The Memoir Land Author Questionnaire #28: Rachel Somerstein

"Can I propose a new genre? The reported-historical memoir."

Sari Botton

Aug 09, 2024

Here’s the twenty-eighth installment, featuring Rachel Somerstein, author of Invisible Labor: The Untold Story of the Caesarean Section. -Sari Botton

Rachel Sommerstein. Photo by Joe Lingeman.

Rachel Somerstein is the author of INVISIBLE LABOR: THE UNTOLD STORY OF THE CESAREAN SECTION, out from Ecco in June. Her essays and reporting have appeared in the Boston Globe, the Guardian, Longreads, the Rumpus, and the Washington Post, among other publications, and she’s been featured on Fresh Air. Rachel is an associate professor of journalism at SUNY New Paltz. She’s been teaching writing to undergraduate and graduate students since 2007. You can learn more about her and sign up for her newsletter/soon to be Substack at rachelsomerstein.com or find her on Instagram (@rachelesomerstein) or Twitter (@rachesomerstein).

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How old are you, and for how long have you been writing?

42, and since I was in grade school.

What’s the title of your latest book, and when was it published?

Invisible Labor: The Untold Story of the Cesarean Section, which came out in June.

What number book is this for you?

One!

How do you categorize your book—as a memoir, memoir-in-essays, essay collection, creative nonfiction, graphic memoir, autofiction—and why?

Can I propose a new genre? The reported-historical memoir.

The book traces my experience from my first birth—a traumatic, unplanned c-section—to the birth of my son four years later. My experience provides the narrative thread that pulls you along. And, the book integrates reporting, interviews, and medical, social, and cultural history to widen the frame: to understand how what happened to me could have happened.

What is the “elevator pitch” for your book?

In 2016 I had a cesarean without adequate anesthesia at a US hospital that boasted of its expert maternity care. INVISIBLE LABOR tells the story of how clinicians could possibly have made such a terrible mistake; how the birth shaped my identity and the future of my family; why I felt so much shame about having had a cesarean; and how I went on to become a mother for the second time. In those ways, it’s a story of survival, and particularly what survival means to me as a Jewish woman whose grandparents survived the Holocaust.

But it’s also a story about how, in about half a century, cesareans evolved from rare (around 5 percent of births) to more than 1 in 3 in the US. How did we get here? To answer that question, I explore c-sections’ present and history. Doing so brings into view the US’s biggest social, technological, economic, and structural problems: the financialization of medicine, the medicalization of birth, structural and systemic racism. I tell this story to explain why birth looks the way that it does today in the US—how the past has shaped the present—and why, given those conditions, my birth ended up the way it did.

In 2016 I had a cesarean without adequate anesthesia at a US hospital that boasted of its expert maternity care. INVISIBLE LABOR tells the story of how clinicians could possibly have made such a terrible mistake; how the birth shaped my identity and the future of my family; why I felt so much shame about having had a cesarean; and how I went on to become a mother for the second time. In those ways, it’s a story of survival...

What’s the back story of this book including your origin story as a writer? How did you become a writer, and how did this book come to be?

I was working on an academic book about photography when I decided to write INVISIBLE LABOR. It was an epiphany kind of moment, 11 o’clock in the morning at my desk, when I realized that the c-section was the most important thing that had ever happened to me and I needed to write about it. I put the academic book in a drawer and ended work for the day—the realization felt that big.

I started by writing an essay about my birth that appeared in Longreads in 2018 (thank you, Sari, for publishing it). (Ed. note: <3) It sounds obvious now, but I didn’t realize at first that a birth story could open up larger questions about women’s credibility, pain, racism, the role of technology—big, systemic issues. Once I did, I started reporting about maternal mistreatment in the US in a way that explores those themes, and that integrates narrative, history, and research, based on other people’s birth experiences. I found that I really enjoyed writing those pieces. They were so satisfying! Then, as I read more about c-sections, I began to see that I could do something similar with my own experience: I could use the operation as a way to think about American culture, and my own place in it as a woman. I saw that there was a book there.

In terms of my origins as a writer, I started taking writing classes for high school students at Columbia University when I was a teenager. My teacher, Leslie Woodard, believed in our work, and also communicated that writing was worth doing. A number of students from those classes grew up to become writers (Diana Lind, the late David Gerrard). The atmosphere Leslie cultivated made us see writing as a worthy pursuit.

But I spent years spurning nonfiction, even though I was doing a lot of it: my first job was at ARTnews; I freelanced as a journalist while earning an MFA in creative writing (fiction). It took me awhile to figure out that I could write nonfiction that was creative, literary, and narrative-driven—that employed the craft I associated with novels and short fiction.

Another important component to the book’s origin story is that I had to come to terms with how profoundly the birth had affected me. Only once I recognized the birth’s impacts on my identity—that I had developed PTSD—could I begin to write about it.

What were the hardest aspects of writing this book and getting it published?

Some of the research was emotionally difficult, like about the ways that cesareans were used to control women’s fertility. I’m sensitive about that because of the ways that my birth shaped the number of children I have, as I write about in the book. I also struggled with the chapter about pain, and at one point asked my editors if I could just leave it out (No, they said, which was the right answer). That made for some difficult writing—not only on the level of, How do I put this material together? But also, How do I see my way through this when doing so means thinking through ideas that are really activating, emotionally? There were times when I wondered why I had chosen to write about such a difficult part of my life. Why, I asked myself, had I chosen to walk right up to the electric fence and basically put my hands on it? But of course the answer to that is that I wanted to write about something with real stakes, emotionally—which would translate into real stakes for the reader.

It was also difficult to finish writing the book while parenting two young children and holding down my job as an associate professor. I was on sabbatical for a year when I wrote the bulk of the manuscript, which of course was challenging because writing is a job, but coming back to teaching and my other responsibilities as a professor while also revising the manuscript was very difficult. I’m glad that I did—I made the manuscript better on that second revision—and I’m also glad that I never have to do that particular combination of things again (teach, write my first book, change diapers).

As for publishing, I’m fortunate that my editor saw the book’s potential and had the vision to understand what it could be before I even did. And then, when she left that house, and we moved to a new imprint, I was lucky again: my new editors believed in the book and helped me to make connections I was struggling with.

How did you handle writing about real people in your life? Did you use real or changed names and identifying details? Did you run passages or the whole book by people who appear in the narrative? Did you make changes they requested?

I left out identifying details about the hospital where I had my baby, and changed or withheld names to conceal the identities of the providers who took care of me. The legal read encouraged me to do this even more thoroughly, and I did. This book isn’t meant to initiate a lawsuit, and it’s not an axe to grind.

My fact-checker talked with my mother and my husband about passages where they appear. In a few cases, those conversations brought out information that I hadn’t known. They’d concealed details from me so as not to upset me, which the fact-checker shared (with their consent). I incorporated those changes in the manuscript, also with their consent.

What’s interesting about those changes is that they’re a reminder about how we conceal things from one another all the time, to protect each other. And, it took a third party—someone not me—to bring those stories into the light.

I also use initials to refer to my children, since they can’t really consent to having their (Google-able) names associated with the book.

It’s also a story about how, in about half a century, cesareans evolved from rare (around 5 percent of births) to more than 1 in 3 in the US. How did we get here? To answer that question, I explore c-sections’ present and history. Doing so brings into view the US’s biggest social, technological, economic, and structural problems: the financialization of medicine, the medicalization of birth, structural and systemic racism. I tell this story to explain why birth looks the way that it does today in the US—how the past has shaped the present—and why, given those conditions, my birth ended up the way it did.

Who is another writer you took inspiration from in producing this book? Was it a specific book, or their whole body of work? (Can be more than one writer or book.)

I was inspired by books that blend the personal, the historical, the reported, and the scientific, like Sarah DiGregorio’s book Early, Meghan O’Rourke’s Invisible Kingdom, and Linda Villarosa’s Under the Skin. Rachel Louise Snyder’s book Invisible Bruises was also a lodestar. It moved my heart and my mind and showed how little I knew about domestic violence, which is so common but also, too often, stigmatized and just beyond public view. I wanted to do something similar about surgical birth.

I was also thinking about books about motherhood—or where mothers are the main characters—in books like Diane Evans’s Ordinary People, Deborah Levy and Rachel Cusk’s work, Charlotte Gordon’s Romantic Outlaws, Heidi Julavits’s The Folded Clock. I thought about where I might fit into that.

What advice would you give to aspiring writers looking to publish a book like yours, who are maybe afraid, or intimidated by the process?

Just start writing. And then when you are ready, I’d try to publish an essay or reported piece of creative nonfiction on the topic. That will give you a lot of information: not only whether what you have to say is publishable, but if you want to say it, have more to say than that single piece, and if you want to devote a book to doing so.

I’ll also say that it’s okay that publishing a book can take a long time. When I was younger, I was in such a rush to write my first book. I remember being in my 30s and despairing with some writer friends about lists like 5 Novelists Under 35, and knowing I wouldn’t be on them. And, I’m so proud of INVISIBLE LABOR. I couldn’t have written a book like it when I was younger. I hadn’t read enough. I didn’t have a solid enough idea of what I wanted to do, or even what was possible.

What do you love about writing?

Figuring out what I’m trying to say. Making connections across the text that wouldn’t have been obvious to me until I started to write. This usually comes in revision, which I love.

What frustrates you about writing?

Sometimes I get really stuck and can’t figure out what I’m trying to articulate. I’m a muscle-my-way-through-it person, but that doesn’t work when you’re stuck; you have to get up and do something else. I find that part—recognizing when I need to take a break—really difficult. Sometimes I also intensely dislike writing the first draft.

What about writing surprises you?

That sometimes the understanding of what you are trying to say, and how you’re trying to say it, is totally clear. That happens to me when I’m out walking, not at my desk. But that when you start writing, that slips away. What felt so solid and firm was actually completely ephemeral. But then, by the same token, that insight can also reappear, and give you another chance to grab it.

Does your writing practice involve any kind of routine, or writing at specific times?

I try to write early in the morning when my kids are just waking up, or before, or generally before too much of the day has gotten away from me. When I’m rolling I will write whenever and for as long as I can. But I can’t write a first draft at night. I’m too spent.

My writing/revision practice seems quintessentially elder millennial, in terms of my inefficient use of technology: I write longhand, type, print, then edit longhand and type up the changes. I can’t edit on the computer, not effectively, and I can’t quite compose on the computer either.

It’s okay that publishing a book can take a long time. When I was younger, I was in such a rush to write my first book. I remember being in my 30s and despairing with some writer friends about lists like 5 Novelists Under 35, and knowing I wouldn’t be on them. And, I’m so proud of INVISIBLE LABOR. I couldn’t have written a book like it when I was younger. I hadn’t read enough. I didn’t have a solid enough idea of what I wanted to do, or even what was possible.

Do you engage in any other creative pursuits, professionally or for fun? Are there non-writing activities you consider to be “writing” or supportive of your process?

I read a lot, and widely—memoir, fiction, history, creative nonfiction, magazines, news, academic stuff. “Old” writing and contemporary work too. I talk a lot with my very smart friends.

I also have to move, and especially, to walk in the woods. Sometimes it will be hard for me to motivate myself to leave the computer—like, Do I really have time for this? Invariably those are the times I come back with fresh insights on the material. I find that the older I get, the more I need to move. I also go through periods where I do a lot of yoga and reach some insight at the end of class, in savasana.

Parenting is also both supportive of my process and an obstruction to it. Supportive because my kids keep me in the world, and out of my head, to a degree that grants me necessary distance from what I’m working on. My kids also have this view of the world that’s unadulterated by the BS of adulthood and time confetti, that slows me down and opens my eyes. (“Mama, do you hear the birds singing?” my son asked me the other day; I realized I was in such a rush to get everyone to school/camp that I had totally filtered out birdsong.)

But of course, parenting young children and writing can also be impossible. There are only so many hours in a day. Sometimes when my kids are hopping around me and I’m trying to work, I think about how Jane Austen supposedly wrote in the drawing room, and how she must have had to ignore constant interruption. If she can write Pride & Prejudice, I can finish a paragraph.

What’s next for you? Do you have another book planned, or in the works?

I have two projects in the works that I hope will come to fruition. One is a children’s book. The other is a nonfiction investigation/memoir. I’m cooking up a Substack that will feed the latter.