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“Your son won’t make it past delivery.”
I heard those heart-rending words from my doctor 13 weeks into pregnancy with my first child, and I will never forget the moment. My unborn son, he told me, had developed cystic kidneys, causing low amniotic fluid which in turn would inhibit lung development. He would suffocate upon delivery, if he even made it that far. Faced with this grim prognosis, my husband and I did what we knew was best for our son. We ended the pregnancy during my second trimester, at 13 weeks.
But some second-trimester abortions could soon be threatened.
A bill that House Republicans passed last week would ban abortions after the 20-week mark. Labeled the Pain-Capable Unborn Child Protection Act, the bill purports to protect fetuses who can “feel pain.” Last Thursday, Sen. Lindsey Graham of South Carolina introduced a similar bill to the Senate along with 45 Republican co-sponsors.
If the Senate passes the bill, it will go to President Donald Trump, who promised on the campaign trail to sign such a law, if given the chance.
For women who choose to end a pregnancy in the second trimester — medically defined as between the 13th and the 27th week of gestation — the reasons often involve medical complications. As an obstetrician and a woman who has had a second-trimester abortion, I must emphasize the damaging effects of this bill. Without my procedure, I would have been condemned to carry to term a baby doomed to suffer and die — even as I continued to see patients and delivered other people’s healthy babies.
About half of fetuses with serious anomalies won’t be detected until an ultrasound at 20 weeks. It’s also after this gestational age that other pregnancy complications can occur that endanger women’s lives, such as ruptured, infected membranes or severe preeclampsia. Contrary to what the far-right claims, pregnancy does kill women.
We are more than vessels for new life; women deserve their own agency. This ill-informed bill inserts the government where we need it least: between patients, families, and doctors at the cusp of life and death.
A difficult decision
When I started as an obstetrician, I thought I had it all. Fresh-faced and done with residency, I was eager to start the family I always wanted with the man I loved. I was well-schooled in the risk of birth abnormalities that can complicate a pregnancy, and that reality loomed near at each ultrasound.
We seemed to be on our way with a healthy pregnancy when the thunderbolt struck. I was 12 weeks pregnant with my first child. During what we thought was a routine checkup, we found out that my first son, my loved and waited for child, would be born with cloacal exstrophy. His lower abdominal wall had not formed correctly. Instead, a mass of organs as big as his head had formed between his little legs. In the ultrasound, I could barely see his legs and his tiny feet looked already clubbed. His spinal cord was tethered; he would never walk or have a functioning bladder or bowels.
We barely had time to process the news when a week later, the situation worsened. Two conditions had developed that are common for fetuses diagnosed with cloacal exstrophy — his kidneys weren’t working, and therefore his lungs wouldn’t develop. After eagerly preparing for our child, my husband and I were told there was little hope he would survive past delivery. We both agreed that as his parents, our responsibility was to save him terrible and futile suffering. At 13 weeks, we ended the pregnancy.
I grew up Catholic, and very spiritual. I always had differences the Church, but was drawn to the passion for social justice found there. I had strong feelings about the value of life in all forms. My parents weren’t doctrinal, and themselves had a liberal take on church teachings. Being around so much Catholicism impacted me, and I was very uncomfortable with the idea of abortion.
During residency, I had declined to perform abortions, but my compassion and understanding grew toward these women and families facing what seemed to be nearly impossible situations. My own abortion further challenged my beliefs around my faith and life. My husband and I loved our first son and wanted him dearly. We named him Thomas, and I will forever mourn him. As my husband is Jewish and my family is devoutly interfaith, we remember and honor his life by saying Kaddish every year on his yahrzeit and on Yom Kippur. I have never for a second doubted that this was the right thing to do for myself, my family, and for Thomas.
As an obstetrician, I am intimately aware of why women choose late term abortions. It is never done lightly.
Given my work as an obstetrician, I knew that many women who have had second-term abortions faced life threatening maternal or fetal medical problems. Others are dealing with geographic or financial barriers, often put in place by legislators, that delay them from seeking the care they need. Some women who are victims of rape, incest, and abuse face potential retaliation and need to schedule their appointments in secret. It’s extremely rare for second-trimester abortions to be purely “elective.” These situations are personal and difficult, and women need to be able to make decisions without interference from politicians.
Over the next few years I had three more first trimester losses — all miscarriages between five and seven weeks, and all while working as an obstetrician. Reproductive challenges do not play favorites — they cut across lines of economics, race, religion, and geography. Every month, I see families in impossible situations due to maternal health, fetal congenital anomalies, or other complications that make termination an important option.
Some stories from my practice include a pregnant woman who found out at her 20-weeks scan that her baby had a complex heart defect and was missing half of its brain tissue. Her daughter wouldn’t survive after birth — we ended the pregnancy by induction a few days later. She was 30 years old with two beautiful girls at home; the family had been so excited about this third baby.
Another woman I treated was pregnant with twins. She had cervical insufficiency. At 21 weeks, her body couldn’t hold the pregnancy inside any longer, and her first baby was slowly delivering at a highly premature age. Neither of the twin fetuses would make it to viability, and the risk of serious infections was very high if she waited to deliver the second fetus. After discussion and prayer, she decided to terminate the pregnancy.
This has nothing to do with protecting fetuses from pain, as the writers of the bill like to say. The only reason anti-choice politicians — even Dan Lipinski, a Democratic representative in my state — support these medically unnecessary restrictions is to push their narrow-minded, out of touch agenda.
As an OB, it’s clear to me that anti-choice politicians don’t have women’s health in mind. Twenty-week bans hurt women and families. You can never know what the right decision is for a family in impossible circumstances until you’ve been there yourself.
Cheryl Axelrod is a proud NARAL Illinois member who works as an obstetrician in Evanston, Illinois.
This essay originally appeared on Medium.
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