Uterus Transplants and the Social Pressures of Biological Motherhood

Last week, the Cleveland Clinic announced that it would begin performing uterus transplants on U.S. women. Over the next several years, 10 women participating in the clinic’s transplant trial will receive a uterus from a deceased donor. They’ll spend the following year healing, and then they’ll attempt to get pregnant through in-vitro fertilization. If a pregnancy results, the women will be required to deliver by C-section. The transplants will then be removed—after one or two births—for a total of three major surgeries.

The uterus transplant process is risky. After the transplants and during their pregnancies the women will be taking anti-rejection drugs similar to those used after hand and face transplants. The drugs suppress the immune system, which results in an increased risk of infection. Also, immunosuppression could cause a developing fetus to suffer side effects, ranging from “major severe malformation to delicate neurocognitive defects.”

A transplant recipient should be ready for the possibility of organ rejection, and the additional complications that may result from the transplanted organ’s removal. The women in the Cleveland Clinic trial will undergo “general anesthesia, in-vitro fertilization, major gynecologic surgery, pregnancy with potential high-risk complications, cesarean delivery and eventual hysterectomy to remove the graft.”

These women, like all women, have the right to make their own reproductive choices—even if they’re risky. Many of these choices are complex and difficult. But when women have adequate and affordable access to birth control, abortion, IVF, surrogacy, adoption and even uterus transplants, they also have the power to control their reproductive destiny.

However, it’s worth considering the social pressures at play that equate true womanhood with the ability to become a biological mother.

Take for instance a 26-year-old woman undergoing screening to determine if she can participate in the Cleveland Clinic’s study. She was devastated when she found out, at age 16, that she didn’t have a uterus. She explained to The New York Times how she felt about wanting to become pregnant:

“I crave that experience,” she said. “I want the morning sickness, the backaches, the feet swelling. I want to feel the baby move. That is something I’ve wanted for as long as I can remember.”

She told the Times that “finding out she had no uterus had made her wonder if anyone would ever want to marry her.”

I’m happy that a uterus transplant will allow her—and others like her—to experience pregnancy. But, I question the societal gender pressures underlying her incredible determination. This young woman, a mother of two adopted children, seems to be feeling pressure to experience motherhood in a very specific way.

I understand the determination to become a mother. Aside from the fact that it’s a natural part of life, socialization makes the experience of motherhood hard to separate from the experience of being a woman. Young girls play with toys that teach them about mothering—baby dolls that can be dressed, changed, fed and pushed around in miniature strollers. I was certainly socialized for motherhood. Like many other women, I started babysitting when I was still in middle school, where I learned how to supervise and entertain children, change a diaper and put a baby down for a nap.

Add to that the pressure of being a biological mother, and you begin to understand why these transplant candidates may want to assume the risks involved in receiving a transplanted uterus. I know from personal experience that, even when it could pose a threat to your own wellbeing, the chance to carry a baby yourself is compelling.

Two years ago, I started to wean myself off the drug Methotrexate, which I take to control the Rheumatoid Arthritis (RA) I was diagnosed with in infancy. Methotrexate is considered category X—it cannot be taken during pregnancy. In fact, at higher doses than those I take, it’s used to induce abortion.

Though I was ready to get pregnant, nothing had changed about my RA—it was still active. I’d taken Methotrexate on and off for 20 years, and had most recently been put back on it to help control my active RA. So the idea that I could nonchalantly stop taking it, though endorsed by my doctors, was a bit irrational.

And sure enough, going off Methotrexate was a disaster. I flared. I spent months limping around, joints red and swollen, left elbow bent and locked in place. I developed Baker’s cysts behind both knees. I needed multiple injections in my knee joints. All in all, it took me almost a year to recover.

I made an appointment with a doctor who specialized in complicated pregnancies, and he explained that because of my RA, any pregnancy of mine would be high-risk.

And there were lots of other competing complications. First, my time off Methotrexate was not going well, which meant that if I stayed off it during pregnancy, the flare might continue, or get worse. Next, my RA is so severe that during pregnancy I would need to stay on another medication strong enough to control the disease. At the time, I was on Remicade, a medicine you receive via IV infusion every eight to 10 weeks. Remicade, though effective for RA, made me tired and nauseous for days after I got it. More troublingly, the data on whether Remicade was safe to take after the first trimester of pregnancy was non-existent. Remicade could potentially suppress a baby’s immune system as well as my own.

In addition, after years of taking the oral steroid prednisone, my bone density is, well, terrible. I could break a hip while pregnant, after giving birth, or even during childbirth.

What else? A C-section, because of all the immunosuppressants I take, would be dangerous if I had to have one. My doctor also mentioned the risk of blood clots, stillbirths and third-trimester miscarriages.

Would I willingly assume those risks? No. I wasn’t ready to throw my wellbeing into jeopardy for the period of time it would take to conceive and then carry a baby. My concerns for my health, both physical and emotional, won out.

Just barely. I agonized over the decision, and I still do. I’m 35 and the window feels like it’s closing. Will I regret this choice? Was I too selfish? Was I right?

I still bring up “trying” with my husband. When my joints get a little bit better, and my RA feels a little more controlled, the dream of pregnancy returns.

So I understand why someone may be willing to undergo something as invasive as a uterus transplant. I’m with them. I so badly want to touch my belly and feel a baby moving inside. I so badly want to hold that baby in my arms. It’s hard to let that dream go.

Uterus transplants will give women who had lost hope a new chance to control their reproductive choices: They can now choose the option of experiencing motherhood through their own pregnancies.

If women walk into these procedures fully informed of the risks, advised by doctors who will weigh the pressure to experience pregnancy alongside what women want, uterus transplants will represent medical innovation at its best. But questioning the restrictive gender norms that might influence those choices is critical.

Photo via Shutterstock



Katherine Macfarlane is a law professor in Boise, Idaho. Her writing has appeared in BUST, The Huffington Post, The Hairpinthe Intima, and Northwestern Magazine. Follow her on Twitter @KatAMacfarlane.