An overview of maternity matters in Ireland since 1916 by Rhona O’Mahony: The Annual Hospital Reports of the 1920s have striking similarities to my own, chronicling increasing activity and inadequate resources. Unexpected money from the infamous Irish Hospitals’ Sweepstakes allowed for the refurbishment of a number of hospitals during the 1930s, including the NMH, but despite some recent refurbishment, the building is little changed from what it was in the 1930s.

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The Early Pregnancy Unit in the Rotunda is a quiet side space away from the rush and heave of pregnancy and ambulance deliveries. I like the receptionist. She is pleasant and soft, with red shoes and a positive disposition. I remark on her shoes; it is not often you see a woman in red shoes. They are pretty, flat, shiny, I think. She wears them with black trousers. Her desk is full of Post-Its and I know she knows I am fine by the way she looks at me and responds to my questions.

I don’t feel like I belong there, nor have I anything in common with the ladies beside me. They are miscarriage ladies; I don’t know this world.

It is alien to me. I know the emergency room, with my big, heaving, contracting belly and the clickity-clackity-clack of the baby heartbeat echoing around the room, surround sound. I sigh, look at my watch, wonder what Alec is doing to entertain Joshua on Parnell Square, sip water from a plastic cup and wait. (Times) >

(by odonovcj)

Author

  • Rachel Cusk, born in Canada in 1967.
  • Spent most of childhood in Los Angeles.
  • Moved to England where she finished her second-level eduction in a convent school.
  • Read English at New College, Oxford.
  • Has written several works of fiction, and won literary prize for some of them.
  • Praised as one of the most promising young contemporary writers.

A Life’s Work

  • Published in 2001.
  • Whether it was the author’s aim or not, this book provides a sympathetic voice for those whom she believes do not have confidence in their own intuition in dealing with the mental and physical anguish involved in pregnancy and childbirth.
  • She wishes to share her experiences of this time in her life, as she goes through them, for the benefit of those in a position of fear, similar, perhaps, to her own:

◦         “For now, this is a letter, addressed to those women who care to read it, in the hope that they find some companionship in my experiences.”

  • The book was criticised for being almost too harshly honest and giving what many regarded as a very bleak outlook on motherhood.
  • What is undeniable is that Cusk presents the darker, more frightening and grim aspects of her experiences. Her perspective is shaded with fear of pain and change, and marred throughout by feelings of self-doubt and inadequacy. She feels isolated, as if she is alone in going through her experiences, both physical and psychological.

Fears

  • What is clear from the first few paragraphs is that Cusk recognises a permanent barrier between mind and body. These are two separate, independent entities that she strives to maintain in such a way, as if to say that by doing so she can keep each in order and under control.
  • Soon comes her realisation that a reconnection between these two parts of her is to be forced upon her by her pregnancy and the incumbent birth of her daughter. It is beyond her control, not to mind her choice:

◦         “In pregnancy, the life of the body and the life of the mind abandon the effort of distinctness and become fatally and historically intertwined.”

  • Another thing that becomes glaringly obvious from the first few pages is Cusk’s fear of the pain involved in the impending labour and parturition. What makes this fear worse is the fact that she, somewhat guiltily believes herself to be incapable of dealing with the pain when it comes:

◦         “I would feel not only pain but terror that I had felt it, that I had registered an injury so small when the fact of this great and mysterious agony lay so immovably in my future.”

  • I get the feeling from some of the words she uses, that Cusk may not have planned the pregnancy. Quite apart from considering it as an act of her readiness to move on to the next stage in life, as I imagine having a child would be for many women, what comes across from the author is that she feels the pregnancy was forced upon her, that it was not of her own conscious volition that she undertook the challenge of procreating. She uses the unusual metaphor of a prison to describe pregnancy, and what is particularly worrying is the way she equates giving birth to escaping from the prison:

◦         “Knowing the pain which every inmate must endure as a condition of their release.”

Later she remarks:

◦         “My sex has become an exiguous, long-laid, lovingly furnished trap into which I have inadvertently wandered and from which now there is no escape.”

  • One of the conditions of carrying a child that Cusk finds particularly difficult to manage, or get her head around, is the curtailing of her independence of mind and body that accompanies it. It is as if she must reshape herself to fit the mould of expectant mother, and this, for her, is too much of a challenge to readily do. Cusk clearly values her freedom of spirit, and she deals with hostility toward anything that impinges upon this right of hers. An interesting point to note here is the way that the processes of motherhood are traditional, they have been handled in a similar way for years and that Cusk is becoming part of this legacy, whether she likes it or not. She calls it “The biological destiny of women”. She is essentially powerless to alter its course, “as if I had boarded a train”, she writes.

Metaphor

  • Cusk enters into a four-page metaphor about a walking holiday in the Pyrenees, that I feel encompasses each of the points I have made up to now. She likens her pregnancy to a mountain and giving birth to climbing down from its summit. We could draw parallels between this idea of a mountain and Cusk’s view of her own body, but we won’t go into that.
  • The challenge she feels in returning to her much-loved state of distinction between mind and body comes across in her saying “I cannot reconnect with my route without going all the way back down the mountain”.
  • This also brings to mind the point that Cusk feels the pregnancy forced upon her. The task of descending the slope is one that she in a sense did not choose.
  • Her fear of the pain that childbirth will bring is evident in the words:

◦         “Like a stone I begin to skip and bounce, cartwheeling in the air. I am, I realise, utterly unprepared to meet pain, even though I know that very soon I will probably break my neck.”

  • Despite the fact that she seems to value her independence highly, it comes across that when she is faced with having to climb down the mountain by herself, without any direct help, but only instruction, this realisation of having an utterly personal challenge ahead of her is frightening:

◦         “Filled with self-pity, I am angered that he does not intend to take me down himself.”

Changes

  • The cognitive changes Cusk expects in herself: the intuitive responses that should give her confidence in her ability to handle the approaching childbirth do not come, and this frightens her.
  • She only sees the physical changes that occur in her body, as she “become[s] a cocoon”.
  • The season changes to winter, and as the physical changes of her pregnancy continue, we get a hint that Cusk is suffering symptoms akin to those of seasonal affective disorder:

◦         “Winter draws in. I begin to feel a more or less constant despair at my predicament. In the mornings, when I wake up, I observe the rising mountain of my stomach and have to fight surges on intense claustrophobia.

  • One of the things that affects her more than anything else is how her pregnant state has become an excuse for people to invade her personal space. She can no longer be anonymous, insignificant, or free to act and think as she would like to, under normal circumstances. She says:

◦         It is the population of my privacy, as if the door to my room were wide open and stragers were in there, rifling about, that I find hard to endure. … I am not living freely but in some curious tithe.”

  • The author feels insulted in a way that others can take advantage of the obvious nature of her condition to infer information about her. It is one of those things that impinges on her sense of freedom, and thus she finds it hard to tolerate.

Natural Birth

  • In the midst of all the pregnancy literature she must sift through, she finds a concept that is immensely attractive to her, i.e. that of natural birth. In what I feel is Cusk’s attempt to shrug off “the disempowerment” she feels, she clutches to the idea of going without medical intervention in her daughter’s birth. By taking an active step out of her own conscious intention, she can comfort herself that she is retaining some sense of her own free will.
  • What is attractive to Cusk is the thought that natural birth “doesn’t hurt”. She likes the idea that “Pain… has been created by its expectation”. If she ceases to expect the pain, then she will not have to suffer it.
  • Also, it seems she is taking some consolation in the fact that, as far as I can tell, natural birth is a concept promoted and practised by women. There is a hint of feminism in Cusk’s denouncing of the role men have to play in the abstraction and dramatisation of childbirth. According to the house of thought that supports natural birth, it is men who conjure up all the ill feelings of pain and risk during labour:

◦         “as long as you realise that hospital is a place where MEN are, and hence that as soon as you set foot in one your chances of artificial rupture of membranes, chemical induction of labour, electronic foetal monitoring, stalled labour, epidural, paralysis, forceps delivery, Caesarean section and the need for the baby to be artificially respirated afterwards are greatly increased.”

  • It becomes clear that Cusk’s push for a natural birth at home is little more than another attempt to avoid the pain that she so fears. The little potential for comfort she may have gained from the prospect of having a natural birth is weak and her hopes are transient. It isn’t long before her hope is easily crushed by more reason to fear pain, as she eyes the midwife’s toolkit sitting menacingly in her bedroom.

◦         “In its dense, concentrated blackness, like a bomb, I see a long moment of forestalled horror, of disbelief, of dammed-up but pressingly, explosively imminent reality.”

Birth

  • Again, we see the hint of seasonal affective disorder, as spring comes and she expects this to bring with it a sense of readiness for the birth that is no longer very far away.

◦         “The year is creaking on its hinger: soon it will open and let in the light of spring. I have been waiting for this light as for the signal of my readiness, but it never comes.”

  • In the midst of the panic surrounding the discovery of the reverse-oriented placenta, Cusk sees her daughter’s face, and for the first time the thought of the foetus as another, real human being enters her head. The prospect of being obligated to remain in hospital and undergo intense medical intervention terrifies her, and she flees the building.

◦         “I am told I must now remain in hospital. Rebelliously, desperately, I discharge myself and go home.”

  • In the author’s description of the obstetric ward and her encounter with the consultant obstetrician, the Caesarean section procedure is likened to the removal of a growth or a cyst, without, perhaps, giving the event its due significance.

◦         “I ask whether the baby is ready to be removed and am assured that it is. He has delivered babies like kittens, like feathers, like thoughts, babies that hardly exist.”

  • During, the procedure, Cusk undergoes what could be considered an assault, though she has come to the somewhat apathetic conclusion that there is now no point in putting up a defence, since this would be futile, similar to every other effort she has made to maintain her own sense of well-being and autonomy in this pregnancy.

◦         “Now that I have been given a day, an hour and a demarcated sphere of anxiety, I grow mute and limp with acceptance. … I don’t know to which front to send my defences, where to concentrate my powers of endurance, and so I give up and hang my head.”

  • The moment when her daughter is taken out of the womb and begins to breathe is beautifully described by the author, though there is little of the emotion and sentiment that one might expect. It is as if the beginning of her daughter’s life is a sort of celestial event or change in the universe that occurs. There is no reference to the biological importance of the event.

◦         “Some transfer of significance has occurred: I feel it, feel the air move, feel time begin to pour down a new tributary. The world adjusts itself.”

  • At this point, we see the only mention of the baby’s father in the whole chapter. He is not referred to as husband, partner or any other term that may hold emotional significance for Cusk. It opens up again the idea that the baby was forced upon her, as if the pregnancy was unplanned, a task to be faced by her and her alone, without the help of the father.

Style

  • Makes a great argument for the point brought forward at last week’s session, that much of our communication is done by metaphor and simile, where words are used that mean something entirely different, with the intention of conveying a particular slant on a topic. Cusk frequently does this, to great effect, I believe:

◦         “I fear my soul is being uncaged and allowed to fly away.”

  • Her tone is predominantly devoid of positive emotion, preferring to dwell on the more sinister, harmful and threatening aspects of what she describes. Although she tells us intimately of the fears she suffered throughout her eight months of carrying the foetus, there is no reference made to any joyous spin on things. Even the jokes she makes are delivered in a cold, dry manner.

◦         “If you’d been born a hundred and fifty years ago, he says, you’d be dead by now. I reply that most people would and he laughs uncomprehendingly.”

  • Most of the events of the pregnancy are narrated in the active voice – “I make”, “I say”, “I feel”. I believe this accentuates the fact that the book is a recount of her experiences, as she underwent them, and not simply a bare telling of the facts of what happened to and around her during this time of her life.

(by mcbridei)

An Insistent Tide is a short story about one woman’s journey through the final stages of child birth and how situations changes quickly and don’t always go according to plan.

We join Janice in a dream just before her water’s break. She is dreaming she is lying on a beach with water flowing around her thighs. At first she seems at peace in a trance like state but then begins to feel pain as her uterus expels the water as series of “waves”. A bird fly’s high over head, its spirit is described as rising which perhaps represents the foetus about to become a baby. This dream as well as the later ones shows how the mind is in tune with the body.

She is awoken by a call from her husband, when she tells him her waters broke he seems hesitant to accept this, suggesting she gets a plumber. Then when she says she is in labour he asks “Why do you say that?” suggesting she doesn’t know her own body. We feel as if the relationship between the two isn’t very close. I would expect as a woman approaches birth of her child it would bring partners closer together.

Next Janice arrives at the hospital where she is examined by her doctor, called Dr. Ming. Janice seems to have respect for Dr. Ming as she seems relaxed in her presence. We see Janice is a little annoyed with Dr. Ming’s vague answers when she replies to how long labour will last when she says “That depends”.

When she thinks back to the books about pregnancy she read, she refers to them lie exam preparation, showing that a few months ago giving birth seemed like a distant event and she was more concerned with her day to day living. This is completely understandable considering all the other changes she would have to adjust to. Sections which bored her at the time now seem very relevant.

When Janice goes for her ultra-sound she describes the equipment as a “wand” implying it is like magic, while words like “hissed” suggest a more sinister side to the equipment. We then are once again reminded of the distance in Janice’s relation with her partner when she forces “a casual disregard for her husband’s absence” when Dr. Ming asks about his absence. This distance is almost painfully echoed when she refers to being able to contact her husband in North America as giving “the illusion that he was nearby”. When Janice says she has to go as the contractions get worse Oliver asks “Did you bring the champagne?” which really makes one question his priorities and concern for his wife.

Janice then enters another dream, this time induced by laughing gas. Once again she is on a beach but there are two birds this time. We sense something is wrong when the fish start to nip furiously at her thighs. Suddenly one bird appears to collapse and the other dives after it. The one who fell most likely represents her child whose face she felt she should recognise while the second one was Dr. Ming who is trying to save her child. This is confirmed when she wakes up to find Dr. Ming trying to find out why the unborn child’s heart rate is dropping. For me this really shows the fate Janice has in Dr. Ming when she knows in her dreams Dr. Ming will come to help as soon as her body feels the child is in danger. This shows once again that mind and body are intertwined with each other.

Yet conscious Janice still doesn’t seem to recognise that something is wrong when she remarks naively “That’s wonderful” to Dr. Ming’s comment that she can feel the umbilical chord. Eventually she the gravity of the situation hits her when she realises her baby will suffocate. Dr. Ming seemed to want her to figure this out for herself instead of telling her straight away. This highlights that doctors sometimes have difficult things to say and they need to develop ways of dealing with this.

Dr. Ming decides instantly that a Caesarean section is required. Janice is shocked by the sudden change in plans, she had always imagined thing to go gradually wrong. This shows how health care staff always have to be prepared for the worse. Janice was shocked by how a simple decision changed so much for her.

Janice shows remarkable control when her husband calls asking about videos at such a crucial time yet she just  tells him  to get them if he wants as she does not want to burden him with news of the current incident.

As Janice is whisked towards the Caesarean Section room she is told “everything will be fine” but Janice sees this as just a mantra that they would say no matter how things were. As she passes other rooms she hears women grunting and men shouting “Push, Push”. This reminds her and us that every minute of everyday new children are being born and women becoming new mothers.

When she reaches the room we sense an element of desperation on the team as they try to get an anaesthetist. Yet no matter how many times they are paged they do not turn up. This shows the understaffing that is present in many hospitals and reminds us that the staff are human and can’t be everywhere at once.

We once again see that Dr. Ming is very experienced when she spins into her gown. While previously we saw that the mind and body are closely linked she is still unable to stop the contractions and her baby from crushing the umbilical cord. She feels hopeless, describing herself as “dissolving into this table”. Yet suddenly survival instinct seems to take over her when she shouts “you don’t need the anaesthetist”. Dr. Ming looks shocked yet relieved that she is now able to do the procedure despite breaking away from normal practice. Janice almost instantly questions her decision but it has been made. She is then dosed with morphine, injected with the local anaesthetic lidocaine and her skin is frozen. Through out the procedure Janice issues a series rhetorical questions trying to distract herself from the pain. She seems to become separated from her body as she hears herself screaming as if from the outside.

She then enters another dream in which a “gravity lower within her … had been removed” but it is replaced with pain. She wakes to see herself being stitched up with the “movement of a bird’s nest-building”. This image is poignant as if her womb is getting ready for the next child whenever it may come. The story ends with Janice no-longer feeling pain.