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Child-Bearing Loss

My Late-Term Abortion

by Gretchen Voss. This article was originally published in the 1.25.04 edition of the Boston Globe Magazine and is posted with permission.

Way too excited to sleep on that frigid April morning, I snuggled my bloated belly up to my husband, Dave. Eighteen weeks pregnant, today we would finally have our full-fetal ultrasound and find out whether our baby was a boy or a girl. I had no reason to be nervous, I thought. I was young (if 31 is the new 21), healthy, and had not had so much as a twinge of nausea. Well into my second trimester, I was past the point of worrying about a miscarriage.

The past 3 1/2 months had been a time of pure bliss -- dreaming about our future family, squirreling away any extra money that we could, and cleaning out a room for a nursery in our cozy, suburban home, then borrowing unholy amounts of stuff to fill it back up. From the day that we found out we were expecting a baby -- on New Year's Eve 2002 -- we thought of ourselves as parents, and finding out whether the "it" was a he or she would cap the months of scattershot emotions and frenetic information-gathering. I just couldn't sleep. I invited our 105-pound yellow Labrador "puppy" into bed with us and snuggled even closer to Dave.

Later that morning, at quarter past 9, Dave held my hand as I lay on the cushy examining table at the Beth Israel Deaconess Medical Center office in Lexington. As images of our baby filled the black screen, we oohed and aahed like the goofy expectant parents that we were. "Can you tell if it's a boy or a girl?" I must have asked a million stupid times. The technician was noncommittal, stoic, and I started feeling uncomfortable. Where I was all bubbly chitchat, she was all furrow-browed concentration. She told us that she had a child with Down syndrome, and that none of her prenatal tests had picked it up. I thought that was odd.

Then, using an excuse about finishing something on her previous ultrasound, she left the room. Seconds passed into minutes while we waited for her to return. Staring at the pictures of fuzzy kittens and kissing dolphins on the ceiling, I knew something was wrong. Dave tried to reassure me, but when the ultrasound technician told us that our doctor wanted to see us, I started to shake. "But she doesn't even know we're here," I said to her, and then to Dave, over and over. That's when I started crying. I could barely get my clothes back on.

The waiting room upstairs, usually full of happy pregnant women devouring parenting magazines, was empty. Our doctor, who usually wears a smile below her chestnut hair, met us at the front desk. She was not smiling that day as she led us back to her cramped office, full of framed photos of her own children.

As we sat there, she said that the ultrasound indicated that the fetus had an open neural tube defect, meaning that the spinal column had not closed properly. It was a term I remembered skipping right over in my pregnancy book, along with all the other fetal anomalies and birth defects that I thought referred to other people's babies, not mine. She couldn't tell us much more. We would have to go to the main hospital in Boston, which had a more high-tech machine and a more highly trained technician. She tried to be hopeful -- there was a wide range of severity with these defects, she said. And then she left us to cry.

We drove into Boston in near silence, tears rolling down my cheeks. There was no joking or chatting at the hospital in Boston. No fuzzy kittens and kissing dolphins on the ceiling of that chilly, clinical room. Dave held my hand more tightly than before. I couldn't bear to look at this screen. Instead, I studied the technician's face, like a nervous flier taking her cues from the expression a stewardess wears. Her face revealed nothing.

She squirted cold jelly on my belly and then slid an even colder probe back and forth around my belly button, punching it down every so often to make the baby move for a better view. She didn't say one word in 45 minutes. When she finished, she looked at us and confirmed our worst fears.

Instead of cinnamon and spice, our child came with technical 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 got. What they knew -- that the baby would certainly be paralyzed and incontinent, that the baby's brain was being tugged against the opening in the base of the skull and the cranium was full of fluid -- was awful. What they didn't know -- whether the baby would live at all, and if so, with what sort of mental and developmental defects -- was devastating. Countless surgeries would be required if the baby did live. None of them would repair the damage that was already done.

I collapsed into Dave. It sounds so utterly naive now, but nobody told me that pregnancy was a gamble, not a guarantee. Nobody told me that what was rooting around inside me was a hope, not a promise. I remember thinking what a cruel joke those last months had been.

We met with a genetic counselor, but given the known as well as the unknown, we both knew what we needed to do. Though the baby might live, it was not a life that we would choose for our child, a child that we already loved. We decided to terminate the pregnancy. It was our last parental decision.

So this is our story -- mine, my husband's, and our baby's. It's not a story I ever thought I'd share with a mass audience, because, frankly, it's nobody's business. But now it is.

On November 5, George W. Bush signed the first federal ban on any abortion procedure in the 30 years since Roe v. Wade, and the first ban of a surgical technique in the history of this country.

"I'm pleased that all of you have joined us as the Partial-Birth Abortion Ban Act of 2003 becomes the law of the land," Bush said. After singling out 11 political supporters of the bill -- all of them men -- the president whipped the 400-strong, antiabortion crowd into a frenzy. "For years a terrible form of violence has been directed against children who are inches from birth, while the law looked the other way," he said to cheers and whoops and hollers.

The signing ceremony staged by the White House was part evangelical tent revival, part good ol' boy pep rally, ending with the audience muttering "Amen." The president stoked the crowd's moral indignation with emotional platitudes like "affirming a basic standard of humanity" and "compassion and the power of conscience" and "defending the life of the innocent."

But on that Wednesday afternoon, President Bush never addressed what, exactly, the ramifications of the bill would be. His administration portrayed it as a bill aimed solely at stopping a "gruesome and barbaric" procedure used by healthy mothers to kill healthy babies. That portrayal served to spark a national, emotional knee-jerk reaction, which precluded any understanding of the practical outcome of the legislation. But it was those very real practicalities that immediately prompted three lawsuits and got three federal courts to prevent the bill from actually becoming law, starting a fight that will probably drag on for years.

At the heart of the debate is a term that legislators concocted. They created a nonexistent procedure -- partial-birth abortion -- and then banned it. They then gave it such a purposely vague definition that, according to abortion providers as well as the Supreme Court, which ruled a similar law in Nebraska unconstitutional, it could apply to all abortions after the first trimester.

Though some proponents of the bill say that they merely want to ban a specific medical procedure -- properly called intact dilation and extraction, which accounts for fewer than one-fifth of 1 percent of all abortions in this country, according to a 2000 survey by the Alan Guttmacher Institute -- they never specifically called it that. Instead, the bill is written in such a way that the much more common procedure -- dilation and evacuation, which accounts for 96 percent of second-trimester abortions, including my own -- would also be banned.

Supporters of the ban have argued that this procedure is used on babies that are "inches from life." But in the bill, there is no mention of fetal viability (the point at which a fetus could live independently of its mother for a sustained period of time). Nor is there any mention of gestational age. Thus, the ban would cover terminations at any point during pregnancy. (In fact, Roe v. Wade already protects the rights of a fetus after the point of viability, which occurs sometime after the 24th week of gestation, in the third trimester of pregnancy. Massachusetts bans all abortions at and beyond the 24th week, except to protect the life or health of the mother. Indeed, according to the Massachusetts Department of Public Health, in 2001 there were only 24 abortions after the 24th week, out of a total of 26,293 abortions.) By not mentioning viability, critics say, this ban would overturn Roe v. Wade, which clearly states that women have the right to abortion before fetal viability.

So what does it all really mean? It means that all abortions after the first trimester could be outlawed. No matter if the fetus has severe birth defects, including those incompatible with life (many of which cannot be detected until well into the second trimester). No matter if the mother would be forced to have, for example, a kidney transplant or a hysterectomy if she continued with the pregnancy. (Legislators did not provide a health exception for the woman, arguing that it would provide too big a loophole.)

In the aftermath of the signing of the bill, its supporters spoke about having outlawed a medical procedure and protecting the nation's children. "We have just outlawed a procedure that is barbaric, that is brutal, that is offensive to our moral sensibilities," said Bill Frist, the Senate majority leader. Its opponents bemoaned an unconstitutional attack on legal rights. "This ban is yet another instance of the federal government inappropriately interfering in the private lives of Americans, dangerously undermining . . . the very foundation of a woman's right to privacy," said Gregory T. Nojeim, an associate director and chief legislative counsel for the American Civil Liberties Union.

But lost in the political slugfest have been the very real experiences of women -- and their families -- who face this heartbreaking decision every day.

I don't know what was worse, those three days leading up to the procedure (I have never called it an abortion) or every day since. I clung to Dave. He was always the rock in our relationship, but I now became completely dependent on him for my own sanity. Though abortion had never been part of his consciousness, he was resolved in a way that my hormones or female nature or whatever wouldn't let me be. But I worried about him, too. The only time I saw him crack was after his brother -- his best friend -- left a tearful message on our answering machine. Then I found Dave kneeling on the floor in our bathroom, doubled over and bawling, his body quaking. That nearly killed me.

I don't remember much from those three days. Walking around with a belly full of broken dreams, it felt like what I would imagine drowning feels like -- flailing and suffocating and desperate. Semiconscious. Surrounded by our family, I found myself tortured by our decision, asking over and over, are we doing the right thing? That was the hardest part. Even though I finally understood that pregnancy wasn't a Gerber commercial, that bringing forth life was intimately wrapped up in death -- what with miscarriage and stillbirth -- this was actually a choice. Everyone said, of course it's the right thing to do -- even my Catholic father and my Republican father-in-law, neither of whom was ever "pro-choice." Because suddenly, for them, it wasn't about religious doctrine or political platforms. It was personal -- their son, their daughter, their grandchild. It was flesh and blood, as opposed to abstract ideology, and that changed everything.

I was surprised to find out that I would no longer be in the care of my obstetrician, the woman who had been my doctor throughout my pregnancy. It turned out that she dealt only with healthy pregnancies. Now that mine had gone horribly wrong, she set up an appointment for me with someone else, the only person who was willing to take care of me now. I felt like an outcast.

As we drove to his private office in Brookline that Monday, April 7, 2003, I couldn't shake the feeling that we were going to meet my executioner. I had never met this doctor, but I did look him up online. With thick, mad-scientistlike glasses, he looked scary. In person, though, he reminded me in both looks and manner of Dr. Larch in The Cider House Rules. He had the kindest, saddest eyes I had ever seen, and he sat with us for at least an hour, speaking to us with a heartfelt compassion and understanding that I had never encountered from any doctor before. His own eyes teared as Dave and I cried.

He explained the procedure to us, at least the parts we needed to understand. Unlike a simple first-trimester abortion, which can be completed in one quick office visit, a second-trimester termination is much more complicated, a two-day minimum process. He started it that day by inserting four laminaria sticks made of dried seaweed into my cervix. It was excruciating, and he apologized over and over as I cried out in pain. When I left the examining room, my mom and my husband were shocked -- I was shaking and ghostly white. The pain lasted throughout the night as the sticks collected my body's fluids and expanded, dilating my cervix just like the beginning stages of labor.

The next morning, Dave and my mother took me to the hospital in Boston. I was petrified. I had never had any sort of surgery, and I fought the anesthesia -- clinging to the final moments of being pregnant -- as I lay in that stark white room. As I started to drift off, my doctor held one of my hands, and an older, female nurse held my other, whispering in my ear, "You're going to be OK, I've been here before, lean on your husband." It was my last memory. When I woke up, it was all over.

Dave had to return to work the next day. He didn't want to leave me, and he certainly didn't want to return to the furtive stares of his co-workers, all of whom knew that we had "lost the baby." I really don't know how he did it. My mother stayed with me at home for the next week, trying to glue my shattered pieces back together with grilled cheese sandwiches and chicken noodle soup. I had no control over my emotions. I felt like a freak in a world full of capable women having babies, and I couldn't stop whimpering: Why did my body betray me?

For months, I hid from the world, avoiding social outings and weddings. I just couldn't bear well-meaning friends saying, "I'm so sorry." So I quarantined myself, and would try to go about my day -- but then, bam, heartbreak would come screaming out of the shadows, blindsiding me and leaving me crumpled on the floor of our house. It wasn't that I was questioning our decision. I knew we did it out of love, out of all the feeling in the world. But I still hated it. Hated it.

I wrote my doctor a long thank-you note on my good, wedding stationery. I thanked him for his compassion and his kindness. I wrote that it must be hard, what he does, but that I hoped he found consolation in the fact that he was helping vulnerable women in their most vulnerable of times. He keeps my note, along with all the others he's received, in a large bundle. And he keeps that bundle right next to his stack of hate mail. They are about the same size.

The trio of lawsuits that has been filed points to the Supreme Court's decision three years ago that overturned a similar so-called partial-birth abortion ban in Nebraska. The court, in Stemberg v. Carhart, ruled in a narrow, 5-4 decision that the ban was unconstitutional on two grounds: the lack of an exception to protect a woman's health; and the fact that the ban would prohibit even the most commonly used and medically safe abortion procedures throughout the second trimester of pregnancy. Many legal scholars think that this federal ban will also be ruled unconstitutional on those same grounds.

Because of the lawsuits, the Partial-Birth Abortion Ban Act of 2003 cannot be enforced, though it could be years before the abortion debate winds its way through the system and heads back to the Supreme Court. By that time, the composition of the court could be entirely different. "We are looking for a permanent restraining order," says Petra Langer, the director of public relations and government affairs for the Planned Parenthood League of Massachusetts. "Who knows what the long-term situation will be? If George Bush is reelected, all bets are off, unfortunately."

But even the short-term situation is bleak. The doctor who performed my termination has stopped doing the procedure, worried that he might get caught up in a lawsuit. He is not a lawyer or a politician, and he doesn't know what this law means for him right now. "I may go to jail for two years," he tells me. "They can suspend my medical license. It would cost me a fortune to have a lawyer to defend me."

His fears are justified. "There are bunches of doctors out there who could be prosecuted today under this legislation," says Roger Evans, a lawyer for the Planned Parenthood Federation of America. The three injunctions cover only doctors who are affiliated with Planned Parenthood clinics, who are members of the National Abortion Federation, or who are one of the individual plaintiffs in the Nebraska suit. This leaves "scores of doctors who, if they perform an abortion that falls under the very broad definition of the banned procedure, could be prosecuted," he says.

The doctor who performed my termination talks about the women he has helped through the years -- the pregnant woman who was diagnosed with metastic melanoma and needed immediate chemotherapy, the woman who was carrying conjoined twins that had only one set of lungs and one heart, the woman whose baby had a three-chambered heart and would never live. Now, he is turning these women away. "Now, today, I can say no, but what is she going to do?" he says sadly. "What is she going to do?"

Way too nervous to sleep on that frigid morning this past November, I snuggled my bloated belly up to my husband and curled into a little question mark. Sixteen weeks pregnant, today we would finally have our full-fetal ultrasound, finding out whether our baby was developing normally. Given what happened the last time, I had every reason to be nervous.

The last four months had been a sort of emotional no man's land where the baby was concerned. While we were elated to be pregnant again, we were also terrified. It was hard to become fully attached to this pregnancy, knowing that it could be taken away from us. Instead of shopping for layettes, we were consulting genetic counselors. We now knew all too well that pregnancy was a hope, not a promise.

In the lobby at Beth Israel, I shoved my face into a tattered Redbook, waiting for Dave. As soon as he walked in, I started crying. "I'm so scared," I said. "I know, but everything is going to be OK," he answered, and gave me a hug.

Dave held my hand tightly as I lay down on the examining table. This time, the technician was chatty and jokey, while I was silent and concentrating. She pointed out the kidneys and the stomach, the two hemispheres of the brain, and the four chambers of the heart. I started to feel more optimistic. Everything looked fine, she said. She printed out pictures for us. She asked us if we wanted to know if it was a boy or a girl. She never left the room.

My doctor said the ultrasound was completely normal. Completely normal. They were the words I craved to hear, but at the same time seemed almost impossible to believe.

As the rest of our prenatal testing results started to pile up, all of them completely normal, we began to let hope back into our hearts. Of course, we know that anything can happen at any time. We'll never forget that. There will be many more months of worry -- and then, I guess, a lifetime more. At least for now, though, things look hopeful for our son. But I worry about my friends who are planning to have children now and in the near future, friends who are as naive as I once was. It's a different world these days. "Now, it's like the Stone Age, it's like a Muslim country here," says the doctor who performed my procedure. "This is the most backward law, it is not for a civilized country. If this was Iran, Iraq, I wouldn't be surprised. But to pass this law in the United States, what is this government doing?"

Last revised: January 2004

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