When the journey to motherhood is fraught with danger

By Evelyn Tsitas

The media loves the story of the miracle baby who struggles to survive against the odds of being born premature. However, there is an equal lack of silence on the reasons behind such births. The fact that women's bodies fail – and fail regularly – to ensure a smooth passage to a normal, 40 week birth reflects a deeper issue that puts them at odds with feminist perspectives of health.

On every level, women who have high-risk pregnancies are made to feel like outcasts. As a society, we do not like imperfect people, bodies that fail. This is especially true of women's reproductive success. Women who repeatedly miscarry or only achieve motherhood because of high-tech medical intervention are not celebrated and their stories remain largely untold. The language used by the medical profession highlights this: these women are referred to as “habitual aborters” or have an “incompetent cervix”.

It's not just the media who ignore these imperfect women. Other women ignore them, too. I am not just talking here about the competitive birthers, the women who trade easy labour stories, or even "zero to hero" stories, but the feminists who decry any intervention in pregnancy and birth as a medical conspiracy.

As a feminist, and a woman who had two high-risk pregnancies, it is hard to reconcile this. How can we sustain feminist thinking from outside the mainstream, from the marginal site of high-risk pregnancy? We are not women who can free birth, home birth or even use a birthing centre. Where do women who can only achieve motherhood through invasive medical intervention in pregnancy fit in?

Are these women the pawns of the medical profession? Mere passive bodies that are under biological surveillance? Controlled, voiceless, compliant?

I argue otherwise. My experience and those of the women I interviewed for the high-risk pregnancy book Handle With Care is these women are in fact strong, in control, determined. We have both challenged and confronted the medical profession. We may have had caesareans, we may have been medicalised, we may have had a less than ideal picture postcard experience. But by and large, we have become, in the end, mothers.

Against the odds, is that not a triumph in itself?

Monica Dux, co-author of The Great feminist Denial, writes that there are parallels between Susan Sontag's point about cancer patients in her groundbreaking work Illness as Metaphor, and contemporary attitudes to fertility. "If she'd only started earlier….stuck with IVF…then perhaps she'd have a baby. And then if she doesn't do those things, then who does she have to blame? Only herself." (The Age, 3 Dec, 2009)

The blame game is difficult with high-risk pregnancy. Can you blame people with a pre-existing medical condition such as cystic fibrosis or heart disease? Can you blame women whose cervix fails in pregnancy for no apparent reason? I suggest that though we would like to as a society, we do not. And that is why it is easier to focus on the premature babies who are born as a result of women's bodies failing in pregnancy.

While there are no accurate figures on the actual numbers of high-risk pregnancies in Australia because of discrepancy in categorizing, medical experts believe there are more coming through the system, both in public and private hospitals. In fact a great many pregnancies can be considered high-risk. There are many reasons that women are facing greater complexity in pregnancy. Obesity and diabetes are on the rise. In general women are older in their first pregnancy, with fertility issues and medical conditions such as hypertension more likely.

Yes – society can perhaps blame women who are obese – and also women who have waited "too long" to become pregnant. However, high-risk pregnancies can affect women of any age. Women are likely to be considered high-risk if they have a pre-existing medical condition or have had complications with a previous pregnancy. Examples of complicated pregnancies include medical, surgical or psychiatric problems or fetal complications, such as multiple births, high blood pressure, heart problems, diabetes, kidney disease, epilepsy, bipolar, premature birth, poor fetal growth and blood group incompatibilities.

These are not things you can plan to avoid. The only way of maximizing your chances of a successful outcome if you are high-risk is having top quality medical care and often being bed ridden and on a lot of medication. You are prodded, probed and monitored. Even then, there is no guarantee of coming out of the experience with a live baby in your arms. As for a nine month journey – few high risk women make it that far along. They are the women whose babies fill the Neonatal Intensive Care Unit, or have the low birth weight babies who struggle to breastfeed and establish sleeping patterns.

This poses a conundrum for those of us who are both high-risk and feminist, as who is surveilled, when and for what purposes with the new reproductive technologies are key feminist questions.

As Adele E. Clarke and Virginia L. Olesen, the editors of Revisioning Women, Health and Healing note: feminists have taken up cultural and scientific analyses of women's health with both "vengeance and enthusiasms." They agree that conflicts among feminists about reproductive and other women's health issues have just begun to be examined.

They ask: how can we sustain feminist thinking from multiple standpoints – from outside centres of power, from various marginalised sites, as well as from the hearts of federal bureaucracies?

I suggest that we open up the debate here – and give a voice to high-risk women and their closely monitored pregnancies. Do they see themselves as victims of the medical profession – are they passive but defective vessels? Do they on the other hand feel stigmatized and responsible for their own predicament? Or, despite being medicalised, do they feel somehow empowered that despite the odds, they are on the journey to – or have achieved – motherhood?
It is important to remember that some pregnancies begin normally but problems develop later. Even the fittest, healthiest woman can suddenly discover her pregnancy falls into the high-risk category when she develops a problem. According to the South Australian clinical research program SCOPE, one in five (nineteen per cent) of all first pregnancies encounter major problems in late pregnancy such as pre-eclampsia, spontaneous preterm birth and fetal growth retardation, and these problems are life threatening in three per cent of pregnancies.

Having only achieved motherhood myself thanks to high level medical care in two high-risk pregnancies, I continue to be astounded at how the media chooses to ignore high-risk women's stories. I co-wrote Handle With Care, a book on high-risk pregnancy to give these women – and their partners – a voice. A small independent publisher picked it up, as well as a major book distributor. Mainstream publishers dismissed the book as "not sexy enough". After all, I was told, who wants to read about an "incompetent cervix?"

It is as if high-risk women are an affront to the natural order for somehow daring to strive for what doesn't come naturally. What does it say about a society that celebrates IVF success stories, but ignores the courage of a woman lying flat on her back in a tilted hospital bed for 15 weeks, or the woman with cystic fibrosis juggling her medication so she can have a baby without birth defects?

I would suggest that binaries are not useful. We are not perfect or less than perfect, we are not high-risk or low risk. All journeys to motherhood are full of risk. The human race continues because some have less risk and an easier journey than others, but it also continues because those who have the hardest time also are prepared to endure and to fight and to take charge. They are more determined, and play that journey to motherhood in their heads as well as their wombs.

This is what my motherland blog is about – a social critique of the stories about pregnancy, motherhood and risk in the media.

Join me and my co-author Caroline van de Pol as we offer a different perspective of women's health issues. And please – go to our website and buy the book for someone who needs it – www.preciousfamilies.com




Evelyn Tsitas is a doctorate student at RMIT University, Melbourne, and the co-author of Handle With Care. She has two school age children.

When the journey to motherhood is fraught with danger