The “A” in Abortion
Texas law now bans abortion once a fetal heartbeat can be detected — usually around six weeks, a time when many women may not realize they are pregnant. The law makes no exception for pregnancies arising from rape or incest, or to protect the mother’s mental health. Or in cases where the fetus has been diagnosed with a birth defect incompatible with life outside the mother’s womb, as was the case with my full-term son, Matthew, who died the day he was born.
In my case, the only hint of trouble arose when the obstetrician ruptured the fetal membranes to enhance labor, but no reassuring wave of fluid followed. In the “birthing room” at the Washington Hospital Center — a cheery sun-filled room with yellow paisley curtains, a rug, and a plush chair that made it seem more like a living room than a hospital room, except for the stirrup-equipped delivery table set off to one side and the wooden board propped against the wall — we passed the time talking, taking pictures of our excited faces reflected in the polished stainless steel fixture over our heads, and regularly checking in with my parents, at home with our 3½-year old son.
Once the contractions had begun in earnest, my labor progressed rapidly, and drawing from our Lamaze classes, I launched into the ha-hoo breathing I had been practicing for months. No anaesthesia for me or for this life I was pushing out of the protective bubble of my body. We had no idea that from the moment of conception, Matthew carried a gene that would cause his kidneys to develop countless cysts, rendering these organs useless without my own body’s filtration system. We didn’t know these sponge-like masses would swell to huge proportions by the end of the second trimester, and by delivery, would tear my perineum so badly that I would require five stitches. Nor did we know Matthew wouldn’t … and couldn’t … make a sound when he was born, since his compromised kidneys were never able to provide enough fluid needed for his lungs to develop normally, which would have allowed him to breathe on his own.
We later learned the name of the birth defect that took our baby’s life: infantile polycystic kidney disease (ARPKD) — a rare and always fatal condition that results from a defective gene from both mother and father with an autosomal recessive pattern of heredity, which meant there was a 25% risk that any of our pregnancies would end up like this one. The risk never diminishes and can happen twice or more in a row. You never know. The worst part was we never got to hold Matthew; they whisked his blue-tinged body out of the room in order to hook him up to machines that would purr life back into him, though not before the beauty of his black hair and blue eyes were indelibly registered in my brain. Now 42 years later.
Losing Matthew also left an indelible mark on my life. It took years for me to work through my grief. What kind of world was this where parents have to helplessly watch a child die an excruciating death? What happened to “the natural order” of things where parents die before their children? As is the case with many couples experiencing pregnancy loss, my husband and I divorced, but for us, it was many years later. I also lost faith in things working out if you try hard enough or want them badly enough. I learned to control everything I could, since there was so much beyond my control.
My experience with Matthew turned me into an ardent abortion supporter.
* * *
The Texas abortion ban includes a provision whereby anyone may submit an anonymous tip to a “whistleblower” website to identify and sue abortion providers who don’t comply with the law. Plaintiffs have an incentive to report these violations, since they may be awarded a minimum of $10,000 for a successful lawsuit. Neighbors turning in neighbors evokes how German citizens were encouraged to report to the Nazi authorities the whereabouts of any Jews in hiding. In colonial Massachusetts in the late 1600s, neighbors testified against neighbors during the Salem witch trials. Hawthorne’s The Scarlet Letter, also set in colonial Massachusetts but earlier in the century, tells the story of Hester Prynne, found guilty of adultery and condemned to forever wear a scarlet “A” standing for “adultery.” Her incensed neighbors, including some envious of her beauty, flocked to the scaffold where Hester was made to stand for three hours.
Morality, it seems, lies in the eye of the beholder, which is another way of saying we don’t always see eye to eye. Could the “A” of abortion be turning into the new scarlet letter?
When it comes to adultery, what we say we believe drastically differs from our actions. We call this business of looking the other way “moral flexibility.” However we look at it, and whatever we call it, justifications of the sort engendered by the erosion of behavioral ethics result in a nation-wide ethical morass.
In a recent Gallup poll (June 9, 2021), 89% of Americans said they believed that it was immoral for married men and women to have affairs — a percentage that has remained consistent for the past two decades. However, the percentage of married partners who admit to cheating has continued to increase, with some reports as high as 30-40% or more, and the gender gap appears to be decreasing. It’s no surprise that Americans tend to condone these affairs. On the other hand, according to the same Gallup poll, a record high of 47% of Americans believe abortion is morally acceptable, and 49% of respondents identified themselves as “pro-choice,” yet we have the Texas ban as well as Georgia’s failed attempt to criminalize women seeking abortion within the state and beyond state limits. The Supreme Court is expected to rule on these efforts to overturn Roe v. Wade, a ruling that may well clear the path for many more states to pass more restrictive abortion bills.
Access to abortion varies across the globe. For example, voters in Ireland chose to legalize abortion in 2018, but Poland recently instituted an almost complete abortion ban. Abortion remains greatly restricted in several Latin American and African countries. I was surprised to learn that Russia has one of the most liberal attitudes concerning abortion — perhaps a holdover from the Soviet era when abortion was considered an acceptable form of birth control. However, according to Russian Anna Starobinets’ gripping account of her own abortion experience in Look At Him (Three String Books, 2020), sensitively translated by Katherine E. Young, many women don’t utilize the free but cumbersome institutional abortion services provided by the Russian Ministry of Health, but rather choose to seek private care. Some even leave the country, like Starobinets, who traveled to Germany after making the gut-wrenching decision to terminate her pregnancy due to her baby’s fatal birth defect. Like Matthew, her baby had cysts throughout his kidneys, though the exact diagnosis was “bilateral multicystic dysplastic kidney,” for which, like ARPKD, there is no treatment.
At first I could not bring myself to read Starobinet’s book. When first released in Russian, it “ignited a firestorm … prompting both high praise and severe condemnation for the author’s willingness to discuss long-taboo issues of women’s agency over their own bodies,” according to the book jacket. However, the fact that I’d never read any account of another person at risk for this kind of pregnancy loss made me hungry for details. Had the technology for diagnosing this condition improved during the intervening 33 years between our pregnancies? Are we any closer to identifying the culprit genes and correcting them prenatally? Did Starobinets get a chance to hold her baby? Did she bury him? Did she suffer from PTSD? Did she lose her trust in the universe?
Reading this award-winning book was grueling for me on more than one level, yet each day I would read a little more, hoping, perhaps, to assuage some small part of the guilt I had been carrying around for so long for never having held Matthew or comforted him as he was dying, and also for being part of a joint decision to stop all “heroic measures,” a euphemism for “pulling the plug.”
I go back to that moment in time, just having given birth, with blood still running down between my legs, exhausted from the physical effort, shivering despite the blankets the nurse piled on me, and in a state of disbelief, or rather not wanting to believe. They ask if we want to look at him, and my then-husband leaves the recovery area for the neonatal ICU located somewhere else in the hospital, but I say no. When he returns, I ask him to describe what he saw, and he says “mostly a mess of tubes and wires.” This is the time I should speak up, insist they let me see him, hold him, sing to him, lull him from this world to the next. Instead I say nothing, except to agree to pull the plug.
Look At Him gets its title from Starobinets’ midwife urging her to look at her dead baby, warning her that women who don’t look at their dead babies “later lose their peace of mind forever.” Starobinets relents the next day and is brought to an ordinary room equipped with a couch and coffee table, where she confronts a wicker basket in which lies her blue blanketed baby, cold from having spent the night in a refrigerator. She’s drawn to the baby’s tiny lips, “pursed as if to cry out, a cry that will never be uttered. A cry that I must not, cannot hear — but all the same, I hear it … and it suddenly dawns on me that I am making those sounds. It’s me whimpering, not the dead baby in the basket.” As I read these words, I felt more clarity about why I have found it so hard to forgive myself for not looking at Matthew.
Reading Look At Him did succeed in lessening my guilt about removing Matthew from life support. Apparently, babies born with severe kidney issues only live a few hours, whether or not they are hooked up to a machine. While a ventilator may help them breathe for a short period of time, it ends up shredding whatever lung tissue they were born with. Ironically, the space created by having one fewer thing to feel guilty about was immediately filled by the fear that the ventilator had prolonged Matthew’s suffering.
As abortion again takes center stage in national and international politics, Look At Him underscores the fact that even with birth defects, there are still so many sides to this issue. Some women might decide to carry to term a baby they know cannot survive outside their body and might even take comfort knowing they spent as much time together as possible with their baby. For others, the mental anguish from carrying such a baby to term might be too horrible to imagine.
* * *
Starobinets movingly describes the mental toll and intimate details of pregnancy loss, a subject that is not generally discussed in Russia. Americans seem much more willing to talk and write about these topics. And yet. What if I were to tell you that the baby I carried for my third pregnancy was diagnosed with ARPKD at 22 weeks by a sonographer using cutting-edge technology at Yale-New Haven Hospital whom I discovered after weeks of research at the National Institutes of Health Library … that I was given two options: carrying the baby to term, knowing she would die the day she was born or terminating the pregnancy … that the labor pains I experienced at 23 weeks could barely be controlled by scheduled doses of Demerol … that I watched episodes of “The Hulk” on my hands and knees from my hospital bed, transformed into a pain-ridden monster desperate for the next injection … that my then-husband looked at the lifeless form I delivered, but I was unable to do so? Would some of you brand me as immoral in the same way you might had I confessed, say, to having an affair?
It is hard to find reliable data on what percentage of women have undergone abortions in America, though it is considered a common procedure. According to a 2014 study done by the Guttmacher Institute, a pro-choice organization known for its rigorous research methodology, 25% of women will voluntarily terminate their pregnancies before age 45. In 2017 that percentage dropped to 18%. The downward trend in abortion rates seems to be continuing, but there has also been a decline in the number of pregnancies. It’s not known how much of this decrease in abortion rates is due to restrictions placed on access and whether there has been a shift in the reasons women seek abortions. For some, the decision may be an easy one, while others may truly labor over how to proceed. The take-away here is abortion isn’t for everyone, but for women everywhere, it should remain a viable choice.