In a conference room cluttered with cold Chinese take-out, I sat with Jane as she wolfed down shrimp and noodles, finally eating lunch at three p.m. Jane was a small woman with ocean blue eyes, golden dot freckles, and a pixie cut. She listened patiently as another OB/GYN resident in the room talked about a recent study proposing C-sections as standard of care over natural birth.

I watched the male resident make his argument, his black hair sticking out at odd angles from his head, wondering if he’d just woken from a nap or hadn’t slept in days. He argued that C-sections were more controlled, more reliable. There was the cord, shoulder dystocia, scheduling.

Jane got up from the conference table and tossed her paper plate in the trash. “C-sections don’t wake you in the middle of the night. They don’t interrupt golf outings or vacations,” she said, wiping her hands. “But there’s a longer recovery, risk of infection, less oxytocin, a whole host of other complications. And women have been birthing babies since time began.”

The male resident nodded without response.

Jane began to walk. I trailed behind her white coat through a maze of hospital hallways. I was a first-year medical student, eager to learn. We lost the resident somewhere along the way. “Why is it that men always think they can control women’s bodies?” Jane asked.

This was 2001 and I was twenty-three-years-old. Abortion had not yet been ruled illegal by the Supreme Court. I had not yet birthed my own three children. Jane’s words passed over me like puffy clouds on a sunny day. I wasn’t thinking about the ways in which women’s bodies have been controlled and dominated for centuries. I was there because I wanted to see birth, the beginning of life, the idyllic version I’d conjured from myths and movies and conversations with my mother and grandmother. Jane’s question hung in the air and then evaporated.

We arrived at the room of a laboring woman named Nina, who was groaning on her side in bed. A white patterned gown fell open to reveal the smooth brown skin of her back. She heaved with each breath. Jane checked her vitals, looked at her contractions on the monitor.

“They’re getting stronger,” the woman whispered.

Next to the bed was an empty metal chair. I wondered if anyone would come to sit with her.

Jane reported that Nina was four centimeters dilated and that her body was working hard, doing all that it should. She straightened Nina’s gown and gently pressed her hand.

Nina looked up at Jane with watery brown eyes, eyes that moved around the room, searching, and then closed. With the shades drawn, the room was dim in spite of the early spring colors I knew were emerging outside the hospital walls. Green lights flashed on the monitor hooked to Nina’s arm. She shifted to one side of the bed, then the other. Being tethered to a machine, she couldn’t walk or stretch or do much of anything. Nina wasn’t asking for pain medication, but she seemed to need something other than the bed and the dark room. We left her there alone with her contractions and the empty metal chair.

Next, we met Isabel, a woman in her later twenties, who was past her due date and had been induced with no success. The decision had already been made to do a C-section. The team of anesthesiologists arrived to inject pain medication into Isabel’s spine. The needle was enormous. I cringed as the doctor pierced skin around her lower back and pushed the metal shaft into her body. An epidural was supposed to numb her quickly, but tests revealed that Isabel still had sensation in her legs. She was good-natured as they gave her more from the large needle. But the extra medicine didn’t take either. Jane explained later that because Isabel was severely overweight, she needed a higher dose, but there is only so far you can go. The team decided on general anesthesia, which meant we would go to the OR and that I would scrub in.

This was my first operating room experience in medical school. I was thrilled to be invited when I knew virtually nothing about being a doctor, but I was also disappointed that we couldn’t stay with Nina to see a natural childbirth. I had fantasized about being there when the soft limbs of a newborn unfolded and hearing the sweet wobbly song of fresh lungs. I’d imagined the mother and family in the room, together welcoming this new life. Instead, we cleaned and covered ourselves: blue scrubs from the basement laundry, a cap over my curly hair, a mask to cover my face, each side of each finger scrubbed in a circular motion all the way up to the elbows with sterilizing soap. The gloves and gown came out of a sealed package and were put on me by a nurse already in the OR. Though I looked like everyone else in the room, I was an outsider.

As we set up, Jane explained that C-sections were a big part of an OB/GYN’s job. “If you’re considering this for a specialty, you have to like surgery,” she warned. Still in my first year of medical school, I was idealistic. I wanted to help families and children perhaps in rural or under-served areas. I wanted to save people, to comfort them, to be there for life and death. Sterile scrubs and scalpels were not exactly part of that picture. As I listened to Jane and weighed the future, my mind kept pulling me back to Nina, laboring alone in the dark room, attached to the monitor. Had someone come to sit in that empty chair? Had someone set her free from the confines of the bed or at least opened the shades on her window?

I held my breath as Jane made the first cut into Isabel’s abdomen. I was sure that Jane had done this a hundred times or more, but there was a tiny baby under all of that skin. I stood opposite Jane with a long plastic suction tube. My job was to vacuum Isabel’s blood, so Jane could see what she was doing. It was difficult to cut any further, as Isabel had layers of scar tissue from previous surgeries.

I’d learned in Histology that scar tissue is a surgeon’s worst nightmare. The collagen that forms to replace healthy tissue is stiff and weaves itself unpredictably around nerves and blood vessels, muscles, and connective tissue. “Everybody should plan to sit tight for a while,” Jane reported to the team of nurses and techs. “We’re gonna have to dig this baby out.”

“Jesus,” one of the nurses said, exasperated. “There’s so much fat here you can barely see that she’s pregnant.”

Isabel couldn’t hear these comments. Her eyes were taped shut; her mouth was forced open with a breathing tube; a cocktail of hypnotics, opioids, and muscle relaxants coursed through her veins. But I was shocked with the nurse’s blunt observation. She wouldn’t have said that if the epidural had taken and Isabel was conscious. I continued suctioning pools of burgundy blood, my own mouth closed behind my mask.

*

My grandmother had seven babies during the late nineteen-forties into the early sixties. When she delivered my uncles and my mother, women were routinely injected with a mix of morphine and scopolamine, which created something called “Twilight Sleep.” Yet this cocktail did not take away the pain of childbirth. It just erased the memory of it, leaving an eerie blank space in a new mother’s mind. Hallucinations were a scary side-effect of the drug. Laboring women like my grandmother were often tied to the bed and padded so that their own flailing limbs would not endanger them. I imagine rows of women tied up like cows. Together, yet totally alone. And when it was over, when the men smoked their cigars and clinked their glasses of brandy or champagne, when their babies were tightly wrapped and put inside their arms, the women would have to carry the weight of the darkness they endured.

I once asked my mother about her delivery with my older sister in the seventies. While most of the time she enjoyed talk of babies, this question silenced her. “It was traumatic,” was all she said. “I don’t want to tell that story.”

My father was in the room when I asked. He said something about forceps, but my mother stopped him from saying anymore. Just as my grandmother quietly carried her own scars from childbirth, my mother did, too.

*

By the time we arrived at Isabel’s uterus nearly four hours had passed, and I’d almost forgotten about the baby. Her uterus was reddish purple, soft and free of scar tissue. It seemed somehow to be swelling up from the rest of her internal organs, saying, Here I am. “Okay, here we go,” Jane said. “Let’s call pediatrics.” While one of the nurses went to the phone, Jane carefully sliced Isabel’s red-purple womb open. I saw the baby’s head, wet strands of black hair, eyes sealed shut. Jane reached for him in blue gloves. I waited for that first breath, the scream I’d heard in the movies. I waited for the moving fists and tiny kick of the feet. But there was no scream, no noticeable first breath. His body was flaccid and soft.

My heart began to pound. “What’s wrong with him?” I gasped. “Why isn’t he crying?”

The nurse next to me laughed. “He’s on mommy’s drugs,” she explained.

Jane cut the cord and handed the baby over to the pediatrician, who checked his vitals and worked to clean and wrap him.

“Is he okay?” I asked.

“He’ll be fine,” the pediatrician said.

As Jane began to sew Isabel back together, I felt myself relax. The baby was healthy. Isabel would be okay. I wasn’t thinking about what came next: the sleepless nights, the feeding every two hours, the organs that had been shifted and layers of severed connective tissue that would lead to pain and immobility, the exhaustion mixed with hunger and fear and joy. I couldn’t possibly have known any of that yet.

*

When the time came for me to deliver my own babies, I was thirty and had already dropped out of medical school. In spite of my birth plan that included music and flickering battery-operated candles, my first child got stuck in the birth canal with something called shoulder dystocia. There was no music or candle light. He was born silent like Isabel’s child, but he was also blue from a lack of oxygen. The midwife immediately cut the cord and swept him away from me to do CPR on a small cart next to the bed. He did not breathe. They called anesthesia and were ready to intubate him. In a desperate panic, I told my husband to go and talk to him where he lay alone and frozen on the little plastic hospital cart. I knew somewhere inside of me that he needed to hear our voices as he had inside my womb. I will never forget Seth’s words. “Hey, Little Guy,” he said, as he took our son’s tiny hand. I will never forget the scream that emerged from the baby’s lips after those words, a blood curdling, beautiful scream that went on for days. The sound of his father’s voice had saved him.

My recoveries from childbirth were mostly quick. The pain, for me, came after. With my oldest it was the trauma of his birth. I could not talk about it without a rush of fear and sadness overwhelming my body. Would he die in his sleep? Would his brain be compromised because of the lack of oxygen in the first few minutes of his life? Was there something I could have done to prevent it?

With my second and third children, the agony came with feeding. I had too much milk, not enough, plugged ducts, mastitis. Fever, chills, the unbearable feeling of shards of glass in my breasts. I was sure during some of those post-partum days that I would simply die and never be able to care for my children. Through all of it, my husband was there. He held my hand during labor and kept the nurses at bay when I needed to be alone. He cooked for me and took care of the older kids and the dog. He played soothing music and prepared warm compresses for my breasts. Both sets of our parents came. My sister, too.

How would I have managed with an empty metal chair?

Here I was, blessed with three natural births and healthy children, a caring and supportive husband, what some women would give anything for. But it was not idyllic. It was nothing like the myths and the movies. Some people say that having children is a choice women make. But what about rape, incest, feeling pressured at a young age? Even women in loving relationships do not get to choose if or when to have a baby. My younger sister—who served in the Peace Corps, attended graduate school, and now works overseas—was not ready for children until her later thirties. And then it became difficult for her to get pregnant. A doctor in Thailand told her she’d never be able to have babies without some kind of medical intervention. She began to feel as if her body was broken, dried up. She regretted her choice of waiting, which only made her feel worse and more desperate to get pregnant.

Women long for pregnancy.

They fear it.

They burn from the judgments about it.

And ache from the loss of it.

Or from its pain and scars.

I have never met a woman who has not felt the weight of her womb.

*

When she was twenty-three, one of my college friends made the agonizing decision to have an abortion. She told me about the millions of questions at the clinic, the feeling of having to defend herself over and over again. She was not in a stable relationship. She was in school and had an unreliable income. Though the decision was hard, she was not ready to become a mother and she was sure about that. She did not feel very much pain during the procedure, but she was not prepared for what came afterwards. As the young woman next to her in the recovery room screamed because she wanted her baby back, my friend felt a profound emptiness. Years later, she still could not shake the feeling. She knew that she had made the right decision to terminate her pregnancy. She’d gone on to get a graduate degree and began working as a field biologist, but as each year passed, she could not help thinking about that young woman in the recovery room, who begged for her baby back. She was haunted by it.

*

At close to eight p.m., we were still in the OR. My stomach was empty, my legs wobbly, and my arms ached from holding the suction tube in one place for hours.

Jane looked up at me. “You’ve been here too long,” she said. “Clean up and head out.”

In the hallway, after removing my mask, gloves, and hair cap, I washed my hands and walked out the green double doors. There in the waiting room, I was met by a little girl about the age of seven. She ran up to me with big brown eyes and a pink and yellow barrette holding her side ponytail. “Do you know Isabel?” she asked.

I stopped in my tracks, seeing a whole family stand up from their seats—another woman about Isabel’s age with dark curls, an older man in green sweatpants, a woman with gray hair and bright red nails. “Yes,” I said. “I do.”

“Is she okay?” the woman with the nails asked.

Here was my chance to be the hero I’d imagined, to glow in the light of this waiting family. But I didn’t feel like a hero. We had drugged and taped and cut Isabel open. We had pulled her unconscious baby from her womb and handed him to a stranger. I felt drained, defeated. “She’s doing fine,” I managed to say.

The little girl asked, “Is the baby okay?”

And I took a breath.

Even though the florescent lights of the hospital stung my eyes and the spring sky was already dark beyond the windows, even though I was drained and defeated, here was this bright family waiting to take Isabel and her baby home. They had waited for hours together. I had no idea they were there, praying and hoping, loving their daughter, their sister, their mother. Even when the nurse spoke rudely about her body, even as Jane dug, frustrated, to her womb, Isabel’s family was right here. I felt undeserving of being the first to tell them the news. What did I know in my first year of medical school? But I could not turn around and grab Jane or one of the nurses. I was suddenly the authority, the “doctor” they’d been waiting for.

They were patient as I gathered the courage to speak. “He’s a little sleepy,” I explained. “But he’ll be just fine.”

They all looked at each other with wide eyes. The little girl ran to hug her grandfather in the green sweatpants, who scooped her into his strong arms and kissed the top of her head. I stood watching for a moment, inside the glow of this family, inside the layers of all I’d seen that afternoon. There was Nina and the empty metal chair. There was Isabelle unconsciously enduring ridicule during surgery. There was the silent baby and this beautiful family and the weight of my own expectations. There was Jane’s question and my own womb and all the women before me and the women who would come after me. In that moment, I couldn’t possibly carry it all. I was exhausted and hungry and only twenty-three.

-Amy Amoroso

* Names and identifying details have been changed to protect privacy.

Amy Amoroso is a writer, mother, and teacher in Portland, Maine. Her essays “Cut Wide Open” (2014) and “Your American Dream” (2020) were selected as Notable Essays in the Best American Essay Collection. Her work has been published in The Sun, Mount Hope, Upstreet, The Maine Review, and others.