Alessandra Voena

Stanford University

I gave birth to my first child almost 12 years ago on a sunny Chicago late summer morning. The pregnancy had been extremely smooth, but for “morning sickness” that accompanied me up to week 18 and was supposed to signal that a strong, healthy baby was growing inside of me. I use quotes because “morning sickness” is a puzzling euphemism for vomiting at any time of day. The delivery was also a very smooth experience, thanks to the marvels of modern pain-reduction technology, and I was home a couple of days later feeling that this motherhood thing wasn’t really as hard as I had been led to believe. Classic rookie mistake.

My beautiful, voracious daughter was one week old when, while nursing, I unexpectedly hemorrhaged. The recollections of what happened next are blurred by time and the innate instinct to forget. I remember that, when the paramedics arrived, I was lying on the bathroom floor in a pool of blood that got my hair wet. Other memories are even harder to revisit: the ambulance ride with my protective husband, the uncomfortable ultrasound report (“Your uterus is full of junk”), the sudden realization that things were actually quite serious, the emergency surgery, and, finally, the reassuring physician who woke me up at Mercy Hospital saying “It all went well, but you lost another 800ml of blood in the OR and we need to keep you for a few hours to see how your body responds.” Indeed, my heart rate spiked after a short walk around the ward, requiring me to receive a blood transfusion and further delay returning to my daughter, about whom I was thinking every second. I got back to her two days after the initial bleeding, puffy from the medications, anemic, and, frankly, still in a state of shock. For weeks, I kept reliving those moments through unpleasant, intrusive thoughts, while focused on rebuilding my milk supply and learning to parent a newborn.

Even as a labor economist, I find it difficult to gauge how one should appropriately account for near-miss birth experiences. For losing a third of one’s blood supply, and many nights of sleep after that. A couple of weeks after that incident, I was back on Skype (yes, I am that old!), but how productive or creative could the work I did then have been? The love of my family and the knowledge that my daughter’s wellbeing depended on my ability to rapidly recover brought me back into action quite quickly. I learned you can love being a mom and love being an economist with equal intensity, and there are no scarcity or tradeoffs in that. Of course, there is a binding scarcity of hours in a day, and I have not learned how to resolve that struggle yet, and probably never will.

Health shocks can happen to anyone, and junior faculty are generally not well insured against their consequences. This is a serious issue in itself for the fairness and the effectiveness of our evaluation processes. Childbirth, however, happens almost exclusively to women. It is challenging for all mothers, and dangerous for many. My story is ordinary and has a happy conclusion: another beautiful (but less voracious) baby boy was born three and a half years later, and I was voted tenure shortly after that. Post-partum hemorrhage affects around 4% of all births in the U.S., often happening with no known risk factors. It is among the main causes of maternal mortality. Pre-eclampsia involves roughly another 5%, and is more common for older mothers, as many of us are once we enter the profession. Post-partum depression hits over 12% of U.S. mothers. Some of these women are our coauthors, former students, and other scholars we write tenure letters or hiring cases about. We typically never learn what they are going through. Ignoring these data is a choice we make when designing gender-neutral policies, and it puts academics who give birth at a systematic disadvantage.