TERRY GROSS, HOST:
This is FRESH AIR. I'm Terry Gross. After giving birth to her first daughter, my guest, journalist Angela Garbes, started breastfeeding. She'd been told by medical professionals, books and friends that breast is best, but she didn't understand what was so special about breast milk. So she did some research and wrote an article for the weekly Seattle paper The Stranger, where she was a food writer. What she learned about breast milk amazed her, and it amazed readers, too. The piece went viral. That led her to do further investigation into pregnancy and childbirth. Now she has a new book, called, "Like A Mother: A Feminist Journey Through The Science And Culture Of Pregnancy."
You don't have to be a mother or even a woman to be fascinated by the science and physiology that she writes about. Garbes had her first child nearly four years ago when she was 37. She gave birth to her second child just two months ago. A heads-up to parents of young children - we're going to be talking clinically about childbirth and about some of the things that can go wrong.
Angela Garbes, welcome to FRESH AIR. So your book is really about your first child, you know, delivering your first child and everything you've learned about childbirth. But I should say you had your second two months ago (laughter).
ANGELA GARBES: Yes.
GROSS: So (laughter)...
GARBES: So I'm still learning a lot.
GROSS: Yeah. How're you doing?
GARBES: I'm doing OK. Honestly, I'm not totally sure. You enter - I was earlier calling it the milk cave.
GROSS: (Laughter).
GARBES: You enter a necessarily domestic inward place after you have a baby. And having a book out at the same time is an interesting contrast because that goes out into the world, and you have to be a very public person in many ways after that. So I'm walking a fine line. I'm living on the edge, maybe? I'm not totally sure. But, overall, I'm happy.
GROSS: OK. I think one of the most fascinating chapters in your book is about the placenta.
GARBES: That was my favorite chapter to write.
GROSS: (Laughter) OK. And I want to start by saying, like, you had a friend who had who had given birth who said to you, they might not mention this to you, but, after you're done giving birth to the baby then you first have to expel the placenta, and there's going to be more contractions and something else kind of large (laughter) that you have to expel from your body. Were you surprised to hear that?
GARBES: I was. I was. I mean, the way she said it, it was - it felt visceral, something physically real when she said it. And it was - you know, there's so much about pregnancy and childbirth that it's all theoretical, and you're like, yeah, I'm ready for that. OK, I can push a baby out of my vagina. Yes, and then there's this placenta. They do tell you that that's going to happen.
But what a physician or a midwife or a childbirth educator tells you is often very different from what one of your best friends will tell you. And so when she said, just know that you're going to have to push this whole other thing out, I realized on another level what that would be like. I mean, as it turns out, both of my births have been by Caesarean section, which was not what I had hoped for or planned on. So I never actually had to push a baby or a placenta out. I had a different experience.
GROSS: So explain what the placenta does. Like, we all know the placenta nourishes the baby. But you describe it as an organ. I never thought of it as, like, an organ. So tell us, like, the basics of what the placenta does.
GARBES: So it is an organ. It is an organ. It's a one-time-use organ that grows in a woman's body to support the baby. And it has two interfaces, has two sides. The placenta interfaces with both the mother and with the child. And so it nourishes the child by establishing a really deep connection with the maternal blood supply, and it takes that blood and it draws the nutrients from it. So that's the nourishment part. It also does gas exchange. So, you know, exchanging oxygen for carbon dioxide. It filters waste. And it's an organ that - one of the things that's so fascinating about it and that we don't ever think about is that it's an organ that precedes all of the other organs. So before a fetus develops, kidneys, liver, stomach, the placenta acts as all of those things.
GROSS: So does it keep growing as the baby grows?
GARBES: It does. It keeps growing, and it can be up to 2 pounds by the time a pregnancy is at term. But it has a very finite lifespan. So when you hit 34 weeks, which is close to full-term pregnancy, it stops growing, and it actually starts to deteriorate and age.
GROSS: So when you had your first child, you felt really strongly about wanting a vaginal birth. Why was it that important to you?
GARBES: I think I was always fascinated by childbirth and the strength that it takes to birth a child. And I had a strong belief that this is what my body was built to do. This is what women's bodies, female bodies and women's bodies have been doing for thousands of years, and I was excited to be part of that tradition and I was excited to feel that power.
GROSS: It was also a microbial reason (laughter)...
GARBES: Yes.
GROSS: ...Why you wanted to do it. Would you explain?
GARBES: Sure. So we're learning more and more these days about the human microbiome, which I find fascinating. So, you know, the number of microbes on your body far outnumber the number of cells in your body. So we think of bacteria as being kind of gross, they're the cause of illness. But in fact, what we're learning is that they're very helpful, and they're part of us, whether we - you know, we might never see them, but they're there with us and they're doing a lot of good work. They're helping us have a healthy digestive system, among other things.
And so I had heard that we have a vaginal microbiome, women do. And so when you give birth, childbirth is really messy and the babies exit through the birth canal through the vagina, means that they just get covered - their faces and their bodies - with the mother's vaginal microbiome, with those microbes. And that that's actually - that helps them, you know? That helps them. That's protective to them. It helps build their immune system.
And so I was really excited by that idea, especially since we grow up, many of us, thinking that, you know, our vaginas and our private parts are dirty, and we have to clean them and they're smelly, and that's bad. And the idea that these things that I've spent part of my life being embarrassed or ashamed by would actually be beneficial to my child, I just loved that idea.
GROSS: But it didn't work out that way.
GARBES: No. Definitely not.
GROSS: Yeah. You had to have a C-section. So you were having contractions for days.
GARBES: Yes.
GROSS: But you weren't dilating enough for labor, and it turned out the baby was putting pressure on your bladder.
GARBES: The baby was actually obstructing my bladder, or my bladder was obstructing her. Unclear.
GROSS: So explain why this was so dangerous.
GARBES: So I had been having contractions for a few nights. And the fourth night, I thought that my water had broken. I had gotten up to go to the bathroom, and I threw up and a gush of fluid came out of my vagina, or so I thought. So I thought my water had broken. We went to the hospital, and they did a test to confirm that it was amniotic fluid. And what happened was they came back and said, no, this isn't amniotic fluid. And an ultrasound revealed that my bladder was being obstructed by the baby so I couldn't pee on my own. And through the course of my labor, I was developing a bladder infection. You know, so there's this waste. My body's waste could not exit my body completely. And that was an issue, and my health became a concern. So that's how my labor and birth began.
GROSS: If you've never had your middle cut in surgery, (laughter), you might think, well, they just kind of make an incision and pull out the baby. But there's a lot of layers of tissue and muscle and stuff that has to be cut through.
GARBES: Yeah. This is something that I...
GROSS: Yeah.
GARBES: I didn't even know this. I didn't know what happened to my body until afterwards. Because I wasn't prepared for a Caesarean. It never occurred to me that that might happen. Meanwhile, I was born via Caesarean, and we talk about C-sections. I mean, we talk about people just scheduling a C-section because that's what they - that's how they want to give birth. And we talk about it in a very nonchalant way, but a C-section - and I should say that I'm grateful for my C-sections, and I'm grateful that this surgery exists and that it is commonplace because it saves lives. I believe that. It does save lives.
But we talk about it like it's nothing, and it is major abdominal surgery. You know, they cut through your skin. They cut through the peritoneum, which sort of encases everything. They move your abs out of the way. They cut through fascia. And then they have to move your bladder out of the way using a tool that I think rather horrifyingly is called the bladder blade. And then they get to your uterus, which is, you know, a muscular wall, and then they cut through that.
So, you know, you're informed that you're going to have this surgery, but you don't - I would say that most people don't really know what's going to happen to them, and they don't know the extent to which their organs and their muscles are being moved around. And you're definitely not prepared for when all of the - that goes back in what your body's going to feel like afterwards.
GROSS: You think maybe it's just as well that women, for the most part, don't know what they're in store for with that so that they don't focus...
GARBES: I...
GROSS: ...Too much on it in advance and worry about it?
GARBES: Well, I mean, for me, I always want the information. I want it (laughter). But that's me as a journalist, as a writer, as a really curious person and someone who's very fascinated by the human body. I think that it would be - I would always, though, err on the side of offering that information to people. And if people say they don't want to know - that, you know, they trust the doctors to make the decision - that's their call. But why wouldn't you offer that? An informed patient is generally a better patient, a happier patient.
GROSS: Was the recovery hard for you?
GARBES: It was really hard. I couldn't go up and down the stairs in our house without a lot of pain. I couldn't take a significant walk, which was the main form of exercise that I had late in my first pregnancy. I couldn't really do that until about a month after. I felt really unprepared.
GROSS: If you're just joining us, my guest is journalist Angela Garbes. She's the author of the new book "Like A Mother: A Feminist Journey Through The Science And Culture Of Pregnancy." We're going to take a short break, and then we'll be right back. This is FRESH AIR.
(SOUNDBITE OF JAKE SHIMABUKURO'S "FIVE DOLLARS UNLEADED")
GROSS: This is FRESH AIR, and if you're just joining us, my guest is journalist Angela Garbes. Her new book is called "Like A Mother: A Feminist Journey Through The Science And Culture Of Pregnancy." She has two children. One of them was born in 2014 when she was 37, and her second child was born two months ago (laughter) when Angela was 40. And I want to say, before we go any further, that we're going to be talking, you know, pretty clinically about childbirth. So if that's too explicit for you, or if you have children and you feel it's inappropriate for them to hear it, just - you know, I want you to know so you can decide.
So you had to have a C-section. I'm wondering, if you did not get the C-section, would you have survived childbirth?
GARBES: I don't know, Terry. I don't know.
GROSS: Do you think about that a lot?
GARBES: I don't think about it a lot because I'm here, and I'm alive, and I'm glad (laughter), right? And so I think more - I focus on what I do have, right? But yeah - and, you know, actually, this - in my second pregnancy, my baby was - the second baby was transverse, which is - so normally, in late pregnancy, after 36 weeks, they really want to see the baby head down, and this baby did not want to go head down. And she was not breech, so she wasn't head up. She was basically sideways. And there was no way that - you can't push something that's horizontal out of a vertical opening, so you can't deliver a transverse baby vaginally. And I was trying to have a vaginal birth this time around, and my doctor just told me that very matter-of-factly.
And so, you know, I'm going home. I'm thinking about this. I'm trying to get this baby to turn, wondering how I'm going to do that. And my husband was talking to one of his oldest friends, who is also a family practice doctor. And he was explaining the situation, and he said, so what happened with babies in the past that were transverse? Like, how were they born before C-sections, before you could plan that? And our friend just said, most likely, the mother and/or the baby would die.
GROSS: It's a chilling thing to hear, right?
GARBES: Yeah. Yes. It's terrifying, and it's chilling, and it really puts things in perspective, you know, about what's important here. And, again, I think if we didn't emphasize - if we didn't have this widespread belief that vaginal birth is more natural than a cesarean birth, then I think people could approach that with a little less fear.
GROSS: Was it hard for you - I guess you had no choice but to go for the C-section the second time around.
GARBES: Well, actually, no. Actually (laughter), it was - I did have a choice. And I went through a few different things, which is that I - after weeks of - I tried a lot of things to turn that baby. I was hanging off of my couch doing inversions multiple times a day. I went to see a chiropractor, the idea being that they could adjust me, and maybe my pelvis would open up, and the baby would have more room to turn. We tried burning moxibustion sticks, which are a Chinese - an element of Chinese medicine that are these incense-like sticks that you burn and hold next to your pinky toe. So my husband did that two times a day for 10 minutes on each toe.
We did that for almost a month, and nothing happened. The baby did not turn. So I actually had a manual version done, which is a very intense physical experience in which a doctor - in my case, two doctors - from the outside take a hold of your baby and turn it. And my manual version - it has about a 50-50 success rate, and mine was successful. So my baby did go head down, and I did go into labor, and I was in labor for 24 hours.
But during that time, there was a 12-hour period where I did not progress past 3 centimeters dilated, and you need to get to 10 to deliver a baby. And when, after I had been laboring at home all day, and I felt certain that I was so close to fully dilated, and we arrived at the hospital, and I was checked, and they said, you're 3 centimeters dilated, which is what I had been at 10:30 that morning, I had a realization that there was a very good chance that my labor was going to stall, that I might not get to that vaginal birth that I had hoped for.
And I remember just thinking, I'm scheduled to have a cesarean in three days. I don't really know what's going to happen here. I don't know - I was exhausted. If I continue laboring, there's still no guarantee that I'm going to get to this birth that I want or that I thought I wanted. And so I got on the phone with my doctor and I said, I don't want to leave this hospital without a baby. Can we have a C-section tonight, now? I'm ready.
GROSS: So before you wrote this new book, you wrote an article for the Seattle Weekly The Stranger about breastfeeding because you were breastfeeding your first child and you wanted to know so what is it exactly that makes breast milk so special? That article went viral, which kind of led you to write this new book.
GARBES: Yes.
GROSS: So what are some of the differences between breast milk and formula?
GARBES: So breast milk is living. It's dynamic. So it has - to go back to the concept of microbes, it has microbes and things that exist in the mother's body. And so it adapts to the baby's needs. And formula is a shelf-stable product that can't do that.
GROSS: What do the microbes in the breast milk do in the body of the baby?
GARBES: So the microbes in breast milk will go and they will help seal the intestinal tract. And they encourage a healthy community of microbes in the baby's gut, which leads to better intestinal and digestive health.
GROSS: And maybe also to a better immune system?
GARBES: Yes, yes.
GROSS: And this, I found this amazing. You say that the breast milk changes according to the baby's needs. Like, how would the milk know what the baby's needs are?
GARBES: So research indicates that when a baby suckles at its mother's breast, a vacuum is created. And so some of that baby's saliva is sucked into the mother's nipple. And there are receptors in her mammary gland that are able to read that saliva. And if the mother's body detects pathogens and illness, it can trigger the mother's body to create things to combat that infection or that illness. And so that's how it happens. And she called it baby spit backwash. And that just blew my mind. And I thought, why don't we all know this? I mean, this is a hugely motivating factor for me to keep breastfeeding, which is what I was looking for at the time, quite honestly. And when you hear that and you realize that your body can adapt and essentially provide custom-made medicine for your child, that is extremely powerful.
GROSS: My guest is journalist Angela Garbes. Her new book is called "Like A Mother: A Feminist Journey Through The Science And Culture Of Pregnancy." We'll talk more after a break. Also, John Powers will review the new TV series "The Split" about a family whose business is family law. And Ken Tucker will review the new album by singer and songwriter Courtney Barnett. I'm Terry Gross, and this is FRESH AIR.
(SOUNDBITE OF JULIAN LAGE'S "PRESLEY")
GROSS: This is FRESH AIR. I'm Terry Gross back with journalist Angela Garbes, author of the new book "Like A Mother: A Feminist Journey Through The Science And Culture Of Pregnancy." The book is part journalism and part memoir. She had her first child at the age of 37 in 2014. She gave birth to her second child just two months ago. When we left off, we were talking about breastfeeding and the unique qualities of breast milk.
When you're writing about breastfeeding, you also write about how at first, you thought, like, well, this will be more efficient, it'll be less time consuming than doing formulas. And then you figured out uh-uh (laughter).
GARBES: Yeah, no. I mean, we talk about - I naively thought, you know, breastfeeding is free. And what I've since realized is breastfeeding is only free if we don't value women's time.
GROSS: How much time - are you breastfeeding now?
GARBES: I am breastfeeding now.
GROSS: Yeah, give us a sense of how much time it takes.
GARBES: So an infant as young as mine - she's under 3 months old. She eats every two to three hours. And when you start the clock on two to three hours, it's not when the baby's finished eating, it's when the baby starts. And it usually takes - it's individual. But my baby takes about 20 to 30 minutes to eat. So I'm spending 20 to 30 minutes feeding a child. And then really an hour and a half later, I'm doing it all over again.
And when I was working at the office, when I started, I was pumping milk three times a day. And that's a half hour that I would take to go and sit in a small room and hook myself up to a machine that takes the milk out of my breasts and puts it in bottles so I can take them home. It's a lot of time. It's basically another full-time job. It can easily take eight hours of your day.
GROSS: And the problem is not just that it's time consuming, but, like, you're literally losing time at work. And maybe you can't work because of all the time you're losing. That's what you mean by it literally costing you.
GARBES: Yes. There's a study that I cited in my book that says that - and this is - one version is that they measured it, and they said, you know, the first six months of breastfeeding is the equivalent of about $16,000 in salary.
GROSS: Did you ever taste your own breast milk?
GARBES: Yes, I have.
GROSS: How'd it taste to you?
GARBES: Sweet.
GROSS: Was it hard for you to decide whether you wanted to taste it yourself or not?
GARBES: Well, it's mostly - it's sort of, like, incidental contact, you know. Like, breast milk just - it drips. It sprays. It - you know, usually when I wake up in the middle of the night, sometimes the sheets are wet. It just gets everywhere. It drips through things. And so if it's on my hands, sometimes the easiest thing to do is, you know - if my breast falls out of my baby's mouth, sometimes it's spraying.
You know, it's not just one hole that breast milk comes out of in your nipple. There's many holes. And it can be a powerful spray. So it gets on my hand. And instead of wiping it off, I'll just lick it off. That's really more - it's not like I set out to decide - which is interesting since I worked as a food writer. I'm surprised I didn't really decide to just sit down and taste it. But it's mostly just here and there that I end up tasting it.
GROSS: If you're just joining us, my guest is journalist Angela Garbes. And her new book is called "Like A Mother: A Feminist Journey Through The Science And Culture Of Pregnancy." We're having, you know, a pretty clinical talk about pregnancy and childbirth. So you know, just in terms of - if you're listening with a child, you probably would want to be aware of that.
GARBES: Can I say that I think it's - I appreciate that you're giving that heads-up to your listeners. But it's also really interesting to me because - of course, people can make decisions about what they think is appropriate for their child to hear. But I believe that part of the reason why I wrote this book and part of the reason why I'm really frank about the body and talking about it is this is where we all came from. You know?
Like, children are actually closer to these things than maybe we realize. I think it's adults who are uncomfortable talking about this stuff. I think children - they're exploring their bodies. They have these new bodies that they're figuring out. And especially in terms of pregnancy and childbirth, like, this is relevant to everyone of every age. We were all born. We all have a mother. A person got pregnant and gave birth to us. And this kind of stuff - I don't know. I have a hard time hiding that from people.
GROSS: Yeah. I understand exactly what you're saying. The place where I part company from you a little bit is, I imagine - I remember when I first found out where babies come from. And I thought, no, that's impossible.
(LAUGHTER)
GROSS: And I think, you know, most girls, anyways, go through that same thing. Like, no.
GARBES: Yeah.
GROSS: You've made a mistake. Don't lie to me. Like, that's inconceivable. And it's so shocking 'cause you don't really understand, like, how a body can change to accommodate, you know, birth. And it can be a pretty upsetting thought, when you're a kid, to think about that.
GARBES: Yeah. No. you're right. I'm so deep into - I'm in this place where I think everyone should know about this because I'll find it - it's so interesting...
GROSS: Well, I think - a difference between adults and children...
(LAUGHTER)
GROSS: ...In terms of what they should know. And I think it's - I mean, I agree with you. I think it's great for adult men and women to really understand what's happening in the body when somebody gives birth because women are going through this. And I think a lot of men, particularly men years ago, like, really didn't comprehend what goes on. And it can seem pretty simple when you're not, like, in the room or being told...
GARBES: Yeah.
GROSS: ...Exactly what's going on. And it's not simple.
GARBES: No, it's incredibly complex. And we know so little about it. And it is the most essential biological process. We all go through it.
GROSS: So this is a very personal question to ask. So you're welcome to tell me you don't want to answer it.
GARBES: OK.
GROSS: So before you gave birth to your daughter, you had two miscarriages and an abortion. I don't know the circumstances of the abortion. But when you were trying to get pregnant and then you had a miscarriage during one of those tries, did you find yourself regretting that you'd had an abortion?
GARBES: No. Certainly after I miscarried, I had - there are so many thoughts that you have. And you're - you're grieving. And so it's very complicated. And it definitely - the thought did pass through my mind. Is that pregnancy that I terminated, was that my baby? Was that my chance at having a baby? And did that just go away?
But I don't regret it. And I was with my husband at the time. And I don't know that our relationship would have survived us carrying that child to term and whatever we did with it or having that. You know, I don't really - I don't want to live with regret. And I don't regret that at all. It was my choice to make at that time. And that was the right decision. But it is really complicated.
And I think part of those thoughts are caused by a culture that makes us feel like miscarriage, in some ways - because we don't talk about it - many women think that they did something wrong or somehow it's their fault. And they're made to think that - you know, in this case, what you're asking about for me having a previous abortion, thinking - do I regret that? Did that somehow play into it? It didn't. And we lose sight of that because we don't support women. Yeah, it's very complicated. And people will go through lots of different thoughts. And - but no, I don't regret it.
GROSS: There are some things you'd like to see changed in kind of typical maternity procedures. One is that you think everybody should routinely have a doula as part of their childbirth.
GARBES: I think - it's not specifically that everyone - everyone should have access to a doula...
GROSS: Access to a doula.
GARBES: ...If they want that. But what really...
GROSS: So you're talking about health insurance here?
GARBES: Health insurance or just know that that's an option for them, ideally. I mean, there's - I feel like we're so far from that. What I really - what I want - and I make this point in the book that, you know, there are studies showing - they call it the doula effect - that if you have - the more technical term is continuous labor support. And that's someone who is not a nurse, even though nurses can provide excellent care. If you have someone that's not working for anyone but you then outcomes are better. There's usually less pain medication, which, you know, pain medication is great, but they have their own side effects and, you know, risks. There's less surgery. There's less, you know, forceps and vacuum-assisted births. But, more importantly, women feel happier. They have more positive memories of their births. And that's huge.
GROSS: One of the things you would like to see all women routinely get after childbirth is physical therapy.
GARBES: Yes.
GROSS: That seems really obvious to me, but I know it is not part of the standard protocol.
GARBES: It definitely isn't. And, you know, I wrote a chapter all about the pelvic floor and pelvic health, and my own - I had chronic hip pain after my first birth. And, you know, I went out and I researched and I spoke to a physical therapist, and it's wild. I never went and got physical therapy. (Laughter) And I found movement - you know, I started taking a regular dance class and that really helped me, and that made me feel strong in my body again and really relieved a lot of the pain that I was experiencing. So I think I just thought, I figured it out. I solved that problem.
Well, fast-forward three years. I've given birth again, and I just went for my first PT appointment, physical therapy appointment, a couple of weeks ago. And what I discovered is that the movement that I've been doing for the last couple of years that made me feel really good might actually be contributing to the pain that I'm having. I never knew. And so here I am, someone who wrote a book, like, you know, having a certain level of knowledge, and I may have gotten it all wrong. And I never would have known that if I hadn't gone this time around for physical therapy. And I didn't know that that was even an option for me after my first birth, and that's a problem. You know? Women are able to access this care now, but you have to know to ask.
GROSS: So last question. Did you have to pump before coming to the station to record this interview?
GARBES: I did not pump. I fed and then dashed out the door and made sure to put nursing pads into my bra because it's getting around the time that any moment I could begin leaking, which can be really uncomfortable and embarrassing (laughter).
GROSS: So are you anxious to get back home to your baby?
GARBES: Not really. I mean...
GROSS: (Laughter).
GARBES: ...I've spent a lot of time with her. This is really fun and exciting to talk to you. So I think, you know, I'll be really happy to see her when I get back to her, but, you know, any time that I'm able to feel like myself and feel free, I cherish that. (Laughter).
GROSS: Well, I wish you good luck with your new book. I learned so much from it. Thank you so much for talking with us.
GARBES: Thank you so much. It was a pleasure and a real thrill to talk with you, Terry.
GROSS: Angela Garbes is the author of the new book, "Like A Mother: A Feminist Journey Through The Science And Culture Of Pregnancy." After a break, Ken Tucker will review the new album by singer and songwriter Courtney Barnett. This is FRESH AIR.
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