My Third-Trimester Abortion

Apr 13, 2015 | Dandy Walker Syndrome, Stories, Termination after 24 weeks

The grace of certainty found me on the Zakim Bridge.

By Kate C.

This article is based on a talk the author gave to OBs and medical students at her diagnosing hospital.

I am here today to tell you about my third trimester abortion. Before I begin, I want to make two things very clear:

First, I am here to speak with you because I want to share my experience. I am not afraid to share, and you shouldn’t be afraid to ask questions if you have them. I think people often hold back to protect me, but they needn’t bother. I live with these memories every day. There is no angle from which I haven’t looked at this. Openhearted questions will not hurt me.

Second, this is a story about a massive family crisis. Most of the tale occurs in what I like to call crisis mode: a way of operating which is probably very familiar to many of you experienced doctors and counselors. In crisis, I asked only the questions I absolutely had to ask. My doctors and counselor, likewise, spoke the facts they had to speak, and no more. Much was left unsaid. I am a world expert on very late-term abortion because I am one of a scant few women who has experienced it. But I am not the world’s leading expert on the laws surrounding my abortion, nor on the range of procedures practiced on bodies other than my own. So I may not understand all things perfectly, even within my own story. I am a woman of science, and I like to have my facts straight. But the best I can do at this point, is to recognize some of the blank spaces in my understanding of this very personal experience.

Now, for my story. I love babies. I love children. My husband and I wanted a big family. Four kids. We started young, and by the time I was 27, I was pursuing a PhD in engineering. I had a glowing pregnancy which culminated in a healthy, wonderful baby girl: my eldest daughter.

The second baby did not come as easily. I suffered three miscarriages in grad school. When I fingally got my sticky baby, the pregnancy was challenging. I was quite ill for quite a long time. Five months. I was exhausted because this pregnancy brought on sleep apnea. I eventually dropped from my PhD program and started writing up my masters thesis instead. I was massive at my graduation ceremony, one big, black, polyester tent. I had to leave after 10 minutes on account of heat exhaustion.

Still, it was worth it. I was pregnant with another daughter, exactly what I wanted. I had a nagging worry from early in the pregnancy. An ultrasound technician had seen a shadow of a concern at my anatomy scan, but the finding was reversed with full confidence at a level 2 ultrasound.

“If it’s still bothering you,” my midwife said, “I can schedule you another ultrasound, just to set your mind at ease.”

Feeling a bit alarmist and silly, I agreed. That is how I found myself one Wednesday, lying back on an ultrasound table, chatting it up with a technician at NEMC, as she smeared jelly all over my giant abdomen.

“Why are you here today?” She asked, before she started.

“Peace of mind,” I told her. “To reassure me that there’s nothing wrong with my baby’s brain.”

I watched my baby on the screen. Saw the tech measuring and remeasuring that one big black part of my baby’s brain, cheerfully waiting for my reassurance.

“I can’t believe it.” I said. “This baby is going to be her own unique person. Every time I picture her, I picture my eldest daughter. But she won’t just be a repeat of my daughter! She’ll be different.” I marveled.

The technician pierced me with a stare.

“This one is going to be different.” She told me. The congenial pleasantry had dropped like a stone from her voice. “They’re all different.”

She left me then, knitting a tiny sweater while I waited for the doctor. I didn’t recognize the OBs who entered the room. One asked me what I was knitting—was it for the baby?

“Yes!” I said, proudly, and I spread it out in the proper shape so that she could see how it would come together with a few weeks more work.

“It’s beautiful,” she said. Here eyes were so sad.

She told me about the black spot, about the holes in my baby’s brain, the missing pieces. She named it for me, Dandy Walker.

“We can definitely arrange an adoption, if that is something you want.”

I almost fell of the table. Adoption? She must not understand. I loved my baby. I wanted my baby. I had tried so very hard for this baby, and given up so much for her already.

“We might be able to arrange an abortion… “ she continued, “but we just don’t know. We used to send women to Kansas for this, but we can’t do that anymore.”

She told me about keeping the baby, too, of course, and just scratched the surface about what that would involve. NICU, social workers, maybe a c-section. She left space for my questions. I didn’t know what to ask. I was in shock. I wasn’t even crying.

“Are children like this ever normal?” I asked.

“Yes. Sometimes they are.”

She explained much more to me, about further testing. MRI. Amnio. She wouldn’t, couldn’t give me the answers I wanted—what to expect from my child. Then she left the room.

I called my husband at work. Then, only then, did I burst into tears. I was unintelligible when he picked up the phone.

“Where are you?” he asked.

“The hospital.” I choked.

“I’m coming.”

There was much more that day, but it doesn’t matter. They couldn’t get us into MRI until Friday, so my job for the next 48 hours was simply to wait. And waiting was the hardest part. My husband, who drags himself into work even if he is sick as a dog, stayed home. We sent our 2 ½ year old daughter, to stay with my parents in the suburbs.

I was terrified. I thought about what it would mean to have a kid on the short bus. In the special classes. I wondered how much money you need to save to be able to die peacefully knowing your disabled daughter will be okay. I thought of the adults I know whose lives were transformed when they took custody of disabled siblings. I thought about the autistic boy I babysat for, and about how stressed his mom was all of the time, how palpably miserable his parents’ marriage was. I grieved for my carefree motherhood and for my daughter’s innocence, and for my marriage.

Most of all, I grieved for my baby girl whom I did not know how to help.

I cried until I had cried myself out. Then I cried some more. I didn’t sleep. I crept downstairs in the middle of the night and wept on the couch—then I felt deep shame for my tears. This stuff isn’t supposed to matter to a good mother. Good mothers are supposed to want to make sacrifices for their daughters. Good mothers are supposed to love their babies no matter what, roll with the punches, and not ask for anything more.

I picked up my knitting needles.

“Why bother?” I asked myself.

“Because at least she still has arms.” I answered, with a morbid chuckle.

Hours and many tears later, my husband came down to find me sobbing again. He gathered me up in his arms and carried me, massive and swollen, back to bed.

Friday came. I had finished the sweater in just two days. I sewed the seams and wove in the ends. Then we drove into Boston for our MRI. We had other appointments, too: echocardiogram, genetic counselor, and, at the end of the day, neonatal neurologist.

At some point, I asked about a DNR.

“She might not be able to swallow,” my genetic counselor had said.

“Then that’s it.” I told her. “No feeding tube.”

Apparently you can’t refuse a baby a feeding tube, which surprised me, but I didn’t ask about it. I didn’t have a good idea of people’s alliances, and I worried that if I said the wrong thing, I might invite legal scrutiny—social services—Go look into that mom who wants to starve her baby to death. So even though I was interested in Hospice, I didn’t press the point at that moment.

Instead, I took a wait-and-see attitude. Maybe my baby would be one of the lucky Dandy Walker babies who is totally normal, just a little clumsy. Heck! I’m a little clumsy!

But the neurologist had only bad news. The worst case scenario from our spectrum of possible findings:

For some reason, that last one was where I lost it. I cried like a spoiled child. I want to breastfeed my baby. I want to. I want to.

There was just so much that my baby wasn’t going to be able to do. I grasped for something …

“What will this baby be able to do?” I asked. “Will she just… sleep all day?”

The neurologist gave a long pause, then looked away.

“Babies like this one,” he sad, “are not generally comfortable enough to sleep.”

And that is when I got it. The fortress of my hope and denial came crashing down. I thought hard about a baby who cannot sleep or hold her head up or swallow, but can seize and vomit and choke. A baby who can’t learn much, and won’t live long, but will know her parents, may even smile if she has a moment of physical relief. I understood that even my earlier nightmare of the short bus was an unrealistic expectation for this baby—my baby girl.

We asked no more questions. We simply thanked the doctor and left.

I turned to my husband in the car. There we were, stuck in rush-hour traffic on the Zakim Bridge. My desperation was mounting, but I couldn’t speak the words.

So I asked my husband, who always says what I want to hear, “I need to know what you want to do. Not what you think I want you to say, but what you really want. I need you tell me.”

“Kate, you don’t have to do this, okay? But I think we should ask about the abortion.”

It was such a gift, his speaking the word first. All my fear and dread dropped away. The pain and darkness that had held me like a prison these last two days, evaporated. I felt full of light and fresh air. Grace found me in the middle of rush hour traffic on Rte. 93. And I knew. I knew that, because my husband and I agreed, I would pursue this abortion at any cost. Nobody else’s opinion mattered anymore.

People say this is the hardest decision a woman can make, but for me it was the clearest, easiest decision in a very hard, sad situation. It was the decision I could live with. I could live with ending my daughter’s life before it began. I could not live with bringing her into the world to suffer.

We called the OB as soon as we got home. She was delivering triplets, and couldn’t take the call, so I left a message.

She called back at 6:30 PM and talked fast. “I’m so sorry, but if you want to pursue the abortion, you have to call before 7:00 PM to schedule your appointment. They’ll be closed for the weekend after that, and this can’t wait even one day. You have to be on a flight on Monday morning to Colorado. You have to show up to your appointment on Tuesday morning with $25,000, up front, and stay for the week. The procedure is four days long. It ends on Friday. It has to be complete by 36 weeks.

I would be 36 weeks, 0 days on Friday. There was no time.

We didn’t need time. I called immediately. My husband booked our flights. We named our daughter over the weekend, to recognize her as part of our family, and to spend a little time with her, named, before we had to let her go.

On Monday, we boarded our flight with a story about being only five months pregnant with twins. Airlines don’t let eight-month pregnant women fly.

We got the money from my parents’ retirement fund, which could afford the hit.

We showed up first thing Tuesday morning for our appointment. We were worried the clinic might be hard to find, but the low-lying brick bunker covered in surveillance cameras and surrounded by barbed wire couldn’t possibly be anything else.

The procedure was four days long. The first day was testing and counseling, all day long. At the end of the day, I signed the consent forms with Dr. Hern as my witness, and he took me for the injection.

Physically, it was the same as an amnio, one long needle into the womb. But unlike an amnio, this needle penetrated my sweet baby, too. It found her heart and delivered its KCl. If it hurt her, she did not show it.

“One injection.” I reminded myself. “Even a healthy baby gets a dozen pricks by the time her first year is up. Just one shot.”

Though this was minor stuff, physically, it was emotionally devastating. I fell apart.

“How do you feel?” Dr. Hern asked.

“So sad,” was all I could muster. “So, so sad.”

He handed me a fistful of tissues and gave me an awkward but genuine pat on the arm. Then he left me with his best and warmest nurse.

“I’m going to miss her,” I said.

“I know you are,” she told me.

I spent the next few hours on my hotel bed, feeling my baby’s motions slow and then stop. When I stood up, my belly, once so taut and high, sagged low and wide and lifeless.

Days 2 & 3 were laminaria days. It hurt! I had a hard time lying still.

“Relax!” Dr. Hern yelled in annoyance.

“Someday,” my nurse whispered after he left, “we’re going to shove some cotton up in Dr. Hern and see how he likes it.” I laughed—quietly this time, as I had been chided once before for disturbing the dignity of the clinic with my strange brand of crisis laughter.

My husband and I spent those two days sightseeing. The wildflowers bloomed in the foothills and alpine meadows. We saw deer and ponderosa squirrels. As the laminaria expanded, I had to slow down. I was very nearly sick at a busy scenic overlook. We enjoyed this strange parallel universe where we pretended to be on a romantic vacation in between our tragic appointments.

Friday, it was time for my induction. I had had an epidural for my first birth, and I was a little bit afraid of what my body had in store for me. There is no anesthesiologist at the clinic. Dr. Hern is obsessed—in the best possible way—obsessed with patient safety. He does not want to introduce even the slightest chance of unnecessary morbidity. He also wants to keep patients’ costs down, and anesthesia is expensive.

So it was demerol for me. Which, for the record, is like the pain relief of a warm bath plus some light hallucination.

The birth was incredibly smooth. Two-and-a-half hours of labor. A little vomiting. Then a sudden urge to pee, followed by inadvertent pushing and a rushed waddle down the hall to delivery.

“Stop pushing!” Dr. Hern chastised me. Which was like telling someone mid-wretch stop vomiting! This would be much easier if you’d just quit throwing up!
And my baby slipped through my pelvis and into the skilled and careful arms of my grumpy savior.

Dr. Hern returned to my labor room some time later, and brought the body. I had asked to see her. He offered to leave her with us, alone, but we liked having him there.

She was beautiful. She looked like her big sister. I laid a kiss on her forehead. She was still warm, but not quite warm enough.

The next day was Saturday. We flew home, back to our lives. I did not cancel my 30th birthday party that weekend, though it wasn’t much of a celebration.

I survived those early days by taking care of my daughter. When she saw me again, she laid a hand on my belly, as I knew she would, and she asked the question she always asked me with her musical little laugh:

“Mommy, is there a baby in your belly?”

“No. I answered. No more baby. Baby’s gone. Baby died.”

She started crying with me, but from the surprise of it, the spoiling of our little game. She asked me every day for two weeks, then, finally , she stopped asking.

The people in my community eventually stopped asking, too. “Stillborn” always fell on deaf ears, so I took to saying, “She died. The baby died.” The way I said it to my two-year-old. They heard that.

I’m in my third year now. I have survived my first year of grief. I have gone from newly bereaved to experienced mentor in my online support groups. I have been trained as an abortion doula—which is apparently a thing. I have sought treatment for PTSD. Last winter, I gave birth to my rainbow baby, and named her for light after darkness. She lifted her head off my chest and stared right into my eyes to greet me, moments after her birth—two things my lost baby never would have done, and I finally believed that her brain was whole.

I’ve opened up about my experience and my choice during a time of much public restriction and vitriol against abortion. I have been surprised at the support I have found in my community. Once people hear my story, most of them finally understand why a woman might need an abortion so very far into her pregnancy. I can hardly blame their misunderstanding. I didn’t get it, either, until it happened to me.

And that’s what brings me here. To help you understand—and to demonstrate some of the challenges I faced in pursuing this abortion.

First, I was operating in an extremely restricted environment, and the stifling legal limitations and the dwindling paucity of providers is only getting worse. I grew up here in the very medical and quite liberal Northeast. I was shocked that I could not access the care I needed at home. I think that’s a shame. Not a casual shame, a real, true shame, as in, something we in Boston should be ashamed of. The sense of fleeing from my home, my entire support network, and the law dramatically compounded the trauma of my experience. It took a personal tragedy and made it scary and isolating.

My financial limitations were also considerable. I didn’t have $25,000 in cash, nor credit on my card. Given a couple of weekdays, I might have been able to extricate money from my own retirement account in time, or take a lien on our house, or get a loan with my bank, but I didn’t have a single weekday between my MRI and my appointment. That Monday was spent on an airplane. Without the full financial support of my parents, this never could have happened. My insurance company reimbursed me only 10% or so of my costs, claiming “out of network provider.” Later term abortion is accessible only to the wealthy. Most Americans don’t have any choice at all.

I was also suffering from limited information. I’m not blaming my counselor or doctors here. As I said at the start, we were in full-blown crisis mode. My ignorance about third-term abortions came from a lifetime of being steeped in a culture that casually perpetuates ignorance and misinformation about abortion. When I stepped on that flight to Colorado, I wasn’t sure that I’d ever come home—least of all that I’d keep my uterus. I thought I was doing something incredibly risky. Thanks to Dr. Hern’s skill and 40 years of developing the safest methods ever practiced, my procedure, risky and tricky as it was, remains safer than live birth.

But, in the wrong hands, this procedure is incredibly risky. Just months after my return from Colorado and Dr. Hern’s excellent clinic, another doctor, Kermit Gosnell, was convicted of myriad atrocities related to providing illegal later abortions in his clinic in Philadelphia, PA. He was found guilty of infanticide, as well as spreading disease between his patients because he did not bother to autoclave his instruments and reused disposable instruments. It made me sick to read about this. The worst part of all: if he had been my one last hope, even knowing what I know now, I would have gone to him for help. Most people think this is pre Roe v. Wade stuff, but it is contemporary. Desperation leads to extreme and terrible outcomes when all the safe doors are slammed shut.

Which brings me to my backup plan. I certainly hope that if I had not found an abortion provider, I would have further discussed infant hospice with my team and come to some other choice I could live with. But when we didn’t know if abortion was an option, my husband and I spoke briefly about going off the grid, somewhere nobody could override a DNR. I have to emphasize how incredibly risky that would have been. My baby was likely to developed hydrocephaly. Her head might have swelled to unsafe proportions before the birth. Her poor muscle tone made her a challenging case for vaginal delivery anyway. I could have died trying to birth her outside of a hospital. But I thought about it. It feels stupid now, but I know I wasn’t stupid, I was desperate.

Even after surviving and healing from my abortion, I have faced other challenges. Some come from living here in America, where people are quicker to argue than to extend their empathy. It happens in small ways. I have friends who have been turned away from infant and pregnancy loss support groups because they “chose” for their babies to die. I even have a friend who was stalked because of her choice to end a wanted pregnancy. And Dr. Tiller, who should have been there for me in Kansas, wasn’t because he was shot in the face by a domestic terrorist.

I’m lucky that my personal community has held me with such love and understanding, but even in this kind place, I have met with challenges in myself. My friends who have had second trimester abortions compare it to removing their babies from life support. I can’t do that. I euthanized my baby. Some friends who have had early abortions take comfort in the products of conception being tissue, just tissue. I can’t do this either. My baby weighed more than my big strapping husband did when he was born. My baby has a name. My baby’s ashes were scattered in the Atlantic Ocean on her first birthday. Sometimes it’s hard to make it all fit.

There were two gifts for my baby: Peace, or Life, and I could only choose one. I chose peace. It’s not something I take lightly. It’s also not something that I regret.

At first, losing my baby blew me into a million tiny, sharp pieces. I tried for a long time to put them back together around all these hard truths. In the end, I found it isn’t about putting myself back together like a puzzle, it’s about softening enough to mold a new self with the pieces, to wrap them around the hard and conflicting truths like so much clay. And when a sharp edge pokes at me, I just remember how it felt when the grace of certainty found me on the Zakim bridge, and I know that I am suffering so that my daughter never has to.

 

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