The Full Baby Scrum or DEAR MOTHERS IN CHRONIC PAIN by Megan Moodie
I was in labor for like eighteen hours until I had just finally had it. I didn’t want to, but, like, epidural, you know? Like ‘ah, I need a break.’ It wasn’t really my plan, but whatever, it felt right for me at that moment. But then, after my daughter was born – I was lucky, no bad cascade ending in a C-section – I just felt so great. Strong, amazing. Those hormones! Whoa! Did you deliver vaginally?
I did. But I had a complicated situation. I spent the last three months of my pregnancy with excruciating abdominal pain. Doctors didn’t know what was wrong with me. My partner thought I might die. I’m still kind of in pain all the time. Like, every day.
[awkward silence]
How old is your son?
Five.
*
You can’t know what it’s like until you experience it; it is unlike any other pain the body can produce; and you forget it immediately afterwards and can never remember it again: some of the wisdom of childbirth pain.
It is true, in my experience of talking to other women who have given birth, that we don’t dwell much on the pain itself, the actual experience of it – the stabbing and heaving and ripping. Conversations about birth somewhat inevitably turn to our moral relationship to pain: Did we have an epidural? Is this good or bad? How do we feel about the way we deal with pain – guilty, empowered, confused?
Most of us are ambivalent about the pain itself, I think, and still scared of that moment when we felt our mortality, and our baby’s mortality, a knife edge between life and death, superstitious that we landed on the other side. We are scared of not knowing nearly as much about the universes inside and outside us as we’d like to believe we know. But we don’t talk about it much because touching one’s fear of death is not really playground chat, or so I’ve learned the hard way (oh, those awkward silences!), and the quagmire of inadequacy and shame around pain is too deep.
Maybe that’s even okay. Maybe it’s good to forget, adaptive, as some suggest. But since my son’s birth in 2010, I have also learned that there is an entirely different pain of childbirth, and this one we need to talk about a great deal more. I want to write a love letter to the women, the silent congregation, who do the work of caring and life-sustaining in chronic pain. This is my first draft.
If, as philosophers like Elaine Scarry have long argued, pain pushes the edges of our abilities to communicate and use language, the particular condition of hurting constantly while caring – let’s call this hurting while in a structural position of the anti-heroic, the feminine, the one whose labor is almost always invisible – is a double burden on the storyteller, the letter writer. I try to explain it, to summarize, to describe. I fail. I am embarrassed that, as someone who has always prided myself on my efficacy with words, I am mute and meek in this task. But when a friend said recently “I would never know you live the way you do. You are so good at hiding your pain. I never see it,” I realized that I had more than a writerly problem.
You may have seen articles in the mainstream media recently about women and chronic pain. There are some very disturbing facts out there, if you care to pay attention to them. 100 million adults in the U.S. live with chronic pain, and the majority of these are women; women are at greater risk for all common forms of pain and report greater sensitivity to pain.[1] About 15% of women ages 18-50 have chronic pelvic pain (in real numbers this is about 9.2 million women), for which the majority (61%) have no diagnosis.[2] Women are less likely to get the pain relief they need after heart surgery – doctors prescribe tranquilizers instead – and women with cancer and AIDS are less likely than men to get adequate pain treatment.[3]
So it’s maybe not paranoia to think pain and its treatment is a deeply gendered issue.
Even more astounding, a recent study from the University of Michigan found that post-birth injuries approximate those one would see after major sporting events; in fact, in an interview about her research, the lead author surmised that if men made similar complaints in the six weeks after a big game they would likely be prescribed diagnostic image testing (MRIs) and treated immediately for their injuries. Women are told “ ‘Well, you’re six weeks postpartum and now we don’t need to see you – you’ll be fine.’ But not all women feel fine after six weeks nor are ready to go back to work and they aren’t crazy.”[4] Birth injuries can include: pelvic floor injuries, pelvic microfracture, hip tears, hip dislocation, sacro-iliac joint trauma, broken tailbones, pubic bone fracture, levator ani muscle tears, abdominal adhesions of all kinds, and more. A not-insignificant list, but ask any expectant mother about what might happen to her body during birth and you will likely only hear about things like dilation and contraction.
Of course, not all of women’s chronic pain is related to childbirth, women in chronic pain are not all mothers, and there are many different challenges to care work that are just as difficult as struggling with a pain condition. (So many love letters to write…) But there are large numbers of women suffering from pain conditions that are caused by or related to reproduction (including those, like endometriosis, that can keep women who might like to be mothers from being able to have biological children) and, as far as I have been able to find, very few spaces to talk about these conditions. Or the pain itself. Or how it feels to try to make dinner for a whining toddler when you can hardly get off the couch because you’re having a fibromyalgia flare or it’s the time of the month that endometriosis means you are bleeding all over your body.
I joined the silent congregation in 2010, when I was thirty weeks pregnant with my son and admitted to the hospital for abdominal pain that felt like what I imagine it would feel like if someone heated up a steel rod and stabbed it through me, from front to back. Two years and many invasive tests later, we learned that I had torn the labrum of my left hip. As an example of how pain complaints may be differentially evaluated based on gender, my injury, which is more common in women, can happen during pregnancy and delivery, and often manifests as pelvic pain, takes more than two years on average to diagnose.[5] In my case, I am quite certain that the only reason I was eventually diagnosed with a hip injury at all was because a G.I. specialist to whom I was referred (“Hm. Left side abdominal pain that’s not your ovary? Maybe it’s your colon!”) was in her early forties and had given birth to two kids. She listened closely to my symptoms and said that there was clearly nothing wrong with my digestion – other than some nausea from dealing with the stress of undiagnosed pain all the time. I had a joint injury – and she should know, she told me, as she had hurt her sacro-iliac joint during the birth of her second child and was still in physical therapy.
I was lucky. I have fairly good health insurance and was able to take a little time off of work. A corrective surgery followed my diagnosis in 2012. And then another in 2013, when I did not get better (the first surgery did not actually work and the labrum had re-torn, which I had been told was “almost impossible”). I still deal with pain in my hip, groin, and back on a daily basis, including elusive nerve pain that radiates to my foot and is likely a result of the surgeries themselves. Each morning begins with a body scan, lying in bed: Does my leg feel like it’s plugged into an electrical socket? How much pain will I be able to stand before I have to lie down or take one of the various medications I’ve been given to help me get through the day? Can I even get through the day ahead at my full-time job? What if I can’t? What could I reschedule? What will I be able to do with and for my son, who is now five and healthy and wakes up every day ready for me to jump into his magical world where zombies battle dragons for magical crystals and we have to run thirteen laps around the house to help counteract their diabolical spells?
My pain has been a part of my son’s life since the moment he was born. There are many things I have not been able to do: trips to the beach I cannot take, because the uneven sand is difficult to manage; hours I cannot spend on the floor building Lego towers because my leg tightens up and I can’t walk afterwards; hikes in the redwoods we have cancelled because that morning, for whatever reason, a shifting barometer or a wave of hormones, I woke up in such terrible, burning pain that it’s all I can do to get him a piece of toast and start a movie. We talk about my pain like other families talk about the weather – What kind of day is it today?
And my son’s sense of anatomy is different than that of other five year-old boys’. The other day he stubbed his toe and, in the characteristic blend of off-kilter syntax and big vocabulary that is my precocious son, said “Oh man, momma. Ouch. That was just worse than any hip incident. Really, worse than a hip incident.”
That story makes me laugh. What was not so funny was the day he asked me if it was his fault my hip was always hurting. “But it happened when I was in your tummy. Did I do that to you?” Of course I gargled tears in the back of my throat and said that it was not his fault, that carrying him in my body was a great gift, and that sometimes accidents happen. He remains skeptical, though, and when someone who doesn’t know about my medical history asks me about my cane (on a bad day) or my limp (on a pretty normal day) and I explain I have had a series of hip injuries, he usually interjects “It all started when I was in her tummy.” As a feminist mommy, I want to tell myself it’s okay that my son has seen that women’s bodies aren’t magical, but vulnerable, tissueful, tearable things. But it always crushes me a little.
Because like most mothers, even those who know better, I always have a nice wad of guilt stuck to me somewhere. We live in a world that tells mothers that no matter what they’re doing, they’re probably doing it wrong. What we are is never enough, never correct, and if you need a reminder, just troll the mommyblogs and Pinterest – it won’t take long to find someone who is questioning every single one of your life choices while making gingerbread mansions from scratch or shaming you because you enjoy something as archaic as baking.
This cultural demand that we see ourselves as inadequate is exacerbated for those of us who live in chronic pain and sometimes, perhaps often, cannot even do the “normal” things like park visits and Lego time. I think often of the daily struggle of a friend of mine who lives with Complex Regional Pain Syndrome (CRPS), a serious and understudied neurological condition that can arise after something as simple as toe surgery and causes sufferers to feel like their bodies are burning from the inside out. She has a four year old, and such terrible pain that she has to take three different medications just to be able to stand up. On a good day, she is heavily sedated by a slew of neurological and pain meds. CRPS affects the clothes she can wear – an underwire is a particularly awful torture, and jeans, or even just waist bands in general, are impossible. Pink sweatpants, tissue-weight seamless t-shirt: the chronic pain uniform.
Forget Pinterest. The books and support programs that are out there for chronic pain sufferers, many of which draw on Buddhist philosophy or New Age meditation techniques, would tell her to focus on her breath, to savor the parts of her body that are not in pain. But they are silent about what to do about her son, asking for cookies and a piggy back ride. Try telling a toddler “No, I can’t read you that book for the four thousandth time because I’m trying to savor the calm in my pinkie finger.” These techniques cannot work for us, and so we end up feeling like failures in yet another aspect of parentdom: the basic ability to be focused on the needs of another. Pain demands attention. There is never enough to go around.
My mother, a retired nurse and extremely compassionate woman, has asked me more than once what I think women with birth-related injuries might have done in the past. Fifty years ago, a hundred years ago, before there were MRIs with contrastive dye? Surely hip and other joint injuries from birth didn’t start in the 21st century? Surely endometriosis is not a new condition?
I discuss the possibility with friends. Maybe injuries and pain conditions are worse because we’re not as active as our grandmothers – we sit more, walk less, and have less free time. Ergo, we all have pelvic alignment problems, core weakness, autoimmune disorder, neurological malfunctions. Or, conversely, maybe women today do so much more strenuous athletic activity than in the past – marathons and Zumba and soccer – that we are seeing new injuries. I had been a runner and had a hard-core yoga practice before I hurt my hip and I know many labral tear patients are athletes as well as moms. There’s no obvious answer, though it might explain 19th century women’s fondness for laudanum. “Well, mom, my guess is that they drank. A lot.”
But the truth is that I have no idea, or how I would live through my pain if not for the possibility that the next treatment of the next doctor might bring some relief. I feel like there are no cultural traces of the mother in chronic pain and this makes think, self-consciously, that maybe we are living outside history. Is it so strange to want an archive? Evidence that you are not singular?
Then I find Elena Ferrante’s Neapolitan novels. In the first of the four books, My Brilliant Friend, the main character, Elena Greco, known as Lenu, describes her mother for the first time (she is writing about her six year-old self):
I wasn’t agreeable to her nor was she to me. Her body repulsed me, something she probably intuited. She was a dark blonde, blue-eyed, voluptuous. But you never knew where her right eye was looking. Nor did her right leg work properly – she called it the damaged leg. She limped, and her step agitated me, especially at night, when she couldn’t sleep and walked along the hall to the kitchen, returned, started again (44-45).
In Ferrante’s description of Lenu’s mother, I immediately recognized a birth injury. Lenu’s character at the time is, like most children, unsympathetic to what her mother’s limp might mean – the fact that her mother’s ill humor and fear might be coming from chronic pain does not occur to the child, whose only form of empathy is really fear for herself.
For Lenu, her mother’s disability gets inextricably linked to her own need to perform well in school, and in life. She overachieves with gusto. When Lenu’s best friend, Lila, replaces her as the best student in the class, her anxieties eventually focus on her body. The voice of adult Lenu tells us
… surely it was then that worry began to take shape. I thought that, although my legs functioned perfectly well, I ran the constant risk of becoming crippled. I woke with the idea in my head and I got out of bed right away to see if my legs still worked (46).
The passage reminds me of my son comparing all of his injuries to hip pain, but then, of course, society invites my son to disidentify from my physical form. He does not worry that his body will become my body in the way that Lenu, almost inevitably, must. But I love the way Ferrante focuses on how our anxieties, even ones we cannot articulate, perhaps about motherhood before we are mothers, enter into our experience of mobility and shape how we bend and flex.
To be honest, Lenu’s mother is not a likeable character. She holds her daughter back, doesn’t try to understand her. She is abrupt and judgmental. I came to have compassion for the mother, though, I thought I knew her secret, why she was angry and gruff all the time. I followed her closely as she limped into and out of scenes for the next several hundred pages of the series.
Then, in Book Three, Those Who Leave and Those Who Stay, Lenu has her first child. Suddenly, inexplicably, she can hardly walk for the pain in her hip. She is in agony and rocked by the realization that not only may she have misunderstood her mother’s body and her disability, but that it may be something they share. I cried when Lenu described her first pregnancy:
I was in my seventh month and my belly was heavy… Maybe I made a wrong movement, I don’t know, I felt a painful spasm in the center of my right buttock that extended along my leg like a hot wire. I limped home, went to bed, and it passed. But every so often the pain reappeared, radiating through my thigh toward my groin. I learned to respond my finding positions that alleviated it, but when I realized that I was starting to limp all the time I was terrified, and I went to the gynecologist. He reassured me, saying that everything was in order, the weight I was carrying in my womb tired me out, causing this slight sciatica. Why are you so worried, he asked in an affectionate tone, you’re such a serene person. I lied, I said I didn’t know. In reality I knew perfectly well: I was afraid that my mother’s gait had caught up with me, that she had settled in my body, that I would limp forever, like her (236-237).
Seven months, just like me. A happy, healthy pregnancy that suddenly turns scary and painful. A body that doesn’t seem to be cooperating. A feeling of failure, like being sucked into a bog, a place Lenu had been trying to avoid all her life. I was with her.
Because the truth is that amidst all the pain and the medical procedures (not just two surgeries, but an epidural nerve block, “trigger point” injections (sometimes seven at a time) in which lidocaine is shot into spasm-y muscles and produces severe bruising, cortisone injections that cause pain flares, acupuncture, deep heat ultrasound, and chiropractic adjustment) and medications (pain medicines, muscle relaxers, neurological drugs of various kinds), I have raised my son, completed a book, and gotten tenure at a research university. I give talks; I travel to see family; I volunteer at my son’s school. I even went back to India, where I do research as a cultural anthropologist, after the first surgery. I have a great partner, one of those modern, “involved” dads, but I live the busy life of a 21st century working mom and yes, I expect quite a lot from myself. I identify with Lenu, too. I am not just her mother, bitter and resolved, because I want to do and to achieve, and not to fail.
My hip is failure. My hip is stasis. My hip is the opposite of freedom because pain places limits. What else do I want than to be limitless? In energy, in ambition, and yes, in love?
I could end by telling you that I have a different relationship with pain than I did when this all began, that I have realized it has given me as much as it has taken away. Some days this is true. Some days I think that without the full baby scrum and the toll it took on my body I would not have given myself permission to do things like read all four of Elena Ferrante’s novels. There is something sedentary about my relationship with my son, but we have developed a kind of verbal play that we both love. We sit together and tell stories, we make up rhymes, we have joke-telling contests. We don’t get to run around on the beach all the time, but we share imaginative worlds that we might not if I had been more mobile.
But chronic pain does not transpose into parable easily. For many in the silent congregation, there is no denouement, no “and then I learned…” In the last two Ferrante novels, Lenu’s pain waxes and wanes, but never leaves her completely. It relapses. It has to be managed. That weakness that she so despised in her own mother is her own condition of existence. And there is no neat lesson at the end, no reconciliation with her mother. Perhaps she rewrites her childhood from a more empathetic perspective, yes. But there is no narrative resolution. In Book Three, exhausted from grappling with the pain constantly, Lenu asks her mother “What happened to your leg, why do you limp,” and her mother’s reply is “What does it matter to you, mind your own business” (241).
Pain may not always bring us together. It is isolating and there are many, many women living with it and doing the hard work of trying to care for themselves while they care for others. They may be hiding their pain – some of us are, as my friend pointed out, very good at it – but it is splitting their consciousness, wracking them with guilt and, often, simply hurting. They will likely not ask for help because they see their role as helping others. They will likely have learned that there is a statute of limitations on complaining about pain to others, and often keep it to themselves. They are a silent congregation.
But they are angry, too. Angry at doctors who don’t take them seriously and friends who ask “wait, aren’t you better yet?” and a society that says that any form of disability or vulnerability is anathema. Angry at insurance plans that are too expensive or refuse to pay for things that could help. Angry that they have to endure the noxious weight of sexism in their bodies. I wonder what Lenu’s mother might have said, if she’d had the words: This isn’t fair. You’re all crushing me. It hurts.
Sister, I feel your pain.
* * *
Postscript: I wrote this piece as a love letter to the silent congregation of mothers who suffer from chronic pain and illness, and a love letter it remains. But in light of last week’s election results, I want to end with a plea: like many marginalized groups in this country, those with disabilities and chronic pain and illness are likely to be at grave risk in the coming months and years. The effects of illness are not evenly distributed, nor are the illness themselves. African American women, for instance, have higher rates of autoimmune disease than other groups of women and are also less likely to receive adequate pain management.
Many of our sisters and brothers will be threatened on multiple fronts, at the crossroads of racial, economic, and bodily oppression. You may not see these folks in the streets, at rallies, marching; they will often be forgotten. Please fight for them, for us, too.
Photos courtesy and (c) Michael DeAngelis.
[1] RB Fillingim et al. 2009. Sex, gender, and pain: a review of recent clinical and experimental findings. Pain. 10(5): 447-85.
[2] Susan D. Mathias et al. 1996. Chronic Pelvic Pain: Prevalence, Health-Related Quality of Life, and Economic Correlates. Obstetrics and Gynecology. 87(3): 321-327.
[3] Judy Foreman, “Why Women are Living in the Discomfort Zone,” The Wall Street Journal. January 31, 2014.
[4] Laura Bailey. Childbirth an Athletic Event? Sports medicine used to diagnose injuries caused by deliveries. University of Michigan News Releases. December 1, 2015. available at http://ns.umich.edu/new/releases/23330-childbirth-an-athletic-event
[5] Megan Groh and Joseph Herrera. 2009. A comprehensive review of hip labral tears. Current Review of Musculoskeletal Medicine. 2: 105-117.
About the Author
Megan Moodie is a feminist, writer, and mother who lives in Santa Cruz, CA. She is also Associate Professor of Anthropology at the University of California, Santa Cruz, where she teaches cultural anthropology and feminist theory courses to undergrad and graduate students. Her main topics of research are gender politics and indigeneity in South Asia – her academic book, We Were Adivasis: Aspiration in an Indian Scheduled Tribe, about the Indian affirmative action system known as “reservations,” came out last summer from the University of Chicago Press. She’s currently at work on a novel set in India. Author photo by Shannon Brown.
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