Four months into my third pregnancy, far enough along that I’d managed to quiet the anxiety I’d felt in the wake of two previous losses, I went for a routine checkup and was told my son was in trouble. My son. Miles. That was the name we’d chosen for him. We had heard the whooshing of his heartbeat. We had seen him grow limbs. We had watched those limbs flail about on the screen. Genetic testing had confirmed he was healthy. We had nothing to fear. Or so we thought.
At that four-month ultrasound, the black sea of amniotic fluid that had surrounded him before was gone. He was squished between small pockets of black, tucked in on himself, so contorted it was difficult to know what we were looking at. The doctor explained that there could be a deformity with his kidneys or urinary tract preventing him from processing and excreting the amniotic fluid. He said it could also be a problem with the placenta, or a tear in the membrane, leading to leakage. When I asked what would happen if the fluid levels didn’t improve, he said Miles would likely press against his umbilical cord, cutting off his only life line. Even if that didn’t happen, there was a risk of severe birth defects from vital organs getting compressed.
There was nothing to do but wait and see.
After two weeks of bed rest, I went back to the doctor. I’d had no signs of anything being wrong so I was cautiously optimistic. Then, just seconds into the ultrasound, the doctor sighed and said, “I’m not seeing a heartbeat.” I heard a primal-sounding scream and it took a moment to realize it was coming from me.
I was too far along for a D&C (dilation and curettage), so there were two options: A D&E (dilation and evacuation), which involves dilating the cervix with medications and/or instruments, then taking apart the fetus and removing it through the dilated cervix; or labor induction. I couldn’t imagine giving birth to Miles. The doctor said he’d been dead for nearly two weeks. I wanted to see him in my mind as a healthy baby, not a lifeless, gray, very miniature human. I opted for the surgery.
“I don’t actually do D&Es,” the doctor said. He gave me the card for someone who did. I was confused about this until I did some googling and realized that D&Es are most often performed by doctors who see women for abortions. Many doctors, especially those affiliated with religious hospitals like mine, do not know how to do this procedure.
When I was sent to a clinic nearly an hour away, I couldn’t shake the feeling of being punished for my predicament. The doctor who saw me was exceedingly kind. His wife was his assistant. She wiped tears from my eyes as he placed small rod-like devices inside my cervix so I would be dilated enough for them to remove Miles from me the next day. This was as excruciating as it sounds.
On the day of the surgery, two words were written in black marker on the packet they gave me: fetal demise. I can’t imagine a more depressing pair of words. I was put under anesthesia and next thing I knew, it was done. My son was no longer with me. As painful as this reality was, I was grateful for the surgery. It allowed my body to let go and it allowed me to begin the process of grieving.
I desperately wanted to carry Miles to term. He was my third loss. I had another after him before giving birth to my daughter. I might seem like the last person who would support abortion rights, but I do. Becoming part of the pregnancy loss community has made me intimately aware of the complexities of abortion and why access to this procedure is so important.
While the Supreme Court is allowing federal court challenges to Texas’ restrictive abortion law, it is still leaving the law in effect, meaning abortions after six weeks are outlawed in that state. If restrictions on abortions become the norm in this country, that doesn’t just affect women who don’t want their pregnancies; it affects many women who do. Here’s why:
Abortions are sometimes needed for women who want their pregnancies.
There are tragic cases of women who come to find that they are carrying a baby with defects that are incompatible with life. The baby’s heart is still beating, but there is no hope of long-term survival. In her book Poor Your Soul, Mira Ptacin writes about her experience with this upon finding out of her daughter’s severe defects: “Their facts were incessant. Words I couldn’t pronounce. Holoprosencephaly. Images I cannot forget. Clubbed feet. Deformed spine. Collapsed skull. Broken heart.”
When most people think of abortion, they don’t think of the women like Mira Ptacin who have to terminate for medical reasons (TFMR). They don’t think of the agony these women would endure if they could not terminate, if they had to carry a doomed baby to term, only to watch him or her die outside the womb, after an inevitably traumatic labor. These women don’t want to abort their pregnancies. Abortion, for them, is a heartbreaking necessity.
With abortion bans in place, doctors may feel handcuffed when it comes to doing what’s best for their patients. One tragic example of this is a case in Poland, which has a strict ban on abortions. Izabela, a 30-year-old woman, was in her 22nd week of pregnancy when doctors noticed a lack of amniotic fluid (as I experienced with my son). Instead of intervening to end the pregnancy, her doctors took a “wait and see” approach. She died of septic shock. Sadly, there have been similar cases in Italy and Ireland.
Abortion bans may mean doctors are not trained in procedures needed for pregnancy losses.
According to a new study published in Obstetrics and Gynecology, residents who were in programs without training in providing abortions felt less prepared to offer care to people experiencing pregnancy loss.
Dr. Jody Steinauer, one of the authors of the paper and Director of the Bixby Center for Global Reproductive Health at the University of California, San Francisco, said, “As states become increasingly hostile to abortion access, it’s imperative that people understand how essential abortion training is and find a way to get these residents trained. Without this training, people around the country will lose access to not only abortive care, but also to comprehensive, patient-centered care for pregnancy loss.”
Dr. Nikki Zite, a co-author of the paper, said, “If we’re sending residents out into the world less prepared to provide this type of care, patients might not be offered all the options because their physician lacks the confidence to provide them.”
As it is, pregnancy loss is associated with a high rate of posttraumatic stress. In the largest study so far to assess the psychological impact of early-stage pregnancy loss, approximately one in four women suffered posttraumatic stress one month after a pregnancy loss. Restrictions on abortions translate to restrictions on options for women who are enduring pregnancy loss, thereby compounding their trauma.
It’s time to put women first. As a Polish abortion rights group wrote in the wake of Izabela’s death, “They were waiting and watching, until the fetus’s heart stopped beating. She also had a heart that kept on beating.” Yes. There are so many women, like me, with beating hearts who deserve the very best care possible.
This post was written by Kim Hooper, co-author of All the Love: Healing Your Heart and Finding Meaning After Pregnancy Loss.
