Woman Who Thought too Much, The

by Limburg, Joanne

  I dreamt that I was lying on a bed in a hospital ward. My abdomen was cut open, and the baby, tiny in a white sac, and attached by the umbilicus, was laid on the sheet next to me, its heart visibly beating. [30/12/02]

  I remember telling the midwife counsellor about this, and about the sense I had in the dream, that I could nurture the baby to term in this way, if only I were to remain on that bed, lying on my left side, absolutely and perfectly still.

  Of course, it wasn’t possible to remain completely motionless in my waking life. Although I had been able to give up working, I still had to leave the house to go to the shops or to see friends, and inside the house I still had to face the stairs I could fall down, the bath I might drown in, the knives I could cut myself with, the gas hobs which could set my sleeve alight and the food which might choke me. When I thought about my state of mind, I was reminded of a picture I had seen in some book I had been shown as a schoolgirl; there was an article about phobias in the book, illustrated with cigarette card-sized cartoon panels, each one captioned with the name of the phobia it depicted. At the bottom of the page, as a kind of visual punch-line, was a picture of a man who had squashed himself into the corner in the room, his legs pulled up to his chest, arms clasped tightly around his knees; little whizz lines around him showed that he was shaking; sweat poured down his face and his eyes popped. The caption said: Pantophobia – fear of everything.

  In March, when I was six months pregnant, I finally told my doctor about the pandemonium in my head. She watched me as I gibbered on about how anxious I felt all the time, how terrifying it was just to negotiate the aisle of a busy shop, how I was afraid to go on trains because they might derail, how I hadn’t really given myself much time to recover from the miscarriage, had I? How hard it was to cross roads, how I couldn’t travel to London because of terrorism, which was absurd because hadn’t I once commuted day after day, years before the IRA ceasefire? I don’t know what I expected her to say after that, but I do remember that when she said the word ‘medication’, I was utterly stunned. As I had come to understand it, psychotropic medication was only offered to pregnant women as a last resort, and it simply hadn’t occurred to me that I could ever be that ill. Until that moment, I had always seen myself as just sane enough: I might be neurotic, but at least I always had insight.

  I backtracked, said how important it was to me to protect the baby, how I couldn’t take unnecessary risks. I’m no Howard Hughes, and don’t normally suffer from obsessions about contamination, but that changed while I was pregnant: I had sat one lunchtime in the maths department canteen, hoping nobody would notice that I was inspecting each little forkful of my chilli con carne – I wanted to make absolutely sure that every last cubic millimetre of mince had been cooked through properly. I was reluctant to take paracetamol, which was allowed; reluctant to take so much as a sip of white wine. How could I reasonably be expected to take a serious, psychoactive, prescription-only drug? But rather than praising me for my responsible attitude to my foetus, my doctor came as near to losing her patience as I have ever known her to do – and she’s often been pushed. Listen, she said, you are not well. Anxiety is bad for the baby and if you carry on like this, you will not be fit to look after it when it arrives. That was persuasive: I agreed to take the medication.

  The doctor approached the business cautiously, speaking to a psychiatrist who specialized in obstetric mental health, then coming back to me with a prescription for the safest, ‘cleanest’ drug available: an SSRI called citalopram, which I was to take at a low dose for the foreseeable future. I had the sense – surprisingly, in retrospect – not to go surfing for citalopram horror stories while I was still pregnant, but I downloaded some information on citalopram and pregnancy just the other day and found more articles warning of the risk of ‘neonatal withdrawal syndrome’ for babies who had been exposed in utero to SSRIs in the third trimester. The reported symptoms listed in the articles included irritability, constant crying, shivering, increased tonus, eating and sleeping difficulties, convulsions, respiratory distress, cyanosis, apnoea, seizures, temperature instability, hypoglycaemia, vomiting . . .35 When my newborn son was examined in the post-natal ward, after a long labour and an emergency C-section, he was found to have a low temperature and hypoglycaemia, and did not feed easily, but whether this had anything to do with the citalopram, as opposed to the traumatic nature of his arrival, to my incipient, as-yet-undiagnosed hypothyroidism or to any number of other factors I couldn’t even name, is impossible to say. I can say for sure, though, that he has turned out to be a remarkably happy child – and he certainly doesn’t get it from me.

  The citalopram did not remove the anxiety – one can’t knock out an elephant with a glockenspiel beater – but it did take the edge off it, so that I was able to move about more comfortably, within the small compass I allowed myself. I started going to the local coffee morning group, began to make friends among the local mothers, went shopping for the baby’s things. A good twenty-week scan had given me some confidence, and I was aware, as each week passed without incident, that my baby’s chances were getting better and better: twenty-eight weeks was the ‘viability’ threshold; at thirty-three weeks my pregnancy manual told me that my baby ‘has an excellent chance of survival if it comes out now’.36 I relaxed, somewhat, and was even able to write – a little.

  The focus of my activities and anxieties now switched to the birth. While I watched my bump grow and waited for the big event, I had the antenatal classes to occupy me. We took two courses – one run by a small local charity, and one at the NHS, to familiarize me with the hospital and its ethos – and I was an appalling little swot at both of them. All the way through my pregnancy, I binged on information, as if childbirth and motherhood were two more dissertations for me to research. My questions to the midwife counsellor continued, but there were also books to read, and the Internet to trawl. The independent birth teacher, at least, encouraged this approach, and handed out wonderful things at her classes: a diagram to show which hormones were released at which point in labour; information sheets about the reasons for each intervention, and their attendant risks; we could even become acquainted, if we wished, with the local hospital’s policy on every single aspect of perinatal care. I looked through the hospital’s statistics on interventions, types of delivery, morbidity and mortality with the midwife counsellor. I discovered and followed exercises which would minimize the chance of a posterior – and more difficult – birth. I produced a splendidly detailed birthplan, complete with plenty of conditional verbs to show that I understood how unpredictable the whole process was. I knew about the C-section performed on a goat in seventeenth-century Switzerland. I knew that pethidine, an analgesic used in labour, had been developed by two scientists working for I.G. Farben during the Nazi era.

  If maternal researches made any difference to birth outcomes, I’m sure I would have had one of the easiest deliveries in medical history. But they don’t, and neither did they assuage my fears. When we were shown around a room in the delivery unit, so nakedly a hospital room full of hospital equipment, so obviously waiting to be filled with screams and splattered with blood, I was horrified. Next day I wrote:

  Last night saw the Delivery Unit at the hospital. The strength of my reaction took me by surprise. The woman pushing in the next room didn’t throw me at all, but I hated the room. The hospital-ness of it, a room such as one might have chemo in, I thought. A room full of horrible memories. One of those too-high, slablike, hospital beds in the middle (which, OK, one can push to the side), facing a wall with a ghastly, bland example of tea-towel art on it. A door to the right leading to the hospital-smelling hospital corridor, with people in scrubs pushing equipment down it, and a window on the left with a view of the car park. My gut feeling was, ‘I DON’T WANT TO BE HERE!’ All the grieving ghosts of miscarriage, family illnesses, family deaths. I came home and cried, and cried for grief and anger today, morning and afternoon. What shall I do? [1/5/06]

&nb
sp; At least I could console myself with the thought that I hadn’t disgraced myself too much in the classes; I never cried or ranted until we were safely back home, and never once had I asked the only really compelling question, the one that goes: what if we die?

  32. Washington Post, 16 May 2006

  33. Lori E. Ross, PhD, and Linda M. McLean, PhD, CPsych, ‘Anxiety Disorders during Pregnancy and the Postpartum Period: a Systematic Review’, Journal of Clinical Psychiatry, 67:8, August 2006

  34. Helen Hardacre, Marketing the Menacing Fetus in Japan (Twentieth Century Japan – The Emergence of a World Power), (University of California Press, Berkeley and London, 1997)

  35. See the article ‘Citalopram Hydrobromide’ on www.rxlist.com; also ‘Citalopram in Pregnancy and Breastfeeding’ on www.obfocus.com

  36. Kaz Cooke, Rough Guide to Pregnancy and Birth (Rough Guides, London, 2001)

  Harm

  56. I sometimes have an impulse to hurt defenceless children or animals.

  The Padua Inventory

  ———

  No one can do everything right – not even a mother.

  Arlene Eisenberg, What to Expect the First Year

  Birth-planning, researching, exercising – it was all a distraction, really, from that unaskable question. All I truly wanted from the birth was that the baby and I would emerge from it alive. Secretly, I also hoped that my child’s birth would be like mine – quick and early – but I wasn’t counting on it, which, as you’ll already know, was just as well. My son was a term baby, and his birth took many hours, a birthing ball, a birthing pool, an artificial rupturing of membranes, several monitors, countless lungfuls of gas and air, a sampling of blood from his scalp, three midwives, a spinal block, a small army of obstetricians and, ultimately, a scalpel. None of this bothered me much: the baby was stuck, and by the time they took him out he had his cord wrapped twice round his neck and my placenta was abrupting, so there was never any question in my mind, then or since, that the C-section was necessary. My only regret is that I was listening when the midwife told me and Chris in the recovery room that she’d heard the obstetrician saying they’d gone in ‘just in time’. Yes, I certainly could have done without that.

  After some-length-of-time-or-other in the recovery room, the baby and I were wheeled into the post-natal ward and Chris went home to sleep. We stayed there for a few hours, the boy squeaking and snuffling in his plastic box and me flexing my reawakened feet under the blankets and wondering when they would let me move and pick my child up. A paediatrician came by at some point to do his routine examination; he told me that the baby had low temperature or low blood sugar or maybe both or something else and that they would get a baby-warmer down from the transitional care ward. Then I was told that the equipment couldn’t be spared and we were being taken up. As my bed and I were being pushed into our new slot, a group of midwives and nursery nurses gathered at the foot end and asked me which formula I preferred . . . Did you get that? I said, THEY ASKED ME WHICH FORMULA I PREFERRED.

  Unlike the emergency Caesarean, which I had, deep down, been expecting all along, this came as a shock, an absolutely appalling shock. As I said in the letter I wrote to the ward manager a few months later:

  As I had always intended to breastfeed my son exclusively, on demand, until he was six months old, I was completely taken aback by this question, and was devastated to be asked it. Nothing I had heard in the ante-natal classes, let alone in the breastfeeding workshop, had prepared me for a situation in which formula would be given to my baby without my being asked how I wished to feed him first. Although I could not answer the question satisfactorily, I was able to explain that I intended to breastfeed, and would therefore be grateful if [my son] could be given his formula in a cup rather than a bottle . . . After this, [he] was taken away from me, his mother, without my permission, and given his very first meal by a nursery nurse, an event I found more distressing37 than anything I had experienced during the labour.

  To anyone living outside the new mother/new baby bubble, this must seem like an absurd overreaction, a plum example of middle-class maternal preciousness; indeed, when I look at this paragraph now, I feel quite embarrassed by it. Take a look at the same incident from inside the bubble, though, and you can begin to understand why I was so upset, and why, in the following months, I remained so stuck in my upset that my health visitor suggested I write the letter, if for no other reason than to help me move on.

  Another new mother, who like me was having trouble breastfeeding, and was having to supplement with bottles of formula, said to me wearily one day that to bottle feed was, among all the other dreadful things, ‘a social faux pas’. We were both a few months into motherhood by then, and heavy with shame. Well, of course we were: we’d met at Active Birth classes; we were educated, left-leaning, middle-class women, a poet and an artist respectively; we believed in natural birth, breast milk, and not allowing the Man to use the occasion of your baby’s birth to sell you shit you didn’t need – like environmentally polluting scented babywipes, for example, or disposable nappies, or evil corporate formula. It was about doing right by your baby, right by the planet, and also about showing you hadn’t been duped. Pity the poor, disadvantaged, ignorant women who gave birth on their backs full of drugs, then stuck a disposable on their baby’s backside and shoved a bottle into its mouth. They didn’t have access to the information that we had; they couldn’t afford the classes; they didn’t have the social reinforcement you need to breastfeed.

  I was so much luckier than they: I’d been drinking in the reinforcement long before I was even pregnant. My relatives breastfed; my friends breastfed; I read newspaper and magazine articles about research that showed me how, all the time, they were discovering new and different ways in which breast-feeding was wonderful. Then, when I was pregnant, I joined the NCT and they sent me more literature along similar lines; I learned from various online sources that formula was not only inferior for the child but risky too, as unlike breastmilk it could never be completely sterilized, and what’s more, your child would have few defences against all the pathogens paddling around in it because he would not be getting the benefit of the antibodies that his mother would have been able to dispense daily from her naturally germicidal nipples. I also learned that a woman’s risk of breast cancer decreased in proportion to the length of time she spent breastfeeding. This is all true as far as it goes, but it doesn’t follow that if you don’t breastfeed, your child will die of septicaemia and shortly after be reunited in the family vault with your own cancerous body. And if you are better at assessing risk than I was, you’ll appreciate that.

  The reinforcement reached its antenatal crescendo with the NHS breastfeeding workshop. We all watched a video which showed us how great things were in Norway, which apparently leads the world in maternal nourishment. Look: here is the sophisticated bar/restaurant, all woody and glassy and Scandinavian; here are the beautiful tall folk in evening dress, milling about with their drinks and their gravadlax;38 here is the woman sitting on the lovely designer chair with her evening gown half open, and, as the narration says, ‘nobody blinks an eyelid if junior has some supper too’. Never mind that it wasn’t like that here, that our mothers and aunts – bless them – might say things like ‘my milk was too thin, you see’ or ‘they’re much too big: you’ll suffocate the baby’ or ‘no more than ten minutes each side’ or ‘isn’t there some room where you can do that?’ We knew better now, we knew that nobody’s milk was too thin, that the baby’s demand would stimulate the perfect level of supply, that human babies had prominent noses for the sole evolutionary purpose of not getting suffocated by oversized tits, that if you kept the baby on long enough to get to the creamy, nourishing hindmilk, then baby would get all he needed for the first six months, that it was just a matter of getting a good ‘latch’ and they had the counsellors to show us how, that once we had the latch and the supply and demand thing sorted, we’d be away and could breastfeed, discreetly, anywhere, even
in the most sophisticated of wood and glass dining venues.

  The midwives explained to us that it would take a few days after the birth for the milk to ‘come in’; however, we would from the start produce a yellowish liquid called colostrum, which would begin to give the baby the benefits of our mature immune systems, and would provide enough incentive for the baby, who would be born with a couple of days’ worth of fat in reserve, to establish a good sucking habit. We were not to worry about the baby losing a little weight – that was normal – and it was best, in this early period, if we didn’t let anyone come between us and the baby with formula. Except, they didn’t add, if the staff consider the baby’s temperature, blood sugar and fat reserves too low; in which case, they didn’t advise, you might like to consider which brand of formula you prefer.

  Or perhaps they did add something like that, and I just chose not to hear them. It was probably at the workshop that I learned that cups were less prejudicial to successful breastfeeding than bottles. So my son was fed by cup, at two-hour intervals, and the feeds marked on a schedule. A day or maybe a couple of days after, a nurse thought she detected signs that his blood sugar level had dropped sufficiently to put him in immediate danger, so he was given a lumbar puncture, dosed with intravenous antibiotics and fed by tube for twenty-four hours; then it was back to the cups again. I was told not to pick him up between feeds, as his temperature could be better regulated by the heated cot. Chris came in on each of the five days that we spent on the ward, and learned to cup feed, and to change nappies. I wouldn’t go near the cups, because I was still working to my own strict version of the breastfeeding workshop agenda, and didn’t want him to take any food from me that wasn’t my own. I tried to attach him at every feed, sometimes with a staff member helping or hindering me; I breast-pumped like fury, I cried buckets and fidgeted irritably with my surgical stockings. By nightfall, I was so exhausted that I could only wheel him to the nursery for a few hours, and trudge back to my bed, half grateful, half resentful. I was resentful because he was mine, and I wanted to take charge of him, to be his mother; I was grateful because I knew that I was weak, and anxious, and incompetent, and he had to be better off with anyone else in the world than me.