Sunday Rumpus Essay: Knocked Over: On Biology, Magical Thinking, and Choice

At the end of June, headed home from vacation, I bought some whitefish fillets and a trout steak at a smokehouse in northern Wisconsin, then ducked into the bathroom and peed on a plastic stick. It took maybe four seconds for the plus sign to pop up, bright, unshakeable blue.

I called my sister from the parking lot. “I’m totally pregnant. What the fuck?”

I’d spent the last ten days frantically checking my underpants for blood, scooting to the bathroom at the slightest hint of damp. I talked to my body.

“You’re not pregnant. You can’t possibly be pregnant. How could you be pregnant? Get real.”

Because, come on. Forty-four-year-old women don’t get pregnant by accident. Everybody knows that. It’s a statistical impossibility, right? If they do get knocked up it’s after years of anguished effort. After charting cycles and mucus and basal body temps. After Clomid, after hormones, after freezing their eggs.

I’d internalized all the fertility horror stories, all the despair and all the cats. So much so that, weeks earlier, when the condom disappeared and we looked at each other aghast, we talked about STDs, not babies.

“I think I’m too old to get pregnant,” I said. I may have laughed.

*

At first I was giddy. I was pregnant! What the hell? It was nuts, yes. But it was a fact and, to my great surprise, once I climbed over the boulder of the truth of that fact, I was happy.

I’ve never fantasized about marriage — about poofy dresses and gaudy rings — let alone about the maternity tops and nursery wallpaper that tend to follow. In my 20s and 30s my fantasy life tilted toward Pulitzers and exotic international travel. (It still does.) Kids were implausible, hypothetical at best, and if I ever tossed and turned over a ticking clock, I usually forgot about it by morning.

Instead I watched, curious but detached, as two-by-two my friends got married, bought condos, and multiplied. Since I’d managed to not have children so far, went the logic — if you can call it that — I must not want them, right? If and when I did, I would have them, when the time was right. Right?

But that time didn’t come.

“Why WOULDN’T you have a baby now?” said a friend, when I fessed up to what was up. “You’d be a great parent.”

That was nice. And I wanted it to be true. I also wanted to barf and I couldn’t stay awake past sunset, but I was so high on hormones that it didn’t matter. This unplanned, unexpected, preposterous potentiality felt like a strange gift — one with the power to lift me up out of the muck of midlife questions.

I wasn’t having a crisis, exactly – I had meaningful work, good friends, my health. I was just so tired of the same-old same. Past pursuits left me limp. I didn’t want to go to the bar, didn’t care about that new restaurant, this literary scandal, whatever next big thing. I had abandoned the dream of a four-star career, and from where I stood the prospect of a few years in babyland looked pretty good. Friends and family had braved that frontier already, had set up homesteads, paved the trails. I knew it wouldn’t be easy, but what was? Hit me again, life — give it your best shot. I could totally be a parent.

But as I marched on through the days that followed exhilaration snagged, as it does, on cold, rocky facts. Such as:

I am old, of “advanced maternal age” in the medical lingo of motherhood. When you’re over 40 pregnancy can be perilous – for mother and baby alike. Gestational diabetes, high blood pressure, preeclampsia, placenta previa – not to mention the skyrocketing risk that the child might be born with a chromosomal disorder (one in 66) or might not be born at all: as many as one in two pregnant women over 40 miscarry before 12 weeks – they have, in the lingo, a spontaneous abortion. And even assuming none of the above, what about being 60 with a teenager in the house? How, exactly, did that work?

I am poor, or close enough. In fact, I only recently re-acquired health insurance. I’m doing better than a few thin years back, but I’ve got just a slippery grip on the boho bottom rung of the middle class. I work from home and have a fair amount of freedom, but decent part-time child care would drain my savings within months. I was going to support a child … how?

And, yes, I am single. I’d presumably be all on my own, though of course I’d have to tell the guy – this man who I liked a lot but who was not my boyfriend, and wasn’t on track to be. Oh shit. How was I going to tell him? He was a good guy, but this was not what he signed up for when he took me out to dinner.*

*

At various times over the last ten years, I’ve been lectured by one friend or another about those annoying expiring eggs. If you’re a childless woman over 35, you probably have been, too.

“You need to start working on having a baby NOW,” scolded one, hijacking a perfectly pleasant dim sum with gruesome tales from her odyssey of fertility treatments.

“If you want to have kids, just find someone to get you pregnant asap,” directed another, sipping tea in a Park Slope cafe. “It doesn’t matter who,” she added, almost as an afterthought.

I listened and nodded and then forgot about it. Besides: How dare they presume to tell me what to do? I’ve got my own thing going on here. Don’t they know 40 is the new 30?

And yet, like spring tulips, or taxes, the babies kept coming, all around. I held them, soothed them, and sucked in the powdery smell of their soft baby heads. I chipped in to buy strollers and copies of Goodnight, Moon. I babysat and carried bags loaded with plastic buckets to the beach. One baby in particular may have saved my sanity, through her implacable babyness, as I cared for her through a bitter winter of crushing unemployment and romantic disappointment. And even as my friends’ complaints about nipple chafing and colic left me out in the cold, the cynic in the corner, ever-ready with an eyeroll to say, “Enough about your bloody boobs, let’s go smoke,” I did look at them, children and their mothers alike, with awe and with wonder.

And when too many of those same friends suffered, in turn, wrenching divorce, I thought, my God, how awful. And, also, “I’m lucky.” But the kids – if this is the price they paid for these kids, maybe it was worth it?

*

I went to the doctor.

“Congratulations!” she said. “This is exciting. There’s no reason this can’t be a normal, healthy pregnancy.” A pause. “You must be a bit overwhelmed.”

I was – and not just by the cells dividing south of my navel. Did you know that, currently, only 12 percent of individual health insurance policies offer coverage for basic maternity care? That such coverage is mandated by only eight states? I didn’t, until suddenly I did.

Carriers in states without a mandate may offer coverage in the form of a rider, a package of benefits above and beyond the basics. But in addition to being expensive, and often sorely limited in scope, these riders, it turns out, are not something you can opt into once you become, in fact, pregnant. Because, of course, at that point your pregnancy is a pre-existing condition.

To say I was distressed would be a civilized gloss. I was on fire with the white-hot fury of 100 suns after gleaning this information from the internet. Thankfully, a phone call to my own carrier, Aetna, informed me that it was a moot point. Because, not only does Aetna not offer maternity coverage as part of my carefully acquired insurance package, it does not offer any maternity coverage at all, even as a rider, on any individual benefits package.

Babies, it turns out, are not cost-effective for the insurance industry. Because, guess what? When women purchase maternity coverage, it’s a pretty good bet they plan to use it.**

The base cost of nine months of prenatal and three months of postpartum medical care for a routine pregnancy and delivery is estimated at $10,000. One office visit with the ob-gyn my GP had packed me off to was going to run $400, out of pocket – and even though Aetna wasn’t about to cover me, I make too much money to qualify for Medicaid.

I stood in front of the (very kind) receptionist, sweaty and humiliated. “I’m sorry,” she said.

“Thanks,” I said. “It’s my own fault. I should have checked.”

*

I was five years old when Roe v. Wade was decided. I grew up with choice, reproductive and other, as my birthright.

When I got pregnant at 20, in college, the choice was clear. There was the 45-minute drive to the closest clinic, the counselor, the oblivion, and then the groggy drive home, maxi-pad packed between my thighs. Afterward, there was pizza.

What I didn’t expect, what no one prepped me for, including the (very kind) counselor, was that the dust kicked up in the process of choosing one choice over another doesn’t drift away once the choice is made.

In the months that followed my abortion I flailed. I don’t remember much, but I do remember the crippling waves of panic. I couldn’t eat; couldn’t breathe. I landed in the emergency room a few times, hyperventilating, numb, convinced I was dying, and my boyfriend was stuck with the fun task of feeding me daily doses of Xanax as I crawled across the finish line of the semester. After that, I dropped out of school for a while.

That clear choice? I’m glad I made it, even though it sucked.

Now, two dozen years later, I’m not a scared student anymore. I live in a big blue city in a state that, so far, has resisted the pressure to play pinball with women’s health. I have citizenship and I have agency and I have options. I did the math, adding up the costs of health care, child care, education, better housing. I thought about the guy, still in the dark, though not for long — and I looked up the nearest Planned Parenthood.

*

How does this story end, this modern choose-your-own adventure? Does it end with a bouncing baby or cold, clinical regret? Is there something in between?

I’ve spent most of my professional life as an editor, shaping clear story arcs out of baggy narratives; helping writers craft coherent characters and identify conflict, nudging them to fill in missing facts and excise extraneous ones – the ones that don’t advance the story.

Despite this, or maybe because, I have a strangely hostile relationship to tidy endings and smooth story arcs. I long for messy stories that don’t end with an epiphany – confusing stories awkwardly told by unreliable narrators. I crave stories bold and weird enough to stay ugly and leave questions unanswered.

I hated the movie Knocked Up, for example, as much for its pat, redemptive ending as for its casual nonengagement with even the idea of abortion. “I don’t care if it’s fiction!” I railed at its fans. “That never, EVER happened!”

At some point most people – and by “people” I guess here I mean “women,” though I’d hope this could be extrapolated to include men, and filmmakers – learn, through more or less painful personal experience, the futility of magical thinking. You know what I mean: The passionate conviction that, against all factual evidence, the alcoholic will wake up sober. That the married man will leave his wife. That the New Yorker will come knocking. That positivity can cure cancer. That visualization can conjure wealth. That an accidental pregnancy can be a blessing in disguise.

All of this may or (more likely) may not happen. But whatever the outcome, it’s not thanks to the power of hope and faith. The world turns inexorably, no matter our most tightly held desires, and what change we do manage to effect is the product, most often, of grinding hard work. Fairy tales, in short, don’t come true – and the ability to envision realistic, sustainable fantasies – and execute them — is a hard-won key to adulthood.

I knew all of that. But I couldn’t shake it, this fairy tale of a crooked life path made straight and bright by a baby. I still wanted to believe.

*

“I mean, I’m sorry – but I just think that people who can’t afford to have kids, they shouldn’t.”

My friend was talking about some random pregnant cousin, but her words chilled. She didn’t know. How could she know I’d just been at a low-income clinic, asking about prenatal heath care?

Back when I had a full-time job and comprehensive health insurance, I worked 50, 60 hours a week. I didn’t have time to date, let alone have a baby. I loved my job, but I could barely take care of my cat. I could not have afforded a child, by the sheer economics of time. `

Then, when the bottom dropped out, I left that job. It was my choice, one I was lucky to be able to make. I could probably have gotten a job in advertising or communications. I hear about these jobs, jobs with summer hours and margarita nights and full-ride benefits, and I know that the corporate path is a choice many people make in the name of security. But I didn’t. Instead I chose to keep trying to patch something new together and call it a career.

Does the choice to hold tight to my independence and make my time my own make me less qualified to have a child? According to Anne-Marie Slaughter, this should be giving me a leg up in the game of work-family balance! Instead, parenthood was shaping up to be yet one more thing, like decent health insurance, or a writing career, that is now the exclusive province of the monied middle class. If I wanted a baby, should I have looked for a rich man to marry? Taken that job in PR?

Another friend tried to set me straight. “There’s no birthright to come into the world with a two-parent, prepared-in-every-way family with parents between the ages of 26-36,” she pointed out. “We both know enough people who on paper looked like the perfect family who have exploded in one way or another or several.”

*

I worked it over. And over again. I felt like a fool, but I wanted to go through with it, to at least see what happened next. Money? Paternity? I would figure that out. I was an educated adult with friends, loving family, at least a few resources.

But, wait, was I abdicating personal responsibility by feeling inclined to let nature take its course? Was I selfish? Was I secretly seeking the social legitimacy motherhood confers upon a woman, even if it’s motherhood of the illegitimate kind?

Was I prepared for the irreversible effect a child would have on my finances, my future, and, quite possibly, my health?

Or, but, wait, was I conflicted – was I considering an abortion — because I have internalized misogynist cultural messages that say that women should be seen and not heard, should sublimate her own desires to those of the patriarchy, should be a pliable, no-strings-attached fuck buddy? Should not, above all else, be inconvenient?

Like most people, my sexual life holds plenty of secrets, some painful and some just plain private. But pregnancy isn’t a secret you can keep for long. Was getting pregnant – or, really, staying pregnant – just a narcissistic bit of sexual exhibitionism?

Or was I just, still, unfathomably naïve?

“I think it’s a mistake,” he said, when I screwed up the nerve to get in touch. “It’s your choice, of course. I’ll support it, whatever you decide. But I think it’s a mistake. It just doesn’t make sense.”

He was right, of course, his voice alarmed, cracking in raspy patches across the bad connection. It didn’t make any sense at all.

*

When I saw the first blood I felt a wash of relief, which I quickly plugged with a sandbag of denial.

Perhaps the best-known fact about miscarriage is that no one talks about it. But what they really don’t talk about, when they’re not talking about it, is how much it can hurt. In your heart, yes, and also in your guts.

A few hours after the phone call with the would-be father, I started to spot, first a dull rusty clot, then the palest pink smear. As if my seven-week-old embryo had heard the fear in his voice, said, “OK, then,” and begun the 16-hour process of detaching itself from my uterine wall. As if by magic.

Mercury was in retrograde. It was, for crying out loud, Friday the 13th.

I tried to convince myself the spotting was normal. Happens all the time, right? At that point I was wrung out, and starving. I went to get a burger with a friend and ate half her bacon-blue cheese pizza as well. Then, on the way home, at the grocery store, came the hemorrhagic gush, the brightest clear red.

I went home, drank some wine. So, I thought. This is what a miscarriage is: A lot of blood and sadness, and these little pings of pain.

At 5 a.m. stabbing, crescendoing cramps kicked me up out of uneasy sleep to scream and clutch the pillow. Then came phone calls, to a nurse, to my sister, to a friend. My roommate begged me to go to the ER. And when, hours later, after one final pelvic-splitting contraction, it slid down my cervix with a pop, a 3-inch oyster of blood and tissue and the tiniest tiny fingers. I yelped, surprised. But that part? It didn’t hurt at all.

It plopped into the toilet and sat there till I scooped it out into an empty hummus container. I poked at it with the end of a plastic spoon. Turned it over. It was so small, this thing that loomed so large. I was too tired to be upset. I was just happy the pain had stopped.

*

I buried my seven-week-old embryo, my oyster, on the banks of the Iowa River. I didn’t mean to take it across state lines. In shock, a zombie really, I drove that night to Iowa City to give a book talk. I forgot it was in my bag; I’d taken it with me to the (heartbreakingly kind) doctor at the low-income clinic, who told it wasn’t my fault, these things just happen. But once I realized what I’d done, I had to work with it. So the next day, hormones leaching from my body after night sweats had soaked my sheets, I got some frozen yogurt and walked my hummus container down the University of Iowa campus to the water.

I crawled down onto a slab of concrete along the riverbank and dug a little hole in the sticky clay soil, then pried off the lid and splashed it all in – a rank stew of blood and urine and tissue that reeked with the tang of day-old death. As the liquid dribbled down the slope toward the water and soaked into the clay, what remained was revealed, bleached of color, a cold spoonful of pale membrane and mass. I covered it with soil and rocks, then mumbled something intended to make me strong and called my parents.

The next day it took six hours to cover the 250 miles between Iowa City and Chicago. I kept having to pull off the interstate and cry. I cried for blotchy days – in the car, in bed, at the clinic where I applied (fruitlessly) for retroactive Medicaid to cover the bills the pregnancy left behind.

And then, eventually, I stopped crying. And when my grief floated way, I was left with … nothing.

“Of course you feel ‘empty,’” said the therapist. “Something is missing. There was something there, and now it’s gone.”

*

“It’s for the best, obviously,” I said.

“No hard choices had to be made,” he said.

“My body just made the choice instead.”

But I felt cheated. I wanted my mind to have made the choice.

Being pregnant was overwhelming. I was confused and beyond stressed — but I can’t remember when, for such a brief window, I felt so empowered. If nothing else, I had thought, pregnancy takes time. I had time to sort it out, this idea that could maybe be a baby, or not.

But, it turned out, I didn’t. My time was up.

“Spare me the self-help bullshit,” I snarled at my sister while I sat, snot-nosed and gasping, behind a gas station off I-88 on my way home from Iowa. “Life isn’t Eat, Pray, Love. If you try to turn this into a teachable moment I will fucking scream.”

But, of course, narrative demands closure, so here it is:

It’s exhausting, day in, day out, making choices. Who hasn’t dreamed of a deus ex machina, a magic wand? It’s so much easier to let things slide, to be too stressed out, too busy, too tired or hungover.

But choice is power. It forces you to live in the active present tense, not the editorially lazy passive construction of this-happened-to-me. Make a choice and you can’t abdicate responsibility to the real or perceived will of others or the now of perpetual distraction. Make a choice and you confront the closed mystery of the choice not chosen. If ambivalence is a hallmark of denial, choice is an acceptance of time, mortality, limits.

There’s a lot of magical thinking about pregnancy going around these days. In the personal sphere it’s a waste of time; in the public sphere it is terrifying and destructive.

Contrary to the beliefs of conservative politicians, women’s choices about pregnancy are not a question of will, or luck, or magic vagina barricades. Getting pregnant is neither punishment nor reward. It is not a magical blessing or a curse — and it most definitely is not a silver bullet you can use to shoot yourself out of a rut. It is a plain biological fact that may or may not result in a healthy baby, that could immeasurably enhance or irreversibly damage your life prospects.

Women are raped and get pregnant. Women in loving monogamous relationships who want to get pregnant can’t. Women with five children are forced by circumstance or religion to have more. Lesbian women who long to be parents have their hopes squashed by red tape and bigotry. Single women who get pregnant by accident and suddenly have to re-evaluate their attitudes toward the whole question of whether they will ever raise children end up miscarrying.

In the world of women’s reproductive health, choice isn’t only a euphemism for safe, legal abortion. Choice — true choice — entails sex education and work-life balance and accessible, affordable prenatal medical care for all pregnant women, regardless of income or employment status. (For the record: If I’d waited two more years to get accidentally pregnant, such coverage would be mandated as part of an essential benefits package by the Affordable Care Act ).

Did you know that if you are pregnant and French, you get 16 weeks of mandatory paid maternity leave plus an optional three years of unpaid leave, no strings attached, plus low-cost day care, plus financial support for single parents? They’ll even send a nanny to your house once a week to help you clean up.

Of course, that’s France. What could true freedom of choice look like in this country? It would mean a social and political structure that looks out for the well-being of actual real-live children — and their mothers — rather than using their hypothetical lives as weapons in a neverending demagoguic death match. It would mean not having to reduce every game-changing life decision to a calculation of dollars and cents.

I was not raped or victimized. I am not 13, uneducated, or impoverished. I do not live in Kansas or Alabama or North Carolina or Arizona. I did have some excellent consensual sex without benefit of wedding ring or adequate health insurance. And then I got pregnant and the choices at my disposal threw me into a monthlong tailspin until, in a few painful hours, those choices vanished, through a very nonmagical physiological process.

No one has unlimited choices; that’s a fact. So what lingers after this long, hot, confusing summer is this: With so many forces legitimately outside our control – forces of biology, history, geography, age — why is every woman in the United States not running blue-faced onto the field to do battle with those who would take what choices she does have away?

* Just as I felt extremely conflicted about dragging a man into fatherhood, I am conflicted about dragging him into this essay. So for the most part I’m trying to leave him out, even though that means forfeiting the chance to dig into some other interesting questions about reproductive choice, gender, and society. You will also just have to take my word for it that he could not, for various reasons, be part of the big picture. Sorry!

**For some uplifting reading, go here to download the National Women’s Law Center’s 2009 report “Still Nowhere to Turn: Insurance Companies Treat Women Like a Pre-Existing Condition.”