How misogyny makes women ill

The sobbing young woman had barely closed the door behind her before the colorectal surgeon turned his face to me and said: “If you ever have children, for God’s sake make sure you have an elective caesarean. I wouldn’t wish that on anyone.” As a graduate medical student, I masked a secret beneath my baggy attire. “Actually, I’m five months pregnant,” I replied. “So it’s not really theoretical in my case.” His face flushed crimson and he apologised profusely, but in fact, I welcomed his candour. His patient had endured chronic pelvic pain and the shame of urinary and faecal incontinence ever since the traumatic birth of her first baby a year earlier. My own secret fears of being mutilated in childbirth were now running wild. I knew what the NHS thought of women who were “too posh to push”.

Secrecy, stigma, blame and ignorance run like toxic waste through The Stitch-Up, a fierce polemic about the medical misogyny and gender violence that disfigure healthcare. Its author, Emma Szewczak, deploys brutal honesty about her own birth traumas and their ongoing consequences to devastating effect. On the very first page, she recalls how a midwife, stitching her up after the birth of her second child, “snipped and snapped – every so often dropping the bloodied scissors into the metal bowl with a clang to get a better purchase on a stitch with her fingertips, pulling it taut like the women in films fixing corsets”. When Szewczak suffers a violent episode of vomiting, the midwife is stopped in her tracks. Something is protruding from Szewczak’s splayed legs. After an ominous pause, the midwife utters the worst words anyone has ever said to her: “Your vagina’s fallen out.”

This hideous example of the power of language to wound in medicine is the first of many. The consultant who inspects Szewczak’s prolapsed vagina neither names nor explains the problem, but comments airily: “It could be fine but it’s impossible to say. Go home. Don’t overexert yourself! See how it goes.” When the prolapse recurs just before Szewczak’s six-week post-birth check, a GP chastises her for causing her own suffering: “You overexerted yourself, didn’t you?” Unsurprisingly, an undercurrent of rage and bitterness propels this book, with Szewczak discovering she has joined generations of women who have been failed by medical patriarchy.

Her central thesis is that as a female patient you are “damned if you do, damned if you don’t” – not least because centuries of male bias in medicine have led to unacceptable gaps in knowledge about female bodies. In order to recognise illness, you first have to know what health looks like. But in biomedical research, the archetype of “normal” has traditionally been a lean, white male. People who deviate from that norm in terms of sex, race or gender have tended to be excluded, misrepresented or – in the most all-encompassing form of bias – judged to be infirm by definition. Womanhood is the prime example, long regarded as an inherently pathological condition. Under the medical gaze, women have been branded weaker, feebler and at permanent risk – unless “fixed” by a hysterectomy – of being tripped into hysteria by their unruly uterus.