Navigating the minefield of reproductive healthcare – my journey through a life-threatening pregnancy
I already knew when I saw the second pink line. Even though it had happened only a week before, my body was telling me, as it had the previous times, that I was pregnant before I drove to the store and bought a test. Looking at the proof, two things crystalized in my brain simultaneously. The first was that something was wrong, this wasn’t a normal pregnancy – the word ectopic was already flashing in my head. The second was the sudden certainty that I absolutely did not want to have another baby.
My husband and I had tabled the discussion about more kids. I hadn’t felt quite ready to declare us “done” with creating our family; we’d talked about fostering, adoption or just having another biological child; but the enormous, looming shadow of our student debt and the fact that we were barely scraping by from paycheck to paycheck always seemed to end the conversation. The years slipped by and before I knew it my daughter was a junior in high school, my son was about to start middle school and I was staring in horror at a drugstore brand pregnancy test on a Thursday afternoon.
No matter how much I loved being a mother, unless something drastically changed with how our culture treats child rearing, I didn’t want to go back to the beginning. Struggling to pay for childcare and working full time with no sleep and no social or institutional support is extremely unappealing. What our economic and social culture demands of parents is ridiculous. Thankfully, we were able to muddle through with our kids; but I had no desire to roll the dice a third time.
We were about to head out of town for a long weekend with my in-laws but I called my midwife’s office while still holding the test and she called me back within fifteen minutes and talked me off the ledge. I shared my fear that not only did I not want to be pregnant but that I also thought something was wrong with the pregnancy. We planned for me to come in for subsequent blood tests on Monday and Wednesday of the following week.
When my husband got home we packed for the trip and conferred in quiet voices, agreeing that we didn’t want to tell anyone until we knew what was going on. Both of our families are religious and conservative and, though we’re far from either, I didn’t want to deal with everyone referring to this as a baby and creating emotional drama when we weren’t even sure of the situation ourselves.
The weekend was long and tense. I tried to enjoy the time with family but the weight of the unknown happening in my body was overwhelming. My husband and I took long, chilly walks along the shore of Lake Michigan, uselessly discussing options but coming back to the uncertainty of what we were dealing with again and again.
The next week I went for two separate blood draws, two days apart, and then waited for the results. Although I didn’t plan to have another baby, I’d chosen to go to a CNM (certified nurse midwife) for my well care because, in my experience, they had more time to listen to patients and were open to a less interventionist approach to health. The first time I visited for my annual exam, Carrie and I hit it off and I deeply appreciated her openness, wisdom and humor. At the end of the week, she called to tell me that the bloodwork was consistent with an ectopic pregnancy and that she would refer me to an OB/GYN for treatment.
I have to admit, when I researched the doctor she’d scheduled me with and saw that he was an older white man, I groaned out loud. I know – any type of stereotyping is wrong – but my experience with the older, white male doctor who delivered my oldest daughter was a nightmare. He refused to listen to any of my concerns, referred to me as “little lady,” and told me to stop reading books about pregnancy. When the day of my daughter’s birth arrived, he ignored all of my wishes, botched her delivery abominably and left me with a serious birth injury that required subsequent surgery to correct.
As a pregnant 19-year-old in a small New Hampshire town with no health insurance, my options on where I got my medical care were limited. Now, however, they were not so I called Carrie back to see if we could switch me to a female doctor. She responded that it would take several weeks to get in with another doctor and assured me that this one was very good.
As I drove to his office in the suburbs of Minneapolis, my anxiety was peaking. About my health, yes, but also about how to navigate this situation in the political reality of the U.S. in 2012. Even though I considered Minnesota a progressive state, some quick research had already informed me that if I chose to end the pregnancy that my options were very limited. In 2012, there were only four clinics in the state that provided abortion services. That number has since increased in Minnesota but decreased in the U.S. overall.
Fortunately for me, the OB/GYN was very supportive. Rather than subjecting me to an exam that was likely to be inconclusive at 3.5 weeks in, he told me that, in his experience, when women seem very sure of what was happening in their bodies, they were usually right. (Way to play against type, old white dude. Rock on.)
He suggested that we schedule a methotrexate injection in another two weeks (chemotherapy is used to end an ectopic pregnancy in very early stages), along with an internal ultrasound the day before that to verify the diagnosis. Two weeks later, the ultrasound confirmed that the pregnancy was indeed in my right fallopian tube and I headed to the cancer center for the injection.
My husband and a dear friend both offered to come with me but I refused, not wanting to make a big deal out of the situation. When I arrived in the waiting room, I realized that me being there alone probably seemed weird. Everyone else had someone with them, but I just wanted to get it over with. Ten minutes later the nurse injected me with a largeish syringe of chemical cocktail and I was out the door.
The doctor and nurses had warned that there might be some nausea and cramping, but to go to the emergency room if I had severe pain as this could be an indication of a life-threatening rupture. I felt nauseous for the rest of the day, but by the next day I was feeling almost back to normal. Two nights later I started having waves of pain in my lower right abdomen every few minutes. The pain was so intense that I couldn’t sit still. I was pacing and wringing my hands as my husband and teenage daughter tried to figure out how to help me. Eventually we decided to go to the ER.
While we were checking in, my husband sat with the administrator while I paced and hovered behind him. I was still in far too much pain to sit. He tried to explain the situation as I choked out the specifics and the name of my doctor while trying not to cry. Already I could see the disbelief on the faces of the hospital staff.
“What makes you think you have an ectopic pregnancy, hun?” the woman behind the desk asked skeptically, watching me as I struggled not to crawl out of my skin from the pain. At this point the pain that I was experiencing was worse than (unmedicated) labor had been with either of my kids and I was mostly being met with condescension.
Between waves of pain, I explained that if she could just pull up my medical file she would find that I’d been treated for the ectopic pregnancy a few days before right down the hall at the cancer center. After much conferring among the staff, I was finally moved into a triage room.
For the next hour, I was subjected to the same disbelieving interrogation by two nurses, followed by an ER resident. None of them offered any type of pain relief and none of them pulled up my chart in the hospital’s record system. During the last round of this, I finally lost my composure, demanded to talk to the attending physician and uttered that most magical of words in our broken healthcare system: “lawsuit.” They scuttled and a few minutes later the attending came in to inform me that someone from OB would be down to see me shortly.
The OB resident arrived quickly, offered me some Tylenol for the pain and, after examining me, concluded that my fallopian tube had not ruptured. He explained that the tissue from the pregnancy was being reabsorbed by my body and that it could be a painful process. As it turned out, I would experience these waves of pain sporadically in the coming weeks. Each time, the metaphor he gave me would blaze across my brain unhelpfully: “It’s like trying to pass a dried pea through an earbud wire.”
I survived my experience navigating the layers of our reproductive healthcare system; but I’m a white, middle class, married woman with health insurance. What might that experience have looked like if I was a woman of color, undocumented or uninsured? Or even if my husband hadn’t been there to back up my claims in the ER?
It’s been clinically established that women’s pain is taken less seriously in medical settings. This is even more true for women of color. Women’s health is under-researched and largely misunderstood in the greater medical community. All of this is a logical extension of the fact that women are questioned and disbelieved about what happens to their bodies at every turn, from the HR meeting to the Senate floor. We’re told that we don’t have the right to make decisions about our bodies because that privilege is reserved for old, white men with power.
A few weeks ago, the Texas state senate passed one of the most restrictive anti-abortion bills in the country and the Supreme Court chose not to block it. The bill is based on pseudoscience about a heartbeat that is not a medical reality in the early stages of pregnancy. It relies on citizens for its enforcement, offering a bounty for those who inform on doctors, nurses, family members, counselors and anyone else who “aids and abets” an abortion patient.
Even though I live in Austin, Texas now, this bill would not stop me from getting an abortion if I needed one. I have the privilege and resources to go elsewhere to obtain care if I need to. You know who doesn’t? The millions of women living in poverty in a state with the second highest rate of maternal mortality in the country. The undocumented women who are held in border camps or detention centers. The women who live more than 250 miles from the nearest abortion clinic.
In my role on the board for a local nonprofit that provides mental health services, I’ve spent the past few weeks in conversations about how we will handle it if we get sued for providing services to women in need. I’ve watched the staff worry about what would happen to their clients and whether they’d be named in a lawsuit for doing their jobs. Poll after poll has shown that the majority of Americans believe that abortion should be legal so how are we still here?
Texas has the highest rate of uninsured women of reproductive age. It has the worst record of first trimester pregnancy care. Black women are three times more likely to die in childbirth here than are their white counterparts. The people who passed this law don’t care about babies and they certainly don’t care about women. They care about control.
I was lucky. My story of an unexpected pregnancy could have gone very differently, and I recognize the role my privilege played in that. Women, all women, deserve equitable and adequate healthcare, including a full range of reproductive health services. We need a healthcare system that supports our health, not a gaslit legal minefield.
Don’t forget to vote.