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Coming Back From Having A Third Kid, I Didn't Know Where To Start
A Conversation with Allison Yarrow
When my youngest was about five months old, I spent a nerve-wracking, boob-bursting afternoon going from my doctor’s office to the fancier ultrasound clinic two floors down and then finally to the hospital radiology department for an X-ray in an effort to locate the IUD that had been placed in my uterus the month before. I now have this very cool picture of my skeleton and two tiny scars on my abdomen from the surgery necessary to retrieve the rogue device.
As I head into post-childbearing life, I look back on my birth control journey with some measure of regret and a decent dose of anger. I wish I had known more about what hormonal birth control might do to my body beyond preventing pregnancy, because it turns out that the list is long. I wish I had been given good, comprehensive, research-supported information on all of the options by my provider so that, when I inevitably chose a method in spite of the potential drawbacks, I would know that if I felt bad later, I could be reasonably certain about what was causing it. But this is not how care worked for me, or for many of the 1300 women Allison Yarrow surveyed when researching her new book. Birth Control: The Insidious Power of Men Over Motherhood is not just about contraceptives. It’s about pregnancy and birth and (almost nonexistent) postpartum care. It’s about the stories we were told and the stories we ourselves tell about all of these life-altering experiences, and how often those stories are based on bad or incomplete information. This is Allison’s beat, her special skill: shifting the lens and revealing another angle on a story we thought we knew with writing that is compelling and cathartic even as it reveals painful truths. Read on for our conversation about Marcia Clark, defensive birth classes, and the gift of narrative-making.
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Your first book, 90s Bitch, was such an important part of the MeToo reevaluation of the many cultural moments in which we villainized women who were actually victims or just trying to have a job and live in the world in the same, untouched way that men get to. Birth Control feels very much in consonance with all of that in terms of unpacking the stories we were told about our bodies and pregnancy and birth.
Birth Control and 90s Bitch are both at their core books about remedying injustice. And they were, I think, inspired by and fueled by a deep anger that the world is not right. It's not right for us, and it's not right for lots of people. I was never a believer that feminism was going to fix any of this. It's a movement comprised of unique and beautiful and different and diverse perspectives, but it's also a minority movement and to expect it to undo centuries of systems of patriarchy and supremacy...
90s Bitch for me, I mean, really, an agent reached out to me and was like, ‘An editor wants a book about women in the nineties.’ And I was like, ‘That's not a book, that's a topic. What is that?’ So I started digging into it. And it was like, oh, the story of women in the 90s is the story of the way women were treated, and what we had hoped for – the promise of feminism, what we had imagined being an equal human being in the world to be – and then that failed promise through the lens of all of these various figures in sports and politics and culture and literature and Hollywood. All of these stories are different but they're also all the same. It was that a woman decided to be in public, reach for power, and was swiftly attacked. And we see the footprints of that today. I had a four month old baby when I went back to work to write that book and was just only beginning to understand what motherhood even was for myself and in the public sphere. And so there isn't even a ton about motherhood in 90s but I finally started to see how Western culture understood us through Marcia Clark's experience.
I remember that Marcia Clark part so vividly. Just that whole courtroom scene where she has to say, ‘I can’t be here at that time, I have to take care of my kids,’ and everyone's like, how dare you. Like, obviously, she can't do this job if she also has to take care of her kids. And we lived through that and what did that do to us?
Yeah, we were kids witnessing that. I remember that message that somehow leading a professional life and fighting for injustice was in opposition to motherhood or to parenting. And it was sort of a lie that we'd been telling for decades.
And I think I’m still recovering from that. My instinct is to keep kids and work in totally different spheres. That idea that you can't let the public-facing part of your life see the private-facing side, I think it sounds crazy when I'm saying it, and I think this whole newsletter might be an attempt to bridge that gap, but I internalized a lot of lessons from these very public women at an impressionable age.
Right, the hiding. I mean, I definitely have been guilty of that too, of hiding my work from my kids and hiding my kids from my work. And these are parts of me but I'm all one being. And being all of us, being able to be free enough without punishment, to be honest about how we actually spend our time, want to spend our time, shouldn't be a privilege.
We actually met when you were promoting 90s Bitch.
Yes, in St. Louis. Right?
In St. Louis. And I remember it so clearly because, speaking of hiding, I had to bring my baby to the event even though I didn’t want to because it wasn’t a book about babies and I was worried she would be disruptive. But I really wanted to go and, because I had her there, we started talking about kids and you asked me what it was like having three. And in my head I was like, oh, she's thinking about having a third because nobody asks those questions if they’re not thinking about it.
Nobody asks, yeah. I remember asking you that.
Were you thinking about this project, too?
I guess when 90s Bitch came out, oh God, I guess I had a three-year-old and a one-year-old. They were so little. And I knew I was going to write a book about birth, but I kind of thought I was going to write a book about the postpartum experience. I had this residency at TED and the topic I was looking into, and then the residency talk I was going give, was about postpartum, the void of care in the days, weeks, months, and time after birth. I remember doing the interview for the residency and being asked, ‘do you have the childcare to do this?’ The people considering me were so thoughtful, and I was just like, ‘yes, yes, of course I do.’
Do you think they would have asked that of a man? I mean, I guess it’s considerate but would you be interviewing if you couldn't do it?
That’s a good question. I don't know the answer to that question. I was definitely the only person in my cohort with small children and I think it was more of- I was really oversharing about my experience and I didn't take the question as a ‘can you do this?’ I took it more as a, ‘can we support you? How are you being supported here?’
That's much better.
Because in the interview I'm telling them all about how there's no postpartum support and you don't have this and you don't have that. And they're like, ‘Well, wait, do you have the things you need?’ And I was like, ‘Yes, some of them, but also no. No one does.’
Right, it's structural.
So I started an investigation into that world and it was like an onion. I realized it's obviously not just postpartum. And many of my cohort members were like, you’ve got to look at race. I was obviously looking at sexism, but racism obviously figures heavily into why people who give birth don't have what they need. And then just also there was my own gas lighting myself that I had to kind of untangle.
In terms of the birthing stuff?
Yes, in terms of my own birth experiences and the stories I was hearing in my reporting from other people about theirs. I went into birth and I was like, I'm definitely giving birth in a hospital. Why would I go anywhere else? 99% of people go to the hospital. My husband and I took The Bradley Method, which is partner-coached childbirth. It was us and two other couples, eight weeks, three hours each session, so hours and hours thinking about and planning for childbirth. And the class was incredibly defensive. It was like, here are all the things that they want to do to you in the hospital and you don't need any of them really, or it needs to be a conversation. I was very prepared for that. And yet I still was like, well, I'm going to go to this place. I picked this place. I'm going to stick with this care team in this place that I picked when I really shouldn't have, especially when my actual birth happened, which, it was precipitous. I had a baby in two and a half hours. I remember not understanding what was happening but I do remember being like, we said we had to get to the hospital, let's go to the hospital. And I should've just stayed where I was because the baby was coming out of my body.
But it's so hard. You think it’s a potentially life and death situation, and before you do it, you have no idea how your own experience is going to go.
But it's not. It’s not a potentially life and death situation. We are made to do this thing.
Right but that has always been the message. There’s so much fear-mongering around birth that it’s impossible to know what we can or cannot do.
The calculation I had in my head was, if I stay put, we're going to have to call an ambulance. And they're going to swarm in here with their tools and yelling, and they're going to take this baby away from me.
Because everyone tells you that that's the way it works. If you accidentally have a baby at home, you have to call an ambulance. And now that I’ve read your book I can say, well, do you? But so much of this is reprogramming. I love where you describe how we talk about birth as breaking a person — metaphorically in terms of feeling despair during labor and also literally in terms of tearing — and the difference between thinking about birth as breaking and thinking about it as stretching. The idea that we and our bodies are made to stretch to do this thing, to meet this challenge. How we talk about things matters and understanding birth this way requires unpacking thousands of years of storytelling.
Yeah. I mean, it requires that we hear that storytelling and that we tell our stories, and that's not happening.
Most of the stories we tell are of the opposite, how things went awry.
Yeah, how medicine saved us. I mean, it's really complicated, and everyone's experience with this is different but what we know is that, by and large, what's being done to people when they enter the hospital is rooted in tradition and not evidence. And it's often coercive, if not outright abusive. And everyone should have the birth experience they want, but I mean, they have to be able to consent to their own care, and they have to be able to be the expert in their body when they're birthing, and that's not happening. And that means if you go in and you say, ‘listen, I want a C-section, I don't need to have a reason. That's what I want to have. That's what feels the best to me.’ You should have that. And if you want to have a birth in which you don't have these interventions, then you should have those as well. I mean, it's really should be up to choice. I think birth in our society is taboo, and that's why we fear it and why we think we need all the intervention because of this societally created fear. If birth were more normalized, if my own birth was not the first birth I'd ever witnessed- I mean, that's the case for most people. If you ever even witness a birth, it's your own, the first time you witness one or any time.
That's so true, yeah.
And that's crazy. I mean, especially considering historically what we came from, I mean, in early America when Black and indigenous women, midwives, attended all the births, we know from the evidence that they were mostly safe and went pretty well. And they were a tradition that women practiced together. I mean, as a pretty young girl, you were attending labors, you were helping out, and it was just this beautiful coming together. It's inherently powerful. It's inherently the most powerful act that humans are capable of, creating and birthing a person.
Right, you write that reproduction and birth are about power and the balance has shifted almost entirely toward doctors and hospitals and not toward the people who are actually giving birth. I'm a firm believer in the power of storytelling and changing the way we talk about things, but how do you even begin to change that when it's so deeply rooted- there are plenty of well-meaning doctors but this is a systemic problem of hospitals and insurance companies.
It's a systems problem. It's a hospital systems problem. It isn't an individual- I mean, it's individual, we make up systems. But yes, it's when all of the incentives are about moving people through the place, it's about capital. It's about the cost of the labor and delivery room. Whether or not you have surgery in there, it's a room that can be converted to a surgical suite and so your insurer or Medicaid can be billed at a higher rate for that room and that's why they have to put you in that room. And just all of the things that are done. It took me a while to untangle this. You asked earlier about the gaslighting and the untangling that I was doing for myself. I surveyed 1300 women and people who've given birth and asked them all kinds of questions about their experiences, and you hear enough stories about, ‘well, I got in there and I needed the Pitocin. They told me I needed my contractions to be sped up, and then I couldn't tolerate the pain because contractions with Pitocin, with synthetic oxytocin, are way more painful than natural contractions. And then I needed to have the epidural. And then once I had that, I couldn't feel what I was doing.’
It's a snowball effect.
‘And so I couldn't push. And then it was dinner time, or I was taking too long or something, and so they're like, surgery now, you're going to have C-section.’ And so you just hear the story over and over again. And it's not that I don't believe- everyone's experience is valid, of course. And also, people are given all of what's called a cascade of interventions, not because they need them, because of a system that incentivizes costs and speed over birthing people being the experts in their bodies and their own lived experience.
When I was reading the part of the book on tearing and episiotomies and consent, I obviously thought about that Fleishman is in Trouble scene where Claire Danes ripped my heart out and threw it across the room. And I think of that show, and the book, as a sister to your work in the focus on the way that stories shift based on who gets to tell them and the way that we can see how we were shaped in retrospect, but not in the moment. Do you think that that's every generation's burden? What messages do you think our kids are getting right now that they'll be unpacking in 20 years? I'm scared to even think about that, but I wonder.
I don't think it's a burden. I think it's a gift to be able to live your experience, formulate feelings about it, and even a narrative, and then to be able to look at that with distance and change it. And maybe it's a gift as a writer because it's gold.
Ugh that’s so beautiful. And it sure is gold for writers.
But also, there's no keeping it the same forever. What does that do for us? I think the same experience can mean many things to us. And what do we tell our kids? We're all doing our best to validate their feelings. We've gotten a lot of coaching toward that end.
Yes, every day on Instagram, someone's coaching me to let my kids feel their feelings.
Yes, right, and this whole generation of people for whom doing that was not encouraged necessarily is fascinating. But I open the book with an account of speaking to three 10-year-old girls in Brooklyn about the sex education that they're getting. Or not getting, it ended up being the case.
Right, I read that and I was like, oh, come on.
I know. I was just sure it was going to be better than what I was getting. I was positive of that because I grew up in Georgia and I got abstinence-only sex education, and so I figured it would be better than when I went.
I went to yeshiva so we didn’t even really get that but I always thought that public school students got real sex ed. Apparently not.
It's synopsized but the takeaway was, okay, puberty happens and people have stuff that comes out. For boys, it's going to be semen, and it's going to feel good, and it's going to relax them, and they're going to like it. And for girls, it's going to be blood and it's going to be messy, and we're going to have to clean it up and go to the nurse at school to get the supplies that we need. So there was no female pleasure and I think the line that I'm drawing here is if we're not learning about what our bodies are capable of and how powerful they are from a very early age, that's going to impact us if and when we want to become parents. I mean, when I was trying to get pregnant, I actually did not know that you could only become pregnant a few days a month.
No, I don't think I know anybody who did. Those of us who went to yeshiva may have known that there are a few days that are better for getting pregnant but not that it’s so limited.
That was very clear in my survey too. It was a very high number of people who, same deal, did not know that. And you need to know that. You need to know about pregnancy, you need to know about birth. It's not just that it needs to be included in formal education, it needs to be part of the cultural narrative that we share and that we are-
That we talk about with our children. I loved your characterization of the menstrual cycle as the fifth vital sign because I was never taught to understand my own bodily rhythms. And, speaking of the 90s, I think I felt like it was more feminist to ignore them because of the cultural messaging that implied that hormones made women crazy and incapable of doing important jobs in the world. We're used to thinking of birth control as freeing and revolutionary for women, which it certainly has been, but it can also be true that it can be harmful. Before I had kids, I was just given birth control pills without any conversation about what they might do to my body and my life.
It's just such a common experience because we assume that removing a period means nothing else is lost.
Yeah, for convenience. I mean, the cycle matters. Having a cycle matters. And birth control doesn't make your period better. It makes your period go away. And that should be a choice people get to make.
With an understanding of what the implications are. At one point when I was on the pill, my husband was like, ‘do you realize that you complain about feeling nauseous every day?’ And I was like, ‘oh, do I? How interesting.’ And when I went off of birth control to have my first kid, all of a sudden I felt so much better. It was making me miserable for so long, and I had no idea that it was doing that and that I could just solve the problem by…not taking it.
There are other implications because the menstrual cycle is a process in the body that we can look to, to tell us more information about our total health and our body. And that something is being lost when people go on birth control for reasons that are not about controlling not having children. People, kids are still prescribed birth control all the time for heavy periods.
Speaking of changing stories, I've been thinking a lot about revision lately and so the thing that I'm obsessed with now is talking to people about what didn't make it into the book. Was there something very dear to you that you had to cut or change?
I actually wrote a ton about menstruation and birth control. The first thing I did when I started this book was I wrote a ton about those topics because I couldn't believe what I was learning. And it's related to everything that we were just talking about – the effects of putting hormones in your body and stopping a physiological process that's actually quite necessary and informative for you about your body. And what does that mean? But it was too much. I was coming back from having a third kid and I didn't know where to go and I didn’t know where to start. And maybe it was just too fresh to write about birth in a way, so I was going around a little? I mean, that must've been what I was doing, but I also was very fascinated by everything I was learning in that category.
It’s wild to me. And doctors talk about IUDs, or at least my doctor did, as this very low-key intervention. It’s localized, low-dose hormones but it does often change your cycle.
I should actually add it to this cascade of interventions that I talk about in birth. And then you leave the hospital and the next thing that happens is nothing for six weeks. Nobody looks at you. You are at the pediatrician six times but then you finally go back to your provider and they peek at you, they tell you you can have sex with your husband if you're in a heterosexual relationship, and then they offer you an IUD. There's no perinatal mental health screening, there's no checking for the pelvic floor and diastasis recti and how's your body functioning? It's like, let's give you another thing that we can bill for and not really have to pay a whole lot of attention to you.
And IUDs can be really great. I was a huge IUD evangelist until my fourth one broke out of my uterus.
Oh my God.
There was a whole search and rescue involving laparoscopy. And actually, when it was happening, my doctor, whom I really love- incidentally, I feel like that's how a lot of these stories go, people will say, ‘I love my OB but here's this crazy, terrible thing that happened to me.’ So that’s another thing to unpack. But she was like, ‘yeah, actually three different doctors in the practice have had this happen to them in the last two months.’
The doctors had it happen to them. Is that who it happened to?
Yes, yes. Good parsing of that.
Any responsible conversation about contraception after birth includes a full spectrum conversation about all of the options, what is possible. That should include vasectomy as part of the conversation. It shouldn't be like, what kind of birth control are we going to put you on now? An IUD? It's not a conversation. It's a consenting conversation. It's a conversation that removes your ability to actually consent to what's being offered. It's just like, what kind? Not yes or no, and here are all your options.
I didn't know that terminology, that’s something I learned from your book. I mean, I knew the word consent, but I didn't understand how it was used when you consent someone. That it’s not the same thing as getting consent.
I had a lawyer in the book tell me informed consent and refusal is the law, but culturally, in obstetrics, it does not apply. It means that your provider is supposed to explain to you any drug, any procedure that they're offering to you, they have to tell you what it is. And they can't manipulate you into choosing it or not choosing it. They have to equalize your ability to say yes or no. And if they're not doing that, then they are consenting you. They are doing something to your body. And I describe going into the hospital in labor with my second, and I got into triage after a long time in the waiting room. And [they said] hop up on the table, spread your legs, we're going to do the pelvic exam now. That's not me consenting to care, that's me being consented to care. And by the way, I didn't want to have that exam. I wanted to be admitted to the hospital, but I didn't need that. And we have a lot of good evidence that pelvic exams, especially at that point in pregnancy, are pretty much useless. And they can do all kinds of things like introduce bacteria or just be uncomfortable. Who likes a pelvic exam? And if it's being done with no purpose and you're being consented to that procedure, it's so wrong on so many levels.
Yeah. I mean that's one of those things that we take as axiomatic. They have to see how far you're dilated before they can let you into the hospital. But it's about speed, right? They only want someone who's far enough along that they will not labor in the hospital for three days.
Right, even though we know from the evidence that how far dilated you are is not an indicator of when you will give birth to a baby. There are many factors that are involved with that. I mean, somebody can go from four centimeters to ten in an hour or five minutes or days. We don't know. There are other factors to consider. And the Midwives Model of Care that centers physiologic birth and people as experts in their own bodies while giving birth will tell you that you have to look at other things. You have to look at, how is the mom feeling? How is her emotional state? That's actually one of the factors you look at. And we're just denying people the opportunity to fully be in their birthing experience and in their bodies, and we're consenting them to a bunch of care that they don't need. And then wondering why 45% of people describe their births as traumatic.
It's so sad that it's mind-blowing to me that you would consider the mother's emotional state, because that has never been my experience.
Yeah, we know we need darkness. We need quiet. We need to feel safe. We need to not be interrupted. There's six things. You need to have these things to give birth. That's what you need. You do not have any of them in the hospital. They actively deny you every one.
Right, and this idea that you are the expert. That's not a message that I ever received, that I was the expert in my own body.
No, we're not given that opportunity, but it's just the truth. And we have to fight for that recognition, because I don't think we're going to be safe giving birth in this country until that's a given.
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