Essay: Kate Montagueon care

Lockdown Letdowns

According to the Australian Breastfeeding Association, when a newborn first latches to their mother’s nipple they trigger tiny nerves which release hormones into the bloodstream. The sucking produces a surge in two hormones: prolactin, which stimulates the milk-making tissues; and oxytocin, which causes the breast to ‘let-down’ the milk.

Oxytocin – produced at the base of the brain by the posterior lobe of the pituitary gland – is sometimes called the love hormone because it is also released during two other moments of physical intimacy: sex and childbirth. The immediate postnatal high, or rush, that some speak of after delivery owes much to this hormone, which during birth is released in large amounts, triggering bone-crunchingly painful contractions but also a well-nigh rapturous euphoria that seems instantaneously to overwhelm pain on the moment of delivery. The many and varied traumas of labour are said to fade almost instantaneously, as mother and child are ensconced in a biochemical love bubble.

This is what Sylvia Plath recounts in The Bell Jar, when Esther watches a delivery with her terrible boyfriend, Buddy, who is training to be a doctor:

The woman’s stomach stuck up so high I couldn’t see her face or the upper part of her body at all. She seemed to have nothing but an enormous spider-fat stomach and two little ugly spindly legs propped in the high stirrups, and all the time the baby was being born she never stopped making this unhuman whooing noise.

Later Buddy told me the woman was on a drug that would make her forget she’d had any pain and that when she swore and groaned she really didn’t know what she was doing because she was in a kind of twilight sleep.

I thought it sounded just like the sort of drug a man would invent. Here was a woman in terrible pain, obviously feeling every bit of it or she wouldn’t groan like that, and she would go straight home and start another baby, because the drug would make her forget how bad the pain had been, when all the time, in some secret part of her, that long, blind, doorless and windowless corridor of pain was waiting to open up and shut her in again.

The experience of childbirth is radically singular, varying in dramatic ways not only from mother to mother, but from birth to birth. I’ve given birth twice and have had two very different experiences with oxytocin – with my first, I was given a synthetic version to bring on labour and, ultimately, felt very let down by the love hormone, but I enjoyed more of a kick with my second. Compared to the pharmacy I inhaled with my first (from the induction drugs, to gas, water injections, morphine, and epidural, through the mind-bending painkillers I was on for days after), none secured the sort of ‘twilight sleep’ of my body’s own oxytocin levels the second time around.

Proponents of the ideology of ‘natural’ childbirth and motherhood will tell you that simply locking eyes on your baby, hearing their cry, touching their skin, or even just thinking of them will trigger the hormone. It’s one of those peculiar physiological reflexes to a psychical event, what neuroscience might view as the plasticity between the psychological mind and neurological brain – or what psychoanalysis might recast as echoes between internal and external realities. This physiological letting down of the milk reflex and its attachment to feelings or affect can also take on a more depressive letting-down of feeling too; some mothers experience melancholy, anxiety, even something like homesickness associated with the let-down.

It would seem the postpartum body can also be suspended for days, weeks, or months between the Eros and Thanatos of oxytocin. After my waters spontaneously broke with my first child, my body struggled to go into labour, and so a synthetic version of oxytocin had to be administered via cannula. With that baby, I struggled to get any let-down of milk in the first days and weeks – and now the mechanical hum of a pumping machine haunts the memories of those first weeks of motherhood.

Multiple online breast-feeding pages encourage women to relax, to release their shoulders, to listen to music, to enjoy baths and showers, all in order to trigger this oxytocin induced let-down. And yet, as if we need to say it: the triggers of breastfeeding are not just an interaction of chemicals, biological or physiological, they are also profoundly environmental and social. Though I had more of the high of oxytocin during the birth of my second child, it took weeks for one breast to get the let-down message. While suffering from mastitis, not only the breast but I too felt suspended in a state of engorged anxiety, wondering how much of this had to do with having some blockage in my chemical wiring between pituitary gland and nipple, and how much of it had to do with a nationwide lockdown.

On the fifteenth day of March this year I gave birth to our second child. It was a Sunday afternoon and by all standards a fairly straightforward labour. My husband, Mark, and I arrived at the Royal Devon and Exeter Hospital around midday and three hours later the midwife helped us welcome Jack by bringing a pot of tea and marmite on toast. (So British!) It was a whole world away from the birth of our first son Finn, who was evacuated via emergency C-section at 3am in Sydney.

While I held Jack in my arms, four and a half years later, I felt the rush of oxytocin as an engulfing warmth. And yet here I was, on the other side of the world, more alienated in a material sense to anything and everyone we tend to think of as home – in a health-care system with which I had no real familiarity; no family waiting at the doors to meet this new baby; and, as I soon discovered, a split second away from being isolated from everything else, from the friends and support systems we had created in the two years since moving to the UK.

The day Jack was born, the hospital had begun to disallow visitors to the maternity wards and, in the following week, all face-to-face postnatal health visits and healthcare checks would be cancelled or transferred to online consultations.  Covid-19 had been seeding in the UK for weeks already, and by mid-March, the models suggested that infections were doubling every two to four days. Contact tracing and community testing had been abandoned the week that Jack was born because of ‘widespread community transmission.’ Tens of thousands of people were being infected every single day.

The Thursday before Jack was born, Boris Johnson had given a press conference in which he portended that many ‘families would lose loved ones’ before this was over. I remember feeling anxious, but I had no sense that the threat was imminent. We were preoccupied with our own circumstances. There is, of course, a huge amount of privilege that attends to this non-thinking, to the belief that disaster or tragedy will happen elsewhere, in poorer countries, in countries with weaker or more exclusive healthcare systems, to other families, in different households.

In January, when we first heard about this new virus, it seemed far away, in China, and even as it looked like it was spreading to other parts of the world, to Europe, to Italy, and to Spain – it still felt like the incalculable losses would not happen here, and even as it started to spiral in the UK, surely it would stay predominately in the urban metropolis, as opposed to where we live, in the semi-rural West Country.

Perhaps I was in some sort of self-preservation mode, in that fortieth week of gestation. Perhaps it was also that I had lived most of my life in a country with a relatively robust public health care system and that I did not appreciate how badly eroded the National Health System was after years of Tory rule and austerity.

And yet, in early March, the pandemic was already widespread across the UK. Now, as I write, more than six months later, the UK has the fifth-highest death tally in the world; the twelfth-highest per capita deaths; and the fourteenth highest case-fatalities (4.2%): there have been over 55 000 excess deaths during the pandemic in the UK. The reality is likely to be even worse considering the government’s official figures, from which these rankings are calculated, are well below the number of times Covid is recorded as the likely cause of death on death certificates.

This is not to reduce everything to inhuman numbers – there are no winners here – but to counterpoise two competing realties on that Sunday in March when Jack was born.

On that Sunday, the day I felt the beautiful rush of endorphins and fresh excitement for a future wrapped up in this new bundle of flesh, the UK should have already been under lockdown. My midwife – whom I remember telling us was about to go away for a celebratory weekend because her husband had just finished chemo treatment – should have had access to PPE. If we knew then what we know now, we would have been more terrified than anxious. The disaster was not just seeding exponentially; it had already been sown, through decades-long attacks on the NHS, through the gutting of public health and social provision, through the lack of testing capacity, the lack of contact tracing capacity, right up to the government policy around ‘herd immunity’. Professor Neil Ferguson, one of the government’s key scientific advisors at the beginning of the pandemic, suggested in June that had the UK entered lockdown just one week earlier, that weekend, the number of deaths would have been halved. In real terms, more than 20,000 lives might have been saved.

I remember the sixteenth day of March vividly. Coming home from the hospital it was brilliant and sunny. The first real day of spring – which, after a long winter spent either teaching in dark classrooms or huddled on a picket line, would have felt momentous in any event. Yellow daffodils had forced themselves aboveground alongside our front steps.  The superstitious part of me took this as a good omen. I was still riding the high of the birth and was miraculously well-rested after a night in hospital alone with Jack, which had been such a stark contrast to our weeklong stay with Finn. Jack was sleepy, he was latching (albeit awkwardly), and he didn’t feel as much like an alien as his brother did. I had shared a ward with two other women and, because partners were not allowed to stay, the birth stories shared between us complete strangers that night made for an intimate solidarity. I often find myself wondering how those women are doing, how the coming months were for them and their new babies.

I didn’t know it then, but those women were the last people (apart from Mark and Finn) I would meaningfully talk to, within a shared room, for months. It was the day we came out of hospital that Matt Hancock, the Health Secretary, announced that ‘all unnecessary social contact should cease’. That week, we had a tentative couple of visitors, who furtively left care packages at our door and then shouted well-wishes from the footpath. I will forever be thankful for those very dear friends who looked after Finn while I was in labour, for the M&S pies, for the extra-large box of chocolates, for the whiskey (that I couldn’t drink), and for that crate of wine sent by friends back home in Australia.

Precisely one week later – now struggling with breast-feeding, unable to see a midwife because of a persistent dry cough I had developed since coming home from the hospital, and feeling a postnatal comedown to match the high I had experienced a week earlier – the UK entered a more formal lockdown. On 22 March, the Prime Minister told the country that we all ‘must stay at home’ with only ‘essential workers’ given cause to leave.

We were able to leave only for very limited purposes, such as shopping for necessities or for an hour of exercise a day, provided there would be zero interactions with members of another household. I remember Mark urging me out of the house for that one hour. I had barely changed clothes in a week, or left the lounge. One hand supported this constantly feeding newborn at the one breast and the other held a pump to the other breast. My cough was persistent and dry but not severe. Jack would only feed from one breast and I didn’t know whether he was gaining weight because no-one could come to weigh him. We still hadn’t been officially discharged from hospital because we had not been able to see a midwife.

My searches switched between ‘breastfeeding with covid’ and ‘breast not producing milk, lump’. I had become convinced I had a tumour or something equally malignant, which was why Jack would not feed off one of my breasts and why there was no let-down. I could feel a really hard lump, and the next day I developed a high fever. The rational part of my brain told me this was mastitis, that I had had it before with Finn, but the very sleep-deprived part, the part struggling with wildly oscillating baby blues, kept switching between Covid-19 and cancer. I couldn’t see my GP because I had a cough and a temperature – but I was prescribed antibiotics over the phone. I still had a dry, persistent cough, but I couldn’t get tested because at that time in the UK anyone with symptoms had to just ride it out at home.

In the two and a half years since leaving Australia for the UK, I don’t think I have felt more alone. James Wood recently wrote in the London Review of Books, ‘To have a home is to become vulnerable. Not just to the attacks of others, but to our own adventures in alienation.’ I remember also my dad, when I first told him of our surprise pregnancy with Finn, saying something like this but about having children: that parenthood means vulnerability.

I think I’m beginning to understand more now, and particularly since living so far away from home, that to care for someone or something is to become a little more alienated from yourself – because you are no longer this wholly intact person, that part of you is always elsewhere. I now felt a sense of urgency and necessity to get home. I wanted to be close to my own parents. I wanted access to a health-system that felt familiar. I wanted to be tested for Covid-19. I wanted to feel safe.

I remember getting home with Finn after a week in hospital and receiving a call from our GP in Glebe – she was ringing to see how we were. I cried, and told her Finn would not latch. She called us down to the surgery, arranged a lactation midwife to see him, and put together a mental-healthcare plan for me. We could come in every day until he was feeding or until I was feeling better or both. It worked. I felt safe, I felt like things would eventually be okay, I felt cared for.

While Jack’s entrance into the world had been so much easier, I now felt increasingly alone. I didn’t feel like there was anyone to call, I couldn’t see a GP, I felt I didn’t have access to healthcare unless it was an emergency – and I appreciated that this was not an emergency, that people were dying, and that many families were losing loved ones. I started googling ‘passport for Australian newborn living in the UK’. The consulate in London was closed for passport appointments – and how could we even get there if we wanted to? London was the Covid hotspot and we were under lockdown. Anyway, Jack’s birth would need to be registered in order to apply for a passport – and with registrations of births now suspended he was officially an alien resident. In fact, his birth wouldn’t be registered until June.

It burned in August when Scott Morrison – in response to cancelling more flights back to Australia and introducing a $3000 a head bill for hotel quarantine – suggested to Australians abroad that they had been given ample urging – since 17 March – to return home. What about those who could not fly in March? What about those women who were in their final weeks of pregnancy when an international flight is completely out of the question, and what about those Australian babies born in other countries, without passports, not to mention those individuals or families, like ours, who would hardly be able to foot the bill for a flight (becoming more expensive by the day) let alone hotel quarantine? No, getting home was materially impossible.

Despite this, and though living paycheck-to-paycheck, we remain lucky to have that paycheck, as well as a visa agreement that allows us healthcare. Elsewhere on the island, a Ugandan asylum seeker named Mercy Baguma was discovered in her flat in Glasgow. The sound of her infant son crying alerted the neighbours. She was dead.

I know now there were people I could have called for help – a wonderful breastfeeding group running out of Finn’s school had a Facebook group and was meeting via Zoom, but early on I was exhausted and afraid and barely keeping the seams of our physical worlds together. I lacked the energy or imagination to find these other communities online. All I knew was that the community midwife and health visitor couldn’t visit, that I couldn’t see my GP in person, and that I couldn’t get home.

I have wanted to express something of the bizarre experience of those first few weeks of lockdown with a newborn. That it was a massive let-down after the birth. How those weeks bled into months. Many have already written that the pandemic has urgently refocused attention on care – care in our public health systems, aged care, caring for one another, self-care. For me, because of the weird admixture of pandemic and newborn, it refocused my attention on a particular type of maternal care. Gestational, and reproductive care, and also the gendering of domestic care. It’s made me think about the materiality of this type of care – care for those whose life is utterly dependent on care, who cannot care for themselves – small children, those who are ill, some of our elderly, those left materially destitute, or stateless. This is more than an ethic of care, of being kind, of tending to oneself or one’s garden: this kind of care is a material condition for life, no less significant than the air we breathe.

I’ve had many thought-fragments but it has been hard to write them down. I bought a notebook online in the first couple of weeks, but it only contains a handful of semi-legible notes jotted at 1am or 3am. Even now, seven months on, I’m still stuck squarely in the soupy mix of sleep deprivation, which makes stringing words and sentences together harder than usual. That sleep deprivation, the breaking up of unconsciousness into 45-minute intervals, so that you lurch in and out of consciousness as if you were on drugs, does something particularly weird to time and space. As the cognitive faculties are numbed this exhaustion heightens other senses such that small, banal things appear particularly catastrophic. It would appear that this is what lockdown can do as well. For so many of us, space and time have simultaneously shrunk and expanded in ways that seem to mimic life with a newborn.

The language of the pandemic is one of containment; our worlds have become smaller as we limit our social contacts to single households, or as children re-enter school in pods or bubbles, and as the logic of social interaction becomes one of distance and distancing. Even now, across county lines and national borders so many of us remain suspended in various stages of lockdown, shielding or self-isolating or social-distancing. At the same time, our domestic and private spaces have never been more occupied – or, at least, they have never been more occupied by everyone all at the same time. Surfaces are so regularly disinfected that we remove all trace or residue of human contact. We can’t touch or hold one another.

While space seems to contract, time in other ways seems to stretch out and expand. March, April, May, June, July, August, September, October, all fold back into March – when this new way of being began. Every day feels like Sunday as the normal routines that would normally punctuate our week are dislocated and reorganised. For my five-year-old son, Friday night anchors the week because it is pizza night; for my husband, it is Tuesday night, the greatest night of all: bin night. Again, this is not so dissimilar to life with a newborn: the weird disorientation of new nocturnal rhythms or their complete absence, the repetitive rituals of feeding, changing, rocking to sleep, feeding. Repeat. Repeat. Repeat. Life slows down in some ways, expands to fill days and weeks with a sameness hinged to the necessities of care, while space contracts around domestic labours.

Simone de Beauvoir once described the state of ennui that comes with maternal care: ‘Because housework alone is compatible with the duties of motherhood, she is condemned to domestic labor, which locks her into repetition and immanence.’ It would be wrong to generalise too much, between reproductive care and the sort of care work that Covid-19 has brought to the fore. But it is true that in both instances there is a real contradiction. Care-work, from domestic and reproductive to health-care, education, and services is both essential for the material survival of those that depend upon it, hence ‘essential workers,’ but it is also undervalued. We only have to think about the undervalued, unwaged work that goes on in our households, or the variform ways in which essential or ‘key-workers’ in this crisis are uniformly exploited as cheap labor, to be forced into the workplace.

While my experience of lockdown has been entirely synchronous with the life of a now seven-month-old, and is from the perspective of maternal labour, this is only one type of labour within a much larger ecology of work that has been unevenly celebrated and exploited during the pandemic. There is, clearly, enormous disparity between my own experience of being able to work from home, as so many middle-class professions have been able to do so, and the many ‘frontline’ workers, forced into potentially contaminated spaces not only because they are ‘essential’ and ‘key’, but also because under capitalist social relations they are undervalued to the point of disposability.

Life became more liveable with the easing of restrictions this summer, and I sought out maternal communities both in person and online, whose people have been struggling in different ways first with having and then caring for infants during this pandemic. Two women run a baby room out of the local school.

During normal times, it is open all day as a walk-in social space, with tea and coffee and cake, with slings and reusable diapers, and with breast-feeding support and infant nutrition. Because of cuts in local funding, this sort of work is no longer funded by the government at all, and yet it remains–because of the labour of these women – as an essential space and service for parents. Not yet able to open the doors at the beginning of July, but with outdoor meetings permitted, a Friday morning meet-up was organised, in a local park under the trees near some bike humps. I remember walking over nervously, masked-up and with hand sanitiser at the ready. I hadn’t socialised in person with anyone in months, and had barely introduced Jack to another human outside our own house. He was by then almost four months old. I remember instant warmth, massive relief, and the release it felt to talk with others who had recently had babies under the weirdest of circumstances. We sat in a circle, meters away from one another, and exchanged fragments of conversation. New mothers were helped with the positioning of babies while feeding, others with latch issues. We spoke about reflux, about sleeplessness, about siblings struggling at home, about seeing and not seeing grandparents. If I had been able to measure my oxytocin levels that first morning they would have been high, to match a rising sense of communal hope. It reminded me of four other women and their babies, now the most kindred of friends, I had had met at the Camperdown health clinic as part of a parents group when Finn was eight weeks old. That I’d felt a similarly intimate sense of belonging, of wellbeing, of care.

If the pandemic and its lockdown have been a reminder that care is labour, meetings like this confirm that the labour of care is always collective.

Writing now, it’s November and spring in the southern hemisphere. I’m still homesick, and we still can’t get back home. I can almost smell the jasmine around the streets of Sydney. I find myself playing ‘Australia Street’ by Sticky Fingers on repeat:

It was a real sunny day, we were chilling in the land
Of the Camperdown Park, nobody had a frown
Reminiscing on the days when we used to have a blaze
Everybody came around and we laxed out on the laze
And I remember when we’d drink
And we’d smoke, and we’d spar, and we’d laugh
And the night would just go on and on
For the rest of my life, that memory will stay
Man, fuck, that was a good time

I’ve been thinking about our former lives in Camperdown: the student houses and tiny flats we occupied in the area; the pubs and the beer-gardens in which we’d drink into the small hours; the streets and cafes where my now-husband and I first met; the hospital where Finn was born; the parks where that first mothers’ group would meet and where Finn first walked. But the song’s hook also gets me: ‘I don’t feel afraid from you.’ This line, with its awkward grammar, speaks straight to our moment by reminding us what has been beautiful and life-sustaining but which is now potentially a lethal threat and so a cause for fear: our collective and communal being, our lives with others.

Here in the northern hemisphere, UK cases are increasing exponentially again. The Government’s Scientific Advisory Group for Emergencies (SAGE) has been warning for weeks that the number of deaths in a second wave might exceed those seen in the first, and last week England entered a second national lockdown. Apart from key or essential workers, everyone must stay home; all but essential shops are closed; households must not mix. The groups on which I have come to depend will no longer be able to seek reassurance in physical proximity to one another. Other forms of sociality doggedly persist: Finn has gone back to school and Mark and I have been teaching university students in classrooms for several weeks – unlike the first lockdown, university staff are now counted as essential to the economy and on-campus teaching is being pursued despite multiple outbreaks across numerous campuses. Not a single one of my ten class groups has remained unaffected by actual infection or by the requirements for self-isolation. The state-sanctioned phone app designed for track and trace has sent me multiple exposure notices, usually within an hour of a student writing to confirm their own positive test. The year feels like it is repeating itself, only now we are heading into winter, not spring: with approximately 35,000 new community cases per day, hospital wards filling up, a public health system still in tatters, a broken test and trace program, incoherent government messaging.

And yet, I feel more resilient than in the first half of the year — I think, in part, because I feel more cared for, with and by the communities I have found. A London-based group, The Care Collective, write that ‘only by proliferating our circles of care — in the first instance by expanding our notion of kinship — that we can achieve the psychic infrastructures necessary for building a caring society that has universal care as its foundation.’ While economic force and government policy have eroded all but few of these circles, replacing our care and our kinship with transactional partnerships, this is the only way we get through this crisis: together.