Thanks for the shout-out Molly. And ditto Nancy, I'm a fan of your work too, and it's so meaningful to have our books part of the same conversation!
This piece made me think about how important it is to look at the connections between zero acceptable risk to the baby --> fetal personhood laws ---> restrictions on abortion is super important. Doing so shows that in yet another way how constraints on bodily autonomy in one area of reproductive care (ie, abortion) also show up in other areas (ie, mothers who want to see their pregnancies to term, but want to balance risk to the baby with risk to themselves).
The first line of this piece stopped me dead in my reading tracks…I gave birth on March 10 and the nurse in L&D triage asked me what my main goal was for my delivery as part of the registration questionnaire she had to run through. The question stumped me partly because I’d never had to answer registration questions before as I have precipitous births and I barely make it to the hospital to begin with, but also because I was in the middle of contractions and I’d never really given Much thought to the question. My initial response was that I wanted to have an easy, smooth, natural, unmedicated delivery. But then a second later I (subconsciously) realized I’d said the wrong thing and amended my answer to “I just want a healthy baby”. Until reading this, I didn’t realize what I had just done. I started by giving my wishes for me. Then, after the nurse kind of looked at me funny, I realized that’s not the “right” answer. Crazy how culturally ingrained this is.
Thanks so much for including my book in this piece, Molly! (And I'm such a fan of Rachel's work, so I'm excited to see that conversation, too.)
There's *so much* to say about everything you write above, but for now, about the cover--yes, I love the way her head is a little cut off! In the earliest version of the cover, the woman and her child were in the bottom right and it wasn't working, and when the designer made them bigger and repositioned, it was like, boom, yes!
Loved this article! I thought about this a lot when it came to nursing my baby. I had an extremely traumatic emergency c-section that resulted in my baby coding and me being completely knocked out because I could actually feel the knife slicing through my skin (my nurse anesthetist fucked up). I remember being wheeled into the c section, shaking and puking my guts out because of the bad medication concoction, and thinking, dear god let this child be alright and then please put me out of my misery. From the time I woke up from that c section, in so much pain and so exhausted from the 24 hours of labor that preceded it, I had extreme post partum anxiety that went completely unrecognized and untreated for nine months. I almost never slept because I had trouble nursing so I pumped instead and would check on my child constantly to ensure that he was breathing. I realized after only a month of pumping while recovering from the c-section that I just could not survive the lack of sleep any longer. I bottle fed my baby from that point forward, which allowed my husband to share much of the nighttime burden of feeding the baby. I still didn’t get nearly enough sleep because of my anxiety, but at least it was manageable.
It was such a hard first year — on me, my marriage (my rage was crazy high), and my child I’m sure. I know I wasn’t always emotionally all there for him.
I get so mad thinking about how the advice for mothers is to try to nurse when it was just absolutely not the best option for my body or my health. It just can’t be for so many women who struggle with post partum mental health issues or traumatic deliveries. I mean seriously, it is standard practice to be woken up by nurses mere hours after having our stomachs ripped open to feed our babies. It feels like you’re being tortured. And then you feel guilty for not liking it.
With my second child, I (together with my good husband) prioritized my sleep and mental health from the very beginning over nursing and it was night and day a better experience for the whole family.
I don’t feel guilty any more. I gave my babies my whole freaking body and mind. They can drink some store-bought formula.
"I don’t feel guilty any more. I gave my babies my whole freaking body and mind. They can drink some store-bought formula." -- Yes to this, Ashley!
Thank you for sharing this. Such a great example and I love where you landed in the end after going through so much with your first.
This is a part of the discussion that I had with Devika Bhushan (coming up next week), the "advice for mothers is to try to nurse when it was just absolutely not the best option for my body or my health."
I watched a 1940’s movie with Shirley Temple a few nights ago “The Bluebird of Happiness” - and the link to your researchers statement about the candy and the wrapper was in a scene in the movie. Where souls are coming from the “holding playground “ get on the stork ship all happy. What struck me was the mothers only sang joy when the baby arrived! And no fathers included at all. That hasn’t been my experience in the love of life and the coming of a wanted child. Wow. We really have to let go of a lot of back wash about what it means to be human. Thanks for this article. I needed it today
So what is a good replacement for the harmful "all I want is a healthy baby"? "All I want is a healthy mother and baby"? Feels like a stupid question, but it isn't obvious to me.
I think the replacement is leaving room for nuance.
It's the word "all" that is especially problematic. Then add in the context of "healthy" and "baby" and it makes the priorities hyper-focused when they don't really need to be. We can want a healthy baby AND a positive birth experience. We can want our own health and emotions supported, even in high risk situations.
We can weigh the risk to the baby relative to the health and happiness of the mother. If an intervention reduces a 0.05% risk by half, but has a 40% risk to harm the mother's mental and physical health, one has to wonder if it's worth it. But if it's a 10% risk to life and limb for the baby, and 10% risk to the mother, then yes, do it. It's all about the numbers. We need to get honest about what they are. We can't do zero risk. That's just not how life works.
I wish I had said when I was pregnant, "I just want my whole family to be healthy and happy" (which includes myself but still doesn't raise any alarm bells for those insistent on maternal martyrdom)
I think about all of this all the time! I'm writing about sacrifice and women's bodies this week too, and thank you thank you to both of you for doing the research on this. It feels like it's never been more important!
Yes you can!!! Can is the power! We know it’s there and we are choosing to focus on what we want to create- you are doing it Molly !! (Ps that’s a line from a Ziggy Marley song)
I wish I had encountered this idea before, that "zero risk to baby" in literally every arena is an unattainable goal. The impossible expectations for mothers start pre-pregnancy! UGH. Thank you for doing this work.
All of these statistics blow my mind. I did so much reading about pregnancy and postpartum but I can see now it was mostly tailored around protecting and supporting baby rather than asking me what I needed/wanted (not that it’s a binary). I barely even blinked at the risks, even having a retained placenta that was found at 7 weeks pp (I called at 5 weeks saying I was bleeding quite a bit, the response “it’s uncommon for a breastfeeding mother but maybe you just got your period back.”). I didn’t even stop to process because all I was focused one was how quickly I could get back to breastfeeding after surgery. It’s honestly just washing over me now, 5.5 years later.
Your note made me think about how, when I was a couple days postpartum, I collapsed on the kitchen floor and my husband had to remind me that I was also "a patient" and that I needed to let him take care of me. I lost a lot of blood during the birth (probably should have gotten a transfusion) but there I was two days later, trying to do all the things around the house *for the baby*. Not a single medical professional, at any point reminded me that I was also a patient and I also needed special care and rest after the huge medical feat that was a complicated birth.
That must have been so alarming. In all the ways--collapsing, realizing that disconnect, and also the limitations in the support that actually allow us to be treated as patients alongside our babies.
Your post has stimulated me to write about my experience. <3
This piece is going live on Monday. I will be tagging you and your newsletter, but I reference you multiple times. Do you prefer to be referred to as Molly, Dr. Dickens, or Molly Dickens, PhD throughout? I noticed in your recent interview it was Molly so I just wanted to check.
You report infant mortality rate, which is how many babies die after being born, and it doesn't involve deaths that occur after viability in utero or during labor, while I was referring to the latter being about 1/1000. Anyway you seem to agree that not less than 1/1000 live births end in the baby dying, while maternal mortality in the highest mortality group is 50/100.000 live births (that is 0.5/1000, so less than half). If you have read any study regarding mortality in maternity wards in low risk women you'll find that almost all studies involve some (previously healthy, normal weight, term) babies dying, while no mother dies in labor neither of preeclampsia, nor hemorrhage, nor infection etc.
This doesn't invalidate your point as I said, and surely causes of death must be taken into account, it's true that babies die of natural causes while mothers often die of preventable causes, but this furtherly strengthens the point against society and confirms that naturally childbirth is much more dangerous for the baby than for the mother.
Then, it's true that a mother's body is straining in order to build and give life, but it's also true that pregnancies are a kind of eu-stress which has long term benefits: it's true that if you don't take in enough calcium your body will take it from your bones but it is also true that after childbirth, breastfeeding and then weaning mom's skeleton is going to return to its normal bone density or even to improve. The same is true about aging biomarkers, as was stated in a study that was popular on social media last year. The same is true about breast cancer risk, which is increased during pregnancy and for some time after, but then sinks to be much lower than the risk for women who never had babies, especially if mothers have nursed and/or had their kids young (the relationship between pregnancy, breastfeeding, age and breast cancer is very complex and fascinating).
Again, we do matter and nature didn't think of us as disposable rubbish 😉
Ok, I'm following now. Your points are spot on. Thank you!
Putting aside the "body's prioritization" argument...
This point -- "babies die of natural causes while mothers often die of preventable causes, but this further strengthens the point against society and confirms that naturally childbirth is much more dangerous for the baby than for the mother." -- actually feels like the crux of the risk:risk issue. When we go into birth with the expectation that childbirth is naturally more dangerous for the baby (and you have to admit it is still a very very very very low chance of infant death during delivery), are we just setting more women up for the preventable causes of death during and after? And short- and long-term illness (e.g. mental health issues)?
I agree with most of what you state here, but it should be noted that both historically and at the moment more babies die during childbirth than mothers. It's true that evolution doesn't necessarily need the mother to survive, but a surviving mother could lose one baby and then have another 10 babies, while one live baby is just one live baby. This should not excuse the zero risk tolerance for babies (also it's not possible to achieve it), but for intellectual honesty purposes it should be noted that birth is far more dangerous for the baby. During pregnancy too, when the mother is critically ill or has a serious accident etc it's much more likely for her to lose the baby than to lose her life.
Late stillbirths (not including first trimester miscarriages) are over 1 out of 1000 pregnancies: maternal deaths are much lower than 1/1000 deliveries. So, nature has of course some way to protect babies and indeed pregnancy is riskier than non-pregnancy for a woman, but nature usually chooses mothers over their babies.
It's just society that has decided that a woman is a wrapper and a baby is a candy, not nature itself
I'm not sure of the exact childbirth survival rates (if you have that, please share!) but looking it up quickly, the last reported infant mortality rate in the U.S. (2022) was 5.6 deaths per 1,000 live births, with the leading causes as 1) Birth defects; 2) Preterm birth and low birth weight; 3) Sudden infant death syndrome 4) Unintentional injuries (e.g., car crashes) and then 5) maternal pregnancy complications.
Not only is the maternal mortality rate higher than the infant mortality rate but the leading cause of maternal death is actually suicide. To me, this reflects where the stress inflicted on the mother as a way of decreasing the risk of death/injury/negative outcomes for the baby before/during/after birth could play a role. Not proven, of course. So, you are right, the evidence is not there.
Yes, my commentary on evolution might have been a bit cheekier than necessary. I was more considering how physiologically, the pregnant body really tests the limits in the interest of growing and birthing a new human. E.g. if the maternal body doesn't ingest enough calcium, the body will start stripping it from the bones; blood pressure and heart rate changes reflect diversion of blood for baby; changes in insulin sensitivity reflect making glucose available for the baby.
I was not referring to the extreme of critical illness or serious accident but that is a good call out. Interestingly, I think there is something about how spontaneous abortion/preterm birth in cases of extreme illness reflects the adaptation that its better to take a chance on the outside than stay inside an ill/fevered mom's body? I'm not terribly familiar with that research but I feel like I read it somewhere...
Thanks for the shout-out Molly. And ditto Nancy, I'm a fan of your work too, and it's so meaningful to have our books part of the same conversation!
This piece made me think about how important it is to look at the connections between zero acceptable risk to the baby --> fetal personhood laws ---> restrictions on abortion is super important. Doing so shows that in yet another way how constraints on bodily autonomy in one area of reproductive care (ie, abortion) also show up in other areas (ie, mothers who want to see their pregnancies to term, but want to balance risk to the baby with risk to themselves).
YES! Wrote about this a little bit here -- https://maternalstressproject.substack.com/p/the-psychological-assault-of-a-post -- but it definitely deserves more attention.
This absolutely shows up in forced birth and how limiting access to reproductive care closes the door to options that factor in maternal risk.
Also the fact that "personhood" refers to a ball of cells but NOT THE HUMAN CARRYING THAT BALL OF CELLS 🤔
Yes to all of this!
The first line of this piece stopped me dead in my reading tracks…I gave birth on March 10 and the nurse in L&D triage asked me what my main goal was for my delivery as part of the registration questionnaire she had to run through. The question stumped me partly because I’d never had to answer registration questions before as I have precipitous births and I barely make it to the hospital to begin with, but also because I was in the middle of contractions and I’d never really given Much thought to the question. My initial response was that I wanted to have an easy, smooth, natural, unmedicated delivery. But then a second later I (subconsciously) realized I’d said the wrong thing and amended my answer to “I just want a healthy baby”. Until reading this, I didn’t realize what I had just done. I started by giving my wishes for me. Then, after the nurse kind of looked at me funny, I realized that’s not the “right” answer. Crazy how culturally ingrained this is.
Oh wow. Thank you for sharing this, Ashley! It is truly amazing how ingrained what this is. For you and the nurse.
Why have a question like this on the registration questionnaire if there is only one "right answer"? It's a trap!
Thanks so much for including my book in this piece, Molly! (And I'm such a fan of Rachel's work, so I'm excited to see that conversation, too.)
There's *so much* to say about everything you write above, but for now, about the cover--yes, I love the way her head is a little cut off! In the earliest version of the cover, the woman and her child were in the bottom right and it wasn't working, and when the designer made them bigger and repositioned, it was like, boom, yes!
the cover is SO GOOD.
Loved this article! I thought about this a lot when it came to nursing my baby. I had an extremely traumatic emergency c-section that resulted in my baby coding and me being completely knocked out because I could actually feel the knife slicing through my skin (my nurse anesthetist fucked up). I remember being wheeled into the c section, shaking and puking my guts out because of the bad medication concoction, and thinking, dear god let this child be alright and then please put me out of my misery. From the time I woke up from that c section, in so much pain and so exhausted from the 24 hours of labor that preceded it, I had extreme post partum anxiety that went completely unrecognized and untreated for nine months. I almost never slept because I had trouble nursing so I pumped instead and would check on my child constantly to ensure that he was breathing. I realized after only a month of pumping while recovering from the c-section that I just could not survive the lack of sleep any longer. I bottle fed my baby from that point forward, which allowed my husband to share much of the nighttime burden of feeding the baby. I still didn’t get nearly enough sleep because of my anxiety, but at least it was manageable.
It was such a hard first year — on me, my marriage (my rage was crazy high), and my child I’m sure. I know I wasn’t always emotionally all there for him.
I get so mad thinking about how the advice for mothers is to try to nurse when it was just absolutely not the best option for my body or my health. It just can’t be for so many women who struggle with post partum mental health issues or traumatic deliveries. I mean seriously, it is standard practice to be woken up by nurses mere hours after having our stomachs ripped open to feed our babies. It feels like you’re being tortured. And then you feel guilty for not liking it.
With my second child, I (together with my good husband) prioritized my sleep and mental health from the very beginning over nursing and it was night and day a better experience for the whole family.
I don’t feel guilty any more. I gave my babies my whole freaking body and mind. They can drink some store-bought formula.
"I don’t feel guilty any more. I gave my babies my whole freaking body and mind. They can drink some store-bought formula." -- Yes to this, Ashley!
Thank you for sharing this. Such a great example and I love where you landed in the end after going through so much with your first.
This is a part of the discussion that I had with Devika Bhushan (coming up next week), the "advice for mothers is to try to nurse when it was just absolutely not the best option for my body or my health."
It is absolutely maddening.
I look forward to following that discussion with Devika!
I watched a 1940’s movie with Shirley Temple a few nights ago “The Bluebird of Happiness” - and the link to your researchers statement about the candy and the wrapper was in a scene in the movie. Where souls are coming from the “holding playground “ get on the stork ship all happy. What struck me was the mothers only sang joy when the baby arrived! And no fathers included at all. That hasn’t been my experience in the love of life and the coming of a wanted child. Wow. We really have to let go of a lot of back wash about what it means to be human. Thanks for this article. I needed it today
We certainly do have a lot to let go of!
So what is a good replacement for the harmful "all I want is a healthy baby"? "All I want is a healthy mother and baby"? Feels like a stupid question, but it isn't obvious to me.
Not a stupid question at all!
I think the replacement is leaving room for nuance.
It's the word "all" that is especially problematic. Then add in the context of "healthy" and "baby" and it makes the priorities hyper-focused when they don't really need to be. We can want a healthy baby AND a positive birth experience. We can want our own health and emotions supported, even in high risk situations.
We can weigh the risk to the baby relative to the health and happiness of the mother. If an intervention reduces a 0.05% risk by half, but has a 40% risk to harm the mother's mental and physical health, one has to wonder if it's worth it. But if it's a 10% risk to life and limb for the baby, and 10% risk to the mother, then yes, do it. It's all about the numbers. We need to get honest about what they are. We can't do zero risk. That's just not how life works.
That's the math. Zero risk is not how life works!
I wish I had said when I was pregnant, "I just want my whole family to be healthy and happy" (which includes myself but still doesn't raise any alarm bells for those insistent on maternal martyrdom)
I think about all of this all the time! I'm writing about sacrifice and women's bodies this week too, and thank you thank you to both of you for doing the research on this. It feels like it's never been more important!
Getting that feeling too (clearly 😄).
Glad to be in this fight with you, Lane!
The “candy wrapper” metaphor feels too apt—and getting more so all the time.
“I have tried to avoid writing about current affairs in this country but the shit just KEEPS COMING.” Keep that shit off your mind Molly!!
ha! I can't I can't!
Yes you can!!! Can is the power! We know it’s there and we are choosing to focus on what we want to create- you are doing it Molly !! (Ps that’s a line from a Ziggy Marley song)
Great insights, Molly!
I wish I had encountered this idea before, that "zero risk to baby" in literally every arena is an unattainable goal. The impossible expectations for mothers start pre-pregnancy! UGH. Thank you for doing this work.
Thank you, Madeline! It permeates everything!
All of these statistics blow my mind. I did so much reading about pregnancy and postpartum but I can see now it was mostly tailored around protecting and supporting baby rather than asking me what I needed/wanted (not that it’s a binary). I barely even blinked at the risks, even having a retained placenta that was found at 7 weeks pp (I called at 5 weeks saying I was bleeding quite a bit, the response “it’s uncommon for a breastfeeding mother but maybe you just got your period back.”). I didn’t even stop to process because all I was focused one was how quickly I could get back to breastfeeding after surgery. It’s honestly just washing over me now, 5.5 years later.
Amazing, right?
Your note made me think about how, when I was a couple days postpartum, I collapsed on the kitchen floor and my husband had to remind me that I was also "a patient" and that I needed to let him take care of me. I lost a lot of blood during the birth (probably should have gotten a transfusion) but there I was two days later, trying to do all the things around the house *for the baby*. Not a single medical professional, at any point reminded me that I was also a patient and I also needed special care and rest after the huge medical feat that was a complicated birth.
That must have been so alarming. In all the ways--collapsing, realizing that disconnect, and also the limitations in the support that actually allow us to be treated as patients alongside our babies.
Your post has stimulated me to write about my experience. <3
oooh, do it! And then share it with me please ❤️
This piece is going live on Monday. I will be tagging you and your newsletter, but I reference you multiple times. Do you prefer to be referred to as Molly, Dr. Dickens, or Molly Dickens, PhD throughout? I noticed in your recent interview it was Molly so I just wanted to check.
awesome! You can reference me as Molly throughout :)
Thank you!
You report infant mortality rate, which is how many babies die after being born, and it doesn't involve deaths that occur after viability in utero or during labor, while I was referring to the latter being about 1/1000. Anyway you seem to agree that not less than 1/1000 live births end in the baby dying, while maternal mortality in the highest mortality group is 50/100.000 live births (that is 0.5/1000, so less than half). If you have read any study regarding mortality in maternity wards in low risk women you'll find that almost all studies involve some (previously healthy, normal weight, term) babies dying, while no mother dies in labor neither of preeclampsia, nor hemorrhage, nor infection etc.
This doesn't invalidate your point as I said, and surely causes of death must be taken into account, it's true that babies die of natural causes while mothers often die of preventable causes, but this furtherly strengthens the point against society and confirms that naturally childbirth is much more dangerous for the baby than for the mother.
Then, it's true that a mother's body is straining in order to build and give life, but it's also true that pregnancies are a kind of eu-stress which has long term benefits: it's true that if you don't take in enough calcium your body will take it from your bones but it is also true that after childbirth, breastfeeding and then weaning mom's skeleton is going to return to its normal bone density or even to improve. The same is true about aging biomarkers, as was stated in a study that was popular on social media last year. The same is true about breast cancer risk, which is increased during pregnancy and for some time after, but then sinks to be much lower than the risk for women who never had babies, especially if mothers have nursed and/or had their kids young (the relationship between pregnancy, breastfeeding, age and breast cancer is very complex and fascinating).
Again, we do matter and nature didn't think of us as disposable rubbish 😉
Some references:
- about mortality rates, an example stating about 0.5/1000 low risk babies die during or immediately after labor while no mother dies: https://pmc.ncbi.nlm.nih.gov/articles/PMC2742137/
https://www.ncbi.nlm.nih.gov/sites/books/NBK555483/ this is another where perinatal mortality is stated while maternal deaths didn't occur
- about osteoporosis: https://pmc.ncbi.nlm.nih.gov/articles/PMC4266784/
- about breast cancer: https://pubmed.ncbi.nlm.nih.gov/32816282/
- about aging biomarkers: https://www.statnews.com/2024/03/22/women-health-pregnancy-aging-research-bmi-breastfeeding/#:~:text=%E2%80%9CIn%20a%20period%20of%20approximately,the%20Yale%20School%20of%20Medicine. (I know it's not from PubMed but I couldn't find the original study)
Ok, I'm following now. Your points are spot on. Thank you!
Putting aside the "body's prioritization" argument...
This point -- "babies die of natural causes while mothers often die of preventable causes, but this further strengthens the point against society and confirms that naturally childbirth is much more dangerous for the baby than for the mother." -- actually feels like the crux of the risk:risk issue. When we go into birth with the expectation that childbirth is naturally more dangerous for the baby (and you have to admit it is still a very very very very low chance of infant death during delivery), are we just setting more women up for the preventable causes of death during and after? And short- and long-term illness (e.g. mental health issues)?
I agree with most of what you state here, but it should be noted that both historically and at the moment more babies die during childbirth than mothers. It's true that evolution doesn't necessarily need the mother to survive, but a surviving mother could lose one baby and then have another 10 babies, while one live baby is just one live baby. This should not excuse the zero risk tolerance for babies (also it's not possible to achieve it), but for intellectual honesty purposes it should be noted that birth is far more dangerous for the baby. During pregnancy too, when the mother is critically ill or has a serious accident etc it's much more likely for her to lose the baby than to lose her life.
Late stillbirths (not including first trimester miscarriages) are over 1 out of 1000 pregnancies: maternal deaths are much lower than 1/1000 deliveries. So, nature has of course some way to protect babies and indeed pregnancy is riskier than non-pregnancy for a woman, but nature usually chooses mothers over their babies.
It's just society that has decided that a woman is a wrapper and a baby is a candy, not nature itself
I appreciate this, Erika.
I'm not sure of the exact childbirth survival rates (if you have that, please share!) but looking it up quickly, the last reported infant mortality rate in the U.S. (2022) was 5.6 deaths per 1,000 live births, with the leading causes as 1) Birth defects; 2) Preterm birth and low birth weight; 3) Sudden infant death syndrome 4) Unintentional injuries (e.g., car crashes) and then 5) maternal pregnancy complications.
Not only is the maternal mortality rate higher than the infant mortality rate but the leading cause of maternal death is actually suicide. To me, this reflects where the stress inflicted on the mother as a way of decreasing the risk of death/injury/negative outcomes for the baby before/during/after birth could play a role. Not proven, of course. So, you are right, the evidence is not there.
Yes, my commentary on evolution might have been a bit cheekier than necessary. I was more considering how physiologically, the pregnant body really tests the limits in the interest of growing and birthing a new human. E.g. if the maternal body doesn't ingest enough calcium, the body will start stripping it from the bones; blood pressure and heart rate changes reflect diversion of blood for baby; changes in insulin sensitivity reflect making glucose available for the baby.
I was not referring to the extreme of critical illness or serious accident but that is a good call out. Interestingly, I think there is something about how spontaneous abortion/preterm birth in cases of extreme illness reflects the adaptation that its better to take a chance on the outside than stay inside an ill/fevered mom's body? I'm not terribly familiar with that research but I feel like I read it somewhere...