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In The Exam Room: Unexpected Pregnancies and Hard Choices

Today's post is from Patricia Harman, author of The Blue Cotton Gown: A Midwife's Memoir. Harman got her start as a lay-midwife on the rural communes where she lived in the '60s and '70s, going on to become a nurse-midwife on the faculty of Ohio State University, Case Western Reserve University, and West Virginia University. She lives and works near Morgantown, West Virginia, and has three sons. In the interest of privacy, the names and some identifying details of the women she discusses in this post have been changed.

Harman.jpg I am standing in the exam room, in the Women's Health Center, listening to the rapid heartbeat of a four-month-old fetus on a Doppler. The patient, Carey McDonald, 17, a slim blond cheerleader, is alone today. Sometimes her mother, a single waitress, comes with her. The father of the baby, a star football player on the hometown team, denies paternity. "But it's his!" Carey told me. "It is! He's the only boy I've ever been with and even that was only two times." Carey and her mom will raise this baby together.

I don't ask the young woman if she thought of using a condom. I don't ask her if she had access to a birth control clinic. I don't ask if her mother ever talked to her about sex or if she had sex education classes at school. It's too late for that now.

Natalie Lopez is a 29-year-old travel agent. She's seven weeks pregnant and accompanied, at this first exam, by her lover of three years. "I can't take birth control pills because of the other medications I'm on, but we used protection every time." Her eyes water over and she hands me a folded white paper on which are printed the names of two antidepressants and a mood stabilizer. "We want to be parents. I've always wanted a baby. But I can't have this one. The medications I'm on are toxic and there's a high chance the child will be born with a congenital defect."

If Natalie had come to me sooner, to get a more effective method of birth control, this might not have happened. But Natalie doesn't have health insurance. There are over 17 million women in the United States that don't have health insurance.

Diane Boggs is only twelve. Her eighteen-year-old cousin sexually assaulted her. Afraid people would say it was her fault, Diane didn't tell. Sitting on the exam table, she hangs her head low so her long red hair covers her face and the tears fall into her lap. She is, by ultrasound, sixteen weeks pregnant. Her grandmother, Mrs. Boggs, a widow, who's raising Diane alone, clutches her pocket book and takes a deep breath. "I never believed in abortion, but I can't raise another child. I'm already seventy-three."

Diane is too far along for a simple termination. A second trimester abortion is difficult to find. In some states they're illegal. The pressure of the pro-life movement has closed abortion centers. Older physicians in private practice, skilled in the procedure, are afraid to help, even in cases of incest, for fear of reprisals by anti-abortion activists. Ninety percent of counties in the United States don't have access to reproductive termination.

Ruth is a forty-five year old, married mother of three who had a tubal ligation after her last delivery. She is ten weeks pregnant. "The doctor told me there was only a 2 in 1000 failure rate for the sterilization, but I never thought it would happen to me. My husband has been laid off his job and I was trying to make him feel better." She smiles a half smile and looks up at me from the corner of her eye... then her expression changes.

"I love my children more than anything. I just never thought I would be in this spot, but you see, it's all we can do to keep up with the ones we have. My youngest is autistic. Ron lost his health insurance along with his job. I'm one payment behind on the house and can barely afford the heat. I don't know where to turn; none of my conservative family would understand or help me get a termination. What am I going to do?"

I'm thinking of lending Ruth the money to drive to Maryland. The cost would be $400 dollars.

We live—if you are a health care provider, a female, a parent, or someone who cherishes a woman—in dangerous times. The Health and Human Services Department of the U.S. is cutting funding to reproductive health centers and birth control education programs in schools. Right to lifer's, who picket on the sidewalks in front of abortion centers, still heckle and humiliate vulnerable patients seeking services. The pro-life movement has energized around their new calendar girl, Sarah Palin.

I am a nurse-midwife, not an ethicist, but I know Diane, Natalie, Carey, Ruth, and Mrs. Boggs. I don't even ask myself what I would do in their shoes.

This is their very private decision. I give them a handout on reproductive centers, all of them two hours away. I tell them how many weeks they have until they must make the appointment and not to make a decision in haste. I provide prenatal vitamins and prenatal care, should they decide to keep the pregnancy. I talk to them about giving the baby up for adoption. I give them birth control afterward and try to prevent another unwanted pregnancy.

In thirty years, I have never met a woman who made the decision to terminate with a dry eye. I hold them in my arms while they cry.

Maybe, if those who judge could sit in the exam room with Diane and her grandma, they would understand that, as a society, we must do all we can to avert such unintended pregnancies… and sometimes we must weigh one life against another.

You may also want to listen to this radio interview with Patricia Harman or read this excerpt of The Blue Cotton Gown.