This is a very personal account by feminist writer Naomi Wolf of the modern experience of pregnancy, birth and motherhood in the United States. The author’s analysis of healthcare practice, mothers’ rights and social attitudes is interspersed with descriptions of her own experiences and those of other mothers that she has known and interviewed. Reading it was a deeply thought-provoking and an emotional experience.

She takes an honest look at the image of pregnancy as a time of unalloyed, peaceful, joyous anticipation: and acknowledges what all mothers know but do not allow themselves to say, that this image is a sugar-coated half-truth. The other side of pregnancy, especially a first-time pregnancy, is that it is also a time of darkness, grief and fear. With the birth of a new life and the forging of a mother, comes the death of the care-free indepdendence we used to know. On top of that there is the fear for our baby, the fear of the future, the impossibility of knowing how we will cope with this huge burden of responsibility. There are bitter spasms of regret and a mad desire to rewind and change our fate rather than face the seemingly insurmoutable challenge of coming to terms with it.

Then there is the way that pregnant and labouring mothers are treated by the healthcare system. Despite the myth that pregnancy is a special time of great joy and reverence, antenatal care is often compassionless and bleak. You feel like you are on a production line, where emotion and worry are not taken seriously – and, indeed, are thrown at us as a chastisement. “You shouldn’t let yourself get so upset – it’s bad for the baby!”

With regard to labour, Wolf describes and condemns the “birth industry” (worse in America because of the profit motive, but not absent even here where there is no profit motive but still plenty of desire to seem heroic and avoid legal actions).

The demands of hospital protocol, driven by profit and lawsuit avoidance, mean that women are frequently subjected to interventions that are medically unnecessary. It is profitable and heroic to intervene, because doctors get paid more and get more kudos, for a “difficult” high-tech birth. More subtly, there is the production-line time pressure – get the woman in, get the baby delivered, get them both out. Time pressure leads to interventions (from induction to episiotomy and Caesarean) that are designed to speed labour up more than to meet genuine need.

These practices are based on a need to save costs, but also reinforced and justified by a belief that labour is safest when it is quickest, that allowing labour to draw out merely extends the period of risk. I guess this stems from the image of labour as a condition to be treated, rather than what some midwives call “a natural cycle of wellness”. Certainly it does not stem from any credible research because all the credible research appears to point in the opposite direction – that the high-speed, high-tech birth has (at least in normal cases which do not present special risks) if anything worse outcomes for women and babies than the low-tech, natural approach that allows women to labour at their own pace.

Wolf goes on to dicuss the experience of motherhood, especially new motherhood.

She exposes the appalling frequency with which poor aftercare and a lack of support lead to postnatal depression.

She talks about the difficulties women face in the labour market, and the way that it is always the mother who has to take a professional hit, always the mother who has to be flexible, deal with childcare, work part-time, compromise her own aspirations. Always the mother, never the father.

She describes how strong, feminist women (like her, and like her friends) find themselves renegotiating their marriages from a position of weakness. The source of that weakness – the baby. Husbands know that, for the sake of the baby, their wives will not leave them. They know that they can do more or less what they want, they can continue to work and socialise just about as much as they did before: they are now the breadwinners and they can call the shots. They can do all this, and leave their wives, the mothers of their children, to burn out with the new demands upon them, confident that, for the sake of the family, their wives will not walk out.

In an epilogue, Wolf tries to imagine what the world might be like if women and motherhood were truly valued, truly treated with the reverence to which society currently pays lip service at best. Her “Mother’s Manifesto” sounds quaint – but not because the world it envisions would not be possible, desirable or workable. Just because it is painfully obvious that her dream will not come true.