It began with an empty feeling in her arms. A physical sensation that something was missing and a longing to cradle a baby in her arms. Susan Johnson was in her late 30s and after years of making a career for herself as a highly regarded novelist, she found she wanted a child. Her new book, A Better Woman, is an account of the birth of her two sons and its painful aftermath. It is a highly personal story, a confession, one woman's extraordinary tale, but it speaks to many.
Every mother has her own birth story. Johnson's is not for the squeamish - but then neither is life. With the birth of her first son, Caspar, her body was pushed to its very limits and it failed her, humiliatingly, miserably. She developed a recto-vaginal fistula - a small fissure running between her rectum and her vagina - which later resulted in a temporary colostomy. "What an outcome from having one little baby," a therapist commented before surgery.
What happened to Johnson was extreme and rare - the story of her physical collapse is unlikely to be yours. But her narrative is a powerful evocation of the traumatic journey a woman - any woman - makes from non-mother to mother. You are the same, yet different. You are forced to relate to the world and everyone in it differently.
It is about the wonder, the joy, the messiness, the exhaustion, the non-stop screaming, the blood and the guts and the gore. It is about the all-consuming demands of a newborn baby and the dramatic impact on your life of giving life to another. As Johnson writes: "A new baby craves nothing less than the whole of its mother, a mother's arms, a mother's body, a mother's milk, a mother's sleep. A new baby takes the sleep from your eyes, the breath from your lungs, a new baby requires that you lay your body down as the bridge on which he will learn to stand."
When you meet Johnson, what strikes you first is the care she must have taken with her appearance. A 43-year-old Australian, she is orderly, neat. Her long dark hair is carefully blow-dried, her clothes, all polka dots and bold colours, are well chosen. This is a woman who likes to feel in control; a woman who knows what it is like to lose that control.
In an era when we are increasingly filled with a sense of our own omnipotence, a belief that everything is ours for the taking, whenever we like, Johnson's book is a scary reminder that rather than being in control of life we are often at its mercy. "I'm one of that great 'me generation'. We felt we had absolute control over our lives. You could choose when to have a child, when not to have a child," she says.
"What you come up against with questions of reproduction and childbirth is the fact that it's not all about you. I think it's a great lesson in realising that you do not have ultimate control of your destiny. We cannot control life so why do we think we can control birth?
"It's the unexpected, the dramatic. It's about forces beyond our control. It's one of those extreme, primitive passages. I don't think anything can prepare you for that. I've had to learn to my cost that sometimes you can't have everything. Sometimes not everything is risk-free. Sometimes you have to pay for what you get. We're not very fond of that idea - that sometimes there are costs." In some ways childbirth in the western world has become sanitised - or at least has the appearance of being sanitised. Women have elective caesareans, bloody sheets are whisked away, mothers rarely die in childbirth; mortality rates among new-born babies have been dramatically reduced. It is easy to forget how dangerous life and giving life is. "We've got very short memories," says Johnson.
"It's only been a matter of a generation since women and babies were dying in childbirth. It's as if we've collectively forgotten how the possibility for danger is always there in childbirth. "It's still there for women in the third world where women still die regularly in childbirth, or else their babies die. "Fistulas like mine occur regularly in most third world countries."
And even in the sterilised, hygiene-conscious, gowned and masked labour wards of the west, "Life and death will be right in the room with you, you will feel life's breath upon your face and know the throb of life's blood," Johnson writes. "You will sense for a moment the meaning of existence, how fragile the membrane is between life and death, and then the curtains will close again on life's mystery and you will be left with only the vaguest dream."
For after giving birth, you are hurled full-on into life. She gives a graphic description of what it is like to have a child that won't stop screaming. How your heart begins to pound, your temples throb, the spit on your tongue and between your teeth dries; there is sweat on the palms of your hand and the soles of your feet. "You will hear screams in the shower and in your dreams, you will hear screams through walls and through deepest sleep, you will hear screams through the very lining of your head. Your whole body will be one long scream and here is the rub; there is nothing you can do about it."
She tells you about the intimacies of her body and her life; about lactating and defecating; about her failures as a mother; about screaming incoherently at her two toddler sons because she can't bear them fighting; about pushing her elder son down the corridor because he refuses to go to sleep, pushing him so hard that he falls. She tells you about a marriage breaking down; the bickering about who's earning the money, the fears about having sex after a colostomy. "It's as honest as I could make it," says Johnson. "It became much more graphic and revealing than I had intended originally. But I thought, if I'm going to write about this subject I must do it in a way which is as honest as possible."
The marriage is back together, though Johnson's husband has reservations about the book, understandably. Johnson herself has no regrets apart from one brief passage when she talks about the irrational thoughts that go through your head when you're exhausted. In her diary entry for Sunday, November 12 1995, it occurs to her that she hasn't yet heard Caspar stirring and she thinks: "If he's dead, at least I'll be able to sleep."
If nothing else, Johnson's story is a vivid, lurid antidote to the romanticisation of motherhood and the myth of the have-it-all, do-it-all woman. This is someone privileged, educated - she has money and a supportive family - but she's no Nicola Horlick. Her passion is writing, which is squeezed into a few minutes while her children watch Teletubbies. She writes in her head because there isn't time to put it on paper. Babies will not fit into the cracks of life, as she puts it. Small children, she says, are like ink on blotting paper, "seeping out to the very edges of your life, leaving no white space whatsoever". Try to make them squeeze into the tiny spaces between the other parts of your life and it will take its toll: "We've bought the myth of the superwoman. That we can have it all. But perhaps there are costs for our children. Maybe we let them down in some way."
Of course we do, in some small way, every day. Johnson's book reminds us of that. It also reminds us of the terrible, terrifying beauty of having a child. It's life in the raw - blood, tears and BabyGap clothes. But we'd do it all again, wouldn't we?
In Johnson's words: "Yes, yes. A thousand times, yes."
• A Better Woman: A Memoir, by Susan Johnson, is published by Aurum Press, £12.99
