There are two times you are completely alone - when you are pregnant and when you die
- Minnie's story in Misconceptions
Insensitive treatment in a fertility clinic, eventual conception on giving up fertility treatment, and gradual relaxation into self-acceptance. Then a traumatic birth, the agony - the torture! - of contractions. Eventually, in terror, choosing an epidural, which led to a cascade of the usual medical consequences: stalled labour, distressed foetus, oxytocin drip and forceps delivery - at the time a relief after coming within a whisker of a Caesarean.
After all that came a terrifying fever as the result of a birth-related infection that lasted for months (epidural anaesthetic carries a 400 per cent increased risk that the mother will need antibiotics). There was the public health nurse saying "I can't believe they let you home from hospital with a baby that small" and handing me a bottle. Why was I persisting in breast-feeding, she wanted to know, couldn't I see my baby was hungry? What followed, as I persisted in breast-feeding, were months of colicky cries, loneliness, the forced march of exhaustion, fear that I'd never be a super-mum coping with baby and career.
Broken sleep, then an intruder breaking into the house - within inches of me and the baby - at 2 a.m. Waking in a panic for months.
The paediatrician saying, about my baby's small size, "You smoked, didn't you?", when I hadn't touched a cigarette in seven years and had spent the entire pregnancy eating as recommended by the sunny birth guide, What to Expect When You're Expecting. Then the unexpected, when you are no longer expecting, but surviving: the slow slide into a depression that went undiagnosed.
That was my experience, and nothing had prepared me for it. I felt like a failure. I took steps towards redemption with two subsequent births, both natural and - amazingly - energising at Mount Carmel Hospital, Dublin, with supportive midwives and an understanding obstetric gynaecologist who offered me respect. I finally understood the almost orgasmic high Sheila Kitzinger writes about - but I know I was lucky to experience it.
I have also been redeemed, a little more, by reading Naomi Wolf's stunning new book about pregnancy and childbirth, Misconceptions: Truth, Lies and the Unexpected on the Journey to Motherhood. She had expected to give birth in an alternative birthing centre with a mahogany bed and chintz curtains at the windows. What she got were misleading answers to her intelligent questions from a system that pretended to be "alternative" but was actually staunchly traditional. As she was swept down a hall to a clinical environment, she realised that the hospital's promises of natural birth had been nothing but an "advertorial".
The breathing lessons she'd taken in her hospital-sponsored pre-birth classes were useless. In panic, she accepted an epidural anaesthetic which resulted in foetal distress and a traumatic Caesarean birth, following which she was too exhausted and disorientated by drugs to bond with her baby. Later, she succumbed to post-natal depression. The only reassuring thing about Wolf's latest book is that if all this can happen to her - a forthright, intelligent, inquiring, assertive, feminist, Al Gore-advising darling of the literati - then we are certainly not to blame if it happens to us.
Wolf's memory of her first birth is of being delirious, drugged and pinned. She was shivering with cold and in shock from seeing what she was not meant to see: "Seven men and women, in plastic goggles and pale green cotton suits, are working. Their gloves are bathed up to the elbow, and their busy instruments are messy, with streaks of bright red. The locus of their full attention is down where my stomach should be. No one notices that I see what their hands are dipped in: my centre, an open cauldron of blood."
Wolf, despite her feminism and education, felt this treatment meant she had failed in some way. Her idea of what birth should be made her highly critical of the medicalised, intervention-focused birth system. She felt the system was wrong, but in New York there was no alternative such as there is in Holland and Denmark, where independent midwife centres support birth, where one-third of babies are born at home and where maternal and neo-natal mortality rates are lower and percentages of normal births higher.
Wolf, like many of us, would like to see a middle way where the minority of mothers and babies who need high-tech intervention get it, but where the majority who do not need such interventions are not forced into them because it suits maternity hospitals. She's not arguing for an idealised version of natural childbirth, but for a more honest approach where women at least have a chance of natural childbirth. Wolf believes that women have been misinformed by medical professionals who imply that unless they avail of the full range of possible interventions, they are putting their babies' lives and health at risk.
On her second birth, despite knowing what she knew, Wolf surrendered once again to a loss of control. She would ultimately have another Caesarean because, her highly recommended doctor told her, her birth canal was too narrow. A midwife later measured it and told her it was normal - but Wolf had been given no choice in a medical culture which has protection against lawsuits as its priority.
Turning her experience into a book is Wolf's career choice, and a good one. Undertaking research into childbirth practices, she learned that women are not being told the true risks of epidural anaesthesia, that they are being given unnecessary episiotomies, and that "emergency" Caesareans as often as not protect doctors rather than babies.
The US system that Wolf writes about is not so different from the Irish one, as articles by Marie O'Connor in The Irish Times have recently shown. The US ranks 18th in the developed world in maternal and neo-natal mortality rates; the Republic rates 17th. Episiotomy rates here are high, epidurals are routine and, while we don't yet have the huge Caesarean rates of the US (between 30 and 50 per cent), we're getting there.
Birth, as we know it, is the end of women's autonomy, as Wolf learned only after she had sacrificed her youth and freedom to motherhood. Independent women find themselves stymied by an intimidating medical hierarchy, by the dependency of their babies and by a social system that refuses to support them. Yet there is a cultural taboo about complaining.
"Not only are we inadequately informed about what pregnancy, birth and new motherhood really involve, we also lack the freedom to describe what we have seen for ourselves along the way. For complex cultural and personal reasons we are expected to keep the full range of our feelings and discoveries to ourselves," writes Wolf.
"Why didn't anyone tell me?" she wanted to know, after her experience of the maternity ward. Then a friend said: "When at the end of The Wizard of Oz, Dorothy asks 'Why didn't you tell me?', Glinda the Good Witch replies, 'Because you wouldn't have believed me'."
Wolf writes: "Midwives today passionately believe that birth has become too pathologised, and that obstetricians justify a high degree of medical interventions in part because they see almost all circumstances of birth as pathological. Midwives object to classifying all births as 'low risk' or 'high risk', for example - a categorising system that does little to help women think of birth as 'part of the wellness cycle', as midwives say, and something they can manage with confidence."
Misconceptions is not reassuring, but then, Wolf believes, "what is most distressing is not the prospect of a woman hearing about some of the tougher aspects of labour and delivery honestly told, but, rather, the psychic cost on mothers-to-be of literature that is determined to focus on happy talk and sentimentality".
New motherhood is not a state of natural bliss for most women. When our experience is at odds with the pink-hazed ideal, when there are no "fresh hands" to hand the baby to, when our partners go to work dressed in Hugo Boss while we stay at home in baby-stained tracksuits, when our sex lives disappear, we tend to become depressed, Wolf writes.
Feminism, as anything more than a political stance, will have had an influence on society the day that we make birth a joyful experience over which women have some control. The day that society supports parents - whether they be new mothers or fathers of four - will be the day that feminism, in the sense that it values the role of nurturers, will become real.
New developments in assisted conception and fertility treatment have taken women down a disturbing route, Wolf writes. The pro-choice movement has been central to the feminist agenda, which has given approval to doctors who screen babies for congenital abnormalities and to fertility doctors who practice selective abortion. Wolf found that pregnancy made her challenge her beliefs and wonder if these doctors are going too far.
After she saw her own baby at three months' gestation, looking like a wise alien in her womb, she realised that she could never abort the child. So when she had a blood test which showed her foetus was at risk of spina bifida, she refused amniocentesis, a test which would have told her for certain whether her baby was affected.
Fertility treatment is creating other harrowing dilemmas for women. For example, selective abortion is used by doctors in the US who implant more fertilised eggs than a woman's body can possibly nurture. If more than two of these embryos implant, doctors may then encourage women to abort the remaining foetuses. Yet feminists who would once have been pro-choice have found themselves paralysed by indecision faced with the real-life choices thrown up by assisted conception.
Wolf had a friend who conceived in vitro and was pregnant with triplets. The friend was given the choice of selectively aborting one of the foetuses and giving birth to twins, or having a slighter chance of giving birth to three healthy babies. Her friend, in the company of Wolf, decided to place her babies' fate in God's hands. She decided against selective abortion, then eventually lost all three babies.
Wolf asserts that she is still pro-choice, but she asks whether a woman really has autonomy over her "independent" body. After all, when a woman's body contains two lives, is it really autonomous any more? Of all the issues raised in Wolf's book, this is the most compelling: here is a pro-choice feminist questioning the main plank of traditional feminism. Real feminism, she seems to conclude, is about having choices and being supported in those choices. Today, Wolf is a mother of two, working from home, with a wealthy husband and a house in the country - that is as feminist as she's going to get, for the moment.
The stubborn refusal of the medical Θlite to acknowledge women's birth needs is one sign that feminism hasn't worked. While she doesn't say it, you can hear Wolf's discomfort that, as a feminist, she thought the right to terminate a life gave women power. No, she says, it does not. We have to start again and fight the battles that are really worth fighting, beginning with birth, parenting and the family. Otherwise Wolf's daughter - and mine - will discover in 10 years' time that there is still no such thing as equality.
Misconceptions: Truth, Lies and the Unexpected on the Journey to Motherhood is published by Chatto & Windus (£12.99 in UK)
Kathryn Holmquist's parenting column resumes in EL on Tuesday