Author Danielle Valentine joins us to discuss her book “Delicate Condition,” a pregnancy horror book that depicts the darker sides to fertility, pregnancy and healthcare. Mayo Clinic expert Dr. Ali Ainsworth joins to help us understand more about the logistical and emotional challenges of fertility journeys and assisted reproductive technology.
Author Danielle Valentine joins us to discuss her book “Delicate Condition,” a pregnancy horror book that depicts the darker sides to fertility, pregnancy and healthcare. Mayo Clinic expert Dr. Ali Ainsworth joins to help us understand more about the logistical and emotional challenges of fertility journeys and assisted reproductive technology.
This episode was made possible by the generous support of Ken Stevens.
TW: Miscarriage, pregnancy loss, infertility
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Dr. Denise Millstine:Welcome to the “Read. Talk. Grow.” podcast, where we explore women's health topics through books. In the same way that books can transport us to a different time, place or culture, “Read. Talk. Grow.” demonstrates how they can also give a new appreciation for health experiences. Books can provide understanding of health topics and provide a platform from which women's health can be discussed.
At “Read. Talk. Grow.,” we’re using books to learn, in the hopes that we can all lead happier, healthier lives. I'm your host, Dr. Denise Millstine. I'm an assistant professor of medicine at Mayo Clinic, where I practice women's health, internal medicine and integrative medicine. I am always reading, and I love discussing books with my patients, my friends, my professional colleagues, and now with you.
Our book today is “Delicate Condition” by Danielle Valentine. Our topic today is infertility and pregnancy complications with a bit of a twist. I'm so excited about our guests. Danielle Valentine is the New York Times bestselling author of books for adults and teens, including the Barnes & Noble YA Book Club Pick “Two Sides to Every Murder” and “Delicate Condition,” which was adapted by Ryan Murphy into “American Horror Story: Delicate,” starring Emma Roberts and Kim Kardashian. Danielle is also the author of “The Merciless” series under the name Danielle Vega. She lives outside New York City with her husband, daughter and two ornery cats. Danielle, welcome to the show.
Danielle Valentine: Thank you so much for having me. This is quite an honor.
Dr. Denise Millstine: Our expert guest is Dr. Alessandra Ainsworth. She's an assistant professor in Obstetrics and Gynecology, specializing in Reproductive Endocrinology and Infertility. She completed medical school at the University of Kansas and both residency in obstetrics and gynecology and fellowship in reproductive endocrinology and infertility at Mayo Clinic. During her fellowship, Dr. Ainsworth obtained a master’s degree in biomedical science. Her clinical interests include infertility, fertility preservation, premature ovarian insufficiency, recurrent pregnancy loss, assisted reproductive technology and in-vitro fertilization.
Dr. Denise Millstine: Ali, welcome to the show.
Dr. Ali Ainsworth: Thank you for having me. Happy to be here.
Dr. Denise Millstine: Well, this is a new one for “Read. Talk. Grow.” “Delicate Condition” is a brand-new genre for me, sometimes called pregnancy horror. Anna Alcott is a newly famous actress who's been receiving fertility treatment along with her husband, Dax. We meet her as she's in the middle of a cycle of IVF, in-vitro fertilization, and becomes pregnant. When she's diagnosed with having a miscarriage, she continues to feel and have her body respond as though she's still pregnant, but something is still off.
All right, Danielle, talk about this genre. What is this and who is the reader you picture reading this book?
Danielle Valentine: So it's so interesting that this has now become a genre. When I was first writing this book. It really just came from a place of, I'm a horror novelist. I've been writing scary books for teens for over a decade. That's what I do when I need to kind of process something difficult, is I turn it into a horror story.
And the idea for this book came out of my own pregnancy journey. I was starting to talk with my husband about wanting to have children. We attempted to get pregnant. It took longer than we expected. And then when we got pregnant, I suffered a miscarriage which was devastating and hard and weird. And I just couldn't go back to writing scary books set at prom, right after that. I needed to write about what I was going through and what I was experiencing, and I got my start writing these fairly gruesome body horror novels and I honestly can't think of anything that fits more within the body horror genre than pregnancy.
Shortly after my miscarriage, I got pregnant with my daughter and even that experience was so gruesome, so weird, so surreal. And the entire time I was pregnant, I just kept turning it into a horror story in my mind. So this is kind of a long, drawn out way of saying that the audience for this book was me. I wrote the book that I wish I had while I was pregnant. So many of the books that we give to women who are pregnant are happy showing this really rosy sunshiny view of pregnancy. And that's not the reader I was. I needed something that felt like I felt on the inside, and I felt pretty weird. So I wrote a really weird book. And I think there are other women out there who need a weird book while they're going through this, and I hope they find it. I hope they enjoy it. So that's really where this book came from.
Dr. Denise Millstine: That is so insightful, and I hope they find it as well, because people need different forms of telling story, especially as they're processing. But to hear you talk about framing it as part of your own healing for your journey and your loss, and I'm sorry for your loss with your miscarriage.
Ali, I'm sure this is new for you too. Tell us your reaction to the book and also tell our listeners what it's like to work in a fertility practice.
Dr. Ali Ainsworth: Yeah, I think, Denise, I had a similar reaction to you, which was I have never heard of this before. Me as a person, I don't read, I don't watch any scary anything. I did, Danielle, read your book, and I sat in a corner so that blue ball cap with the glasses was not looking over my shoulder.
Danielle Valentine: That’s fair.
Dr. Ali Ainsworth: It does add a whole new layer to know that this came from your personal experiences. The question of what it's like to care for women. I often tell people when I first meet them in the infertility clinic, I'm happy to see you, and I'm really sorry that you're here. Right, there are some parts of life that we're happy to engage in, and another thing I tell them is often what started as a fun endeavor isn't fun by the time you're here, right? And that could be getting pregnant the first time. That could be getting pregnant after a pregnancy loss and infant loss. Right? There's so many life experiences that come with our patients into the door. So it is hard in many, many ways to go through this, to go through infertility treatments, to go through pregnancy. So to hear that this, Danielle, is how you process, is new. Right, we hear new things all the time from our patients. You're not my patient, obviously, but a new a new spin on how to process these. So yeah, happy to talk more.
Dr. Denise Millstine: Well, I think you're right, Danielle, that we see, not just in books and movies, but we see pregnancy portrayed in this highly romanticized, glorious, beautiful, loving time. And it is a miracle and it is wonderful. It does have its moments. But if that's the only side of it that's being told, there's a lot missing. And I think it has women wondering if they're the only ones for whom their pregnancy wasn't perfect.
I love your dedication for the book. It's for everyone who's experienced pregnancy, child loss, infertility, or labor and for the people who believed them when they said it hurt. It's just so powerful and beautiful and meaningful dedication for a horror novel, Danielle.
Danielle Valentine: Well, you know, I often tell people. So I've been in this genre for God, you know, since I started writing in my early 20s, I've been writing horror. And you meet a lot of people who say exactly what Ali said, that “I don't read horror. It's not my genre. I am too scared.” And I like to tell them it's an acquired taste. It's like I don't eat spicy food or I don't drink coffee. You would like it if you learned how to, how to read it and how to process it. It's challenging and it's not intended to make you feel comfortable, but I truly believe that there is an access point for everyone for horror. I say this very confidently because my husband hated horror and when we first got together, would not read any or watch anything that was scary. And I have slowly taken him to the dark side and now he will admit that there is something there that he enjoys. So I got started reading and watching and listening to it in an early age. So I kind of got grandfathered in, I guess. But I think it's important. I think it's an important way for people to process pain, especially for people who maybe aren't processing it the way that's more socially accepted, just crying and being sad. It can be easier to access that grief through horror, I think.
Dr. Denise Millstine: I just think there's so much wisdom in this, and I'm so grateful we're having this conversation, because when you read horror, you are promised something. You are promised that you will be uncomfortable and that it is not real and so that does allow, in many ways, the writer to get to darker aspects of the story, where if it was contemporary fiction, for example, you might be called out for being too graphic or too much, and in horror there almost is not too much.
Let's talk about Anna. So we know there are going to be these uncomfortable scenes in the book. But we start with Anna nearly missing her egg retrieval procedure. As a reader, I literally felt anxious from the get-go, and I was wondering, Danielle, if that was intentional, to kind of introduce the reader early on to say you're going to be uncomfortable in this read. So try the first few pages, and if this isn't for you, the rest of the book maybe isn't going to be for you.
Danielle Valentine: Yeah, that was definitely intentional. When you're writing horror, you really want to establish the tone of the novel as early as possible, and usually that's before anything really scary has happened. So any small thing I can do to set it up, to make it clear that, like, this is going to be something that is going to challenge you a little. This is going to be something that makes you uncomfortable. I'm working on doing in the early chapters.
Beyond that, though, I really wanted to make a comment about the hoops that women are required to jump through to get pregnant to perform this miracle. You mentioned earlier that it was a miracle, but it's a miracle that women make happen that women are actively working toward and it's a messy miracle and it's not easy. And I wanted to set up from the first page that it is not easy. It is not something that just happens beautifully for every woman. There are a lot of women, there are a lot of people in this world who have to work very, very hard for the possibility that this might happen, and I really wanted to make that clear from the first page.
Dr. Denise Millstine: Yeah, I think that's such a great point. And maybe, Ali, you can tell our listeners even what the egg retrieval is, which is what Anna, the main character, is preparing for at the beginning, and how that's not something you just put on your calendar and show up for. There's a lot of preparation that happens before that.
Dr. Ali Ainsworth: Yeah. So the egg retrieval is one of the major endpoints of an IVF stimulation cycle. So Danielle, to your point of, in burden of care, an IVF cycle is on average 10 to 12 days of injections, two injections initially then three. But during that time monitoring by blood work and ultrasound is extraordinarily disruptive to life outside of the IVF clinic, especially for patients who live a few hours from their fertility clinic or a center that has access to this type of monitoring, it becomes a full day event. So at the end of those 10 to 12 days, is the egg retrieval done under anesthesia, we call it conscious sedation. So I describe it to patients that they are asleep but breathing on their own. And as you mentioned, Denise, really precisely timed to the degree of take your last injection at 9 p.m. on this night and 36 hours later at 9 a.m., is your egg retrieval. So there is, you know, maybe an hour window, but it really is critical because outside of that hour, we risk premature ovulation, those eggs being released into the body before we can actually retrieve them in the egg retrieval process. And without that, all of that time and effort and money is lost. So it is very precise and extraordinarily burdensome for the patients who go through this.
Dr. Denise Millstine: And in that first scene of the novel, Anna has her day planned to the minute she's getting ready, she's got a friend to take her to the clinic, and she gets this panicked phone call from her husband to say she is late. She was supposed to be there an hour ago. And it's devastating because like you said, she's had injections, she's had appointments, she's been looking for this as a key point to keep moving the process forward.
Danielle, not every woman having fertility treatment is a movie star, but many women who have IVF are living very busy lives. And you put Anna into that rhythm of needing to choose between appearing on things that were important for her professionally and going to work functions versus being available for some of these processes. Can you talk about that messiness of the process?
Danielle Valentine: Yes, I would love to. So when you're working on a novel, you often try and come up with the character who is the worst person to put in this situation. So you're trying to come up with, okay, like, who is the person who is going to be challenged the most by the situation that I'm creating? And I couldn't think of anyone who would have a harder time than someone who is like, quite literally in a spotlight, who is being watched all of the time, who is famous.
When I was going through my miscarriage, I remember there was a (Hollywood star), who was similarly going through pregnancy loss. And she had to, like, post about it on her social media and basically make it clear to fans who had been following her journey what had happened, because it was public. And I remember thinking at the time, that I couldn't conceive of anything more painful than having to publicly talk about something so difficult at such a vulnerable, raw point of my life. So that's really where the Hollywood star actress part of it came from … is this idea that you have to live through the most painful thing you've ever been through, and you have to do it publicly with an audience.
Beyond that, one of the things that I experienced, I was getting pregnant and having my first kid in my late 30s in New York City, and all of the rooms that I walked into, whether it was prenatal classes or new parenting groups or whatever it was, I would hear the same, the same fears being spoken of again and again by the women around me. And it was, I don't know how to stay myself, how to stay true to all of these goals I had before I had a child, and also be the mother that I want to be. It was this constant tension between those two things. And I definitely felt that when I was having a child. And so I really wanted that piece to be part of that as well, which is another reason I thought, actress (as the protagonist) is really good because you have this tension, you have this struggle of, I spent my whole life building this career, it's important to me, but I also want to be a mother. And we tell women that they don't have to choose now, and to an extent that's true, but once you are faced with the everyday challenges of trying to be there for your child and trying to be there for your work, that is something that didn't just go away. And so I really wanted to talk about that as well and to bring that into the novel. It's a complicated issue, but I very much wanted that to be present in the pages. That's what went into creating Anna's character, those two very real tensions that I felt.
Dr. Denise Millstine: There's just so much in this novel. There are so many components of women's health and what women navigate. You mentioned almost even as an aside, in one scene, there's this division between women who have children and women who don't have children as a very defining factor. I don't know if either of you want to comment on that. I'm sure you both have thoughts.
Dr. Ali Ainsworth: I’m still thinking about everything you said before and how maybe Denise, we come back to this? You know, this person in the spotlight is not only going through their own process that often carries with it unreasonable, inappropriate shame. Meaning not that that person had an inappropriate response, but the way society makes women feel to have shame and isolation and that, “This is not common, we don't talk about this,” right is like still where my brain is from before. So I'll let you take a first pass. Danielle, at Denise’s question.
Danielle Valentine: Well, I think that just before we even get to that, I think that that's such a smart insight to bring up because, yeah, there is this feeling of shame or of having done something wrong.
I remember when I went through my experience, this woman, one of the nurses, said something to me and I don't think she meant it to be shaming. I don't think that was intentional at all, but it stuck with me. I had a wedding that was coming up right before I had my miscarriage. And I remember just asking, just like, “Ookay, am I going to be okay to travel? And I have this wedding.” And she made a comment where she was like, we don't want more people to know about this than have to, essentially, we don't want you to have to pull out of this wedding and tell people why. And it was just an aside, like a small comment, but I just remember being like, I told you that this was one of my best friend's weddings. Why would I feel shame about telling her that I was going through something so medically traumatic? It was almost as though I just was struggling with like, “Wait, am I supposed to feel more ashamed about this than I do?” Because it was so strange to me that she would say that, and it's just these small, small things that people saying again, I don't think they mean anything by them. I don't think that they're intending to make you feel bad, but when they layer and they add up and it ends with women feeling like they shouldn't be talking about these things, or that they should feel bad about what had happened, for reasons other than just their grief that they lost something they were so excited for. And that was definitely present when I was writing the book. Yeah, it was definitely something I thought about a lot.
Dr. Ali Ainsworth: And that it compounds what almost all of my patients are already feeling themselves. So when I see someone with a recent pregnancy loss, in every single visit I say, “If you have not heard this before, I want you to hear my voice in the future that you did nothing to cause this. There's also nothing you could have done to change this,” which is both freeing and heartbreaking in the same moment. And then to say, “Are there things that you're holding on to? Is it that you did exercise or you didn't exercise, that you slept on your back or you didn't? Let's clear the air.” You know, like easy to say, hard to take to heart. But those little comments, Danielle, add to what we as mothers, to future mothers, what women are already doing to ourselves. And then to hear that from people in healthcare, in positions of power, whatever that may be, is kind of an added layer to all of that.
Danielle Valentine: That is incredibly true.
Dr. Denise Millstine: Well, and I think this is an overall comment on the culture of healthcare directed at women, that we do have a tendency systematically to blame people for what happens to them. Or as women, we've been raised to think, what did I do wrong to cause this to happen? So, Ali, that's such a beautiful way to approach, particularly miscarriage.
And, Danielle, for your experience with your miscarriage and this healthcare professional, this is part of the reason we created “Read. Talk. Grow.” was that was around miscarriage and how nobody talks about it. It's really unclear what you're supposed to do. You're just supposed to kind of silently go through it, pretend nothing's happening and go back to work.
Ali, what did you think? This is getting really far in the book, and we're going to come back, I promise. But what did you think about the scene where, for our listeners, Anna, the character has what she believes and is told is a miscarriage. I thought it was a really excellent depiction of one way that can happen.
Dr. Ali Ainsworth: Some of the healthcare providers that are providing the counseling on what we might expect for miscarriage have never had a miscarriage, which doesn't mean they can't provide that care. But to say, in some scenarios you're going to have, “It's going to be like a heavy period.” It might be. It also might horrifically not be for you. And to have any kind of guidance on, I am already like outside of my body in a way. So like my perception of what is happening is different because I am grieving. When am I safe? When am I not safe? Like, what is normal and not normal? Is it pretty wide spectrum related to miscarriage? So to not be able to say those words in a patient language that is meaningful to them, I think is part of the, “service” may be too strong of a word, but may be area that we as the medical community could do better in terms of miscarriage, both about physical symptoms and emotional. These are normal things that people go through. It's not just you. And also how can we keep you safe in multiple ways through this process.
Danielle Valentine: That's so important. And it's so it's so helpful to hear that it's something that even medical providers struggle with. When I went through it, really one of the biggest reasons I wanted to write this book is because I went through this miscarriage, it was very difficult, and I remember thinking afterward that every single depiction I saw of miscarriage on television, in fiction, in movies, anywhere, was just, it wasn't my experience and was also the same. It was always this like a woman would fall or she would scream. And then in the next scene they're like, oh, she lost the baby. And it was that quick. And that was what really bothered me. It was just the fact that it was so fast and that they immediately seemed to know what was happening.
In my experience, it took about 48 hours before we even had any, before anybody even said the word miscarriage to me. And everybody was just basically like, calm down. That was the message I was getting over and over and over again. “It's fine. It's just a little bleeding, calm down.” And even though I knew that it wasn't right and I could feel that something was wrong, I was really not. And I understand why people do that. I understand that it was, you know, intended to keep me from getting upset when we didn't know what was going on yet. It kind of had the opposite effect on somebody who likes to have all of the information and likes to just be told really upfront what the possibilities are. And so I felt like I was not being treated like an adult, but even the actual scene where she's at the hospital and she has the miscarriage, that was very much taken from real life. It was important to me to have what I felt was a more accurate depiction of that in fiction.
And of course, when I was writing it in my wildest dreams, I'm like, I would love to see this someday on a screen depicted a little bit more, just a little bit messier, just a little bit more like, this is kind of what it feels like. And so it is very surreal to know I can now go watch Emma Roberts recreate my exact experience on “American Horror Story.” So now we do have, what I feel is a little bit, at least, more accurate to my experience. As you both mentioned, that every woman's experience is very different. But now we at least have another one that we can look to, I hope.
Dr. Denise Millstine: We can transition from talking about miscarriage. I just want to mention that in a prior episode, we talked to Jackie Polzin, who wrote a book “Brood,”about a year in the character's life after she'd had her miscarriage and the grieving process. And to your point, these lossesare to be grieved, and they are not these “one moment to get over it,” which is, I think, the story that we're sold. Women need space, people need space to process when pregnancy loss happens or when complications happen.
Let's talk about the fertility process. This is a large part of the early part of the novel. So she's missing appointments and is forgetting to put medications in the refrigerator, which are critical that they be refrigerated. She's missing calls from her doctors, which is out of character for her. This is somewhat common that we'll say, ‘Oh, it's pregnancy brain,” or “Uou must be forgetful now because of your hormones.” But in fact, this is gaslighting. But can we talk a little bit about that tension with how we treat women when they're going through treatment or when they're pregnant in regard to that?
Danielle Valentine: Yeah. I mean, this theme throughout the novel was really inspired by medical gaslighting and this experience that many women have, and many women often have for the first time during their pregnancies, of not feeling like people are taking their concerns about their own body seriously, of not listening to them when they're saying, this is painful, this hurts.
I was very lucky that I was surrounded, for the most part by a very responsible, intelligent, kind medical providers. But every now and then there would be somebody who just kind of discounts the things that you're saying about one the things that I was saying about what was concerning, what I didn't understand, what I needed explained more. The miscarriage was obviously like a big moment. I felt like I had told many people something's wrong and was told, “It's okay, it'll be fine, it'll go away, if the bleeding is not this heavy or the pain doesn't feel like this, etc.,” these kind of statements.
And then throughout my actual miscarriage and my successful pregnancy, the way that the pain is kind of minimized was something that I remember very clearly, starting with my D&C, the procedure right after I had my miscarriage was told, oh, it will just be a pinch, it won't hurt. And then the pain was so bad that I nearly passed out. And then moving on into my successful pregnancy, it is very common. You would get this kind of a statement of like, oh, “It won't hurt, it'll be a little uncomfortable,” these kind of words to describe what ended up being excruciating pain or extreme discomfort. And again, as somebody who just really appreciates people being upfront with me and having all of the facts so I can prepare myself emotionally and mentally, I felt really gaslit often about some of these things. And yeah, it just, it was stressful and so that kind of led me down this rabbit hole of learning about the history of women's health and where this comes from, why we do this, that I think medical providers are often trying to overcome, or at least the really responsible ones are often trying to overcome. And so it just was such an interesting theme, and there was so much there that I really wanted to dig into with this.
Dr. Denise Millstine: I would say some are trying to overcome it, and more often people aren't even aware of it because it's so much a part of our culture. Ali, comment about how women are believed when they go through care.
Dr. Ali Ainsworth: Yeah, I was thinking about on the provider side of all of this, there are times that a patient is experiencing something that is new to me. That doesn't mean it's not true, but it sometimes means I don't have a reason. I can't explain it to them, which can be uncomfortable right? We're kind of used to this doctor-patient relationship, that the doctor should know the answer to everything, and for both the provider to admit I don't know, and for the patient to accept that answer as an educated and honest answer. There's a bit of tension there on both sides of that relationship. So early pregnancy bleeding doesn't always end in miscarriage and to say we don't know what will happen, is both honest and not at all reassuring or satisfying to hear. And then, in regard to pain, I had a patient a few weeks ago who was describing pain after surgery. And part of our conversation. I'm probing all of the things, all of the categories that I know could be true. And there probably is one that explains it. But also, to be honest, I don't know that I have a perfect explanation for this, right? So let's try this. But that takes time and input. And you know, ongoing conversation from both parties, which isn't always true for a variety of reasons. Right?
Dr. Denise Millstine: I think patients would like to think that we always have the answer. But really often you're getting an opinion, anexperienced opinion, but very often getting an opinion.
Ali, can you talk a little bit about the fertility medications? I'm really trying hard not to spoil the book so that makes it hard to go into the middle and certainly to the end, but just the injections, the mood swings, the bloating. We see another character doing injections who has bruising of all different ages. Can you talk about the medications? Generally not specifics, but you know what women who might be going through fertility could expect. Or if somebody is thinking about somebody going through fertility, understanding what that woman's navigating.
Dr. Ali Ainsworth: Yeah. I think first to say that when we're talking about these injections, we're mostly talking about in-vitro fertilization or IVF. So there are oral medications that have their own side effects. But focus to this conversation, I often tell patients that in the first eight days of those injections, and a reminder that 10 to 12 is an average but not a requirement for the length of time, the physical symptoms are less so because the ovaries haven't grown as big as they will, so bloating often starts around eight. But you know, admittedly, everyone is different. Everybody's ovarian reserve, how many eggs they have, how many eggs will grow is different. Body habits are different, right? But later in stimulation, people describe more physical symptoms, that feeling bloated, full, just kind of blah like very much not themselves. Prior to that, it is more pain with injections, there are certain types of injections that kind of burn more when you inject them than others, these are subcutaneous injections most often, which means a small needle, often injected into the abdomen many times. Almost always, but not quite, when we see people for their egg retrieval at the end of all of this, right, there are multiple bruises across the abdomen from those two injections, maybe three injections or more a day.
I think the mood symptoms are really different across individuals. Most of my patients continue to work, which may only be credit to what they're working through. But what I mean by that, I don't at least have the sense from them that it's so disruptive that they can't do what is expected of them. Again, a loaded statement to a degree, but some people do feel extra sad, extra irritable. Some people feel pretty good actually having high estrogen levels. Female bodies as an oversimplification of that word in general, like estrogen compared to progesterone, for example. But I think a wide variety of symptoms is not uncommon, meaning each patient doesn't have the same experience throughout this. But I think the physical part becomes more noticeable and the latter half of those injections and doesn't resolve on day of egg retrieval.
It takes a week or two for the ovaries to shrink back down, which is I think sometimes surprising … they think the day of egg retrieval, “my life is going to be better, I am going to have eggs on the outside, my symptoms are going to be over,” and it's still a long road when you think about embryo development, the resolution of the ovarian follicles and shrinking back down.
Dr. Denise Millstine: It strikes me like the way you're describing it, it's so extreme what is done to the person's body when you prepare them for this egg retrieval that the body needs to recover from this incredible physiologic or super physiologic stress.
Okay, Danielle, make some comments about events happening during the course of pregnancy that aren't expected. Because we've said all women probably have some surprises in their pregnancy journey, not necessarily of the kind that Anna has to navigate, but will you just comment about that in the book and how important that was when you were writing it?
Danielle Valentine: Oh, happily, this is really what kind of inspired the book to begin with, is becoming pregnant and realizing that it was quite a bit more gruesome than I was led to believe.
So throughout my pregnancy, the symptoms that really shocked me there were the smaller ones. So the fact that I would struggle to breathe, I didn't realize that what I read — I feel very overwhelmed talking about this with doctors and sure that I am going to say something incorrect — from what I read, it's because the child is growing, so the fetus is growing so large in your body that it's crowding your internal organs, so lung capacity is less. So I had a really, really hard time breathing starting from about six months on. That was just very difficult.
My fingernails were weaker and drier and would often like split. My gums would bleed. Other parts of my body were extremely dry to the point, I just I have dry skin anyway, just to give you way too much information about my own body. So I already have dry skin, and my skin would become so dry that my hands and feet would crack and bleed, particularly as I was pregnant during the winter.
And all of these things, you look it up online, you're like, is this normal? And almost any symptom, if you look it up on Google, which you're not supposed to do, because it's actually quite horrifying, but you look it up on Google and somebody just like, oh yeah, that's totally normal. You know, the baby is basically seeping your own nutrients to grow itself, and your body doesn't care quite so much that you have enough to keep you healthy and safe. Or at least that's what Google told me again, feeling very overwhelmed talking to doctors here who can tell me immediately all of the ways in which I am incorrect.
Dr. Ali Ainsworth: But Danielle, I think to normalize as an OBGYN, when I was pregnant with my first daughter, I was also googling right? Like I knew about pre-eclampsia and all of these other things, but like the smaller details that impact our day to day lives as pregnant women, it can't be covered in a 15-minute prenatal visit, right? So it was also know to me like, is this normal? Oh no. Yes it is.
Danielle Valentine: Are my eyes supposed to feel dry? Like are my eyes supposed to hurt inside of my skull? That seems odd, but yeah. No it's not. It's very normal. And so there were lots of small things like that, that then ended up in the book and more hyperbolized ways, that just shocked me. I was just like, oh, that's just that's normal. That's what we that's what we deal with. So it was yeah, it was a journey.
Dr. Denise Millstine: It's a big job to make a new person. So it does pull from your own resources, whether that's the nutrients that used to go to give you strong nails. I think only a horror novelist would describe that as the baby seeping those nutrients from, you know, I think Ali probably describes that different.
Danielle Valentine: Little bit different, a little bit different.
Dr. Denise Millstine: All right. So I want to not spoil the book. I'll say that again. But talk about the ending, because I do think a major theme of this book is the importance of women supporting women and coming together to embrace a woman who's going through fertility. I felt quite hopeful at the end, even though a lot of things happened to Anna and her family, but we just comment about the importance of women supporting other women and having friends. Whether you're going through fertility, pregnancy, pregnancy loss, and even healthy pregnancy, birth of a child, just how important that is. I just want to hear from both of you.
Danielle Valentine: Well, I will say that after I had my daughter, you kind of find a new group of women, of people who have also had children, whether that's through just meeting people at, you know, daycare pick up, or if you actually do a mom’s group. I move to a new neighborhood, and there was a huge community of women already here who had children the same age as my daughter.
And this thing just happens where you get together frequently enough, and then you start talking about your own experiences and what happened. And I just noted that every woman has a story about their pregnancy, their birth, and how it affected them and that they hold with them even after their kid is born and is getting older. So I would just kind of collect these stories of women who had been through it. And many of the stories were far more horrifying than my own, were interesting in a different light. And that kind of led me to reading about other just historical stories about pregnancy, which is you'll see there are little sections in the book, talking about other people's experiences with the pregnancy and I thought that was really important to include, because my experience, Anna's experience is not the only experience. It's not even the, you know, the dominant experience. It's an experience. And I wanted to make it clear that lots of people have different experiences.
So yeah, like just being surrounded by those women, hearing what they've been through and like seeing the ways that we all try to come together to support women as they go through difficult things, and women and anyone who can give birth. It just made me feel really hopeful that there are these communities that exist, and they are important and they're necessary for continuing to bring children into this world. That labor is really important. We talk about birth and pregnancy a lot is a miracle. But it's just, it's really, it's labor. It's the labor of women.
It's the work of women. And that work of coming together to support women who are going through it is just so incredibly important. So again, without spoiling the book, I don't know that I can talk a little bit more about some of the more the twisty things that happen without really giving things away, but that was what really inspired me, is the idea of women coming together and the village that we form. That we that we are able to be a part of, if we're very, very lucky to find a community that that comes together to help you through it.
Dr. Denise Millstine: And that was one of the reasons I knew we had to talk about “Delicate Condition” on “Read. Talk. Grow” with how it comes together. Okay, Ali, tell us.
Dr. Ali Ainsworth: As I listen to you both talk to me, the pursuit of pregnancy, whether it ends in parenthood or not, is such a transformative experience that both changes you as a person. And I think, at least for me and for many of my patients, when you walk into this, many people have had adverse events in life, but also for many this is the first adverse event, and it is messy and there is grief and joy and hope amidst all of this. Right? But I think in that process, there emerges for many, more openness, whether that's with their healthcare provider or their friends or their family, than they started with. And you could think of this in a lot of, I have very dear friends that are not parents, and we connect through other transformative experiences, right. But specific to women's healthcare and pregnancy, I just think how much changes for you as a person, allows you maybe to be more open and more receiving and participating in these deep female friendships because of everything that you have both gone through and kind of who you have become changed, who you are changed, as a result of all of that.
Dr. Denise Millstine: How beautifully said.
Danielle, as I mentioned, there's so much to unpack in this book. I think we could have a whole women's health conference just focused on all the lessons in your book.
Congratulations on the success. It is really remarkable and a completely different shift in looking at fertility and pregnancy experience. Thank you for writing “Delicate Condition,” and thank you both for being on “Read. Talk. Grow.”
Danielle Valentine: Thank you. Thank you so much for having me. This was such a delightful conversation.
Dr. Ali Ainsworth: Yeah. Thank you. And my first horror novel is I checked off the list. So happy to be here.
Danielle Valentine: Hopefully it's open up the door for a new genre. You’ll go seeking them out now.
Dr. Denise Millstine: Maybe. “Read. Talk. Grow.” is a product of the Women's Health Center at Mayo Clinic. This episode was made possible by the generous support of Ken Stevens. Our producer is Lisa Speckhard-Pasque and our recording engineer is Rick Andresen.
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The podcast is for informational purposes only and is not designed to replace a physician's medical assessment and judgment. Information presented should not be relied on as medical advice. Please contact a health care professional for medical assistance if needed for questions pertaining to your own health. Keep reading everyone!