Jane | How many births are really wanted? An OB-GYN reflects

reproductive responsibilityparentingecological overshootambivalent

Feb 25

Jane went into obstetrics and gynecology after her own terrifying pregnancy experience. Now a fulfilled single mother of two, she shares her observations on the pressures women experience to have children, on the ethics of having children amid the global ecological crisis, and on her own fight against the pronatalism of her profession.

Jane (00:00):
As I began to look at the connection between population and ecological overshoot a while ago, there was a moment when the hillside was on fire in California and you could see the fire from the window of the labor room. And I remember placing a baby on the mother's abdomen and seeing the flames in the distance and thinking to myself, this is a calculus that is not going to work out for everyone.
Nandita Bajaj (00:38):
That was today's guest, Jane. Hello everyone, and thank you for joining me on this journey. My name is Nandita Bajaj, and I'm the host of Beyond Pronatalism, Finding Fulfillment, With or Without Kids, an interview series in which, through intimate conversations with women and men from diverse backgrounds, I explore how they are courageously and creatively navigating pronatalism - the often unspoken pressures to have children, whether from family, friends, or the culture at large. In each episode, I dive into personal stories with people who are forging unconventional pathways to fulfillment, including redefining what family means to them, whether that means being childfree or childless, having biological kids, adopting or fostering children or animals, or creating close-knit communities of friends and loved ones. Hi Jane. Welcome to the podcast. I am thrilled to have you here.
Jane (01:37):
Thank you so much for having me, Nandita. It's really great to be with you today.
Nandita Bajaj (01:41):
Wonderful. I've had the pleasure of hearing about your really wonderful journey, both personally and professionally, but for our listeners, can you say a few words introducing yourself?
Jane (01:53):
Absolutely. Yeah. So I am a assistant professor of OB/GYN, and I am recently in academic medicine. For the most part of my career I was a practicing obstetrician gynecologist for the last 20 years. And interestingly enough, I came to medicine in part due to a health scare that I had. I was pregnant and I told my partner at the time that I was pregnant, this was back in 1995, and at the time he seemed excited about the pregnancy. Having said that, within a couple of hours, the relationship turned southward and he became abusive and I was no longer safe to stay in a home together. And so I was staying with some friends and all of a sudden, one day I went out on a run at 5:00 AM and I had this sudden sharp pain in my side and I passed out on the street.
(02:52):
A bus driver woke me up. I went home to my friend's house and I called the nurse hotline and the nurse said, yes, you might have gas. I told her I was pregnant, but she said, yeah, it might just be gas. And so I laid on the couch all day with shooting pain up to my shoulders. And so by the time that friend got home from work, she says, you don't look so well. So she took me into the E.R., and in the E.R. I was diagnosed with an ectopic pregnancy. And in that moment in the emergency room, when I realized that I was bleeding to death internally, I had no health insurance, I had no checking account. I had given up graduate school to marry this person. And so I really was dependent in a way that I vowed to myself in that emergency room that I would never be again.
(03:40):
And in fact, it was in that emergency room that I decided I wanted to become a doctor. So it was an incredible moment in the sense that it was a real turning point for me. And I had previously been in landscape architecture, so the relationship was over. He's a somewhat famous philosopher, and he ended up saying that the idea of becoming a parent was incompatible with being the philosopher that he wanted to be. And I don't know, I was a writer at the time and I had left graduate school because he had said that he would support my writing. And I was young and I was so thrilled that someone thought that I was a great writer. And so it was this combination of the poet and the philosopher and the philosopher choosing the life of the mind and myself, the poet, also the woman, being tied down to the body. So in a way, I felt like it was somewhat an eternal struggle that humanity has faced with the ability to rationalize behavior through the life of the mind, when women, 50% of the population, are struggling with the life of the body, especially when it comes to pregnancy and reproductive rights and all of the ways in which the law and society and culture and expectations write their stories on our bodies, on women's bodies.
Nandita Bajaj (05:03):
That's incredibly wonderful framing. I love how you set the life of the mind and the life of the bodies and how really it's women having to straddle between the two lives, figuring out how much emphasis to put on the mind and the body, and whether or not we become parents, that possibility is always there. We're always paying attention to our bodies. Let's continue to go further into your story. I'm totally fascinated.
Jane (05:37):
So I think that when I emerged from that situation and then I had to go back and do post- baccalaureate pre-medical studies because I was not planning on going to medical school, I found myself in medical school in a state, South Dakota, that has a lot of antipathy towards women. And I wanted to start the first Medical Students for Choice Chapter at the University of South Dakota. And I was told by multiple faculty that I would be ruining my career by doing that. And I thought to myself, well, I don't know if you guys understand this Chapter is really here just to augment any information that's lacking in the curriculum about access to birth control and access to abortion, which is a federally protected right last I looked. And so to me, it was like no harm, no foul. I had no idea why this was going to be controversial, but the fact that they told me not to do it actually made me want to do it more because I was like, you must be hiding something if you don't want us to get education about reproductive rights, like what's behind that door.
(06:40):
Anyway, so we did that. We brought in faculty from Planned Parenthood to lecture us about aspects of contraception that were not being provided in our curriculum. We allowed students to travel up to Sioux Falls and go to Planned Parenthood and see what a patient goes through in a options counseling, in an actual surgical abortion procedure, and to really just kind of broaden the horizon of the students. And at the time, we did get some threats. We got some death threats from colleagues in our medical school class saying that they were going to bomb our meetings. And honestly, I didn't take it seriously, but I took the rhetoric seriously, because I think that there's a lot of rhetoric on the right that it gets repeated so often that it becomes acceptable that we talk about women accessing healthcare in a way that brings violence forward or that makes it somehow a question that she should want to be able to have control over her own body.
(07:36):
And then I also became a board member at Medical Students for Choice, the national organization. And so I ended up being profiled in Time Magazine and I gave interviews to the AP and the school got really, really mad about that because, it was interesting, they didn't want to be seen as backwater. They didn't want to be seen as not providing appropriate education to their students because remember, this is a publicly funded university, but at the same time, they capitulated to the legislatures who probably threatened them if they did talk about abortion in medical school. So they got angry at me, they retaliated against me. And the year that I left the legislature in South Dakota almost passed a bill banning access to progesterone, so progesterone IUDs, Depo-Provera, a very common contraceptive. And it just pointed out the clownishness, the degree to which the right wing has captured so many bodies in America that they would outlaw a single molecule, a single chemical that's used for so many different purposes.
(08:44):
We use it for abnormal bleeding. We use it for women who have fibroids. Regardless, we're seeing it in Louisiana right now. Louisiana on October 1st just passed a law saying that they have to lock, behind lock and key, misoprostol or Cytotec, which is a medication that we use to prevent hemorrhage after a woman gives birth. And so, in the days before October 1st, the OB/GYNs in Louisiana were having to practice drills in which they were running to the cabinets and unlocking them to get this drug, because when a woman starts to bleed after giving birth, she can actually die within a couple of minutes if the bleeding is not controlled. And so the idea that they were practicing their sprinting drills in order to access a medication that is available around the world for women to use in the setting of hemorrhage just goes to show you how far these legislators will go to try and diminish women's access to reproductive healthcare.
(09:40):
So after the University of South Dakota sabotaged my residency application, I did this thing that's called a scramble. So I looked at the programs that were available and I chose one and they chose me. And so I went there and it was in that city, Honolulu, that I met my now ex-husband. Now I say ex-husband because there were flags, Nandita. I should not have married this person and we were not good together. Having said that, we decided to have children together, and I conceived my twins when I was 38. I gave birth when I was 39. And so I do think that I stayed in that marriage in part because for one, I thought that the only way that I would have children would be in a traditional heterosexual marriage. And that's actually one of the regrets that I have, is that if I wanted to be a mother, there were other ways that I could do it.
(10:34):
And I didn't have to stay in a deleterious marriage. I didn't realize how far I had fallen from my own sense of self and my own consciousness until I was sexually harassed by my boss at work. And I told my ex-husband what had happened, what my boss had done to me, and his response was, if it meant keeping your job, you should have just let him. He said, we really need that pension and this health benefit. We're not going to find something like that anywhere else. In that moment, I realized I was alone. I was swimming through what felt like icy waters. I remember this sense of compression on my chest, like my lungs were sinking in cold, icy water, and I realized the marriage was never going to work if that was his opinion of me. And we separated about six or seven months later. And so it took a long time after the separation in the divorce to get back to the person that I was in July of 2003 when we met, and to have the full confidence that I had at that time. It took a long time to build that back.
Nandita Bajaj (11:53):
Definitely. That's a harrowing journey that you went through, and I'm so sorry with the way things turned out at the time. What has your experience been like being a single mother? Are you in full custody of your children?
Jane (12:07):
No, we have 50-50 custody, and I'll be honest, I actually have been very, very, very fulfilled being a single mother. I wish that I had never married him. I wish that I had chosen to, if I wanted to be a mother, that I had chosen to do that on my own and that I had disabused myself of this idea that you have to be in a heteronormative relationship in order to be a mother. I think there's lots of paths to parenthood I could have adopted. There's lots of things that I could have done. I regret that I clung to a cultural norm that probably didn't fit me, but I tried to make it work anyway. I guess I will say that I recognize that I wanted to be a really good mother to my children. I chose to become what's called an OB hospitalist, so that means that I work not in a clinic, but I solely work in the hospital providing obstetric and gynecological care.
(13:06):
And it means that I'm able to prioritize them in a way that if I had, say, staff and overhead that I was responsible for and having to meet minimum requirements for earnings, having to say to patients, I'll be there for your birth, which might mean that I would not be there for my children and their events, et cetera. So being an OB hospitalist allowed scheduled shift-like work, and I really felt like I was able to put a lot of creative energy and thoughtfulness and care into raising my boy/girl twins who are now 16. And so I actually, due to the climate crisis, I wanted to move to New York and I had to wait until the twins were 14, because the state of California says that at 14, the children can determine which parent they might want to live with. And so that meant that I could move away. And so my daughter moved with me to New York State in 2021, and my son stayed in Los Angeles with his father.
Nandita Bajaj (14:11):
It seems like you really thrived being a single mom and being able to manage both your professional and your personal loves.
Jane (14:20):
Yeah, I think I have hit a good balance. The proof will be in the pudding in terms of how many years of therapy they need to go through. I think a huge part of parenting is recognizing who they are and listening to them as opposed to imparting any goals or objectives that I might have had for them. So it meant exposing them to a lot of different things, whether it's music, whether it's art, whether it's sports, whether it's theater. And so I felt like I did a good job of at least exposing them. I don't think it is a parent's job to necessarily inculcate everything that they will have going forward. They are born at a unique time and a unique place. They have friends, they have other influences than what I had. And again, I really think that my job was really just to take cues from them and be their champion in what they wanted.
(15:13):
They're still writing their story, so I'm not quite even sure what that thing is for either of them. Having said that, I did try to question a lot of the gender norms for them growing up, and in part because I was sexually harassed at work and I did end up filing a lawsuit and I was successful at that lawsuit, I then became very interested in examining the facts, the data around what happens for women and minoritized individuals in their work settings. And in the process of that, I wonder how much my questioning of gender norms and of the patriarchy, I know that obviously my children were exposed to that. I don't know, especially for my son, if I could have been a better boy mom to him, because I feel like there were times when if I questioned the patriarchy or questioned the way in which the patriarchy exhibited its power, that he maybe took it personally or that I wasn't able to both question forces and structures and systems, obviously, that were outside our home. That's one point where I feel like I'm worried that I didn't do a good enough job,
Nandita Bajaj (16:29):
And that's a really hard balance to strike. I can completely understand, and I know friends who have had similar difficulties in trying to find the right balance in raising boy children, kind of inculcating this sense of nurture and care, and then receiving these very opposite messages, especially there has been a resurgence in this toxic culture, like a lot of men reclaiming masculinity as a way of asserting power. So I hear you.
Jane (17:04):
Yeah, and I think that some authors I feel have helped me on this journey. I think Peggy Orenstein's book, Boys and Sex, showed me how when boys are growing up, that there is a need in our society for boys to feel like they are part of manhood or boydom, which is about traits that are typically masculine. But unfortunately in our society, a huge component of the introduction into manhood is the rejection of the feminine and the necessity to make sure that you exhibit your manhood by demonizing or having derogatory language toward or by abusing women or being mean to them verbally, sexually, physically, that that is a way to show your male friends in whose club or whose fidelity that you want to belong. And so what I came to understand is that we can raise boys, and boys can become men without having to reject the feminine, without having to demonize the feminine, without having to make laws against the feminine body.
(18:19):
And so I'm not sure if I did that. I hope I did that, but that is a really important enterprise that I think we have for us now as a society is also men recognizing that the patriarchy isn't working for them. And actually women cannot do all of this work. Men who recognize that the patriarchy doesn't work for them, it's not healthy for them, we need them to be taking some of these actions as well to be voicing their concerns, to be getting involved. It isn't about women taking power. It's about recognizing that the forces and the cultural structures should be designed in such a way that they allow everyone to flourish, not just a given sex or gender.
Nandita Bajaj (19:03):
Exactly. And to also recognize as a parent what you're up against, right? Cultural influences are so, so strong, but to me it sounds like you've really thrived as a parent. And now that you are kind of on the other side working on bringing children into this world through your role as an OB/GYN, are there layers of pronatalism that you see within your own work?
Jane (19:31):
Oh my gosh, every single day. There are so many times when a patient will come to the hospital, oftentimes they have a pregnancy that's either too early to see its location, or they have what we call it, a pregnancy of unknown location. So we're worried that it could be ectopic, right? So we need to follow them, do ultrasounds, make sure that they don't have this life-threatening diagnosis that I had, this ectopic pregnancy. And in the course of those conversations, of course, one of the things that we ask is, is this a wanted pregnancy? Do you want to be pregnant? And that is the inflection point where I see so many cultural, familial, political, religious parts of pronatalism start to enter the conversation, because in the privacy of the exam room, a patient might say to me, I don't want to be pregnant but... And then you will hear all of the other influences that might be in the back of the room informing her decision.
(20:30):
And you realize that she ultimately has agency, but she might not feel like she has agency, right? And that's where I feel like the pronatalism forces are having some of the most deleterious effects, because we would always wish that if someone wants to be pregnant, that number one, they have the ability to conceive. And number two, they have the ability to have a pregnancy without coercion. And when we talk about coercion, I feel like coercion is a powerful word, and it doesn't always mean that you're being sex trafficked or that someone is threatening physical harm if you don't continue your pregnancy. But there are a lot of ways in which coercion is a small little stream or rivulet that is silently in the background influencing someone's decision such that they don't feel that they can either identify what they truly want or that they can say what they truly want.
(21:25):
And if I had one wish for women, it would be that they had the ability to sort of pull away all the layers of all the expectations of political structures, of cultural structures, of familial structures, and find out what is it that they want. Because what I end up seeing is I end up seeing people who have babies and who throughout the pregnancy will have a tension of, you can feel it, it's palpable, where they're ambivalent about the pregnancy. And it's okay obviously to have ambivalence and then decide, you know what? My ambivalence is gone. I'm really good with this decision. But the truth is, is that sometimes that ambivalence carries through to the birth of the child, and I'm sure the pediatricians could take this story over and tell us about how that ambivalence or how that not feeling a hundred percent in the decision to have that child shows up in the life of the child. So it is something that would be my wish, but I think we're so far from that.
Nandita Bajaj (22:23):
We are. We are so far from that. And what are the kinds of things people say in the privacy of the room with you when they say, I didn't want to be pregnant? What are the kinds of reasons they give you?
Jane (22:35):
They might say that he wants this, or my mom said that it's a good idea. Or many women say, well, I can't terminate. And obviously I just listen. I don't reflect back. I don't offer any judgment or anything like that. But I do think that obviously our culture has convinced some women that the idea of terminating a pregnancy is an abomination. It goes against God, it goes against nature. It goes against maybe their familial structures. And that is all true. And I absolutely understand and respect that. Having said that, I do think that obviously every child that comes into the world should be a wanted child. It makes me sad that people feel that they don't have agency, that the decision about whether to continue a pregnancy might have very strong bias or influence from some of these outside sources.
Nandita Bajaj (23:29):
Absolutely. Yes. And given that you are working at the intersection of the ecological crisis, and then you're also an OB/GYN helping to facilitate these births, and I know we've talked about the conflict that we feel about what the future holds for potential children that are being raised today. It's something I think about a lot, and I know you do too. And I wonder if you have anything you want to say on that, just the heaviness that you feel being in that role?
Jane (24:07):
Absolutely. I think that as I began to look at the climate crisis and the ecological crisis, I began to make a connection between population and ecological overshoot. There was a moment when the hillside was on fire in California, and you could see the fire from the window of the labor room. And I remember placing a baby on the mother's abdomen and seeing the flames in the distance and thinking to myself, this is a calculus that is not going to work out for everyone. Some people will escape natural disasters that are going to befall humans at a greater and more accelerating rate, and some will not. And the problem that I see is that I don't feel that the government is telling us all the information that we need to know. I don't feel like towns and cities are. I don't feel like the scientists are.
(25:06):
We look at the study that was done by The Guardian, by Damien, the editor of The Guardian, where he interviewed over 600 climate scientists and asked them what they thought was in the pipeline for warming for our earth. Their overwhelming consensus, I think it was something like 65% said that they thought that we would pass 2.5. Now, 2.5 means that none of what we have now looks like it does. It means that agriculture and the ability to provide food for ourselves and for our children is going to be impacted. It means mass migration. It means more and more category fives, maybe category sixes or sevens. It means the destruction of infrastructure. It means that humanity becomes a small tribe. And so if that is what's built into the system in terms of greenhouse gases and biodiversity loss and food loss, et cetera, I don't feel like today's parents are getting 0.1% of that information.
(26:17):
They are not getting that memo. And so whose job is it to convey to parents so that they can determine, well, maybe we only want to have one child, or maybe we don't want to have any children. And you see it in the interviews of Gen Z because they reflect back and they will say, I'm not having children in this crisis. But how did that person get the information that they needed to say that and to make that decision? Is everyone getting that information? No, I would say they're not. Some people can watch the news and see what happened with Hurricane Helene being twice the size in width of Hurricane Katrina being 800 miles across instead of 400 miles across dropping 90 trillion gallons of water inland like it did. And some people see that and say, yikes, if that's what we're looking at in 2024, what is 2034 going to look like?
(27:09):
And other people are like, Hey, there's food in the grocery store right now. What do I have to worry about? So I think that your question is so good. It's my favorite thing to think about and talk about, but it is so complicated and there is no one answer. There is rather the ability to see, however, where the math falls out, where the calculus is to read the papers that you write with Bill Rees and others who are telling us that we are in ecological overshoot. We're using four to five earths in the United States. We only have one. How are we going to get to one? Because nature will bite back until we get to one. And that 'bite back' period, that 'find out' period is going to be extremely painful. And we're not talking about it in relationship to informed consent as to whether or not we shouldn't be having children.
Nandita Bajaj (28:03):
Yes, you said all of that so well, and I love also the informed consent phrase, that children they don't get to consent whether they want to be brought into this world or not. What would it mean to engage in informed consent on behalf of that child? And it doesn't mean you don't bring a child into this world, or you do. It just means you really thought so deeply about this decision beyond your own desires. But I feel like what you talk about today and what we are constantly working on is so many people aren't even allowed to lean into their own personal and authentic desires. Because pronatalism is so strong, it really obstructs our own journey into this most important decision. I really appreciate the work that you're doing trying to dismantle to whatever degree you can, this pronatalism within the medical field, but also your own personal decision that you're really happy with and fulfilled with. Is there anything that we missed that you wanted to talk about?
Jane (29:05):
No. I'll be honest, I just want to continue the conversation. I think that I've been so thankful for the readings that have been put in front of me. I'd like to not work as much at the hospital as I do. I'd like to read more books, because I think there's so much knowledge here. So I will say I just hope that we can continue the conversation
Nandita Bajaj (29:25):
And we absolutely will. I love talking to you always, Jane. Thank you so much for joining me today.
Jane (29:31):
Thank you, Nandita.
Nandita Bajaj (29:33):
That's all for today's episode. Thank you so much for listening. What did you think of this episode? Do you have your own story you'd like to share? Check out the show notes to see how you can get in touch with me, whether you'd like to share feedback about the show or a particular episode, or whether you'd like to join me on the show to share your own story. I'd love to hear from you. Thank you so much again for joining me today, as we collectively discover and celebrate the many different pathways to fulfillment beyond pronatalism. Beyond Pronatalism is brought to you by Population Balance, the only nonprofit organization advancing ecological and reproductive justice by confronting pronatalism. This podcast is produced and hosted by me, Nandita Bajaj, with the support of my production team - Josh Wild, Elisabeth Strunk, Alan Ware, and Kirsten Stade.