Infertility II: A Social and Historical Perspective with Margaret Quinlan

In this episode, I interview Margaret Quinlan and hear her perspective about the social phenomenon surrounding the topic of infertility. Margaret M. Quinlan is an associate professor in the department of communication studies at the University of North Carolina at Charlotte. She explores how communication creates, resists and transforms knowledges about bodies. She critiques power structures in order to empower individuals who are marginalized inside and outside of healthcare systems. She authored approximately 40 journal articles, 17 book chapters and co-produced documentaries in a regional Emmy award-winning series. She co-authored "You’re Doing It Wrong! Mothering, Media, and Medical Expertise (Rutgers) with Bethany Johnson." TRANSCRIPT: Sara   Welcome to the Birth Words podcast, episode number 22.   Introduction:  You're listening to the Birth Words podcast. Utah based birth doula and Applied Linguistics scholar Sara Pixton digs into the language of pregnancy and birth to help expectant women claim their power as life giving agents, engaged in a praiseworthy work. This podcast aims to promote positive birth paradigms, and is not intended as medical advice.   Sara   Before we jump into today's episode, I just wanted to pause for a minute and encourage you to get out your Instagram, go to Facebook, find Birth Words, give me a follow. You can stay up to date and share it with anybody that you know who may be interested in the language that we use to make birth better. Give it a share, give it a follow, and then we'll see you online!   Sara   Margaret Quinlan is an associate professor in the Department of Communication Studies at the University of North Carolina at Charlotte. she explores how communication creates, resist and transforms knowledge about bodies to critique power structures in order to empower individuals who are marginalized inside and outside of healthcare. She authored approximately 40 journal articles, 17 book chapters, and co-produced documentaries in a regional, Emmy Award winning series.  She co-authored You're Doing it Wrong! Mothering, Media, and Medical Expertise with Bethany Johnson. So, I'm just thrilled to be able to talk with Maggie today about the work that she's done. And we're going to focus specifically, today, on a chapter that she wrote in that book, You’re Doing it Wrong, about infertility as an extension of the episode. I previously aired Episode Seven about infertility. So Maggie, welcome to the podcast! Maggie   Thank you so much, Sara. It really is an honor. And I'm really looking forward to talking to you about, not just my research, but my research with Professor Bethany Johnson. And we've been researching women's health and the history of infertility and other health related women's health related issues. So I'm looking forward to digging into a little bit of that today.   Sara   Excellent. Will you start by giving us just a brief overview of your book, You're Doing it Wrong?   Maggie   Sure, so Bethany and I were interested in the ways in which new mothers face (and we see mothers as a pretty broad term) many of the same health issues, confronted by women for generations, and Stephanie is a historian and I am in Communication Studies. And so we were interested in how the number of lay experts and technical experts is, you know, potentially growing, especially on social media. So, what we did was we looked at what we call the life cycle of early motherhood, which is preconception through toddlerhood. And we looked at different crises that individuals could potentially face during during those times such as fertility and conception, challenges in pregnancy behavior and outcomes, premature birth, infant loss, having a child in the NICU, developmental delays, you know, other postpartum health issues. So, what we were interested in is how during these crisis moments, individuals tend to receive a lot of advice from experts, such as, like, doctors.  As well as from other individuals, friends, family members, strangers and individuals.  Add on social media. So, we looked at the ways in which, throughout history, what those messages have looked like and then what do they look like today on social media?   Sara   Excellent. Thanks for that overview. I think that's a really important work that you're doing, and any listeners who have gone through that life cycle of early motherhood, like you're talking about, I'm sure can relate to some advice, whether solicited or unsolicited, that they received, how it has impacted their journey. So I think you're doing really important work. I'm excited to talk more with you about it.    Maggie Thank you.    Sara Yeah! So, like I mentioned, and you wrote this entire book, I believe, is it nine chapters?   Maggie Yeah!   Sara So, you dive into a variety of topics in this life cycle of early motherhood. But, because I keep my episode short, and because we could go on for hours and hours, we're just going to focus today on a really little piece of it, which is chapter two, when you talk about infertility.  So, in chapter two, which you titled: “A State of Mind? Fertility Treatment(s) and Expertise,” you state that the World Health Organization considers both male and female infertility as a disease. And then others, like Marion Sims, in the 1850’s saw women's bodies as machines that need to be fixed by an expert mechanic. Even today, treatments are often “overly fixated on the problems of the body,” and the experts who can, “fix them.” How does this perspective and the linguistic framing that accompany it affect wouldbe expectant couples and their experience through the journey of infertility, and then if they're able to become pregnant, how does it affect them throughout pregnancy and postpartum?   Maggie   Well, while you were asking the question, the first thing that came to mind was the story of Dr. Dickinson, who practiced in the early 1900s. And we found in his medical journals and in his papers about how he used, he was a doctor who did fertility treatments, and how he used his sperm and other men's sperm to artificially inseminate women. And he did not often tell the women, and the women did not tell their male partners that they were part of the problem. And so, this was a really fascinating story to uncover, because, you know, just this sort of this fear the protection that many individuals did to protect men from the emotional and relational turmoil of infertility. That there, you know, it was believed that men would not come back from disaster, learning about their failed masculinity, or they wouldn't bond with the child.  We even saw some early 20th century public divorce cases where the woman ended up getting the custody of the child for the first time because they thought about that it was not the father sperm that that was being used. And so, that example is really interesting because, in some of our research with women undergoing infertility, I think of a woman named Vivian, and she did not tell her husband that he has low sperm count, because she, you know, wanted to protect him and didn't want him to have to deal with it. Where, you know, we still see today that many women going through infertility, that they're the bodies that undergo a lot of the treatment, and they're expected to take on the emotional labor from the health crisis. And that they're expected to keep the emotional stability of, of the relationship.  And so, in terms of, you know, what we saw throughout history and what we what we see today that, when thinking about how this could impact possibly becoming pregnant or the birth experience or the postpartum period, that if couples are already not dealing with some of the emotional issues, are not in a really stable, strong point in the relationship, when undergoing some of these are having intimacy issues, that those are going to be issues that they follow through them through pregnancy, birth, and the postpartum period. And so, you know, we still see that today, right? That you're not considered whole, if you're not a mother, your identity is supposed to be, you know, you're supposed to naturally be a mother and you're to blame, or female failure, or the failure of the woman if infertility occurs. And so, you know, we still see a lot of women going through infertility dealing with depression, social life force, isolation, depression, or relationship issues, sexual dysfunction, right? Going through all this. So, you're able, then, to become pregnant, some of those issues, for sure, would follow through, right?   Sara   Yeah. Wow, that is heavy. And so important that you're shedding light on it so that we work to change some of that. That is really heavy and difficult for those women who are feeling the weight and the blame, it should be a shared journey to shoulder with somebody else. All right, thank you.  I'm gonna move on to the next one. A question which, again, deals with infertility and you wrote about in chapter two. So, you wrote that the social and emotional challenges of those facing infertility are very similar areas, eerily similar you can say, to others in their shoes over 100 years ago, although there's a much higher likelihood that they'll be able to become pregnant and birth a healthy baby.  So, why does the social and emotional journey remain so challenging in such similar ways, when so much has changed?   Maggie   Yeah, it's interesting. I wonder, you know, after going through the historical aspects of this, I am curious about how much has really changed, that we still believe the biological mandate and we assume that there was, you know, romantic love that produced this child, which is a romantic, you know, 19th century idea. That there's still the same messages that, if that doesn't happen, or if you're not able to have a “healthy,” baby, that somehow you failed, that you're shamed on that, you know, we see the link that women do when going through infertility treatment. That in, not in this chapter, but in some of our other research about Instagram and infertility, we see women who have Instagram accounts that are just for their infertility journey and can't be usually connected to their name. And they go there to, you know, create community and to protect their identity. They're not telling others in their lives that they're struggling with this and are connecting and trying to get lay medical expertise through these through these sites. And so, what we would think has shifted a lot in many ways, haven't.  So, I think about, just even the shame and the stereotypes about African American women who are infertile, that they are sort of a double failure because the idea that African American women are, women of color are, hyper fertile. And then, they're not that sort of a double failure, and viewed with a lot of racial stereotypes. And so, we have groups like fertility for colored girls and another group called Broken Brown Egg, that tries to, you know, bring awareness to the silence that happens for individuals who go through infertility. And so, in my opinion, even though the likelihood that an individual will get pregnant has really increased, that I would like to personally have had seen more of a shift in, in how some of the challenges that individuals going through infertility face.   Sara   Yeah, that makes a lot of sense. And I think that that's a phenomenon that is not unique to this realm that cultural frameworks sometimes just change very, very slowly. So even if there's technological improvements that are changing rapidly, on top of that, underneath, you've got a cultural framework that is really takes a lot of work to progress and evolve. Is that what you found?   Maggie   Absolutely.    Sara   All right. Well, I guess we're doing the heavy lifting work of changing that underlying cultural framework.   Maggie   Yeah!   Sara    Right.    Maggie   And more to build on.     Sara   What's that?   Maggie    I said, a lot more to be done   Sara   For sure. Yeah. And more numbers are needed and a lot more awareness. And so, you kind of started to touch on the role of social media. So, my next question brings that in: what role does the discourse of social media play in shaping understandings of fertility? And you've talked a bit about the supposedly lay versus technical dichotomy, but blurred on social media, and how does that affect would be parents?   Maggie   Well, one thing, you know, we talked a lot about, my research partner and I, is that if somebody on social media shows that they're confident, that somehow is confused with being an expert in something, so if you're somebody who sells Shakeology, right, that you're an expert in this and that is, sort of, your idea of something that could, that could cure infertility or could could help get your body in the right, not superfoods right to be able to, to prepare for a baby. And so it's interesting in, you know, Facebook groups that I belong to when different social media aspects, you see a lot of people posting, you know, I could post something and get a response from lactation consultant, I could get a response from a pediatrician, I could get a response from somebody who you know, sell, you know, some sort of organic product or something, CBD oil, right? And so, you know, we see a lot of people posting and it's been fascinating to watch how even individuals are able to speak back to some of the discourse and in these spaces, right, we saw a natural medicine practitioner who was posting on Instagram, about how, you need to prepare your garden for having, you know, for having a child, and I saw women speaking back to this person saying, you know, I'm vegan, I've done acupuncture, I exercise, I look very healthy, but I have, you know, terrible egg quality and that has nothing to do  with what you're saying. And so, I think it's an interesting space where individuals can speak out, they can have their voice recognized, they can talk about how some of the language used to talk about fertility or women's bodies is inaccurate. And I think, sometimes these are safe spaces where women can do this, but that they wouldn't feel safe, maybe doing it in or disagreeing in their doctor's office. And so, you know, we've seen ways in which women can share care packages with each other for when they connect with people going through the same treatment cycle. And sending care packages or medicine to each other, or, you know, the ways in which some of these natural practices even have really have sort of a medical academy to them, and so I see it, I tend to see social media as, having a lot of dark qualities, a lot of negative social support, but I have definitely myself benefited from some of these communities in ways that, you know, I've been able to connect with people going through some of the same struggles that I have, or I've been able to donate my breast milk to a woman having trouble, or her babies or something.  So, you know, it's like, I do see a lot of potential of these moments and social media to to connect people, but I'm also very cautious of how, sometimes you'll see a lot of fertility e-courses and we talk about them in our, in our book, these e-courses are sort of painful. Yeah, a lot of them pedal the idea of, you know, get just getting your mind right or you know, just relaxing, and they use a lot of 19th century language. Which, if that doesn't work for you, it, you know, places a lot of blame or puts a pile of shame on you, because you weren't in the right mindset to do that. And, you know, you'll see a lot of people in that desperate state, you know, most likely signing up for these because they can't afford a $30,000 treatment and an $800 course that would allow them to get in the right mindset to “get pregnant.” You know, the ways in which that, you know, plays on the medical academy and the reason that, you know, we need to be aware of the practices happening and to help people understand that, you know, just getting in the right mindset or going on a vacation or drinking a glass of wine, for a lot of people, is not going to get them pregnant, and then you see a lot of that same message in social media today.   Sara   Yeah. How do you feel like that interplays, with the messages they may be receiving on social media with the face to face interactions these people struggling with infertility might be having with their doctors or with close friends and family?   Maggie   I think that's a great question that I think a lot of women do internalize these messages, right? That there's this great post that we have Instagram posts that we got permission to use. And it shows this woman who has all of her infertility meds, you know, on a desk or something that she has, you know, different alternatives, such as super foods or coconut oil and all of those also embedded in the image is, you know, a candle to help her relax and then she has a card that says, you know, reminding her to relax. And so, I think you get that these messages are so internalized in people's experience and, you know, I think doctors need to know that individuals are doing acupuncture and they are doing ultra alternative medicine, as well as, that's the medicine or the protocol that's been prescribed to them through infertility. And so, that this is just a part of our culture and you know, we need to be, we need to be talking about it, that people are going to do alternative and biomedical approaches to infertility.   Sara   Thank you. And thank you for doing the work to get people talking about it, get people aware of the complexity, the struggles and the layers and things that are heard and read and how this all kind of jumbled together to make a rather confusing experience for people going through infertility.   Maggie   I have, just the cost of it all makes sense, why individuals are, you know, are doing everything possible to possibly have a baby and the toll that's taking on them financially, emotionally, relationally, etc.   Sara   Yeah, it's expensive in more ways than just financially, takes a toll on many aspects of our being. All right. Well, I feel like we've just kind of scraped the surface of a very complex topic, but I invite all of our listeners to look into, You're Doing it Wrong! Can you remind me the subtitle Maggie?   Maggie   Yes, You're Doing it Wrong! Mothering, Media, and Medical Expertise.    Sara   Thank you. And thank you for talking with us today about where those messages are coming from, because no woman wants to be told she's doing it wrong. And so, thank you for your work to help us dig through where those messages are coming from and realize that there are, just, many approaches and many layers of this challenging life situation that comes to so many.   Maggie   I think it's comforting, you know, probably to your listeners to realize that you're not the only one going through these messages, that women throughout history have had experiences. And so for me unpacking the historical arc was really helpful in saying, "Okay, I'm not alone, that women throughout history have been getting this message." And, you know, what, what can I do about it? Or how can I work through some of these messages to help me through work through the crisis that I'm experiencing at this moment.   Sara   Thank you. Thank you for your work, and thank you for talking with me today. It's been a pleasure.    Maggie Thank you, Sara! It was a lot of fun.   Sara   Thank you for joining me on today's episode. As we wrap up, I just want to extend an invitation if you are liking what you hear on the podcast, if you feel like you've learned something, or it's given you a new perspective, that's been helpful if it's given you power or confidence, or helps you reflect on the language that you use, please leave a review. I'd love to hear your thoughts. I'd love to hear what's helpful and what's working for you. And please share with your friends, colleagues and neighbors so that we can spread the influence of Birth Words.   Outro: Did words play an important role in your birth experience? If you're interested in sharing your story on the podcast, go to www.birthwords.com. If you're liking what you hear on the podcast, please leave a review on your podcast app. For more resources about harnessing the power of words to benefit the birth experience, visit www.birthwords.com.