Who Are We Really Protecting?
By: Megan Lord, MD
I recently took care of a pregnant woman - we will call her Rosa - who had emigrated to the United States from Central America. In a previous pregnancy, disaster had struck. The fetus had abnormal kidneys, which could not make urine. Amniotic fluid is mostly fetal urine and is needed to help the fetal lungs develop. Thus if a fetus has kidneys that do not function, they often develop lungs that do not function. Despite all of the wonders of modern medicine, nothing could be done that would allow this fetus to survive outside of the womb. He was delivered alive and died six hours later. Rosa went home without her child, heartbroken.
Pregnant again, Rosa hoped things would be different this time around. Our team met her about mid-way through this pregnancy (19 weeks and six days), when she learned that this fetus also had abnormal kidneys. When we first shared these findings, through an interpreter, she was given all of the options – an amniocentesis, serial amnioinfusions, second opinions, and an abortion. Her immediate response was that she wanted to remain pregnant; she and her husband hoped for a miracle.
Rosa missed the next few prenatal appointments due to numerous barriers. She has limited access to transportation. Most of her family does not reside in the U.S. She speaks a Mayan dialect for which it is difficult to get interpreters. Many patients in her situation work full-time, but do not have paid sick time, so each appointment means that they must take time off work and forgo income, making it difficult to pay for the things that their family needs.
When we saw Rosa again at 24 weeks and two days pregnant, I called three different interpretation services to try to get someone on the phone who could speak her dialect. Eventually I was able to get an interpreter, who was available for just 10 minutes. Under normal circumstances, this visit would have lasted nearly an hour.
In the time since her last ultrasound, Rosa had decided she wanted more information about abortion. She knew that continuing this pregnancy carried risk. If she continued the pregnancy, she would need another cesarean. Her last cesarean had resulted in a wound infection and a prolonged hospital stay, and she was afraid that could happen again this time. A pregnancy termination is much safer for the mother than continuing the pregnancy and having another C-section. A termination would get her home to her other children sooner, and she knew it was unlikely she would be bringing them home a new baby brother, no matter what she did. No matter which she chose, we knew she would almost certainly go home empty-handed, so she wanted the best chance to be healthy for her other children. I listened, but ultimately had to inform her that we had missed Rhode Island’s deadline to have an abortion by just two days. We discussed traveling out of state for a procedure, but the cost and burdens of missed work and childcare necessary to travel placed this out of her reach.
Rosa’s care was delayed because of many things beyond her control. Further, the time lapse between the fetal diagnosis and her decision to terminate the pregnancy, deprived her of an option that would have been available to a more affluent, English-speaking patient who could have sought care earlier or travelled to another state. She was forced to remain pregnant.
She declined all heroic interventions and has to watch her belly grow and feel her baby kick, knowing that when her son is born, he will likely die just like his brother. She will risk preeclampsia, blood clots, infection, and will undergo another major surgery to deliver a baby she will likely never take home. All because of a deadline. A deadline imposed not by clinicians or patients but by lawmakers. A deadline that she could not meet because of the many demands placed on her as a poor, immigrant mother in America. A deadline that is based not on safety or science, but on political ideology. A deadline that has forced her to take the riskier path, and robbed her of the freedom to choose for herself what is best for her and her family.
Women like Rosa must have access to high-quality, equitable, and affordable reproductive health care. In a country that is so beautifully diverse, our systems of care need to be prepared to provide the support that patients from diverse backgrounds sometimes need. Comprehensive reproductive healthcare should be available not only to the rich, but to all men and women in this great nation. No woman should be forced to continue a pregnancy with a fetus that cannot survive delivery if she does not want to. No woman should have to place her own life at risk to protect a fetus that will never breathe fresh air or feel sunlight on its face. I cannot take away the pain of Rosa’s loss: the moments she imagined with the son she has lost and with the son she will lose. I cannot give her back the first steps, the wet toddler kisses, the scraped knees, and the high school graduations that will never be. But if not for these laws, I could ease the suffering of her delivery and decrease the chances that her other children will have to mourn the loss of their mother to complications from pregnancy.
So, tell me, who exactly are these laws protecting, and at whose expense?
