Like a Mother

Angela Garbes

• Publisher: Harper
• Year: 2018
• ISBN:
  9780062662965
• Topic: Medicina
• Subtopic: Ginecología, obstetricia y partería

A candid, feminist, and personal deep dive into the science and culture of pregnancy and motherhood

Like most first-time mothers, Angela Garbes was filled with questions when she became pregnant. What exactly is a placenta and how does it function? How does a body go into labor? Why is breast best? Is wine totally off-limits? But as she soon discovered, it's not easy to find satisfying answers. Your obstetrician will cautiously quote statistics; online sources will scare you with conflicting and often inaccurate data; and even the most trusted books will offer information with a heavy dose of judgment. To educate herself, the food and culture writer embarked on an intensive journey of exploration, diving into the scientific mysteries and cultural attitudes that surround motherhood to find answers to questions that had only previously been given in the form of advice about what women ought to do—rather than allowing them the freedom to choose the right path for themselves. In Like a Mother, Garbes offers a rigorously researched and compelling look at the physiology, biology, and psychology of pregnancy and motherhood, informed by in-depth reportage and personal experience. With the curiosity of a journalist, the perspective of a feminist, and the intimacy and urgency of a mother, she explores the emerging science behind the pressing questions women have about everything from miscarriage to complicated labors to postpartum changes. The result is a visceral, full-frontal look at what's really happening during those nine life-altering months, and why women deserve access to better care, support, and information. Infused with humor and born out of awe, appreciation, and understanding of the female body and its strength, Like a Mother debunks common myths and dated assumptions, offering guidance and camaraderie to women navigating one of the biggest and most profound changes in their lives.

Chapter 1
Now What?

When, for the first few weeks, the only evidence of pregnancy I had was the memory of my doctor’s voice on the phone and a plastic stick that I had peed on, it was hard to know what to do with myself. Freshly pregnant, but also fresh from the sadness of losing a pregnancy, I found myself asking the same question over and over: “Now what?”

Try as I might, after learning that a microscopic proto-person was growing inside me, I wasn’t able to just go about living my life as usual. I had a hard time simply “being” pregnant, and I felt compelled to “do” it properly. I knew that I wanted to do everything I could to keep myself and my baby healthy, learn about the risks involved, prepare for the physical changes to come, and try to stay positive and hopeful. I knew I should also do my best to make the most of the time my husband and I had left as a family of two.

“Sometimes birth choices are not about perfection or fears but just the way we happen to be living,” wrote Randi Hutter Epstein in her cultural history of childbirth, Get Me Out.1 I think the same is true for the choices we make throughout pregnancy. The way we happen to be living right now is marked by an overwhelming amount of information, as well as an astonishing number of ways to get that information. It can add up to a lot of mental noise.

Yes, we get facts and guidelines from our doctors, midwives, and nurses, but we only see these care providers every few weeks and, typically, for less than thirty minutes per visit. There’s a lot more time—and questions, big and small—that make up the daily experience of pregnancy. And so, increasingly, we turn to websites, books, online forums, and social media. There is no shortage of pregnancy advice out there, and all of it can be summoned to our screens in a matter of seconds.

Quick searches on common topics such as contractions, early pregnancy symptoms, and birth options yield pages of answers from a seemingly infinite variety of websites including Web MD, Healthline, Mother Rising, The Bump, BabyCenter, BabyCentre UK (in case you want to see what moms in other countries are told), What to Expect, Parenting, Giving Birth With Confidence, Momtastic, Babble, New York magazine’s The Cut, American Pregnancy Association, MedicineNet, Fit Pregnancy, Cafe Mom, the Mayo Clinic, Women’s Health, Planned Parenthood, Mama Natural, Huffington Post, and the National Institutes of Health.

These resources represent a mix of medical organizations, personal blogs, health and lifestyle magazines, scientific research, feminist publications, health-care providers, news organizations, and government institutions. They each serve a particular agenda, but it’s hard to tell whose exactly. The authors of these articles, lists, and summaries (if they are even listed) don’t always link to sources, so it’s hard to trace where the facts are actually coming from.

In a mere ten minutes of scrolling through my Facebook feed, these articles all showed up as suggested or sponsored posts, or as content from websites that several of my friends had “Liked”:

• 6 Strange Things Your Body Will Do While Breast-Feeding
• What I Wish I’d Known Before Giving Birth: 4 Things About Pregnancy One Mother and Yoga Teacher Learned the Hard Way
• 8 Crucial Things Men Need to Know About Pregnancy
• 23 Underrated Parenting Products That Actually Work
• 7 Co-Sleeping Myths That Are Actually True

Every article we click on through Facebook and Twitter, every Google query we type in, and every Instagram post we “Like” triggers algorithms, so the information and images we see are constantly being custom-fitted to our interests—and our fears. The messages, which come quickly, one after the other, tell us to trust doctors but also to be skeptical. To trust birth and be open to its unpredictability, but also be scared because you might die. They say it is okay to let your baby cry it out at night, she won’t remember in the morning, but also be aware that her body will be flooded with the stress hormone cortisol and her unconscious will learn that you, her mother, are willing to abandon her when she needs you the most.

When pregnant friends ask me for advice about things, I tell them, only half-jokingly, to never look on the Internet, because you can find whatever answer it is you are looking for. Want to know that home birth is empowering and orgasmic? No problem. Want to learn how home birth is fatal and the midwives who encourage it are inept? Check. Want to know that sitting in a hot tub for ten minutes will help your tense, pregnant body relax and feel better? Got it. Want to read about how it could dangerously raise your core temperature and that you probably shouldn’t risk it? Click right here. Sifting through these contradictory messages amplifies the already tremendous sense of responsibility you have as an expectant mother—not only do you have to take care of yourself and the helpless embryo inside you, but you need to sort through all the information and figure out The Truth.

Several friends recommended The Healthy Pregnancy Book, written by husband-and-wife medical team William and Martha Sears. (The Searses are the authors of a series of books, the Sears Parenting Library, which includes The Baby Book, The Baby Sleep Book, The Breastfeeding Book, The Fussy Baby Book, and The Discipline Book.) William is a pediatrician and medical professor and Martha is a registered nurse; together they raised eight children. I figured I could learn a great deal from them.

Indeed, I did learn from the Searses. But when I first opened The Healthy Pregnancy Book and began reading the introduction, I was startled by an image. There on the second page was a gray, delicately shaded pencil illustration of a baby nestled cozily in a womb, its arms and legs crossed. A thought bubble emanated from the baby, carrying a firm message: “Mama, take good care of yourself so I can grow better.”

The illustration appeared regularly throughout the book, offering pointers and seeming to suggest that I needed help with my priorities. “Mama, make our health your hobby,” the baby reminded me on page 4. I was only eight weeks pregnant (my fetus was kidney bean–size and arguably had more in common with a bean than a person), and yet here was this fully formed baby admonishing me for mistakes I was already making.

“Do you really want to eat that?” the baby asked incredulously on page 54. It was reclining next to a red box titled, “Science Says: Gain Extra Weight, Labor Extra Long.”

Pregnancy guidebooks like these are valuable—they offer a basic understanding of the biological process of pregnancy, fetal development, and childbirth—but my experience with so many of them was that they were more instructive and prescriptive than informative. I don’t mean to pick on the Searses here—other books such as What to Expect When You’re Expecting and Your Pregnancy Week by Week were just as loaded with value judgments, some subtle, others brazen. Chapter six of The New Pregnancy Bible: The Experts’ Guide to Pregnancy and Early Parenthood, the most easily available guide at my public library, is titled “Looking Great” and suggests that pregnancy is a good time to “pay special attention to your hair, skin, teeth, breasts, and feet.”

If you want to know what to expect, it is that a lot of people will have a lot of expectations about your pregnancy and what you “should” be doing. And these expectations can break you.

But, I wondered with each book I picked up and put down, instead of focusing on what is “good” and what is “bad” in the external world of pregnancy, why don’t we invest more time and resources in understanding what is going on in its vast, internal world? Women deserve to have access to information so we can make our own educated choices—not information repackaged in the form of instructions about what those choices should be.

Instead of learning how to care for my nails or make a pregnancy salad, I wanted to learn about the placenta, the entirely new organ that my body was growing—the one that was making it possible for me to nourish and sustain my daughter with just my blood. I wanted to know what causes one pregnancy to make it to term and what causes one to end prematurely. I wanted to understand why the onset of labor and the course of birth, which happens to thousands of people every day, is so painful and unpredictable. These things seemed like pretty basic stuff.

There is plenty of useful information out there, but there is just as much targeted content and marketing material that influences not just how we feel about pregnancy but how we feel about ourselves. So many sources instruct us on what we ought to do—and how: how to arrange our priorities, how to move and what to eat, how to think about emotional fulfillment.

In pregnancy, I thought a lot about the women who came before me. My own mother willingly endured three C-sections. She didn’t use any pregnancy books, didn’t have the Internet, and never lost hours of her life down the rabbit hole of BabyCenter forums. She loved my brothers and me fiercely but didn’t know a thing about the term “attachment parenting.” I thought of Lola Lily, my maternal grandmother, who lost two babies and birthed nine others in the Philippines and never had a single ultrasound. She was a professor of chemistry, an avid ballroom dancer, and a charmingly vain woman. It wasn’t hard to picture the horrified expression that would come across her face if I mentioned taking a break from dyeing my gray hair for fear of the (possible) negative effects on my fetus.

Many of us, without thinking, will pick up our phone to Google something before we use it to call our own mothers or friends. We’ve been trained to discount informal experience in favor of more official, definitive resources—even when the origins of these things are dubious or unclear. Advice and information now comes less often from average people who are giving birth and rearing children and more often from medical professionals, online influencers, and so-called experts.

* * *

Women have always grown, birthed, and raised babies with the benefit of knowledge passed down through generations of other women. For centuries, in every culture around the world, midwives guided birth. They were mothers, grandmothers, aunts, and neighbors—older women who had no formal training other than decades of firsthand knowledge and experience. They advised laboring women on when to move, rest, or push, offered physical and herbal comfort, delivered babies, and tended to mothers and newborns in the days and weeks after birth. They understood pregnancy and birth as significant but normal events in the lives of women, not illnesses or conditions that needed to be treated.

But in late nineteenth- and early twentieth-century America, against the backdrop of a rapidly industrializing and increasingly wealthy nation, a new expert—the doctor—came to be the indispensable authority on these topics. In his 1894 book The Care and Feeding of Children, Dr. Luther Emmett Holt advised against relying on women’s wisdom and experience, warning that “instinct and maternal love are too often assumed to be a sufficient guide for a mother.”2 His words paved the way for physicians to set the rules mothers would be expected to follow.

The 1910 publication of Medical Education in the United States and Canada by Abraham Flexner, a review of medical schools across the country commissioned by the Carnegie Foundation, led to millions of dollars in funding for schools such as Harvard, which enrolled mostly upper-class white male students. This money came from the charitable foundations of wealthy industrial families such as the Carnegies and Rockefellers. With considerably less resources, most smaller schools, including medical schools that enrolled black and female students, were unable to compete and were forced to close.3 Medicine moved from a healing art practiced by various types of people in different classes to a profession requiring eight years of expensive training.

At the time, nearly half of all babies born in America were delivered by midwives, most of them working-class immigrants and black women.4 This figure was deemed unacceptable by members of the emerging gynecological and obstetrical community. In 1912, J. Whitridge Williams, a professor of obstetrics at Johns Hopkins University, set out to promote his formally educated peers over lay midwives. For his report “Medical Education and the Midwife Problem in the United States,” Williams surveyed the faculties at 120 m...