Bearing Stories | Graphic Medicine

The Shiniest Jewel: A Family Love Story
One Good Egg: An Illustrated Memoir
Baby: A Soppy Story
Kid Gloves: Nine Months of Careful Chaos
New Life
Waves
The Facts of Life
Dear Scarlet: The Story of My Postpartum Depression

Books reviewed by Kevin Wolf

Every pregnancy is typical and atypical; that is, they are all unique; just like the stories reviewed here. Some are more medically informative than others. They each cover different topics but don’t view them as being the end all for any of those pregnancy-types. The stories provide two forms: words and pictures both of which are essential to give the authors point of view. All are memoirs with two (New Life and Waves) having a writer who’s the memoirist and a separate illustrator. The other six under review are written and drawn by the memoirist. Some of these stories are very painful and took a lot for some of the authors to lay this part of their life bare. Though this might sound contradictory to what I’ve already written, I hope others will find some comfort in knowing they aren’t alone by perhaps finding themselves in one or more of these authors’ works. These works should be applauded for their honesty, beautiful rendering, and heartfelt qualities. I provide a brief summary of these eight graphic works—published since 2008—reviewed just before I show their more detailed reviews.

I include two brief reviews for Waves & Baby. The former because it’s so intense and much of the book is wordless, I’d like you, the reader, to buy the book and live the feelings Waves pours over you. Much of Baby is about infancy and parenthood and not pregnancy. And strictly speaking, Dear Scarlet: The Story of My Postpartum Depression by Teresa Wong isn’t a book about pregnancy—the author’s pregnancy and delivery is covered on four pages (11-14)—but primarily about post-pregnancy, I’m reviewing this book for two reasons. First, it’s directly related to pregnancy; and second, it’s the only book I’ve seen connected with bearing stories that’s written by a person of color. This story isn’t meant to represent persons of color—that would be ridiculous—just as the other books reviewed here don’t represent what all white people go through. Clearly, there’s plenty of overlap between any pregnant persons and their stories. I hope that comes through from these reviews and when you read any of these great books. I’m looking forward to seeing more books connected to pregnancy by anyone who provides a different perspective and/or covers different issues connected with pregnancy.

I often summarize medical topics covered in any of these graphic works but since Kid Gloves: Nine Months of Careful Chaos by Lucy Knisley does a good job debunking five miscarriage myths (53-58) and most of the works have an upsetting miscarriage, here they are:

Miscarriage isn’t rare because about 25% of all known pregnancies end in miscarriage. Furthermore, about 18% of fertilized eggs (zygotes) are never implanted in the uterus; and there’s about 40% that are don’t stay implanted for four weeks—the likely time a woman might do a pregnancy test. That means about 49% (1 – (1 – .18) x (1-.40)) of zygotes disappear before pregnancy is confirmed; of the remaining 51% “pregnancies” 25% of them are miscarried, leaving about 38% (51% x (1 – 25%) being born.
Based on information collected by Lucy miscarriage isn’t caused by minor alcohol use, though it should be avoided, before pregnancy is known; nor is it due to prior birth control; nor from exercise; that is, it’s not the pregnant person’s fault.
Stress might have a very small impact (~2% under life-and-death stress over prolonged time period); and some stress is typical.
Some outsiders might think it’s not true, but the grief one feels after a miscarriage is very real. There are support groups, grief counselors, and other professionals—and perhaps friends and family—that can help.
Some miscarriages are unavoidable (~60% of the 25% of known miscarriages; according to Lucy), but there might be medical treatments that can reduce the chance in the other 40% of miscarriages.

Website references that are included herein are mostly ones I found and not from an author of one of the books reviewed. Any quotes or other information followed with a page number comes from the book being reviewed. I regret any errors. With one exception (The Facts of Life), none of the books site their sources, nor provide additional resources. Kid Gloves refers to her internet Pregnancy Research—though no websites provided—before each chapter about her own pregnancy experience; and she has some Reading (primarily graphic works) and Browsing articles at the end of her book.

Women and pregnancy have been given short shrift historically; and that hasn’t been in the distant past. Even recently—prior to the late 1970s—in the United States (U.S.) employers could discriminate for maternity related events. Employers didn’t have to provide health insurance to cover pregnancy services; employers needn’t provide disability benefits from maternity; unpaid maternal leave wasn’t a required employer benefit; and some insurance companies—even if they covered maternity costs—could have long waiting periods, like 270 days, to avoid providing coverage to persons who bought health insurance to have an upcoming birth covered. There were three reasons for this; first some argued—including before the U.S. Supreme Court—that maternity benefits were discriminatory because they didn’t apply to men and women equally. Second, maternity was considered elective and not caused by an accident or disease, which were the standard reasons for health insurance and disability coverage. And third, the reason for long waiting periods was to avoid adverse selection (an insurance term which means the individual waits to buy health insurance until they know they’re going to use it (i.e. in this case, until they know they’re pregnant)). What changed in the United States (most other countries were way ahead of the U.S.)? The Supreme Court held in General Electric Company v. Gilbert (1976) that it wasn’t “sex” discrimination under the 1964 Civil Rights Act when General Electric excluded pregnancy-related disabilities in their employee benefits plan which covered non-occupational sickness and accidents. Congress overruled this decision when they passed the Pregnancy Discrimination Act (PDA) of 1976 (“A bill to amend title VII of the Civil Rights Act of 1964 to prohibit sex discrimination on the basis of pregnancy”). Insurance companies often had excluded maternity benefits in their coverage before this law. The initials MSAAOD or MSAAOC (maternity same as any other disability or condition) started appearing on health and disability policies. When I was born the typical length of a hospital stay for a vaginal delivery was five days. That time length was winnowed down to one day by the mid-1990s in the U.S. Because of Women’s activism and push back Newborns’ and Mothers’ Health Protection Act of 1996 was signed into law on September 26, 1996 and required health insurance plans that offer maternity coverage to pay for at least a 48-hour hospital stay following vaginal childbirth and at least 96-hour stay for a caesarean section. The Affordable Care Act of 2010 requires maternity benefit to be covered as an essential health benefit (EHB) on the state run health exchanges. Now maternity benefits are typically covered under health insurance and human resources policies and treated like any other health-related condition. There is still no required paid maternity leave in the USA, though it’s—from six to eighty-six weeks—available for mothers in all other OECD (Organization for Economic Cooperation and Development) countries; and 34 of 41 OECD countries provide the benefit to fathers, too.

Summary of Books Reviewed

The Shiniest Jewel: foreign adoption

One Good Egg: in-home or in-office insemination & in vitro fertilization (IVF); medically detailed

Baby: comic strips.

Kid Gloves: difficult pregnancy & birth; medically detailed

Waves: surviving miscarriage

New Life: older male’s perspective of unexpected pregnancy

The Facts of Life: “…It’s more a matter of staying pregnant, not getting pregnant …” (162)

Dear Scarlet: postpartum depression

Two of these graphic works take place in France (Waves & New Life); translated from the French; and provide the writer’s story with illustrations by another person. The other six are written and illustrated by the storyteller. Two occur in the United Kingdom (Baby & The Facts of Life); and one occurs in Canada (Dear Scarlet: The Story of My Postpartum Depression). The French, UK, and Canadian works take place under a national health care system that has comprehensive coverage, low out of pocket expenses and paid family leave policies. The last three take place in the United States with ad hoc insurance coverage and unlikely paid family leave; two of which (One Good Egg: An Illustrated Memoir & Kid Gloves: Nine Months of Careful Chaos) have pregnancies discussed; while the last is for an adoption (The Shiniest Jewel) of a Russian baby.

After doing most of the reviews here, I realized they were about white women’s pregnancy tales. Health care providers should be sensitive to all their patients, including those that have different backgrounds than themselves racially, gender, orientation, culturally, economically, socially, and in all other ways. I’ve seen one pregnancy-related memoir Dear Scarlet from a person of color. There’s a short piece called Black Mothers Face Far Worse Health Outcomes. How Do We Fix It? by Whit Taylor that appeared in The Nib. Whit was pregnant at the time she wrote that piece and was researching pregnancy. This piece has over 20-panels and includes Serena Williams’ (Tennis Super Star) birthing tale. Serena knew her own body better than her hospital doctors. After an emergency C-section, her concerns were initially ignored. She asked for a CT and the blood thinner heparin after she had trouble breathing—she knew she was prone to blood clots. Because the hospital people personnel thought they knew better, they delayed finding and treating the clot in her lungs (pulmonary embolism) which led to coughing causing hemorrhaging at her C-section incision. Serena Williams almost died. I provide some U.S. maternal and infant mortality statistics by race later in this review; but just know that the United States has the worst record of infant and maternal mortality among developed nations; and even worse for people of color. Whit found “Black women are over three times more likely to die from pregnancy related causes than white women.” And includes a study by Arline Geronimus, Professor of Health Behavior and Health Medicine at University of Michigan which found white women in their twenties were more likely to birth a healthy baby than those in their teens, while it was the opposite for black women. Whit quotes Marlene Morris, [birth] doula: “There are some awesome midwives, nurses, and doctors, but too many assume that black women are angry, on Medicaid, and don’t have a birth plan, and can tolerate more pain [than white women].” I highly recommend Whit Taylor’s piece and hope she extends this graphic work to her entire pregnancy experience. Also see It Take a Village by Zoe Hopkins and Amancay Nahuelpan a short comic about an aboriginal pregnancy.

Below are my reviews of the eight graphic works.

The Shiniest Jewel: A Family Love Story

“I’m adopting a baby … from Russia,” announced Marion Henley—barely age 49 and making adoption plans since 45—in her memoir, The Shiniest Jewel: a Family Love Story (Jewel), to her parents. Jewel by turns is touching, very funny, circle of life story of Marian learning the foreign adoption process with the support of Rick—an eight year, often long distance, and getting stronger relationship—friends and family. The months-long silence from the adoption agency becomes unmerciful, especially with personnel changes at and errors by the agency. This book doesn’t provide a checklist, resources, or detailed information about (Russian) adoption; it does give a sense of the complexities and financial aspects of adoption; and it does show that the adoption process can be as emotionally fraught as birthing a child. I highly recommend this memoir.

At one point, Marian’s mother says Marian is like her father “Your head rules your heart …,” whereas after reading Marion’s comic strip, Maxine (books: Cartoon Novel (1987) and Laughing Gas (2003)), I always thought she was wonderfully heart-driven. Even Marion thinks, “I’m like my father?” (30) Her books are filled with metaphorical emotions (e.g. Maxine literally playing with a boyfriend’s heart only to drop and break it; and another strip as child Maxine bringing home a kitten and puppy with her mother saying “No!” and “years later” bringing home a jobless, homeless, divorcé to be told “NO!” again).

The primary medical aspects—which aren’t provided for educational purposes but for background—in Jewel are related to Marian’s emotionally distant father. Pre-Jewel’s start he survived heart bypass surgery, prostate cancer, and throat cancer; the latter is why he has a device to feel the vibrations from his throat to give him voice. Marian’s relationship with her father grows over the course of Jewel. We learn very little about Marian’s mother. We do learn the medical history of Marian’s eighteen-month-old adoptee.

This black and white inked memoir with almost no shading is in Marian Henley’s distinctive style of very fluid lines, cutely drawn characters, and metaphors out the wazoo. It’s one continuous tale with no chapter breaks. Word balloons are borderless with a small line showing the speaker. She has very emotionally expressive images (e.g. Marion shows herself responding to the word ‘marriage’ in one panel with five faces (shocked, appalled, angered, sweaty, and nauseous) over the words, “had … always … made … me … feel … sick.”) (12) Even her hand-lettering is joyful, playful, or painful (e.g. languidly, cursively flowing “S i l e n c e w a s h i s w a y” (51) when she writes about the gagged heart of her father’s love.) Marion likes literal metaphors—like a cat leaping out of a bag carrying a banner that reads: “Marion’s adopting a baby from Russia!” (24)

There are a few shortcomings in Jewel, including:

Though this book is about foreign adoption it’s short on the technical aspects of adoption.
It mentions there’s lots of paperwork (state and federal), and contact with specialists (nurse practitioners, CPA, notaries, lawyers, adoption agency). But it doesn’t give enough details how this ends up bringing her new toddler from Russia to the United States. For example, Marian does detail her travels, arrival in Russia, meeting her son, and the Russian authority interviews (providing the required dozen pink roses to the regional Director of Education (105)); just not the rest of the adoption process in some detail.
Along those same lines, there’s no resource list provided at the end of the book.
Her highly recommended agency screwed up including: not telling her all the legal documents she needed; not having the right people at all her travel locations; changing her agency contacts without telling her, etc. That’s all the more reason why Marian could make Jewel more helpful by telling the reader what’s needed or at least providing good resources or an adoption checklist. This book came out in 2008 and her adoption was in 2004; but resources existed back then that would’ve been helpful to share with the readers.

Her other book is Pucker Up: the Subversive Woman’s Guide to Aging with Ruth Pennebaker (2015)

One Good Egg: An Illustrated Memoir

“You only need one” is an often repeated phrase (sperm … egg … ovary … zygote …) in One Good Egg by Suzy Becker. To that I would add one good OB/GYN, wife, and stopping one bad OB/GYN from a medical disaster. We learn in wonderful detail about the author’s pregnancy decision-making (when) and process (how) to have her baby. We learn about all parties involved (Lorene who becomes wife), Steve (sperm donor), and various doctors and nurses who assist along the way. Events are presented to allow the reader to almost live them. There’s a lot of visual and textual humor in One Good Egg. I highly recommend this illustrated memoir.

One Good Egg begins with Suzy’s life from college. She creatively expounds her life events over the phone to a nurse (Mary)—as substitute for the reader—that brought her to that moment; and as the introductory story unfolds Suzy draws the nurse filing the author under Lesbian … Loser … then Mary doing nails … “so there it is, Mary. How I got to be thirty-eight and childless” … and finally Mary’s asleep with a glass of wine. (4-14) For the rest of One Good Egg readers follow Suzy’s pregnancy process and attempts in great detail. We watch her own birth; the finishing touches, publication, and book tour of her first memoir (I had brain surgery, what’s your excuse? Workman Publishing in February 2004) which also has a lot of medical content.

This book covers Suzy and Lorene’s desires and how medical personnel sometimes thwarts them, which requires Suzy and Lorene to try to take back control sometimes or cede control at other times. Her goal is to self-fertilize at home with her friends’ sperm. But once sperm is deposited with a sperm bank, she couldn’t withdraw any except to medical personnel; and Suzy was ok with IUI (intrauterine insemination; i.e. she checks her ovulation timing to have sperm put in her uterus under medical supervision) but not IVF (in vitro fertilization—inseminating with a fertilized egg). Because of early unsuccessful pregnancy attempts, Suzy later goes along with the pre-pregnancy doctor’s desire to IVF.

Suzy does mention a few resources used in One Good Egg (e.g. books: Taking Charge of Your Fertility and Alternative Families, a class she took on artificial insemination, that she maintained a “baby file,” “Couple Considering Parenting Support Group,” artificial insemination advisor, lawyer, loads of thoughtful decision-making and logistics of foreign sperm donor who was a travel friend; and post-pregnancy: What to Expect When You’re Expecting, birthing class, yoga, acupuncture, a sensitive-to-her-needs-and-desires OB/GYN. At times Suzy argues with her insurance company for getting pre- and post-pregnancy services covered.

There’s a lot of humor both textual and illustrative in One Good Egg including how Suzy and Lorene learn the gender of their fetus. Suzy provides her vivid dreams. And their home state, Massachusetts, allowed domestic partners and same-sex marriage over this same time span. There are lots of wonderful hand-lettered black & white illustrations providing additional commentary of the typeset text. Suzy is very visual in explaining her current activity. For example, an upside down, squat vase looks kind of like a uterus! (49) “Good Ovary” often argues with “Bad Ovary” images. Suzy provides an image of “Woods infinitum” whereby “Fertility Woods,” next to “Miscarriage Woods,” next to “Amnio Woods” are all surrounded by unknown woods. (147) There’s a sine curve which is “Sine of Losing Mind.” (79)

Medical mentions include: day 3 labs (i.e. two days after her period starts); hysterosalpingogram (HSG; assess infertility by radiologically viewing uterus and fallopian tubes to see if either fallopian tube is blocked and if clear greatly reduces chance of ectopic pregnancy); day 12 follicle test (to measure a woman’s remaining egg supply); ovulation predictor kit (OPK; if “surge in luteinizing hormone … which separates the egg from the follicle[, then] fertilization occurs 1 to 3 days later, 36 hours optimally (44)); lots of acronyms to learn (e.g. BBT – basil body temperature, EWCM – egg white consistency mucus), personal speculum. We learn eggs live 1-2 days after release; sperm 3-5 days, while ‘girl sperm’ are larger and slower than ‘boy sperm.’ (47) Suzy has Steve’s medical history. Suzy provides lots of details of the entire insemination process; sperm storage, scheduling appointments, and IUI. The reader finds what little control Suzy has over the process of becoming pregnant artificially and that it becomes ruled by the sperm bank’s director; with Suzy missing at least 8 ovulations waiting for all the rules to be followed. Different inseminators had opinions that did not significantly improve chances of becoming pregnant. Suzy finds out “Inseminations have to be medically supervised, but [hormone—which need careful preparation—] injections don’t?” (92). Suzy has an hCG [human chorionic gonadotropin; hormone created in placenta after conception] test for an ectopic pregnancy (115, implantation in fallopian tube). They want birth to be “as naturally as possible.” (147) There are natural birthing classes (158-164). Suzy’s “good” OB/GYN averted disaster when another OB/GYN briefly took over Suzy’s care (173-175)!! Her actual delivery is wonderfully anti-climatic.

Suzy has written several comic strip collections (All Better Book (1992), All I Need to Know I Learned from My Cat (and Then Some) (1990, 2007), My Dog’s the World’s Best Dog (1995)), and a middle school series (Kate the Great: Except When She’s Not (2014) and Winner Takes All (2016)); she’s also authored some children’s books ( Manny’s Cows: The Niagara Falls Tale, Books Are for Eating Reading, and Kids Make It Better).

Baby: A Soppy Story

Baby: A Soppy Story by Philippa Rice is filled with lighthearted comic strips. For example, Philippa says, “it’s time … [next panel] … I’m going to tell you my PIN number …” and she does and Luke, her life partner, immediately forgets it! Less than half the book (~40 pages) covers pregnancy, while the remainder is about infancy. There are some whole page home, couple, and triple (parents and baby) scenes, too. This book has wonderful life vignettes … with one justified outburst. For example, in four panels—getting closer in each panel and not yet knowing she’s pregnant—just sitting Philippa, thinks “<silent feeling> … I’ve never felt so motion sick in my life … Could it be … don’t get carried away.” And she’s pregnant, of course. The overall story arc is of pregnancy to birth to first parenthood to babyhood. We see tender and exhausting events; and advice asked & unasked for. It’s simply drawn in black, white, and red; with non-ballooned dialogue. And there are English phrases, like “lie-in” (rest … yeah … sure). Well worth the quick read. Other books by Philippa Rice include Sister BFFs (2018), Our Soppy Love Story (2013), My Cardboard Life (2011).

Kid Gloves: Nine Months of Careful Chaos

I don’t keep up with anyone from their websites—not friends, family, or strangers. Therefore, I was unaware of any of the Bearing Stories before their books were published—likely one or more years after their story’s events occurred. Lucy Knisley writes in Kid Gloves: Nine Months of Careful Chaos about letting her web-audience know about her pregnancy when she was in her Third Trimester because they had been so supportive when she had communicated about her miscarriages. And she’s been an “open book,” if one has been keeping up with her through her prior books or website. With motherhood she fully expected slowing her book output, except she’s published at least four books since her son’s 2016 birth. She hopes her child won’t resent being written about (even if only as “Pal”), because of her sensitivity and “that he’ll read how much he is loved in the lines on the page.” (149) Hank Ketchum’s son, Dennis, was resentful of the creator of Dennis the Menace, but that could be a special case. For those willing to participate in such a study, it might be interesting to research children of cartoonists’ reactions to their parents’ tales of their actual/fictional lives played out for better or for worse.

Lucy Knisley has presented much of her life in graphic works (French Milk—Lucy & her mother eating their way through France, 2007; Radiator Days—early comics, 2008; Relish: My Life in the Kitchen, 2013; Something New: Tales from a Makeshift Bride—her wedding plans, 2016; Look at My Cute Cub: Cartoons on Parenting, 2017; You Are New—baby picture book, 2019; Go to Sleep (I Miss You): Cartoons from the Fog of New Parenthood, 2020. Some of these books straddle her time before having a baby and after having one, so of course she has her tale of becoming a mother, namely, Kid Gloves. Lucy writes, “[Kid Gloves is] a combination of what I learned, what I wish I’d known, and what little I knew.” (7) Lucy has a straightforward drawing and writing style, making me want to quote much of her reportage of events. Rather than do that I’ll give highlights and my highest recommendation that mothers- and fathers-to-be read this book for themselves.

The cover of Kid Gloves provides a cute and more real version of Michelangelo’s Adam’s creation image with co-creator Lucy ex utero nearly finger to finger with her son in utero. Each chapter begins with a drawing of a growing fetus (white on black) and photograph of Lucy’s stage in pregnancy broken up by pregnancy research. Lucy uses lots of pictorial metaphors (after second miscarriage she was down a well with other women pulling her out by her writing pencil—symbol of communication; needing to rebuild her goals brick-by-brick). Lucy starts reading other’s graphic works that have pregnancy loss in them, including James Kochalka’s American Elf, and Terry Moore’s Strangers in Paradise. She read comics by mothers. Lucy mimics (or copied) their drawing style for each artist/writer’s portrait.

Lucy had lots of medical explanations—usually without citing sources. We see early on first medical hardware image of an intravenous (IV) drip bag which hints at problems at birth. (5) We read first medical problem—listeria—when Lucy writes she went nine months without deli meat to avoid listeria (1,600 cases/year in US; can lead to miscarriage, premature baby or life threatening infection in newborn; they’ve also been traced to hotdogs, celery, sprouts, cantaloupe, soft cheeses, and ice cream). (7) Other medical information includes contraception (like implant, 13-17); urinary tract infection (60% of women; with 25% having recurring UTIs); history by oppressive, ignorant men with their ridiculous explanations like a ‘wandering uterus’ and ‘hysteria.’ (22-23); reproductive process (25-28, including the slave-testing wretched ‘father of gynecology’ J. Marion Sims “and the speculum he invented was made from spoons he found;” and her therapist tells her to treat herself like she’d treat a baby “with kid gloves.” (73)

Lucy had a hysteroscopy (put dye in uterus to look for structural problems). An operation removed the septum in her uterus. Lucy covers “conception misconceptions” and the biology of pregnancy, including medically assisted means. (83-88)

Since the 1980s, 16 states—Arkansas, California, Connecticut, Delaware, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia—have passed laws that require insurers to either cover or offer coverage for infertility diagnosis and treatment. Of those states, fourteen have laws that require insurance companies to cover infertility treatment and two states—California and Texas—have laws that require insurance companies to offer coverage for infertility treatment (from National Conference of State Legislatures’ website May 29, 2020).

Lucy covers the trimesters of her pregnancy over three honest and detailed chapters (e.g she felt nauseously hung-over-like for six weeks); and more and more pregnancy research. There’s secrecy (wanted to get beyond twelve weeks when miscarriage likelihood declines), unfortunate sickness-producing laughs, hunger, review of pregnancy superstitions (109-112); be wary of nonsense on the internet; sister-in-law had mastitis (painful infection of breast tissue, likely from blocked milk ducts); Lucy napping with pregnancy pillow and pregnancy snore (indication of pre-eclampsia (aka toxemia)—high-blood pressure & proteins in urine, generally managed with medications). John, Lucy’s husband, was initially very stressed about impending fatherhood, but calmed down at about 24 weeks when he first felt Pal (baby’s nickname) move. Lucy discusses becoming a parent or not. (137-140) She recommends a lactation consultant over the breastfeeding classes. Lucy was sometimes frustrated with her OB/GYN, especially ignoring symptoms she told him about. Lucy discusses caesarean-sections, but doesn’t mention the huge growth in its use in the U.S. (before 1970 it was < 5% of all live births, >20% since 1985, and >30% since 2006; source: page 4 of Cesarean Section: An American History of Risk, Technology, and Consequence by Jacqueline H. Wolf (my sister), 2018 Johns Hopkins University Press).

The only part of the book that isn’t in color is when serious problems arise during the delivery and Lucy is unconscious for an emergency C-section and its aftermath because of pre-eclampsia. Kid Gloves gives John’s perspective during that two day period; and when Lucy revives to see Pal for the first time the color literally comes back into all of them. (192-203)

Lucy disclaims—as do I—having direct knowledge of medical science; and she provides some information about natural vs. anesthetized childbirth and doctors vs. midwives (208-215). Lucy points out “America’s maternal mortality rate is the highest in any developed nation, and it’s been steadily rising since the year 2000 [actually since 1990]. It’s much worse for women of color.” (214) One message Lucy doesn’t point out—though it wasn’t possible in her case and for some others—that vaginal delivery (over C-Section) is better for the baby because it jumpstarts the baby’s—especially gut—microbiome (Mueller, N. T., Bakacs, E., Combellick, J., Grigoryan, Z., & Dominguez-Bello, M. G. (2015). The infant microbiome development: mom matters from Trends in molecular medicine, 21(2), 109–117).

The U.S. Center for Disease Control (CDC) study, based on analysis of U.S. national data on pregnancy-related mortality from 2007-2016, found that the maternal pregnancy-related deaths per 100,000 live births (the pregnancy-related mortality ratio or PRMR):

Non-Hispanic black: 40.8
American Indian/Alaska Native: 29.7
Asian/Pacific Islander: 13.5
Non-Hispanic white: 12.7
Hispanic: 11.5

Overall Black and AI/AN maternal mortality was 3.2 and 2.3, respectively, times higher than the PRMR for white women—and the gap widened among older age groups. For women over the age of 30, PRMR for black and AI/AN women was four to five times higher than it was for white women.

In 2016, infant mortality rates per 100,000 live births by race and ethnicity were:

Non-Hispanic black: 11.4
American Indian/Alaska Native: 9.4
Native Hawaiian or other Pacific Islander: 7.4
Hispanic: 5.0
Non-Hispanic white: 4.9
Asian: 3.6

Waves

Waves, metaphor for fathomless uncontainable loss, is poignantly written by and based on Ingrid Chabbert’s life, wonderfully illustrated by Carole Maurel and translated from the French by Edward Gauvin. The language is brief, poetic for a difficult pregnancy with a fitting blend of worded/wordless images. The loving wife/wife couple is unnamed. Drawings look like watercolor; except some with black, white and grey wash. Waves overwhelms with feelings of a young hopeful couple. It moves from having trouble becoming pregnant to the joy of finding you are pregnant to the devastation of loss; from no color to what-could-have-been to finally … slowly finding color again with laughter and other forms of creation. This book is a very worthwhile mix of dreams and reality unfolding. Though I’m not writing a very lengthy review here, it’s not because there isn’t a lot to see; it’s so much better for the reader to live this work for themselves, because it’s a sweeping piece that carries you away … like a wave.

Waves opens over several wordless pages with a woman walking on sand [page turn] light red rain [worried look] red sky [next page] face away toward blue-turning-to-red ocean [fright] run toward floating paper boat on red sea … reach … fall [page turn] water rising … drowning [page] hand reach out “Sometime we drown, drinking in the sea. … A sea as red as a heart that’s stopped beating. …” And she awakens from a nightmare? Wife requires multiple hospitalizations from blood loss … she authors a story to read to the child-yet-to-arrive, child-not-to-be. This book is heartbreaking. We continue through therapy … such a loss never ends … but there is a beyond …

Ingrid Chabbert has authored about sixty children’s books, including The Day I Became a Bird, In Shape, A Drop of the Sea, The Last Tree, Elma: A Bear’s Life, and I Love to Be Bored. Carole Maurel illustrated many books and authored Luisa: Now and Then adapted by Mariko Tamaki. Waves won the 2019 Harvey Award for Best European Book.

New Life

“My name is Xavier. I’m 48, and I’m a new man. … My best years lie ahead of me” (7) so almost begins New Life written by Xavier Betaucourt, drawn by Yannick Marchat and translated from the French by Montana Kane. New Life provides a late-in-life pregnancy from a father’s perspective. Xavier decides to divorce and start again: “New Life” has multiple meanings from the writer’s new start, to his future new baby with Lea, and this graphic work brought to life to document the events. I have some qualms about the abrupt—only a few pages—ending of Xavier’s marriage and younger life. We learn nothing about his first wife except they had “a lifeless marriage” (4) and we learn more about his adult son, who’s twenty, from that marriage. Xavier is a hard character to like, but I appreciated his honesty. New Life shows the author’s process of moving from that early marriage to independence to starting a new seemingly better suited relationship.

After the prologue, the chapter breaks are months from June to January as the squares progress from 1 to 8 on a hopscotch layout always starting with “earth” as the first “square.” Xavier is forty-eight and Lea is forty and had been told she couldn’t have kids; because she has no eggs. Xavier enjoys being childless with Lea … and when confronted with Lea’s pregnancy wonders if he’ll die and his child will grow up fatherless … he’s filled with doubt … feeling old … but wants the child with his last name though not married to Lea. Like I wrote, Xavier is hard to like. Xavier’s father had left the family when he, his brother and sister were young. Lea’s unexpected pregnancy is explained by an OB/GYN as “medicine is not an exact science (43)”

Xavier’s mortality becomes a primary theme, which Lea tolerates, but eventually becomes frustrated with. There are two other relationships critical to Xavier: his brother’s and his son’s. After we learn Lea is pregnant (June) Xavier writes, “The old adage confirmed it: for every death, there is a birth. … My brother died two months ago.” (20) [As an aside, I’ve never heard this ‘adage’ before. And it’s not true. From a demography perspective it would mean a stationary population—neither growing nor shrinking in size; which is never true except from a theoretical perspective]. From an artistic perspective Xavier is trying to write his brother’s death and Lea’s pregnancy balance. Xavier visits his brother’s grave and his brother for advice or as a sounding board for his plans or lack thereof.

Xavier’s son is about to turn 20. They always got along in the past. New Life shows an interesting two-page pictorial trail (22-23) from the present to father and son walking a winding path of his early childhood as buddies … to his twenty year-old-son being “tough for him to imagine his father making a new family …. “ It is several months for Xavier to tell his son he’ll be having a half-brother which he takes very badly.

Xavier goes through midlife crisis tropes: getting divorced, finding a younger woman, buying a motorcycle and he blathers in counseling [abbreviated dialogue]: “I’m having a baby … It’s not that I wanted one … I’ve already been there … I was told it was medically impossible, but now it’s happening, so go figure … I’m too old for this … I’m not ready … So there’s the question of abortion, of course. But how can you deny the person you love what they want most in this world? … Plus would I even want that? I don’t think so. … Contradictory, right? Yes, I’m aware of that.” (39) Xavier’s pictured in counseling as covered in the sticky glue of his mental state … Then he’s tiny and sitting, lying, and finally, standing on the chair having purged his concerns by ending with they’re going to try out the kid thing by getting a cat. (40) To all of this the counsellor only says “Er … you know it’s [getting a cat] not the same thing right?” (40)

There aren’t many medical scenes in New Life. There’s almost no pre-natal visits mentioned except to confirm the pregnancy and two ultra-sounds to give us the gender. There are no birthing classes mentioned. Whereas France has very comprehensive maternity benefits which includes up to four pre-natal classes by a midwife; which includes labor stages, pain relief, breathing exercises, complications, baby care, and breastfeeding; according to the article that I gathered this information from there aren’t births at home in France “except by accident;” and maternity leave is 16 weeks, typically six weeks before and ten weeks after birth. Pregnancy and birth are covered by their national health care system. The days mentioned in New Life are spread out in all chapters, except the last when the delivery date nears; helps the reader feel some of the same anxiety as Xavier.

There are several interesting visuals throughout New Life. A dove, symbolizing new life, appears many times. Water colors are used when Lea & Xavier are around; while scenes between Xavier and his dead brother are often black, white and grey with a colorful flower representing his brother’s daughter. Xavier’s signature look is light or secondary colors (green, pink, cloudy blue), while Lea’s is red. Periodic images of Xavier being tiny while children are giants when he feels he can’t go through fatherhood again; or vice versa … when he can. There’s a touching baby naming scene with their baby giving his/her opinion. We sometimes see the baby in utero. For presumably artistic reasons, the publisher modified the cover in the English edition with only focusing on Lea & leaving anxious Xavier and beach kid toys and sandcastle mounds that appeared in the French edition, out.

Other books by Xavier Bétaucourt include two nonfiction comics: Bouclier Humain (Human Shield) with Grand Angle, then Noir métal (Black Metal) through Delcourt. In 2016, he released Le Grand A (The Big A), a biographical comic through Futuropolis, and most recently, his autobiography with Too Old for You.

The Facts of Life

The Facts of Life (Facts) by Paula Knight is a memoir of the difficulties that can occur, contrary to society’s norms depicted about marriage, womanhood, and pregnancy. This book is a memoir of the pseudonymous Paula Knight. In the afterward she writes, “Apart from Neddy (a family heirloom rocking horse) all the names in this book have been changed, including my own. This probably seems odd given it’s a memoir, but it helped me to write more freely, and, over time, name and character became inextricably fused.” (238) Facts is part of the Graphic Medicine Series published by The Pennsylvania State University Press, which has over twenty books in the Series, including Graphic Medicine Manifesto by MK Czerwiec, Ian Williams, Susan Merrill Squier, Michael J. Green, Kimberly R. Myers, and Scott T. Smith. I highly recommend Facts.

Paula’s upbringing in the United Kingdom (UK) in the 1970s internalized the goal to have a husband and then children. This graphic work lives up to its title with Paula moving from her birth to youthful exploration of where babies come from not knowing how all the body parts work or whose parts are needed create some funny scenes. “Test tube babies” (in vitro fertilization—IVF) made news in 1978; but not really explained well by her mother. At Paula’s age 9-10 and older was very inquisitive about periods; What’s ‘making love’ like? How does a man not wee? What’s a johnny? (38)

Her mother, grandmother, some teachers, TV, advertising, or her best friend, April, spend hours in many days emphasizing motherhood. But many explanations led to confusion. For example, her dad would say, “The world’s a bad place … Human beings are just like parasites crawling over the face of the earth! There are too many people.” (46) Paula’s grandmother saw her post-college living with a boyfriend as being sinful; her kids would be “bastards”; and her dad would be “’art-broken” if she doesn’t want children. (59)

A female grade school teacher uses confusing euphemisms to special class for female students when responding to question is bathing alright during one’s period she said, “Hygiene is important, especially … downstairs” (40) And a student doesn’t understand because her bathroom’s upstairs. Age 10 Paula’s period starts; her mother is very helpful and gives her a pad. She could talk to other girls about her period but not when boys were around. Women relatives didn’t talk about it. Paula had painful periods with migraines. “For something that was supposedly natural, normal and healthy, the world seemed intent on concealing the existence of periods. This did nothing to make me feel at ease with my own blood. … Especially with TV adverts insisting it was BLUE!” (42) Human Reproduction was part of biology class taught by a male who was embarrassed. “The purpose of coitus was for fertilization. No mention of recreation, or of contraception [nor presumably sexually-transmitted diseases].” (43)

Her trek toward pregnancy almost seems Sisyphean; lots of frustrations and discouraging medical news. Not having children can be appropriate and a joy too. Some people are unable to have kids, and others, though able, shouldn’t have or have had them for the way they treat their children. For Paula Knight, though she desired a child, her health issues make staying pregnant and birthing a child difficult. Her ME/CFS (myalgic encephalomyelitis/aka, chronic fatigue syndrome) might lead to infertility and leaves her too exhausted to provide the care and attention a child would need, so adoption wasn’t viable either. Full disclosure: I’m married with no human children. Some information that’s never mentioned in this graphic work is: By age 45 in 2018 19% of women have no children in the UK and 15% in the US.

UK colloquialisms mentioned: bairns (Scottish; children); johnny (condom); and home in the pudding club (pregnant).

Chapter splash pages provide more symbolism as acorn falling from tree (One), squirrel planting acorn (Two), and tree sprouting (Three). The third part of Facts has surreal aspects to it; starting with the literal seedlings sprouting. Did you know that acorns that don’t float are most viable? Paula shows many touching, sometimes overwhelming images of a difficult and frustrating pregnancy process (e.g. Paula in fetal position with others’ word balloons sympathizing; 111-116). Her emotional distress is on display when she draws herself fading away when a near positive (faint extra line) pregnancy test was false; and subsequently deemed a miscarriage. The afterward provides Paula’s thinking on some visual choices (e.g. a childhood turtle as metaphor).

There’s an out-of-place sequence of events that adds to the third section’s surrealism. Jack, Paula’s beau, and Paula are on holiday when driving a country road they see an elderly woman crossing the road. They pick her up and notice she’s wearing a cinched belt around her neck. She says she’s from a “care home.” Jack stops in to a local farm to look up the address of the nearest care home. They drop her off when she seems to be recognized at that home; but there’s no explanation or questioning of the cinched belt around her neck, nor the home’s lax security in being able to wander off.

Medical topics mentioned in Facts include: morning after pill; “glandular fever” (infectious mononucleosis) and viral fatigue syndrome (viral infection with 22% having chronic fatigue six-months after getting mono); cervical screening; the wrong advice by a nurse that the pill would extend the life of her egg production (83). Thyroid function tested (Paula “discovered that if [she] was in the USA, with [her thyroid] test results, [she]’d be treated for hypothyroidism—and that the UK lab ranges were wider.” (87)) Paula had thyroid issues (low TSH; thyroid-stimulating hormone) so received thyroxine during pregnancy. Hypothyroidism means thyroid has low hormone productions with no cure; can be treated; can cause infertility among other consequences. There are excellent images of a difficult and frustrating pregnancy process. One needs three miscarriages before fertility testing is done; and three months of fertility testing are explained in detail. Paula’s progesterone level isn’t stable. Vitamin B12 injections increased her energy levels; magnesium reduced muscle fatigue. And too late to help, she finds out that had she started her thyroid treatments years earlier, she may have had a reduced chance of miscarriage.

At the back of the book there’s an afterward, glossary of acronyms, references, photo credits, acknowledgment, and notes on artistic works mentioned. Other books of Paula Knight’s include: It Takes Two to T’wit T’woo and Roble’s Rain Dance (Bonney Press, 2012).

There are at least two amazing points in the book where the reader gets a glimpse of the frustrations that Paula goes through to try and have a child. There are many others, but these two stood out to me. The first is a few images in the prologue and the other is the source of the book’s cover. The prologue of Facts puts the reader inside a car. There’s a male (Jack not-yet-named) driving from right-hand side (UK); and a female (Paula) looking toward the backseat smiling then light beams coming from behind Paula’s head; stopping at tree nursery to plant three baby trees; and having a hot drink at a picnic table with mature leafy tree in background—emphasizing some of the surreal aspects of this graphic work—with a dog marking the tree. At first when I wrote these words I used “father” where the word “male” appears and “mother” for female …. and looking toward the backseat I thought was at a human child; but that’s just how much parenthood is built into my psyche that would lead to that automatic conclusion; and it matches the overarching theme of Facts (i.e. that assumptions are automatically made with respect to womanhood and pregnancy); and perhaps the reader’s frustration that the backseat doesn’t hold a baby. And the second scene is the cover showing Paula and Jack with a “come hither look.” This occurs on page 94 when Paula ended taking birth control to promote pregnancy and she detected the signs of ovulation so presumably love-making to follow. Therefore, from both these scenes the reader is expecting a baby. And the reader’s minor frustration at this lack is nothing compared to Paula’s and Jack’s.

Dear Scarlet: The Story of My Postpartum Depression

Written as a letter to her daughter, Teresa Wong’s Dear Scarlet: The Story of My Postpartum Depression lays bare Teresa’s struggles and survival. This review loses some of the gentleness of Teresa’s letter because I’m like a voyeur who finds this letter meant for her daughter; and I can’t match her language (e.g., She tells scarlet, “The other day, you told me that when you grow up, you want to be a mommy” (7)). Instead, I’m changing Teresa’s roll to third person narrator here. This book is brave, at times horrifying and infuriating because of lack of support from the hospital staff, and calming if the reader becomes an observer of Teresa’s post-pregnancy survival with the support of her husband, mother, brother, a postpartum doula, medications, counseling, and others. Teresa’s postpartum depression (PPD) went untreated for two months after Scarlet’s birth. When Teresa realized she needed help, she found it and she learned she wasn’t alone. That’s probably the biggest lesson for anyone at any time; and especially, for pregnancy related matters: you’re not alone! I highly recommend this work.

Teresa is filled with doubts about parenting; she thinks over six panels, “What if my kids hate me? … What if I don’t like them? …What if they grow up to be terrible people? … Or they regret ever being born? … I’d probably mess them up. …I mean, who thinks this way?” (9) She covers her pregnancy and delivery in four pages; and trimesters in three panels: “How can I vomit so much and still be alive? … How can I be so tired and still be alive? …Please kill me now.” (11-14)

Teresa’s mother (Poh Poh) came by daily to take care of Teresa: “In Chinese culture, mom and baby are confined to the house for the first month after the birth. … The mom gets a chance to recover, while the grandmother gets quality baby time.” (59) And eventually, we see Teresa enjoying her daughter and why she addressed this letter to Scarlet. (105) The open dialogue Teresa has with Scarlet at the end of Dear Scarlet is amazing, and just the sort of lesson I wished my parents had told me about their own difficult times in their lives.

Visuals show simple and stark black and white line drawing with no need for shading. In a large hospital room with mother and daughter in hospital bed & crib both appear small and distant: “… I felt lost. I had no maternal instincts and no clue how I was supposed to take care of a baby.” (18) She provides a visual aid of her postpartum body. (21) Teresa shows her depression by emphasizing black background with white lettering writ large, because she was fragile and anemic and unable to do what “every other mother can do …” (50) Teresa shows “My Depressed Mind” as a schematic of a head with the negative phrases substituted for portions of the brain. (53) Teresa kept having a dream of climbing into a grocery store bin & being drowned in apples … the book cover; symbolic of being overwhelmed when carrying out common errands like grocery shopping.

Medical aspects of Dear Scarlet are mostly negative. If one were to use one word to explain Teresa’s hospital medical treatment post-delivery it would be incompetence. Every page piles on with no explanations, neglect, and fending for herself. (e.g. not recognizing Teresa’s depression; leaving the newborn alone with an exhausted mother; nonresponsive calls by nursing staff; monitoring hemoglobin levels without explanation; no one telling her she had lost half her blood during delivery)! Her baby was neglected by Teresa because she was in no position to help her child. It’s maddening how the staff isn’t around for a new struggling mother! Another example is that breastfeeding was very painful for Teresa though she only thinks “ow, ow, ow, …” and doesn’t voice it to staff; and to their credit various nursing positions were tried but all were painful and she got a referral to a lactation consultant. Teresa provides a chart of her guilt with respect to not breastfeeding; including … “To this day, I worry your health issues were a direct result of my selfishness?” Scarlett’s dad claims Scarlet’s health problems are true of breastfed babies too; but it might only be partly true because breastfeeding reduces food allergies, eczema, and constipation—being Scarlet’s problems—in babies; among many other benefits; e.g. see American Academy of Pediatrics). I don’t want to add to any mother’s guilt over not breastfeeding, I’m only trying to set the record straight. Not all problems lay with health care practitioners—though they should’ve been more inquisitive and listened to Teresa’s gently voiced issues, like she might be depressed at 10-day check-up—but Teresa was prone to think and not voice her concerns and a healthcare professional often downplayed what little Teresa was willing to say. The healthcare professionals should learn to recognize from body language when a patient leaves concerns unsaid; or at least inquire into their patients quietness. Teresa provides a PPD checklist with all of the items applying to her: “excessive crying; feelings of shame, guilt, or worthlessness; recurrent thoughts of suicide or death; loss of appetite; changes in sleep patterns; fatigue or lack of energy; and fear that you’re not a good mother.” (79) Teresa, once she asks for help, simply shows much of her help in four panels: AJ’s (postpartum doula) help; daily medications (Zoloft); counseling with PPD specialist; starting to get better. (88)

I’ve discussed eight books here, the most I’ve done in a single review, because these books provide different pregnancy aspects or perspectives. I hope that the reader finds one or more of these books useful as a teaching/learning tool, answering their curiosity, or providing support and comfort. You are not alone!

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