Back in 2019, I reviewed Hard Pushed, Leah Hazard’s memoir of being a midwife in a busy Glasgow hospital. Here she widens the view to create a wide-ranging and accessible study of the uterus. As magisterial in its field as Siddhartha Mukherjee’s The Emperor of All Maladies was for cancer, it might have shared that book’s ‘A Biography’ subtitle and casts a feminist eye over history and future alike. Blending medical knowledge and cultural commentary, it cannot fail to have both personal and political significance for readers of any gender.

The thematic structure of the chapters also functions as a roughly chronological tour of how life with a uterus might proceed: menstruation, conception, pregnancy, labour, caesarean section, ongoing health issues, menopause. With much of Hazard’s research taking place at the height of the pandemic, she had to conduct many of her interviews online. She consults mostly female experts and patients, meeting people with surprisingly different opinions. For instance, she encounters opposing views on menstruation from American professors: one who believes it is now optional, a handicap – for teenagers, especially – and that the body was never meant to endure 350–400 periods compared to the historical average of 100 (based on shorter lifespan plus more frequent pregnancy and breastfeeding); versus another who is concerned about the cognitive effects of constant hormonal intervention.

The book forcefully conveys how gynaecological wellness is threatened by a lack of knowledge, sexist stereotypes, and devaluation of certain wombs. Even today, little is known about the placenta, she reports, so research involves creating organoids from stem cells that act like it would. The use of emotionally damaging language like “irritable/hostile uterus,” “incompetent cervix” and “too posh to push” is a major problem. The sobering chapter on “Reprocide” elaborates on enduring threats to reproductive freedom, such as non-consensual sterilization of women in detention centres and the revoking of abortion rights. And even routine problems like endometriosis and fibroids disproportionately affect women of colour.

Hazard has taken pains to adopt an inclusive perspective, referring to “menstruators” or “people with a uterus” as often as to women and mentioning health concerns specific to transgender people. She is also careful to depict the sheer variety of experience: age at first menses, subjective reactions to labour or hysterectomy, severity of menopause symptoms, and so on. Where events have potentially traumatic effects, she presents alternatives, such as a “gentle” or “natural” Caesarean, which is less clinical and more empowering. The prose is pitched at a good level for laypeople: conversational, and never bombarding with information. That I have not had children myself was no obstruction to my enjoyment of the book. It is full of fascinating content that is relevant to all (as in the Harry and Chris solidarity-themed song “Womb with a View,” which has the repeated line “we’ve all been in a womb”).

Here are just some of the mind-blowing facts I learned:

• Infant girls bleed in what as known as pseudomenses.
• Research is underway to regularly test menstrual effluent for endometriosis, etc. and the uterine microbiome for signs of cancer.
• The cervix can store sperm and release it later for optimal fertilization.
• Caesarean section and induction with oxytocin now occur in one-third of pregnancies, despite the WHO recommendation of no more than 10% for the former and the danger of postpartum haemorrhage with the latter.
• After childbirth, a discharge called lochia continues for 4–6 weeks.
• There have been successful uterine transplants from living donors and cadavers.
• Artificial wombs (“biobags”) have been used for other mammals and are in development; Hazard cautions about possible misogynistic exploitation.

With thanks to Virago Press for the free copy for review.