And I do want to mark this with a TRIGGER WARNING, because the descriptions of the things that can go wrong with a pregnancy may be understandably difficult for some women to read. I publish them not out of any sense of gratuitous voyeurism or shock value but to illustrate the need for basic human compassion in situations like that, and I'm grateful to the women who have shared such personal stories
The ruling against intact D&E, the ruling that allows the Supreme Court to overrule the best judgment of a physician and a pregnant woman, makes reference to the fact that the procedure in question is "gruesome." It's true. Most significant medical procedures are. But although an honest examination of the procedure is enough to squick a person out, so is an honest examination of the consequences, both physical and emotional, when a necessary medical procedure is made unavailable and politics are played with a woman's life, physical and emotional health, and future fertility.
Gretchen Voss shared her story with Marie Claire magazine.
When I was 18 weeks pregnant at my doctor's office in Lexington, Massachusetts, I remember eagerly anticipating the ultrasound that would tell my husband and me whether our baby was a boy or a girl. We were so excited, oohing and aahing like the giddy, expectant parents that we were.
The technician, however, was quiet, and I started to panic. We learned that the ultrasound indicated that the fetus had an open neural-tube defect, meaning that the spinal column had not closed properly. We had to go to Boston immediately, where a new, high-tech machine could tell us more.
In Boston, the doctor spoke using words no pregnant woman wants to hear - clinical terms like hydrocephalus and spina bifida. The spine, she said, had not closed properly, and because of the location of the opening, it was as bad as it could get.
What the doctors knew was awful: the baby would be paralyzed and incontinent, its brain smushed against the base of the skull and the cranium full of fluid. What they didn't know was devastating: would the baby live at all, and if so, with what sort of mental and developmental defects? Countless surgeries would be required if the baby did live, and none of them could repair the damage.
It sounds naive now, but I never considered pregnancy a gamble. Sitting in the doctor's windowless office, I tried to read between the lines of complicated medical jargon, searching for answers that weren't there. But I already knew what I had to do. Even if our baby had a remote chance of surviving, it was not a life we would choose for our child.
I asked over and over, "Are we doing the right thing?" Our family - even my Catholic father and Republican father-in-law, neither of whom was ever pro-choice - assured us that we were. Politics suddenly became personal - their daughter's heartbreak, their son's pain, their grandchild's suffering - and that changed everything.
Martha Mendoza, too, certainly wasn't hoping that her pregnancy would end in abortion.
I could see my baby's amazing and perfect spine, a precise, pebbled curl of vertebrae. His little round skull. The curve of his nose. I could even see his small leg floating slowly through my uterus.
My doctor came in a moment later, slid the ultrasound sensor around my growing, round belly and put her hand on my shoulder. “It’s not alive,” she said.
She turned her back to me and started taking notes. I looked at the wall, breathing deeply, trying not to cry.
I can make it through this, I thought. I can handle this.
I didn’t know I was about to become a pariah.
I was 19 weeks pregnant, strong, fit and happy, imagining our fourth child, the newest member of our family. He would have dark hair and bright eyes. He’d be intelligent and strong — really strong, judging by his early kicks.
And now this. Not alive?
My doctor turned around and faced me. She told me that because dilation and evacuation is rarely offered in my community, I could opt instead to chemically induce labor over several days and then deliver the little body at my local maternity ward. “It’s up to you,” she said.
I’d been through labor and delivery three times before, with great joy as well as pain, and the notion of going through that profound experience only to deliver a dead fetus (whose skin was already starting to slough off, whose skull might be collapsing) was horrifying.
I also did some research, spoke with friends who were obstetricians and gynecologists, and quickly learned this: Study after study shows D&Es are safer than labor and delivery. Women who had D&Es were far less likely to have bleeding requiring transfusion, infection requiring intravenous antibiotics, organ injuries requiring additional surgery or cervical laceration requiring repair and hospital readmission.
There was this fact, too: The intact D&E surgery makes less use of “grasping instruments,” which could damage the body of the fetus. If the body were intact, doctors might be able to more easily figure out why my baby died in the womb.
We told our doctor we had chosen a dilation and evacuation.
“I can’t do these myself,” said my doctor. “I trained at a Catholic hospital.”
My doctor recommended a specialist in a neighboring county, but when I called for an appointment, they said they couldn’t see me for almost a week.
I could feel my baby’s dead body inside of mine. This baby had thrilled me with kicks and flutters, those first soft tickles of life bringing a smile to my face and my hand to my rounding belly. Now this baby floated, limp and heavy, from one side to the other, as I rolled in my bed.
And within a day, I started to bleed. My body, with or without a doctor’s help, was starting to expel the fetus. Technically, I was threatening a spontaneous abortion, the least safe of the available options.
I did what any pregnant patient would do. I called my doctor. And she advised me to wait.
On my fourth morning, with the bleeding and cramping increasing, I couldn’t wait any more. I called my doctor and was told that since I wasn’t hemorrhaging, I should not come in. Her partner, on call, pedantically explained that women can safely lose a lot of blood, even during a routine period.
I began calling labor and delivery units at the top five medical centers in my area. I told them I had been 19 weeks along. The baby is dead. I’m bleeding, I said. I’m scheduled for a D&E in a few days. If I come in right now, what could you do for me, I asked.
Don’t come in, they told me again and again. “Go to your emergency room if you are hemorrhaging to avoid bleeding to death. No one here can do a D&E today, and unless you’re really in active labor you’re safer to wait.”
At last I found one university teaching hospital that, at least over the telephone, was willing to take me.
“We do have one doctor who can do a D&E,” they said. “Come in to our emergency room if you want.”
But when I arrived at the university’s emergency room, the source of the tension was clear. After examining me and confirming I was bleeding but not hemorrhaging, the attending obstetrician, obviously pregnant herself, defensively explained that only one of their dozens of obstetricians and gynecologists still does D&Es, and he was simply not available.
Not today. Not tomorrow. Not the next day.
No, I couldn’t have his name.
They inserted sticks of seaweed into my cervix and told me to go home for the night. A few hours later — when the contractions were regular, strong and frequent — I knew we needed to get to the hospital. “The patient appeared to be in active labor,” say my charts, “and I explained this to the patient and offered her pain medication for vaginal delivery.”
According to the charts, I was “adamant” in demanding a D&E. I remember that I definitely wanted the surgical procedure that was the safest option. One hour later, just as an anesthesiologist was slipping me into unconsciousness, I had the D&E and a little body, my little boy, slipped out.
Around his neck, three times and very tight, was the umbilical cord, source of his life, cause of his death.
This unnamed mother chose to spare her child the constant pain of a rare and unexplained disorder.
In November, when I was 22 weeks pregnant, we received news that would forever change our lives. A sonogram at the perinatologist’s office revealed that our son, Thomas, had a condition known as arthrogryposis. The doctor’s face spoke volumes when he returned from fetching a medical book to confirm the rare diagnosis. He explained that arthrogryposis was a condition that causes permanent flexation of the muscle tissue. The condition could be caused by over 200 different diseases and syndromes, with a wide array of severity.
He asked for permission to do an immediate amniocentesis, and for the first time he used the word “termination. It was then that I first realized the gravity of our situation.
My husband and I were shocked and struggled to comprehend what we were being told.. It would take two weeks to receive the results of the amniocentesis, which might reveal the cause of the arthrogryposis, but we already knew that the prognosis was not good.
The ultrasound showed that Thomas had clubbed hands and feet. His legs were fixed in a bent position and his arms were permanently flexed straight. He had a cleft palate and swelling on his skull - a condition that would likely kill him in and of itself. Due to his inability to move, Thomas’s muscles had deteriorated to 25% or their usual size, and his bones to 25% of their usual density.
My husband and I were sent home to grapple with the news and face an unwelcome decision: whether or not to continue with the pregnancy.
… By the time the amnio results came back, we had two days left to make a decision before hitting the 24 week mark – after which, no doctor in Texas would terminate a pregnancy. The results were devastating. Our son had no chromosomal disorder. There was no explanation at all for his condition, and as such, no way to predict the scope of his suffering. We would have to make our decision based strictly on what the ultrasound had revealed.
My husband and I decided that we would have to use the golden rule. We would do for Thomas what we would want done for us in the same situation.
We tried to look at the evidence as honestly as we could. Even the best case scenario was abominable.. Thomas would lead a very short life of only a few years at the very most. During those years he would be in constant pain from the ceaseless, charley-horse-type cramps that would rack his body. He would undergo numerous, largely ineffective surgeries, just to stay alive. He would never be able to walk or stand; never grasp anything, never be able to hold himself upright. He wouldn’t even be able to suck his own thumb for comfort. And this was only if we were lucky. The more likely scenarios tended toward fetal death and serious health complications for me.
We made our decision with one day to go and left for Houston where we would end Thomas’s suffering in one quick and painless moment. Though we wanted to stay at home, _______ was no longer an option, as all of the hospitals were religiously-backed and there was no time to convene an ethics committee hearing.
In Houston, God graced us with some of the most compassionate people we’d ever met. The first was our maternal-fetal medicine specialist, who confirmed that the prognosis was even direr than originally thought. In a procedure very similar to an amniocentesis, Thomas’s heart was stopped with a simple injection. In that moment, as I held my husband’s hand, I met God and handed him my precious boy to care for, for all eternity.
Over the next 17 hours I labored to deliver Thomas’s body. It was a painful experience, but the only option given to a woman at 24 weeks gestation. Thomas Stephen _______ was born into this world just after 6:00 a.m. on November 27, 2002 – the day before Thanksgiving.
The loving nurse who’d helped us through labor cleaned his fragile body and brought him to us. We held our boy for the next hour as we said goodbye. Our own eyes confirmed what our hearts had already come to know: that Thomas was not meant for this world. The hospital’s pastor joined us and we christened Thomas in the baptism bonnet I’d worn as an infant.
On that same page, follow the link to "Loving Zeke" for a reminder that the freedom to choose includes the freedom to carry a fetus to term, regardless of the circumstances.
It's easy to look at a healthy baby sleeping peacefully or a healthy toddler running around in the park in the sunshine and imagine a perfect world where every fetus grows into one of those healthy kids. Unfortunately, our world is far from perfect, and problems arise in pregnancies every day - serious, life-threatening problems that happen to much-wanted and already-loved children. To pass a universal law on a subject that concerns only unique individual cases is ridiculous. To legislate with some imaginary, perfect world in mind is not going to make that world come into being.
It will, however, hurt people. It hurts women. Forcing a woman to carry around the body of a fetus that will never see toddlerhood, that will live a short, miserable life (if it lives at all) while she waits for the court to rule from on high as to whether she's worthy of the medical procedure her doctor recommends is gruesome and inhumane. Forcing a woman to endure the pain of labor and vaginal delivery of a dead body or of a fetus that will live a brief, miserable life is gruesome and inhumane. Forcing a woman to undergo a D&E, dismembering the fetus and leaving her without so much as a body to hold and grieve over because a Supreme Court justice finds the alternative unpalatable, is gruesome and inhumane.
What isn't gruesome and inhumane? Understanding. Sympathy. Compassion.
[A]mong the audience members was a Los Angeles physician named James McMahon, who had made a specialty of performing late intacts and then bringing the fetuses to women who had asked to see them. “Having it intact was a goal, so they could do that, and have this closure,” recalls McMahon's widow, Gale McMahon, a nurse who helped run McMahon's practice until he died of complications from a brain tumor in 1995. “I knew what it meant to these women, to be able to hold them, and be able to coo over them and say goodbye. It was profound. I got material, and sewed little tiny sheaths, and we got tiny hats we could dress them in. I would put them on a clean cloth, and I would swathe them. Many women spent hours in there, and showed them to their other children. It was always treating the babies with the respect the parents would want them to.”