Episode 52 SN: The Right to Choose your Reproductive Destiny: Tova’s Story

This show is focused so far on the unexpected elements of the emotional or physical toll of pregnancy and birth. Today that story is extended to include the emotional and physical impact of a pregnancy that didn’t find its footing and ended in abortion. Abortion is obviously a topic most people have strong feelings about. And unfortunately, those strong feelings tend to flatten the conversation, when in reality like all elements of reproduction, thinking and talking about abortion requires nuance. Some people may seek out first trimester abortion early in their pregnancy and feel like this choice. This procedure is like any other medical procedure. For other women. It comes with more personal or cultural or religious baggage and it’s in no way easy for them to make that choice. In today’s episode, my guest has a second trimester abortion and her pregnancy which many complications arose. And her experience of working through the grief of this loss is impactful to hear and very much a story that I will carry with me for a long time.

To find Tova’s book, Finding my Muchness, here

And her current Venture, Spark’d Earseeds

Statistics on Abortion

https://www.guttmacher.org/news-release/2017/abortion-common-experience-us-women-despite-dramatic-declines-rates

https://www.cdc.gov/nchs/products/databriefs/db136.htm#:~:text=The%20estimated%20number%20of%20pregnancies,2007%20has%20been%20well%20documented.

https://www.guttmacher.org/gpr/2019/09/us-abortion-rate-continues-drop-once-again-state-abortion-restrictions-are-not-main

Twins in the Womb

https://www.verywellfamily.com/twin-chorionicity-explained-4114659
https://fetus.ucsf.edu/monochorionic-twins/
https://women.texaschildrens.org/program/texas-childrens-fetal-center/conditions-we-treat/monoamniotic-twins#:~:text=Monoamniotic%20twins%20are%20identical%20twins,they%20also%20share%20a%20placenta.

Di/Di, Mo/Di, Mo, Mo

https://www.healthline.com/health/pregnancy/mono-di-twins#:~:text=Mo%2Fmo%20twins%20are%20monozygotic,amniotic%20sac%20for%20both%20babies.

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. This show is focused so far on the unexpected elements of the emotional or physical toll of pregnancy and birth. Today that story is extended to include the emotional and physical impact of a pregnancy that didn’t find its footing and ended in abortion. Abortion is obviously a topic most people have strong feelings about. And unfortunately, those strong feelings tend to flatten the conversation, when in reality like all elements of reproduction, thinking and talking about abortion requires nuance. Some people may seek out first trimester abortion early in their pregnancy and feel like this choice. This procedure is like any other medical procedure. For other women. It comes with more personal or cultural or religious baggage and it’s in no way easy for them to make that choice. In today’s episode, my guest has a second trimester abortion and her pregnancy which many complications arose. And her experience of working through the grief of this loss is impactful to hear and very much a story that I will carry with me for a long time. 

Let’s get to her inspiring story.

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

 

Tova: Hi, my name is Tova and I am coming to you from Las Vegas.

 

P: Oh lovely. Is it is it 1000 degrees there?

 

T: It is a basically about 1000 degrees. Yes. Yes Today is particularly hot I think perhaps the hottest day

 

P: so today’s episode is on abortion, which is a tricky topic and looking for people to talk about it in 2022 There’s still a lot of shame around it, which I’m disappointed to see. I’m  the mother of two teenage daughters. And I hope they don’t grow up with the same context that many of us grew up with. particularly unfortunate given that abortion is relatively common. I think the numbers I’ve seen and suggested that on average in the US there’s something like 6 million pregnancies and just under a million abortions a year. I’ll put links to these numbers in the show notes. Having said that, I only know one person who’s had an abortion and I only know about that because I was there right

 

T:  that you know you only saying that I know of right which can’t be right. 

 

P: Like can’t be right. There must be people around me doing that. So I appreciate that you have offered to share your story which is a little bit of a of a different version.

 

T: I think it’s probably a lot of a different version. But yes, yeah. Well,

 

P: I’m imagining that most people who have to make this decision when you did have to do it for similar kinds of reasons.

 

T: Yes, yes I. At this, you mean at the stage of pregnancy where I was when I met my students? Yes, I believe most. Most, if not almost all people who get to that point, though I can’t speak for everybody and I personally know from not only my experience, but then post my experience the women that I connected with which were a huge part of my story. My journey as they say,

 

P: so do you want to sort of walk us in is Was this your first pregnancy? It was not.

 

T: No, So this was my second pregnancy. My oldest I was married my oldest daughter was just about one years old when I got pregnant. Me and my husband. We had a plan as everyone does that, right. That’s what the whole show is about. 

 

P: Yeah. Yeah. 

 

T: Like we’re gonna have two kids. We’re gonna have them close together. They’re gonna be best friends. Yeah. And then we’re done. And then we’re like getting back to life as usual. That was our plan. And so we had our first daughter that pregnancy was a little there were some issues that came up but ultimately everything was okay. And then as soon as she turned one, we were like, Okay, let’s get working on the second. So we can get through that we had decided like on her first birthday. We’re like that’s the start to try. I also apparently in retrospect, doing some dad got pregnant on her birthday. 

 

P: Wow. 

 

T: So like, we were like, Okay, let’s try and that second pregnancy turned out to be identical twins. They were girls, which was really surprising because that stuff happens to other people and not that it’s not hereditary identical twins is completely random. They say and there are no twins not there’s definitely no identical twins in my family like I don’t know any.

 

P: So how far along Do you find that out? Is that eight weeks or 10 weeks or 

 

T: we found out? I was like literally already showing it five weeks? Like I’m a little girl and I was like, this is weird. And I joke to my husband the night before the first ultrasounds like five or six weeks, you know, I was like, Oh my God, why am I already showing like is this gonna be twins and then lo and behold, we shut up at the ultrasound. And they relied like that. 

 

The tech didn’t know how to communicate, and was like, Oh, it’s twin… There’s two and I was like, What are you talking about? No, you’re mistaken. And my nose was like, yeah, no, we’re no, she’s like, No, there’s no there’s the one and there’s the other but I don’t see a separation between them. She said. I was like, What the hell does that mean? Like I don’t know anything about what you’re talking about. 

 

P: And it sounds like conjoined twins. 

 

T: And that’s what I said. I said what are they like, conjoined. I was like, she looked at me like I was the idiot. And she said, No, there’s supposed to be either in two sacks, but we’re not there in the same side. And there’s supposed to be a membrane between them. But I don’t see it. You have to get a higher level ultrasound to see the membrane. I said, Well, what does that mean? And she was like, well, basically, if there’s no membranes, really high risk. And you know, it’s basically a done deal. I’m sure. I’m sure it’s there. We’ll send you for the ultrasound. Like yeah, yeah. So immediately, I went home and I was like, Hello, Dr. Google. 

 

P: Yes. 

 

T: And I started immediately learning what the risks were a if they don’t see the membrane, and then everything else that falls into that pocket have identical twin pregnancy complications and it’s a big bucket. 

 

T: Okay, a little twins anatomy here. Baby sits in a sack connecting to the placenta with an umbilical cord. That SAC has two membranes and inner one called the amnion. And another one called the Korean majority of twins have their own placenta and their own amniotic sac. twins who share the amniotic sac, so no inner membrane separating them. Also share one placenta 70% of identical twins share placenta, but only 1% share both a placenta and a single sack. Sharing a placenta the source of nutrition and oxygen and waste removal can cause issues Tova will talk about some of these two I wanted to outline our resource sharing and blood supply with resource sharing. The umbilical cord that connects the babies to the placenta can attach the placenta in different places. If they attach it away that doesn’t share the placenta evenly. The fetuses can grow at different rates. Second issue is that when those two umbilical cords send out blood vessels into the placenta, these vessels can grow together, meaning twins will be sharing their blood supply, which can lead to issues 90% of the time, it does not lead issues and everyone’s fine and 10% of the time, it does lead to issues.

 

T: So when there is no membrane, the probability of those cords getting wrapped around themselves and each other tied in knots and everything is tremendous.

 

P: It sounds right, that makes sense. Right? And so that’s the risk. That’s what’s creating the risk. 

 

T: That’s what’s creating one of the risks Okay, all right. So then the membrane they went for the higher level ultrasound they saw the membrane so that mitigated the risks of the take most of the risks of the tangling, all the risks are still there to a degree, but that main tangling up

 

P: just a quick word here before we dive into some medical terminology. There are three different categories to describe how to ensure the amniotic sac and the placenta, die, die mo die, and Momo die die is like to singleton pregnancy sharing the uterus. Everyone gets their own amniotic sac and their own placenta. Mo di refers to monochorionic di amniotic twins, so one placenta, but each baby gets their own amniotic sac vomo refers to monochorionic mono amniotic twins who share a placenta and a Sac

 

T: so hours were Momo that’s what they call them. A one placenta one sack but it did have the membrane the primary risk when you have a Momo identical twin pregnancy is that the placenta itself isn’t feeding into both umbilical cords evenly, and that the blood flow flows through the placenta from one baby into the other. Or that there’s you know, the veins and arteries across the surface of the placenta they overlap and where they overlap things don’t always go where they’re supposed to. One baby generally would get more of the blood and nutrients and one baby would get less. So both babies are at risk, one for overload and one for deficiency. And when that happens, it’s called twin to twin transfusion syndrome or TTTS. At the time, this is 13 plus years ago, it was very hard to find people who knew what they were talking about very hard. Even the doctors there were there were like three doctors in the country who say that they understood this disorder and it was so rare. And I would say one of the biggest points of pride or just a positive outcome from my experience and the collective experience of a lot of women or families that experienced this at that time or since then, is that we found each other and collectively that community has made a huge impact on awareness and Doctor knowledge and ability to treat this. So that’s a little sideline 

 

P: that’s amazing. 

 

T: It was amazing because back then like it was like finding a needle in a haystack. I don’t know if it’s just that I’ve been in this haystack. Now that I know I can see all these needles, but I can get to that to 

 

P: you guys find each other on Facebook. 

 

T: It was pre Facebook groups. There were there was a twin to twin transfusion message board and anonymous message board, which is where I started and there was just a handful of women who were like I was just diagnosed, they don’t know what to do help. I mean stuff like that. Now now it’s all on Facebook. So anyway, we we found that we were pregnant. I read all the research on TTTS. Ultimately, the goal was not to get it right. Like ultimately, if the placenta is doing its job, right baby a baby B they’re both thriving, all is good. So I found a new doctor. We saw him I think at like 12,13 weeks, and he was like oh everything is good. There’s a membrane I have a picture. It’s beautiful. One baby on top of the other. They look like they’re in bunk beds. And they were like, right, he’s like, okay, come back in four weeks. We’ll see how they’re doing. 

 

So we came back at 16 weeks. And he saw the very first morning signs of TTTS. So the first warning signs are an imbalance of fluids. So each baby surrounded obviously there’s a membrane and you want each sack to be about the same. And one of them was smaller one of the sex was a lot smaller than the other. And he basically said here’s the deal. At this point at 16 weeks, they’re already showing it imbalance This is most likely going to develop into TTTS and you’re probably going to lose them both. And if you don’t, they’re probably both going to be born with like severe disabilities and you don’t want that I imagine so you probably want to just terminate the pregnancy and I’ve done all this research. Yeah, I was like well first of all, I know that there are like treatments for this. So there was this laser treatment, which was relatively new. At the time, there was like an amniotic reduction which removes some of the amniotic fluid from the baby that has more to allow for self correction and the other baby to get like there weren’t things and I was like, can we talk about those things. He’s like, they’re probably not going to help too much. And he’s like the laser surgery like nonsense. Like, okay, like, is it even possible to terminate one in order to save the other? 

 

P: Yeah. 

 

T: And he was like, no. I was like, what? I read it on the internet, like, 

 

P: yeah, yeah, yeah,

T:  what are you talking about? So I was like, we can’t talk or be doctor. It was really, like I’m joking, but it was obviously horrifying. And then he literally said, I have to go teach a class now. I won’t be here in two weeks. I have vacation. So you’ll come back in four weeks and we’ll see if everything’s still okay.

 

P: That’s a weirdly long leash. 

 

T: Yeah, he basically was set and then he left he left us in his office to go teach a class B my husband sat there looking at each other like, what just happened? Sorry. Yeah, a lot of curves and you’re totally allowed to curse. Yeah, I was like, what what?

 

Like, like, basically you said, Come back in a month and we’ll see if your babies are dead yet. I mean, that’s what he said to us. Yeah. We were like to find a new doctor. And we ended up going to New York to Presbyterian Hospital where they had an expert on staff who was one of the few people trained in the laser surgery that is used to ablate the overlapping veins and arteries. On the surface of the placenta or otherwise deal with high risk pregnancies of this type. And we started going there. And we were going every two weeks.

 

P: Was that prognosis more positive? Did they think the pregnancy could still work out?

 

T: They did all the ultrasound the high level ultrasounds, all the things and I’ll be honest, it was so early, they were excited air quotes since we’re not going to see me but they were excited for my case, because they believe these things to be so rare and they had just started like the guy who technically was trained in laser had just finished his training in Europe on how to do it. And he had never actually done one yet here in the States. So I was like, his potential to to do this big surgery. The way TTTS progresses is in in five stages, or five stages. The first stage is an imbalance of fluids. This second stage is when the imbalance maybe reaches certain measurements like they would measure the widest gap of a fluid in the baby that was more tightly packed. And when it hit a certain stage, you were officially stage two when a certain measurement then and this was back then, not only has it hopefully changed, it probably has changed but we change these layers. So they would not do laser surgery unless you hit stage three, but we were not there. 

 

P: Yeah, 

 

T: we were basically at stage one, one and a half and he was like this is good news. You know, we’re going to monitor this carefully. We’re going to do high level ultrasounds throughout the pregnancy, baby B had a lot of fluid and baby A had less but baby it had she had a healthy amount of fluid. It was just less the secondary and third signs were like kidney failure because the baby was less the kidneys fail to develop. So when they start seeing that there’s other secondary signs and I had none of that. I was all wet all of it was just a fluid imbalance. So I was coming in. Believe it was every week, maybe twice a week, driving into the city paying $40 to park high level ultrasounds, keeping an eye on it. And the thing that we knew was that if we were qualified for laser surgery, we would do the laser surgery. We talked about doing an amniotic fluid reduction. 

 

P: Yep. 

 

T: But some people had done a fluid reduction and then subsequently did a laser surgery if they still needed it if the amniotic fluid reduction didn’t work, but the amniotic fluid reduction increases the risk of rupture, and so they don’t want to do it if a laser surgery has the potential to be needed. 

 

P: Yeah, 

 

T: especially in my case where they were super excited to maybe be able to do it. They didn’t want to do an amniotic production. They wanted to wait and see. 

 

P: Yeah. 

 

T: Because if it stayed and each baby was developing well and their kidneys were developing well, and there were no secondary signs we were we were good and we were aiming for 24 weeks, like the bare minimum, because also they said and again, I think they know better because of the accumulation of parents who voiced their experience. They said after 24 weeks, the risk goes down. A lot of anything happening, whatever. It’s not true, but that’s what they said. So we were aiming for 24 weeks.

 

P: God This feels like a bit of a sprint. 

 

T: It was horrible. It was I mean it was it was just like in the thick of trauma day after day after day not knowing and you’re like you’re living and your body is doing this. And you don’t know what’s going on in there. Like you’re just like I don’t know, you just don’t know like day to day is was it where’s the fluid? I’ve been like feel does it feel fluid on the right side or like what do I know like and then they’re not doing anything but watching it. Right? Right? If we had the laser ablation and they each were just getting 50% of the placenta and they were kind of functioning on their own things. And one died, it would suck, but it wouldn’t affect the survivor. 

 

P: Yeah, 

 

T: since we couldn’t get the laser ablation we never qualified for it. We knew if God forbid one died, that would create basically a de oxygenation of the blood in her system, which could then flow through the placenta into the healthy baby and shut her down you know, create damage of some degree and you don’t know don’t know the degree, you don’t know anything. You don’t know anything. That was it. That was our that was our situation just after we go get the things consistently. The baby that had more fluid, they were like she’s fine. The baby that had less fluid was the one they were more concerned about. They were like She’s good. She got like two and a half centimeters, the other one had like 12 or 13 centimeters. Again, my numbers might not be 100% but they were optimistic. And then at 23 weeks and 2 days maybe I went in for my weekly ultrasound. And I was feeling actually really good because the pressure on my stomach was less than it had been and I was getting bigger and I’m small I’m like maybe 5 foot one and so it was a lot, a lot of carry weight. And we went in and did the ultrasounds and they were like, oh, have you eaten anything? And I was like, I’m like okay, and the doctor came in and basically he was like so the baby with the more than one they weren’t worried about died. 

 

P: ugh

 

T:  sometime between our previous ultrasound which was like five days earlier and that day she had died. And so that’s not anything more profound to say. It was horrible, horrible, horrible,

 

P: so unexpected.

 

T: It was very unexpected, because for the first time I was feeling good, of course I was feeling good. Because her fluid level because we’re in so anymore because she wasn’t super fluid. Yeah. And so the baby they were more worried about Baby A. She was doing fine on camera. But there was no way you know, her fluid levels were more balanced now. But there was no way to know what happened to her brain. 

 

P: Yeah, 

 

T: which is where the damage would have happened at the impact of the death of her sister. And so we were at like I said 23 weeks and it was 23 weeks and five days.

 

P: Oh my god,

 

T: we discovered that. And they specifically by the way, scheduled that appointment before the 24th week when they were scheduling it, they look at the calendar, they look at my dates, just because of all the impact that those numbers have on so many parts of this process. So basically they said to me, so here are your choices. And we I mean we obviously had discussed this at length throughout the prior weeks like what happens if what happens if what happens if what happens if and we had decided that without the laser surgery. If one of them passed away We were going to terminate because the risk to the survivor was too great. 

 

I mean, and I was in the at this point. I knew women who had had their twins and last one and a half survivors who had severe mental and physical handicaps. I mean across the board from similar situations. I didn’t know a ton, but I knew enough I had seen even the ones who some of them who had the laser they’re survivors still had issues. But there was one in particular as the woman in Europe who her her daughter at that point was maybe eight or nine her survivor and I mean it was heartbreaking but she was going through raising this child could not was Yeah. And so we had 24 hours to make a decision because they needed to start the process on the 23rd day 33rd week and sixth day in order to fall within 24 week guidelines of New York City. And so that’s the decision that we made.

 

And that’s what we did.

 

I guess you might want to ask a question.

 

P: I’m so sorry. are covered with goosebumps that’s so traumatic to make it that far. And I think I wrote to you that we had a very touch and go pregnancy till the very end and then she they took her early she had open heart surgery. We never talked about it. 

 

T: Really 

 

P: we never talked about what happens or what it was too scary for some reason. And this is a complete fantasy. I’m imagining that articulating it puts it out in the world in some way that I can’t manage. Right so

 

T: I would agree with you there the the talking about it. I make it sound like We’re so mature and coming to the table like two thoughtful adults. That’s not exactly what it looked like. I mean, I think with with the twins having our daughter at home, and she was like one and change at this point and she was not an easy child. Or an easy teenager but I just knew I couldn’t. I couldn’t manage I wasn’t equipped and I wasn’t going to burden her with that. My sister in law has a special needs daughter who is high level needs not high level. Like she needs a lot of help and still not as much as many other you know special needs kids. And I look at my sister in law in Awe, I’m not equipped for that I am far too selfish, if that’s what it is. And I’m like, No, well,

 

P: are you making this decision for your daughter as well? Right. So,

 

T: I mean, I’m making the decision. For everyone. My marriage, my daughter, my future like thing and and even I hate to say it in a way but like for in my situation where they were twins that were bonded. Like there was something about them being able to rest together that brought me peace. 

 

P: Yeah, yeah

 

T:  I mean, I know that for a lot of people in my circumstances. Obviously you just don’t want one. If you can have one you’ll yeah but considering all of the all the moving parts of this, you find comfort where you can 

 

P: Yeah. 

 

T: And then there was comfort in that you know that they come together

 

P: and you did everything you could right You did everything at 7 million appointments and different doctors and you know kind of tracking you down and doing your own research and finding the people and

 

T: I mean, we knew more than most of the doctors, even the specialists. And in the months and years afterwards, the amount of work or like I was saying achievements or knowledge that has happened in this so rare again, air quotes because you can’t see them. It’s not as rare. As one might say it is rare, but it’s not that rare. 

 

P: Yeah, 

 

T: I was saying that we only at the beginning when I was pregnant. It was 2009 basically 2009 so I guess Facebook existed but didn’t really have groups and stuff like that. And the message boards that I was on were anonymous message boards on other platforms you just find it like and and what I noticed on those boards and they had sub groups and stuff, but it was almost like people would come in and say help I got a diagnosis. I don’t know what to do. And people would come on and be like, Oh, you’re gonna be fine. I got my diagnosis last year with your pictures and my beautiful twins. They ended up fine we got the laser everything’s fine. You hear a lot of that it’s gonna be fine because in my case, it was fine. 

 

P: Yeah. 

 

T: In the years post our loss, a lot of those groups started to reform on Facebook. 

 

P: Yeah. 

 

T: And a lot of the people from those groups that were anonymous in those groups, now we’re showing up not anonymous. On Facebook, in new groups. And it was the same pattern where somebody new would join the group and say, Oh, I just got a diagnosis. I don’t know what to do bla bla bla bla bla and people would chime in, everything will be fine or now. They ultimately I mean, they said other things too, obviously. But what I eventually started to realize was that you would sometimes see these women who would post and you would follow along we had our appointment above and then they would post bad news. We lost them both we did the surgery one was fine and then the other day, and then you would never hear from them in the group again. 

 

It’s not that they weren’t there that nobody wanted to hear from. Right. Like if you’re a new mom and you’re like, Oh no, I just got a diagnosis. And you’re the mom with two dead babies. You’re not gonna be like, Oh, everything’s gonna be fine. But my babies died..Right? So those women became invisible in the group, except when people would post pictures of their identical twin and it was hell on earth. 

 

You’d be scrolling your feed, already grieving your heart out and then identical twins, which is like the number one trigger like you see that? And it just, it just breaks you. So people would ask to not post pictures. And then the people who had survivors, they’re like, Oh, well, we should be able to post pictures of our children. Because we’re so proud and happy. We want to give hope to other parents who are currently pregnant and we think our picture give hope. And we’re like, no, like you cannot do that. It’s like trigger warning there. was a big rift in this community. And I have a big mouth Jewish mom was like, Fuck this. This is not working for everyone. So I posted and I was like like, I was like you cannot be posting this. It’s too painful. And they basically said, Well, if you don’t like it, go start your own group. 

 

So I did I started a group for those grieving a TTTS loss. There’s well over 1000 Women in that group now. 

 

P: wow

 

T:  there’s a lot and that’s obviously just a small fraction of the families who go through this are the ones who are having a find on our group on Facebook, but it is through that platform that these families have been able to come together and compare notes and learn that there’s more than just twin to twin transfusion syndrome that there’s another variation called TAPS, which is they used to call the acute TTTS Where it suddenly showed up, like the baby died, where now you can see warning signs and you can test different blood levels to see indicate like none of this information existed. We have parents in that group who are vocal proponents and teaching and connecting with the biggest doctors around this so that they know better and can do better and train on this It is it’s through the families. It’s through the parents who connect and the ones who go silent in the main TTTS group because they’re like, no one wants to hear from me. And so we I created this new group, this new platform, I don’t run it anymore. I like handed it off to like after like seven or eight years because you can only hold on to that for so long. But I’m still in the group. Occasionally it’ll pop up

 

P: going through this process. Do you go to the hospital you have to go to like Planned Parenthood or 

 

T: Well, in my case, so I was 23 and a half weeks I went to the outpatient portion of the hospital because it’s a three day process by the way, it’s not like so you go the first day I went and they in my case, I inserted a needle and they stopped her heart with potassium, I think immediately so it was quick and painless. And you can see it on the monitors for me, obviously, and scary and all the things, but again, I was comforted by the knowledge that she felt no pain. She got to go surrounded by my wombI mean that she would not have to be born. I know people who you know know their baby’s not going to start and I respect everybody’s decision to do what they need to do. But for me, being able to know that she never do anything but the comfort of my body and my love. That was big. 

 

And then they are they give you like seaweed insert to dilate you and you wear them. They come back the next day to see how dilated you are to just basically go home still carrying in my case two babies. And then 48 hours later I went to the outpatient portion of the hospital. They had asked me if I wanted D & E or if I wanted labor and delivery but they and my husband highly discouraged me from going through labor and delivery because it would be in the hospital with other moms who are laboring and delivering. And also because I knew I wanted to have another baby. I don’t want that. 

 

P: Yeah, totally

 

T:  to tarnish my future labor and delivery with with with my future babies. That being said of all the decisions we had to make throughout this entire pregnancy. That is the one that stuck with me as perhaps the only one that I wasn’t sure I made the right one. But I don’t think there was a right one. So I don’t know that I made the wrong one. I just I made that decision. I wasn’t aware when you do a D and E or D and X at that point. I went in they walked me into the operating room. They basically knocked me out and I woke up 17 minutes later and the babies were no longer in my body. That’s the process as far as what I experienced. The babies are not fully intact that I did not know had I known that on know if it would have been I don’t know I don’t know if it would have affected 

 

P: your questioning whether you should have gone through labor and delivery. 

 

T: Yeah. Because in the aftermath of it, you feel crazy, right like okay, there’s the grief. And then there’s the what a fucked up story. Like you tell that story you’re like that can’t have possibly happened. And I had no evidence of them. No evidence of them that was what I didn’t have. So I was especially so what do they do with the babies? Right, so in most cases, the hospital respectfully disposes of the remains. And at that point, I could not, I could not make decisions. 

 

P: Yeah, 

 

T: and I was like, okay, like, I keep I don’t know, just do what you normally do, I guess, right? My biggest piece of gratitude is that somebody in my family who had had miscarriages were Jewish. I’m not the most observant person, but they were like the babies have to be buried in a Jewish cemetery. I was like, I don’t fucking want to know anything about what you’re talking about. Like, I was still praying it was in those two days. 

 

P: Yeah, 

 

T: she was like they have to be buried at the Jewish cemetery. And I was like, leave me alone. If this is important, do arrange it. You go call whoever needs to call my in laws, the doctors. I don’t care. But I don’t have the I don’t have the bandwidth for it and figure it out. Because I’m not dealing with it. The only thing I did do is I said to them at the hospital. I said my family is taking care of it so that somebody’s going to make sure they’re buried in a Jewish cemetery. And they were like, oh, so we should just like, refrigerated or whatever. I was like whatever you do, I again, yeah, zero bandwidth. So after everything was said and done, I’m back at work, right? an entirely different person than I ever was everything I ever knew everything I ever was everything I ever thought. Everything I ever saw myself as like not anymore. And I had no proof like people are treating me like I’m normal and there is nothing friggen normal. But did I imagine this? Like I literally started thinking did I imagine this? Did this really happen? I did. It’s that’s a pretty disturbing kind of place to be. And then I called my mom and I said by the way, where are those babies buried and she you know, traditional Jewish history historically does not allow the mom to know these things. Like they think it’s better. Like oh, just pretend it never happened. Because Are you sure you want to know? And I was like I am 100% Sure. I was at work and she told me the name of the cemetery. And I Googled it. And there’s a search bar on the website, where you put in a last name and find out where anybody at that cemetery is buried. So I put in my last name. It popped up fetus A and fetus B. It was literally the first real world acknowledge meant that they existed. Was this our website? Not the original question, but the original question was about why the labor and delivery versus the D and D are just

 

P: because you wanted it to feel real. So that’s, that’s a legitimate that’s a legitimate thing. And the other thing I was gonna ask is, if you have any rituals around the loss, I know in Japan and probably other places there are rituals around miscarriage and stillbirth and abortion so smarter we don’t have that really here. There’s nothing

 

T: in the communities that I’m part of people will do like the balloon floating things or they’ll celebrate a birthday steal or some of them will. They’ll buy gifts. They’ll go with their living children buy gifts on that baby’s birthday, then donate them. That’s really nice. Yeah, there are beautiful rituals. That people families create for themselves. I didn’t I have my own private things that matter to me even to this day. It’s been 13 years I wear a necklace with a little sun and a daisy on it, which were their nickname sunshine and Daisy. I mean, Its the only piece of jewelry I wear I never take it off. I think part of it was my husband was very much like a thing happened and now we’re going back to our life. You know, they deal with it differently. He even actually got close to an acknowledgement of actually grieving for years. I think there was like he was thoroughly there to like, support me and protect me or give me the space I needed all the things he thought he was working doing for me, but if you asked him were those your daughter’s key would be like No, I think it was probably at least it’s been 13 years. I think it’s probably seven or eight years before I ever heard him. Even acknowledge them in a slightly more personal like he finally got a space to kind of process it and it happened quickly and quietly. It was only like something I kind of tuned into going on with him. So for me to like do a ritual felt annoying or like you know that it required other people’s involvement 

 

P: Yeah, 

 

T: you know, it was it was.

 

P: I totally relate to that. And I, you know, my daughter survived and she’s 20 now and I did not use the word dead for 10 years. I couldn’t use the word but all through my pregnancy. They’re like oh, she’s definitely gonna die. She’s not gonna make it. She and I and I literally could not use the word and her name and a sentence for 10 years after and it worked out.

 

T: Right. Yeah. I fully, fully relate to that. Yeah, there’s there’s certain words constantly like they just you make those associations and there are unbreakable that said, 

 

P: Yeah, 

 

T: but um, yeah, so I did find so much of my own healing feeling or voice. My healing came from using my voice. So for instance, I like the doctor that was so excited to do the surgery but never got a chance. He was a young doctor, he was very ambitious. He was nice guy. He was kind he’s also the doctor that did the abortion. And he you know, he would call and follow up with me afterwards called to see how I was doing. It was really nice. And about a few months afterwards, probably around I saw I went to the cemetery about six weeks, probably within the timeframe of that, I decided to write the doctor a letter I wrote him a four page single spaced letter typed sharing my experience after because a he was with my husband on team like, let’s just do the DNX you don’t really want to see those babies and and that and then also the other women who I was connecting with online who whether they had labor and delivery or some of them also had they would get handprints and footprints like the hospital had a process and I told him we should have to and actually then he called me and thanked me profusely because like you know, sometimes get a car but I never get something like this. This is so meaningful and touching that you took the time to write this. And he’s like and you’re right. He said if you if when we send a patient to the hospital, knowing they’re gonna have a stillbirth. There’s a whole plan in place for capturing the lock of hair and the handprint and it never occurred to them in these circumstances to do that, in fact, the place where I went to have the actual surgery where they removed the babies. It’s like one of those multi surgeries. You’re sitting there with a bunch of other people getting their, you know, ingrown toenails like worked on and just the sensitivity meter was so off as like out to here, walking into surgery. In this. Yeah, the girl that the nurse walking me down the hallway like I was crying, and I sniffled. And she turned to me and she said, Do you have a cold? It’s like, no, yeah, I’m crying. What so stuff like that? 

 

P: Yeah, yeah. 

 

T: In the surgery place. There was like a feedback form. Like after my surgery, they gave me apple juice and some crackers. And I was crying and they gave me these tissues and the tissues were like sandpaper on the feedback form. I was like, maybe try some soft tissues. Your tissues suck.

 

P: Yeah, yeah. Something comforting, right? 

 

T: Like be comforting. Yeah, I just found like, the more I opened my damn mouth, the better I felt. Yeah, about like making it better for the next person, right and next person who goes through this, give her some Kleenex instead of sandpaper, right, the next person who goes through this don’t let the nurse say something so stupid. Right. And, and that is really what fueled basically my last 13 years. My whole life, everything. Everything became about how can I take this experience and use it for every little bit of good that I create from this it to a degree and it’ll never fully but to a degree amortizes the giant pneus of my loss. And specifically also I’ve been on a mission. You know, I started a business after this a whole women’s empowerment brand around helping these women that I was connecting with refind their light and their joy after grief and trauma and pregnancy loss and infant death. And each little piece of that puzzle was a piece of my healing and a piece of making my loss worth it and a piece of justifying the choice that I made. And I realized that early on that if I had followed through and continued to pregnancy and my daughter was born with all the disability any of the all of it my whole life would have been derailed. And it would have been about raising this child about helping my other daughter cope with a disabled sister. My marriage likely would have fallen apart my finances would not have worked all the things that these families go through. Thankfully, because of a 24 hour window, I was in a position to make that decision for my family.

 

P: Yeah, 

 

T: and I’m grateful for it every day. Because every day, even now I try to live my life, making that decision worth it, whether that’s building the business to make other women happy, or showing up at the coffee shop with a smile even if I’m having a shitty day because I know it’s going to impact somebody else. Everything good that I can do is in justification of the reality that I’m not home taking care of a disabled child for the rest of my life. The price I paid to have a beautiful, easy life is a huge price. So this would be paying it forward.

 

P: It is an amazing way to memorialize the twins. to live that goal the time.

 

T: Yeah, you know, I used to when I was doing the work working with those moms, a lot of them would get so trapped in their grief. Because the grief became the link to the baby to the child right if they if they if they somehow move out of the grieving stage. It’s like they’re leaving that that baby behind and their memories behind or they forget or it’ll show that they don’t really love that baby. So much of the work I did was trying to let them see that it’s not that you’re leaving the baby behind. The baby is pushing you forward. Like do to live find beauty you’re here. That’s what they want for you and to be able to celebrate life and marry that concept to the memory of that child instead of the grief to the memory of that child. It’s so much better. It’s just better. 

 

P: Yeah, 

 

T: that’s what I had done actually with for me with with this. I got pregnant very quickly after the after the twins died. So they died in September. I was pregnant again by January with my youngest, so I’m not a waiter. I’m not 

 

P: so on purpose. 

 

T: Oh very much on purpose. Thank God Yes. Like literally literally I woke up after they knocked me out for to remove the babies from my womb. I fell asleep crying. I remember and I woke up on my husband was standing above very first words out of my mouth where I want to be pregnant again. And I don’t know if I met pregnant with them or like let’s get the show on the road because 

 

P: yeah, yeah. 

 

T: Unfinished business. I don’t know. I don’t know which I’ve never but those are my first words. And through that pregnancy, I was very much obviously still very much in grief. And I proactively was looking for light. So I had a visual of this new baby inside of me I felt dead on the inside. Just black. So it was like everything below skin level. And then when I found out I was pregnant, it was like again, the visualization of this tiny teeny tiny beam of light inside of me that was just trying to grow like trying. And so I started wearing sequined clothing to visually connect myself and my outer skin to that tiny little bit on my deep deep inside. And that’s kind of the platform that actually fueled the whole business I created was like this idea of joy and light on the outside being a catalyst to connect your joy and light on the inside. 

 

But for two years straight straight through that whole pregnancy. Two years straight. I don’t think there was a single day I didn’t wear something sparkly even on like my crappiest days and I came to fully connect, that proactive seeking out of joy with my twins. I mean obviously there were many many, many, many days where I would cry and grieve and you know all the dark side of grief. But be like I was saying being able to anchor them in my memory of them and my love for them onto something positive.

 

P: That’s amazing, amazing thing to make your connection stronger every day and something that you enjoy visiting and know right like That’s amazing.

 

T: Yeah, even this interview because like I don’t really have much opportunity to talk about them every now and then in my new business. You know, it’ll sprinkle it in, but it’s not a main, you know, focus. But yeah, it was like I was looking forward to the interview. Because I like to talk about them and I don’t get an opportunity and a lot of people are like, Ooh, you know, like you wouldn’t want to talk about something sad or you know, something so filled with grief. But 

 

P: also the truth of the matter is it’s more complicated than that. Right? There is definitely grief but there’s a whole bunch of other things right. So

 

T: yes, there’s I mean, the grief is it’s part of the foundation. And a lot of time has passed. I remember early on I was on those boards, the pregnancy loss boards, unlike Baby Center even before Facebook, and I remember seeing somebody post Oh, it’s been seven years since my loss and I’m so sad or whatever, whatever and I turned to my husband and I was like seven years oh my god, I don’t want to feel like this in seven years. Why are you still talking about it? Your perception of it is so different. Before and then immediately after, and then like down around like 13 years. It’s a whole other. Yeah, it’s a whole other thing. It’s a part of me. I couldn’t make them live. I couldn’t change reality. So

 

P: well and the whole pregnancy the whole process is so transformative, right? I mean, it’s different than you know, I miscarried at six weeks It comes with different expectation and a different experience and a different so it is a unique experience in that way and I understand what you’re saying I can see why

 

T: Yeah, I look at pictures of myself from before. And it literally feels like I’m looking at a different woman. I was a different person entirely. I mean, I would say especially in like the first seven or eight years, and when I was doing that work that was completely different parts of my old me have returned you know, I’m like naturally kind of a sarcastic cynical a little bit kind of New Yorky and and as I went through the stages of healing and connecting with other women, just kind of seeing how we’re all more the same than we are different even though we’re different than we are the same. Like it really opened me up and really allowed me to learn how to listen and like see people through a deeper lens. It taught me something I never knew before or wanted to know like how to sit with someone in a when they’re in pain. Yeah. Oh, no, no, I am not the person for that. And still now years later, it’s still okay like, hard sometimes but I know how to do that. I know how to show up other people better than I ever would have. I have not experienced any of it. 

 

P: yeah, yeah That makes total sense. We you tell us what’s the name of your business? How do we find it? 

 

T: Well, the business I started back then was called Finding my Muchness. I actually have a book. Like I wrote a book I have been having here because I was cleaning. So that was me a bunch of years ago. You can’t see it on your podcast, but I mean my muchness the website I think has a lot of buggy errors because I haven’t really touched it in many years. It was built on that premise of like the line I used to be much muchier but then I lost my muchness it’s a line from Alice in Wonderland. And I heard that line and I was like I was like there is something I can sink my teeth into the business today. Today. I own I run it with my husband. It’s called ear seeds and we make acupressure products that are worn on your ears for all sorts of health conditions. 

 

I had spent my whole career in the fashion industry in New York City making stuff once I started the muchness project and was doing meaningful work for the first time in my life. I could eventually no longer work in the fashion industry. I started having panic attacks because I was trying to proactively live a life seeking moments of joy. And my job required me to be like, oh China, that’s the wrong shade of pink re do it. Do it like I couldn’t do it. It was just too conflicting. I’m so now actually I couldn’t even this to like this experience. 

 

I had to quit my job in the fashion industry. I did it for 20 years. I couldn’t do it anymore. I learned online business. My husband was an acupuncturist. He was fully supportive of me making that move. And he also has always been committed to kind of finding ways to help in his industry to help the practitioners. And so it’s about two years after our loss when I finally quit my job, and then three minutes later the insurance company that covered like 90% of his patients changed their insurance plan. So both of us found ourselves unemployed staring each other in the face at home with two babies. 

 

And we’re like, What the hell do we do next? And this was eight, almost nine years ago and then we came up with this idea for this business and we started it in New Jersey. It’s been fantastic. Honestly, I mean, to be able to create a business that helps people and then to hear from the people who it’s helping. It’s almost an extension of what I was doing this this idea of learning that for every little bit of good that I put out. It just it’s like reaching out your hand. To help someone originally it was the moms on the message boards, you know somebody saying Help, like I’m drowning? 

 

P: Yeah, 

 

T: I said like on the message boards when I was early in my loss I would want and be like help drowning. And some Mom who had been there before me would like reach your hand across the internet, be like you’re not drowning, you’re fine. Come and pull it up. And then as I started to understand the grieving process and see the patterns that that we all would go through, and someone would come on a message board and say help, I’m drowning and I would reach my hand and say can not drowning. You’re gonna be okay like and pull them forward. Now, even through this new business, which is in total, totally different. It’s just meaningful

 

Tova it so moving to hear about how you translate this exceedingly difficult experience into something beautiful. That’s helping people. Thanks so much for sharing your story. You’re very welcome.

 

Thanks again to Tova for sharing her story. 

Episode 27SN: How did We Get our Current Culture around Pregnancy & Birth: Ask the Historians of Science

Talking to my mother and other women from previous generations it sounds like they got pregnant and gave birth in a culture that’s different from the one we face today. Based on these talks, I have often wondered how we got to the specific point we are at: where pregnancy is a very medical experience, C sections are so common,  we seem to be just starting to talk more openly about miscarriages and the postpartum period, and women are trying to navigate the demands of breastfeeding and work. In today’s show I interview two historians of science to get a sense of how we arrived at this particular moment in which we find ourselves.

Dr. Judith Leavitt

Lamaze method

https://www.healthline.com/health/pregnancy/lamaze-method-pain-relief

Dr. Janet Golden

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 a mother of two girls…I’m also a daughter…and from talking to my mother and other women from previous generations it sounds like they had a very different pregnancy and birth experience than I did. Talking to my mother I have often wondered how we got to the specific point we are at: where pregnancy is a very medical experience, C sections are so common,  we seem to be just starting to talk more openly about miscarriages and the postpartum period, and women are trying to navigate the demands of breastfeeding and work. In today’s show I interview two historians of science to get a sense of how we arrived at this particular moment we find ourselves in….

First I’ll talk to Dr. Judith Leavitt from University of Wisconsin and then I’ll talk to Dr. Janet Golden from Rutgers university about maternal mortality, and miscarriage and hospital births and breastfeeding, among other things

Paulette: Hi, today I’m excited to welcome my guest, Dr. Judith Leavitt, who was the Ruth Blier Professor of History of Medicine history of science and Women’s Studies and the Associate Dean of Faculty at the medical school, University of Wisconsin Madison. She’s the author and editor of many books about women’s intersection with public health and medicine in America, and 2010 authored a book about changes over time and a father’s experience of birth. I feel lucky to get to talk to her today about how we find ourselves in the current birthing environment. Welcome Dr Leavitt. 

Dr. Leavitt: Thank you very much. 

P: So I’ve been reading your book brought to bed childbearing in America 1750 to 1950, which focuses on the experience of women mostly white middle class but it includes some details about immigrant women and women of color. These questions will all come from reading that which kind of blew my mind, in part because it’s shockingly relevant. Regrettably, so the first thing I want to ask is that in our not so distant past maternal mortality rates were super high, (accurately counting maternal deaths remains a tricky thing to do, even today, but according to dr leavitt’s book, she writes, “the statistics show that deaths from maternity related causes at eh turn of the twentieth century were approximately 65 times greater than they (were) in the 1980s”) and I’m wondering if women looked forward at all to start doing families like they do today or was the threat of their health, Overwhelming Do you have any sense of that.

Dr. L: I think women were very aware of the fact that childbirth was dangerous, and they were aware of it, not necessarily because they knew about national rates or any numbers around that but they did know and had experience with women who had difficulty, and had come close to death with childbirth and they also knew women who had died in childbirth or whose babies had died in childbirth, so they were certainly very aware and I’m talking now 18th century and 19th century, very aware that child birth was dangerous, I saw that worry very much in their writing. And let me say that I read women’s diaries and letters, for the most part to get their own point of view at the moment that it happened not and sometimes in the, in their memoirs and memories of past events but a lot of it was very current in their minds and they were very eager to have babies. They were scared, because they knew it was dangerous, and I think some of the choices that they made about what they wanted for their childbirth, had to do with that danger fright, that they had. But they were just enormously eager to have children. Also, and it didn’t seem to lessen that eagerness, the fact that it was dangerous, dangerous I think it did influence their choices, a lot, and one of the points of my book, I should say is that I think women’s choices is largely what drew changes in childbirth history over time, used to be thought that doctors kind of forced women into the changes that happen, and doctors certainly played an important role, especially in the 20th century, but my contention in my book is that it was women who made the choices that they made and they made them as you started out this conversation by saying because they were fearful that they might die or might get into some serious physical difficulty in childbirth. And those changes, you know, I always thought, unfortunately tended to medicalize childbirth more than it might have happened, traditional childbirth was an event that happened in women’s homes, and women were surrounded by women, other women who had had children, their mothers, their relatives, their aunts, their cousins, and their friends. And it was around that female birthing bed that male physicians started to enter the 18th century,In those situations, most frequently they were invited in when women were having a long and very difficult labor, and they thought that maybe physicians could help. And it was forceps that physicians first brought to that helping effort, and many physicians said all they had to do is rattle the forceps in their pockets to get the women’s labor to progress more without them. 

P: A little adrenaline, sure…

Dr. L: And that’s right exactly, and that they were invited in for those difficult kinds of childbirth, normal obstetrics wasn’t called obstetrics The ticket was called childbirth was midwife assisted and friend assisted and it was a very female event, and the physicians that did come in the male physicians were those that could enter a female, environment, and survive many didn’t many got scared by all the women around the birthing bed and left. Really, not, not doing much, 

P:  that’s super interesting I guess I didn’t, it didn’t occur to me that there was selection in the types of births that doctors first attended. So I imagine their success rate was low in part because they’re at the most challenging births,

Dr. L: right, except that they did have some success, obviously, helping birth. But midwives had a lot of tools in their kits, walking women around keeping them, mobile and and vertical was very helpful to a lot of women as they tried to get thrugh labor so midwives, had a lot of things they could do did do successfully midwives, it was really among the most important medical practitioners in the colonial period in America, by far, and they did more than just deliver babies they did a lot of other things that, because they were the, often the nearest and the most familiar of the health people that a woman, or family could call, they did call midwives to do other things, midwives. There’s a wonderful book on a colonial midwife by Laurel. LAUREL Thatcher over, called the midwives tale, and in we get a lot of what we know about late 18th century, early 19th century. Midwives from that. One of the things that we learned that was, I think, something we didn’t necessarily expect to learn is that midwives kept very very full, gardens, a lot of herbs that they would use in their medical treatments and some, some having to do a childbirth with them having to do with other diseases as well. So they were, pharmacists, as well as healers, and they were really very important part of whole scene around health and disease in the 18th and 19th centuries,

P: as women moved to the hospital in the 20th century is that the death knell for midwives because I feel like midwives are not nearly as common today.

Dr. L: Well, midwives started to be replaced in the 19th century, so it was well still in the homebirth period that doctors wouldn’t be called increasingly for normal deliveries as opposed to difficult deliveries, and then it depended on who you were, how much money you had who you knew who you might call so doctors when they started coming to normal deliveries in the 19th century, they often came with midwives, that is midwives came and midwives might even call them and they’d be both of them around the birthing doctors are very kind of gradually taking over some normal births, especially urban ones in the 19th century, but it’s really in the 20th century when childbirth, moves to the hospital that midwives are most replaced by doctors and it’s really the midwives still in the south, well into the 20th century, in rural areas and in some rural areas in the north, especially immigrant rural areas but immigrants in the cities also might have tried to find an immigrant midwife who spoke their language and call her in before calling in a doctor before going to the hospital so midwives have been involved in childbirth. Always in American history, and are still. But as you know, a very small part but I think a slightly growing part of childbirth today, and it’s mostly, I think among some immigrant groups, Hispanic immigrant groups, for example in Texas are very user friendly to midwives and other rural groups. There’s a big Midwife center in Washington state, and is catching on around the country, again I think somewhat urban, as well as rural by a lot of middle class women who feel they have voice and who don’t choose to go to the hospital. So, midwives and birthing centers which are often run by midwives are increasingly used it’s still a small percentage of total births, but it is an increasing number. 

P: Yeah, on this podcast I’ve talked to a bunch of women, both from England and Australia, where it’s just a much more common practice to go to a midwife unless you have a complication and deliver birth there which I wonder if that contributes to their low C section or lower than ours. 

Dr. L: Probably. Yeah, wonderful book, new book on the history of homebirths that deals with 20th century home births and Midwifery, which you may want to look at by Wendy Klein. It’s really a good entry into that question. 

P: I’m wondering about all these journals that you read. If anybody talks about infertility, how that was handled.

Dr. L: If they did, I didn’t pay attention to it at the time I was looking at some I’m sorry, I think, I let me tell you that when I started this research, it was really very hard to find childbirth accounts everyone told me don’t even look, You’re not going to find anything people don’t write about it, it’s this kind of taboo subject even Well of course I knew that wasn’t true, but I, I had to find ways to find childbirth stories, and so what I did when I went to an archive for example is look at family papers, kind of scanning through family papers until it was a birth, and a child in the family. And then I would go back to the women of reproductive age in that family. Nine months or further to see their child birth experiences and when and how and when they got pregnant and so that’s when I found a lot of a lot of women writing about wanting to get pregnant about excitement about getting pregnant, and they wrote about, you know their excitement when they were getting married and their excitement that they would get pregnant and their excitement about getting pregnant. And those women I found because they had had babies so in terms of women who might have been infertile, I probably wouldn’t have found them in that way of searching, unless that same woman has some infertility issues in her, her own experience, Shannon Whitleycombhas written a wonderful book on the history of miscarriage and that is partly about insecurities

P: in brought to bed it says the women who did not lose any of her children either at birth, or in the early years of their lives was rare in 18th and 19th century, far more common to the woman’s experience was the necessity of accepting the deaths of numerous offspring. I was wondering if because that was such a reality if miscarriage didn’t get any attention. If it was you know relatively early like it does today because he was surrounded by the death of children.

Dr. L: No, absolutely, it did. In that sense it did but but the ones I was talking about were ones, women who had lost children they had live birth, yeah, yeah. So in that sense I was, I was not talking about those women and infant mortality was just spectacularly high. In those years, and women experienced that they sometimes didn’t name their babies until they were a year or  two old because they were worried that that would be kind of Jinx, their success and raising them, and very often they named babies, after baby who had already died,

P: that’s interesting

Dr. L: or a child who had already died so there was Elizabeth who was in the grave and Elizabeth who had just been born or had been born a few months before, when they were finally named so a lot of families, you know, made one of my it was one of my difficulties in searching out experiences because you might have had three Elisabeth’s in a family, and trying to figure out which one was the one that I might get a birth story from, 

P: yeah. Yeah

Dr. L: That’s hard.

P: Yeah, it’s hard to imagine that, I mean obviously we kind of know, we know that intellectually but it’s hard to imagine what life was like with those editions, and that threat.

Dr. L: Exactly. And there have been people have written about it as if women didn’t love their children until they were a certain age because they were afraid to emotionally commit. And I don’t think that was true at all. I think women committed. The incident of birth, most of them are certainly in the first year of life.

P: In my first pregnancy halfway through the pregnancy. Doctors found that I had an autoimmune condition that was attacking the fetal heart. And so for the last three months they kept saying she’s not going to survive, she’s not going to survive and I had this struggle, on the one hand, you might try not to get attached to the idea of this baby. Although you’re already very pregnant with her. On the other hand, I thought, That’s not realistic. I’m already attached, and there will be no way to dampen the pain by waiting to name her. I’m sympathetic to the idea that naming someone makes them more real and more embodied, not naming them doesn’t make them any less real For me, that idea I can connect to. I myself was not able to say, and she’s fine. By the way she’s so good 19 Freshman. Freshman in college. 

Dr. L: Good for you for sticking it out. That must have been very difficult. 

P: It was super stressful, but you know, not naming a child, you’re still in love with the child right there’s no, no getting around that. 

Dr. L: Right. 

P: so another thing you mentioned in your book is that, women moved to hospitals to deliver before the death rate in hospitals, actually dropped below the death rate in home births and you have that great graphic of urban versus rural death rates which will forever be emblazoned in my mind, and I’m wondering if that was an issue of failure to communicate information effectively, how was that gap created. 

Dr. L: No, it was the same thing I had talked about for the earlier period women were always seeking out something that was going to make their childbirth experience better. And they always thought that paying attention to what was the most advanced in medicine was going to help them the most. So that’s why they got doctors involved in the first place with with difficult births, it’s why they have kept doctors involved for normal births, so called normal verse in the 19th century. What was interesting, it wasn’t just give me everything you have, I’ll take it with the doctors, the women always remained very critical of what doctors would do they were, they wanted the forceps, but they didn’t want the forcepts. 

P: Yeah, 

Dr. L: they wanted something that anesthesia for example, women really really wanted anesthesia after the middle of the 19th century, and yet, they wanted to be the ones in control of it not necessarily give that control to doctors. So there’s constant push and pull between women and physicians, even though it’s women who wanted the physicians and what they had to offer. You can’t really think of this as something kind of straightforward, so the move to the hospital was part of that, that women thought that the hospitals would have something to offer and one of the things that hospitals had to offer was around the clock care, which women were having a harder and harder time finding at home, it used to be that relatives would come they’d move in for, you know, maybe months to help you around childbirth and early childhood for the babies and your sister would come and it would be easy, relatively easy to have somebody with you all the time for all the help that you needed. Well that became harder and harder as the 19th century wore on, as women were in the workforce more as families who are more mobile and moved away from their original family. So women had that real drive to look for some place that they could go and have care that they didn’t have to worry about. So that was a big part of it. Another part of it was the physicians once surgery was getting established in hospitals, physicians themselves were moving into hospitals, instead of doing office care and home care. So it was harder to get physicians to attend you if you wanted a physician. If you stay at home so that that was part of what women wanted and it was also that part of it was something physicians wanted it was a lot easier for them to have nurses on call and everybody ready and they just run in and hold out their hands and deliver the baby, where everyone else had done all the work so that was easier for them they didn’t have to worry about the horse and buggy, they didn’t have to worry about cranking up their early automobile they were set in the hospital and had a much easier time too, so it was really a push and pull from physicians and then from women’s  end wanting to move birth into the hospital, they didn’t, I think realize as you put it about that mortality might still have been high in the hospital that infection was still an issue in fact is a bigger issue in the hospital than it was home. If they knew about it, it wasn’t the predominant thing in their minds they were looking for what they hoped would be a safe experience with people who knew what they were doing around them. What they didn’t realize that first generation that went into the hospital and it wasn’t the whole generation obviously all at once. The first women who went into that school didn’t realize consciously, what they were leaving behind. They didn’t realize the female world that they had created at home, which had been such a comfort to them and had eased the birth transition so well. They didn’t realize they were losing that if they went to the hospital, hospitals, they labored, if you can imagine this we don’t do this anymore they labored alone delivery room obviously there are people around them, the physician and probably the anesthesiologists and nurses in the labor room they were mostly alone nurses would come in from time to time to check if they were dilating, how far dilated, they were to check that they were okay maybe offer them some ice cubes, maybe not even that. Otherwise they’d be alone. And that was really, really hard to make that transition from being in the comfort of your family and friends to being alone as they put it, alone among strangers that’s why I named my book brought to bear because in the early period women were brought to bed by their friends by their relatives by people they loved and who loved them. In the hospital, they were alone among strangers, women in labor rooms would talk about listening to doctors and nurses talking outside in the corridor. they might come to the door and look at you, but they wouldn’t really come in and hold your hand and give you the kind of comfort that you wanted and needed if you if  labor was going to progress. Well, so it was a very difficult transition in that sense, but as I say women didn’t know they missed it until they missed it, and then they missed it badly.

P: Yeah, no kidding that that sounds really dramatic I talked to a woman yesterday who was born in Britain but her family’s from Nigeria. And she was saying when she got home from the hospital, her mother was with her for living with her for a month and you know that her mother in law came and she was saying in Nigeria that is the common practice that exactly what you described, which is that someone moves in with you to take care of everything, and the mother’s feet are not to hit the ground and, which sounds kind of amazing and she herself was saying, it’s much harder to do you know that we live in England because everyone has a job. So, you know, my mom can’t live with me anymore because she has to go to work.

Dr. L: so I recreated that a little bit when I had my first child, I’ll tell you this experience, it was on the delivery table, literally the delivery table when I was pushing, I’m working so hard that I realized the birthing mother is the most important person in that room, and, of course, working the hardest of anybody in the room. And the story historically from her point of view had not been told we knew about the doctors we knew about the nurses we knew about the midwives, you know less about the nurses and midwives and we have since come to know but we knew about childbirth from the medical point of view and we did not know it from the birthing woman’s point of view. And that’s right there is where my book was conceived as my child was pushing her way into the world, I knew I had to tell, try to tell the story from my point of view my working hard point of view. And the other thing that happened which was totally inadvertent but quite wonderful. In my first birthing experience was that I was doing a Lamaze delivery which was in, in my day a little unusual, 

P: the lamaze method was developed in 1950 by a french obstetrician and it was a natural birthing technique that focused on regimented breathing for each stage of labor

Dr. L: and the nursing student class heard about it and wanted to come in and see it. And so I had about 10 nursing students around my bed, all female. So, other than my husband who was there, I had recreated without knowing it, the female part of the experience, and it did help they all saying happy birthday when Sarah came out and it was, you know, it was quite a party in that sense in the same way as it had been what we used to call social childbirth, it was a social childbirth and a female social childbirth. 

P: That seems fitting. 

Dr.L: Yeah, it was but I didn’t know it at the time.

P: Let’s talk a little bit about Twilight sleep if it seemed as though, women were edging away from that social circle that was so helpful. It sounds like Twilight sleep was just the end of that.

Dr. L: it was, but one of many things in the hospital that ended that Twilight sleep was seemed very very attractive to women women, as I found out who call themselves feminists who wanted to imbibe that they men, choosing the way they wanted to have birth. When I was a feminist writing this book, I was thinking of feminism as something that meant I controlled the birth itself and that was a slightly different use of the word feminist but they were feminist and they wanted to choose and they had heard about this method this we’re talking about the second decade of the 20th century, in the 19 teens, and they had heard about this childbirth technique in Germany and wanted to bring it to America, and basically it was giving the laboring woman, a combination of scopolamine and morphine which would morphine to dull the pain and scopolamine to help you forget it, and it would kind of put you into this totally relaxed state of sedation and not really knowing what’s happening to you, and you would deliver your baby and then you would wake up and some women who did that. I remember having had a baby they didn’t know they had had a baby, so he missed the whole thing, which for me was really terrible because I loved the whole thing, I loved it, not in the kind of romantic, fuzzy pink way. 

P: Yeah, 

Dr. L: but in a way that helped that I understood the power of my body in a way that I hadn’t understood it before I had a baby. And that was incredible to me that a body, a woman’s body can do that, and I wanted every minute of that experience I wanted to be awake and alert for it, which is why I didn’t want medications but in, in the twilight sleep. Example women wanted that medication wanting to forget it wanted to wake up with a baby and not knowing it and not having felt it, and they did that until they realized that the dosages in those early years of using scopolamine and morphine the doses weren’t well regulated were, weren’t well understood and some of the babies were very lethargic after being born and the women not necessarily in great shape themselves so it was something that fell by the wayside pretty quickly in that form, but was continued to you be used once they understood dose medication, well into the 1960s. You may be still being used in places, my sister in law had a scopolamine Birth in the 70s but it was a way to medicate women without them, understanding it as medication per se. I think anyway they liked it and they came to the hospital for it so yeah they ended up one of the things you did under the effects of it was thrash about a lot and so they would put women into these into bed, high Canvas sheets so they couldn’t see and they couldn’t fall out, which also, you know freaked me out because you’re really alone in that environment, and I didn’t like that but they loved it, so.

P: Yeah, it sounds like horse blinders I’m not for that. And do you have any insight on abortion was it handled by midwives, was it a political issue, or the 18th The 19th 

Dr. L: well, yes and no. I mean, in traditional societies and including our own life was not seen to exist before quickening between the 16th and 20th week of pregnancy. So until a woman felt movement, you didn’t worry about that and yes women tried to get abortions if they didn’t want to have their babies and they helped each other do that. Midwives sometimes helped some, some absolutely refused to help, and doctors got into the act and helped, and then some also absolutely refused to help, until the late 19th century was seen as perfectly fine for quickening because it wasn’t seen as you had life yet. Technically, so people did it and, and the problem was finding a way to do it successfully. And of course, there weren’t a lot of very successful remedies. Then, and the same with birth control, you know, they tried all sorts of things for birth control and weren’t necessarily successful, 

P: that is super interesting to see how many historical lines from the past are still totally relevant today.

Dr. L: I do think that we are re experiencing many of the things we as individual women are really experiencing many of the things that women in the past have and we have some of the same concerns they may be manifesting slightly differently today but they are. There’s a lot of a lot we can learn from women in the past.

P: Yeah, the issue of control is so, fundamental to every woman who talks about her story about control over her bodyand almost everyone universally says, when they feel a loss of that sense when things are being done to them, it feels terrible and not natural and, and that seems true forever and I can see why women fought so hard to have people with them.

 

Dr. L: People with them and to make birth plans, even though a lot of women know that the birth plans can get thrown out…maybe too easily. They make them and they, they put a lot of stake in them, because they really do think about what they want in a childbirth experience, and of course many doctors really try to give them that. And pay attention to their birth plans and help them with that. And others just say dear, dear, I know more about this than you do, don’t worry just put it in my hands. So, you know we have those experiences, right away first in the hospital in the early 20th century and we still have today. You know, it’s something that we can look back on and see how did women, those women who kept control how did they do it. Yeah, and we can learn from that.

P: Oh, thank you so much for taking us on this tour of where we’ve been and hopefully where we’re going.

Dr.L: Well thank you for asking me. I hope that was useful.

P: Yeah, it was great. Thank you

P: and now a little bit more on where breastfeeding fits into the current day picture:

A special welcome to Dr Janet golden, a professor at Rutgers who specializes in the history of medicine, history of childhood, women’s history, and the American social history. She’s the author of several books, including most recently, babies made us modern how infants brought America into the 20th century, which is a very intriguing title, thank you so much for coming on Dr. Rosen. 

Dr. Golden: Oh, thank you for inviting me. 

P: One thing I want to talk about today is breastfeeding and sort of how we got where we are now culturally, I think there was no push to get my mother to breastfeed, as opposed to my kids when I, when they were born, there was an enormous push to breastfeed. So I’m wondering if you could kind of walk us through how we got here.

 

Dr. G: All right, that’s it, that’s a great question and I think we can say that there’s a very long history of forces, promoting breastfeeding and forces opposing breastfeeding, it’s very different in the United States than in other places, of course, where, just as an example. The French were very concerned to promote breastfeeding and for reasons of health because they were being outnumbered by the Germans and they wanted to build a strong healthy population that can then it becomes out of fashion to breastfeed everybody wants to have a wet nurse or send a baby out to a wet nurse so there are constant changes in this history 

In the United States, you know for most women in the early centuries of what we will call United States history, you pretty much had a choice of breastfeeding or using animal milks which weren’t as well formulated as they might be today, and most people simply didn’t have the means to purchase them out to maintain it properly if they did purchase it, they didn’t have refrigeration so breastfeeding was really the way to go until these canned formulas developed and then the formula companies jumped in and said get rid of wet nurses. Feed your baby the scientific way and go with melons, baby food or go with Borden’s condensed milk in a formula. So there was pressure in the other direction 

P: is that like 1950s When is that?

Dr. G: that really gets going in the end the first formula is get going in the late 1860s 70s 80s 

P: Oh, Wow, 

Dr. G: so they start pushing that only a few people can afford it, of course, the breast, but breastfeeding begins to look unscientific and so there’s, you know, we start selling the, the sugar formulas that go into the milk formulas, and of course once you have running water clean water indoors, you have electricity or gas heat to boil things, it just becomes a lot safer to do that. Now obviously, there is some controversy when formula companies are promoting these powdered formulas in countries where people don’t have access to clean water, low income they have to dilute the formulas so they’re not healthy for babies but we’re not, we’re not going to talk about that so we’re really gonna say that by the post war period 1950s Breastfeeding is just out of fashion it seems primitive It seems something that poor women do. The modern scientific ways is to bottle feed, and then it’s very precise you can measure how many ounces did my baby, drink some baby books had you weigh the baby before you fed the baby and then feed the baby and see how many ounces, they took in, and then people began to push back against that and saying no. Why should this commercialized enterprise these be in charge, why should medical authority dictate over what’s natural for women, let’s go back to breastfeeding and of course there is good scientific literature that says it’s, it’s a better alternative, you know, cows make milk for calves women make milk for babies, you know it’s it’s a natural correctly designed product, but of course not everybody can do it and not everybody wants to do it so we live in a world now where two things are true. One is that I think we can stipulate that scientifically medically speaking babies are better off drinking milk, designed for babies, which is from human females, But we can also say that. Secondly, we live in a world where we get clean water, we can properly prepare our formulas the formulas are well designed, and not everybody can or wants to breastfeed their baby so both things are true, and we’ve gone in the direction of making it easier to promote breastfeeding in hospitals, maybe a little too pushy on that as you can explain, and we’ve also reformulated to use a bad pun there are our WIC program and other things to support breastfeeding and we’ve put in, in places that employ large numbers of people we put in stations where women can pump their milk store their milk etc so we’ve made it certainly made it easier to be a breast feeding person, but that that has, I think shaded over for some people to be almost a command, and making people very resentful and unhappy with that, you know, I guess we live in a world where everything is polarized nowadays even taking care of infants.

P: yeah, That seems to be the case and a lot of women describe how they expected breastfeeding to be easy, because it is natural, but I don’t know that those two things go hand in hand, and once it is difficult, then there, then they think it’s something that’s wrong with them and all of a sudden it’s a comment about their ability to be a mother…after you give birth, that is the first thing that you’re doing. So, it’s challenging to have the first thing be something that’s not necessarily super easy. Do you have any sense of how common it is to have trouble breastfeeding.

Dr. G: I really don’t know because I think I’m sure there are studies on that I’m sure it’s difficult in the beginning I believe it’s harder for women who’ve had cesarean sections and have had some anaesthesia in their system, I believe it gets easier with second and third and fourth. So on children. But certainly, initiating breastfeeding it’s often better done if you have a mom or a support person who can get you through it it’s, it can be, you know it can be painful. Problems do develop you need support breastfeeding may be natural, your body may be designed to do it but that doesn’t mean you necessarily know how to do it. Some infants have trouble sucking latching on, you know it’s not, it’s not a perfect and easy thing to do, but I think what makes it so hard for people is the, the weight of expectations and judgment, you know, we live in a culture, I think it’s fair to say that the easiest people in the world to pass judgment on are either people like us who we feel we can do better than other moms in the, in the hospital with us or in the birthing center with us, and then people who are different from us and who behave differently from us and we can say oh they’re different and there’s something wrong with them. And oftentimes that judgment is really about women and about mothers and about child rearing. And that I think makes it all the harder, all that judgment that goes on and, and political divisiveness,

P: Yeah, and what I find, talking to people is that it’s not always on the surface, sometimes it is a it is a buried expectation that you don’t realize until you don’t meet it. Many women have come on the show and talked about how breastfeeding is the super painful and difficult thing and the latch didn’t quite work and the baby wasn’t getting enough milk, but it was still hard to give up, Because her expectation was, you know, good moms breastfeed.

Dr. G: Right. Just like when other women wanting to breastfeed and the 50s and the expectation was you’re a bad mom. Because you’re not buying the most up to date formulas and the fancy bottles that go with it. So, if we took the judgment, out of it. I think it would be easier for people to breastfeed it would be easier for people who didn’t want to breastfeed to bottle feed, it will be easier for people who want to partially breastfeed and partially bottle feed to be comfortable with that, but there’s the idea that we, that we have to pass judgment on this and make people uncomfortable about their choices. It’s always been that way, but it doesn’t have to be that way.

P: Well that’s interesting to hear that that is always the case so even when the pendulum swung the other way and people were being discouraged from breastfeeding, you were made to feel bad if you breastfed.

Dr. G: You were made to feel bad and there are many many stories of women who said I want to breastfeed my babies and the nurses would would only would start the babies on bottles without telling you so it was hard for them to latch on and then they would only bring you the babies every four hours even if babies were hungry and they’d cry themselves to sleep, and then they start wiping down your breasts with alcohol and other antiseptics. Oh they made it, you know, because it seemed like you were doing it seemed dirty if I can put it that way to put your baby on a breast and when you could have a scientific bottle that was you know had been sterilized to the right degree and gotten out all the germs so. As difficult as women today have it who choose not to breastfeed and get judged by nurses or by their friends or their doctors, it was a different way, maybe 50 6070 years ago.

P: That’s sort of shocking and I guess I don’t know whether I would call that marketing exceedingly creative because suggests that the scientific way is to do something that’s made in a lab, as opposed to what your body has produced, that’s sort of amazing.

Dr. G: Well, that you know we were very into measurement. So, how much is your baby weigh how much did How big was your baby how fast is it growing so if you can measure how many ounces your baby drank and write that down, which a lot of moms had charts to do that that just seemed like a very scientific thing to do.

P: Yeah, that that’s fair and I’m sympathetic to that and actually I don’t know if you’ve heard of a company called hatch. No, they have a very special changing pad with really sensitive monitors in it so that you can weigh your Baby and breastfeed and weigh them again, and it’s there’s an app on your phone and you can check it out and and it is for that purpose explicitly because so many women who breastfeed say I have no idea how much they got or if they drink anything or you know what’s going on so it’s funny that science has come to meet that demand another way.

Dr. G: Right, well, you know, our medical world is always in part about marketing, They’re very much intertwined, because you can sell people on science, whether it’s the science of hygiene and cleanliness or it’s the science of measuring your baby for a time women, middle class, upper class women were encouraged to buy scales and weigh their baby every day and write it down you know because measuring is science. So, and then the marketers got very into this our department stores have infants departments, they used to have nurses who works there who would tell you the right things to buy and give you medical advice so you know that that the world of science which has brought us many, many wonderful advances is also about the world of marketing which has brought us many, many products and they do get tied up together and help to sell each other.

P: That’s shocking to hear that there were nurses at department stores, impossible to imagine, and I guess a great way to sell stuff. 

So let’s talk for a little bit about these baby friendly designated hospitals, the impetus for this came from the WHO World Health Organization, 

Dr. G: right, it’s a worldwide effort

P: in the 90s, and then I’m sure it looks different here than it does in other countries, in 2007, it says that less than 3% of United States births occurred in 60 Baby Friendly designated facilities, but by 2019 28% of births are in 600 Baby Friendly facilities and Baby Friendly is a designation you get if you follow this 10 step approach to encouraging breastfeeding, but it sounds like it’s almost aggressively to the exclusion of anything else. 

Dr. G: Well, I would, I would say two things about that one is it’s fascinating to see how much it’s grown and I’m sure that has a lot to do with the marketing of the hospitals, right, if you have health insurance and you pick that hospital, because it’s a Baby Friendly Hospital and you like it, you’ll continue to bring your insurance cards when and go back to that hospital so that’s that’s good for the hospital. It is probably good for hospitals to move away from promoting bottle feeding to supporting breastfeeding, that how aggressively they do that, I would assume is to some degree determined by the, the nurses on the obstetrics floors, and how seriously they promote breastfeeding over bottle feeding, and if you think about it from the nurses perspective, if you have rooming in and a mom can pick up her baby and breastfeed on demand, then that’s a lot less work for the nurse taking the baby back to the baby part of the hospital and feeding the baby, him or herself. So there are all sorts of incentives built in for the hospitals for the staffing of the hospitals for the baby, certainly, you know if you’re going to support breastfeeding, which is a good thing overall, But how you handle that I’m sure it’s very idiosyncratic, and it may depend on whether you have the night nurses or the day nurses and are they new hires are they the older hires how they feel about it.

P: Yeah, it’s interesting to see sort of what’s developing and just so interesting to me that there’s this cultural shift that happens you know almost on its own cycle, where it goes back and forth. So, can you imagine at some point in the future where breastfeeding will be out of fashion.

Dr. G: It may well change because now, you know, now we’re beginning to see what uh what environmental pollutants are in women’s bodies and in breast milk so maybe they’ll have formulas that don’t have those pollutants and we’ll move away from it. When we talk about breastfeeding we’re talking about the health of a woman and a baby and a family and workplace issues and social issues and environmental issues, and it all gets encapsulated in this tiny realm of Will you or won’t you breastfeed, but there really so many bigger surrounding issues is breastfeeding supported by do we have six months of paid family leave in this country. No we do not, you know, that might be a better support for breastfeeding or partial breastfeeding, then what happens in a Baby Friendly Hospital or a baby unfriendly hospital if we want to label the other ones

P: that oh that sounds much more expensive, potentially, potentially much more helpful but much more expensive. 

Dr. G: Right. 

P: The other thing that seems tricky about maternal health and newborn health is that I feel like it has not received as much medical attention. You know all the issues that come with pregnancy, many of which remain a black box preeclampsia we’ve known about for hundreds of years, we’ll still know kind of how that works. So it’s, it’s tricky to see what will be the lever that will encourage a shift in one way or the other to change.

Dr. G: Right, I mean we still have many many women who’s who are uninsured. 

P: Yeah, 

Dr. G: even with our expanded Medicaid and programs there. We have undocumented women, who I believe if they call up a center, they can get prenatal care, and they’re supposed to not wait more than six weeks but in fact I think there is not enough services for them, their children are going to be Americans. They’re here. And yet we’re denying them a kind of Healthy Start There are so many complicated issues around pregnancy and birth that are much more expensive as you say, not necessarily harder to solve because the rest of the world seems to solve them. But if we don’t have those conversations then we bring it back to this individual well that mom didn’t breastfeed or that mom should breastfeed or why is she fully breastfeeding and leaving the baby formula when she goes to work We’re talking about individual decisions, but we’re not talking about the structure in which they’re made. 

P: Well, so you bring up a good point other than vastly more generous medical supports that other countries give their women. Is there any do you have any sense a theory about, you know why culturally in America, you know postpartum care is one visit at six weeks, and I as far as I can tell, you know, after you’ve been through, almost 10 months of pregnancy and an exceedingly challenging delivery, you could, you could use care before then, but we, but we don’t do it that way. Do you have a sense of like, what else is driving those differences between US and other countries.

Dr. G: Well, you know we have a for profit healthcare system. So, I believe that if you’re an insurance company said, Is there any data to say you need continuing care that, you know, first year after giving birth. Well, no their baby will go to the pediatrician and you as the mom, you’ve had your one postpartum visit you’re done. Why do we have to pay for another visit for you. So we have that problem right there. Yeah. And, and I think that there’s just a sense of, you know you’re you’ve become. you go from being the vessel for the baby you deliver the baby then the baby is going to get that the S chips care the Medicaid care the private insurance care the clinic care, but you as the mom you’re kind of done to your next pregnancy I guess, Or your annual gynecological checkup. We don’t and so we have a very high maternal mortality rate in this country as a result of that, but we have a strong tradition, really, I would say from the post world war two period of saying, everything is a private matter, you know, It’s for you to go to your doctor. It’s for you to decide if you want to be pregnant or not pregnant, we don’t, we don’t have a system that says, we have some responsibility to our citizens and non citizens who are here and who should have good healthcare.

P: Dr golden thanks so much for coming on and talking to us today. I feel like I’ve learned a ton.

Dr. G: Okay, well it’s been wonderful to talk to you.

P: Thank you again to Dr. Judith Leavitt and Dr. Janet Golden for giving us a sense of the factors over time that have come together to contribute to the pregnancy and birth culture we have today. Thank you for listening, and if you liked this episode, please consider sharing the podcast with your friends.  The next episode is a return to a birth story…and this story is really, in some sense, a loveletter to becoming a parent–it showcases the many challenges that sometimes have to be overcome to get there…