The failure of medical terminology in the post-Roe world.
Note: This article addresses IVF.
I taught English for twenty years before I learned the language of failure surrounding my body. In a clammy windowless room at UCSF Parnassus, I became a victim of “Advanced Middle Age.” I was thirty-eight years old and pregnant with twins. As San Francisco’s teaching hospital, UCSF was barebones: there would be no celebratory “champagne” breakfast when I delivered, as the hospital in Pacific Heights promised. Instead, I was guaranteed a room on the fifteenth flour — a room with a view, but one where the windows couldn’t be opened.
“We don’t want women to jump out,” the hospital tour guide told me.
Advanced maternal age and its close cousin, the geriatric pregnancy made me want to throw someone out those windows. These terms assumed that I had let my fertility “go,” as the grey hair and lumpy bodies of middle-aged women are so often described. My age was a danger —both to my babies and to myself. There were no positive connotations behind this use of advanced. This was no AP Exam. My body was simply past its expiration date, and my mind — most likely my ambition — had led it there.
“You’ve had a great pregnancy,” Dr. Robertson announced. The paper gown draping my knees rustled as the ultrasound wand probed my abdomen.
“Are you high?” I asked. The watery screen of the monitor reflected my surprise. “I fucking hate being pregnant.” I could not say this sentence in public. But Dr. Robertson was an advocate for women, a legend at UCSF, and I trusted her. At my four-month visit, she’d taken one look at me and announced, “You don’t look like yourself. You’re going back on the Prozac.”
The problem with being pregnant was that I never felt like myself, even on Prozac. There were two aliens growing inside me. “They look like chicken cutlets,” my husband laughed when I brought the ultrasound pictures home. “I prefer small crustaceans,” I joked, even though fear crawled over me. I was scared of post-partum depression. I was scared that IVF had been a mistake. What if my husband and I had tried for so long and so hard to have children and then we hated parenthood?
I could say all these things in Dr. Robertson’s exam room. Then I would leave. In the subterranean tunnels of the parking garage, I would return to my “glowing” fecundity, to my joy, to a culture that told me my life was finally starting, that I should love being pregnant, to all the other nouns and adjectives used to trick women into believing the pregnancy dream. How else, besides with words and images, could a culture persuade us that a ten-month gestation is only nine?
“You’re not the first woman to tell me she hated pregnancy.” Dr. Robertson laughed and tapped my knees to sit up. “You’ve had no medical issues. A great pregnancy —"
“Right.” Across the room, the ultrasound monitor emitted a static hum, filling the room with low frequency anger. “Besides this ten-month-long hangover? Besides not being able to exercise? The fact that I had to stop working?”
Dr. Robertson waved my protests away. “It will all be worth it. Plus, most women your age worry about an incompetent cervix. Too much weight with twins bearing down. We stitch it closed. You’re lucky.” Dr. Robertson patted my shoulder, as if rewarding me for my obedient cervix, for my brain’s ability to control my female body.
I crossed my legs and thought, not for the last time, about the fifteenth-floor windows, with their bird’s-eye-view over the twisted pines of Twin Peaks. “Incompetent” assumed that a woman’s cervix hadn’t taken enough classes, that it was unruly, not up to the assigned task.
Perhaps, as other women told me when I complained about the many ways pregnancy contained and constrained my body, I was being too sensitive, taking this all too seriously. “It’s just medical jargon,” they said.
“Sure,” I nodded. “But show me where ‘Advanced Paternal Age’ shows up on any man’s records. When was a man ever diagnosed with an ‘incompetent’ penis?”
As Roe v. Wade taught us, a woman’s body is a cultural battleground, and words matter.
The term cervical incompetence first appeared in the seventeenth century. In The Practice of Physick (1658), Peter Cole described the state whereby “the orifice of the womb is so slack that it cannot rightly contract itself to keep in the seed.”[1] As feminist historians have documented, the seventeenth century was marked by a profound anxiety over the idea of woman as a “leaky vessel.”[2] This was the century of the witch hunt. Female power threatened to overflow, to leak from every orifice – in words, fluids, and evil spirits. The female body, then as now, needed policing. Something unnamable about its creativity needed to be contained, lest it invade everything, challenging the heads of family and state. In Cole’s description, there is no egg. The woman’s primary goal is to nurture the man’s seed. At the time, medicine had only partly advanced beyond the sixteenth-century homunculus and the belief that a man’s penis shot a miniature, fully formed human into the womb.
In 2024, language matters. People tell me we have progressed since I gave birth in 2008: my cervix is no longer “incompetent”; it is now “insufficient.” Surely this is a pyrrhic victory when we have J.D. Vance suggesting that families with children should have increased voting power? When he says that the problem with our government is that it is run by “childless cat ladies”? In the face of all this talk, I can’t help but think we have returned to the homunculus, to the idea that women are only as important as our ability to birth life. When teenagers are being forced to carry to term, the cervix is no longer merely incompetent. It has been co-opted, colonized by Supreme Court justices who have made the government the doctors and handed them the cerclage sutures.
In 2024, we have a presidential candidate fighting against mythical “post-birth” abortions, and we have women who no longer control their bodies, women who have died because the fetus was deemed more important than they were.
In 2024, my twins are sixteen years old, and my daughter has fewer reproductive rights than I did at her age. On a personal level, I have spent the last two decades of my life trying to find a language with which to approach my aging body. Twenty-plus marathons and a two-year-long application to the Police Academy later, I am searching for the competence that our culture stole from me. When I was forty-five years old, I stood on the start line of the three-hundred-yard dash at the Police Academy, deliberately pitting myself against twenty-year-old male recruits. Maybe I was unruly when I passed them. Maybe I was hysterical when I wrote One Bad Mother, trying to take on the prescriptive cult of motherhood. Today, it is still 2024. The only thing I have any certainty or confidence in is the fact that I, as an individual, have “advanced” beyond my Advanced Maternal Age, even if our culture has not.
Notes
[1] Elizabeth Goulding and Boon Lim. “McDonald transvaginal cervical cerclage since 1957: from its roots in Australia into worldwide contemporary practice. BJOG: An International Journal of Obstetrics and Gynaecology, Vol. 121. 9: 1107. July 22, 2014.
[2] Gail Kern Paster, “Leaky Vessels: The Incontinent Women of City Comedy.” Renaissance Drama. Essays on Sexuality, Influence, and Performance. University of Chicago Press, 1987: 43-65.
Previous to her decision to apply to the Police Department, Megan Williams was a professor of English at various universities for over twenty years. After graduating from Haverford College, Megan received her Ph.D. in English from Temple University and taught at Lafayette College and Santa Clara University. Her book One Bad Mother is available now from Sibylline Press. Portions of it have received recognition from the New Millennium Award in Nonfiction, the Cagibi Magazine Prize, Panther Creek Award in Non-Fiction, and William Faulkner Creative Writers’ Competition. Last year, Williams won the PNWA award for nonfiction. She and her family currently reside in Bellingham, Washington.
Images:
Public Domain Review
Picturing Pregnancy in Early Modern Europe
Plates from Spiegel’s De formato foetu liber singularis (1626)
This story/commentary is brilliant and disturbing. Thank you for the perspective and may your views outdistance the dystopia