Late Term Abortion Is Health Care: A Personal Story

[Content note: This post includes discussions and descriptions of specific instances of fetal distress and abnormality, infant death, maternal morbidity and maternal mortality. This note also applies to linked material.]

This is not the most dramatic, heartwrenching, or important story you will ever read about abortion.

But it is mine.

I lived most of my adult life without a strong desire to have children. I’m still not entirely sure I am cut out to be a parent, and none of the people I partnered with, male or female, were people I especially longed to co-parent with.

That changed a few years ago, when I met K, my current partner. He’s the first person I could imagine having children with, a person who is already a great parent to a child from a previous relationship. For the first time in my life, I really wanted to have a child with another person.

Because I was over 35 when we met, I was keenly aware that we didn’t have a lot of time to make a decision. And because I was myself born to a mother who was nearly 40, I already had some idea of the health risks involved in a pregnancy later in life. My mother spent most of her last trimester when she was pregnant with me on bedrest.

Basically, it gets harder and harder to conceive every year in the mid 30s or so. If one does manage it, there is an increased chance for fetal abnormalities and as well as maternal complications. And a lot of these complications don't show up until later in pregnancy. Gestational diabetes (which increases the risk for diabetes later in life), pre-eclampsia (which can cause kidney failure) pre-term rupture of membranes (“water” breaks too early), placental abruption (placenta separates from the uterus) are just a few examples. I’m also at risk for HELLP syndrome, both because of age and because of a family history with it.

As far as fetal abnormalities, many of these also are not detectable until later in pregnancy. For older mothers, the risk of chronomosomal defects increases. One of the better known of these is Down Syndrome, but there are several other possibilities. Some, like Patau Syndrome and Edwards Syndrome (which can be associated with anenecephaly, among other things), usually mean that a baby will survive only a few hours, days, or at best, months. Others may cause developmental disabilities, of varying kinds and degrees, but a child born with that particular chromosomal abnormality might still have a good overall prognosis for quality and length of life. And some are very unpredictable.

My mother, who passed away not long ago, had often spoken to me about her anxieties that I would be born with Down Syndrome. I was a “surprise” baby, and she was unaware of her pregnancy until the second trimester, complicating things even further. She told me that she often talked to me while she was pregnant, encouraging me and assuring me that I would be loved no matter what. She was ready to love and welcome me, in any case, and she apparently told me so, frequently, when she was pregnant.

What she didn’t voice to me for many years were her anxieties that she and my father might not be able to care for me properly if I did have Down Syndrome. As older parents, she feared they might become incapacitated themselves or even die while I might have many years of life left, and still be in need of care. What would happen to me then? Who would have my guardianship? Could my significantly older siblings do it? What about if they, too, became ill or passed away? Would I be provided for? Would I be loved? And now I was wondering the same thing about my ability to ensure a lifetime of care (and not just care, but loving care) if I had a child who needed it into their adulthood.

As I investigated, I learned that we have much better ways of detecting fetal abnormalities today, compared to when my mother was pregnant with me. But we still can’t predict, in many cases, how severe certain conditions may turn out to be, including whether they will even be compatible with life or not. Or whether there may be a life, but only a brief one of suffering and pain. Depending on the abnormality, my partner and I might be facing an tough decision whether to continue with the pregnancy.

Both for myself and for my fetus, there would be many risks if I tried to become pregnant, risks that might not materialize until late in pregnancy. There were emotional, difficult, and highly personal questions I would have to face. Decisions that would be made between me, my doctor, my partner….and a ridiculous state and national government.

For example, what if I found out that my pregnancy would lead to a long-term health risk, putting my ability to make a living in question? Between my partner and I, I’m the primary breadwinner. But 43 state legislatures think they know better than me and my doctor about when my pregnancy might need to end. I live in the US South, so it’s no surprise that my state is a restrictive one.

And about my doctor… there are only four physicians still providing late term abortions in the United States. I don’t live anywhere near their clinics. Ending a pregnancy electively would not be easy.

Nor would it be cheap. Does your insurance cover abortions? Mine doesn’t. At least I don’t think so. It was pretty hard to get a straight answer out of them when I called to ask, but basically, unless my life is at risk, I would seem to be footing the entire bill for any abortion. Plenty of states openly ban various insurance plans from covering abortions. The story of Dana Weinstein, who had to end a pregnancy due to severe fetal abnormalities, was heavy in my mind. She faced $17,500 in bills –all from trying to end her fetus’ suffering.

But even if it were an emergency procedure rather than a planned one, I might not be able to find a local hospital to perform an abortion. Catholic affiliated hospitals have refused to perform abortions even in the case of pre-term membrane rupture (one of the significant risks I would be running). And there are states where restrictive laws keep all hospitals from performing these needed abortions. Would I be forced, like Danielle Deaver of Nebraska, to give birth and then watch as a baby with undeveloped lungs slowly suffocated to death? Would I myself die of infection or other complications that could be easily prevented by an abortion?

With great regret, but in light of the risks and restrictions, I decided not to pursue a pregnancy. Some people might have made a different choice, but for me, this one seemed best. And the lack of abortion access was the number one reason. Had I had confidence that I could access one if I really needed it, I would have gone ahead.

I don’t write this asking for pity. As I said, my story is far from the most important or tragic one about abortion. I am basically content with my life, with being an aunt and step-parent rather than being a mother, and with turning the energy I might have given to my own children to other things. I love my partner and he loves me. We are a family.

There are many reasons for pregnant people to need an abortion. Abortion’s availability—or lack thereof— can also play a role in the decision to even try for children. Ceding even an inch of ground in this discussion is actively harmful. So-called moderates and even progressives have too often ceded that sure, abortion is icky and tragic and nobody should have to pay for someone else's abortion! Thus the ridiculous insurance situation. They have too often ceded allegedly “reasonable” abortion restrictions, particularly on later term abortions, which are really anything but. Thus the additional and unnecessary risks for what are already high risk pregnancies. They have acted as if abortion is something shameful, to be whispered about or not mentioned at all, and coddled religious sensibilities that risk human rights. Thus the denial of what should be routine healthcare to people with doomed pregnancies.

Instead of whispering, it needs, desperately, to be shouted: ABORTION. IS. HEALTHCARE.

No, Debbie Wasserman Shultz, I am pretty far from “complacent” about abortion. I have never, ever been complacent about abortion, not in all the years that “moderate” members of Democratic party were busy ceding my ability to end a pregnancy. Turns out, they were also ceding my possibility of beginning one. My life has been altered because of somebody's complacency--but it sure isn't mine.

[This post has been slightly edited to clarify medical information. My thanks to Flyby in comments.]