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22 February 2023

Secrets of the womb

Leah Hazard’s new book shows how this complex, life-giving muscle has been maligned and misunderstood.

By Sophie McBain

It is astonishing, really, how little most people know about the womb, the origin of all humanity, our first home. At school you might learn a bit about conception, those diagrams of tadpole-like sperm butting up against a giant egg, zygotes dividing into blastocysts, or the six-week embryo, a kidney bean with eyes, transforming into a recognisable baby. These are usually drawn against a white background, no womb in sight. I don’t remember reading anything about the miraculous, life-giving interchange that occurs between the blastocyst and uterus, or how the womb grows a whole new organ within itself, the placenta, to nourish the developing human, or how a mother and her embryo are so intricately bound together that many years after she gives birth, she will still carry her offspring’s DNA with her, becoming a living chimera – something that at least makes intuitive sense.

Female anatomy has long been treated by scientists as less important and dynamic than men’s, and has been dangerously understudied. The womb was incorrectly seen as a vessel, interesting only if it housed a baby. It is, in fact, a muscle: “we can compare it quite accurately to a clenched fist, not only in size, but in power,” writes the midwife and author Leah Hazard in Womb, a gripping exploration of the science of the uterus, the politics of medicine and the future of reproductive freedom.

A deeper understanding of how the womb works might help us better prevent miscarriages or fight infertility, and drive other medical breakthroughs. To do this, we need to think about it differently – Womb is partly a superb piece of PR for a much-maligned organ. In many cultures menstrual blood (or to use the unpleasant scientific term: menstrual effluent) is seen as dirty, a contaminant even. This squeamishness prevents us from seeing that menstruation is a fast, scar-free healing process – a regeneration as impressive, Hazard suggests, as a starfish regrowing a severed limb. 

Hazard is the author of the 2019 bestseller Hard Pushed, a memoir of her work as an NHS midwife that is both funny and deeply moving. Her style in Womb is sometimes that of the cool teacher in school: “Brace yourself, reader. It’s shark week,” she writes when introducing her chapter on menstrual blood. Her writing is by turns sardonic and rightfully outraged, because women continue to die and suffer needlessly as a result of scientific prejudice. Take the medical establishment’s response to the discovery by the American researcher Christine Metz of a reliable way to detect endometriosis using menstrual blood, instead of via a painful and invasive biopsy. According to Metz, scientists at the US National Institute of Health were unimpressed: why bother collecting effluent, one suggested, when a biopsy will do?

Hazard’s writing is most vivid when she returns to her professional experiences, describing the science and art of midwifery, the heart-stopping moments that precede life and death, the knowledge she has at her fingertips. She writes in stomach-churning yet transfixing detail about how a Caesarean works – how (you might want to put down your toast here) some surgeons will remove the uterus to repair it, letting it rest on the woman’s belly before reinserting it. All while the woman might be cradling her own baby on the other side of a surgical curtain, completely unawares.

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[See also: The women who shaped modernism]

Hazard also writes of the gentle intimacy of a midwife’s examination, the information she can glean simply by looking and feeling, the awful moment when something feels wrong: “perhaps your heart skips tightly into your throat as you realise this uterus feels rigid and wooden: the unmistakeable sign of a concealed bleed. Somewhere under your hand, the placenta is shearing quietly away from the wall of the womb. Your fingertips have told you how this story starts; your brain, whirring, alive, trained for every eventuality and emergency, knows how it ends.” How awe-inspiring it can be to watch someone read your body like Braille. I thought of the many times in pregnancy that I’ve exposed my huge, swollen belly to the searching hands of a midwife and tried to scan her face for clues or reassurance – what do you know?

Many of the discussions in Womb centre on the politics of medicine: what subjects are studied, whose expertise counts? Long before the advent of modern scientific methods, midwives had devised strategies to deliver babies safely. By the 15th century, they had discovered that ergot, a fungus found on sheaves of rye, could be used to speed up contractions, to treat postpartum haemorrhage or as an abortifacient. When doctors sought to improve induction procedures in the early 20th century, they started by refining ergot.

Occasionally, dodgy science has a long aftermath: Hazard mentions “irritable womb”, a diagnosis that might even today be given to a woman experiencing painful contractions who is not in labour, but that has no medical basis. Sometimes a man claims credit for discovering a phenomenon any woman could tell you about: enter John Braxton Hicks, the doctor who gave his name to the painless contractions that pregnant women can have throughout pregnancy. Heartbreakingly often, there are stories of women who sensed that something was wrong and were ignored by doctors with deadly consequences.

A tension emerges, because women often experience both too little medical attention and too much: medical interventions often seek to control the womb’s natural processes in ways that aren’t always desirable. Around a third of women in the UK have their labour induced or augmented with synthetic oxytocin, and up to 90 per cent receive the synthetic hormone to speed up delivery of the placenta. Research is emerging to suggest that Syntocinon is being overused by impatient medics who are unused to managing slow and fitful labours, leading to higher rates of postpartum haemorrhage.

Doctors can now successfully transplant wombs and they are edging closer to creating artificial wombs: in 2017, researchers safely nurtured pre-term lambs – who were born at the very cusp of viability – in biobags. Some feminists have argued that artificial wombs will finally bring about gender equality. But Hazard warns that these advances hold the potential for abuse: would doctors conclude that babies are safer in artificial wombs – where their progress can be continually monitored and tinkered with – than in women’s unpredictable, fallible, inscrutable bodies? Already a disturbing proportion of women feel coerced during pregnancy and childbirth – forced into C-sections or inductions, denied requests for pain relief – and Hazard writes of the many ways that women’s reproductive rights have been violated, a terrible historical thread that runs from the Nazis’ forced sterilisations through to reports of migrant women given hysterectomies in American immigration detention centres. 

[See also: Have Conservatives done enough for women?]

Womb is passionately argued and deeply humane. It is rare to find writing about pregnancy and childbirth that doesn’t judge women for the choices they make, or that are thrust upon them: was she too posh to push? Was she too numb to labour properly? Is it a shame every time a woman gives birth in a hospital bed, rather than in a candlelit bathtub at home? Hazard understands the many complicated factors that shape women’s reproductive choices, and argues that a good birth is one that a woman feels good about – a simple insight that nonetheless eludes so many.

Womb: The Inside Story of Where We All Began
Leah Hazard
Virago, 368pp, £18.99

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This article appears in the 22 Feb 2023 issue of the New Statesman, The Undoing of Nicola Sturgeon