“I Have a Front Row Seat to Some of the Most Interesting Stories of Humankind”

A Conversation with Dr. Chavi Karkowsky

This month I was thrilled to talk to Dr. Chavi Karkowsky, a maternal-fetal medicine specialist, mother of four, and author of High Risk: Stories of Pregnancy, Birth, and the Unexpected. The book published back in March, a month notable for being a totally normal and chill time for all, especially medical professionals. Chavi’s writing has also been published in Slate, the Daily Beast, the Atlantic, and the Washington Post, among many other publications. I was grateful that she was able to carve out some time for the newsletter, especially since COVID cases are once again surging in New York City, where she lives and practices, and her children are cycling in and out of the periodic quarantines that come with the privilege of in-person school. It was especially interesting to talk to a writer with a full-time job unrelated to writing and we discussed the ways in which a non-writing job can make writing while parenting both harder and easier. Read on for our conversation on what it’s like to try and write a book with very little knowledge of the publishing industry, how giving birth is like being the Incredible Hulk, and why we can’t think of pregnancy and childbirth as something that only affects people with uteri.

Lives in: New York City

Lives with: Spouse (Josh), 4 stir-crazy kids

Favorite place to write: Coffee shops, when that was a thing; with terrible pop music blasting through my noise canceling headphones. Now, on my couch, with my noise-canceling headphones, but it's not the same. 

Favorite time of day to write: I haven't had daytime writing time since 2019, when I wrote my book and we were abroad - a different life! I have returned to my day job as a high-risk obstetric specialist in New York City, where I also coordinate a lot of our outpatient COVID response and other care, as well as continuing to work on our inpatient and L&D units, along with other duties. It is very full-time work, especially in 2020, so my only writing time is 9:30pm onwards, the "second shift" after kid bedtime. It's not optimal, and I find it takes a lot to get me into a flow state and really get something done. A hard deadline can be key for making it happen. 

What are you reading right now? My talented friend Miriam Udel just came out with her book of Yiddish children's stories, "Honey on the Page" - lovely, strange stories with unconventional lessons, perfect for this weird and anxious time. Also, my kids are decimating the graphic novel section of the library, and I'm right there with them. I'm loving Jerry Craft's nuanced but absolutely kid-relatable investigations of adolescence, race, and privilege in "New Kid" and "Class Act.” 

What are you watching right now? My day job is quite intense and, in the days of COVID (and COVID recurrence), it can be quite dark, so I did a lot of watching Great British Baking Show and the Netflix Babysitters Club series. Do you know how hard it is to find a show that is light, not stupid, and without misogyny? It's so hard. Then in a complete turn, I absolutely devoured Queen's Gambit, though it's quite a bit darker than what I usually seek out, and I'm surprised at how much I was able to enjoy it. 

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My first question, before we get to your excellent and very important book, is actually: how are you doing? Because you are right now working in a New York City hospital where you had, I'm sure, a very crazy time back in the spring, and then a little bit of a lull and now it's picking back up again.

Yes. It's getting bad again. I was exposed to COVID last night because I ran into a room without thinking. I was wearing a mask because we always wear masks but I wasn't all geared up. Even just in these few months, I've forgotten how you have to be so vigilant and fight your instincts. So right now, my family is healthy and we're okay. It's getting bad again and I really don't want to do this again, but I think we're gonna.

It’s hard to believe that NYC frontline workers are being asked to walk into that particular fire again, after the crucible of this past spring.

The only thing I'll say is different is my kids are in school now. I mean, sort of. Two of them are just now getting out of quarantine from a kid in their class. But in March and April, if somebody was going to bring the virus home, it was going to definitely be me and the guilt of that was overwhelming. And now, we've made some choices. We're being careful and there's a lot of risk mitigation but if the virus comes to this house, it might be from one of the kids, or it might be from me. There's something about that that is a little bit of a lightening of the guilt and it does make it a lot easier. Also, I think we kind of know what's coming and there's also the delusion of, we went through that whole terrible time and nobody in our house got sick, so we'll just do that again, probably. That's what my husband says, he's like, ‘Just keep doing that. That worked great.’ I'm like, ‘I don't think that's how it works, honey, but okay.’

So, vigilance.

Vigilance plus delusion.

Right. I think you need a certain amount of delusion actually, for a lot of things, including becoming pregnant and having kids. And also, incidentally, writing a book so if we can go back into the Before Times, can you walk me through your decision to write this book, the actual writing of the book? Tell me that story.

I was writing pieces intermittently for Slate and my editor, who at the time was Laura Helmuth, was just a very lovely person. At some point, I sent her a piece and she wrote back, ‘Have you ever thought about writing a book?’ And this is the depth of my low self-esteem with regard to my writing because I looked, and I was like, ‘Oh, she doesn't want me to send her pieces anymore. This is her very nice way of telling me to go away.’ And my husband was like, ‘Okay, I'm sorry, let's review the English language and what this email means. This is a nice thing. This is a compliment.’

It had never occurred to me before that. For anyone who's not knowledgeable about this, the writing of a book is a complicated, long-term task, of which only the end part is the actual writing of the book. So you have to write a book proposal. On the strength of that book proposal, you usually have to find yourself an agent. On the strength of that agent, you usually have to find yourself a book deal. And then you sit down and write the book. I initially started it and I didn't really know what book I wanted to write. I just knew I wanted to say something longer than 750 words and that this seemed to be one of the only ways to get someone to let you do that. And there's some wisdom to the process where the book proposal that you're forced to write in order to get an agent in order to get a book deal does make you build this castle out of string that doesn't exist but maybe could. I remember I needed to have some reasonable number of chapters so I just would make up a chapter and throw it in there. And my agent kept having to tell me, you don't have to write the book you sell. You just have to sell the book, and then you write a book, and they can be a little bit different from each other. And then what's funny is I mostly wrote the book I sold. Those chapters that I just made up and threw on there, they were legit. Like, through sheer force of will, we make them.

I wrote a dissertation which is not the same thing but that having to imagine what it could be before you actually get down to it is familiar. I just want to back up for a second because this might be of interest to those readers of this newsletter who aren’t in the know about publishing: how did you find your agent?

Here's the summary of the knowledge that I have gained in this process. I asked people how you do this and some people said look for agents of people that wrote books that you like and your agent is almost always thanked on your book so you just open Atul Gawande’s book look at the acknowledgement page and you can find his agent. I did that and I would send them my book proposal and then it'd be radio silence. People don't write back. You are at the bottom of a long, long pile that is being sorted by some underpaid intern and it is all very sad. Then I started to get a little more professional about it so what I did was I got a subscription to Publisher’s Marketplace, which has a database of all the deals that have ever been made. I started to look for things that sort of matched what I was about to do: women's health, medicine. I wanted something that was maybe a little funny, but also serious and sad. And I got to my agent, Jessica Papin, because she had just sold a book about sexually transmitted infections called Clap, which I thought was hysterical.

That’s a great title.    

It’s a really funny title. She specifically said she was looking to amplify women's voices and had an interest in women's health.

Hello.

Exactly, amazing. The other thing I did is I had been sending everybody the same book proposal and the same cover email and you can't do that. You're selling yourself, you have to take a minute to think about why they would want to throw their future in with yours because they eat when you sell. They don't eat if you don't sell so you have to prove that you're going to be somebody who pays their mortgage. I still don't think I've paid her mortgage. It's going to be a while, Jessica, I'm really sorry. It’s a long game. Anyway, I feel like I had a month or two where I was sending letters out to agents and waiting six weeks, eight weeks. A couple of people would call me back, one or two wanted the full proposal, nobody came through. With Jessica, I sent it to her and later that day she asked for the full proposal. The next morning at 6:00 AM, I had an email being like, ‘I'd love to sit down with you and talk.’

That must have felt so good.

In all honesty, we were about to move abroad. The whole thing, if it hadn't come together, it would have fallen apart.

That brings me to my next question. You were doing all of this, this pre-book work, while working as a doctor. What was the balance like at that point?

I am not great at balance. Balance is not the word I would use to describe it. I always feel like the honest answer to people who ask, ‘How do you do it?’ is that I don't cook and I don't clean and if you don't do those things, it clears up a whole lot of your day. I would rather work a 24-hour shift than do either of those things. And I often do.

So you have somebody else who is doing that. One of my projects with this newsletter is to try and demystify how people publish when they have other very constant demands on their time. You have four children and you also have a full-time job that is not writing.

I have a job that is not writing that is extremely full-time. I worked a 24-hour shift yesterday into this morning, then I slept for three hours, then I got up and did six hours of work for my day job because now I'm in more of a leadership position so the emails don't stop and we're preparing for a COVID surge so everybody needs 16 different protocols by yesterday. But I have always outsourced as much as I could afford. And I have this privilege where, on the one hand, I have a really demanding day job but it's also a day job that pays a lot in our current culture. I work a lot but I also get paid more than many other people who work as much as I do. This is also part of parenting. I have to be careful to outsource the stuff that it doesn't matter if I do. I don't think it matters if I do my kids’ laundry but I don't want to outsource the things that I should do, like helping them with their homework. And sometimes it can be a little hard to figure out what's what, and it changes as your kids get older. So that's something I'm always trying to figure out. So I don't cook and I don't clean and I try very hard to figure out what is important that I actually do, and I do those things.

In many ways, this is a personal book. You bring in your own experiences as a doctor and as a patient. But it was only when I got to the last chapter that there was that moment of intersection of motherhood and work. You describe texting your husband to make sure he's there by the time the babysitter has to leave, kind of directing the orchestra of family life from afar. I'm always asking writers how they manage that juggling but this seems like a more high-stakes version. You have two sets of people's lives dependent on you, at home and at work.  You kind of have to be in two places at once. Are your male colleagues feeling that too?

It's very funny because I work in OB-GYN, so almost all my colleagues are women.

Do you find that that’s a common thing for women?

I know, for example, even in OB-GYN, where most of the trainees and most of the young doctors are women, when you look at the departmental chairs, they're almost all men. So that's still true. I do think it gives me two things. It gives me a model. I work with a lot of women who have successful families and have managed it. It also has given my husband a very particular independence and role that I sometimes think otherwise would not have happened. I was breastfeeding and I'm a mom and I was on maternity leave but when I went back to work, I went back to work. I would be gone for 18 to 24 hours. And he would do things and he wouldn't do them my way, he would do them his way. If I had been around, we probably would still be doing them my way, but his way is okay. It works. He has also just a really lovely relationship with the children, really lovely bedtime routines, things that I think if you don't absent yourself, maybe wouldn’t have been developed. I don't know. He's also a really special person.

Again, it's important to me to have writers who have been successful, have published, telling people, especially as parents like, ‘This is how I did it.’ And a supportive spouse seems to be one important factor for some, though certainly not all.

He’s not just supportive. He thinks that when I have something to say it’s important, that it should be said, that it's worthwhile to make time in our family for me to go say it, which I feel is a loving, beautiful level of appreciation. I will often act like writing is my hobby, and he'll say, ‘No, you have to go do that. That's important. I'll put the kids to bed.’ That's really beautiful.

Absolutely. Ok, so you get your agent. You're going abroad, talk about that.

My husband had the opportunity to move to Tel Aviv for two years for his job and we have moved a lot of times for my training and my job so we worked it out. The week we were moving to Tel Aviv, my agent – who is very editorial, she had helped me work on the book proposal and edit it and make it more appealing – sent it to publishing houses. And I had a couple of calls with publishing houses which I took from a hotel room in Tel Aviv, because we still didn't have an apartment, at like three o'clock in the morning my time. And nobody bought the book, nobody wanted it. So we went back to the drawing table and my editor helped me restructure the book proposal so that it would make more sense. I don't know if this is too technical for your audience, but the book didn't have a structure.

We love details around here.

The book didn't have a structure so I think people didn't understand what I was trying to do. Now, it has a rough structure of following a pregnancy through trimesters and arguably, some of the chapters have a very nebulous association with their time in the pregnancy but even just that overlay of that temporal structure made the book understandable to people. So we rewrote the book proposal, it took three months, we sent it back out to publishers, and – I feel like this needs to be transparent – we ended up with one offer and we took it, and that is my book publisher now.

So were you working as a doctor when you were abroad or just writing?

I was not working [at first]. We had moved to Tel Aviv and I was trying to get my licensure and all that stuff established. It ended up being much international bureaucracy, way harder than everybody told you before you got there. So I actually wasn't working which was a really dark time for me. It turned out it validated a lot of my life choices. I definitely need to work. Ultimately, I got the book deal and I was trying to write and writing alone, writing as a full-time job, was actually very unhealthy for me. It was very lonely, especially since we had just moved to a new city, very introspective. I didn't find my balance until I started eventually working in a hospital. I was working at an ultra-Orthodox hospital in the north which was not what I expected to be doing but it ended up being wonderful. I was working three days a week, no weekends, no nights – which is very different from my current schedule – and writing two days a week. And that was fantastic, I think that’s the perfect schedule for me.

So you were able to write the book while you were abroad and having this wonderful schedule. Do you think you would you have been able to write it had you been on your current schedule?

I don't know. That's a good question. I needed a lot of brain space. At the same time, I will tell you this. I made a schedule for myself. I was supposed to write the book for a year but I hadn't understood that it was a year from when you come to an agreement, not a year from when you signed the contract, so by the time I understood that I was already three months behind, so I made myself a very strict schedule. I was supposed to finish a chapter every three weeks which is very quick. It was intense. But I get very little done until I'm on deadline so part of me wants to say I don't know if I would have had it right now, I'm too emotionally exhausted. I don't have the room to play or think or even research or, I don't know, just follow Google links to where they'll take me. But part of me also says, ‘You never get anything done when you have plenty of time.’

There are a lot of stories in the book. Were you writing them down at the time when they happened, or did you have to think back and remember them years later?

I mostly am remembering but I also had a blog that I started around 2009/2010 when I was a fellow. I was just starting my maternal-fetal medicine training and I had a nine-month-old, which is exactly when you're like, ‘Let me start a blog.’ I remember waking up in the middle of the night being like, ‘I need to be writing. I'm going to go start a blog’ and I've got a toddler asleep in bed with me and this seems reasonable. I can't explain these things.

Sometimes wish I wasn't like this but I think at some point you say, ‘This is how I am and we're going to work with what we have.’ The reason I mentioned the blog is because I do have stories there and I have stories that I remember. There are stories I also use because I teach a lot of medical students and I still always think a story is the best way to teach something. There are ways to never forget that you'll hurt somebody if you forget this very minor thing. I think a story is very potent way to get that across. But I also did have the blog for things like that last chapter which describes a night on call in real-time. I came home from a night on call and I had a giant bruise on my left thigh that I could not remember how I had gotten, which I felt was just so on point. There's just such a found metaphor.

I also had one blog post that I would one day love to be a chapter in something, which was just basically the story of a night on call told only through dialogue that I say. At the time I was pumping for twins.

Oh, God.

Yes.

How did you-

It was really hard.

How do you even do that when you're being called every minute?

You're not always being called every minute but I did feel like pumping was another bodily function that I may or may not have time for that night. I would run upstairs and I’d be like, ‘Listen, I’m covering triage. I need three extra minutes to put my shirt on, so call me earlier.’ And all these nurses, they're L&D nurses, they do breastfeeding education, they know exactly what I’m doing, so there is something to that, where the hardest thing I’m doing is also what they have devoted their lives to. It was insane and hard, and there were many nights I did not get to pump, and we're not even going to talk about some of the dubiously safe things I did. Anyway, the twins are nine now, everybody's fine.

They're nourished, they survived.

They’re nourished, and if they're not, it's not because that. We can talk about how it was the compensating for the fact that I wasn't home, we could talk about that. It was a challenge and I did it. I probably didn't need to do it, but I did it, and I love them. And everything would have been fine if I didn't do it too.

I was struck by your description of labor and delivery as an ‘immediate transition into powerlessness.’

I think there's something really interesting about the ways that birth is treated and the setting. I think one of the things that's very surprising to people, I do not know if this was your experience, is that birth is extremely physical and it is involuntary. Even the most educated person, even the person who's done it before, there is a point where you have to grapple with the fact that, like digestion or sneezing, your body is doing a bunch of really complicated, really overwhelming things without your consent, without asking you, and often in ways that you did not want to do. I don't mean this is a bad thing. I think it's a superpower. It is an amazing thing, but I think that many people are very surprised, they are very overwhelmed by the experience.

But it’s not a superpower that you're in control of, it feels like someone else is driving the bus.

It's almost being the Incredible Hulk. It’s a superpower, but it actually doesn't care about your brain and it’s very overwhelming for your brain. I think there's also an element here where as somebody who's a provider in a system which can take power away, I think the experience itself, even if done in a hot tub with your favorite midwife- not a hot tub, a birthing pool-

Don't give birth in a hot tub.

No, don't give birth in a hot tub. I think for many, many women, it's an overwhelming physical experience. One of the things that I learned from the midwives that I worked with for a long time is that there's this typical transition period where people become fully dilated and ready to push. And for many women, it is basically that as you are becoming 10 centimeters dilated, you are overwhelmed with the feeling of total despair. Like, ‘I can't do it. This is never going to happen. It's all over. I'm just going to die. We're both going to die. Do my C-section.’ It's exactly what people say. And what I have said to people is, ‘We're going to talk about whether you can do it later. Right now, you are doing it, so let's just do it and then we'll talk about it. You are doing it, fact on the ground’

That is so fascinating.

Isn't it fascinating? It's also my favorite metaphor for parenting, life.

That at the moment when you're actually doing it, you-

You're like, ‘It's all over, I give up’. Despair.

Despair. I’ve only had medicated births and this is the first thing that’s made me want to try it not but-

I know. It does happen sometimes with medicated births. I think there's some really complicated hormonal thing going on. That was very precise from an MFM with 17 years of training. Anyway, it does happen for other people too, for people with epidurals or even with C-sections. But there's just something powerful, I think, about it being this moment where you give up and you think you can't do it. Then maybe just minutes later, your baby is delivered and everybody is happy. There's joy in that room, but there's also such relief. The joy that we have that is mixed with tragedy averted, this huge relief, is I think just really unparalleled.

I was going to use that exact word, unparalleled.

Sara, I had a whole chapter about joy and it got cut. A whole chapter.

Oh, no. That’s too bad because I'm very interested in the nuances of joy.

I think there's something about the darkness that gives the joy depth and it doesn't mean I want my patients to suffer, but you cannot deny that there is something about having gone with a patient through depths to joy that is just unusual.

Isn't that the joy of parenthood though, also? I think about the quality of joy that I've experienced as a parent and it’s not better or worse, necessarily, but different, and I think that that's the reason, all the bad stuff, but I don't know.

I don't know. It's very interesting to me. Anyway, there's a whole chapter somewhere on my hard drive that says discarded scraps to be done with later.

I would maybe rename that to something- I’m always labeling things ‘Do Something With This.’

Do something with this. Fix. Be smarter next time.

Sometimes it's not about how good something is. It's just that it needs to find its right home.

This was really interesting to me because she was, in general, a very light editor and I liked her very much. I sent this chapter to her and she was like, ‘Oh, this is like a bunch of vignettes that are powerful, but it's not a chapter.’  And basically, it was like she had pulled my heart from my chest and stabbed a knife into it because also now I was three weeks behind my schedule. I think it's just interesting what makes it into a chapter, why wasn't that good enough? There's something there that I think is interesting where it's like the story isn't good enough, I need a little more exposition.

Is this an activist book? You said that our ability to tell a story is one of the most powerful tools we have to learn and to change things in the world. Were you hoping to change anything with this book?

It's such an interesting question because the answer is both yes and no. I didn't really want to do a call to action. I didn't want to be like, ‘Everyone go out, we're going to start an NGO about women's health, and implicit bias.’ That's a great thing, it's not what I’m doing here today. Instead, I wrote my last chapter. That was the activism I wanted to provide, ‘you are going to come to work with me, and we will leave this with a little bit more of an understanding of what we ask of women. Then what happens from there is up to you and up to me.’ I’d say there is some activism to that.

I think pregnancy is hard on a body and we're not honest about that. I think the way that medicine and government have historically treated women's bodies is often as if they're cheap or expendable, I think that sometimes that's still true, and I want that to be noted. There's stuff about racism and implicit bias that I think we need to be screaming from the rooftops, and we hopefully are a little more.

Some of that I guess is activism. Also, part of it was this idea that I have a front row seat to some of the most interesting stories of humankind. I want to tell them not because it's going to change your behavior, but because we lose something by not telling these stories. These are just phenomenal stories of the very edges of our human experience and how could you not know about this? I think the answer is yes and no, but I did pull back from being an overtly activist book.

You devote a chapter to talking about racial disparities, including the unconscionable pregnancy-related mortality rate for Black women, which is 3.2 times that for white women. Your point is that nobody thinks that they're racist, but the care is obviously racist to some degree, and that medical professionals treating their thoughts as suspect is the only way forward as a way of sharing some of the power that the system currently grants almost entirely to doctors. What does this look like in practice? Until the field diversifies, because that's certainly part of it.

Part of what I wanted to do with that chapter was to say, great, a lot of the solutions I hear are things that are going to take 30 years to do, like get more Black people into medicine, absolutely, 100% let's elevate those voices. But I have to go to work tomorrow and I could just not go to work. One solution is the white lady doesn't go to work. And there are days where sometimes I do feel like I'm not the right doctor for my patients, but let's just say that on the whole, it's probably better for me to show up. And so I think what I tried to do in that chapter is to say, on the whole, if I'm going to show up and I'm working in a system that is unjust, then let me take that responsibility, let me say that some of the ways it's unjust are because of me, not despite me. And then what can I do about it tomorrow? I'm starting my shift on L&D tomorrow at 7:30 in the morning so what are we doing?

And I came to that the thing that we can address in ourselves is implicit bias, the way that we conceive of the world with the heuristics that we all need as humans to make sense of a complicated world, but which often overlap with racism. And it's sometimes hard to figure out what's what. And I think this real-time interrogation and insight that fighting implicit bias requires of you is really hard. I think it's specifically hard for people who work with their brains like doctors, maybe lawyers, lots of other people for whom implicit bias is a real and present problem.

I would imagine in a field where you have to be constantly making quick decisions, it's also particularly challenging.

Right. For a long time, you're told to listen to your gut. There's the medicine and then there's the art and you have to listen to your gut, and then you're like, ‘But wait, what if my gut is the racist part? What if the reason I'm sending her home is because I'm terrible? Wait a second. Let's hold on there for a minute.’ What I will say is this: when you're a junior person, you have to ask for permission; if you deviate from the standard protocol, you're going to be in trouble. But as I have gotten older and as I have gotten more senior and therefore have the ability to do this, I can say, ‘Hey, I'm not sure whether I should send you home or keep you. Do you want to talk about it? What would you like to do? What would make you feel safer?’ I do a lot more of that now. I think I'm more clear: I don't have that right answer. I'm struggling. Let's open it up to debate.

What I took to be one of the central themes of the book is that sometimes in life there are no clear takeaways. You tell so many stories that even you don't know the ending to.

Yes, that makes everyone really angry, people get very mad when you do not tell them the end of a story.

Another thing that you touch on in the book was the degree to which women want to tell their birth stories, but only in certain circumstances. In my personal experience, I’ll be with a friend or with a group of women, and we’ll somehow get on the topic of birth stories and someone will share something scary or painful or embarrassing, and someone else will say, ‘Oh, right, that. I had that with my third kid,’ but these aren't things that we talk about, in general, in public. Were you worried about whether people would want to read a book where stories of pregnancy, labor and delivery aren’t just warm and fuzzy? That readers wouldn't want to hear about the scary things that happen?

I think it's still something that I am often having to sell when I want to do a book talk or something, feeling like people will say, ‘oh, we’re past all that.’ Or, ‘we’re an older women’s group, we won't want to hear about that,’ or ‘we have lots of men.’ My point is, and I say this very frequently, I think this book and this topic is important for people who've had a baby, know anyone who's had a baby or have been a baby, which is frankly a wide net.

A lot of what I have to say is relevant not just to the experience of pregnancy and birth, but the wider reproductive life that we all live, which includes things like planning to have a baby and the ways we all restructure our lives without realizing it for years before we have a baby. Sometimes the job choices we make or the partners we choose, or the houses we rent where we don't even realize that we're driven by that thought at the back of our mind, ‘maybe at some point.’ And I think that affects men too. I think I say in the introduction that I ruin dinner parties because as soon as I get to one, my end of the table is all about placentas and epidurals and C-sections and I swear I do not bring it up, although I am happy to talk about it, to be honest, because it's interesting

I think a lot of people want it.

They are carrying around a lot of trauma but the people who are carrying around this trauma are not only women, it is also a lot of men. There's a lot of husbands who are like, ‘I still don't know what the hell happened. The person I loved the most in the world was bleeding and in pain and then they took her away. I still haven't worked through that at all and I still don't know what happened and everyone's fine and I can't stop thinking about it.’ That happens actually a lot.

I mean, I'm not delivering placentas directly but it does come up for women all the time and it makes sense that men would have that too. At least the women have that outlet of talking to their friends who went through it.

Somebody might talk to you and say, ‘Oh, yeah, that happened to me too.’ And I don't feel like this is a space men need to take over, I don't mean that. But there is something here that we have lost from our wider society. I think there is a cost to your family. I think there's a cost to your community. I think there's a cost, honestly, to your [public] policy when we think of pregnancy as something that only affects people with uteri. I think that the truth is the reason pregnancy is such a powerful experience that we are willing to go through is because it is also for most of us how we build our family. It's not the only way to build a family, but it is the most common and, in some ways, unfortunately, the easiest, and it's not very easy. It’s a life cycle event and a medical event and a religious event for many and a faith-testing event for others and none of that is unpacked or explored and so much of it is totally mysterious.

I think the other thing that I often talk about a lot is that for many young families, they've never been admitted to the hospital before. This is their first experience being a patient and the experience of being a patient is an incredibly overwhelming one. It's often depersonalizing, but it is also access to this tremendously powerful system you had no idea was sort of running in the background your whole life. And that, I think, in a world where we have to spend most of the last nine months discussing whether or not we have enough ventilators, is of interest to everybody.

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For more of Chavi’s thoughts on pregnancy, birth, and the unexpected, you can order her fantastic book (and support local bookstores!) here but also everywhere else books are sold on land and internet.