Image by Hendra via Adobe Stock

On October 7, 2023, I was just about three months pregnant. As a genocide unfolded before our eyes in the weeks that followed, I reflected a lot on the parallel lives mothers live on both sides of this dystopian world.

Like many others, my social media feed exposed me to countless images of the Israeli military’s atrocities in Palestine. Images of shrapnel seared into the bodies of innocent Gazans are seared into my brain like scars: a woman silently mourning as she tightly hugs a child-sized body bag. A damaged incubator containing shrivelling babies. A girl hanging limp over the window of her destroyed home. Wide-eyed toddlers shaking uncontrollably as they begin to process the trauma that will remain with them for the rest of their lives. Many of these images were censored, black squares politely asking me whether I still wanted to view the photos that they concealed. Apparently their contents were too heinous to set eyes on, and yet not heinous enough to end in reality. There was always the occasional image that slipped by uncensored. In those moments, I wished I had not logged on. I cried often. I was pregnant, but these tears were not hormonal. They were human. I often had to force myself to move away from the screen to limit the horrors I was viscerally absorbing, as if to protect the baby that was living through me.

It was an unusual time to be pregnant, to be growing a new life as I witnessed the lives of others being ended so mercilessly. Over the span of three months of genocide, 20,000 babies were born in Gaza. As I planned for my son’s future, over 16,000 children were killed, futures completely obliterated. Of the nearly 1.1 million children in Gaza, those that survived now faced malnutrition, disease, physical disability, and psychological trauma. As I received excellent care in Toronto through regular prenatal appointments, I read about the horrific and life-threatening conditions that 50,000 expectant mothers in Gaza endured, birthing in unsanitary conditions on rubble-filled floors with limited access to medication. As I felt the pain from the stitches of my C-section for weeks, I remembered the mothers who were forced to have emergency C-sections with no anesthesia. I cannot conceive of their unfathomable pain and the trauma that will forever be bound to the memories of how they welcomed their babies into the world. As one mother from Gaza, Um Raed, told Al Jazeera, “Since the birth, I’ve not known whether I should be focusing on my contractions or on the sound of warplanes overhead. Should I be worrying about my baby, or should I be afraid of whatever attacks are happening at that moment?”

Though my pregnancy felt challenging, my baby boy arrived, healthy and present. When I caressed and gently wrapped his little body in soft swaddles, I kept getting intrusive flashbacks of those babies whose tiny bodies were maimed before their first birthdays, and of those who did not even reach this milestone at all, wrapped in white shrouds. While I had the privilege of enjoying my baby’s first winter through a festive holiday season, I also got chills thinking about the infants in Gaza who have frozen to death.

I often wondered about the purpose of bringing new life into this world full of anger and injustice and pain. But if there is anything I have learned from the Palestinian people, it is their deep-rooted resilience, one that stems from the same faith that I share with them as a Muslim, but has been put to the test in ways I can’t comprehend. They provide us with an important lesson on finding purpose in a world littered with inhumanity: we all have a responsibility to be active agents, building a more just world for all. From the articles and poems we read and write to the dinner table conversations we partake in using the knowledge we choose to seek, from the silent donning of a keffiyeh to the ways in which we raise and speak to our children about the world and its people, we all have, within our own skillsets and capacities, in our respective spheres of life, the ability to partake in this global, growing tide of activism.

Over the course of a year, we contributed what we could. Never has the world been so vocal in its support for a free Palestine. Boycotts have proven successful, careers have been put at stake, and a new media outlet, Zeteo, has emerged, questioning the status quo and bringing challenging conversations to the forefront so that we no longer have to tiptoe carefully around the subject of an ongoing genocide.

Despite the signing of a ceasefire deal 465 days later, we will continue to learn, speak, cry, create, call out, and call it like it is. In doing so, we will watch the tide continue to rise, from the river to the sea, in all ages and stages of life, until injustice is entirely swept away.

My book tour took me across Canada and despite being between 22 and 29 weeks pregnant with twins, it was nearly the same as travelling when I wasn’t pregnant. The only differences: I was deadly tired, I had to check my luggage because I couldn’t lug it around with me, and I had to anticipate well-meaning friends offering me terrible advice.

The advice ranged from you simply cannot travel, you will miscarry, to warnings that my travel days would soon be over. The night of the Vancouver launch, I poured myself a third of a tiny glass of wine. I was getting to the end and I was ready to have wine again. A male friend watched in terror, horrified that I might be doing something reckless.

The perception other people had of my abilities or capacities to operate while carrying twins was what I remember most from my professional life in 2013. People couldn’t believe that I wrote a book with so-called Baby Brain, or that I was capable of a book tour.

That’s why for the past few months I closely watched the NDP leadership race and how Niki Ashton was perceived, celebrated and, often, ignored. 

Each of the male candidates crafted a persona that balanced mainstream electability with edgy social democracy: Angus is a punk rocker who has got your back. Caron is an economist who seemingly ran to be the NDP’s first finance minister. Singh’s landslide victory was, at least in part, thanks to the image he crafted of a stylish, hip fighter who can go toe-to-toe with Trudeau—whether in the House of Commons or in a boxing ring.

But Ashton stood apart from the group—both thanks to her politics and, more insidiously, the limits of her gender and pregnancy.

Ashton’s pregnancy barely entered into the discussion about her candidacy. None of the male candidates made an issue out of it. But they didn’t have to. Once the first wave of articles announcing her pregnancy passed (and then the second wave, as everything comes in twos with twins), silence about Ashton’s capacities emerged, leaving the chatter to percolate on social media alone. This allowed for stereotypes and anti-parent rhetoric to dominate the discussion.

Qualifying the impact that anti-pregnancy bias has is difficult, but the comments I’ve seen are illustrative: questioning the period of time that Ashton would take off, wondering how Ashton would lead the party while also “feeding on demand,” how she would manage work and home life. Those questions could be legitimate, but a debate, whether in the press or among the membership would have to happen. The lack of open debate or discussion about Ashton’s pregnancy is indicative that many NDP members feared that if she couldn’t hit the ground running on January 1 as the leader because she’s covered in baby goo, she is a less desirable candidate than one of the men running.

The reason why I know that these questions aren’t simply innocent is because I’m an expert in what people who do not have twins think about people who do have twins. I, like probably every single twin parent in Canada, have heard it all. Did they sleep together? (Kind of.) Did I breastfeed? (Kind of.) Did I breastfeed them at the same time? (God, no.) Are they identical? (No.) Is it the worst? (Yes.) Is it the easiest way to have kids? (So very no.) How did you ever find time to work? (It was easy: I needed the breaks.) And so on. Buried in every question is an assumption that I’d gleefully puncture.

The conceptions that people have about having twins are usually all wrong. Everything that characterizes a singleton pregnancy flies out the window when you’re blessed with an egg mutation that unbelievably places two humans inside of you. You have no time for reading or practicing parenting theories. The list of issues that characterize the early days with twins is long and rarely fit into what people think it must be like: isolation, boredom, mastitis, double liquefied poo explosions, injuries, hair pulling, quadruple illnesses, travel challenges, daily laundry.

And it’s within this that the stereotypes of the mother’s role are most evident. New mothers are barely allowed to be whole persons; mothers of twins simply cannot be whole persons. They must be laying on the living room floor meeting every single need of their new offspring.

I saw comments like these posed on Facebook in relation to Ashton’s ability to lead the NDP, and they need to be aired and discussed. When silence replaces conversations about post-natal life, stigma and stereotypes about motherhood will take root.

Will Ashton double feed? Will she be up at night when one cries? Can she perform in the House of Commons on two hours of sleep? Is her partner serious about being present for 24-hour care? Can a father ever really replace a mother in those precious early days?

Ugh.

Parenting twins is about survival. In the beginning, all my partner and I did was ensure that the kids were fed, clean enough, and sleeping.

But we also continued to work. We went back to work immediately while our kids were hospitalized (because there was literally nothing for us to do otherwise) and, despite taking some time off, we were travelling again in two months, working on the edges once they were both home. We had the support and help from our friends to make it work. I clocked the most amount of cross-Canada travel for work in my life the year my kids were born.

Pregnancy forces us to re-consider the structures and barriers in place that prohibit participation in politics. And, if we don’t talk about them, we further entrench sexist and ablest barriers. Images of breast-feeding parliamentarians aren’t feel-good examples of women’s liberation. They’re dynamic pictures of how to parent on the fly while maintaining your own career—and every story contains lessons about how to make politics better for new parents.

The silence about Ashton’s pregnancy only served one goal: to quietly convince the membership that a pregnant politician is a liability. As the candidate with the most audaciously left platform, writing her off her because of her pregnancy also meant not needing to seriously contend with any of her policies. Whether or not a majority of the membership supported her vision is one thing. Whether or not a majority of the membership were uncomfortable with her pregnancy is a wholly separate matter.

We have to talk about pregnancy in politics if we have any hope of making things better for politicians who want to bear children.

Creative Commons photo by Flickr user Striatic

I’m not afraid of labour.

I’m not afraid of the intense pressure of my uterus contracting, tightening, pushing…

My cervix slowly dilating… Once open zero centimetres and currently stretching to a whopping 10 centimetres? Bring it!

I’m not even scared about pushing my baby into this world and the likelihood of my vagina tearing.

What I am terrified of is being induced.

There are a couple ways of inducing labour which, when applied to a healthy mother with a low-risk pregnancy, usually happens because she has gone over her “due date.” From what I can tell, more often than not, they cause problems for both the mother and baby.

The most common medical ways to induce labour is with synthetic drugs oxytocin and prostaglandin. Prostaglandin-mimicking drugs like Cervidil and Prepidil are used to thin the cervix and oxytocin-imitating drugs like Syntocinon or Pitocin are used to bring on contractions through intravenous injection.

Some of the reasons why I have no interest in being induced this way:

• While Cervidil is inserted like a tampon and Prepidil is a gel, Syntocinon and Pitocin are given intravenously. Being hooked up to an IV limits mobility making natural pain relief (bath, shower, moving around) more difficult.
• Pain relief is especially important after an induction because as if natural labour didn’t hurt enough, these drugs cause unnaturally strong contractions, often leading to what is known as the cascade of interventions.
• Induction in this way can cause fetal distress (depressed fetal heart rate patterns and decreased oxygen availability.) This often results in the use of forceps, vacuum extraction or C-section—all part of the cascade.
• The unnatural contractions means a woman is more likely to use pain medication (ie: an epidural, a common next step in yes, the cascade…)
• Having an oxytocin drip like Syntocinon or Pitocin, will usually mean continuous fetal heart monitoring. This makes going into the shower or tub for some natural pain relief (warm water) impossible.

I think when my baby’s ready to come out, she’ll come out. They predicted she’d be six pounds at birth, so I would be more than happy to give her a little more time to bake in this oven. If there is plenty of amniotic fluid left, and the baby is not under stress, there’s no need for her to be born so immediately.

It’s important for people (hello, grandparents!) to realize the due date means very little and is only an estimate. It assumes that all women run on a perfect 28-day cycle and that we all ovulate at the same point in that cycle. But that’s not the case.

Only something like three to five per cent of women deliver on their anticipated due date, and most of the time doctors will wait  between seven and 10 days before insisting on induction.

At my last appointment , I talked to my doctor about what would happen if I went over my due date (February 9 — yesterday!). She said she’d give me a week and after that, yes, she’d like to hook me up to an IV, and likely give me Syntocinon.

She was pretty responsive when I asked if there were alternatives to an intravenous intervention. We sorted out the fact that I did not want to be hooked up to an IV unless it was absolutely necessary and she said the alternative could be Cervadil. But if Cervadil’s job is to thin my cervix; at 37.5 weeks it was already 80 percent effaced, I’m not sure what the point is.

I was also surprised and hugely relieved when she told me I could, of course, decide not to have the induction so soon, bringing me closer to 42 weeks if I wanted. I would have to schedule regular non-stress tests to make sure everything was okay in there, which was fine by me.

Not every woman realizes that while the doctor might like a patient to deliver no later than a week after her due date, and if there are no medical complications that would make induction necessary to save the baby/mother’s life, whether or not to be induced really is the mother’s decision.

Luckily, sex is the best drug

There are perfectly natural ways to rustle up a little prostaglandin and oxytocin. Why not bring on labour the way this whole pregnancy thing started?

Semen is the most concentrated source of prostaglandins that exists. The synthetic Cervidil and Prepidil can’t compare. These prostaglandins that occur naturally are not associated with the host of potential problems that come along with the other stuff—won’t cause fetal distress, a ruptured uterus, unnaturally painful contractions etc. Getting some semen on your cervix will help it thin—a necessary step in labour.

Breast stimulation, which goes quite nicely with intercourse, releases oxytocin. Orgasms do the same. When oxytocin is released the uterine muscles contract! That sounds a little more fun than an IV.

In the end, the baby will usually come out when she’s good and ready. Who would want to leave the comfort of a warm, cozy womb anyways? Take your time, baby.

Sources: Ina May’s Guide to Childbirth. While this book has largely succeeded in helping me feel worse about delivering in a hospital as opposed to at home, it has been a great resource, one I relied on heavily for much of the information in this blog post.

When to cut?

Going into the delivery room, you might have decided who was going to cut the umbilical cord. Will the doc do it, or is it something Daddy wants to do?

We often think about who is going to cut the cord, but give little regard to when the best time is to do it. Many people would say “immediately” is the obvious answer. But some people never cut the cord, leaving newborn and placenta attached for the first few days of life.

On this one, I’m most comfortable somewhere in between. I vote for delayed cord clamping (waiting a few minutes until the cord has stopped pulsing before clamping it), but I have no plans to practice Placentophagy (eating the placenta for its nutritional value).

For the most part, a hospital wants to get a woman in and out as soon as possible. Not necessarily because the place is run by a bunch of jerks, but because there is only enough space. Most of the time, the preference will be to clamp the umbilical cord within a few seconds of birth.

But this might not be to baby’s advantage. More and more people are asking for delayed cord clamping, realizing the many benefits that come along with it.

Delaying the cord clamping can allow up to 50% of the baby’s blood volume to flow back into her little body, while early cord clamping results in fewer red blood cells and can cause postpartum haemorrhage, retained placenta and respiratory distress for the baby. Delayed cord clamping may help prevent anaemia later in life.

The Society of Obstetricians and Gynaecologists of Canada says, “Waiting at least two minutes after the baby is born before cutting the umbilical cord may help your baby get more blood supply. This may be most helpful for premature babies. If your partner wishes to cut the cord, this can also be arranged.”

Cord Blood Donation

I was surprised to see how quick the hospital was to push for cord blood donation. It was the first thing we were told about when we went in for an appointment a few weeks pregnant.

There are two public and 10 private Health Canada-registered cord blood banks in Alberta and Quebec.

When we went to visit our hospital to check out where we would be having the baby, a big part of the presentation was spent waxing lyrical about donations. There has been a lot of controversy surrounding cord blood donations, not necessarily because of the early clamping that’s necessary to keep the blood, but because people aren’t so sure of the point of public cord blood banking.

Donating to a public bank makes a lot of sense, I think (it’s public donations that the hospital was all-for). Private donations on the other hand are mind-boggling. The chances your child will ever use his own cord blood are so slim.

And if he has certain illnesses like Leukemia (one of the most common diseases that cord-blood stem cells are used to treat) his own blood likely can’t correct the defect. Treatment would likely end up being taken from a public bank anyway.

Some people take comfort in keeping the blood in case a sibling is ill one day, but private storage of your child’s blood into teenagerdom costs thousands of dollars.

After watching the Hema-Quebec supported video at the hospital it was time for my partner and I to have a long talk about what we wanted to do. He was very touched by the video, feeling that if he had the chance to save another child’s life, he would like to take it.

Maybe I’m heartless, but my vote was for allowing our baby to keep her own blood. We sought out the advice of our doula, who never offers her opinions unless I drag them out of her.

“So,” I asked, “Hypothetically speaking, what would you do?”

She said that if she spent the entire pregnancy taking such good care of herself and the baby by making the right food choices, exercising regularly, and taking prenatal vitamins etc., why deny that baby this last bit of nutrients?

After a little more discussion we decided: Baby, you can keep your blood.

Congratulations! You’re pregnant! First thing’s first: would you consider an abortion?

If your pregnancy was planned or the surprise was a happy surprise, it may seem like a silly question. But more and more new parents are being presented with this option when they are asked if they want to have prenatal screening tests like Amniocentesis or Chorionic Villus Sampling. Based on the results of those tests, terminating the pregnancy can become something that people consider.

To be clear, this is not an argument against abortion rights: women’s sovereignty over their bodies is not in question. What I do question is making invasive procedures routine, especially when the results they produce are not definitive. And the tests also pose difficult moral questions: if the potential for abnormality is present, is that a reason to terminate a pregnancy? People obviously make their own choices for their own reasons, and I can’t stand in judgment of that. What I can tell you is why I decided that these tests were not for me.

Am I being dramatic by calling these tests invasive? Not at all. For an Amnio, done around week 15, a large needle is inserted into the amniotic sac after it passes though the woman’s abdomen and uterus. About 20 mls of fluid is extracted and tested for various disease markers and other potential abnormalities. Can this cause harm to the fetus? You bet. Can it cause a miscarriage? Yes, ma’am.

A test used mainly to screen for Down syndrome (as well as Edwards syndrome, Turner syndrome and neural tube defects like spina bifida) Amnio is standard for women over 35, as the chances of giving birth to a baby with a chromosomal abnormality greatly increase with age.

According to the The Society of Obstetricians and Gynaecologists of Canada, at the age of 27, my chances of giving birth to a baby with Down syndrome are approximately 1 in 1,111. A woman aged 42 has a 1-in-64 chance.

Author and midwife Ina May Gaskin says in her Guide to Childbirth, the reason 35 was chosen as the recommended age is  “…at this age the likelihood of having a baby with a chromosome condition is about the same or greater than the risk the test will injure the fetus or cause a miscarriage.”

Depending on whether you choose to pay for it privately ($375–$900 at one Montreal clinic) or get the free test at the hospital, you will wait between 48 hours and five weeks for results. Probably a very nerve-wrecking wait.

After a CVS, done earlier in pregnancy than Amnio (in the first trimester), you may discover that your baby could be born with Down syndrome. Either you consider this is a reason to terminate the pregnancy, or you spend a very anxious few months wondering and worrying about your baby’s health. Though maybe for some, being armed with this knowledge would be a way to mentally prepare and plan for a baby who was not born “perfect.”

At our first visit with my OBGYN, we were presented with a pamphlet for a private clinic which offers prenatal screening tests. We didn’t open the pamphlet.

I was surprised when a few friends and some family members seemed to think it was careless of us not to do go in for screening. If the test is available, why on Earth would we choose not to take it? Did we need to borrow some money?

Amnio was the first of a long list of medical interventions we would choose to bypass. Just because certain technology is available doesn’t mean we need to make use of it. I am at such a low risk for delivering a baby with a chromosomal abnormality that we felt the risks outweighed the benefits. Secondly, after a very brief discussion with my partner, we knew we would carry this baby to term and love her regardless.

We decided we would enjoy this pregnancy, assume the best, and hope she is born healthy and happy. Just like our parents did.

Safe, affordable midwives are in demand, but a lack of education and funding forces healthy mothers into hospitals. Creative Commons Photo by Dave Haygarth.

It wasn’t until the early 1900s that it became “normal” to have a baby under the watch of an obstetrician in a hospital. But over the last few decades, childbirth has become an increasingly complicated, medicalized affair, with more inductions, surgeries, and drugs than ever before. The advancements have saved many otherwise dangerous deliveries, but it can also traumatize healthy mothers who would otherwise be fine on their own. Cesarean sections are increasingly common, for instance: Canada’s current C-section rate is 28 percent. The World Health Organization says it should be closer to 15.

Modern hospital-based childbirth, says Tonia Occhionero, Executive Director of the Canadian Association of Midwives, could result in a “cascade of interventions.” Sometimes there’s a temptation to use every tool available, even if that’s not always the best option. An unnecessary induction of labour, for example, can produce a snowball effect, with medical interventions accumulating, quickly complicating low-risk births into higher-risk ones.

According to the Canadian Association of Midwives, 70 to 80 percent of women could deliver on their own without complications and would therefore benefit from midwife supervised delivery at home, in a special birthing centre (only in Quebec) or even at a hospital. But health-care providers have been slow on the uptake.

“There are a lot of misconceptions about what a midwife is,” says Occhionero. “But how can we expect the general public to understand when midwifery still manages to be left out of Health Canada’s literature?”

But even without promotion of midwifery, more women are rejecting the assembly-line hospital birth—demand for midwives far outruns supply. There are only 850 midwives across Canada, 435 of whom are in Ontario, the first province where the profession was regulated in 1994. Ten percent of Ontario births are attended by midwife—but 40 percent of women who request a midwife cannot get one. With only six university programs offering certification, the shortage persists.

Occhionero says that situation will continue this way until schools add midwife training, which despite its earth-mother reputation is a highly professionalized four-year baccalaureate degree.

“It’s very regulated,” says Occhionero. “Not just anybody goes around catching babies.”

Illustration by Dave Donald.

It’s just another September day in Nova Scotia—sun shining, birds chirping, a late summer breeze playing in the treetops. Only one thing is different today for Shawna Young: she is pregnant. This one fact makes the sunshine seem a little brighter, the birds’ songs just for her. It’s like carrying around a secret, a secret that makes her smile at strangers and hold her head a little higher. Just yesterday, Shawna and

her husband, Benjie, put their one-bedroom house on the market, already full throttle into planning their lives for their little one. They’d dreamed of moving into a bigger, more family-friendly home when the time came; now, it was finally here. Today, Shawna is on her way to the doctor for her 13-week ultrasound. She knows exactly what to expect: the doctor will say she’s 12 weeks and six days pregnant, and she and Benjie will get to see the little hands and feet of their miracle baby.

But something feels wrong when she lies back in the chair, looking at the ultrasound image up on the screen. There is no movement. She tries to convince herself that everything is fine, even though a nagging feeling in the pit of her stomach suggests otherwise. The nurse’s words come like a blow to the head.

“Well, you’re not 12 weeks and six days.”

“Oh, is the baby measuring a bit small?” Shawna asks, looking helplessly at the blob on the screen.

“I’m sorry,” replies the nurse. “I have no good news for you today.”

When Shawna repeats the nurse’s words to me on the phone from her home in Halifax, I hear her voice crack, and I know it’s not the quality of the connection. For any woman who has miscarried, the emotional devastation is something that lingers long after the event has passed. But for a woman who has had fertility problems and struggled through years of tests, medications, alternative treatments, and thousands of dollars in debt, the devastation is that much harder to bear.

A few days after finding out she had miscarried, Shawna went in for her scheduled “D & C”—dilatation and curettage—which refers to the widening of the cervix so a doctor can scrape tissue from inside the uterus; in this case, excess tissue resulting from the miscarriage.

“I had the distinct feeling we were going to a funeral,” she says of the drive to the hospital. “After a morning of meeting with doctors, nurses, intake people, seemingly half the people who worked in the hospital, I was taken into the operating room. I walked in and climbed up on the table. I extended one arm out straight so they could put the IV in, but they couldn’t get it in, so they had to try the other arm. So I was lying there with my legs in stirrups and both arms extended out and very bright lights shining on me. The operating room itself and the procedure to that point reminded me very much of my egg retrieval for the in vitro fertilization, and as I lay there, the tears just started streaming down my face. I couldn’t wipe them away because both of my arms were extended and being worked on. I felt so alone and such complete and total sorrow. I didn’t fight the feeling, though; I just let myself feel what I felt and grieved for the baby I was about to lose. I was not only mourning the loss of our baby, but I was really grieving for my fertility.”

At 37, Shawna was on her second in vitro fertilization treatment after a year and a half of trying to conceive naturally. The decision put her and Benjie in debt more than $20,000. A single round of IVF can cost up to $10,000, which includes costs other than the procedure fee—women also pay for the drugs they need to inject themselves with in preparation for the procedure, and these can cost as much as $5,000. IVF is currently not covered by the provincial health-care system in Nova Scotia or most provinces in Canada. In Ontario, it is funded only for women with blocked fallopian tubes—no more than 20 percent of infertility cases. Last summer, Quebec became the first Canadian province to bring IVF under its provincial health plan when it passed Bill 26, which allows funding for up to three IVF treatments for women having difficulty conceiving. Outside Quebec, IVF remains a private medical cost in most cases.

IVF involves fertilizing an egg with sperm outside the uterus. It falls under the umbrella of Assisted Reproductive Technologies (ARTs), which emerged in the late 1970s, with the first Canadian fertility clinic opening in 1983. IVF is the most effective ART: with each cycle of treatment, it’s successful 38 percent of the time for women under 35; for women aged 35 to 39, it’s successful 28 percent of the time; starting at age 40, success rates drop to 11 percent. According to the Canadian Fertility and Andrology Society (CFAS), these rates have increased by 10 percent over the last decade.

The causes of infertility are numerous, and doctors usually look at lifestyle factors first—smoking, alcohol, and drug use all inhibit fertility. But the biggest cause of infertility in both men and women is unknown, and the most common type of infertility is unexplained—doctors simply find no reason why a woman cannot conceive naturally; everything seems to be medically normal, but it’s just not happening. In Ontario, infertility is known to occur in one in six couples, and in 2008, the CFAS reported a combined total of almost 10,000 IVF procedures performed in the 28 clinics across the country. However, although it is the most effective treatment, IVF is usually not the first procedure that couples attempt.

According to Dr. Keith Jarvi, director of the Murray Koffler Urologic Wellness Centre and head of urology at Mount Sinai Hospital in Toronto, doctors often try to increase ovulation in women and the number of eggs they produce during ovulation. This is done through stimulation medications that women take for a period of time prior to the procedure, so the sperm have more targets to aim for. If the process, known as Intrauterine Insemination, fails more than once or twice, the next step may be the use of IVF.

“We take the eggs out, take the sperm out, and incubate them together in a dish,” says Jarvi. Once the eggs are fertilized, the doctors take as many embryos as they feel are necessary for optimal chances of conceiving and return them back to the woman’s uterus. If IVF doesn’t work this way, doctors perform Intracytoplasmic Sperm Injection as part of the procedure. “[With ICSI], you can take the sperm and bring it closer to its targets,” Jarvi explains. To do this, doctors take a single sperm and inject it into a single egg, (after they have been extracted from the couple), and then place the fertilized embryo back into the woman’s uterus.

The costs of these procedures ranges anywhere from $5,000 to $8,000 each, not including the cost of the drugs women may need to take at the same time. “And you’re probably going to end up doing it two or three times,” says Jarvi. “You could easily spend a compact car’s worth of money on it. It’s not Lamborghini kind of money, but still, it’s a lot of money.” The huge expense adds a financial burden to the already high emotional cost of infertility, says Shawna. “It is really unfortunate that [the decision to do IVF] has to be a financial decision.”

Beyond the financial or emotional considerations, IVF also has implications for the health-care system. Such procedures result in a high number of multiple births, for one; because IVF costs so much, doctors transfer more than one embryo at a time to increase the chances of one coming to term. Multiple births suffer more complications, and it costs the health-care system a lot to care for them. Many doctors say these multiple births end up costing the government more than publicly funding IVF treatments mandating a single embryo transfer would.

As birth rates continue to drop, many advocates, patients, and doctors alike say that provincial governments need to recognize that these procedures inflict high costs on individuals—emotionally and financially—and additional economic costs on the public healthcare system. The solution, they say, is to make IVF a publicly funded treatment.

Most women spend a great deal of their lives trying to avoid pregnancy. We are taught to practise safer sex and use condoms and go on birth control. We do these things until we want to start a family, and it’s easy to assume that as soon as birth control stops, a pregnancy will occur. We’re conditioned to expect the process to happen naturally, like turning on a light switch. And when it doesn’t, we feel frustrated, angry, and confused.

“You feel at fault because you can’t do something that comes so naturally to everybody else,” says 39-year-old Charmaine Graham, of London, Ont., who has been through 11 IVF treatments. “You’re faced with people who are parenting children and they’re going through [general] parenting angst—they’re frustrated, they’re tired, they yell, they snap—and you just would do anything for that opportunity. I just wanted to go to the grocery store with a baby like everybody else.”

Graham says infertility can be an intensely isolating experience. Not only do women feel like outsiders for not being able to do something natural—and, arguably, what many women may feel is their unique duty—but they are further isolated by constant reminders of their failure.

“No matter where you go, every single person that you meet came from somebody’s womb. That is what we do as a human species—we procreate. And so there’s no way ever to escape that,” she says. “You have a lot of feelings that are paradoxical. You’re really happy for your sister when she gets pregnant, but you also want to smash her head up against the bathtub because you can’t. It’s very hard to live with those feelings all the time.” Of Graham’s IVF treatments four were fresh, and seven were frozen (frozen fertilized eggs are stored in case a fresh treatment fails, which is less expensive than starting again with another fresh treatment). While her husband, Jim, believes the experience ultimately brought them closer, Graham remembers how taxing the treatments were on their marriage at the time.

“You have to deal with the anger and frustration you might have with your partner as a result of them being infertile, or the guilt that you feel for being infertile. And then I have to make this man who loves me live with me when I’m fucking insane going through hormone treatments,” she says. “Women become so focused on just getting pregnant, it doesn’t even become about parenting anymore. Men don’t feel that they’re married to the woman they got married to. Something has hijacked their marriage entirely.”

This is one of the most compelling things about the struggle of infertility: it affects men and women very differently. Even if a man is the one with the issue, the procedure is still done on the woman because she is the child-bearer. “They’re the ones who have to do most of the drugs, they have to do most of the invasive technologies. They’re the ones being poked and prodded,” says Graham. “A man has to masturbate to get his sperm out. A woman has to have a probe put in her vagina, with a 22-gauge needle that goes through the side of her vagina into her ovaries to withdraw the eggs. I think it’s a very separating experience for most men and women.”

Other women agree with Graham that the reminders of what they can’t do never seem to cease. Some describe difficulty attending baby showers, seeing mothers with their children in the grocery store, and even walking by the Santa Claus display in malls around Christmas. And with all of these difficult feelings comes the worst part: paying out of pocket for a procedure that is not even guaranteed to work. No one knows that better than Kerri-Lyn Jessop, 37, of Caledon, Ont., whose three IVF treatments over two years have put her more than $30,000 in debt. “Unless you’re rich, that’s a lot of money to spend to find out an answer to one question,” she says. But it’s not enough to make her want to stop trying.

“Emotionally and physically, I’m not ready to give up, but there’s only so much money in the pot.”

Cheryl Dancey, 41, of London, Ont. agrees. She had 18 IUIs and four IVF treatments, none of which were successful. “As hard as everything else is, it’s not enough to stop you from doing it again. Money is the only thing that can make you not go on.” (Since our original interview, Dancey was able to give birth to a baby girl with the help of a donor embryo.)

Dancey says if IVF was publicly funded, half the burden of the experience would be gone. “It would take all that pressure completely away,” she says. “You wouldn’t have to worry, ‘Well, if I do it, we’re not going to have the house to put the kid in.’”

Many couples struggling with infertility turn to family and friends for financial help to pay for IVF treatments, which brings up the arduous task of explaining their situation to loved ones—something that can be very difficult to do.

“People don’t believe that it’s real,” Dancey says. “They say, ‘You’re not doing it right. All you have to do is relax. So-and-so’s brother’s cousin’s wife did this and she was fine.’ People just don’t get it. Everybody’s got some stupid story that somebody that they’ve known through the grapevine relaxed, or drank a certain tea, and that’s what will fix the problem.”

“The other thing that people also do all the time is that they stop talking to you,” says Graham. “I worked at the university and I was always very open about my situation. So, I’d go missing for a few weeks and I’d come back to work and people would say, ‘Where have you been?’ and I’d be like, ‘Making babies in a petri dish.’ And so everybody knew what I was going through. And then one of them would get pregnant and she wouldn’t come to my office for nine months.”

If IVF were publicly funded, couples could go ahead with treatments privately. They would also be spared having to deal with the naysayers who think seeking such treatment is selfish.

“By the time the government decides—if they ever decide—to fund this, it will be too late for us. My time will come and go by the time that it’s covered,” says Jessop. “We are speaking up for the next group of people that are coming into this. I don’t think I will ever benefit from [it], but I might be able to help somebody else benefit.”

The Ontario government established an expert panel in 2008 to take a closer look at ARTs, especially IVF, and whether it should be funded under the province’s health-care plan. It also examined adoption: its cost and its lengthy, complicated process. The panel released its recommendations this past August, which urged the government to institute a fertility education system, provide a funding strategy for IVF procedures, and make changes to the adoption process.

Dr. Jarvi provided expert advice to the panel, which also included Dr. Arthur Leader, a professor at the University of Ottawa and a partner at the Ottawa Fertility Centre. Both doctors agree that the most important public health reason to fund IVF is to limit the number of multiple births that result from multiple embryo transfers. Leader says that transferring multiple embryos is dangerous and more of a financial burden on the health-care system than IVF procedures would be.

“What the expert panel showed was that, by limiting the multiple birth rate in Ontario, you could save the taxpayer, over a 10-year period, half a billion dollars,” he said. “Twins are more likely to have medical or surgical needs in the first four months of life. The tremendous cost associated with having high rates of twins, never mind triplets, means that caring for them is actually costing the government more than it would have cost to fund IVF for single-embryo transfers.”

One of Leader’s patients became pregnant with twins through IVF. About halfway through the pregnancy, one of the twins died in utero as a result of a congenital heart defect. “It became a highrisk pregnancy,” says Leader’s patient, Kerri Stanford, who was 34 at the time. “We knew that one of the babies wasn’t doing well and was likely not going to make it. It just meant that the whole pregnancy was very complicated and it was watched in a high-risk unit.” Those high risks, of course, entailed high costs, exponentially more than a single healthy pregnancy would have. “Economically, there is a strong argument to be made to fund fertility services,” Leader says.

Leader has another reason he believes IVF should be added to provincial health-care plans: continuity of care for patients. “One of the paradoxes of infertility is that, in almost every province of the country, it’s medically necessary to do fertility testing in order to find out why people can’t get pregnant. In other words, the health plan pays for treatments to diagnose infertility. But once the diagnosis is made, the health plan abandons people, saying it’s not necessary to treat your problem. Then, once people get pregnant, the health plan says now it’s medically necessary to care for pregnant women. There’s a disconnect.”

Months after my first conversation with Shawna, I receive an email from her. “I should be 35 weeks pregnant now,” she writes, still lamenting her miscarriage. She goes on to tell me about one of the hardest parts of dealing with infertility: the public’s misconceptions about it.

“If I had a medical condition that prevented me from being able to walk,” she said, “and there was an effective medical treatment available, society wouldn’t question whether or not I should be able to access it. When someone is paralyzed, people think, ‘Oh my gosh, I could never imagine what that would be like.’ Nobody ever thinks, ‘What would my life be like if I didn’t have my fertility?’”

Advocates for IVF funding see it as positive that the Ontario government commissioned an expert panel to look at the issue, and Quebec’s new law is definitely a step forward. But it’s taking the rest of the country a while to catch up. Medical organizations have questioned Canada’s attitude toward funding, especially in comparison to other countries around the world, many of which do provide funding. Manitoba offers couples who have undergone treatment a tax credit for 40 percent of treatment costs. British Columbia now has the Hope Fertility Fund, which provides financial assistance to residents of the province who can’t afford treatment—commissioned by the UBC Centre for Reproductive Health, the Vancouver General Hospital, and the UBC Hospital Foundation, not by the government. The Nova Scotia government has previously deemed it not medically necessary to provide funding, and the rest of the country seems to agree.

Still, supporters remain hopeful. Beverly Hanck, executive director of the Infertility Awareness Association of Canada, believes all provinces will eventually cover treatment. “I suspect what’s going to happen, and this is my guess, is that they will put it on their platform for the next election,” says Hanck. “It’s a matter of time. But time is important for some of these couples.”

Time is indeed the enemy in the infertility battle. Women feel pressured by time because fertility decreases with age, and after an IVF treatment is performed, waiting to find out if they are pregnant can be excruciating. The burden of infertility is essentially a race against time. And so far, time is winning by a long shot.