re not going to do destroy them. Give them the science for experimentation, or give them to someone else to have that baby giving the embryos to someone else as a form of adoption. I interviewed a woman I think in episode five or six, who did just that she and her husband went through IVF had twins and decided they didn’t want to have more children. And they found families who wanted kids but for whom IVF was prohibitively expensive, and they donated them.

 

N: I mean, I think that that is incredible. I admire this woman. 

 

P: Yeah, totally.

 

N:  I understand. I see the beauty in that. Gesture. I myself personally could not do that. It would feel and this is where that word line the web in life and non life comes in. it would feel to me like giving away my living children in a way to be raised by total strangers. Obviously not quite so extreme. I have a relationship with my living children, but not so far from the same. 

 

P: Yeah, 

 

N: I don’t know what kind of parents these people would be. I don’t know what kind of circumstances you know, they would would put my child and so that didn’t feel comfortable to me. The science research part didn’t feel comfortable because you know, I think I read in my case like science for whose purpose you know, you don’t have any say in what we’re what purpose is, are. Are these embryos being used. And so that vagueness was a discomfort to me. And so I can’t say that I was or am proud of my feelings about these things.

 

P: Well, they, they just are right, they just

 

N: they just are. I often wish you know that I could think of these embryos. As you know, like biopsy tissue or something right, like disposable, you know, useful for scientific purposes. And I think there are people who who can who do think of them way

 

P: this is obviously a really fraught issue and that I brought to Dr. Glenn so Nicole and her partner can’t be alone in this quandary about what to do with frozen embryos. Does your clinic offer counseling or what do we tell people? 

 

Dr. Glenn: You know, I don’t think specific kills like that for our clinics for this topic, but it’s something that I talk to patients about during their IVF and then before they sign it is like, you know, these are the different parts you need me to discuss or you know, you alone, you determine that. And so they have questions, of course, as part of the conversation about like, next step. So when you do it, to be honest, we have less patients that kind of go forward on this part. And I think, kind of like you said, the initial part is I just want to know what to do next, and I just need to keep going. I think that most patients don’t think about that until later on

 

 And unfortunately, I think that this is a personal struggle that they sometimes don’t reach out for, they don’t look at as your decision is such a personal decision. So they talk to their friends, family. Or they talk to other people who have gone through IVF 

 

I went through IVF twice and so that’s also something that you know, you look at it you’re like cheese Wow, this is intense, because not only putting something that you feel is yours and special in this kind of box of three check box do and destroy. Do you want to donate to another person? Or do you want to donate research? And it’s weird to like go from something is very personal just to these three checkbox. And it’s also very finite on your life. It’s like what if something happens to you? What if something happens to your partner, if you have a partner, it’s a struggle for some of our patients to that they decide not to freeze embryos, they actually freeze eggs and sperm separately and then only inseminate one or two at a time. And so in other countries, it’s also illegal to freeze embryos. So in Italy can’t do embryo freezing you can only do egg and sperm.

 

 

N: Potential, you know, that always trips me up the potential that is bound up in them. So I you know, I’ve been thinking a lot and I tried to explore this in the essay about what it means to mother, right? What does it mean to when you think of mothering a child, as I mentioned before, it’s so much of what we love, right? Or what you think about is like nurturing potential growing potential. But what I started to think about as well is how much of mothering how much of parenthood is also about letting go and about seeing your children’s limits? At times and coming to accept you know, what isn’t going to be right like a child is born and it seems like they’re this blank slate and the sky’s the limit and they can be anything and do anything and they think anyone who you know has children in any you know, element for a preschool or elementary school age seems like, you know, there are things that that you need to let go of as a parent and things that your child will not ever be and maybe that’s not disappointing to you, but it’s disappointing to them or maybe in some way it is disappointing to you, but letting go and accepting what isn’t going to be or what shouldn’t be, I think is also a big part of parenting of mothering. So that is ultimately you know, what is what has helped me move forward in my embryo journey.

 

P: So would you say you’re at the end of the embryo journey are we’re still they’re still in limbo.

 

N: It’s still in limbo. I’m still in limbo. But I know the answer. I do know that. The answer is that I have to destroy these embryos, but I haven’t done it.

 

P: I mean, I don’t know if it gives you any comfort to imagine that no matter what you do, there’ll be regret. Because there’s no perfect answer here. Right. But while you’re talking, I’m thinking, why would I would probably donate them to science and then I can literally feel the regret of making that choice. And I don’t have any eggs and I haven’t made that choice. But there’s nothing here except having all the children which is not going to happen right for for almost everyone who goes through IVF that is not what the goal is to have all these have all these children and it’s a little bit of a mismatch between what interventional fertility can do and what our lives look like. 

 

And so maybe there’s some point in the future where they can better estimate which eggs will survive and which eggs will produce and they’ll take fewer and they’ll make fewer embryos and then we won’t have this dilemma because you won’t, I mean, you’re not going to be sad about an egg because you’re shedding eggs every month, right? So that’s a thing. Right? But right now we’re in this mismatch where we can’t I mean, it’s a little bit like everyone who goes through IVF The doctor has to choose how many embryos to put in there within your uterus, which is a wild decision that nature doesn’t force you to make in that way, right? You don’t have access to five embryos.

 

N: Right. Yeah. It is. I think it is a really interesting question because, you know, that I thought about while writing this pieces, would it have made a difference if my fertility doctor had said to me right now is the point in the journey when we’re going to talk about planning for frozen embryos? And yeah, you know, and thinking about that and I want you to be fully aware, you know, that this is a quandary that many parents face afterwards. And I don’t know maybe that would have led me to ask more questions about how many follicles that we’re trying to harvest. I’m not sure, but I don’t know, things might have changed, and maybe those conversations are part of the process now, but they weren’t when I was going through IVF. So it was sort of an unspoken aspect of the of the process.

 

P: I mean, I think IVF sheds some light on how little we know about many of the intricacies of this process. Even if you do IVF as you know, you don’t get pregnant every time.

 

N: Right. Oh, and totally and also you’re not so at the mercy of the knowledge of these doctors, right? Like, are you say that I expect if I have, you know, 13 follicles great like, let’s do it, like, produce 13 follicles. 

 

P: I asked Dr. Glenn. She can imagine a future in which we can grade egg and sperm so well that we know exactly what we need to use to get an embryo that will successfully lead to pregnancy.

 

Dr. Glenn: The problem is the attrition rate. I talked to this when patients are freezing eggs for future use. Is like well, how many eggs do I need and someone that triggered over 80% live birth rate of less than 35 year old would need to freeze 16 eggs? Not every egg survives a freeze thaw process not every egg gets fertilized. Not every fertilized egg makes it to day five. So freezing embryos is a better guarantee that you get embryos out of it.

 

P: Do you think there’s a time in the future where we will be able to identify markers on the egg to know which ones will freeze and which ones won’t? Or which ones will fertilize 

 

Dr. Glenn: future? Who knows right? I’m always impressed about what when I’m an embryology Lab. I’m always impressed but they can do. They also can look at a little bit if they’re doing a procedure called ICSI which is intracytoplasmic sperm injection. If there’s a problem with male factor or problem with the sperm, then they actually can take us in each individual sperm and injected into the egg. When they do that. They have to kind of clean up the egg a little bit. When they clean up the egg. They do get an idea of how good the egg looks and so they kind of grade them that way in our lab, but I’m sure in the future they’ll be able to look at the egg and kind of determine better about potential for how many fertilized and quality and those are our struggles right now is that we have a very limited view of quality you know, we can kind of determine quantity of how many is called ovarian reserve or how many eggs a woman has left that we have very limited achievement of is quality. likely they are to get pregnant with a successful healthy baby. And so there’s so much unknown out there. But it’s also hard because this is an ethical quandary about working with someone’s eggs, sperm or embryo 

 

P: and there’s no way before you make that decision to know whether it would have been viable like thought and let it grow a couple more days and see

 

Dr. Glenn: so a couple more days wouldn’t help or even Nestle work because the lab can only grow embryos to certain points of time and you don’t know until you put an embryo back whether or not it’s going to be good or not personal experience when I did my IVF cycle a few years ago after embryos get to day five, the embryologist looks under the microscope and grades them on how good they look very specific criteria about what’s called Hope Spanner they are embryos actually have a little protein shell kind of like an egg and they hatch out. So they look at that how thin it is how it doesn’t look like it’s going to hatch out and attach to a uterus. Then they look at two things that trophectoderm in the inner cell mass the trophectoderm comes the placenta and the inner cell mass becomes the embryo. They grade them and how good they look. And again there’s very strict criteria.

 

I had almost perfect looking at embryo with fabulous. I had a negative pregnancy test 

 

P: wow so that just means it didn’t attach or do you know what that means? There’s like they

 

Dr. Glenn: just did not attach or if it it tells you it was not good of quality. And there’s other things besides the embryo there’s a signals between the embryo and the uterus. Is a uterus being receptive at that time. Did it not you know get to that point. The and the uterus called Pina bogs and attached appropriately with the cytokines and the protein than amino acids just a little bit imbalanced that day. There’s so much we don’t know about implantation, but the embryo is not the only thing that’s important. 

 

N: You know, I don’t know if I would have had the perspective to ask the questions that might have prevented this quandary that I’m now in.

 

P: I dont know this for sure but I can well imagine that there’s some evolutionary pressure they’re forcing you to focus on reproduction as you know, up to the absence of anything else right because that’s kind of what you’re

 

N: I like that idea. take some pressure off. Yeah, I really like what you said earlier, though, about I don’t remember exactly how you put it but how, no matter what decision, you know, make or I make in this like there’s going to be regret. And I think that that’s also something it’s just a process of coming to terms with right that oh, there’s going to be some answer that makes everything okay. 

 

P: Who is hashing out these ethical issues is there there are medical ethicists who are working on it or? Well, there’s

 

Dr. Glenn: a lot of people that are not only just PhDs, but also there’s like an ethical committee on the American Society of Reproductive Medicine. We have ethical committee guidelines that discuss all these things. And usually you don’t want to just doctors on this panel. You want a lot of other great minds in there too. So there is definitely a lot of research people that you know, do their PhD in ethics. And so I would actually kind of go back to those ASRM community opinions and guidelines for ethics just as we continue to struggle with different topics as we learn more as we’re able to do more you know, when you look at the beginning part of IVF and the you know, late 80s, the chances of success disciple was like 2% and they couldn’t freeze extra extra embryos. They had no capability of doing it yet. And so as we get better at doing things, more ethics come up

 

N: there’s going to be something that happens in the future. That just makes it really, really clear that now is the time when I need to say goodbye to the embryos and I’m still sort of magically waiting for that. I know that I wanted to let go of these embryos but why today on Wednesday at 156 day now, and you know, and perhaps there will be some moments when crystal clear to me in some way that this is the moment when it just poetically makes sense, you know? So that’s I think, just part of trying to tamp down the regret.

 

P: Yes, yeah. Who wouldn’t search for clarity. That’s totally makes sense. I so appreciate you coming and talking about this because there’s not that many conversations about this and everyone who goes through IVF must have some version of this quandary…especially if you go through IVF and it is successful, then the potential of those embryos feels exceedingly real.

 

N: That’s exactly right. Yeah. Yeah. I think watching my son grow also was part of this difficulty in letting go of the embryos. These embryos were formed, you know, at the same time that he was formed, is so tangible to me. He is a particular person is a boy who loves breakdancing and Brawl, parsley, basketball, and his dog, you know, and he has his very particular room and his likes and dislikes and so not so hard to extrapolate from there right these other these other embryos but I I do want to be very clear also just because the abortion debate right now is so front center in our country that I think that our choices my husband’s and my choice, but he’s very much prefer to me my feelings are much bigger than his around this. And so it’s our choice, but it really it really is my choice just because of how his feelings lie. But my choice about what to do with these embryos feels very important to me the fact that I have the freedom to decide what to do with these embryos and that I know, given our family circumstances, given my husband’s and my age, whats right for them, and that to me feels like a part of mothering that feels like nobody terminates life. Nobody destroys frozen embryos because it’s easy, but because that is what they know to be to be right for them and for their life and, and for the life of the embryo or unborn fetus. So that’s just I don’t know if we want to go into all that but I do think since we’re talking about like this sort of like middle place where embryo scan between life and non life, you know, that’s sort of my my thinking on that and all there is right to deal with this like, as you say like coming to terms with the unsettlement of things such a big decision, but I’d still think that it’s a decision women should be able to make

 

P: I totally regret that the abortion debate is so political and so polarized, because it’s kind of a nuanced question, and it is, I think, if really want to talk about the science or what’s at stake. No, that gets into the conversation. It’s treated as is very black and white thing, which clearly it’s not, you’re in this middle space where it’s not in your body, and so even a little bit more leverage over it. But

 

N: I like to offer myself up as an example of someone who does not see an embryo as being as disposable as biopsy tissue, and does see the sort of weight of an embryos potential and yet I absolutely believe with my whole heart that a woman should have the choice of what to do with that embryo.

 

P: I totally agree. I just think like the abortion debate, debate forces women to say not life period at the end, while it is not a life it is something it is potential it is it is something that is important and valued, it is tricky. So maybe there will be more discussion around this topic if the abortion debate wasn’t hanging over it.

 

N: Totally. Well, I do think so many of our like public conversations force us into black and white thinking sort of like that polarized one side or or the other, but embryos really do occupy this very mental state, which is which makes them really interesting to think about. Yeah,

 

P: I totally agree. Well, Nicole, thanks so much for coming on and sharing your story. And I will definitely attach her essay to the show notes because it is beautifully as a writer totally blown away. And probably you do this too. When you read other people’s writings. There’s certain phrases where I think oh, so beautiful and Nicola has thought of it and now I can’t use it.

 

N: That is such a compliment. Thank you so much for your kind words and for reading the essay and for having me on your show.



P: thanks again to Nicole for sharing her story and her struggle about what to do with her frozen embryos…as Dr. Glenn suggested, ethics is working hard to keep pace with science, and until they are fully aligned it seems we each have to figure out how to manage this situation. To be clear I completely support a woman’s right to manage her own fertility, whether that involves a pregnancy or an embryo–but having that right doesn’t make the actual decision easier. I wish NIcole and her family luck and comfort in the decisions that she will make on her own horizon…and thanks to Dr. Glenn for sharing a little bit of her experience and her expertise about the complicated and fascinating process of IVF.

 

I will put a link to Nicole’s writing in the show notes, which can be found on war stories from the womb. Com…

 

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We’ll be back soon with another inspiring story