No One Tells You the Full Truth About Pregnancy and Childbirth

Illustration: Vicky Leta

When I was pregnant with my daughter two years ago, I was a borderline psychotic consumer of pregnancy-related literature. I was riveted by the process my body was undergoing. I felt like a sorceress and a science project.

My bookshelf transformed into a library about what to expect or not to expect or why those other books about expectations were wrong. I hired a doula, whom I was in contact with almost daily. I texted with friends who had small children and communicated with other first-time mothers through my newsletter. I became an encyclopedia of Weird Shit About Pregnancy. I could bring any conversation to a screeching halt by pointing out that at least a pound of the weight gained during a typical pregnancy is blood, because when you’re pregnant, your body makes a ton of extra blood. Isn’t that gross? Isn’t that cool?

But there is so much that the give-it-to-me-straight, medically informed literature didn’t tell me about pregnancy, birth, and the first months of motherhood. Culture-wide, there’s even more that gets minimized or glossed over. So few pregnant people—even those of us who go in armed with as much information as possible—are prepared for what actually happens.

I was not prepared for how much of pregnancy and childbirth seems to just be doctors trying stuff out. Considering how common childbirth is, the amount that the medical community still does not understand about pregnancy is staggering, and so much of what it thinks it does understand was informed by a gynecological history of patriarchal, racist, and misogynist beliefs about women’s bodies. The literature I read explaining symptoms a person could experience during or after pregnancy could be boiled down to: “Here’s a symptom. It could just be a regular thing, or it could mean that you and your baby are going to die. Better call your doctor to be sure.” But when you call your doctor, your doctor is like, yeah, keep an eye on it and go to the ER if it gets worse. When you go to the emergency room, unless you’re hemorrhaging or literally crowning, they usually send you home and tell you to call your doctor. Seeking medical care while pregnant, even under the best of circumstances, is like being stuck inside of the Spectrum customer service phone menu as you try desperately to speak to a human. And then, even when you get somebody on the line, the answer is usually “you’re probably fine.”

Pregnancy: You’re Probably Fine.

I had an easy pregnancy, comparatively. I didn’t get morning sickness. I had a strong aversion to sardines, and the only reason I found out I couldn’t eat them was because I read an article about how sardines are a nutritious treat packed with vitamins and minerals that fetuses just love, so I made a whole sardine-centric recipe only to realize as it filled my home with a fishy aroma that this was my appetite’s limit.

I was in a great mood 75 percent of the time. My fatigue was not debilitating. My extremities didn’t swell. I was dealt a good hand physically; I had one of those cute little pregnancies where even at the very end I looked like I’d swallowed a basketball. My worst symptoms were persistent, painful leg cramps that would wake me up in the middle of most nights, the discouraging addition of prominent varicose veins to my lower legs, and the fact that the 25 percent of the time that I was not in a great mood, I was crying. And every time I brushed my teeth or flossed, I’d bleed so much that my sink would look like an OR from The Knick. And then there were the random, horrifying nosebleeds; the psychedelic, nonstop, occasionally horrifying dreams; the general feeling of visibility and vulnerability when I’d go out in public, or buckle myself into a car that was designed to save human lives by crash testing primarily man-sized dummies; and the fact that for the first half of the pregnancy, my placenta covered my cervix, which meant that a doctor told me not to have sex until the situation resolved itself months later. I had no idea that a prescription for “no sex” was something that might happen during pregnancy, one of the only times in a woman’s life when she can just have unprotected sex with abandon because you can’t get double pregnant! But other than that, pregnancy was great.

I wonder if medical professionals don’t have enough empathy for their patients to convey how life-interrupting childbirth can be, or if those of us who have given birth are afraid to scare people.

Most mothers I know had a much worse time. A friend had morning sickness so bad that she couldn’t get out of bed some days; another could only keep down chicken-flavored ramen and ginger candy. A tiny woman who, despite all of her efforts to eat healthy and stay active during her pregnancy, gained 80 pounds and developed gestational diabetes and had to work for years to regain her pre-pregnancy health. A woman I know had so much anxiety around pregnancy loss after a stillbirth years ago that her doctor recommended an elective C-section three weeks before her due date (pregnancy loss is another thing that leaves women feeling alone). I’ve spoken to women who fell into barely manageable states of antenatal depression, but researchers have done very little to look into mental health solutions that are safe for pregnant women.

A woman I know felt odd one morning at 36 weeks pregnant and went to the doctor just to be safe, only to discover she was suffering from a silent and life-threatening condition called preeclampsia (sudden, dangerously elevated blood pressure during pregnancy). She barely had time to call her husband to let him know she was being wheeled in for an emergency C-section so that she wouldn’t die.

A relative lost a third of her blood and nearly died. A lot of American women die from complications related to pregnancy and childbirth. A disproportionate number of those women are Black.

A friend of mine went into what’s known as prodromal labor early in her third trimester. Her doctor told her that no intervention was possible until she hit 37 weeks’ gestation, which meant that for over a month, she was having irregular contractions at all hours of the day. Have you ever had a contraction? They don’t tickle! There’s nothing she could have done to prevent it; as with many suboptimal pregnancy outcomes, it’s just what happened. Her doctor ordered her on bedrest, which has a measurable effect on the mental health of the women being ordered into it, but only thin evidence to support its use as a prescriptive.

Sometimes I wonder if all this knowledge is kept from us deliberately because of the belief that if more women knew the truth about giving birth, very few would actually want to do it, and our catastrophically low birth rate would drop even lower. I wonder if medical professionals don’t have enough empathy for their patients to convey how life-interrupting childbirth can be, or if those of us who have given birth are afraid to scare people, or some cocktail of these factors.

It wasn’t until I was visibly pregnant that I got a sense of how traumatic it might be to give birth. People would confide in me about failed epidurals, unplanned unmedicated labor, the unimaginable pain of back labor (which has been given the too-cute-by-half nickname of “sunny side up”). I learned about unwanted “cervical checks” that don’t really give doctors much useful information but are still pushed on laboring patients, which, to anybody who has experienced medical or sexual trauma, can add to the fear and pain of an already frightening and painful process.

I did not know that epidurals can fail and wear off or that some kinds of labor induction result in more painful labor. I had no concept of how intense pain could be until my water broke and I spent the next 16 hours trying valiantly to have an unmedicated labor. Worst pain imaginable. People say you forget the pain, but I still remember it. I’ll never forget it.

I had heard about tearing from vaginal births but didn’t know that there are several different degrees of tearing, from a wee little “first-degree tear” to a full-on anus-to-vulva fourth-degree tear. Any tearing at all takes a long time to heal. Some mothers can never pee normally again. Some experience something known as pelvic floor collapse. Imagine if your pelvis had a floor and the floor collapsed. That’s what that is.

I learned about how traumatic an emergency C-section can be to birthing mothers. I learned how traumatic witnessing their partners in labor can be to dads or non-birthing parents. My friend’s husband had to go to counseling after watching her give birth.

Before I had my daughter, I read that after the baby is born, you also must birth the placenta, which weighs more than a pound, is the size of a record, and is made of bloody meat. I knew that removing the placenta was important to prevent postpartum infection, but I did not know that if the placenta is hesitant to detach from its cozy little home in the uterine wall, the doctor on duty might reach their hand into your birth canal and yank the thing out, leaving you with a record-sized open wound inside of your body. Other options for birthing the placenta include a nurse pushing down on your abdomen as hard as she can, forcing the single-use organ out of your body. My epidural worked like a charm (after two attempts), so I felt none of this, but for women whose painkillers are less effective or nonexistent, this is supposed to be one of the most painful parts of labor. Nobody really talks about it.

While we’ve gotten better, collectively, at telling the truth about what pregnancy can do to the body, most of the details we discuss still put the experience into soft-focus, or shrink it down to nine months of minor but comical discomfort that can be shared with a chuckle. Pregnancy is cool and miraculous, and it’s fantastic that our bodies can do it—but carrying a pregnancy to term is also something that could literally kill you and at the very least will change your body permanently.

Yes, there’s a lot more permanence in pregnancy than I was led to believe. Before I started actually talking to mothers, I was under the impression that the long-term effects were primarily visible: stretch marks, “baby weight,” changes in the shape and size of breasts. But pregnancy affects every system of your body. It can leave traces everywhere. Those things I was worried about—how my body would look after birthing a whole human it grew—turned out to be the least of my postpartum worries.

All of this was weird and hard and painful and scrambled my brain and made my hair fall out, but on the other hand, my daughter is fucking cool, and my hair’s growing back now and looks fine.

The first few weeks after giving birth are not entirely a warm, fuzzy time of newborn cuddles and fluffy-robe-wearing. Postpartum bathrooms look like war zones. I had an entire kit of spray-on topical pain killer, a hand-held bidet, and special witch hazel wipes that enabled me to sometimes pee without crying out in pain. And pardon the detour into the scatalogical, but the first post-birth shit is one of the most harrowing moments in a young mother’s life, regardless of whether the birth was vaginal or cesarean.

I had no idea morning sickness and food aversions could last for months or years after giving birth, or that motion sickness could appear out of nowhere and stick around forever. I didn’t know that gestational diabetes could become permanent regular diabetes or that preeclampsia could randomly appear days or weeks after birth. I know women who can’t sneeze without peeing a little bit because of their decimated pelvic floors and people who say their doctors gave them a “husband stitch” without their consent.

I wasn’t prepared for how abruptly the medical care I was receiving would stop within hours of delivery. After giving birth, my baby’s doctor wanted to see the baby four times in the first month, but most OB-GYNs don’t see the person who gave birth for several weeks, even though a lot can go wrong in those postpartum weeks, both physically and mentally. There’s something kind of bitterly funny about taking a postpartum depression assessment in a pediatrician’s office.

Mothers (and fathers for that matter) are not given enough information about how hard breastfeeding is. Lactation consultants love to sloganeer that if it hurts, you’re doing it wrong, but I don’t know a single mother who successfully breastfed her infant without some degree of pain–especially at the beginning. The amount of nipple salves and gels and creams and cooling pads I went through was impressive.

The next time somebody says breastfeeding is “free,” I’m going to lift them over my head like a professional wrestler and throw them into the nearest thicket of bushes. Breastfeeding is a full-time job for the first months of a baby’s life. A breastfeeding mother’s sleep quality is worse than one who doesn’t breastfeed, because she must wake up every three hours to pump or feed. If she doesn’t, she’ll leak human milk all over herself, or her supply will diminish.

Breastfeeding also messes with your hormones, which messes with your sex drive. About three months after my daughter was born, all of the luxurious hair I had grown during pregnancy fell out in clumps, and then I got a ton of new gray hair while breastfeeding. You can also get pregnant while breastfeeding. People do it all the time, because they think that breastfeeding is a foolproof form of birth control. It’s not, unless you count the decreased sex drive as a form of birth control.

Pumping breastmilk absolutely sucks. There’s also something called D-MER, which is a condition where a mother feels deep sadness and hopelessness when she expresses milk. It’s terrible for any woman who experiences it. Then there’s mastitis, which happens when a milk duct gets infected and hurts like hell in addition to being dangerous. And I was not prepared for how breastfeeding sets the mother up to be the default parent, at least until the baby starts eating solids. This, psychologically, is difficult if you want to have an egalitarian division of labor, and it can lead to some tension with a partner.

There were times in those first few months of having my daughter that I was so sleep deprived, so alien in my own body, that I felt like I was about to lose it. I wasn’t prepared for how angry I would get at my husband during the first year of our daughter’s life. None of it was his fault; I was angry at how unfair it all seemed, and he just happened to be a nearby man I could yell at.

I’m not trying to scare anybody or convince anyone to have or not have children. All of this was weird and hard and painful and scrambled my brain and made my hair fall out, but on the other hand, my daughter is fucking cool, and my hair’s growing back now and looks fine. Have kids or don’t; that’s your journey.

Childbearing is an ordeal. And although nobody is guaranteed to have every side effect of it, or even more than a few of them, I wish I had understood more before I’d done it. I wish mothers felt more empowered to speak up and tell the whole truth about their experiences without being accused of fear-mongering. I wish the medical profession as a whole really put its back into figuring out ways to help treat common problems faced by pregnant and postpartum women beyond telling them to “deal with it” or “go to the emergency room.” And I wish I knew what happened to that extra pound of blood I made. I hope it’s doing OK, wherever it is.

Erin Ryan is the writer of the Substack Just Enjoy It While You Can and host of the Hysteria podcast. She lives in Los Angeles with (in order of seniority) her cat, husband, dog, and daughter.