#voicesofcourage

In July of 2015 my husband and I took our first "kid-free" vacation in our 18 years of marriage. Our sons were 17 and 14 and super responsible. About the third day onto our trip I started feeling really "full" and joked to my husband that I felt just like I did when I was pregnant. We laughed and I put it out of my mind, as my husband had a vasectomy when our youngest was a year old. When we got home I continued to feel bloated and not quite right. At age 43 my periods were often irregular so I hadn't noticed I was late. Finally, more as a joke than anything serious, I took a home pregnancy kit. I was shocked when it came back positive! How could this have happened? I came out of the bathroom in a fog and told my husband the results. His urologist later confirmed that his vasectomy had failed. After several long, tearful conversations we agreed that terminating this pregnancy was the best option for us. With two sons nearing college we didn't feel ready financially or emotionally to start all over. Fortunately, we were able to schedule an appointment at our local women's health clinic and two days later I was able to safely undergo a medical abortion. A week later my husband had his second vasectomy.

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I had a patient yesterday who has insurance through her low-wage job at a hospital. Liza is married with two kids, and she relies on pills for birth control. She never missed a dose but became pregnant for the third time anyway: she is in the 1-2% for whom the pill fails. Nevertheless, Liza and her husband wanted to have the baby. Then Liza’s husband lost both of his jobs. They decided to have an abortion. 

At the clinic, Liza learned she would have to go to the hospital for the procedure because she is overweight and had uterine surgery to remove fibroids. She came to see me, and we took care of her in the operating room. Liza’s abortion cost $10,000—an amount that would have decimated her family’s finances if her insurer had refused to cover it. I see at least two or three women every week who are sent to the hospital for their abortions. These women have serious medical problems exacerbated by pregnancy, complications arising from pregnancy, or fetuses with severe abnormalities. They deserve insurance that covers them in an emergency.

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24 weeks into my pregnancy with my second child, the doctor discovered an irregular heartbeat. She reassured me that there was likely nothing wrong, but wanted us to go back to the maternal fetal medicine doctor for an ultrasound. 

The following week at that appointment, the ultrasound discovered there was something wrong with the baby’s heart. The doctor worked quickly to get us an appointment at our local children's hospital that day. The head of cardiology at the children's hospital, after several long echocardiograms, told us he thought it looked like an aneurysm on the outside wall of her heart but that he had never seen this in a fetus. 

The following day the doctor had learned from colleagues that this can in fact occur, although it is very rare. He wanted to admit me to the hospital and begin arrhythmia medication which would cross the placenta and work on the heart of the baby. 

While this aggressive treatment seemed to present options for the baby, it presented risks for me. What about my child at home? What if this medicine affected me? The cardiologist was there to treat and try to save the life of the baby. But what about me, where was my care provider? After much of my own research it appeared that the prognosis for this pregnancy was poor. The complications of the aneurysm with the arrhythmia rarely had a good survival rate. With this knowledge I felt I needed to go back to the doctor who was my provider to find a balanced perspective. 

Our MFM (maternal fetal medicine) doctor had done much of the same research and did not disagree with our conclusions. She was so patient and supportive and helped provide us with the best information she could so we could make a decision. With the very grey diagnosis and conditions seeming to worsen, we made the heart wrenching choice to ensure this child did not suffer, did not gasp for breath when her lungs may not work, did not have an aneurysm rupture. Our baby was born sleeping at 26.5 weeks. We were lucky to have such a compassionate care team. Their understanding was important in our subsequent pregnancy, too.

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We are thrilled to be celebrating the release of our Board Chair, Dr. Willie Parker’s, new book Life’s Work: A Moral Argument for Choice. Tonight we will gather with 800 of Dr. Parker’s friends (including Gloria Steinem and John Oliver) to commemorate this exciting occasion. Today’s Voices of Courage story is a passage from Life’s Work.

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“A young woman—in her twenties, with a couple of kids—came to see me in the Mississippi clinic. She thought she was about nine weeks pregnant, but when we did the sonogram we discovered that she was really more like thirteen weeks. This put her in a different price category. Mississippi has a twenty-four-hour waiting period, so if she could have scraped together the additional money, she would have come back the next day. But she did not. The next time I saw her was three weeks later, when I was back in Mississippi again. This time, when we did her sonogram, we calculated that the gestational age of the fetus she was carrying was at sixteen weeks plus one day. I had to tell her that, because she was over the line, I could not perform her abortion.

The woman started to beg. Please, she said to me. Please. I wanted to do her abortion. And I was incensed at the arbitrary turn her life had taken, due to the caprice and whim of several dozen legislators. She exceeded the ban by one day because she was poor. But I wouldn’t perform her abortion. I couldn’t. I live in a world where health department inspectors check my patient files and root around in my garbage cans. I could not risk breaking the law, even a law that I find unjust, to help one woman, and in so doing jeopardize my ability to help all women. The best I could do was to tell her about the Tuscaloosa clinic, which is a three-hour drive away. But she kept begging. She didn’t know how she was going to get the extra money (as a pregnancy progresses, the cost of an abortion procedure rises) or how she was going to get to Tuscaloosa. I didn’t tell her the thing that burned me most of all. If she lived in another place with less restrictive laws—Washington, D.C., for example—we could have seen her, done her counseling, and performed her abortion all on the very same day. She was penalized not just for being poor, but because she lived in the wrong zip code.” (p. 102-103)

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My patient Gina is 13 years old, much more interested in tracing animals from the children's books in my waiting room than talking to the doctor about her periods. Like her maternal aunt, she bleeds so heavily that she needed a blood transfusion a few months ago. We have used birth control pills to control her bleeding, but the best way to keep her periods manageable, and to keep her off systemic hormones, is a progesterone IUD. Her mother works in a factory, but with the contraceptive mandate in place they have been able to afford the birth control pills and will be able to follow through with getting Gina an IUD.  Without insurance coverage of contraception, they wouldn't be able to afford the best care for Gina.

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Tasha is a 24-year-old, single mother of two young children. She explained to me that she needed to have an abortion because she could not afford another child right now. She has Pennsylvania Medicaid coverage, but due to the Hyde Amendment, which prohibits federal funding of abortion, she did not have insurance coverage for her procedure.

Tasha explained, “I felt so desperate picking up extra shifts at work, borrowing money and selling my things to cover the cost.” Tasha’s extraordinary efforts to obtain funding significantly prolonged her pregnancy by a matter of weeks, thereby necessitating a second trimester abortion.

If the Hyde Amendment were overturned, women like Tasha could access earlier, less complicated abortion procedures.

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I had an abortion at age 16 (I am now 54) after a condom broke. I was terrified of having to tell my parents I was pregnant, so managed to keep it from them. My boyfriend drove me 75 miles to the nearest provider outside of our town, and I had gotten the money from his brother. I was able to finish high school, went to college as I'd planned, and didn't end up marrying the wrong person just because I was pregnant. We had to go out of town, since my mother worked at the local hospital and would have found out. I’m so glad the option was there for me and enabled me to have the life I have now.

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While in my early 20's it wasn't uncommon for my period to last seven full days. My period was relentless. I had such heavy menstrual bleeding that I had to change my tampon every two to three hours or run the risk of menstrual blood leaking onto my underwear and clothes. I used to set alarms on my phone at night during my period so that I could wake up and change my tampon. In my second year of medical school I realized that this was soon to become an issue when I entered the hospital to continue my training toward becoming a physician. I was especially nervous for my surgery rotation, where I could be in the operating room for hours at a time, from as little as one hour to as many as 12 hours. I knew that my attending physician was not the understanding kind, and that I was expected to remain in the operating room for the entirety of the case to learn and assist. Leaving every two to three hours to change my tampon was not going to be an option. So I thought, what are my options? Do I wear a pad with my tampon? Do I switch to an alternative menstrual product? Do I start on oral contraceptives? I decided to try oral contraceptives and it was the best decision I had ever made. My periods became shorter, lighter and less of a nuisance. I didn't feel anxiety about my period interfering with my medical training anymore. I felt like I would be able to continue my education while providing the best care possible for my patients. If it weren't for the freedom to make this choice or the option to obtain birth control, my medical education would have looked very different.

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