Raising Elijah

ALL THROUGH the unknowing summer of 2001, my unborn son lay horizontally within my body like a half-open umbrella, his head pressing hard against my left side and his bottom bulging out on the right. Midwives and obstetricians refer to this position as a transverse lie. It makes birth impossible. You can’t come out of a woman sideways.

All sorts of alignments are common in early pregnancy, but, by seven months, most babies are head down. Of those still off-plumb at eight months, only a minority are able to get themselves vertically oriented in time for labor and delivery. A transverse lie once foretold death for both mother and child. It’s what Caesarean sections are for.

Coming up on eight months, I wasn’t worried yet. But I was soliciting suggestions. My midwife advised swimming. Buoyancy, she said, sometimes encourages side-lying babies to move. And so each evening, I waded into Cayuga Lake—sunlight folding itself into the water or rain pebbling its surface—and struck out for the opposite shore. You swim, too, I instructed my son.

So I spent an afternoon on hands and knees, exploring the hollow of land behind our cabin. I told myself I was investigating the habits of wood frogs, with their eye masks and their freezable blood.

It’s true, I told my crossways son as I scuttled along. Wood frogs are freeze tolerant. They can’t dig like toads or sink to the bottom of lakes like other frogs. So, in the winter, ice fills their abdominal cavities. Their eyes frost over. Breathing ceases. And in the spring, they thaw back to life and are the first to sing.

I crawled over to the grassy slope that descends to a reedfilled swamp and rolled on my back, my head downhill from the bony funnel of my pelvis. I’d read that inverted poses also sometimes help turn babies.

The geological maps for Tompkins County, New York, name the swamp below my head the Thomas Road wetlands. Considered critical habitat, it filters and feeds rainwater into Sixmile Creek, a source of drinking water for the entire city of Ithaca, population 35,000. My feet pointed uphill to the steep, rocky ridges of Snyder Hill that block the afternoon sun far too soon during the short days of the long winters here. This hill also captures and directs the snowmelt, recharging our drinking water well and filling the swamp.

More than water flows down that hillside. Each spring, a great amphibian migration brings toads, frogs, and salamanders from the Snyder Hill highlands into the swampy hollow of the Thomas Road wetlands where they mate and lay eggs. Along the way, each migrant confronts the treacherously busy Thomas Road, and, at great peril, must crawl, hop, or slither across. Every spring, about 40 percent of them, including the rare and the endangered, are squashed in the passage. The odds are especially stacked against long-lived species like spotted newts, which spend the first two years of a fifteen-year lifespan as red efts—a special juvenile stage—before transforming into adults and so must cross the murderous asphalt year after year. Thus, during the nights of peak migration, local college students patrolled this road—environmental studies crossing guards—stopping drivers, lifting and carrying across as many animals as possible.

Lying on the hillside, I was aligned east–west. My son, north–south. Our two bodies resembled the compass rose on the corner of the map. Locked together, we were perpendicular arrows aimed at the four directions. At odds. Crossed. Still, the atmosphere rose above us both. The groundwater flowed below us both. And below that water lay a continuous sheet of shale—the old Devonian sea floor, a graveyard of squids and sea lilies that had lived here long before the earth knew wood frogs or newts. We rested together on the same bedrock.

On what seemed to me the hottest day of the summer, I spoke at a press conference in lower Manhattan. The topic was PCB—polychlorinated biphenyl—contamination in the Hudson River and what should be done about it. It was like being asked to play a bit part in a long-running Shakespearean tragedy. Or, more to the point, a badly directed, over-budget summer blockbuster.

Everything about this story was an epic catastrophe. PCBs are the most vile collection of chemicals ever birthed from coal tar. All together, PCBs possess links to the most feared health problems—cancer, infertility, learning disabilities, and premature birth. By turning eel and striped bass into carcinogenic threats, they had destroyed commercial fishing in the Hudson River.

And they possessed a ghoulish ability to resist ecological degradation. From their burial grounds in the sediments of the Hudson, decades after their 1976 abolition, PCBs are still seeding themselves into the atmosphere. They are still insinuating themselves into the food chain. They are found in trace amounts in everyone’s blood. And they are not going to go away on their own.

Matching the stubborn resistance of PCBs was General Electric (GE). For thirty years GE dumped these oily chemicals into the river from its capacitor plant in Hudson Falls. For another thirty years—through protracted legal challenges—it had stiff-armed calls to clean them up. The U.S. Environmental Protection Agency (EPA) investigation dragged on for ten years. Whole careers were devoted to the study of the situation. And the situation was maddening. PCBs had not only been discharged into the river through pipes, they had also seeped through the factory floor and into the bedrock. As the dense oils migrated through fractures and fissures in the shale, they traveled to the river. The PCB-saturated bedrock itself was a source of ongoing contamination.

But citizen advocacy was equally persistent. As a result, in the summer of 2001, the EPA was about to announce a plan. My task was to describe the prenatal effects of PCB exposure. And so I did—from atop an outdoor dais in Battery City Park, with the state’s attorney general on one side of me and Robert Kennedy Jr. on the other. At our backs, the Hudson and the Statue of Liberty. Before us, the World Trade Center.

As I spoke about the mechanisms by which PCBs prevent thyroid hormone from reaching fetal brain cells, I was aware that my body was as much a part of the presentation as my words. Behind me, PCBs were evaporating from river sediments. Within me, an amphibious baby was swallowing amniotic fluid. And knitting together a brain.

For all my talk of water, I had foolishly forgotten to bring any. I started to worry about fainting. During the speeches that followed mine and while the cameras whirred and clicked, I imagined myself atop the World Trade Center towers. It would be cool up there. And quiet. I focused on thinking of a name for my son.

I had a new idea about that. Earlier in the day, I’d visited the Metropolitan Museum of Art with my artist husband, Jeff, and our two-year-old. Wandering among the contemporary collection, I discovered a watercolor by Faith Ringgold. My daughter’s name is Faith, so I thought I’d show it to her. The painting was a simple American flag, but written on the red stripes were the words of the First Amendment, and written on the white stripes were names that referenced acts of censorship. In between the words “peaceably” and “redress” appeared the name Elijah Lovejoy.

Now, just as the press conference was wrapping up, I remembered: Elijah Lovejoy, abolitionist writer from my home state of Illinois who had walked from Boston to Alton. Whose printing press was destroyed multiple times by proslavery mobs from St. Louis. Who had refused to stop writing. Whose speech on freedom of the press and appeal for protection was ignored by an Illinois court. Who was killed. Whose death captured the attention of Abraham Lincoln. This was a story once known to every Illinois school child. Elijah Lovejoy was a persistent and uncompromising man.

If I’d thought that naming him would make the baby turn around, I was wrong. Back at the Thomas Road cabin, the wildflowers set seed, carpenter bees excavated holes in the kitchen wall, and my daughter explained to me a complicated career plan. She wished to be a midwife and a train engineer. She would run her trains express while delivering babies. She also announced she was done with diapers now. The baby could have them.

And, except for fitful, dream-filled dozing, sleep eluded me. The nocturnal sounds of summer, I reported to Jeff, mostly consisted of the distress calls of foxes. I had no idea what might cause a fox to feel distress in the middle of July, but there it was, every damn night, making unholy sounds out in the woods—shrieks, squalls—that most closely resembled, well, a baby.

Finally came the sound I’d been waiting hours to hear: Far down Thomas Road, a muffler-challenged car was fast approaching. In another minute, it would bomb up to my mailbox, pause, and then roar off into the night again. The paperboy. At least, I thought of him as a boy. In any case, the distant rumble signaled the arrival of another awake human being, whoever it was.

It also signaled the beginning of the end of the night. Since I was too nearsighted to see the hands of the clock and too unwilling to move from whatever least-uncomfortable position I had worked out for myself, the hours spent in bed had become weirdly amorphous. But now I knew that the time had to be, more or less, 4 a.m. And if 4 a.m. comes, can dawn be far behind?

As I entered the final sleepless month of my pregnancy, I began to imagine night as a black body of water I had to cross. The newspaper courier was the lighthouse keeper on the distant shore.

I wondered if he—or she—had any idea how much the unfailing appearance of the newspaper in the predawn darkness comforted me. I wondered if he—or she—could sense, while rolling and stuffing the paper into the plastic box, that I was lying awake inside the darkened house just behind the trees, with various pillows rolled and stuffed around me, listening hard. I told myself that, after the baby was born, I’d write a note and leave it in the newspaper box. Thank you for being my lighthouse. But immediately the idea sounded so hokey that I forgot about it.

Then one sticky night, the baby wiggled and squirmed more than usual. Hour after hour, he persisted. He was working hard. This, too, marked a long-awaited arrival. When at last I heard the paperboy roar off, I got dressed. I walked out to the road in the misty darkness and fetched the newspaper. I made tea, poured granola into a bowl, and sat by the east window. The air turned ink blue and separated itself from the earth. For the first time in a month, I could breathe. Later on in the day, the midwife would confirm what I already knew: We were in alignment, my son and I. He was head down, ready to go.

On August 6, 2001, President George W. Bush received a now-famous intelligence briefing informing him that Osama Bin Laden was determined to strike within the United States—and, more specifically, that he wanted to hijack aircraft. And, even more specifically, that patterns of activity “in this country consistent with preparations for hijackings” had been noted.

Given that I had given birth only once before, I was surprised how familiar the sensation was. Vague crampiness. A band of achy pressure that came and went. Oh, yeah. I remember this. By the time I saw the midwife later that afternoon, I was four centimeters dilated but not yet experiencing progressive contractions. She sent me home to get some rest while I could. “Stay on high alert, though.”

So was I truly in labor? Or just approaching it? Well, I was a mother. I knew how to be patient. If indeed childbirth were a room that one entered—crawling on hands and knees, beseeching, naked—it was a place I’d seen before. Wherever I was now, I was sure to recognize the furnishings when I arrived.

Here was an interesting truth about entering motherhood for the second time: I was just having a baby; I wasn’t taking on a new identity. Furthermore, I now carried with me a skill set. I already knew how to change a diaper in the dark. I already knew how to nurse a baby with one hand and type with the other. I already knew how to talk my way past the pediatrician’s surly after-hours answering service and get a doctor on the phone.

It turns out that field biology also offers a number of transferable credits to the college of parenting. In motherhood, as in ecology, data analysis is complicated, confounded by multiple variables, and boundlessly fascinating. Both activities require humility and a high tolerance for dashed plans and unanticipated outcomes. I realized, soon after the birth of my first child, that I was more prepared for parenthood than I thought I was.

Nevertheless, I was now starting to suspect that having two children was going to require of me something that having only one didn’t. Of course, it went without saying that another baby was going to eat whatever was left of my solitude. That was an easy prediction.

I’d been a mother for fewer years than three. Being a nonparent still felt like my normal state. It was still a surprise to wake up and find a child in my house. But I wasn’t nostalgic. In my experience, a happy single life was like an exotic orchid with particular moisture, light, and temperature requirements. It required a lot of tending. You had to make weekend plans, have a therapist or a pet, and keep track of how many days had passed since you had last dined with someone. Small disappointments had to be monitored lest they balloon into despair.

When you are by yourself, surreal things can happen: You could get lost in a rainforest while hiking to a study site and then step on a snake at the precise moment you realize that you had neglected to tell anyone where you were going. Or an infected salivary gland could send you to the ER on Thanksgiving morning. Five hours later, you might find yourself shivering with fever in a check-out line at a Walgreens, a scrip for antibiotics in one hand, a can of condensed mushroom soup in the other, and a homeless guy in front of you kindly offering to give you, the girl with the puffed-out face, his can of tuna fish. Which makes a nice story but you have no one to tell it to. (Until now.)

Still, in the way it aligns you with all the other nonaffiliated people of the world, there is something democratic and outwardly focused about solitary living. By comparison, family life had seemed to me, when I was an outsider to it, oblivious and tribal. There is something darkly thrilling about watching a crisis unfold and realizing, nobody even knows I’m here.

But from now on, my mental health would be besieged by too much symbiosis rather than too much isolation. My whereabouts would be planned, publicized, monitored, and made a topic of constant negotiation. Including trips to the bathroom. Fine. It was an adventure of another sort.

First was the growing awareness of the fact that I had no saltshaker. Nor any chest of drawers. I just shook the salt right out of the cardboard cylinder it came in and stored my clothes in bins. And my bedspread was a sleeping bag. And the cabin we lived in was rented. These seemed to me signs of a provisional, ad hoc approach to setting up house. As though I were camping out in my own life.

In this, Jeff and I were well matched—he kept his toothbrush and razor in a travel bag on the bathroom shelf, as if any moment he might be summoned to the airport—but I was beginning to wonder if we both still imagined ourselves as work-driven gypsies who could fold up our tents in the night and be gone. That sort of make-do approach to our surroundings might be compatible with one child—you and me and Baby McGee—but it seemed unsuited, in ways I couldn’t fully explain yet, to life with two children.

One of the lessons of ecology is that scale matters. And when you add another organism to the ecosystem, the complexity of interactions increases exponentially. At the very least, moving into a four-square family from a two-parents-anda-kid triangle meant changes to the food chain, the laundry cycle, the infectious disease rate, and the ambient noise level. Matter, energy, and chaos were going to start flowing faster and in multiple directions. It seemed worth thinking about the efficiencies of the household—and more profoundly, what kind of family we wanted to create and in what community we wanted to embed it. Less whimsy, more stability.

My second concern was straightforward: I was having a boy, and I didn’t know anything about boys. In fact, those were my exact words to Jeff six months ago. Biologist or not, I was shocked by the news from the ultrasound technician—how was it possible that I had a male inside of me?—and so I, the brotherless mother of a daughter, had turned to my husband in the hospital parking lot and cried, I don’t know anything about boys!

No one knows what sets in motion the onset of uterine contractions known as labor. A 2010 review of the evidence in the Archives of Gynecology and Obstetrics concludes, “Despite impressive progress in the science and technology of reproduction, the mechanism by which labor is initiated in humans remains obscure.”

Theories abound, and they all focus on intrinsic factors: the cascade of biochemical changes that soften the cervix of the uterus and coax its muscle fibers into synchronized action. Some of these changes are guided by hormones from the endocrine system, some by signals from the nervous system and some by inflammatory reactions involving the immune system. But the ultimate source of them remains unelucidated.

The idea that the physical environment surrounding a pregnant woman may play a part in influencing the onset and tempo of her labor—perhaps by modulating neuroendocrine and immune responses—is mostly not part of the discussion within the gynecology and obstetrical communities. But there is growing evidence for such a role, and it comes from two sources: epidemiologists and midwives.

Epidemiological studies show that women exposed to certain chemical pollutants are at higher risk for preterm birth. Chemicals with the power to shorten human pregnancies include hormone-disrupting chemicals such as PCBs. They also include benzene, lead, and certain pesticides. And they include DEHP, a member of a widely used but little known family of chemicals called phthalates. DEHP is short for di(2-ethylhexyl)phthalate.

One billion pounds of phthalates are manufactured each year. DEHP is used to soften vinyl plastic and, along with other varieties, is added to perfumes, hairsprays, and nail polish. Indeed, perfume use is linked to higher levels of phthalates in the urine of pregnant women. As described in a study published in 2009, researchers at the Columbia Center for Children’s Environmental Health persuaded 311 very pregnant women living in Harlem and the Bronx to wear backpacks containing personal air monitors. These monitors measured actual levels of phthalates in the air that the women breathed during their last months of pregnancy. Researchers found phthalates in 100 percent of these personal air samples. DEHP was associated with shorter pregnancies: Women exposed to higher levels went into labor sooner.

So how might a chemical that imbues shower curtains and dashboards with that instantly recognizable new-car smell abbreviate human pregnancy? Evidence from animal studies suggests that DEHP exposure can induce inflammatory responses in the lining of the uterus. Inflammation is a known risk factor for premature birth.

A second possible route to preterm labor involves DEHP interference with an obscure set of proteins called peroxisome proliferator-activated receptors. These subcellular receptors are the shushing librarians of late pregnancy: they enforce what’s called uterine quiescence. By regulating the expression of certain genes, they keep the taut, stretched muscle fibers of the uterus quietly focused on remaining taut and stretched. As the time of birth nears, the receptors—stationed along cell membranes—are quietly stripped of their authority. Released from the receptors’ stern oversight, the uterine muscle fibers are now free to start twanging. And they do. Soon enough, there’s a riot in the library.

In the presence of phthalates, however, the story changes. Phthalates retire from duty the peroxisome proliferator-activated receptors before their work is finished. In other words, phthalates have the power to shush the shushers. The result may be earlier onset of contractions.

Phthalates are not the only air pollutant that can disturb uterine quiescence. So can second-hand tobacco smoke. So can car exhaust. So can smog. In general, the more fine particulate matter a pregnant woman breathes, the greater her risk for an early birth.

Air pollutants act through multiple pathways to induce labor. Some trigger inflammatory reactions. Others disrupt hormonal messages. Diesel fumes and heavy metals such as cadmium, for example, can interfere with the production of progesterone, which is a key player in regulating the timing of birth. Epidemiological studies have identified links between timing of birth and traffic intensity: The closer a mother lives to a busy highway, the higher her risk for preterm labor. Other studies have identified links between earlier onset of labor and proximity to certain industries. When the Utah Valley Steel Mill closed in 1986, for example, rates of premature birth among pregnant mothers living in the valley dropped. When the mill reopened a year later, rates went back up.

In short, the atmosphere itself (through pathways we do not entirely understand) interacts with a complex, exquisitely calibrated biological mechanism (whose engineering we do not entirely understand) to influence the initiating events of human birth.

From the midwifery community comes an observation about weather events and the onset of labor. Part of the oral tradition among midwives is that human births occur more often during times of decreasing barometric pressure, as during a storm or arrival of a cold front. Such a relationship is not without precedent—surgeons have long noted an association between low atmospheric pressure and increased rates of abdominal aneurysm ruptures—but it has new backing from studies in biometeorology. Although the data are not completely consistent, the results show that the rupture of amniotic membranes and/or onset of labor tend to increase during frontal changes, especially those involving falling air pressure.

Both the epidemiologists’ findings on air pollution and the midwives’ observations about storm fronts have relevance for mothers living in a world altered by climate change. In a warming world, heat waves become longer and more frequent. The higher temperatures speed up chemical reactions between air pollutants—such as car exhaust and evaporating paint fumes. As a result, smog thickens, ozone levels rise, and air quality deteriorates. At the same time, storm systems intensify and barometric pressures fluctuate more wildly.

The twin impact of air pollution and climate instability on the duration of pregnancy is not yet part of biomedical discourse. It should be. In the United States, preterm birth is already the leading cause of death within the first month of life. It’s also the leading cause of disability. In addition to the suffering inflicted on families because of the death or lifelong disability of a beloved child, prematurity is expensive. Each year, preterm births cost the nation more than $26 billion in medical expenses, special education services, and lost productivity.

Much remains to be learned about the ways in which the environment influences the timing of human birth. “The vast numbers of pollutants to which a woman may be exposed have never been considered in an investigation of preterm birth,” concluded the Institute of Medicine in a recent report. Nevertheless, we know two things already: Pregnant women need clean air and a stable climate.

On August 9, 2001, the mid-afternoon high hit 98 degrees, and another temperature record fell. Faith was desperate for a nap but couldn’t settle down. We tried various sleeping spots, various storybooks, various lullabies. Her fretfulness went on and on. During the third encore of “Daniel in the Lion’s Den,” I noticed that my come-and-go contractions seemed to be recurring more purposefully, so, as I sang, I began surreptitiously to time them. They became impressively regular. As did, gradually, Faith’s breathing.

A sweaty arm was flung across my chest, and a hand twirled in my hair. Faith was exhausted. The next contraction was hard and long. I knew that if I got up now, she would rouse and start crying again. And that would be the end of naptime. And without a nap, she would be miserable. Not everyone’s needs were going to get met here. This was a new thought for me. My usual mantra—family first, work second, and everything else after that—didn’t really offer any insights. And so, not for the last time in my life as the mother of two children, I looked at one of my kids and said, I’m sorry, but I can’t always be fair. And got up.

The barometer fell all afternoon. The big storms skirted around Ithaca—thundering in the distance—but the cold front they brought with them arrived later that night. The next day’s high was only 84. By then, I was carrying my son outside my body rather than inside.

He was shy. That was my first opinion of him. And peaceful. The prophetic name Elijah seemed too fierce for him. He was also blond. And in each of those three ways he was unlike his sister. Faith had looked around the delivery room, so her father claimed, before she was even all the way delivered. Elijah kept his eyes firmly shut. Decidedly shut, as if he had not yet completely arrived in this world. Faith’s birth had been like a reunion with someone I’d known my whole life. I’d loved her instantly, hugely, involuntarily. This new child was someone I didn’t recognize.

Back at home, we received a steady stream of friends bearing food, and I recounted the details of the previous night. The story, it seemed to me, contained some notable observations about the influence of the environment on the timing and tempo of labor.

Getting from our cabin to the September Hill Birth Center—a renovated farmhouse next to the county hospital in Montour Falls—had required a 45-minute drive. At the 35-minute mark was Watkins Glen. The road through this village passes by vineyards, dairy farms, bait shops, and offers views of a waterfalllaced gorge. It’s a tranquil place—except on a few nights of the year when it isn’t. Watkins Glen is a NASCAR town. Its fast and fearsome speedway is hailed as America’s Road-Racing Mecca, and qualifying races for two different series were scheduled the night of Elijah’s birth.

When we’d pulled into town, the entire village was a carstereo-thudding tailgate party. And of all the people navigating the clogged streets that night, I was the one least interested in the news that the best lap time in the qualifyings was an awesome 138 mph.

Here were the results of a study I conducted entitled “The Impact of NASCAR Racing on the Timing of Human Birth” [sample size of 1]: Labor contractions ceased. Entirely. As though they had never existed.

With the approval of the midwife on call, we decided to find a nearby hotel for the night rather than return home. Thus began the Joseph-and-Mary search for a room, except that instead of a donkey we were accompanied by a sleep-deprived toddler and, an hour later, had secured something slightly cleaner than a stable. For the second time that day, I lay down with a frantic child and tried to coax her to sleep. And for the second time, just as she drifted off, a hard contraction took my breath away. It was immediately followed by another and then another.

The midwife met us at the door and led me, gratefully, to a whirlpool tub. Immediately, in the way the water floated me, something on the verge of unbearable became bearable again. Something on the verge of terrifying receded. Yes, I was now in labor. Truly in it. Labor was a room with a ticking clock, a tiled wall, and swirls of light. Labor was the shale floor of a briny sea. Magma. Pressure. I descended by Braille. I rose through the squeezing passageway of my own breathing. Labor was a sparkling lake. I could swim a long way. And nobody even knows I’m here.

When it came time to push, I pushed hard. I needed to push. I wanted to push. And whatever other verbs exist in the space between needed and wanted, I did those, too. And then he was in my arms, and the rain arrived, and somewhere in a nearby pond, frogs, like loose banjo strings, started twanging.

With the first baby, you realize that you would sacrifice everything for your child. With the second baby, the impulse is toward self-preservation. The realization is that the whole lurching family enterprise, which now includes two small children, depends on one’s own ability to hold up and carry on.

Two weeks after the birth of my son, I turned 42. I already knew that my own capacity for perseverance depended on accumulating, within each 24-hour period, six hours of sleep in at least three two-hour chunks. Anything less—or more fragmented—for more than a few days in a row—unhinged me. As co-breadwinner for the family, I was back at my desk within days of Elijah’s birth. I needed my hinges intact. So all decisions were now made with an eye toward saving time. Extra minutes were squirreled away and devoted to sleeping. Convenience mattered.

With my first child, what had impressed me about breast milk was its clear superiority over infant formula. Breastfed babies have greater protection against infectious diseases. They hit developmental milestones sooner. They grow into children less likely to contract leukemia or diabetes or asthma. They have higher verbal IQs. They are less likely to become obese. Ergo, breast was best. And I wanted what was best for my daughter, so I gladly nursed her.

With my second child, what jumped out at me were studies that focused on the impact of breastfeeding on maternal health—

For mothers, failure to breastfeed is associated with an increased incidence of premenopausal breast cancer, ovarian cancer, retained gestational weight gain, type 2 diabetes, myocardial infarction [heart attack] and the metabolic syndrome.

With lists like these, I felt my motivation shift from I’ll breastfeed if it kills me to I’ll breastfeed to stay alive. Items on the lists of risks incurred by mothers by not breastfeeding were, to say the least, examples of supremely inconvenient events. And to say the most . . . well, my biggest fears were on those lists. If there was anything I could do to lower, however modestly, the odds that my children would grow up with a cancer patient as a mother, I would do it.

As for heart disease and osteoporosis, I was already willing to engage in time-consuming attempts to mitigate my risks for those problems (jogging in the middle of the night). Improving my cardiovascular health and bone density by sitting on a couch and nursing sounded like an ingenious form of multitasking to me. I mean, I had to feed him anyway.

I began to look at the data on health outcomes of infants from this new vantage point as well. Feeding babies formula increases the chances that they will get sick. When babies are sick, mothers don’t sleep. Households descend into chaos. The needs of other children go unmet. Pneumonia. Diarrhea. Gastro-enteritis. Ear infections. Contagious diseases could sweep through the household. Who had time for that? But to say that breastfeeding offers benefits—as though nursing were a job with stock options and a retirement plan—doesn’t really provide those insights. The notion of “benefits” doesn’t help a new mother know that not breastfeeding likely means more 2 a.m. phone calls to the pediatrician, more trips to the pharmacy, more time spent reading the fine print on the back of the Tylenol bottle, more missed days of work. Or that not breastfeeding may jeopardize her own future health.

Critics who complain that breastfeeding advocacy creates guilt in mothers who choose not to nurse are missing the point. The choice is not between a gold-plated but sometimes tricky, painful, and inconvenient way to feed a baby (breastfeeding) and the perfectly adequate standard model that offers ease and convenience (formula)—even though the sly language we use to talk about infant feeding practices implies as much. According to a 2010 study published in the journal Pediatrics, low breastfeeding rates in the United States kill 911 infants per year and cost $13 billion. That’s the choice.

But pediatric cost analyses of the burden of suboptimal breastfeeding are of minimal use to new mothers. So here are two personal observations from my own untidy, workingmother trenches: 1. Breastfeeding allows you to make crying children fall asleep on demand. Anytime. Anywhere. Nothing to sterilize. No floors to walk. 2. Bottle-feeding takes two hands. Breastfeeding only one. With your free hand you can—read a story to a toddler, analyze data, make dinner, give interviews over the phone, draft a grocery list, write a book.

We were up early. Look, Elijah. Sun. Trees. Crows. Look. Blue sky. Blue asters. Goldenrod. Elijah peeked out through one eye. I laughed. He nursed, and I worked on a lecture for an upcoming talk in Manhattan. When he fell asleep, I took him outside—the morning so lovely—and laid him on a blanket in the grass. He looked like he would nap for a while, so I did a few laps around the backyard with a push mower.

The leopard frog jumped just as the blade reel spun over him. I jerked the mower back but too late. Cursing, I extricated from the blades what was left of the frog and laid the pieces under the blackberry canes at the edge of woods. Leopard frogs are intensely sensitive to chemical pollution. Their populations are in decline. In graduate school, I dissected dozens of leopard frogs. That fact didn’t make me feel any better. Through tears, I decided I would atone for this stupid accident by making a donation to an amphibian society of some kind. In fact, I would do it right now. I carried the baby back inside.

Elijah began a 72-hour jag of crying on Wednesday. He didn’t seem hungry, and, in fact, he cried harder after a feeding than before. On the other hand, he wasn’t eating much. He wasn’t sleeping much either. He was so distraught his breaths came in great, ragged gulps. He wasn’t running a fever. Jeff and I took turns holding him. He cried. He cried in the baby sling. He cried in the baby swing. He cried in the car. Whatever grief and shock Jeff and I were experiencing along with the rest of the nation was soon subsumed by the task of attempting to console an unconsolable baby.

Back at home, I glanced at the week’s postings on an international listserv for lactation consultants to which I had subscribed a year earlier for a research project. It turned out that I was not alone: Ever since Tuesday, breastfeeding mothers across the United States were complaining they were losing their milk, suffering dips in production, coping with nipple pain, or waking up to newly fussy babies. The most reliable reports came from mothers in neonatal intensive care units who had been regularly pumping and measuring their milk for their preterm infants. Hospital-based lactation consultants confirmed that, for many of these mothers, milk volume had plummeted with no other explanation except stress brought on by the terrorist attacks. A lactation consultant from Tel Aviv wrote to say that she was unsurprised. She assured her U.S. counterparts that the effects were temporary.

On September 11, terrorism reached nursing mothers across continents. Entered their milk. Entered their babies. Terror was inside us now, Elijah and me. The connections between the political events in the outside world and the interior ones within the ducts and lobes of my own body were more profound and intricate than I had ever imagined.

The lecture I had been invited to deliver on pediatric environmental health at the New York Academy of Medicine had been planned months earlier. It wasn’t at all clear, in the days leading up to it, whether the event would happen nor not. My host said, frankly, he could not guarantee an audience. I had misgivings of my own. The drive to Manhattan took five hours even before the George Washington Bridge was outfitted with security checkpoints, and I had a one-month-old who would be riding with me across that bridge.

In the end, we decided, as so many people did in those first dazed weeks, that since all possible actions felt wrong anyway, we should just get on with it. And so Jeff paced marble corridors with Elijah on his shoulder—and Faith in a stroller—while I addressed a half-filled auditorium.

In the audience were a number of pregnant women and, as I was getting ready to leave, they approached me as a group. They wanted to know about that most toxic of all synthetic chemicals, dioxin, which, at vanishingly small concentrations, can cause developmental problems as well as cancer. Had the incineration and collapse of the World Trade Center sent a dioxin-filled cloud over Manhattan? They had heard that the towers were filled with PVC plastic and that PVC makes dioxin when burned. Is that right? Were their babies in danger?

I tried to keep my voice calm. Yes, I said, PVC—or polyvinyl chloride, or vinyl—makes dioxin when it burns and yes, the Trade Center was surely full of PVC. It’s used in electrical cables, flooring, wallpaper, and office furniture. I said I didn’t know what health threats the cloud created for the people breathing it—or for the fetuses they might be carrying. Colleagues of mine were researching those very questions. Unfortunately, the answers would be years away. Science takes time, especially when actual exposures are unknown and the outcomes, like subtle developmental deficits, can take years to manifest.

Early next morning, I left everyone in the hotel and took a nearly empty subway downtown. The trains under lower Manhattan were not running, so at some point, I got out and started walking. There were no towers to navigate by, a fact that seemed as surprising as it was obvious. How many weeks had gone by since I was here last, Elijah lying sideways within me, the Towers rising coolly above the summer heat?

I felt as if I were looking back in time at the ruins of some ancient civilization. There was the broken pillar. There was the curl of smoke before the crumbled façade. There was the scrap of cloth fluttering from the blasted window. There was the rubble. There was the gaping hole.

After a while, I noticed that my shirt was wet with milk. Somewhere uptown a baby was wondering where I was. Fumbling with the buttons to my jacket, I dropped my book bag onto the sewer grate. Just then, in a surreal transaction, a cab appeared, a sobbing woman got out, and I got in.

Back in the cabin later that evening, I saw that my green book bag had turned gray with Ground Zero ashes. Lying on my kitchen floor, it was still holding my breast pump and a couple of diapers along with my lecture notes. I lifted the bag gingerly and carried it out to the porch. I’d deal with it tomorrow. For now, I focused on the floor. Around and around I went with the broom, until there was not a speck of dust or ash anywhere. The floor’s vinyl beige squares and bland blue flowers seemed innocent and reassuring. The radio said we were going to war. And I was the mother of a son.

A decade later, here is what we know about the Ground Zero cloud that resulted from the pulverization of two of the world’s tallest buildings and from the fires that burned for three months: It contained cement dust, glass fibers, heavy metals, pesticides, PCBs, asbestos, benzene, soot, and the combustion byproducts of jet fuel. It contained dioxin.

Here is what we know about the impact on children: In the months following the attack, the number of new asthma cases among children younger than five who lived in lower Manhattan jumped. The greater the exposure to the dust cloud, the greater the risk of developing asthma. Among children living in Chinatown near the World Trade Center, rates of asthma increased and preexisting asthma cases worsened. These effects were not temporary. Asthma rates among Chinatown’s children are still elevated.

Here is what we know about the impact on pregnant mothers and their babies: Compared with those living farther away, women who resided near Ground Zero gave birth to shorter, lighter babies. Women who were in the first trimester at the time of the event had shorter pregnancies, and their babies had smaller heads. Newborns whose mothers lived within one mile of Ground Zero had higher levels of DNA damage in the blood cells of their umbilical cords than babies whose mothers lived farther away. The closer a pregnant woman was to the Towers, the greater the damage in the cells of her blood and in her baby’s blood. At age three, children with elevated levels of DNA damage—if they had also been exposed to environmental tobacco smoke—showed modest deficits in cognitive development.

Here is what we know about the boy babies of women pregnant during the 9/11 attacks: Some of them disappeared. That is to say, they were never born at all. And they vanished not just among women living in New York City but throughout the United States. Three to four months after 9/11, significantly fewer boys were born, and the death rate of male fetuses (those more than twenty weeks gestational age) increased by 12 percent.

This gender-selective loss and consequent reduction in the male birth rate is not without precedent. The male birth rate has long been known to decline after “natural disasters, pollution events, and economic collapse.” No one understands the biological underpinnings for this phenomenon. Why should male fetuses be disproportionally sensitive to environmental and social upheavals in the world outside their mothers’ bodies? As the beginning of an explanation for male fetal loss in the case of the World Trade Center disaster, researchers have posited communal bereavement, which is defined as widespread distress after events in which institutions, such as governments, fail to maintain safety and security.

“To know me is to travel with me,” says the frequent flying anti-hero of Walter Kirn’s 2001 novel, Up in the Air, which does not anticipate what air travel became in the months that followed 9/11. Pre-dawn cab rides. Three-hour security lines. Armed soldiers by the X-ray machine. Passengers pulled aside at boarding gates for further questioning. Tape-looped announcements exhorting vigilance. This was the world into which Elijah, finally, opened both eyes. And this was the world in which I learned to know him—as my traveling companion during a fall 2001 book tour.

Our fellow travelers were mostly tight-lipped men on business trips. Elijah was almost always the only baby on the plane, and I was the only passenger hauling an infant car seat. That didn’t exempt us from suspicion. In a Texas airport, my diaper bag was seized and searched between flights, and we missed our connection. We were often culled from the shuffling line through the metal detector and shunted into another for additional security procedures. Elijah learned to hold out his arms when the security guard approached with a beeping wand. We nursed under the watch of National Guard troops—22-year-old boys with bayonet-tipped rifles. Elijah studied them closely.

But mostly we studied each other. We talked to each other. We smiled at each other. We sought refuge together from too much noise and too much light. We learned to sleep and wake in unison in whatever hotel we landed. And when the world became too much, he turned away, burrowing down in the cloth cave of the baby sling in which I carried him. Nobody knows I’m here. And in this impulse toward privacy, toward solitude—I recognized him.

When we arrived home, fall was stiffening into winter. Jeff was eager to reconnect with the new, fully conscious Elijah and I with Faith, who had so, so, so many stories to tell me. “Switch kids” became the phrase Jeff and I used to reorient our parenting so each of us could spend time with the child who had most recently occupied the periphery of our attention. And so I became the daytime parent to Faith and the nighttime parent to Elijah.

The nights in the sleeping loft were much longer now than those I endured in the Summer of the Transverse Lie, but they were no less timeless. I still couldn’t read the clock without my glasses, and, while nursing or changing a diaper, half-sleeping in the darkness, I still wondered what time it was from inside an exhausted unwillingness to go get the answer I was looking for. Not knowing the hour of the night was bewildering somehow. If it was midnight, that was one thing. If it was 4 a.m., that was another. I felt vaguely lost, as though hiking without a compass.

And then, like discovering a cairn on the side of the mountain face, a marker of stones in a wilderness, came the distant, ragged sound of an old Chevy. The paper boy at last. Okay, the newspaper courier at last—somebody who, in my mind, would always be a boy. That meant 4 a.m., with 5 a.m. in view. The night was almost over; dawn was on the way. Soon, I could hand Elijah off to Jeff and sleep for another blessed hour.

Jeremy Armstrong, age 22, beloved son and brother. Whose Oldsmobile sedan had been found overturned in the creek. Who was a pianist, a maple syrup producer, a sailor, a builder of wooden boats. Who had plans for racing stock cars. Who supported his interests by working in the family newspaper business, delivering the Ithaca Journal throughout Ellis Hollow early every morning.

At the funeral, I saw no one I knew. But I guessed that the gentle-looking man in the ill-fitting corduroy suit was his father. He introduced himself as Bob. The skin beneath his eyes was gray. He smiled and looked at me curiously. He took my hand. He thanked me for coming.

It was my turn to speak. I hadn’t come with a script. I wondered how I was going describe to him the relationship I had with his son. How I had depended on Jeremy for far more than the local news. How I had listened for Jeremy’s daily arrivals through the whole long summer of late pregnancy. How his hovering presence at the end of my driveway had welcomed me home from the birth center and from post-9/11 travels. How he had brought, in the dead of every night, a stroke of order to a nearsighted, disorderly, work-driven parent. And, more even than that, how, in a time of terror and war, he had brought fidelity and, somehow, peace. Ultimately, Jeremy’s daily arrival at my house had filled me with a sense of peace. The peace that came with the knowledge that we had all made it through another night. Yes, that was really it. That, and how I had meant to write him a letter last summer and express my gratitude, but I never did.

Bob smiled again. Come, he said. And he steered me to open casket where Jeremy lay, unadorned. Not in a suit. Not on a satin pillow. Thin. Small shoulders. Dark feathery hair. An attempt at a beard—the kind that 22-year-olds try to grow. Jeremy’s brother made this coffin. Both of our boys are sawyers and woodworkers. We homeschooled them. Bob was going to serve as my guide through Jeremy’s life. When the police found him, his hand was still on the gearshift.

Bob showed me photos of his son as a child, running naked through a field, a swamp in the background. I recognized the landscape. We were practically neighbors. Now he wanted to introduce me to his wife Betty, Jeremy’s mother. She was the woman with long black hair, fiercely beautiful, standing motionless at the head of the casket, rooted to the floor.

She took me in. And she, too, spoke before I could find the words I wanted to say. Gesturing at Elijah, sleeping on my shoulder, she said, You never stop feeling that way about them, you know.