Lucky Number Seven: BIG NEWS
And lucky this newsletter is, to me at least. Because I have big news!
Last year, as I was wrapping up final edits on PERIOD, I couldn’t stop thinking of some of the material that I added to the book as the Dobbs decision was being announced… and some of the material I’d had to cut because it was extraneous to the broader message of the book. I started thinking about what it would look like to write a book on abortion, but on the science. I spent a lot of time reading books on the topic, from a personal, legal, historical, or sociological perspective. But I couldn’t find anything that offered a primarily scientific treatment, and certainly not one that grounded the science in the cultural and political understanding of the scientists and doctors doing the work.
Eventually what I realized I wanted to write was something bigger – a book on all the ways pregnancies end. Miscarriage, stillbirth, abortion, parental death, and of course, when they end with an actual baby. I’ve now learned that when it cannot stop thinking about something, I need to write it. So I did. As I wrote in my pitch,
“Uteruses did not evolve to make baby after baby: they evolved to practice and fail, many times over, through menstruation and pregnancy loss spanning one’s entire reproductive years. Of all outcomes, a baby is the least likely, yet most expected: the least supported, yet most demanded. In a culture of compulsory motherhood, it is important to understand that getting pregnant may be simple, but it is not easy.”
I am so incredibly pleased to say that Princeton University Press will be my publisher again, with Alison Kalett having acquired the book as my gifted and thoughtful editor. Michelle Tessler, my agent, was instrumental in making it all happen, which gave me the space to just focus on writing the absolute best proposal I could. Everyone at PUP has made the writing and publishing and marketing of my first book as seamless as I could imagine; I feel so fortunate to be continuing to work with them for book two.
Keep an eye out for PREGNANCY, INTERRUPTED: THE NEW SCIENCE OF MISCARRIAGE in 2025! I look forward to taking you all on my writing process and sharing some juicy tidbits along the way.
A few cool links – this week really one extended comment
To immediately draw parallels to today and why I’m working on a book centered around pregnancy loss, I want to share this story about pregnant people and COVID. A recent study has shown that pregnant people with COVID are more likely to die than those without COVID; this study also shows the significant downstream effects on the fetus, with babies born to pregnant people with COVID more likely end up in the NICU, to be born prematurely, or to have low birth weight.
Here is what is driving me bananas – why aren’t we more up in arms about this? Every time we find out about a teratogenic (meaning, interferes with typical fetal development and causes health problems) virus, bacterium, or chemical, usually there is a giant movement about it. There is a whole campaign around how to avoid it, how to protect yourself, often a movement to engage with the researchers who should have known or should have warned parents, and a focused inquiry into why we let this happen in the first place.
We have seen this with thalidomide. We have seen this with rubella. You can read amazing histories of the mothers, activists, and more who brought awareness to the links between teratogens and what they saw happening with their babies… and often the doctor or two it took for them to finally be believed. In these histories, you can see how knowledge of fetal and neonatal health is so often co-constructed with pregnant people and parents.
What has happened in medicine that is it getting harder and harder to feel like there could be a similar movement about the harms of COVID on pregnant people and their babies? We have many patient advocates and public health scientists speaking up when it comes to being medically vulnerable, immunecompromised, and/or living with long COVID. In my corner of the internet at least, I’m not seeing a lot of patient advocacy or activism coming from parents on how their getting COVID has hurt their kids.
Rubella was seen as a very minor disease before its teratogenic effects were discovered; thalidomide a wonder drug for morning sickness. So I don’t think this is just because of the terrible early messaging that COVID is a nothingburger when it happens to kids.
I think ableism and beauty privilege is part of the picture. COVID is not necessarily disfiguring – and one of the greatest maternal fears expressed over the last several hundred years is that their babies may be “marked” by something they did. From watching a scary movie, to riding in a car on a bumpy road, pregnant people have been taught to fear that their experiences and imagination have the potential to deform their children.
Here's another part of the picture – I could never find the study originally linked in the Forbes article (the article linked only to the main homepage of BMJ Global Health). But I found like what looks to be a similar study and it was a meta-analysis of a wider swath of the globe. These authors found that the parental and neonatal effects of COVID-19 were concentrated on low- and middle-income countries. So while this is happening in the US, it’s happening even more so in, according to these authors, South Asia, South America, and the Caribbean. Out of sight, out of mind.
Being born prematurely or very small has lifelong consequences that we tend not to talk about. Instead, much of the rhetoric around neonatal care focuses on the wonder we feel for technology that allows babies to live outside the womb that might otherwise have not. So rarely alongside these miracles do we consider the hefty percentage who die, or live with low vision, reduced lung function, issues with brain development, and more. And of course this allows us to not consider our community responsibility to care for the families of all children with all types of needs.
One weird period fact
If you are a menstruating person, have you ever been warned that periods will make you anemic? WELL THEY DON’T. There is a difference in iron status between people with ovaries and people with testes starting at puberty. But this difference in iron status has to do with the INCREASE in iron status that occurs with the INCREASE in testosterone among those testes-havers. In fact, years ago when I looked at the relationship between endometrial thickness (a decent stand-in for menstrual volume) and iron status among rural Polish women, I found that those with thicker endometria tended to have higher iron… because in general they probably had a better energy profile (meaning, were eating enough or more to support their activity).
Exceptions to this rule: people with menorrhagia, endometriosis, fibroids, adenomyosis… anything that causes excessive bleeding outside of the typical range. People who run long distances and therefore are killing lots of red blood cells with all of those footstrikes may also be at risk for anemia… though mainly if they are also not eating enough to compensate for all that activity.
But in the end, it’s not that uteruses make you anemic, it’s that testosterone protects you from anemia. And since the comparison group for what is considered healthy is almost always cis men, we look at the levels among people with uteruses and point out that their levels are low, when it would be as accurate to say the iron of people with testes is weirdly high.
Source: Clancy, K. B. H., I. Nenko, and G. Jasienska. “Menstruation Does Not Cause Anemia: Endometrial Thickness Correlates Positively with Erythrocyte Count and Hemoglobin Concentration in Premenopausal Women.” American Journal of Human Biology 18, no. 5 (2006): 710–13.