Fresh Take: Irin Carmon, UNBEARABLE

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0:16Amy Wilson:Hello, everyone, and welcome to Fresh Take from What Fresh Hell? Laughing in the face of motherhood. This is Margaret. And this is Amy. Today, we're talking to Irin Carmon. She is an award-winning senior correspondent at New York Magazine, where she covers gender, law, politics, and more. She is the co-author of the New York Times bestseller, Notorious RBG, and the author of a new book which we'll be talking about today, Unbearable, Five Women and the Perils of Pregnancy in America. Welcome, Erin. Thank you so much for having me. Let's start with a quote from the introduction of the book. For much of American history and medicine, artificial categories of good and bad pregnancies, celebrated or stigmatized, wanted or unwanted, medicalized or quote unquote natural, healthy or unhealthy, planned or unplanned, have obscured the true complexities of people's lives.

1:11Amy Wilson:So, so much of this book is a portrait of different ways people come to pregnancy, different experiences that people have with pregnancy. You talk about your own pregnancy in the book. Tell us what brought you to write this book. So as a reporter for about 12 years before I started writing the book, I was focusing on reproduction in America. Mostly in the beginning, I started out covering legal paddles around abortion. Then I had the opportunity to report all over the country at how different kinds of laws and structures were affecting people's actual lives. And I was always interested, you know, in all the different kinds of experiences of pregnancy, not just people in a situation where they want to end it.

1:53But we know that that was this huge fault line in American medicine and law and politics. And I was really interested in all the different feelings that people had about it, no matter where they stood, and the fact that everyday people's lives were getting caught in this. But it wasn't until I got pregnant myself that I really felt that both the intimate potential violation of somebody making a decision for you about your pregnancy and also an extreme sense of solidarity with people in all other situations of pregnancy. For me, I was so excited to be pregnant. I had a blessedly short bout with infertility.

2:34I got pregnant through IUI. This is not in the book, but just in terms of context. I was really excited to be pregnant when the time was right for me. And I had an easy pregnancy, a textbook pregnancy, and then the world shut down for COVID. So I was about halfway through my pregnancy in March 2020 in New York City in the epicenter. And as a reporter, I started covering the things that were happening in hospitals in those early panicked days of COVID. So I was scared that I was going to have to give birth for the first time by myself. I was going to have a mask. The first part did not end up being true for me.

3:07The second part, I think I ripped off my mask at a certain point, but people were getting tested for COVID on admission and then potentially getting separated from their birth companions. They were potentially getting separated. I wrote about women who were getting separated from their newborns because they tested positive for COVID. The environment was a fear and panic, and I was afraid and I was panicked. And the only thing I knew how to do was to report on it. And then I also found myself going down this journey of reading about pregnancy in a different way. So in the beginning, I had been like, I'm just going to show up and let the doctor do what they're due, pick the right doctor and a workout.

3:44Suddenly, I was very afraid of going to the hospital because I was scared. At that point, we really didn't know very much about how COVID could affect a pregnancy or somebody who is pregnant. And so I just thought, what can I do to spend the least amount of time in the hospital all if it's without in my control at all. Now, we all know 99 % of the times it's not within your control. But I started reading things that I had been avoiding because I thought they weren't for me, like books about midwifery, because I thought, well, if I could labor at home for as long as I can and just come into the hospital, then I will only.

4:15And at that point, they were discharging people after one night if they had a vaginal birth. And so I became obsessed with this project of becoming as self-sufficient as possible if it was with all within my control. And in the end, I was really lucky because I did have a very fast and furious birth and I was able to only be in the hospital for one night and we were healthy and we were safe. And yet I felt like I had so many questions about the way that the system worked when you were pregnant. COVID almost showed us what it looks like when it's ripped apart because there were overworked healthcare providers.

4:51They were running out of supplies. There was fear of death. People were not going to hospitals because they were afraid they were doing unplanned home births, which was also something that I was reporting on, or unanticipated home birth. Oh, and I almost went to a hospital that was closer to my house that was known for having midwives. And I live in New York City and it was a public hospital that didn't have a great reputation among people who had private insurance, but they had created this kind of bubble of midwifery. And I thought, well, maybe I should be going there because another crazy thing that happened during my pregnancy is that there were Black Lives Matter protests in the city.

5:29The mayor instituted a curfew that shut down the bridges and the tunnels and there were checkpoints. And so I was suddenly worried that I was going to have a baby at a checkpoint. So I looked for a hospital that was closer to me. I looked at this hospital, Woodhull. People said, you know, counterintuitively, this is an amazing place. They ended up lifting the checkpoints and the curfew before I had my daughter. We kept to our plan. We were lucky that it all worked out. But then two weeks after my daughter was born, a young woman named Shahasia Semple went to Woodhull and died during the course of receiving anesthesia that she didn't want.

6:00And I just thought, how did something like this happen in a place that I was told was a place where, in particular, low-income women, Black women, which were two ways to describe her, although not the only way, could be treated with respect in their births. And so that set me on this journey of reporting. And then the second pregnancy that I had with my second daughter in 2022 was during the overturning of Roe v. Wade. And the DOPS decision happened while I was, I think it was leaked when I was six months pregnant. I think it was eight months pregnant when it was finalized. And I just felt like we are going to see effects of this across people's pregnancy decisions, not only people who are seeking abortions.

6:45And I also feel this deep connection with somebody who has, even though I live in a blue state and this will not be a decision or a series of laws that will affect me, I wanted to figure out how to tell a story that showed how deeply interconnected all of these different situations of pregnancy were. And those were the starting points. And although the book is not a memoir, I felt like my experience in my pregnancies and as a mom made me want to tell stories of other people that showed that it's not you over there. You were the good mom. You did not have a substance problem or an addiction problem during your pregnancy.

7:21So nothing bad will happen to you. Or you made all the right decisions about what doctor and what hospital to go to. No, this is a broader systemic problem. And so the women in my book, five of them who we follow through the course of their, in some cases, pregnancies, and in some cases, fighting to make pregnancy care better, are up against forces that are so much bigger than just their individual decisions. Right. You said something before about like, I'm in a blue state. So, you know, you would think these laws won't affect you. And I think that's part of what's so hard about this moment, right?

7:51These laws are made sometimes by people who don't understand what it means to be six weeks pregnant, that you really could only have known you're pregnant for two weeks, whatever. We won't get into the details, but it is people don't know what they don't know. And people also think that the right kind of pregnancy, as you say, done the right way, or the pregnancy that is had in a blue stage or the pregnancy that is had with health care will be fine. You're going to get the health care you need. And you were talking about the crazy special details that applied to your first pregnancy. And I just was thinking that each of us have talked about our own childbirth stories.

8:24Every childbirth story has crazy and then you wouldn't believe what happened then. There are no two are the same. There's always some extenuating circumstance and something that goes sideways for a moment, but then it's okay until it doesn't. And so I think that it's been easy for a lot of us to sit outside this and say, but this won't matter for me or my kids or my daughters. But yes, yes, it will. But then very suddenly some little thing, a butterfly beats its wings and it really, really does matter. Well, and of course, the starting point for the writing of the book was the broader impact of Roe v.

8:58Wade being overturned. But the stories in the book, in many cases, they happened before or they're not related to the Supreme Court's decision. And that's because, as you say, no two pregnancies are alike, but that, you know, there is the crazy alchemy of each individual pregnancy. And then there is what hospital can you go to or who's your provider or what are the laws or, I mean, so there's both preventable and non-preventable things. Each person is kind of experiencing both of those. And so, for example, Allison, one of the five women I write about in my book, she is desperate to be pregnant.

9:34She's undergoing fertility treatments, but she's living in a state that because they banned abortion, when she's trying to get the standard of evidence care for her miscarriage, she has to drive for hours because doctors are so afraid that a miscarriage where there's no fetal heartbeat is going to be deemed an abortion by the state. And then, you know, as you mentioned, the blue state aspect of it, it was really important to me. The two of the women that I wrote about, Maggie and Christine, live in New York City, went to the hospital that I talked about, Woodhull. And I was astounded, you know, because the two places that I focus on in the book are Alabama and New York City, that the racial disparity in maternal mortality in New York is worse than Alabama, is more pronounced.

10:18At the time that I was writing my book, a Black woman was eight times likelier to die for pregnancy-related reasons than a white woman. And so the two women in my book, Maggie and Christine, one white and one Black, help illustrate that story and investigate why that is the case. And that has nothing to do with what the Supreme Court did. It has to do with deeper factors that go back hundreds of years and that we're still tolerating today.

10:44Amy Wilson:Yeah, I was going to point out that a large section of the book is a medical history of childbirth and especially how that has impacted and affected Black women. But talk about the medical history aspect of the book and some of the quite shocking things that you talk about as part of that medical history. When I wanted to understand how we got to this point, where, for example, the statistic I just mentioned about the unforgivable racial disparities in maternal mortality, or how it is that I was reading about a tradition of midwifery that was incredibly difficult to access. And by the way, even though I had two great births, my first birth was with an obstetrician who bullied me, who lied to me.

11:30And they were relatively minor things in the scheme of what I write about. But the fact that even I, somebody who reports on this professionally, somebody who did a ton of research, a white, married, middle class, upper middle class woman. I mean, if it can happen to me, I quote Tressie Cotton-McMillan about how pregnancy can be sort of a piercing of the class fail where suddenly you realize, how dare they treat me like this? Because I'm usually treated better by the system. Right. And because childbirth is still the number one reason women are hospitalized for many of us is the first time that somebody has treated us like, to quote somebody else in the book, a child animal.

12:05Yeah. So why was that? And that was why I wanted to put in historical context each one of the women's experiences. So there's a lot of kind of like happy digressions or tragic digressions that happen in the book where we understand why it is that, for example, Maggie, who moves from Canada, why she's experiencing the system that is so different in America and why it is that the black women who are Dr. Yashika Robinson's patients are being treated with such disrespect in hospitals and why she's fighting to provide a better alternative. And so I trace back the history. For thousands of years, pregnancy and birth across cultures were an experience that was attended to by women in the community.

12:49There were trained attendants known as midwives. This is something you find in written and oral tradition for a very long time. This was something that women did together, whether they were actually just supporting or whether they were attending. And it was only in the 19th century that the medical takeover of birth occurred. And it brought with it, eventually, many wonderful things that I am in favor of. But at the time of the 19th century, it was deeply wrapped up in a few things that I think we could agree are not great. One, it was smearing midwives for everything that went wrong, either with maternal or infant mortality.

13:26Accusing them of being ignorant, superstitious, and causing the deaths of newborns. When at the time it was doctors who were spreading fever that was killing pregnant women on places where they attended them because we did not yet know about handwashing. Handwashing and antibiotics were responsible for huge reduction in maternal mortality. They also were suspicious of midwives because they would help women plan to space their pregnancies or to prevent them. Right. And also help them end their pregnancies. And so when doctors in the United States and in Europe in the late 19th century took over birth, it was partly because the medical profession was trying to show how respectable it was.

14:08So they were doing so at the expense of this traditionally female place. They were promising women a safer, cleaner birth in which they called all of the shots. And politically, they were arguing that immigrants and Black women in the South where these traditions had been kept alive were a danger to the white race. And they were extremely, many of them, extremely concerned with abortion among white women who they wanted to keep having many children and also keep subservient to white men. And so the eugenics history was alongside the history of gynecology being the experimentation on enslaved women.

14:49And so I write about Dr. J. Marion Sims, who is called the father of gynecology, whose statue still stands outside of the Alabama state capitol, who's in some ways life-saving discoveries and who invented the speculum, everybody's favorite thing about the visit to the gynecologist, for years experimented on enslaved women who had absolutely no choice as a way of looking for a cure to their fistula, which had been caused by childbirth and which were preventing them from having more children. which was in the economic interest of the slaveholders who held them. And so this history of some women are for experimentation, some women are for the breeding of empire, is deeply intertwined with the history of medicine in this country.

15:35And this is not to say that today there hasn't been a concerted effort to do better, but it's deeply embedded in our history. And so when I write about Dr. Yoshika Robinson, one of the very few Black women who was able to be an abortion provider and also provide birth care and gynecology care to her patients when she's fighting upstream to be able to give respectful options to her birthing patients. It is in the context of just a few hours away, women who looked like her were being used for experimentation by white men who then crown themselves the savior of women. And that paternalism and that lack of respect for the humanity of people who can become pregnant, especially Black women, continues to this day.

16:20We're talking to Irene Carmon about her new book, Unbearable, Five Women and the Perils of Pregnancy in America. And we'll be right back. After a long day in the summer sun, my skin needs a hydration reset. That's why I love Osea's Hyaluronic Body Serum. It's super lightweight to put on, no waiting 10 minutes before you can even get dressed. And even though I'm just starting to use it, the hyaluronic acid is really helping my skin retain more moisture. Amy, agree.

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20:37Because it's shameful, it's gross, it's scary. And so how much do you think that it is being caused by something that I think a lot of us continue to participate in, which is like, I don't really want to know what's going to happen in there. How does that allow these complications to continue? I think it's the right of every individual to share what they want about their own story. But for me personally, in reporting this book, I wanted to show kind of the full range of pregnancy experiences. There are women in the book who want to be pregnant, who don't want to be pregnant, who have beautiful births, who have life-threatening or taking births.

21:10I do think it is changing through platforms like yours and through the internet that people are being more open about the good, the bad, and the ugly. I think the dominant way that we are used to talking about childbirth in particular across classes is as long as you both got home, you know, as long as you've got that healthy baby, I just want him to be healthy. I just want her to be healthy. There There is a suppression of like, even if you, I think I even kind of do it myself. Like, what are you complaining about? Your baby's doing just fine. First of all, not everybody's baby does just fine, but also you matter, right?

21:46So we know also that the dominant culture, not the only one, but the dominant culture of American pregnancy is also like, you should not complain. You should only get pregnant if you can afford it and if you can provide a perfect life for your child. And then once you're done being pregnant, they don't care about you. They won't help. you. They won't provide anything for you. And they sure as hell do not want to hear your birth story. And I understand why also people don't want to dwell in something that is traumatic and they want to put a pretty bow on it. But I think every generation seems newly shocked by the physiology, by, I would say, the thing that I'm most interested in the book is by how you're treated when you're pregnant.

22:27As if you are, again, to go back to Maggie, one of the women's coinages, child animal. So suddenly you are not the person you were before you were pregnant. You are unable to make decisions for yourself because, well, this could hurt the baby as if you don't also have the ability to assess, you know, an informed way what could be right for you and your family and your body. It stops being your body. Your body becomes public property. One of the interesting historical and sociological passages to me in the book is about how this notion of the zero trimester that was coined by the sociologist Miranda Wagoner, which is about the idea that even before you're pregnant, when you're in your so-called zero trimester, you have to be absolute perfection in the course of preparing yourself for someday being pregnant.

23:13And so that means even don't drink if you even have the potential of someday becoming pregnant. Don't make a single mistake. The quote that you read in the beginning, this notion of like, it won't happen to me. When you have women who live in abortion ban states, who are seeking emergency miscarriage and stillbirth care, who have premature rupture membranes, who did everything right, that will not save you. And when you have people who are struggling with addiction and they need help getting thrown in jail, that includes middle class white women now, too. And so running afoul of the ideal of the perfect pre-pregnant, the perfect pregnant woman can carry significant penalties.

23:53And so I understand why people want to stay silent about it. But I think every time somebody opens up a space to hear about what it's really like, we all feel less alone.

24:02Amy Wilson:Dobbs obviously hangs over this book and hangs over women in 2025. We have people listening from all over the country, people who are firmly pro-life, firmly pro-choice, who have very strong feelings about abortion. I thought what was fascinating about this book and something that I think has been so fundamentally missing from the conversation about abortion is the actual experience of women, this sort of facile way that people will say like, oh, well, there's adoption. So we don't need I mean, having had three children, it's as if that period of conceiving a child and giving birth to a child is this sort of blurred out part of the story.