July 27, 2022

To Be A Woman

 At thirty eight years old, I am pregnant for the first time. At thirty eight years old, my mother had already birthed my four older brothers, bringing all of them from Vietnam to America by boat.

In those years, I’ve learned that to bear the identity of a woman is to bear the expectation of making babies. When I was a kid, I naturally absorbed the vision that seemed integrated in every girl’s future: that of being a mom someday. I loved babies and kids younger than me, and I loved being part of a big family, so it seemed inherent and personal rather than structural and societal. I envisioned having three kids: a boy, then a girl, then another boy. Mainly because I wanted to shape my daughter’s life into the family dynamic I saw as ideal: to have the privilege of what I enjoyed--an older brother to guide and protect me; and to have what I wanted but couldn’t--a younger sibling to care for (but not another girl, because that would make me less special). Birth order matters. 

As I grew older, the vision I developed for myself gathered more dimension. As I invested in those layers, I started to see having children as less of a goal and more of a barrier to other goals.  I wanted to be a doctor who took good care of people; the time and energy required to care for your own child would consume the reserve necessary to care for patients. I wanted to be a strong rock climber; this physical progress would be hindered by how pregnancy, childbirth and motherhood would change my body, not to mention how much less time I would have to climb. (When in my early thirties my oldest brother told me I should get started on having kids, and I expressed this concern to him, he cited Serena Williams as a model of a mother-athlete. As with many gender specific topics, I was not sure how to explain to him how this is not at all relevant to me). I wanted to maintain strong relationships with my family and friends; I had seen the challenges of conversing with my friends with kids, the existence of small humans in their lives disrupting their capacity to be attentive and present in other interactions.

When I was thirty four, I broke my ankle in a climbing accident and during the challenging time of immobility, I realized how much I valued control over my body, and the freedom to guide the direction of my life. I decided for myself then that I would focus on these goals without planning around a timeline to have children. 

Then later that year, I was diagnosed with a pre-cancer of my cervix, found on a routine PAP smear.  PAP smears, which take a scraping of the lower part of the uterus and examine it for cancer cells, can find cervical cancer early enough to treat it before it spreads. They are also effective in monitoring recurrence and growth of cervical cancer. This is because most cervical cancer spreads in a linear way: it starts in one place and grows outward from that location. But my pre-cancer is different, because it can spread non-linearly. It can appear in random spots all over the uterus, without the spots being connected to one another. So it’s difficult to determine with regular Pap smears whether there’s this type of cancer in the uterus, because the sample from the Pap smear may just be missing cancer in a different place. So the recommendation is that once a person has completed child-bearing, the uterus should be removed in its entirety (a surgery called a hysterectomy) to prevent future cancer. 

Upon receiving these results, I was struck by the difference between making a decision to not exercise my power to have children, and having that power taken away from me. I was at work when I got the news, and I cried quietly in an empty patient room before I had to see the next scheduled patient. Focusing on other people’s problems distracted me from my own, and suppressed any further processing of what this meant for me.

After work, I went to get acupuncture, which I’d been getting to help my ankle recover (I was trying every modality of healing available to me). While I didn’t think it was doing much for my ankle, I did feel that the needles orchestrated a certain interference with my state of being, sometimes relaxing me and sometimes intensifying whatever emotions I was feeling at the time. That night, the small punctures in my skin forged a tunnel for my tears and I cried with volume.  

When I told one of my brothers this news, he advised me to have my eggs frozen and have the hysterectomy immediately so that I wouldn’t have to worry about the cancer. I know that he was worried for me, wanted me to be healthy, and assumed that I wanted children. When I explained that I didn’t want children badly enough to put my body through the egg freezing process, he--like many women my age and older than me who have experienced fertility issues--warned that I might regret not doing it. The notion that all women want to have children is so ingrained in us that we can’t imagine another woman truly not wanting to reproduce enough to undergo IVF. Moreover, the primary reason I’d want to have my own biological children is not to preserve and perpetuate my genes, but to experience the process of pregnancy and childbirth, which would be lost with a hysterectomy.

I asked my ob-gyn if it was a safe idea to simply continue frequent monitoring with PAP smears indefinitely, and forgo the hysterectomy if the tests were normal.  He repeated what I already knew was the recommendation--that this was safe to do until I was done with childbearing, then I should have the hysterectomy. I tried to explain that even after childbearing, I was wondering if it was possible to avoid a hysterectomy. He didn’t understand my question. It seemed unimaginable that I might want my uterus for reasons other than childbearing--that I might not want to alter my body so significantly, that I might not want to undergo a surgery from which my body would have to recover. Even as a physician who has witnessed the long-term effects of even small surgeries, it was hard for him to see how someone might see this decision as just that, a decision and not a given. Is it not strange that we view this specific part of a woman’s body as purely functional?

When I shared these conversations and my equivocal feelings about childbearing to a close friend, she said, “You’re so good at taking care of people, of all people you should have a child.” As with my brother, I know this sentiment came from a place of care and love. But this both hurt my feelings and offended my sensibility as a person, because why did I need to have a child to take care of people? Didn’t I already take care of people every day, in my work and in my personal life? Why do we see motherhood as the consummate conduit through which to nurture? We all come to pregnancy and motherhood through an individual context, and this has been mine.

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