The following book review was written by Helen King, Professor Emerita of Classical Studies at the Open University.
I’ve just returned from Gustavus Adolphus College, Minnesota, where I was lucky enough to be a guest at their annual Nobel Conference. This year the theme was ‘Reproductive technology: how far do we go?’, and the speakers addressed it from many perspectives: disability rights, race, social science, genetic science, the current state of research to develop a male hormonal contraceptive, and the realities of dealing with a person or couple who can’t conceive without assistance. All the talks and discussions are already online so you can listen at your leisure. I learned about CRISPR/Cas9 gene editing and the possibilities of changing not just an individual, but their line; since one of the events was a comedy improv on the conference themes (and yes, that’s online too), every time I hear CRISPR now I’ll be thinking of a salad crisper, although as ancient Greek myth includes the goddess Hera conceiving by eating lettuce, maybe for a classicist it’s OK to think like this!
On my flight to Minnesota, I read Helen Sedgwick’s latest novel, The Growing Season. It was an appropriate choice, and I’d only just heard about it when chatting to a colleague at another conference. It’s set in a future in which pregnancy and birth have been revolutionised by the use of the pouch: an external womb which can be worn by either parent, over their clothes, supported at the shoulders. It is possible to conceive naturally and then have the embryo transferred to the pouch, or to conceive by IVF. People can get it on their health-care plans or, if they don’t have a plan, they can have a pouch that has already been used. If you can afford to pay more, pouches come in a range of colours and textures, and you can even dress to match your pouch. At the end of gestation, you attend the FullLife birthing centre and the baby is removed from the pouch for you to take home. The Growing Season follows several women and men affected by this technology, including Holly – the first woman to have used it – and her granddaughter Rosie whose pregnancy in the pouch is approaching full term as the novel opens.
For society, the pouch means ‘that everyone was equal now we had moved beyond natural birth’. It’s not just ‘the better way’ in terms of ‘eradicat[ing] the pain of childbirth’; it’s a ‘way to share the creation of life’. It’s open to same-sex couples, ‘Trans people. Older couples. Women with health difficulties. People who wanted to live in groups’. Rosie’s partner Kaz has two fathers: ‘if equality was to be achieved, the physiology, the biology, had to evolve’. Alternative models of ‘family’ feature throughout the book, including the adoption of Eva, and the final years of Freida, an early pioneer of the technology, who moves in with the family of the grocery van driver who delivered to her remote home. The novel thus addresses the nature of parenthood, as opposed to conception: ‘Parenthood wasn’t about being a blood relation, he knew… It was about intimacy’.
Rosie loves her pouch. She’s heard stories both of ‘women who had to be cut open’ and those whose babies had died. She thinks back to ‘All those women from before the pouch. The pain of it was one thing, I know, but what must have been terrifying was the thought of something bad happening, some harm coming to the baby’. Yet – spoiler alert – the birth of her son ends in tragedy. The plot hinges on whether this is the beginning of the end of the technology, or possibly of the human race: does the pouch carry new risks for the reproductive potential of the third generation of those born through it? Does it in some way affect them at the genetic level? Or does the fault lie with the parents? Discussing the past, one character says, ‘It used to be fairly common to blame women, I think … There were all these rules, you know – pregnant women had to eat certain things, sleep a certain way, avoid pain relief’. Are FullLife ‘Hiding the risks from the public, misleading parents. Making them feel responsible’?
Risk, and balancing risk, is a central theme of the novel. What counts as a significant risk, and has the promotion of the pouch as entirely safe been an error? A senior scientist at FullLife, appalled by the death of Rosie’s baby in the pouch, explains ‘There haven’t been many. I promise, if I’d thought… if it was a significant risk…’. Because, as one character says, ‘There are risks … I want people to know that, either way, there are risks. There is no easy choice. There never was’. The alternative to the pouch is ‘natural birth, and all the risks it comes with’. ‘Studies suggest that 60% of stillbirths are unexplained, that 1 in 200 babies are stillborn when using natural birth – so many? So many?’ It turns out that FullLife has covered up the ‘small statistical risk of unexplained fatality’ in the third generation. So the pouch turns out to be ‘an imperfect technology that carried a natural risk … it was a risk that people could choose to take, if they wanted to … it was just a risk’. And the level of risk turns out to be the same as for natural birth: ‘approximately 1 in 200 pouch pregnancies could end in some form of late-term miscarriage. It was the same. The statistics were the same. For the pouch as for natural birth’.
In ‘The Risks of Childbirth in Historical Perspective’, we’ve considered that word ‘natural’ before, and its relationship to ‘normal’. In The Growing Season, ‘nature’ is explored throughout the novel: ‘“We have bypassed nature,” she said. “No,” said Holly. “We cannot bypass nature. We are a part of nature.” “The things we invent are not natural.” “Yes they are. Everything we build, everything we create.”’
The novel is set in the UK, which seems significant when so many innovations in the reproductive field have been based here, from Marie Stopes’ clinics to the Nobel Prize-winning work on IVF by Robert Edwards, Patrick Steptoe and the often-forgotten third member of their team, Jean Purdy. But it’s not the UK we know now because, while FullLife is a company, it has taken over NHS contracts to the point where it controls ‘entire hospitals, every aspect of health care’ and the NHS has ceased to exist. For me this privatisation of health decisions and technology raised questions about regulation, which the Nobel Conference also addressed.
The Growing Season also highlights the role of the media in increasing public fears about new technology: ‘I think half the world was expecting a monster’, says one character about the first pouch birth, which recalls the fears around the birth of Louise Brown, who has talked about the hate mail her mother received. Just as you can now adopt an embryo which has not been implanted after IVF, so in this imagined future women considering abortion can instead donate the embryo for FullLife research into embryo transfer, and pro-life groups pay for the resulting children to be looked after. However, with the pouch, there are fewer women seeking to adopt, so such children languish in ‘care homes’. They have ‘no parents, no family. My God, the younger ones don’t even have names’.
I enjoyed this novel very much: it’s a great way to introduce many of the themes around risk and technology, medicine and society.