Woman Who Thought too Much, The

by Limburg, Joanne

  There is something about screening tests that feels strangely familiar to someone who suffers compulsions. While I do understand that there are clinical reasons for all the various ultrasound scans, blood tests and examinations which are routinely offered to – or imposed on – women ante-natally, it also seems to me that they are rituals, attempts to ward off the anxiety that seems to follow pregnant women about like a malignant cloud. But like compulsions, they only serve to feed it.

  But then, why should we expect a few tests to hold out against such ancient, possibly animal terrors? Pregnant women used to be menaced by jealous spirits and malevolent gods; now they are frightened by statistics. No risk is considered too slight for a good headline. No wonder it took me so long to recognize how aberrant my thinking had become.

  If any pregnant woman was going to wind up trying to escape a notional fire by climbing onto a writing desk, there was always, in retrospect, a good chance that that woman would turn out to be me. By this time, I had been struggling with anxieties of one kind or another for as long as I could remember, and had always found it difficult to face the prospect of risk. It was hard to get me on a plane, hard even to get me across a busy road. Pregnancy and birth, I knew, were a mother and foetus steeple-chase in which you might fall at any fence. I knew this with painful certainty because, a few months before my second pregnancy, I had lost my first.

  In early 2002, I finally put my limping PhD out of its misery and we agreed to start trying for a family – or, at least, to stop trying to prevent one. Of course, I was terrified: of the possibility of failure, of childbirth, of becoming an awful, damaging mother, of giving birth to somebody who might inherit their mother’s capacity for making a misery out of things. On the other hand, I had always assumed that I would have a child, could not imagine life without a child, and there was a relief, of sorts, in giving way to a biological imperative, something so much older and deeper and wider than my own fidgety, changeable reasonings. I might not be able to finish a PhD, but at least I could fulfil my animal purpose. So we put our contraceptives away in a drawer, and two months later I was pregnant.

  A couple of weeks after my positive test, I began to bleed, so I was sent to the local maternity hospital for an emergency ultrasound. That first time, we saw a tiny blob with a heartbeat: a ‘human bean’, as Chris put it. A week later the bleeding stopped. Another fortnight later, it started again. At the next emergency ultrasound, the foetus was a tiny homunculus already, waving its skinny limbs at us. The bleeding got worse, stopped, started, got worse again. We trekked back and forth to the early pregnancy unit and, when that was closed at the weekends, to the gynaecology ward. I made panicky phone calls in the middle of the night to bored-sounding nurses. There were more ultrasounds, examinations, blood tests, careful speeches from midwives and doctors who couldn’t promise anything. On 29 June, I wrote this entry in my notebook, trying to make sense of how I felt, as I contemplated a possible full nine months of unstable, bleeding pregnancy:

  This fear – there must be those who live in this state constantly, for months, years at a time – if their town is under siege, if they’ve had a bad diagnosis – how can they? After a while does it become normal, simply how things are? Does it become something else, some terrible white noise always in the background?

  When the pregnancy had first been confirmed, we had booked a private nuchal fold ultrasound, for extra reassurance. By the time we turned up for the appointment one evening in early July, I was bleeding more heavily then ever. I had also been in pain on and off for two days. In fact, I was in considerably more pain than I was prepared to admit, but something of what was going on must have shown in my face, because as soon as he saw me, the foetal medicine consultant asked what the matter was. I told him about the bleeding and the pain. When he took a look with his machine, he showed us a womb cinched in the middle, as if it were being squeezed by an invisible fist. Its cervix was full of blood, but the baby was still there, clinging on, with a beating heart. ‘You have a fifty per cent chance of miscarrying,’ he said and suggested that we postpone the nuchal. Outside his office, the midwife who worked with him told me to go home and take some painkillers, the stronger the better. ‘But surely I can only take paracetamol?’ I asked. ‘I wouldn’t worry about that now,’ she replied, with unbearable kindness.

  We took a melancholy cab home, then phoned my mother to tell her what the consultant had said. She said she’d drive up straight away. While I was waiting for her to arrive, I squeezed out something that looked like a big chunk of liver and the pain, abruptly, stopped. So that was it, then, I thought. The doctor at the out-of-hours surgery couldn’t see anything for blood, but was inclined to agree with me. She sent me to the gynaecology ward, where I spent a night having my blood loss examined and failing to sleep. Next morning, a porter wheeled me at terrifying speed to the ultrasound department for one last viewing. Astonishingly, the baby was still there, heartbeat and all.

  I was taken back home again. I went straight upstairs to rest, and fell asleep almost straight away, only to be woken soon after by intense, burning pains, more powerful than any I’d had before. In five minutes, I flooded one sanitary towel, then another. On the way back to the early pregnancy unit, on the back seat of my mother’s car, with one last excruciating contraction, it was finally over.

  The doctor who operated on me – to remove the remaining ‘conception products’, as they were now called – told me that it was best to wait two periods before I tried to get pregnant again. My husband insisted that we followed this advice to the letter: the miscarriage had left me thin and anaemic, in need of building up. I had all sorts of new fears about my body and how violently it might fail, but at the same time, all I wanted was to be pregnant again. To be suddenly without child felt like an outrage. I felt picked on, persecuted. I lost any sympathy I had ever felt for the teenage mothers pushing their babies around the shopping mall, and snarled at my husband about how they smoked and swore, how they packed their children into buggies and ignored them, how they plied them with sugary drinks in bottles and ruined their teeth. I went on and on and on at him. I think we were both very relieved that I fell pregnant again so quickly.

  Between pregnancies, I had changed GPs. I chose my new doctor for her obstetric training, made an appointment to go and see her, sat down next to her desk and burst into tears. I told her all about my miscarriage, my past bereavements, my bouts of depression. She listened carefully. When I had finished, she said that I clearly didn’t cope with loss very well and that she was going to refer me to the midwife counsellor at the maternity hospital. Then she asked how I would feel about taking antidepressants again, given that I was hoping for another pregnancy. I said I didn’t know. She said if I wanted to make a properly informed decision, why didn’t I go onto the Internet and research the risks?

  The Internet is a hypochondriac’s best friend, so I didn’t need any encouragement. When I had a look online, I discovered that while there were no confirmed dangers from fluoxetine (Prozac) during pregnancy, there had been some reports of increased risk of miscarriage in the first trimester, and a few more reports of babies being born with withdrawal symptoms after their mothers had taken fluoxetine in the third trimester. It turned out that precious few medicines were officially deemed safe for pregnancy: if they cross the placenta, which most would, then the foetus would receive a concentrated dose of whatever its mother had taken, and could suffer a variety of nasty consequences as a result. Of course, I already knew about the ‘thalidomide babies’ with shortened limbs who had been born to mothers who had taken that drug during the first trimester.

  Thalidomide was a known ‘teratogen’ – literally, a ‘creator of monsters’, a phrase that called to mind those old folk beliefs about foetuses imprinted with the horrors that their mothers had seen. There was no evidence that fluoxetine could lead to the birth of malformed offspring, but then, there didn’t seem to be all that much evidence about fluoxetine one way or another. Th
ere is a serious methodological problem where studies on the use of drugs during pregnancy are concerned, which lies in the fact that it is not ethically possible to do a proper prospective study, a double-blind trial, with a control group – what sane mother would agree to take a substance, in the interests of science, solely in order to see whether or not it would harm her child? The scientific papers I saw had tentative and provisional conclusions, as scientific papers tend to do, and these conclusions usually included a sentence to the effect that, in each individual case, possible risks to the foetus had to be weighed up against the mother’s need for treatment. Faced with all this uncertainty, I did some weighing up of my own, and turned the doctor’s offer down.

  This book has given me the perfect excuse for – I mean to say, has necessitated – further research into all kinds of health issues. I have been very busy feeding terms into search engines, downloading entries from citation indexes and going on frenzied hunting trips to the periodicals shelves of specialist libraries. I have entered, among other combinations, ‘mental illness + pregnancy’, ‘obsessive-compulsive + miscarriage’, ‘anxiety + effects + on + foetus’. Some research has been done into the incidence (new cases arising) and prevalence (all cases reported, whether new or ongoing) during pregnancy of anxiety disorders in general, and obsessive-compulsive disorder in particular. The researchers’ conclusions, of course, are as tentative and provisional as they have to be, but, taken together, they do suggest to me that anxiety disorders, including OCD, are far from uncommon during and after pregnancy; also that women who have previously suffered from depression or severe premenstrual tension are particularly vulnerable; that changes in the levels of gonadal hormones – oestrogen and progesterone – play a part; that although some OCD patients may find their symptoms are alleviated during pregnancy, others will experience a worsening of symptoms, or the appearance of new ones; that the experience of miscarriage may put certain woman at risk of developing OCD.

  Nobody has developed any treatments especially for pregnant women with OCD or its sister ailments. If a pregnant woman is to be treated, it will be in the usual ways: by anti-depressant medication, almost certainly one of the selective serotonin reuptake inhibitors such as fluoxetine, which are considered to be the safest and most effective drugs for such patients. She may instead – or additionally – be offered a course of cognitive behavioural therapy. As expected, the papers’ authors all sound a note of caution about the prescribing of drugs to pregnant women, but it also seems that leaving a highly anxious woman untreated could prove harmful to her unborn child. As a recently published review of the medical literature puts it:

  Recent findings indicate that symptoms of anxiety are common during pregnancy and the postpartum period and that maternal symptoms of anxiety during pregnancy are associated with adverse fetal and developmental consequences. Over-activity of the maternal neuroendocrine system has been implicated in negative health outcomes seen in fetuses born to stressed or anxious mothers. Fetal exposure to elevated levels of hormones (particularly cortisol) may contribute to premature labor and delivery. Maternal exposure to stress and anxiety may precipitate the release of catecholamines that can result in maternal vasoconstriction and ultimately a limitation of oxygen and vital nutrients to the fetus. The exposure of the fetus to maternal stress and increased levels of adrenal hormones therefore has possible consequences for fetal central nervous system development and specifically glucocorticoid brain receptor development.33

  Stress and anxiety have the effect of reducing the blood supply to the womb, which in turn restricts the supply of food and oxygen to the foetus; at the same time, the foetus will be exposed to high levels of stress-related hormones such as cortisol, and this can help to trigger premature labour and birth. In other words, the old wives were right: you should never frighten a pregnant woman.

  When I was frightened by something, I could at least take my fear to the midwife counsellor. By the time I went for my first appointment, I was already pregnant, and she continued to listen to me, answering my incessant and tortuously detailed questions with great patience, for the best part of my pregnancy. Many of my questions, unsurprisingly, had to do with miscarriage and its causes. Even though I had been told by doctor after doctor that most miscarriages were ‘independent events’, in which either foetus or placenta had developed in such a way that the body could only reject it, I could not get the soap opera theory of miscarriage out of my head: a woman is pushed over/falls down the stairs/has a terrible row with her partner/is in a car accident/gets drunk one night with the girls and as a direct result clutches her abdomen, screams and promptly mis-carries just before the closing credits.

  I was particularly concerned that I might be raped. During the first few months of my pregnancy, the so-called ‘Trophy Rapist’ was at large in the south-east. Nobody knew what he looked like, as he attacked from behind, threatening his victims with a knife or a fist if they tried to look at his face. He always took a piece of clothing or property from them, hence his name. Many of his victims were schoolgirls but he attacked grown women too. He seemed to have no preference as to age or type, but one thing was consistent: he attacked in wooded areas. He lurked always in the Home Counties, in woodland, waiting for his meat.

  In those same few months, I had a part-time temping job at the maths department. My route there included a short walk down a footpath which was fenced on one side and wooded – ever so slightly and thinly wooded – along the other. It was a straight path, not very long and anybody passing down it was visible from one end to the other. I was rarely the only person using the path, and I only used it in daylight, but it was, just about, a wooded area and it was, almost, in the Home Counties, so I would always scurry along it, looking over my shoulder. I knew I wouldn’t see him, though; there would be rapid footsteps, a sudden whiff of cigarette smoke and alcohol, then an arm round my neck, a hand over my mouth and that would be it: ‘Trophy Rapist Attacks Pregnant Woman.’

  The midwife counsellor knew of this slightly wooded path and often cycled past it, so I enlisted her help as I tried to assess the exact dimensions of the threat. Did she think there was enough cover for a man to lurk in the bushes? What if he became bold, attacked in the daytime? When she cycled past, how many people were usually on the path at one time: one? Many? None? Was the whole length of the path visible from the main road that she was cycling on? Might an attempted attack be spotted from the road? From the maths department? From the houses alongside? And, say I was unlucky and was raped, would the rape hurt the baby? Would the baby become infected with HIV? Could I possibly lose the baby that way?

  A railway worker was arrested and charged in early December, which put paid to any specific anxiety I might have had about being raped in a certain place by a particular rapist, but my general sense of vulnerability did not abate. When I took my shower or bath after my husband had set off for work in the morning, I always locked the door of the bathroom from the inside, so that no psychopath who might happen to break into the house while I was washing myself could burst in and catch me at my most defenceless. The villain who stalked my thoughts was always the same: his facial features were blurry, as if he had been made out of plasticine, but I could always picture very clearly his great bulk – of course he was a huge man, who could overpower me in seconds – and his navy knitted skullcap, as worn by the men who had hammered at the walls of the glass houses I had inhabited in my pubescent nightmares. I was awake now, and much older, and I understood how absurd and exaggerated my fears were, I understood that the risk of being attacked at random in one’s own home in broad daylight was negligible, but the scenarios I conjured up seemed to have some kind of independent malevolent power. I was terrified by my own imagination, and locking the door was my attempt to placate it. It was a compulsion.

  Locking one door couldn’t accomplish much, though, when my imagination and its horrors followed me everywhere. When I left the house, I walked with great care, a hand over my bump in cas
e it should get knocked by something – the corner of a briefcase, perhaps, or a wire shopping basket – in such a way that the baby sustained an injury. Crossing any road was a horrible ordeal, every time. I could not walk by the river without wondering how long it would take a foetus to drown inside me, should I fall in. I could not look at a staircase without picturing myself falling down it. Every morsel of food I ate was a choking hazard. There are women who feel that the baby is completely protected inside them, that it only becomes exposed to the world and its dangers after the birth, but I did not feel like a safe place for a baby to be; instead I felt painfully brittle, as if I were made out of matchsticks and tissue paper. I started at another temping job after Christmas, but the walk to the office terrified me so much that I jacked it in after only one day.

  Much later, I would read about the Japanese ritual of mizuko kuyo, in which a mother would ask forgiveness of the spirit of her miscarried or – more commonly – aborted foetus, while asking the mizuko jizo, the saint who cared for such children in the other world, to help her lost child on its way. After abortion was legalized in Japan in the 1970s, a portion of the inevitable backlash took the form of terrifying images of vengeful mizukos (aborted children) menacing their mothers, perhaps injuring or killing any subsequent children in utero. Some temples were thus able to make a good deal of money out of the guilt, grief and fear of women who’d had abortions, by performing these propitiatory ceremonies and charging for them.34

  While I couldn’t help being horrified by the way this mythology had been used, I found the images themselves deeply compelling. The idea that a pregnancy might be haunted by an earlier, thwarted one made sense to me. Certainly my two pregnancies, which were so close together, overlapped in my imagination. A dream I wrote down in my notebook illustrates this very well.