If a woman becomes pregnant, she can continue her work outside these restrictions. Work assignments are adjusted to activities without unusual risks, and she remains a productive member of the astronaut corps by assuming one or more of the many technical duties in the branches of the Astronaut Office. As federal employees, women astronauts are able to use sick leave, vacation leave, and family medical leave for their preferred maternity leave duration, usually six weeks to three months. Some women are able to arrange with the chief of the Astronaut Office for part-time work during their maternity leave. Astronauts willing to share their experience reported that they were treated with respect and understanding during pregnancy and childbirth, and so were the women who adopted children. Supervisors and peers were supportive in meeting their needs and adjusting their work assignments as appropriate.

  Rhea Seddon and Anna Fisher, both medical doctors, were the first astronauts to become pregnant. Seddon gave birth first, in 1982, an event that made national news and earned her son the nickname “astrotot,” bestowed by Time magazine. Fisher was the first to fly after giving birth in 1983 and was hailed as the first mom, or “astromom,” in space on her 1984 mission. Both shared their stories in interviews, and Seddon included hers in her memoir.[52] Their accounts reflect some of the considerations affecting the first generation of women astronauts.

  Seddon recounted planning three pregnancies between her missions. As a result of her flight schedule, her children were spaced farther apart than she might otherwise have chosen, with births in 1982, 1989, and 1995. She recalled that at first NASA management seemed caught by surprise and had not yet considered policies for pregnancy. Decisions about what she could and couldn’t do were made on the fly until a more deliberate process developed. Although they were congratulated and encouraged, she and Fisher typically were not consulted about those early rules but found them generally reasonable. Both Seddon and Fisher became pregnant before their first spaceflights, and both waited some time to announce their pregnancies, cautious about possible impacts on their careers. They made it clear that they intended to stay in the corps and do their jobs, and they did not face the consequences for becoming pregnant—demotion or firing—that women working in aerospace had suffered ten to twenty years earlier. Later astronauts did not feel a need to be discreet after the precedent of pregnancy was established.

  Fisher received her mission assignment when she was eight and a half months pregnant and began training shortly after giving birth. She was thirty-three years old, had been at NASA five years, and did not want to miss this chance to fly. She intentionally returned to the office for the Monday morning staff meeting after giving birth on Friday to leave no doubt that she was not debilitated by pregnancy and childbirth and that she would continue to fulfill her astronaut responsibilities. After her second child was born in 1989, Fisher took successive leaves of absence and part-time work to be home with her young children until they reached school age.

  Eileen Collins, from the second generation of women astronauts, became pregnant twice in the 1990s. She commented in her memoir on the trade-offs of trying to plan a pregnancy between missions, often a two- to three-year gap.[53] Mission scheduling can be somewhat erratic with technical problems causing delays or a shuffling of the flight sequence, so it is difficult to predict when you may have an open window and how long it will last. It is also difficult to predict how long it will take to conceive. A woman who is trying to become pregnant is required to alert the Astronaut Office so she will be put on nonflight status and not be assigned to an upcoming mission. For how long should she take herself out of consideration for flight, or should she delay pregnancy in hopes of being assigned to a mission? That decision is one of the balancing acts that only female astronauts face. One astronaut confided that she kept herself on nonflight status for three years without becoming pregnant before returning to active status to pursue a chance for another mission.

  Most female astronauts who want to have children are successful.[54] Including Seddon, who bore three children, and Fisher, who had two, more than twenty women (about one third of the female astronauts to date) have had pregnancies and childbirths before, during, or after their time in the astronaut corps, yielding a total of forty children. All of these women have flown at least once, and most have flown more often. At least three women astronauts successfully adopted children to start their families, and several others gained stepchildren by marriage.

  At a baby shower: (front) Eileen Collins, Kalpana Chawla, Lisa Nowak, Stephanie Wilson; (rear) Kay Hire, Shannon Lucid, Ellen Ochoa, Tammy Jernigan, Anna Fisher, Linda Godwin, Bonnie Dunbar, Janice Voss (standing), Cady Coleman. Ellen Ochoa

  Several women interviewed for this book commented on their experiences in becoming mothers while they were astronauts. They noted that the Astronaut Office was supportive during pregnancy and maternity leave, and they were readily assigned to flights when they returned to work. All reported being able to take the amount of leave they wanted to spend with their infants. Some negotiated part-time work assignments after childbirth to avoid falling behind in their responsibilities. One who adopted a child was able to negotiate a flexible work schedule for several weeks, allowing her to spend time at home bonding with the baby but come in for training sessions so she could remain on her assigned mission.

  Some told anecdotes that probably have no counterpart among male astronauts.[55] One woman resumed her regular work schedule, which included underwater EVA training for six to eight hours a day, while she was still lactating, an experience that she would not care to repeat. Others who were working as CAPCOM on nine-hour shifts had to excuse themselves occasionally to pump milk in a restroom near Mission Control. At least once a pregnant astronaut was summarily removed from a crew already training for a mission, although she would have delivered her baby well before flight. She was later reassigned to another mission but felt the situation could have been handled better by consulting with her. Except for that instance, women astronauts felt that their needs were accommodated, and becoming mothers while on the job had no adverse effect on their careers.

  Fisher had a unique experience after having her first child, flying her first mission, having her second child, and deciding to stay home for a period longer than typical maternity leave. When she returned to full-time duty in the Astronaut Office in 1996 after an absence of seven years, her return proved more challenging than she expected because the office environment and technology had changed so much. During that time, many of her astronaut colleagues from the 1980s had moved on, and she didn’t yet know the newcomers. Typewriters had disappeared in favor of desktop computers, paper correspondence was replaced by email, and overhead projectors and viewgraphs had yielded to PowerPoint presentations. The pace of work had quickened with these technologies, and she had to catch up quickly with new ways of doing things. She still knew the astronaut job, but technology had changed many of the ways of doing it. Fisher has cited that time as the most challenging in her career.[56]

  Looking ahead to long-duration missions beyond Earth lasting a year or more, medical specialists assert that “it will be imperative to prevent pregnancies” in space until the effects of microgravity and radiation on pregnancy and human development are understood.[57] Nor is it yet clear how to deal with common complications, such as miscarriage, ectopic pregnancy, preeclampsia, breech birth, Caesarean delivery, or postpartum hemorrhage at such a distance from emergency medical care on Earth and with only limited available resources on the spacecraft. Younger astronauts in today’s astronaut corps may face different issues and have somewhat different needs related to pregnancy and childbearing as they become eligible for significantly longer missions.

  Fertility

  The 1999 workshop report on gender differences discussed earlier included a fairly radical idea at the time: that assisted reproductive technologies should be included in the medical care of female astronauts who postponed pregnancy until completing their training and first missions and then sought to become pregnant at ages of declining fertility. Jennings, a workshop participant, wrote an internal white paper on the topic, and Jennings and Baker’s review of gynecological issues for spaceflight, published the next year, recognized “a considerable need for infertility services and assisted reproductive technology (ART),” especially for older female astronauts who had delayed pregnancy.[58] After examining the data then available and caring for women astronauts, he noted that the average maternal age after spaceflight was forty-one to forty-two years, an age at which fertility was diminished and the chances of miscarriage and genetic defects were increased. At that time, he reported that the miscarriage rate in women astronauts after spaceflight exceeded 40 percent, most likely due to their age, because it was not yet (and still is not) known whether spaceflight affects fertility.

  Jennings’s opinion that NASA should support ART services for its astronauts arose from certain realities.[59] He noted that most women who entered the astronaut corps had not yet had children, and those who wanted children were waiting until they had served NASA in space, in essence sacrificing their most fertile years to their duties. It would be reasonable for the agency to repay their service by enabling the freezing of younger astronauts’ ova and embryos for future fertilization/transfer and supporting fertility assistance such as in vitro fertilization (IVF) for older astronauts. He made the case that military astronauts received monetary support for fertility services while civilians bore their own expenses, and the disparity was unfair. Thereafter, almost everything NASA published on reproductive health included discussion of delayed pregnancy among female astronauts and the advisability of ART. Jennings continued to champion this cause until NASA adopted in 2012, after more than ten years’ consideration, a policy of supporting infertility and reproductive services, to include freezing eggs and embryos, in vitro fertilization, and other assistive procedures for conception.

  Before this happened, Rhea Seddon was among the first to seek such services to enable another pregnancy after her final mission, when she was well into her forties. She already had borne two children but felt that her family was not yet complete. When pregnancy did not happen quickly, she persuaded her husband, astronaut Robert L. “Hoot” Gibson, to “let me give all our money to the fertility experts.”[60] She was thrilled to give birth again when she was forty-seven years old. Several women astronauts since have tried implantations and IVF with low and mixed success; the instances of successful pregnancies and miscarriages were about equal in astronauts aged forty and older, as also for the non-astronaut population.[61] It is not yet possible to distinguish effects of microgravity or radiation in spaceflight from the effects of normal aging on infertility.

  Women astronauts, like countless women, have been able to exercise autonomy, choose among options, and make reproductive decisions that are compatible with their careers. NASA has supported their decisions without detriment to their professional success. However, public policies and laws that restrict or criminalize reproductive health management and care are a growing concern.

  Behavioral Health and Performance

  Some physicians think that behavioral health is as important as physical health for individuals and crews working in extreme environments, such as submarines, Antarctica, and space. Isolation and confinement are major psychological stressors that may affect mental state and behavior. People in those environments must depend on one another for safety and survival, so any behavior or mental condition that can cause a person to jeopardize safety, crew cohesion, or mission success is of concern for spaceflight.[62] That concern is addressed initially when astronaut applicants undergo psychological and psychiatric assessments during the semifinalist round of selection. Between 1 and 5 percent of applicants are disqualified by psychiatric illness, ensuring that no one with a known history or propensity for behavioral disorders or mental dysfunction is admitted into the astronaut corps.[63]

  No matter how behaviorally and psychologically stable high-achieving astronauts may be naturally, as humans they may be at risk for stress from living and working in space, striving for excellence, and interacting with diverse personalities. Before the International Space Station existed for long-duration spaceflight, reports from cosmonauts, Skylab crews, and research expeditions indicated psychological issues that can arise on missions and the value of preparation and crew support.[64] Individual behavior and interpersonal relations, self-control, clear communication, and teamwork are crucial to mission success. At some point, though, friction may flare, patience may fail, and morale may dip. Poor sleep is often a trigger for irritability, which may then trigger other inappropriate behaviors. It is important to recognize and address such warning signals before they develop into anger, alienation, anxiety, or worse.

  To that end, astronauts are trained in various techniques to manage their own, and support their crew’s, behavioral health. Such training may include personality typing, personal counseling, participating in an analog mission like NEEMO or CAVES or another remote research expedition, taking a wilderness survival course together to improve teamwork and communication skills, developing leadership and followership skills, practicing problem solving and decision making, and learning more about the culture of their international partners. There have been no publicly reported behavioral incidents on space shuttle and International Space Station missions, and there is no scientific indication that men and women differ in reactions to stress or in behavioral health in space.[65] However, interest in research into the conditions that affect behavioral health grew during the shuttle and space station eras as mixed crews spent longer and longer periods in space.

  Research and flight experience since the 1970s have settled on some of the triggers and remedies for behavioral health issues, with a view toward supporting astronauts individually and supporting the productivity of crews as a whole. Physician Patricia Santy took an early look at the relevance of psychiatry to aerospace medicine in 1983.[66] She described the traits of “psychological fitness” for successful performance as an astronaut: emotional stability, high motivation and energy level, emotional control, confidence, good interpersonal relationships, and commitment to the mission. She also discussed, based on studies of submariners and isolated Antarctic researchers, some of the symptoms that could negatively affect performance in an isolated environment: irritability, disorientation, deficits in cognition, and more. Without remedy, group compatibility and performance reportedly declined on prolonged expeditions. Santy postulated that training in group dynamics, problem solving, and conflict resolution would be helpful. She also noted the importance of comfort in the living-space environment, food, personal hygiene, adequate sleep, communication, time off, music, and the option of being alone for astronauts’ well-being and morale. Santy’s review was followed shortly by NASA volumes that addressed the stresses and behavioral implications of spaceflight.[67]

  One of the workgroups tasked by the National Academy of Sciences to review the effects of sex and gender on adaptation to space focused on behavioral health. Their report, published in 2014, noted that there was some evidence, in the general population on Earth, that women had a heightened sensitivity to stress evidenced in higher cortisol and adrenaline levels, and that women were more subject to anxiety, panic, and depressive episodes than men.[68] It was unknown whether similar tendencies occurred in space because no such research existed, but it was considered unlikely that there would be significant differences among astronauts given their psychological screening. It was also noted how alike in personality traits male and female astronauts were. In another study of a mixed group of space station residents asked to keep journals on specific topics, there was no difference between men and women in self-rated parameters of fatigue, stress, workload, or sleep quality, or in accounts of their moods, but an interesting finding was that morale began to decline in the third quarter of their expeditions.[69] By that point, possible reasons included that having mastered their work, it was becoming routine, and that the long absence from home was taking a toll.

  Astronauts train for and simulate most of what can go wrong on a mission, from balky equipment that must be repaired to life-threatening emergencies like a leak in cabin air pressure or a spacesuit. That training equips them to act in problem-solving mode rather than frustration or panic and thus prepares them to cope calmly with stress. Among the stressful situations handled by women astronauts were repair of an inconveniently nonfunctioning toilet (Mary Cleave), which really affected the quality of onboard life; a loss of thrust in a shuttle main engine during ascent (Eileen Collins); a jammed airlock hatch precluding her spacewalk (Tammy Jernigan); and an ill-fitting spacesuit that would compromise her performance and safety (Anne McClain). Surely there were many other stressful circumstances handled quietly that were not reported in the news media. Both women and men have dealt capably with stressors, and there have been no reported breakdowns in NASA astronauts’ behavioral health that put a spaceflight in jeopardy.

  Early astronauts had an aversion to psychologists, psychiatrists, and flight surgeons for fear of being grounded for some perceived weakness. They didn’t want to be analyzed. That attitude gradually changed, in part because the culture changed within the aerospace medical community and society at large. The perceived stigma of counseling for behavioral and emotional issues has virtually disappeared, and the medical approach has become more supportive than negative. It is also likely that the contemporary term “behavioral health” is friendlier and draws less wariness than “psychiatry.”[70] NASA has always had flight surgeons on staff to monitor the astronauts’ physical heath, but in preparation for longer duration flights on the International Space Station, the agency drafted a team of psychologists to determine how best to prepare and support crews who would be living and working in space for months at a time. The Flight Medical Clinic at JSC established a Behavioral Health and Performance Center staffed with psychologists and psychiatrists whose goal is to help ensure mission success.[71] They have been closely involved with the astronauts from candidacy onward, conducting the initial screenings and consulting with astronaut selection boards. They don’t have a vote in astronaut selection, but their assessments are taken seriously. Thereafter, their mission is to help their clients be as successful as possible in their job performance and management of stress or other difficulties. Until about 2005, they did not regularly follow individual astronauts but assisted them upon request. Now every crewmember is assigned a psychiatrist and a psychologist throughout their mission and evaluated for behavioral fitness to fly at least three times before launch.[72] They have private check-in conferences during flight and have relationships based on trust. Staff report that astronauts and their families, who also bear stress related to the spouse’s or parent’s job, now welcome this support and avail themselves of the counseling services offered there.[73]