Book Review: A Womb in the Shape of a Heart by Joanne Gallant

Like many women, Joanne Gallant expected to get pregnant easily and never questioned her own fertility. Happily married and in her late twenties, Gallant and her husband Joey eagerly planned for the family they wanted. A paediatric nurse, Gallant knew more than many about health and well-being but was blindsided when her first pregnancy ended in a miscarriage. It was then that she was diagnosed with a congenital defect, a bicornuate uterus, also known as a heart-shaped uterus. Instead of the normal, more pear-like shape, a bicornuate uterus has two distinct horns. It can lead to miscarriages, pre-term labour, premature births, breech babies (meaning a c-sectin will be necessary), and some studies suggest babies born to mothers with a bicornuate uterus are 4 times more likely to be born with congenital defects of their own. Approximately 4 in 1,000 women have a bicornuate uterus and many will receive this diagnosis at the same moment that they are learning their pregnancy has failed.

In heartbreakingly honest detail, Gallant shares her journey into motherhood. She experiences multiple miscarriages, one after the other. When she becomes pregnant with her son Teddy, the pregnancy is still full of difficulty. While in utero, Teddy is diagnosed with hydronephrosis and seen to have some markers of serious disability. Gallant’s water breaks at 30 weeks pregnant and Teddy is born, via c-section, prematurely. He spends weeks in the Neonatal ICU (NICU), struggling for life.

After I heard about this book on a CBC Books list, I looked around for reviews. I came across one (written by a man) that questioned who this memoir was for. What was Gallant’s purpose in writing about her experience? Was it simply to continue to break down the silence and shame that still surrounds the topic of miscarriage? I thought of this review as I read A Womb in the Shape of a Heart and when I thought of that question, Who is this book for? my answer came back crystal clear: Me! Me! Me! This book is for me!

My first pregnancy ended in a miscarriage at 7 weeks. When I went in for an ultrasound to confirm the loss, the doctor (not my doctor, thankfully) asked me if I was sure I had been pregnant and then casually mentioned that I looked like I might have a bicornuate uterus. There had been no previous indications of this defect I’d carried within me from birth but the shape of my uterus would shape the next years of my life as we navigated having children. This is the first book I’ve read that details an experience like mine. Gallant so perfectly captures the gut-wrenching knowledge that your body has betrayed you, that it has been hiding this secret from you for nearly 30 years. Yes, this is the privilege of the able-bodied, to assume that getting pregnant will be as simple as deciding to get pregnant, but it can be no less heart-breaking.

Gallant’s stories of countless blood tests, the indignity of transvaginal ultrasounds, the fumbling responses of those around you, the frustration and anger that has no outlet, all these were so familiar. Our family had our own experience with prenatal diagnoses and the NICU though nothing as extended as Gallant’s. Mostly it is the emotions that Gallant captures that were so familiar to me. I’ve been sitting on this review for a few weeks because I wanted to write a less personal, emotional review but I don’t think I can.

I want to keep using the word heartbreaking because it seems the most apt. After Teddy is born and is a healthy and growing toddler, Gallant and her husband want to try for another child. At the same time, they have a greater understanding of how lucky they are to have even the child they do. There is the guilt that they aren’t “satisfied” with their one healthy son. There is the heightened joy Gallant feels over every milestone that Teddy successfully reaches, coupled with the constant remembrance of the children that did not arrive. There is the worst fear that she holds deeply and quietly – that somehow God or fate has deemed her unworthy of motherhood. And Gallant describes the physical aspects of a miscarriage in a way that I’ve never read before. Postnatal hair loss is well-documented but did you know it happens after a miscarriage too? Or that low iron levels can lead to a mouthful of painful ulcers?

These babies are figments of my imagination, dates on a calendar that go unnoticed by anyone except me. They are stories I tell and scars I wear. They are me. An invisible, unbearable, significant part of me.

Joanne Gallant, A Womb in the Shape of a Heart (page 206)

In recent years I have been encouraged to see miscarriage spoken of more openly. From celebrities sharing stories of their own pregnancy losses to average women feeling braver and safer to share with those close to them, I am hopeful that we as a society are slowly moving away from the stigma of silence that too often exists around miscarriage. I am endlessly appreciative of women like Gallant who willingly bear their most personal griefs and stories. Gallant’s story may be 4 in 1000 but I think her experience will speak to any woman who has had a miscarriage. And that story belongs to 1 in 4 women.

(I feel compelled to add a little extra note: When I was first diagnosed with a bicornuate uterus, I couldn’t keep away from google. I desperately wanted to find stories of other women like me. I desperately wanted to read “success” stories. When your first pregnancy ends in miscarriage it steals some of the joy and hope from every subsequent pregnancy and it is very hard to get that back. If you have somehow stumbled across this review as a result of similar googling, I want to tell you that, yes, there are a lot of success stories and I am fortunate enough to be one of them. If you happen to want to talk to a real person who has been through this, please feel free to e-mail me at karissareadsbooks[at]gmail[dot]com.)