Miscarriages of Social Justice

I’ve been pregnant twice. Both pregnancies amounted to little more than pendulum hormones, roller-coaster mood-swings, and a madhouse uterus inhabited by ghostly insubstantial shapes. For me, pregnancy ended up being over-hyped, each event promising more than delivered, at least initially. It took years for me to recognize that I got something after all: I came to see the twisting shadows of privilege, inequalities, and oppression across the female body.

Jackson Pollock in My Panties

I was 34 the first time I got pregnant. In February I had started not not trying, weening myself from oral contraceptives and mentally preparing myself to no longer live a childfree life. Along with my then-husband, I hand-wrung about how to grow our family and continue working, me at a Georgia university nearly an hour-and-half commute east of our rental home, him two hours west in Atlanta. But we jumped in, certain that everything would work out.

By March, I was peeing on a stick in my bathroom, the hieroglyphics materializing in white plastic signaling my pregnancy. By April, I stood alone in another bathroom, this time in a stall at my university, fluorescent lighting illuminating the spots of blood. My panty crotch looked like the white canvas after Jackson Pollock’s first drops of red.

The rest of that day formed a surreal landscape, portions vivid, colorful swirls of activity, others stark, blank, abandoned by my consciousness. Over a decade later, I still see myself standing in the doorway of my colleague’s office, the light filtering through her window as I stuttered about the blood coming out of me.

What I remember next is the hospital room, cold, gray, windowless.

“I think your body is trying to miscarry,” the ER doctor said as I huddled on an exam table.

My pregnancy was broken, and my body was shutting it down.

Back home, I sought refuge in my OB/GYN’s office, a place of clean white walls and expensive furniture that looked to have been plucked from an English garden. There was money in the lakeside community in which I lived. Near my rental house was a quaint grocery store, offering a pricey but intimate shopping experience, and up the road sprawled the Ritz Carlton, providing a retreat for wealthy, largely white, vacationers. And there was the lake itself that stretched for miles, beckoning fishermen, boaters, and swimmers, its shoreline dotted by golf courses and vacation homes.

Flanking our lakeside community, though, were struggling towns, to my eyes the signs of their decay magnified by the signs of our prosperity. A short drive north on a sleepy highway edged by shaggy pines sat the county seat, an area sprinkled with antebellum homes and small shops in a picturesque downtown. Sticking in my mind are my memories of the old public school. Right on the side of the highway, the single-story structure seemed hunched over from the weight of neglect, several busted windows never fixed, at least not during my time driving those roads.

Having given birth to politicians, musicians, and athletes, the county seat was historically and culturally rich; however, it languished economically. Unemployment rate high and median income low, the neighboring community was home to primarily low-income families of color and served by an overstretched yet impressively comprehensive health clinic. One summer, I worked at that clinic. On humid Georgia mornings, I would leave my lakeside rental, drive up that sleepy highway and turn into the clinic’s tidy parking lot. Firsthand, I saw the influx of community members arriving for checkups, treatments, and counseling. And I ached: for both the underserved residents and the clinic’s overburdened health professionals. Both community and clinic worked to make ends meet, but they suffered too. The sole counselor, a white lady with corn-blonde hair, had an enormous caseload; meanwhile, the nurses and physician assistant, a diverse and committed group of professionals, pushed themselves even harder after losing their attending physician (too far to drive to the remote clinic for too little pay, as I understood it).

Without a doubt, my miscarriage was excruciating, mentally more than physically; yet, I now see the golden threads of privilege winding their way throughout my experience.

A white, middle-class, educated woman residing in a lakeside community, I had access to a cozy doctor’s office, one that smelled to me like Williams Sonoma potpourri. I had access to an OB/GYN who had time enough to look in my eyes when I spoke, address me by name, and listen to my stories. And I had access to a car to drive myself from my handsome house along a well-maintained road to the pristine medical office building. Unlike many others in the region, I didn’t have to find a ride to a remote clinic, pray that a physician was on-staff, or sit in a rigid plastic chair in a stuffed waiting room as my insides ripped, tore, and drained.  

Still as privileged as I was, I was also soon able to see the invisible forces oppressing the female body.

Mysteries in the Hinterland

In my memories, my OB/GYN appears like a delicate swirl of vanilla ice cream on a sugar cone: her hair icy-blonde, complexion pale, lab coat white, all atop brown pants, and her voice both coolly professional and creamily compassionate.

In some ways, she became a Wise Woman too, the archetypal Feminine who whispered secrets and unveiled mysteries for me—four mysteries in total.

First, I had a nonviable pregnancy, something I had never heard of, at least in name. It was the kind of pregnancy that exposed itself in opaque shadows on an ultrasound monitor and in the swell of a belly, rounded and fecund to the eye, but there would be nothing more.

Second, my body remained oblivious to the fact that the pregnancy would never work, something that made little sense to me. My beta hCG levels (pregnancy hormones) continued rising, my undaunted reproductive system churning, trying to foster a deflating gestational sac around a dying tangle of cells.

“I want a D&C,” I told my doctor after realizing that my body refused to give up on the failed pregnancy.  

D&C, or dilation and curettage, is a lickety-split surgery. It takes less time for the patient to have one performed than to prep for it—to drive to the hospital, to complete forms, to change into a gown, to hop up on a gurney, to get drowsy on a delicious cocktail that makes a woman forget that she’s on the table to get her uterine lining scraped. The way I saw it, I had the insurance, time, money, and motivation. I wanted the hell out of this nonpregnancy-pregnancy.

And here’s the third mystery my doctor, my Wise Woman, unveiled for me:

There would be no D&C, not until my hCG levels declined.

“That would be an abortion. I can’t perform an abortion in the hospital,” her explanation feeling more like a testimonial about how women’s bodies are controlled in hidden ways.

In that moment, the healthcare system instructed me: inhabiting the female body often means inhabiting the place of stuck-ness.

Yet, I also wonder about other women, especially those living in communities plagued by poverty, illiteracy, unemployment, and poor healthcare access. What about women of color who have been historically mistreated and misused within the healthcare system? What about women in same-sex relationships who are often dismissed, if not blatantly discriminated against? What about the women without a salaried job or an insurance card, like the kinds that I had?

Here, I consider the fast-food employees, the grocery store cashiers, and the motel housekeepers, those earning hourly wages who worry about hurting themselves and their families by taking time off work. And I think about the women bleeding, and the nearest hospital almost an hour away by car.

Ultimately, intertwined with my memories of that first miscarriage are my realizations: realizations about women who share with me the physical experience of pregnancy-loss, but not the same socio-economic experience. Of course, these reflections would come later. At the time, I was pissed, particularly as I became aware of how little control I had over my female body.

Continuing to bleed, and at risk of hemorrhaging, my doctor directed me to avoid solitary activities, like walking and driving. Since my job was well over an hour away, I usually hit the lonely, dark interstate by 4:00 am, enabling me to reach my office before my workday began. Additionally, it was the end of the semester at my university, and I had almost 100 college students counting on me to show up. Rejecting the advice of my OB/GYN, I concluded that I would not be giving up the long, solitary drive to and from work.

The truth, though, is this:

I could have taken my doctor’s advice. I could have afforded to take leave from work. I could have propped up my feet in my rental home with its eggshell color carpeting and walls, and a lovely deck that faced the lake. I could have waited in relative safety and luxury for my reproductive system to give up its unproductive fight. How many other women could have done these same things?

At the time, my fury grew, though, fueled by my feeling of being held hostage by a protracted miscarriage and a healthcare system unwilling to help me end it. That’s when my OB/GYN unveiled the fourth mystery.

“I’ll get an abortion,” I declared to my doctor. “I’ll go to a clinic in Atlanta.”

I was determined to escape the pregnancy/nonpregnancy hinterland, that strange in-between place filled with hormonal storms and the swelling landscape that, in fact, was not fecund.

“You’re bleeding,” my doctor replied to my declared intention of having an abortion. She informed me that not only would I have to pay out-of-pocket to terminate my nonviable pregnancy, but more than likely, the abortion clinic would refuse to accept me as a patient because of possible complications.

As privileged as I was, I remained stuck.

Two months into my pregnancy, my hCG hormone levels fell. My husband drove me to the closest hospital, almost an hour away in another charming Georgia town, the kind with regal columns and lazy downtown streets. There, I presented my insurance card before being sedated and wheeled into an OR. The surgeon on duty scraped my uterus clean and after I woke up I climbed unsteadily into the passenger seat of my car and was driven by my husband back to my lakeside home.

The Gift of an Eight-Month Miscarriage

Shortly after my first miscarriage, I left Georgia to return home to Southern Appalachia for a position at another state university. It was a period of renewal and rebirth. I had a steady job as a professor, fantastic health insurance, and we were homeowners in a fabulous neighborhood in a top-ranked school district. So when I got pregnant a second time, I was ready, my confidence resurrected in my reproductive system, as well as the healthcare system.

As I peed on another stick, I told myself, “Maybe this pregnancy will take.”  

It did not.

On my back, my legs spread during the transvaginal ultrasound, I studied the tech’s face, her lips as rigid as the blades of a metal speculum.

“Let me get the doctor,” the nameless sonographer mumbled, not even glancing my way as she zipped from the room. In an instant, the cheery atmosphere evaporated, replaced by a haunting silence.

During my second nonviable pregnancy, I wasn’t as naïve, so I thought.

“I’m going to do the expectant management thing,” I proclaimed to my new OB/GYN.

Expectant management is the non-intervention intervention: no hospitals, no surgery, and no one telling me I couldn’t have this-or-that procedure to end an already failed pregnancy. By electing to miscarry the “natural way,” I would liberate myself from those forces that sought to control the female body.

“It will take about a month for your body to complete the miscarriage,” my doctor said. With that, she proceeded to apprise me of the possible disadvantages (infection!) and advantages (no surgery!) of expectant management.

Though feeling profoundly sad and woefully inadequate as a woman, I also experienced a surprising sense of agency: I would end my second pregnancy on my terms, and it would only take a few weeks, four at most, I assured myself.

Eight months later, I lingered in the pregnancy/non-pregnancy hinterland, my miscarriage still incomplete, but I resided in this place out of choice. After my hCG levels dropped, I could have switched to a surgical option; I had the insurance and the work flexibility, unlike many women in Southern Appalachia.

Once again, as I write this, I catch sight of those golden threads of privilege winding through the tapestry of my narrative.

Southern Appalachia, my home, is a richly complex region and populated by richly complex people; however, it is also a place of pronounced health and economic disparities.

Similar to some communities of color in Georgia, Appalachian communities have long struggled to access healthcare. In the Mountain South, remote medical fairs temporarily take over expansive fields in rural locations or deserted racing coliseums, providing limited—yet valuable—dental, eye, and medical care to thousands.

Years ago, I met a woman at one of those medical fairs, speaking with her at the edge of a cool, early-morning field already swarming with people vying for the limited health services. Facing some concerning symptoms, this woman needed to see an OB/GYN for diagnostic screenings, but, as she explained, she would have to beg a ride from someone down a long, winding mountain road into the city two hours away.

“And, what if the doctor finds something wrong with me?” she asked.

I fumbled for a response, in part, because I was struggling with a dawning recognition: this woman was right. Throughout Appalachia, socio-economically marginalized women must overcome obstacles simply to get an appointment. Then what? How does she get to the appointment, particularly if living in the countryside? What if she receives a troubling diagnosis, one requiring monitoring, medication, and/or treatment? What if she must pay for costs out-of-pocket?

In that field all those years ago, that woman, another Wise Woman, helped me more clearly see the social inequalities some females face when accessing healthcare.

For eight months, my body worked to empty my uterus, and that entire time, I could afford to be as stubborn as my reproductive system. I could afford to refuse surgery. I could afford to risk hemorrhaging—I lived a short drive from the hospital and within a community that housed a highly respected medical school. I didn’t have to beg for someone to drive me off the mountain, so I could be monitored throughout my prolonged miscarriage. I didn’t have to ask time off from work. I didn’t have to decide between feeding my family or paying out-of-pocket for appointments, medication, and treatment.

All I had to do was wait.

Close to the time I would have given birth—had the pregnancy been viable—I completed my eight-month miscarriage. Ensconced in a hotel conference room during an academic meeting far from home and distracted by scholarly presentations, I was startled by the sensation of something oozing out of me. Between panel presentations, I dashed to my private room and pulled down my panties. Laid out on the maxi pad—the thick kind I’d taken to wearing in preparation for this day—was a tangle of fibrous blood, a melancholy reminder of my first miscarriage down in Georgia.

From my best estimate, I spent around 300 days pregnant/nonpregnant. I neither regret nor define myself by these events. What I am, however, is acutely aware of the shadows draped across women’s bodies, a distorted interplay of privilege, inequalities, and oppression.

And what I got from these experiences was sharper sight: I better see the miscarriages of social justice that women experience when inhabiting the female body, especially in the space of reproductive healthcare.