A Childless Motherhood

Well of course! Did we think there would be no consequences? Did we actually think we could get away with it? That there weren’t two sides to the story that we all needed to hear?

Sometimes I think we are so focused on our journey to right a wrong, that we wander off the path to those we hope to save. Things are too partitioned -a modern day rendition of the biblical Matthew 6:3 where the left hand does not know what the right hand is doing… Or, perhaps, is not doing.

If one side of a page seems to contain all the information I seek, I may miss what’s written on the back. I feel no need to turn it over. An article in the Conversation turned the page for me:

https://theconversation.com/losing-children-to-foster-care-endangers-mothers-lives-93618

The author, Elizabeth Wall-Wieler, a PhD student in Community Health Sciences at the University of Manitoba, writes that ‘Mothers whose children are placed in foster care are at much higher risk of dying young, particularly due to avoidable causes like suicide. When a child is placed in foster care, most of the resources are focused on the child, with little to no support for the mothers who are left behind.’

In retrospect, of  course, it seems obvious -the mother-child bond is not something easily missed, and whether or not we attribute it to physiological changes such as oxytocin levels in her blood, or less reductionist, atavistic mechanisms, it is a powerful thing, dismissed only at her -and our– peril.

The author was involved in two large studies, one of them published in the Canadian Journal of Psychiatry, which ‘[…] looked at suicide attempts and suicide completions among mothers whose children were placed in care.

‘In this study, we compared rates of suicide attempts and suicides between 1,872 mothers who had a child placed in care with sisters whose children were not placed in care. We found that the rate of suicide attempts was 2.82 times higher, and the rate of death by suicide was more than four times higher for mothers whose children were not in their custody. […] Mothers whose children are taken into care often have underlying health conditions, such as mental illness and substance use. In both studies, we took pre-existing health conditions into account, so that was not the reason for the higher mortality rates we found.’

And, the author feels, ‘Most legislation pertaining to child protection services indicates that families should be supported, but the guidelines around what is expected of the child welfare system when it comes to the biological mothers are not clear. The main role of social workers is to ensure that the child is doing well. Social workers are already so busy, so it is often hard for them to justify spending their limited time to help mothers resolve challenges and work with them to address their mental and physical health needs.’

Other studies have also addressed the issue of sending children to foster care: ‘A study in Sweden found that by age 18, more than 16 per cent of children who had been in foster care had lost at least one parent (compared to three per cent of children who had not been in foster care). By age 25, one in four former foster children had lost at least one parent (compared to one in 14 in the general population). This means that many children in foster care don’t get the chance to be reunited with their families.’

I thought that the whole idea of fostering a child was care and sustenance until a more permanent placement was achieved or, ideally, the birthparent was able to reassume custody. This is perhaps more likely if the child can be placed with members of the same family -grandmothers, aunts, etc.- but even then, if the mother does not receive adequate support and treatment for the condition that led to the apprehension of her child, the results are apt to be the same.

In Canada, it seems, the mothers most affected are those from the indigenous community -our First Nations. The Canadian Minister of Indigenous Services, Jane Philpott, addressed indigenous leaders about this issue at a two-day emergency meeting on Indigenous Child and Family Services in Ottawa in January, 2018. http://www.cbc.ca/radio/thecurrent/a-special-edition-of-the-current-for-january-25-2018-1.4503172/we-must-disrupt-the-foster-care-system-and-remove-perverse-incentives-says-minister-jane-philpott-1.4503253 ‘The care system is riddled with “perverse incentives”. Children are being apprehended for reasons ranging from poverty to the health and addiction issues faced by their parents. In some provinces, rules around housing mean that your children can be taken away if you don’t have enough windows. “Right now dollars flow into the child welfare system according to the number of kids that are apprehended.” […] If financial incentives were based on “how many children we were able to keep in homes, how well we were able to support families — then in fact there would be no financial reason why the numbers would escalate.”’

But it’s not too difficult to read something else into all of this, of course. Uncondoned behaviour -behaviour frequently associated with poverty or marginalization- is often penalized isn’t it? Sometimes it is as simple as avoiding the transgressing community, further marginalizing it, but increasingly it is intolerance. Refusal to address the underlying issues. Not even trying to understand.

I admit that it is a difficult journey, and the road that winds between the abused child and its troubled parent is fraught. To empathize with the mother when her conduct may have been so clearly unacceptable, is seen as anathema. And yet, an attempt to understand is not a plea for condonation, merely a search for a solution. Nobody should get away with family neglect -but nothing happens in a vacuum. And there are always unintended consequences, aren’t there? Even our best intentions miss something in retrospect -solve one problem, create another. Our focus is often far too narrow -helping one person misses the one standing beside her.

Perhaps it’s time for us to stand back. As Ms Wall-Wieler puts it, ‘Specific guidelines need to be put in place to make sure that mothers are supported when their child is taken into care. This would improve the chances of reunification. And, by virtue of being a human worthy of treatment with dignity, mothers deserve support, even if it does not directly relate to how she interacts with her child(ren).’

‘Of the good in you I can speak, but not of the evil.
For what is evil but good tortured by its own hunger and thirst?’
Kahlil Gibran

 

 

 

 

 

 

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The Venus Figurine

Pregnancy has always had a sacred place in mythology. From the Palaeolithic Venus figurines, to the various stories of deities born from virgins, pregnancy has been cloaked in mystery and draped in awe –the curious interregnum separating being from non-being. That special state when the woman is suddenly not alone in her body, and then, equally suddenly not just a person, but a mother –a transformation that is as miraculous now as it was in millennia past.

It is still a source of wonder for me, even after 40 years as an obstetrician. But I think one has to be particularly careful in its blanket ascription to every woman –To every thing there is a season, and a time to every purpose under the heaven. For many women, it has been a rite of passage, a validation of their gender, whereas for others…

I am always on the lookout for popular articles on pregnancy and its resulting motherhood –not so much for resolution of the pro-life/pro-choice conundrum, but mainly to understand the current societal prescriptions for acceptable attitudes and behaviours of mothers. How intrusive is social media in moulding conduct and beliefs? There were a few clues in an opinion piece in the Guardian newspaper: https://www.theguardian.com/commentisfree/2017/may/30/detach-myth-motherhood-from-reality-future-generations But, judging from the tenor of the piece, it would seem difficult to avoid dissenting views.

The author, Angela Saini, introduces the topic by saying, ‘It’s hard for any woman to escape the expectation to be a mother. The maternal myth suffuses every human culture, from Catholicism’s Virgin Mary to Hinduism’s goddess mother. It’s considered the most natural state of womanhood, leaving the childless woman the object of pity. Let’s not even mention the woman who doesn’t want or like children at all.’ And then she imputes an opinion to a famous restauranteuse who was criticizing the UK prime minister about something –that ‘motherhood somehow makes a person automatically care about not only her own children but everyone else’s as well; and that women who aren’t mothers don’t have the same caring sense towards future generations.’ Fighting words, as they say.

Saini goes on to write, ‘But maternal instinct is not a switch that exists in every woman, ready to be flipped as soon as she smells a baby. Relationships between mothers and their children are frequently far more fraught than the myth leads us to believe. It shocks us that mothers can be selfish. […] There is scientific evidence to suggest that the maternal instinct may even be contingent on a woman’s circumstances. […] maternal instinct may sometimes depend on whether a mother has the support she needs. We’re not a species designed to cope alone. Indeed, we’re at our most social when it comes to parenting, often recruiting many people around us to help. It really does take a village to raise a child.’

Her point, obviously, is that maternal instinct is not an all-or-none phenomenon –it can exist in degrees, and like a flower, it may take a while to fully bloom. ‘[…] motherhood is not always an against-all-odds epitome of selfless caring. Sometimes it can involve emotional calculation, weighing the needs of both parent and child. We all assume that a mother always wants the best for her child, above her own needs. What we seem to deliberately ignore is that a child’s welfare can also depend heavily on the mother’s own needs being met.’

And so, ‘For the sake of both mothers and children, we need to begin detaching the myth of motherhood from the reality. It’s unfair of any society to expect women to be the best mothers they can be without economic or emotional support, just because they should love their children. Not all women are happy to be mothers.’

She concludes by observing that ‘Many mothers will know that birth doesn’t always signal a rush of immediate love. The maternal bond may build slowly over time. For a small few, it may never appear. And some never experience the urge to have children. We think of all these as unnatural exceptions, bucking the normal trend of how a woman is supposed to feel. But the scientific and historical evidence shows that none of it is strange at all. […]The most unnatural thing of all is forcing a woman into motherhood in the anticipation that she will biologically fall into line when a baby arrives.’

As an obstetrician, my responsibilities ostensibly end with the birth of the baby, and yet how can a duty ever end? Delivery is seldom the last time I see the woman and her baby, and it is certainly not the last time I hear their stories. We are all stories.

Jennifer sat in my office crying inconsolably. It started out as most other visits start, as I remember. She was seeing me for her post-partum checkup, six weeks or so after the normal delivery of a healthy baby boy. It was her first pregnancy and everything had gone well in hospital. She had left smiling, if a little stunned at the rapidity of her labour.

When she came into the office she was the picture of contentment, although I did wonder why she hadn’t brought the baby. I don’t deal much with babies, but the mothers usually bring them to show them off. It’s always nice to see how they’ve changed since birth, and marvel at the almost constant eye contact between the two of them. Usually, I get the impression the mother is only half listening to my questions –she is completely involved in a world I cannot really enter.

But when I asked Jennifer how the baby was, her face changed. “Jonathan was marvelous for the first day or so…” she said, her voice trailing off. “But I was so amazed at him, so involved in his every move, of course he seemed perfect.”

The first tear slid down her cheek and she stared out the window behind me for a moment, as if she were afraid I’d ask her more. Then, she grabbed for a tissue from my desk and wiped her cheeks. “Doctor, he never sleeps! I feed him, I burp him, I change him, I rock him… And so does Tony, but it only works for a while, and then he starts again. We took him to the pediatrician, but she just smiled and reassured me. Some babies are like that, she said. It’s not colic, it’s not something Tony and I are doing wrong… And it will settle.

“But it hasn’t! Neither of us are getting any sleep and now Tony and I are fighting… I wish we’d never decided to have a baby…” She stopped talking and suddenly stared at me in terror as if she’d admitted to some unspeakable crime… And to the doctor who’d seen her excitement for her entire pregnancy…

She began to sob. “I don’t think I’m a very good mother, doctor. My friends seem able to manage with their babies… They don’t need any help!”

I waited to hear her out, but she just sat huddled in front of me weeping inconsolably. “Did your mother stay with you?” I said softly. “I remember she was with you in labour.”

She shook her head sadly. “Tony and I figured we could manage.” She wiped her cheeks again and grabbed another tissue. “She wanted to stay and help, but I’ve always been her independent child.” She sighed with a deep stertorous gulp of air. “I was kind of embarrassed to admit I might need some help, to tell the truth…” She stared at me with wide red eyes, like a doe peering out of the woods.

I smiled and sat back in my chair. “There’s an African proverb I’m sure you’ve heard, Jennifer: It takes a village to raise a child. I think it also takes a mother to help her child…That’s what mothers are for, isn’t it…?”

She stared at me for a second or two, a weak and wobbly smile fighting to control her lips. “You mean…?”

“Phone her,” I said.

And she did –right there in the office.

 

 

 

 

Eternal Maternal?

Some things are just not said, just not considered. They fall so far outside of our Weltanschauung they are inadmissible. And we take such comfort in their ubiquity that we no longer feel a need to discuss them. They are so self-evidently true, so axiomatic to our understanding of existence that they seem indispensable. Crucial… Even transcending the need for sentience.

Maternal instinct, for example -the irrevocable compulsion of a mother to protect her offspring even at the expense of her own safety. Characterized as selfless and incorruptible, it often escapes the genetic prison of species boundaries. It is one of those rare attributes that has such survival benefits that it blossomed under the rigorous pressures of evolution. It really is, at least in hominid terms, sacrosanct.

Or is it…? Sometimes there is a need for stepping back from the forever-yawning abyss of unquestioning acceptance. After all, what is instinct? Is it just an under-examined behaviour whose pervasiveness has convinced us of its Darwinian utility? Or is it something else –a hope, maybe? A tachistoscopic view of that which we would like to believe has survived the rigours of the collapse of Eden?

A rather obscure article in the Guardian newspaper –one of many, once I discovered it- attempts a more dispassionate analysis of the universality of maternal instinct: https://www.theguardian.com/commentisfree/2017/may/30/detach-myth-motherhood-from-reality-future-generations?CMP=share_btn_link

It’s addressing the expected attitude of the mother to her baby and the seemingly global societal requirement of her self-effacing altruism towards it –and usually the offspring of others, as well. It’s not attempting to comment on whether or not the woman chose to become a mother –or indeed, whether that might play a major role in her subsequent attitude towards the responsibilities involved. It’s more concerned with the fait accompli.

I have discussed the issues and deeply-rooted cultural assumptions around the decision whether or not to become pregnant in the first place in a separate essay in June 2015: To Have, or not to have ( https://musingsonwomenshealth.wordpress.com/2015/06/02/to-have-or-not-to-have/ ).

No, the Guardian article questions not so much the concept of maternal instinct, as its expanse –or perhaps more accurately, its inexhaustibility. Its sempiternity… ‘[…] maternal instinct is not a switch that exists in every woman, ready to be flipped as soon as she smells a baby. Relationships between mothers and their children are frequently far more fraught than the myth leads us to believe. It shocks us that mothers can be selfish. […]There is scientific evidence to suggest that the maternal instinct may even be contingent on a woman’s circumstances.’

In fairness, I suspect that the article may be a sort of authorial apologia: ‘I myself have had to face down questions from family, friends and even strangers who don’t understand my wish to have only one child. The thought of having more children terrifies me, and has nothing to do with the love I feel for my son. […] a similar argument can be made that maternal instinct may sometimes depend on whether a mother has the support she needs. We’re not a species designed to cope alone. Indeed, we’re at our most social when it comes to parenting, often recruiting many people around us to help. It really does take a village to raise a child. Without any help, it can be desperately tough.’

The author feels that the ‘reasons why women feel the way they do about children is under-studied’ and I certain agree. ‘[…]motherhood is not always an against-all-odds epitome of selfless caring. Sometimes it can involve emotional calculation, weighing the needs of both parent and child. We all assume that a mother always wants the best for her child, above her own needs. What we seem to deliberately ignore is that a child’s welfare can also depend heavily on the mother’s own needs being met.’

Near the end of her essay, I think she makes it clear why she felt it necessary to discuss the topic: ‘For the sake of both mothers and children, we need to begin detaching the myth of motherhood from the reality. It’s unfair of any society to expect women to be the best mothers they can be without economic or emotional support, just because they should love their children.’

I would like to think that as an obstetrician I am not a completely disinterested party in all this –although, of biological necessity, I approach the subject as a non-participant. And now, in retirement, perhaps even more so -I watch from the shadows, as it were, but I’m nonetheless attentive to the roiling milieu. It’s hard to ignore.

I was sitting in the corner of a coffee shop recently, enjoying the relative solitude, when two women sat down at the table next to mine.

“My daughter keeps foisting the kid on me whenever she wants to go out,” one of the women said to her friend.

Emily, you mean?” the friend said with a slow, disapproving shake of her head. “And Jacob…” It was obvious that she objected to a mother –not to mention a grandmother- talking about her family as if they were nameless burdens. Then her expression softened. “My Louise used to do that, I remember. She’d show up at the door unannounced and put Andrew in my arms…”

The first woman took a sip of her coffee and shrugged. “I suppose they all do it, eh Joyce?”

Joyce smiled at the thought. “I used to enjoy the challenge of working Andrew into my day.”

Joyce was a happy person I thought, as I tried to pretend I was reading my book, unaware of their presence. She was probably in her fifties, dressed casually in a grey sweatshirt and dark green track pants, and looking for all the world as if she was enjoying her life.

The woman beside me, however, was tense. I could hear the frustration in the timbre of her words.

“It’s just not fair, though,” she said to Joyce, her voice almost whining.

Joyce’s eyes twinkled even in the soft light of the corner where we sat. “Mothers have to have a break, Mary…”

“Break?” Mary interrupted angrily, “I never got a break, Joyce! I had to bring up two kids all by myself after Ralph left… By myself!”

I could almost feel the exclamation mark slamming onto the table in front of her.

It clearly upset Joyce, and I could see her taking a deep breath before responding. “Wouldn’t you have loved it if you’d had someone to leave them with every once in a while?” Her eyes were spotlights focussed on Mary’s face.

Mary shrugged again. “But I didn’t, Joyce… That’s the point.”

A tenderness suddenly appeared on Joyce’s face and she extinguished the angry glare as she  recalled her eyes. “But Emily does, Mary… And that’s the point,” she said, almost in a whisper.

I’d finished my coffee by that point, so I thought it might seem rude to continue to sit there and listen. But as I l pushed back the chair to leave, I couldn’t help but notice the smile that had finally surfaced on Mary’s face. And something deep inside me smiled, as well; the course of true love never did run smooth