Metaphors of Maternity in Olivia Gordon’s The First Breath: A Memoir of Motherhood and Medicine (London: Bluebird, 2019), £9.99
Like the ‘chimeras’ of the genetic technology she describes, Olivia Gordon’s The First Breath skilfully integrates multiple genres to provide a gripping tale of foetal and neonatal medicine. Part medical memoir, part motherhood memoir and part historical account, The First Breath tells of a generation of children who, even as recently as a decade ago, might not have survived past birth. It is, quite properly, an almost unbelievable and almost unimaginable story — because the procedures, techniques, and knowledge are, often, only recently imagined, and are even more recently put into practice. Gordon captures this world of motherhood sensitively, and it is overwhelmingly novel; but, as she does so, she also deploys a traditional series of metaphors to express her and others’ experience of motherhood. These metaphors serve both to anchor the extraordinary in the ordinary, and so to help us understand this other-world, and also to show how extraordinary the ordinary already is.
Gordon is a journalist and writer whose work has encompassed the subjects of medicine, motherhood and disability. Her son Joel was diagnosed before birth with complications that would mark his first five months of life as a dangerous and difficult time. With her own experiences acting as a catalyst, Gordon explores the remarkable area of foetal medicine. Six years after Joel’s birth she returns to talk with the doctors and nurses that saved her son’s life, and leads the reader into the heart of medical fields that are at the cutting-edge of medical advancements. Technical progress, and the willingness to take calculated risks, allow a range of operations to be performed whose consequences are momentous — the difference between life and death, paralysis and the ability to walk. Advancements have proliferated enormously over recent decades, and Gordon describes these branches of medicine as a ‘fledgling field’ (p. 133), in many ways similar to the ‘fledgling’ babies that they treat. Both are new to the world, and hold much potential in great uncertainty. We accompany Gordon into consulting rooms, operating theatres and hospital staff rooms to share in ‘the private backstage protocols that patients, like the audience of a play or the customers of a business, aren’t meant to see’ (p. 21). Alongside this unique insight into the most recent advancements in medicine, Gordon pulls the reader back into the history of these fields, recounting such milestones as the development of obstetric ultrasound, foetal surgery and neonatal incubation.
The world of foetal medicine is, then, awe-inspiring. Yet, threaded throughout the book, which at times tackles highly complex scientific and medical terminology, is a very human story of a mother and her child. This voice, Gordon argues, can often become obscured in medical literature and research, and her work takes care to provide a testimony of what she describes as the ‘female experience’ of pregnancy and motherhood, portraying ‘what it’s like to become a mother when pregnancy doesn’t go to plan’ (p. xii). As well as paying tribute to the excellent care she received through the NHS, Gordon raises some important challenges to the way neonatal medicine is currently practiced in the UK. In particular, Gordon laments the lack of physical contact between a mother and her baby in the Neonatal Intensive Care Unit, at a time when both need it most. Within the modern, medicalised setting of pregnancy, it can seem that for healthcare professionals, ‘the experience of mother and baby somehow eludes them’, because, Gordon notes, it ‘is not recorded in the scientific papers’ (p. 232).
That is true; randomised control trials do not account for this human, female experience. There is, though, an emerging corpus of research and criticism that aims to attend to, and recover, those female voices. Qualitative studies, as opposed to quantitative research, are more discursive in nature, posing questions to participants to elucidate their feelings in the moment. Gordon’s descriptions of her experiences, and those of others, closely align with the findings of this research. Phenomenological studies form a subset of such qualitative research, focusing on the lived experience of beings in the world. A key method for identifying different facets of a person’s experiences in relation to a particular phenomenon is to examine the metaphors he or she uses to express those experiences or, more accurately, to express his or her relationship to those experiences. Metaphors enable the articulation of the previously inexpressible, creating a connection between two things (the etymology of ‘metaphor’ translates from the Greek as a ‘carrying across’). In the case of pregnancy, phenomenological studies that focus on metaphors can be used to draw out the lived experience of pregnancy, and have done so to great effect. Throughout her work, Gordon’s descriptions of her experience are resplendent with metaphorical language, as are the stories she includes of other mothers. Many of these metaphors echo the findings of methodological studies, and suggest that though these mothers find themselves in a new world, it is new world different in degree and not kind from the new worlds that mothers often find themselves in.
One metaphor which is prominent within The First Breath and the field of writing about women’s experiences is that of the ‘mother as a vessel’. Gordon succinctly expresses the feelings that this metaphor conveys, writing of a phenomenon whereby ‘the mother is reduced to the vessel holding the all-important baby, no longer a person with feelings and thoughts that matter or might be different to the norm’ (p. 233). The vessel metaphor is found in the work of feminist thinkers, often as part of a larger exploration of feelings of obscured identity in motherhood. Adrienne Rich’s Of Woman Born is, like The First Breath, part memoir and part historical account. Rich argues that pregnancy and childbirth can result in ‘the extinguishing of an earlier self’ (Rich, p. 167). Under the patriarchal structures of the modern medicalised birth, she argues, the life the mother once knew is exchanged for the life of her child, resulting in ‘the “death” of the woman or girl who once had hopes, expectations, fantasies for herself’ (Rich, p. 166). This sense of isolation within the medicalised pregnancy can ring particularly true for women who experience complications. The stories of the women Gordon encounters, as well as her own story, articulate these feelings of obscured identity, as every waking hour becomes devoted to the care of their child. When exploring the biological and social dynamics of pregnancy, identifying the metaphor of the ‘mother as vessel’, works to form a communal voice amongst women who share this experience. Engaging with this voice can be an important step in efforts to improve the experiences arising from complications in pregnancy and beyond.
Framing pregnancy as a battle is a further metaphor which Rich’s work shares with Gordon’s and others’. The metaphor is surprisingly complex in the way in which it is used, because the ‘battlelines’ that it helps articulate are not single or clear-cut — there are instead many fronts, and multiple points of conflict. Even within what could be considered a ‘typical’, ‘uncomplicated’ pregnancy (one, that is, where the complications run to plan), women can feel as though their relationship between their own body and that of their baby is adversarial. Science writing shares the metaphor; evolutionary biologist Suzanne Sadedin describes the lining of the womb as a battlefield, the cells of which ‘are tightly aligned, creating a fortress-like wall around the inside of the uterus […] packed with lethal immune cells’. Beyond conception, Gordon relays how Professor Peebles, a foetal medical consultant, explained to her that foetal medicine ‘poses a completely different set of ethical challenges because there are two patients — mum and fetus. Sometimes they’re at odds (p. 11).’ Gordon presents one such case where the ‘two patients’ are at odds in pregnancy, known as Rhesus disease, in which the mother’s immune system fights the blood of the foetus. Yet, in addition to framing their experience in terms of conflict, women with pregnancy complications have used the battle metaphor to describe their fight alongside, and on behalf of the lives of their unborn babies. A study by Rubarth et al. recorded three categories emerging from the battle metaphor used by women with antenatal complications: that of waging ‘the war within’, of ‘fighting each battle’, and of ‘bringing in reinforcements’ to aid their child. This complicated use of war imagery, all bound within the battle metaphor, gives a rich insight into the experiences of women.
Gordon also employs the less traditional metaphor of a rollercoaster to create a sense of the uncertainty and volatility that having a child with genetic differences can bring. A nurse uses this metaphor to give insight to a bewildered mother about what lay before her, saying, ‘the next few months are going to be a rollercoaster’(p. 115). As the reader learns of the trials Joel had to face so early in life, it certainly does feel as though we are riding the rollercoaster of ‘Joel’s ups and downs’ (p. 156). The use of this metaphor to describe the turbulent experience of having a baby with antenatal and neonatal complications is also present in qualitative studies. Participants in the study by Rubarth et al. speak of their experience as a ‘rollercoaster of sadness and hope’ (p. 401), and another study into antenatal complications by Maloni and Kutil similarly noticed the rollercoaster metaphor being employed. Linked to this metaphor is a sense of uncertainty and luck, which ties into Gordon’s concluding description of pregnancy, ‘in the end, pregnancy is a game of chance’ (p. 316). Pregnancy as a game or gamble, itself a metaphor, is something Gordon and her husband Phil grow familiar with, becoming ‘weary old hands at this neonatal game’ (p. 142).
Thus, The First Breath, novel in its content, enters with its approach into a rich tradition of metaphorical language as a means of communicating the oftentimes intense, and sometimes painful, experiences of pregnancy. Gordon acknowledges that there must be a degree of emotional detachment between the doctor and the patients and their families, to enable doctors to perform their jobs. Nevertheless, Gordon expresses the joy and comfort she found when a ‘bridge of understanding’ (p. 333) was allowed to form between her family and the medical team. Metaphor, as a tool for aiding communication and understanding, can help build this bridge.
For the medical profession, a study of the metaphors of pregnancy may improve the experience of mothers, by enabling a shared foundation of understanding between the professional and the mother. This has been indicated by a host of studies performed in midwifery and neonatal nursing contexts, showing the possibilities of an approach to maternity care that understands the multi-faceted experience of pregnancy, and places the woman and her baby at the centre. This dynamic becomes arguably even more important in contexts such as those portrayed in The First Breath, where women depend on their medical team, ‘who hold not only life and death but also the possibility of birth in their hands’ (p. 19).
Elizabeth Whitehouse, 2021
References
Maloni, Judith, and Rhonda Kutil, ‘Antepartum support group for women hospitalized on bed rest’, MCN: The American Journal of Maternal/Child Nursing, 25.4 (2000): 204–210.
Rich, Adrienne, Of Woman Born (New York: W. W. Norton, 1976)
Rubarth, Lori Baas et al, ‘Women’s experience of hospitalized bed rest during high‐risk pregnancy’, Journal of Obstetric, Gynecologic & Neonatal Nursing, 41.3 (2012): 398–407
Suzanne Sadedin, ‘War in the Womb’, Aeon, 4th August 2014
Further reading
Blewitt, Emily, ‘An (Un)familiar Story’ in Motherhood in Literature and Culture: Interdisciplinary Perspectives from Europe, ed. by Gill Rye, Victoria Browne, Adalgisa Giorgio, Emily Jeremiah, and Abigail Lee Six (Abingdon: Routledge, 2017), pp. 46–57
Lakoff, George, and Mark Johnson, Metaphors We Live By, 2nd edn (Chicago: University of Chicago Press, 2003)
Littlemore, Jeannette, and Sarah Turner, ‘Metaphors in Communication about Pregnancy Loss’, Metaphor Soc. World (2019)
Lupton, Deborah, ‘Risk and the ontology of pregnant embodiment’, in Risk and Sociocultural Theory: New Directions and Perspectives (Cambridge: Cambridge University Press, 1999)
Shelton, Nikki, and Sally Johnson, ‘“I think motherhood for me was a bit like a double‐edged sword”: the narratives of older mothers’, Journal of Community & Applied Social Psychology 16.4 (2006): 316–330
