By Cloe Axelson
The waiting room at Careggi University hospital in Florence has all the charm of a Boston bus terminal: dingy, cream-colored concrete walls and steel benches with armrests so sharp they could puncture your skin. A few posters hang neatly. One offers assistance to Italian prostitutes, the others feature diagrams of pregnant bellies with a fetus tucked inside, but I can’t read them because I don’t speak the language. My husband Sam and I are in Italy for an eight-day vacation, our final getaway before we become parents. The hospital wasn’t our list of sites to visit, of course, but I’m thirteen weeks pregnant and noticed blood when I went to the bathroom, so here we are.
When we arrived there was only one other patient waiting on this Saturday afternoon in late July, a very pregnant Italian woman who was accompanied by her husband and four-year-old daughter. She looks unhealthy: sallow skin, swollen ankles, thick toenails painted a horrible metallic gold. She’s also missing teeth and every thirty or forty minutes she excuses herself for a cigarette, which she smokes, slowly, just outside the sliding glass doors. I can’t imagine a similar scene at my obstetrician’s office at home in Cambridge, Massachusetts.
As a kid, I didn’t daydream about having children. I was a tomboy, mostly concerned with how fast I could throw a baseball. In elementary school, I got my hair cut as short as my mom would allow, played on an all-boys little league team and wore a navy blue blazer with brass buttons, like my favorite boy cousins, to family parties. My parents later confessed they suspected I might be a lesbian, but no. I’d just decided that hanging out with the boys was much more interesting than watching them from afar or giggling when they walked by, as many pre-pubescent girls often do. Sam and I began dating our senior year in college. When I got married at twenty-eight, I skipped the wedding boutique circuit and bought a dress on eBay for $89.50.
In my early thirties, I thought childbearing was triggering an epidemic among my friends: suddenly they were giving up big jobs and adventure travel in countries with questionable water supplies for motherhood. My Facebook feed was littered with photographs of my friends’ distended bellies and, eventually, of their infants, red crinkly-looking things that became progressively more adorable and got pricey haircuts. Conversations about politics and career paths were replaced with chatter about nannies, breast-feeding and potty training. Some abandoned city living for the suburbs and bought battleship-sized SUVs. My friends were trading in their old lives for new ones—unrecognizable to me and, perhaps, to them. It was alarming.
And yet having a baby always lingered in the background, as something I would get to eventually, when the time was right. Once Sam finished graduate school. Once I’d run a marathon. Once we’d saved for a down payment. We were also busy: we’d lived in five apartments in three cities and held twelve jobs between us since graduating from college. We’d experienced 9/11 as New Yorkers. I’d traveled solo through Central America for three months. Sam had worked at the White House during the financial crisis. After dating for seven years and being married for five, expanding our twosome meant the end of an era. Having a family was something we’d talked about, but we wanted to be sure we were ready.
When we finally were ready, about three years ago, I discovered that getting pregnant wasn’t something I could do easily. That’s when I started paying much closer attention to my uterus.
I treated my uncooperative reproductive system like I treated any physical challenge, with determination and discipline. I did all the things the books tell you to do: took my temperature every morning to track my menstrual cycle and monitored my girl parts for slippery secretions, which I didn’t even notice I had until I read about them. I also quit eating so much cheese (which supposedly hampers fertility), tried yoga (to relax), drank less wine and, for a while, switched from coffee to green tea. My pillow talk, which was never very good, got worse—I instructed Sam to “plunge me” on more than one occasion.
I was characteristically practical and unsentimental about all the things I was doing, but none of my self-directed treatment seemed to be working. And after a year of trying and failing, it seemed getting pregnant wasn’t going to happen without outside help. I wasn’t ready to think about fertility treatments, so I started to see Lisa, an acupuncturist with an office in my neighborhood. I knew several friends who gotten pregnant after a few treatments and hoped it might work for me, too.
Lisa had a strong Roman nose and bright brown eyes. She’d been an acupuncturist for fifteen years after several years in “quality assurance” at a big pharmaceutical company. The minute I learned she was a national Kung Fu sparring champion, I knew she was the practitioner for me: no nonsense, tough, results-oriented. Once after a treatment she showed me a photo of one of her male sparring partners—his belly was stamped with a yellow-purplish mark exactly the width of her fist.
At every appointment, after I’d positioned myself at the end of her treatment table, she’d ask me a roster of questions about my sleep habits and stress levels and menstrual cycle. I took in the Eastern art hanging on the walls and tried to make sense of the human anatomy drawings with meridian maps overlaid. She told me to watch more television, to relax. When I told her I was training for a half marathon, she implored me to stop running so much and to devote my energy instead to believing my body could be a vessel for new life. I nodded, but thought she sounded hippy-dippy.
I saw Lisa at least once, sometimes twice a week, for five months. (I even made Sam, an economist and Eastern medicine skeptic, go for six weeks as an act of solidarity.) At eighty-five dollars per visit, it cost us a small fortune. I felt great and could set a clock by my cycle, but it had become a comforting ritual that wasn’t getting me pregnant. With the supposed death knell of a woman’s fertility looming (my thirty-fifth birthday), I had to decide how committed I was to becoming a mom. Mother Nature was pushing the issue.
It’s hour two in the cream-colored holding area and I’m beginning to wonder if I’ll ever be examined by a doctor. Especially since when we visited the registration desk, a nurse looked at me and said “La Americana? You sit a few minutes, please.”
I’d started bleeding a few hours after I’d gotten off the plane from Boston. I hadn’t had any medical issues in my pregnancy so far, so my sleep-deprived, jet-lagged brain went for my worst fear: miscarriage. Sam forbade me from reading anything on the internet, which has page after page of horror stories, and together we called my doctor in Cambridge, who instructed me to find a doctor in Florence immediately.
I’d rifled through our guidebook for a recommendation and ended up here: the Accettazione Obstretica at Careggi University Hospital, fifteen minutes by taxi outside the city center, away from the tourists and crowds.
The smoking, gold-toed pregnant patient is still here, though her husband and daughter left an hour ago. She doesn’t seem troubled by the long-wait. We’ve also been joined by a couple who appears to be in their mid-thirties, like Sam and me. The woman, an Australian, has bottle-blond hair and looks to be about six months along. Her husband is fluent in Italian, and he tells us there are only two doctors on call and that two women are in the early stages of labor, hence the delay. I’m trying to stay calm. Sam is reading a biography of Lyndon Johnson in between games of Scrabble on our iPad.
After acupuncture, my first stop in the baby-making industry was my OBGYN’s office. She had to complete several tests before she could ship me off to the fertility specialists, where the real work would begin. She took pints of blood, scraped samples from my insides and dyed my uterus with an eggplant-colored ink. The tests showed nothing: by all measures, my uterus and ovaries were just as they should be. One nurse even exclaimed mid-exam in her thick Boston accent, “Gorgeous, just gorgeous!” Sam got tested, too, after I suspected that his habit of working for hours with his laptop on his lap was frying any potential offspring. But he also checked out as normal. The basic tests completed, we were referred to a fertility clinic with the diagnosis of “unexplained infertility.”
Millions of words have been written about the strange and scientific voyage to parenthood taken by the infertile couple. The werewolf-like rage brought on by hormone treatment, the endless blood draws, shots and ultrasounds. The anxiety and heartbreak of failed treatments. I suspect most infertile couples go about their business in silence, but some make art out of their struggles: a photographer in California documented her journey using eggs, rose petals, tampons and pig fetuses as her subjects.
I didn’t want anyone to know what was happening because it was painful and awkward to talk about. When friends and family asked, “Are you guys going to have kids?” I wanted to tell them to fuck off, but instead I laughed and said, “Oh yeah, we’re on it.” I worried about seeing someone I knew at our clinic and I refused to discuss it, even with close friends. My parents knew things weren’t going as planned, but I didn’t share details, lest they start offering advice. They did anyway. One cold late winter afternoon, my dad and I were at the dog park. I was about to toss a tennis ball when, mid-throw, my father, a soft-spoken Midwesterner in his mid-sixties, said: “You know, you and Sam ought to try facing north. That’s what your mother and I did when we were trying to get pregnant.” I thanked him, but didn’t start bringing a compass to bed.
Our fertility clinic was located at an office park in Waltham, MA, less than half a mile from Interstate 95. It had the feel of a nice department store: high ceilings, lots of natural light, bright cloth chairs in primary colors, two flat screen televisions and dozens of magazines. The place was always busy; dozens of people, just like us, waiting to be seen. In spite of its creepy, factory-like feel, there was something awesome about the cool efficiency of it all. I imagined entire wings of the building packed with cabinets of frozen embryos, lined up like computer servers.
The fertility doctor we were referred to, Rita, was in her early forties with shoulder length dirty blond hair, a wandering left-eye and an easy laugh. She made it clear we had garden-variety infertility, a sensibility I found simultaneously reassuring and insensitive. Rita recommended we try artificial insemination first, moving on to in vitro fertilization (IVF) only if three rounds of insemination didn’t work. We agreed.
Sam would “produce” the sperm specimen at home, then race up I-95 to get it there within the sixty-minute limit before semen starts to sour. He started giving his sperm a pep talk before we dropped them off, holding the plastic cup a few inches from his face and rooting them on with a fist pump, as if each one was Michael Phelps swimming for gold. The insemination procedure takes about five minutes. A nurse would summon me to a private room where I’d undress from the waist down, cover myself with a sheet and prop my feet in stirrups. One time I was on the phone while she took a syringe of Sam’s semen and inserted it, turkey baster-style, past my cervix for a potential rendezvous with an egg. Sometimes, I’d feel minor cramping, but nothing painful; the real agony was waiting for the result.
I’d hold my breath for two weeks. The Google-search history on my phone during that time included things like “what does week one of pregnancy feel like?” and “can you feel an egg implant?” Month after month, after a blood test to check for pregnancy hormones, I’d receive a phone call from a nurse telling me I wasn’t pregnant.
Irrational self-flagellation followed. Maybe I shouldn’t have run that half marathon. Maybe there really is something seriously wrong with me. Maybe the universe is trying to tell me I’d be a terrible mother. With each unsuccessful attempt, my attitude hardened: I started to anticipate failure because it made me less vulnerable to the sting of negative results. Preparing for the worst made me feel in control of a situation that was far beyond my influence.
After our third failed insemination attempt, I needed time away from the fertility factory line. I’d started to peer jealously at pregnant women and stare wistfully at the little leaguers in the park. I was resenting people in my life, as if newly pregnant friends and family were conspiring against me. I was angry with Sam for not being able to bear children, a fact he certainly couldn’t control. I’d become just as preoccupied with not being able to get pregnant as my friends with kids were with nap schedules and play dates.
Within three months, though, I decided I was committed enough to becoming a mother that I was ready to go forward with IVF. This time, I told close friends and my parents what we were up to. It felt good to have a team of people pulling for us. We also made our fertility project the priority. Sam canceled a business trip to Miami and I skipped out on my employer’s big annual conference, things we never would have done before because it belied how much was at stake.
I’ve heard stories of women going through three, five, seven, eleven rounds of IVF. I don’t know how they find the strength. We were very lucky. I was grumpy, anxious and bloated, but after just one round, I got pregnant.
We’re on hour three in the waiting room and the pregnant Italian woman has excused herself for six smoke breaks. Yes, I’m counting. I can smell it on her clothes when she walks by me and it makes me want to retch.
The Australian couple is much more talkative than they were an hour ago. We’re all chatting, they’re asking about our trip and where we’re headed next. It’s already six o’clock: our first full day in Florence, gone. I’m not in pain, but I am jet-lagged and tired, entering hour forty-two without sleep.
Sam and I are contemplating whether he should run out to grab slices of pizza when I hear the front desk call a version of my name: “Ax-sel-son? Clo-way?”
“Yes!” I say, jumping up. We high-five the Australians on our way out of the waiting room.
The doctor’s name is Ippolita D’Amato. She appears to be in her late-thirties with short, brown hair that falls into her eyes and stylish, thick-rimmed glasses. She carries two cell phones, one in each of the pockets of her white doctor’s coat.
Italian is usually a wonderfully lazy language. People take their time, pronouncing every letter, elongating the vowels, every word a song. But Ippolita is on a long, busy shift and her version of the language sounds much less romantic than any Italian I’ve heard before—a rapid bark punctuated by o’s and e’s and heaving sighs. I decide this is probably how real Italians talk. Maybe that’s one bright spot: we’re having an authentic Italian experience.
Ippolita ushers Sam and me into an examination room and instructs me to sit on the edge of a bed that’s hidden behind a blue curtain. A nurse asks me to remove my underwear, hike up my sundress and lie back. I can’t help but think that if I were home, I’d be wearing a gown and have a sheet draped over my naked lower half, the lights would be on, the door closed. Ippolita begins performing a pelvic exam while the nurse revs up an ultrasound machine that, by the size of it, looks to be about twenty years old When one of the phones in Ippolita’s pockets rings, she answers it—”Pronto!” she barks into the receiver—while she’s peering at my cervix. I laugh at the absurdity of it all.
Next comes the ultrasound. The cool gel on my belly, my bare lower half still splayed out on the table.
“You know you have due, yes?” she says.
“Yes, we’re having twins,” I say.
“One heartbeat and…two heartbeats. Bene, bene,” she says.
There is something miraculous about seeing your child (or in my case, children) inside your body, especially when they’re so tiny you can’t feel them move. But there they are, heartbeats flickering steadily on the pixilated screen. Alive. I feel a tremendous sense of relief. The two peapod-sized, thirteen-week beings are jiggling around in their amniotic sacs, just as they should be. I want to hug her. I briefly consider naming one of the twins after her, then quickly dismiss it. Ippolita is a tough name for a kid.
She says the bleeding I had was normal and that everything looks fine. She thinks it was the result of a long flight, dehydration and exhaustion. I didn’t drink enough water on the plane and I’d worked on my computer almost the entire flight. Our hotel room was being cleaned when I arrived from the airport, so I’d walked around Florence for a couple of hours in 100-degree heat. It’s something I wouldn’t have thought twice about before, but is now apparently beyond my physical limits.
She tells me I must be calm. “No running to the top of the Duomo,” she says. “Don’t get too hot. Drink lots of water. Clo-way, remember your body is not your own.”
I read once that being pregnant means you are never alone. Sitting there underwear-less, eyeing Ippolita, it occurs to me I have yet to accept my new reality.
I’d only told a few people I was pregnant before our trip to Italy. I was still able to fit into my clothes and could hide the growing bulge in my abdomen. For all the pain and hassle I’d endured to get pregnant, actually being pregnant was relatively uneventful: I was constantly nauseous (but not vomiting), cringed at the smell of grilled chicken and craved watermelon, but that was it. After three years of trying and failing, I didn’t quite believe it was happening. And as much as I wanted kids, I didn’t want to broadcast the news because I suddenly didn’t feel ready for it. I was worried how people would react once they found out. It’s only natural that children don’t consider who their mother was before she became their mom. My identity as an independent, ambitious, active person would be beside-the-point to the twins. I wondered if my friends and family would also dismiss the pre-kid me in the same way.
I tried my best to heed Ippolita’s instructions. I let Sam carry my suitcase and sent him up the rickety stairs of every cathedral to take pictures from their domes while I stayed below in the shade, a bottle of water between my knees. He hiked while I sat under an umbrella at the beach. And in the early evenings, before dinner, when Sam went out to explore, I napped or read in our hotel room. I hated not being able to move far or fast.
I was happiest once we escaped the triple-digit heat of Florence for the Cinque Terre, five tiny towns perched on the craggy peaks of Italy’s northwest coast. There, I discovered the one physical activity I could enjoy: floating in the salty Mediterranean. I didn’t mind being still as long as I could be in the water. Our last morning on the coast, I sat on a jetty that cut into the blue-green sea and dipped my feet in the cool water. I can still hear the waves, with their persistent rhythm, breaking against the shore, filling the space between the rocks and making their retreat. I knew it’d be a long time before we’d visit again.
The journey from the Cinque Terre to our next stop, Siena, was about three hours by car. Our rental car was only slightly larger than a golf cart and not nearly as comfortable: the air conditioning blew hot air and my knees hit the dashboard. Making things worse, the waist on my shorts was starting to cut into my stomach, even with the button undone. I was already hot and grumpy when I read this sentence from our guidebook aloud to Sam: “When possible, avoid driving in Siena.”
Unfortunately the guidebook was right: no one should attempt to drive in Siena where the streets, which are pedestrian-only, are little more than fifteen-feet wide. Once we entered the city limits, it took us another three hours to find our hotel. As we drove in circles, I told Sam that the map was fucking useless, that I hated this stupid fucking vacation. I twice ran out of the car on the side of the road, heaving and kicking at the dirt like a toddler throwing a tantrum. I felt myself losing control, but couldn’t stop a frustration that made my whole body vibrate.
By the time we checked into our hotel, I was bleeding again. I hadn’t followed any of Ippolita’s instructions: I hadn’t stayed calm and my babies-to-be knew it.
Sam was exasperated and went out for a walk. I took a bath. Our hotel was a one-hundred year old villa once owned by Sienese aristocrats, and the heavy wooden shutters in our room opened up above the patio that overlooked the picture-perfect Tuscan countryside: a puzzle of vineyards, green hills, winding roads and stone cottages.
I could see patches of the late afternoon blue sky from the bathtub. I cupped the warm water over my growing belly, rubbing it with both hands, back and forth, coaxing calm as I looked at my toes peeking out at the far end of the tub. My iPhone, sitting on the ledge of the antique marble sink, played Bon Iver. “Someway, baby, it’s a part of me, apart from me,” one song began. I was overwhelmed by waves of anxiety, the selfish but real fear of losing myself, of never again being my own person. I wanted to be a mom, but I resented that everything I’d once thought was important might soon feel irrelevant and small, as I shed an identity I knew for one I knew nothing about.
A few tears dripped off my cheeks into the water, as I began to plead with my uterus, the organ that had been defiant for so long, and the tiny beings inside. “I’m sorry,” I said out loud. I promised to keep them safe. To be more gentle with myself. To be vulnerable, finally, to the reality of becoming a mother and all the change that would bring. “O.K., guys. I get it now,” I said, my words echoing off the tile. As the sun dipped lower on the horizon, the bubbles lost their fizzle and the water cooled. I could see how my body was changing as new life took root.
I didn’t know then that the two beings floating inside me were girls. Or that my body would stretch to an unfathomable size to accommodate theirs. Or that the toughness required to run a marathon is nothing compared to the toughness needed in labor, and to survive the ragged first year of new life.
I didn’t yet know the sense of accomplishment I would derive from tandem breastfeeding and coordinating nap schedules. The delight I’d feel in watching my daughters feel grass or see the ocean for the first time. The pride in looking at their tiny features and seeing my own in miniature. In being someone’s mom.
The things I used to worry about do seem frivolous in comparison to the relentlessness of motherhood. But I now know that is the natural order of things, even as I sometimes miss the body and life that were once mine alone.
Cloe Axelson lives with her family just outside of Boston. She is a student in Lesley University’s MFA program in nonfiction writing and works for a national education-focused nonprofit.