Why Late-Term Abortions Must Be Legal and Easily Accessible

Nobody has abortions for fun. Nobody wants to have an abortion. And I swear that, as a pro-choice advocate, I do not get any sadistic pleasure from knowing that there are late-term abortions happening in the world. I do want there to be as few abortions as possible. And I also want elective abortions to be done as soon as possible—when a pregnancy is terminated at the pregnant person’s request for reasons other than maternal health or fetal disease, it should not be a late-term abortion.* Nobody wants or enjoys abortions, and there is no evil conspiracy to abort as many fetuses as possible.

There is some fearmongering among pro-life activists that people will decide to have late-term abortions on a whim just because they got bored of being pregnant after a few months. Here’s what literally nobody is thinking: “My belly is starting to get big, this is getting annoying, because it disturbs my ability to exercise, I think I will get an abortion today morning, I’d like it to be quick, so that I can get to my hairdresser’s appointment today afternoon.” This is something that never happens. In reality, late-term abortions are performed on people** who wanted a child but lost their baby due to medical complications.

Most countries that limit abortions have exceptions for cases where continuing the pregnancy endangers the life of the mother. That’s not enough. We also need to include provisions for the health of the mother, beyond merely if her life were in danger. Sometimes a continued pregnancy would cause grave and long-lasting health consequences for the pregnant person. Sometimes a prenatal condition is diagnosed that means a child would die before birth or shortly after. In such cases, late-term abortions must be easily accessible so as to reduce suffering for the pregnant person, and they should not be told to go home and wait for a naturally occurring miscarriage or delivery just because there is still fetal heartbeat.

Unfortunately, in some countries hospitals are not secular, and poorly written laws result in avoidable suffering for a person whose pregnancy resulted in severe medical complications.

For example, let’s look at what happened with Savita Halappanavar who was murdered back in 2012 by conservative Irish lawmakers. She was 17 weeks pregnant when the medical staff at University Hospital Galway denied her request for an abortion following an incomplete miscarriage on the grounds that granting her request would be illegal under Irish law, ultimately resulting in her death from septic miscarriage. Doctors just sat there and did nothing while she was dying, because her fetus still had a heartbeat.

On Sunday 21 October 2012 at 9.35am, Savita and her husband Praveen attended the gynaecology ward at UHG without appointment. She presented with intermittent lower backache.

She was assessed and a treatment plan for back pain put in place. She left the hospital but was told by a doctor to come back in if she had any concerns.

Later that day – at about 3.30pm – she did return. She was upset and crying after having “felt something coming down”, which she had pushed back in.

A midwife working in the ward believed she was miscarrying and doctors were brought in to review the case.

By then, Savita was distressed and in unbearable pain.

The doctors on the ward believed that she was in the middle of a miscarriage – or about to miscarry. They noted that pregnancy loss was both inevitable and impending. They ruled out being able to perform what is known as a rescue cerclage (stitching the cervix closed to prevent miscarriage and allow a pregnancy continue to fetal viability).

The Halappanavars were moved to a single room to allow them their privacy during this devastating episode.

During that Sunday, doctors checked for a fetal heartbeat, which they were able to detect. The plan was to wait for the natural outcome of events.

Just after midnight on Monday, 22 October, Savita began vomiting violently and had a spontaneous rupture of membranes – that is that the bag of membranes around the foetus had burst and the fluid (also known as liquor) had leaked out.

By 8.20am, she was experiencing bleeding but her pain had eased. At this time, the consultant discussed the risk of infection and sepsis with her, explaining the need to continuously check for a fetal heartbeat.

At the same time the following day – Tuesday, 23 October – Savita and Praveen asked about using medication to induce the inevitable miscarriage. According to the HSE report published after her death, they told the consultant they did not want a protracted waiting time when the outcome was inevitable.

They were advised of Irish law in relation to this request with the consultant recalling saying: “Under Irish law, if there’s no evidence of risk to the life of the mother, our hands are tied so long as there’s a fetal heart[beat].”

The clinical plan to “await events” remained and Savita continued to be administered antibiotics while being examined throughout the day. She complained of ‘weakness’ during this time but was eating and drinking normally.

Praveen continued to stay with her through the days – and overnight on a camp bed.

At 4.15am on Wednesday 24 October, a midwife noted that Savita was feeling cold and shivery (the radiator in the room did not work and was documented as being “stone cold”). Both she and her husband asked for extra blankets and the midwife noticed Savita’s teeth were chattering. She was given paracetamol to manage her increased temperature.

By 7am, Savita was suffering from nausea and vomiting. Just over an hour later, the consultant’s team diagnosed chorioamnionitis (an inflammation of the fetal membranes due to infection). Their focus was to find the source of that infection and to give time for the prescribed medications to work.

The plan at this point was for Savita’s vital signs and fetal heart rate to be monitored. She was to be reviewed later with a view to induce labour once there was no fetal heartbeat present.

By 11.45am, the fetal heart had been checked and was still 148 beats per minute (within normal range).

Savita, by lunchtime, was also complaining of chest pain and had difficulty breathing.

Nurses had noted a sudden deterioration of her condition at about noon, and she was “very unwell” by 1.20pm.

Following a review by the consultant team, Savita was diagnosed with septic shock, with chorioamnionitis being considered as the cause.

After 2pm, the plan of treatment was noted to include a dosage of misoprostol, a drug used to induce delivery. However, it was never administered as there was a spontaneous delivery at 3.15pm in theatre, where she had been brought to have a central line inserted.

Praveen was taken into the operating theatre to be with his wife who was extremely upset about the miscarriage.

Savita was then transferred to the High Dependency Unit of the hospital.

Overnight, into Thursday 25 October, her condition continued to deteriorate. She needed increased oxygen and was transferred to the intensive care unit (ICU) at 3am.

She remained critically ill throughout the coming days. She was intubated, ventilated and her cardiac output was decreasing by Friday afternoon.

Despite ongoing measures by the ICU medical staff through to Saturday, Savita remained in critical condition – and deteriorating.

At 12.45am on Sunday, 28 October, Savita suffered a cardiac arrest.

At 1.09am – almost a full week from her presentation to the hospital – she was pronounced dead. Source.

You might have noticed how I intentionally used loaded language, I said that this young woman was “murdered” and that “doctors just sat there and did nothing while she was dying.” It is true that in the middle of a spontaneous abortion doctors cannot know how it will progress. Maybe the fetus will die quickly and everything will go fine. Or maybe it will drag on for days until the pregnant person dies. When trying to guess future events, doctors are dealing with probabilities and they don’t know what will happen. But they sure did know that the fetus was nonviable and that the woman was suffering severe pain. Thus it is fair to say that she was tortured and her suffering was pointlessly prolonged for no good reason. And even though doctors didn’t know it at the time, her life was in danger and she was dying while they just sat there and monitored fetal heartbeat.

Nowadays laws in Ireland have improved, but when Savita was murdered, a poor fetal prognosis did not provide legal grounds for termination of a pregnancy. When Savita asked for a termination knowing that her child could not survive, she was denied an abortion because of the presence of a fetal heartbeat. And Savita’s case wasn’t unique. Such cases are painfully common.

Here’s an example of what happened in the USA:

It’s not always easy for staff in Catholic hospitals to decide when a pregnancy is life-threatening enough to merit action—as Meghan Eagen-Torkko’s story shows.

In 2004, Eagen-Torkko was about seven weeks pregnant when she had an incomplete miscarriage. She worked as a labor and delivery nurse at Providence in Everett, and her insurance covered her only at that hospital. Her debacle shows how the laws promoting abortion and contraception access in Washington can be blunted by religious facilities; if insurance plans only cover Catholic options, comprehensive coverage of reproductive health services won’t help. (Her former employer, Providence, recently announced it planned to enter the health insurance exchange in Washington state and invoke its religious principles to limit coverage of abortion.) There was no other high-risk obstetrics facility in the area… Eagen-Torkko’s only option when she was bleeding and needed urgent care was a Catholic facility.

As a nurse, Eagen-Torkko knew she needed a procedure called an aspiration to remove the remaining tissue from her uterus and stop her bleeding. But care providers at Providence were worried that her fetus might still have a heartbeat. For hours, they performed ultrasound after ultrasound, searching for a heartbeat that wasn’t there, afraid to get in trouble if they missed it. After about six hours, they finally performed an aspiration. During this ordeal, Eagen-Torkko lost enough blood to require a transfusion.

The consequences of this transfusion would become apparent later, when Eagen-Torkko was pregnant again. She had been transfused with blood containing an antigen called Kell. While Eagen-Torkko, like most people, was Kell negative, her ex-husband was Kell positive—as were her pregnancies. Because she was sensitized to Kell by the transfusion, her body produced antibodies that put her next pregnancy at risk of sudden fetal demise. Doctors told her that her fetus could die with no warning and no way to predict it. Source.

I can give you more similar stories:

Alison had first gone to her OB-GYN’s private practice, where her doctor, C. Shayne Mora, diagnosed her with a possible case of placenta previa, a serious condition where the placenta blocks the cervix. He told her to go to the hospital if she started bleeding again. When that happened the next day, Alison went to the St. Joseph emergency room. After an ultrasound showed the fetus was viable, the hospital discharged her. Providers recorded a clinical impression of “threatened abortion,” meaning Alison was at risk of miscarrying. They told her to return if she bled more heavily or ran a fever…

The next day, Alison started soaking through a menstrual pad an hour and returned to the ER. Her medical records show she was again discharged with plans to see Dr. Mora in his office. Three days later, she woke up in the middle of the night bleeding. Around noon, she passed a blood clot the size of a jawbreaker. In the ER for a third time, she described her pain as a seven out of ten. She was running a fever of 100.4 with an elevated white blood cell count, a classic sign of infection. “Appears anxious,” staff noted in her medical records. But the hospital discharged Alison again, this time telling her that her pain might be the result of appendicitis.

Alison and her husband, Richard Bennett, clung to that idea, because it meant the pregnancy might be safe. At no point, they said, did anyone at the hospital mention that Alison had the option of ending her pregnancy with surgery to address the brewing infection that would end up putting her life at risk. Alison’s records at the time of her third discharge still show a working diagnosis of threatened abortion.

By the next morning, Alison was in significant pain and her fever wasn’t responding to medication. She and Bennett returned to the ER. There, records show, a doctor ordered an abdominal MRI to rule out appendicitis and a chest X-ray to rule out pneumonia.

Then Mora arrived. He did a vaginal exam, and Alison arched off the bed in agony.

“It felt like something from the Exorcist, just like flailing from the pain,” she said. Bennett remembers Alison screaming when the doctor pressed on her abdomen. Alison, who recalls having refused pain medication out of fear it might harm the pregnancy, told Rewire.News that the agony radiating from her infected uterus was worse than non-medicated childbirth. Medical records show her fever had spiked to 101.1…

Mora moved quickly. He explained to Alison that she had an infection and needed surgery to end the pregnancy. Bennett asked whether there was any way to save the baby. Mora was firm: No. In fact, Alison’s life might be in danger.

Records show Alison had sepsis, a potentially deadly condition caused by the body’s response to infection. But Mora explained that he couldn’t proceed until the hospital’s ethics committee approved the surgery. Citing Catholic policy, PeaceHealth bans abortion unless its “direct purpose” is the “cure of a proportionately serious pathological condition of a pregnant woman” and it “cannot be safely postponed until the unborn child is viable.” In other words, the hospital would permit the life-saving surgery only if the committee considered Alison sick enough.

Skavdahl remembers Mora saying that if he couldn’t secure the approval, he planned to send Alison in an ambulance 90 miles south to Seattle, a drive that can take well over two hours on the congested highway. “And I’m just thinking, ‘What? You have to get a bunch of people together?’” Skavdahl recalled. “And he goes, ‘Well, it’s not quite as bad as it sounds. I can get them on the phone, it’s not like they all have to get here, but I don’t know how long it will take.’”

It’s unclear from the records how long the committee deliberated, but Alison said it felt like around an hour. “I remember being scared about that,” Alison said. “You’re telling me this is really serious and that my life is in danger, and we have to wait, and these people have to say it’s OK for you to have this procedure you absolutely need.”

Mora’s notes show that the ethics committee approved the surgery because of the risk to Alison’s health. At some point, records indicate she was given misoprostol to soften her cervix. But before she made it to the operating room, Alison miscarried into the toilet. She felt so sick that she thought she might be hallucinating when she saw the white form in the water. She sobs recalling it, six years later.

“I didn’t have to suffer like that,” Alison said through tears during an interview in June. “Everyone deserves adequate medical attention, and information, and choices.”

Alison and her husband said that besides Mora, no one at St. Joseph mentioned the possibility of surgery to end Alison’s pregnancy. She said providers “ignored that whole area,” and neglected to do a vaginal exam, even as they ran tests on her abdomen and chest. During her final visit to the ER, Alison, having searched online for possible causes of her pain, said she asked a doctor if it might be a uterine infection; she said the doctor wouldn’t make eye contact and told her to talk with her OB-GYN. Mora and PeaceHealth declined to comment on Alison’s case. The Catholic health system directed Rewire.News to its statement of common values, which says it “strives to promote the sanctity of all human life.” Source.

It isn’t just women with spontaneous abortions who are poorly treated as a direct result of terrible and religiously-inspired laws or guidelines. Women told that they are carrying live fetuses with fatal abnormalities routinely have to travel far distances in order to abort rather than wait weeks or even months for their pregnancy to die naturally. Now imagine your belly growing bigger and listening to people cheerfully congratulating you on your pregnancy while you are struggling not to break into tears knowing that your child is doomed to die.

In Ohio, as in most of the 11 states with laws targeting public facilities, there is no exception for fetal anomalies. In December 2018, Chelsea, who asked Rewire.News not to use her last name, was about 15 weeks into a planned pregnancy when a specialist at University of Cincinnati Medical Center told her that her fetus had triploidy, a condition where three sets of chromosomes develop in each cell instead of two. Babies with triploidy are stillborn or die shortly after birth.

The news devastated Chelsea, who had suffered a miscarriage months earlier. The condition also put her at higher risk for choriocarcinoma, a fast-growing cancer, and preeclampsia, a potentially deadly pregnancy complication characterized by high blood pressure. Chelsea’s blood pressure had already been unusually high. Then the doctor delivered the final blow: Affiliated with a public university, the hospital would end her pregnancy only once Chelsea was too sick to continue it.

“My head was spinning because of the information that I was being given, but I just felt like I was on an alien planet,” Chelsea told Rewire.News. “There was no question in my mind: I’m not going to risk my organ function to carry a non-viable pregnancy to term.”

The “best-case scenario [was] the baby would be stillborn, or the baby would suffocate to death, which to me was not something that I was willing to put my child through,” she said.

University of Cincinnati Medical Center did not respond to requests for comment.

In greater Cincinnati, the last private hospital to perform abortions for fetal anomalies reportedly stopped doing so in late 2015. Deepening Chelsea’s stress was the fact that Ohio was on the verge of eliminating the procedure she needed; the week of her diagnosis, state lawmakers approved a ban on the most common and safe method of second-trimester abortion, with no exception for fetal anomalies. The day after the doctor called to confirm her diagnosis, Chelsea wrote a letter to one of the bill’s co-sponsors, Ohio Republican Sen. Louis Terhar.

“I cannot have a dilation & curettage (D&C) in a hospital like I did with my last loss, as this baby has a heartbeat,” Chelsea wrote. “Instead I have to go to an abortion clinic with doctors and staff that I do not know. I have to go in with protesters screaming at me on the worst day of my life. I am praying for a miscarriage. I never thought I would say that after experiencing one before. But I thank God termination is an option for people like me.”

Chelsea called Planned Parenthood, where she needed three visits to comply with Ohio’s 24-hour waiting period: One for counseling and an ultrasound, one to sign a consent form after the doctor who would perform her procedure had signed it, and a third for the abortion. She was also forced by law to read a packet about how she could instead parent her child—something she desperately wanted to do—or put her baby up for adoption. Each barrier felt like another blow.

“It just feels like death by a thousand cuts,” Chelsea said. “I kept saying, stick the knife in and keep twisting it, because it just made a bad situation horrific.”

Fortunately, she was healthy enough to be seen in a clinic. Unlike the hospital, Planned Parenthood didn’t offer general anesthesia, although Chelsea would have preferred to be asleep. Three days after her procedure, Ohio Gov. John Kasich signed the law banning the surgery she had undergone. (The law is not yet in effect; Ohio providers have filed a lawsuit challenging it.)…

These situations present a moral dilemma for providers…

Because of her hospital’s policies, the doctor in the Midwest said she has seen patients remain pregnant after they were unable to access an abortion to preserve their health. Discussions about whether to allow an abortion in each case can involve an ethics board, risk management officials, high-risk OB/GYNs, and other specialists. In one case, a patient who had suffered cardiac arrest shortly before getting pregnant did not meet the hospital’s threshold for life endangerment and was unable to afford to travel and pay for an abortion at the nearest hospital that would see her, about four hours away. She ended up miscarrying in her second trimester. In another case, a patient who was dying from metastatic cancer needed abortion care. The hospital took so long to deliberate, she miscarried too.

“Our conversation should have been like, ‘How can we help you heal and meet whatever your goals are in this terrible situation’, and not about this stupid law,” the doctor said.

“My hands are tied,” she continued. “I can’t do what’s right for the patient.” Source.

Are you feeling sick already? I sure do. Reading about cases like these is sickening. In some countries people live in a deeply fucked up society. Here are fragments from an interview with a woman who had an abortion at 32 weeks:

It was around 16 weeks, I think, when we got the scan that looked like his feet were turned in—like club feet. Our doctor said he was OK, that we’d just keep watching it. Then, also around that time, we found out that I had a weird umbilical cord, or velamentous cord insertion. Normally, an umbilical cord is implanted in the center of a placenta; mine was way on the edge. That affects blood flow, affects how blood and nutrients get to the baby, so they put me on rest. And, unrelated, I was also bleeding—these huge bleeds that looked like I was having a heavy period.

None of these things, by the way, are related. They’re all random and rare, and on their own, they’re manageable problems. So I just kept going back every two weeks, and he kept growing, and everything looked good.

How would you describe your state of mind at this point?

Nervous. We weren’t really telling people. I’m tall, and I have a long torso, and it was winter, so I could cover myself with layers. I told my close friends, but I was always saying, “It’s really dicey.” We were braced for the worst.

Then, they did a blood test and found really bad news. Really bad. When my OB called to tell me about these results, she sounded like someone had died. Basically, there’s a certain protein that exists inside the fetus, and a tiny bit is supposed to get into the mother’s blood, but very little. I had four times the median of what’s normal.

So they immediately thought about muscular dystrophy, spina bifida, things like that. They rushed me in, did a full scan, measured everything. And they couldn’t find anything. He looked fine. My doctor said all we could do is keep checking. We kept getting all this troubling information, but as long as he looked good, what are you going to do? Some people probably would’ve aborted earlier, maybe based on projected bad news, but…

After that blood test, you mean.

Yeah, some people would’ve terminated at that point. It was still legal in New York. We had until 24 weeks.

Was that ever suggested to you?

No, no one ever said it. Even later, when the situation was getting obviously very dire, no one brought it up. Or if they suggested it, it was very carefully. After all, it’s very rare to have all these bizarre things happening at the same time, but still, people experience worse things and then give birth to normal babies. Our doctor kept saying, “As long as he grows, this is good news.”

We get, somehow, to the second trimester. Then we find out that his feet really are clubbed. I was so upset at first, because he was officially not going to be perfect. I know that sounds crazy, especially in retrospect—but you have that hope that he’ll be perfect.

Of course.

But our doctor didn’t really care about the club feet. People get casts when they’re babies, and grow up to be fine. I did my research, and soon I was telling anyone who would listen, like, “Kristi Yamaguchi had club feet!” It all became part of this kid being even more special, in a way. He was getting through all these crazy challenges and continuing to grow.

Then, in the 20s, week-wise, they get concerned that his hands are closed in every scan. And at this point, I was getting scans every two weeks. So now it was both his feet and his hands. But there was no diagnosis, and he was still growing. And limbs are secondary. You can have surgery, as long as the brain and the digestive system and the heart are fine.

It must have been such a quietly difficult thing to keep adjusting your expectations.

Our doctor had told us, “Look, if your baby gets to 28 weeks, he has a 75 percent chance of being born and being normal. If we can get him to 32 weeks, he has a 95 percent chance of being totally fine.” So we were just concentrating on that, hanging on to the idea of getting him to 32 weeks.

I’m wondering what you told yourself through all this that allowed you to be prepared for the worst and also hopeful.

There were certainly dark moments. There were months where, every time we went to the doctor, we learned something new and terrible. Every single time. And so at first, I told myself, “Don’t get too attached.” Every single thing we learned, I would Google what it meant, and the risks, and I’d be upset. And then, eventually, I would absorb it into the narrative of this pregnancy and just tell myself, “You know what? This kid is coming from a long line of fighters.”

Right. The bottom line is the hope of getting through.

But then what happened was like—let’s say you’re looking for traffic down a one-way street, and you’re only looking in one direction, and then you get hit by a biker coming down the other way. I was so concerned with his growth, and him making it to a certain period, that it didn’t occur to me that something completely unrelated might come down the pike. Do you know what I mean?

You mean that the abnormality you found out about at 31 weeks was, again, totally random.


But before then, you’d have hit your viability mark. What was that like?

It was getting very obvious. People were getting up for me on the train. Strangers were starting conversations with me about pregnancy. We were even warming up to the idea of some sort of baby shower, which we’d felt like was a jinx. Even if you’re trying as hard as you can to not invest in the idea, at a certain point, you just do.

Did you have stuff for the baby? Names?

We did start to talk about names. We were researching great warriors, because it felt right that this guy should have a warrior name, considering the odds he was fighting. His working name was Spartacus, which was supposed to be a fill-in until we came up with something else. On my Google calendar, my due date said “SPARTACUS!”

We did have some family members get us some things as gifts, some friends who gave us hand-me-downs. We took classes, because neither of us know shit about babies. We took baby CPR. We were starting to tentatively plan that this person was going to show up, and once we hit 30 weeks, we got very excited. We thought, “Even if I go into labor tomorrow, he has a very strong chance of making it.”

What happened at 31 weeks?

We went back to get a growth scan, and we saw the growth had fallen off a cliff. And this was the first time that we had been presented with this idea that there was something deeply wrong with the baby that had nothing to do with me. Until that point, all the really bad news had been with me, and my weird body. He had been thriving despite the environment.

But on this scan, he’d gone from the 37th percentile to the 8th. And he wasn’t swallowing.

Was your husband with you at every appointment?

He didn’t miss a single one.

And this is the one where the doctor told you that the baby wouldn’t be able to breathe.

Yes. With the feet turning in, the hands clenched, the not swallowing, the doctor told us that he suspected there was something muscular going on—something deeply, deeply wrong.

I want to say, also, we were at a high-risk medical center in New York City. We’d been long ago passed off by my regular OB. All the doctors are highly published; we really trusted them. So there was no ambiguity when they realized something was really, really, really deeply wrong. They had been really optimistic the whole time; they see the worst cases and often still get good results. When they were upset, we knew it was bad.

What happened after that appointment?

The doctor said, “Let me talk to the geneticists. Come back in a week.” So actually, this was about 30 and a half weeks. He told us we’d make a decision the following week.

So at that point, we knew that it was probably not going to work out. But at the same time, of course, I was still holding on to hope that, maybe… I don’t want to use the word miracle, but maybe it was a bad scan, I thought.

And you hear the word “miracle” so often in these stories.

Yeah, and I’m Googling everything all over the place. Lots of miracles, so to speak. But so we went back and met with the team. They did an amnio, they did a micro-array. We were looking for a diagnosis, my husband and I: we wanted to be able to call it something, mostly to make sure that there wasn’t something underlying that might happen again. The doctor reiterated that my previous miscarriage had nothing to do with this, but of course a part of me wondered.

In the week previous to this second appointment, I had taken a freelance job just to keep my mind off the waiting. So I was out of town when my husband talked to the geneticist, who said that there was no diagnosis, but that any outcomes would be severe. That’s when he realized that from a medical standpoint, the situation was bad, and terminal. He didn’t realize initially what that meant in terms of our options—that the laws in New York meant we couldn’t do anything in the state. I was shocked too, for some reason, when he told me. I thought, “We live in New York, this is crazy.”

So then we talked about Colorado, and then I came back from that job, and we went back to the doctor’s and got the final, final diagnosis.

Which was?

This baby was unviable, basically. That’s what they say. They say that the baby is “incompatible with life.”

Did you consider carrying to term despite that?

This is another fun side note. I was already going to have to have a C-section no matter what, because two years ago, I’d had brain surgery. And my doctor checked with the neurosurgeon, who wouldn’t sign off on a natural birth. They were afraid that if I pushed, something might go on in my head, so the delivery had to be a C-section. And so we were considering putting me through major abdominal surgery for a baby that’s not going to make it, or risking that I go into natural labor and something pops in my head and I die, basically.

To be clear, if the doctors thought there was any way he might make it, I would have taken that chance. I truly would have put myself through anything. What I came to accept was the fact that I would never get to be this little guy’s mother—that if we came to term, he would likely live a very short time until he choked and died, if he even made it that far. This was a no-go for me. I couldn’t put him through that suffering when we had the option to minimize his pain as much as possible.

So you’re going to Colorado.

There are a few doctors in the country—four of them, you interviewed one of them—who will do this. But my doctor had previously referred patients to Dr. Hern, who’s in Boulder. He’s this 78-year-old man who’s been doing this for decades, who developed a lot of the abortion procedures that we know to be the most safe. He’s had 37,000 patients and he’s never lost anyone. And he’s a zealot, but he has to be. There are websites dedicated to offering money to kill him; his practice has four layers of bulletproof glass. They’ve been shot at. He was there during the Roe v. Wade decision. He’s been through it all. And the only other peer he had at his level was Dr. Tiller, who was killed in 2009.

He’s got no trainees, either, you said.

He has one other guy who is studying with him right now, but that doctor is an old man as well; he’s a guy who was practicing in Texas until Texas passed that slate of restrictions.

My doctor told me: “We’ve worked with Dr. Hern. We know he’s amazing. People who have gone to him have gone on to have healthy pregnancies, and that’s what’s most important to us. We want to make sure you’re healthy and intact at the end of this.” They gave us the clinic’s information, and they told us to let them know what they could do.

So I called the clinic in Boulder, and talked to this amazing woman—the kindest, most patient woman on this Earth, who is used to talking to people in really bad situations—and I told her everything that was going on with us. She immediately said she needed to get Dr. Hern involved because of the history of with my brain. And then it took almost another full week for my doctor in New York, Dr. Hern in Colorado, and my neurosurgeon in New York to all get on the same page about the best course of action.

What was that week like?

Terrible, and sad. I just wanted to be done with it.

How did your emotional relationship to the baby change once you realized he wasn’t viable? Your instinctive sense of what was inside of you?

I got numb. The night that we found out that he really wasn’t going to make it, my husband and I came home and drank bourbon. We raised our glasses and my husband made a toast “to Spartacus.” And when I had a sip of bourbon, it was over. Do you know what I mean? I had been so careful. I had been a health nut throughout the entire pregnancy, and at that point, it was like, fuck it, I’m trying to keep my sanity the best I could.

Of course, I’m still having to walk around looking pregnant and people still commenting on it. And you don’t want to make people feel bad, so you’re going along with it when the guy at the grocery store congratulates you. It feels fucking terrible. I wanted it done as quickly as I could.

What took your doctors a week?

The time difference, the fact that there were three of them, and the fact that Dr. Hern said, in the end, that he didn’t feel comfortable doing the whole procedure at his practice, which is a clinic and not a hospital.

Doctors will tell you: this push to make all abortions happen in hospitals, it’s ridiculous. There’s just no need, normally. When you do need a hospital, your doctors will make sure that you’re in the right place where you need to be. So they decided that the best course of action would be for me to fly to Colorado, and get a shot of this drug that they put through your stomach to stop the baby’s heart, which only Dr. Hern could dispense; then they would give me another drug to keep me from going into labor.

God. And then you got on a plane?

And then I got on a fucking plane back to New York…

Will your insurance retroactively reimburse you for anything?

Today, actually, I sent a request for reimbursement to my insurance company. But I have no idea whether they’re going to accept it or not. Either way, the clinic is really good about working with you as far as your own insurance situation goes: they help you fill out all the paperwork, they make it as clear as possible that this is a medical issue.

I have really good insurance right now, so I do have the hope they’ll reimburse for something. Because here’s one thing you should know. If you get the entire procedure done at the clinic at this late date, it’s $25,000. Cash…

That would be it for most people. Most people are forced to carry to term because they can’t afford that. I’m very lucky to have been able to afford last-minute plane tickets, hotel rooms, and a $10,000 shot. I’m global 1% lucky. And by the way, people are flying to this clinic from all over the world and all over the country. There was a 16-year-old in the room next to me, and there was a woman from Finland. If you’re desperate enough, you’ll scrape it together, I guess. There are also third parties, organizations that will help you pay for at least a portion of it if you truly cannot.

In my case, my mom gave me the $10,000, and I still have some hope that we’ll get something back. From what I understand, my insurance company will probably reject me at first and then it’ll go into appeals and then, eventually, they should pay something. Source.

And, for a good measure, here’s more:

Dr. Jessika Ralph was waiting for her patient to get sick.

The young woman had arrived at Wheaton Franciscan-St. Joseph hospital in Milwaukee, Wisconsin, in labor. She was 18 weeks pregnant, and her twin fetuses were long from viable. She miscarried one fetus within hours of admission, but her labor stalled while the second still had a heartbeat. Because the hospital followed rules issued by the Catholic Church, until the patient hemorrhaged or showed at least two signs of infection—fever of 100.4 or higher, uterine tenderness, rapid heart rate, or rapid fetal heart rate—Ralph could do little except watch her sicken.

So Ralph’s team trimmed the umbilical cord from the miscarried twin as short as possible to minimize the infection risk, and waited overnight.

After about 10 hours, the patient’s temperature soared to 102 or 103 degrees, Ralph recalled in an interview with Rewire in June, a few months after the incident. Ralph and her team gave the patient medication to induce labor. But Ralph could not administer mifepristone, which the American College of Obstetricians and Gynecologists (ACOG) considers part of the most effective drug regimen for such cases. The Catholic hospital didn’t carry the drug, which is commonly used for medication abortions—a failure Ralph believes was religiously motivated and needlessly prolonged her patient’s labor.

At first, the patient’s goals seemed to align with the hospital’s rules, Ralph said: She wanted to try to continue her pregnancy to a viable gestation, even though the chances were slim. But as she rapidly sickened, she and her family pleaded with Ralph to speed up the process of ending her pregnancy. Ralph felt powerless. The fastest, safest method for terminating a second-trimester pregnancy—a surgical procedure called dilation and evacuation (D and E)—was not offered at St. Joseph, where no supervising physicians were capable of performing the common abortion procedure, Ralph said.

For more than 24 hours, the patient labored through painful contractions. She bled heavily, requiring at least one blood transfusion. Her lips and face lost their color. Finally, she delivered a fetus that had no hope of survival…

“You’re in this limbo of knowing that the right thing to do is to induce her labor because she is going to get sick. And when we say sick, I mean, it’s not common but they can die, they can become septic and die from something that we could treat and prevent and never have them get ill,” Ralph said. “How do you tell this patient, in good conscience, ‘I’m waiting for you to get sick?’” Source.

In all of these examples I have quoted here, the fetus was already doomed, there was absolutely no possibility that the child might survive. Losing a wanted child is painful, both emotionally and physically. In such tragic cases doctors should do whatever they can in order to alleviate suffering for the pregnant person. The fact that the fetus still has a heartbeat is irrelevant when it is clear that it cannot possibly survive. However the pregnant person is still alive and suffering. Thus doctors’ goal should be reducing the pregnant person’s suffering as much as possible. Just sitting there, doing nothing, and waiting for the miscarriage or childbirth to occur naturally is cruel. It subjects the pregnant person to avoidable suffering.

In my opinion, it ought to be basic common sense that a termination of a pregnancy must be permitted when the fetus is nonviable. There will be no live child, so why torture the pregnant person for no good reason? Yet for some odd reasons (aka religions) some hospitals still won’t do it. The fact that this is still happening in 21st century is a disgrace and results in countless personal tragedies and avoidable suffering.

I have a family member who got pregnant while treating a tumor. Her own heath at the time was pretty bad. Doctors advised her to consider having an abortion—terminate this pregnancy, fix her health, wait at least a year or two, and then get pregnant again. She was still young enough that she could postpone having her first child without worrying about the ticking biological clock. My relative decided to keep the fetus knowing that this will be a high risk pregnancy with medical risks for herself as well as an increased probability that her child could be severely ill. The pregnancy went well, and at first her newborn daughter appeared to be healthy. I say “appeared,” because a few months after birth the baby developed a tumor next to her right ear. My cousin underwent her first surgery when she was only a few months old. During that surgery, her doctor accidentally cut a nerve thus leaving half of her face paralyzed. My cousin had to go through numerous follow-up surgeries throughout her childhood. On top of that, she also had emotional problems caused primarily by the fact that at school she got bullied due to her appearance—whenever she smiled, it was only with a half of her face.

Why am I telling this story? Because I have heard pro-life advocates saying, “Doctors advised me to have an abortion due to some medical complication, I refused, and now I am happy to have a perfectly healthy child.” Yes, that happens. It’s great that some people get lucky. But others do not. More importantly, when doctors inform their patient that there are complications with their pregnancy, often they do not know what exactly will happen. Maybe the mother will survive without any lasting health problems and the baby will be healthy. Or maybe the baby will be stillborn or severely disabled. Or maybe the mother will die. Doctors cannot predict with a 100% accuracy what will happen with a specific high risk pregnancy. In many cases they can only say that there’s an increased probability that some terrible thing might happen.

Some cases are very clear cut. On one end of the spectrum we have a perfectly healthy uneventful pregnancy where everything goes very well. On the other end of the spectrum we have a woman who is bleeding and will die in half an hour unless doctors perform an abortion. But even then, how can doctors be 100% certain that this woman really will die in just a few minutes? Under poorly written laws, even in such a situation doctors might feel tempted to wait a while and see what happens as long as the fetus still has a heartbeat.

On top of that, many complicated pregnancies are not so clear cut. They are neither black nor white, but some shade of grey. Yes, there is some problem. But doctors cannot be 100% certain that the mother will die or suffer any lasting harm for her health. What can they do in such cases while working in a country with poorly written laws and religiously-inspired policies that urge them to avoid performing abortions at all costs?

And here’s one more point: Laws and guidelines must clearly state that the pregnant person has a say about what happens with their body and child. A panel of doctors should not make these decisions without taking into account the pregnant person’s wishes.

For example, let’s imagine a very problematic pregnancy with little hopes that the baby could survive. Nonetheless, the pregnant person’s life is not in immediate danger. One person might decide: “I want to wait as long as possible, because I want the peace of mind of knowing that I did everything I could in order to keep the baby.” Another person might decide: “I am tired of hoping for a miracle, I can no longer endure the physical and emotional pain of continuing a doomed pregnancy, I want to end this, grieve about my lost child, and move on.” Both would be legitimate decisions.

Alternatively, let’s say that prenatal testing reveals that the baby is incompatible with life and will die immediately after birth. One person might choose not to abort the baby, because they find it more comforting to continue the pregnancy to its natural end, while another person will choose to abort as soon as they find out rather than wait for the bitter inevitability. Again, different people can make different decisions, but it is absolutely crucial that they have this choice. In such circumstances, if the pregnant person decides to get an abortion, it is a medical necessity and not some whim they could live without.

In such terrible circumstances doctors and the pregnant person need to have choices, countries must pass laws that enable people to make the best possible decision in their absolutely terrible situation.

* In the USA there exist crisis pregnancy centers, which intentionally lie to pregnant people that they can get an abortion at any moment, urging them to wait and consider their decision for a bit longer. This way they attempt to drag the time in order to get to the point that it is too late for an elective abortion. This is absolutely terrible and irresponsible. We as a society need to educate people that if they want an elective abortion, it should be done as soon as realistically possible.

** Some of the people who get pregnant are not women, they are either trans men or non-binary. Thus I sort of dislike using words “women,” and “mothers” when talking about abortions.

*** “Late-term abortion” is not a medical term but a political construct. In this blog post I use this term loosely to refer to abortions that are performed relatively later during the pregnancy.


  1. Jazzlet says

    I had colleague who did not know there was anything wrong with her baby until after she had been born, when she failed to breathe and died in the delivery room. The baby looked perfect, but had very little brain matter, almost certainly as the result of a Listeria infection. My colleague was absolutely devastated, she had very much wanted this baby, the little lass looked perfect, but there was no way she could live. My colleague ended up taking six months off to recover, and had six months not been the maximum she could have I think she would have taken longer, Now in her case the abnormality was not discovered before birth, so there was no possibility of an abortion, but I think the intense trauma suffered wouldn’t be much different, I don’t think anyone would take such a decision lightly.

  2. lanir says

    They really call them “ethics boards”? Like the same place we try to get sexual predators hauled in front of? That seems rather telling. How does one get on these boards anyway? Does it require a vast knowledge of medical practices? In the circumstances described the only ethical thing to do is quickly get out of the way and make sure you aren’t holding up procedures like that in the future.

    I have a rather specific viewpoint. I’m adopted and I have no way to find out anything about my biological parents, much less their circumstances. The only thing I know is I was born some time after Roe v. Wade so I was likely born as the result of a choice. I also live in the midwest, where I think most hospitals are owned by Catholic companies. They sell it as a natural extension of the way the church is supposed to care for people, even those who can’t care for themselves, but in reality it’s always about limiting choice where sex and pregnancy are concerned. I’m not going to claim a gender so I don’t speak for anyone else, I’m just me.

  3. Ridana says

    when a pregnancy is terminated at the pregnant person’s request for reasons other than maternal health or fetal disease, it should not be a late-term abortion.

    There are many reasons why someone would opt for a late-term abortion absent maternal health or fetal disease. I’m not willing to second guess those reasons in favor of the fetus over the person carrying it. I agree that later-term abortions are never ideal, for the simple reason that they’re riskier, and so would encourage people to decide earlier. But circumstances can change overnight and make previous decisions moot. I won’t condemn anyone for making that decision in a less-than-optimal time frame, and I certainly don’t want to see their ability to do so constrained by law.
    One thing that really worries me is that Roe v Wade is doomed, and abortions will be outlawed in many or most states. Once that happens, the situation we’re already seeing will become worse: procedures that were once safe will no longer be because no one has the experience to perform them safely. Many medical schools no longer teach how to do even an early abortion, let alone a late-term one or one with many confounding factors. When doctors like Dr. Hern die, with few or no replacements, that’s a lot of institutional knowledge and skill that will be extremely difficult to recover, even when abortion is allowed again (and it will be, once (the non-fanatical) people who never experienced it being across-the-board illegal see what they’ve wrought, again). And unfortunately, pregnant people will be the guinea pigs for recovering that knowledge and experience.

  4. says

    Ridana @#3

    There are many reasons why someone would opt for a late-term abortion absent maternal health or fetal disease. I’m not willing to second guess those reasons in favor of the fetus over the person carrying it.

    Sure, I can think of countless such situations. For example, a person with PCOS and irregular periods realizes that they are several months pregnant. Or a trans man realizes that he has gotten pregnant despite having taken testosterone and imagining that he must be infertile. Or maybe social workers find a woman who suffered domestic abuse and is now several months pregnant. Or maybe a person who wanted a child loses her job and finds out that her husband has a cancer. But all of these examples would require at least somewhat unusual circumstances.

    Also, in practice the reality is that the overwhelming majority of late-term abortions happen for maternal health problems or fetal disease. Hence in this blog post I focused on such cases.

    My personal attitude is that late-term abortions should be reserved as a last resort. Use birth control. If it fails and you don’t want to have a child, get an abortion as soon as possible. If for any reason you find yourself in a situation where you need to terminate an advanced pregnancy, then that’s fine. But it is better not to intentionally procrastinate. If anybody asked me for my opinion, this is what I would recommend other people to do. My own opinion is that, in general, people who have an unwanted pregnancy should try to obtain an abortion sooner without spending weeks or even months procrastinating. The sooner this procedure is performed, the safer it is for the pregnant person’s health.

    That being said, I also have no intentions of forcing my own personal opinions upon other people. I would not try to override another person’s decision about their body regardless of whether I perceive their reasons for making some choice as reasonable or no. I want abortions to be legal, accessible, and affordable. What other people choose to do with their bodies it up to them. It’s the pregnant person’s choice, not mine.

    I can also imagine a case where the pregnant person doesn’t want to be pregnant but cannot afford/access an abortion. Then they win a lottery (or get money in some other way) by the time they are already later in the pregnancy. In my opinion, in a humane society cases like this should not happen. Instead I want a society in which abortions are legal, accessible, and affordable for everybody, including also the poorest people. This way nobody would opt for a late-term abortion just because they couldn’t get it sooner due to lack of access or financial reasons.

  5. John Morales says

    Re the post title, I think it best to distinguish between ‘must’ and ‘should’.

    (Quite different connotations)

  6. says

    John Morales @#5

    Re the post title, I think it best to distinguish between ‘must’ and ‘should’.

    (Quite different connotations)

    The word “should” implies that something is preferable. The word “must” implies that it is necessary. I believe that late-term abortions being legal is necessary, because otherwise some pregnant people die or endure avoidable suffering.

  7. says

    lanir @#2

    They really call them “ethics boards”? Like the same place we try to get sexual predators hauled in front of? That seems rather telling. How does one get on these boards anyway? Does it require a vast knowledge of medical practices? In the circumstances described the only ethical thing to do is quickly get out of the way and make sure you aren’t holding up procedures like that in the future.

    Religious ethics can be rather, well, let’s say “interesting.” For example, a man who rapes his underage daughter can be forgiven by the church. His underage victim who choses to get an abortion cannot be forgiven.

    Anyway, let’s get back to late-term abortions.

    Firstly, I will always prioritize the pregnant person’s wellbeing over that of the fetus, because the pregnant person’s capacity to feel pain, both physical and emotional, is greater than that of a fetus.

    Secondly, I see nothing wrong with killing a fetus that is already incompatible with life. Let’s say you are 20 weeks pregnant when you find out that your unborn child is incompatible with life and will suffocate immediately after being born. If you kill the fetus right now, it will probably feel less pain than if you carry the fetus to full term, give birth normally, and then watch the child suffocate immediately after being born.

    The same goes for incomplete miscarriages, which occur when some products of conception have been passed, but some remains inside the uterus. The child is already doomed, there is no way for it to survive. Thus whether it still has a heartbeat is irrelevant.

    In such cases where the child is already doomed to die, the rational thing to do is to prioritize the pregnant person’s physical and emotional wellbeing. If killing the fetus means inflicting less suffering upon the pregnant person, then the ethical thing to do is to kill the fetus, which is already doomed, thus it is irrelevant whether it lives a few days longer or no.

    But no, when you believe in a stupid sky fairy, then it somehow becomes unacceptable to kill a live being with human DNA as long as they have a heartbeat. Or even when they don’t have a heartbeat or a nervous system—some religious people oppose hormonal contraception on the grounds that it may kill a fertilized egg.

    Similarly, I also believe that euthanasia must be legal for terminally ill patients who suffer severe pain. Religious people generally disagree with this, because they imagine that only their sky fairy can terminate the life of a human being.

  8. Jazzlet says

    Ridana @#3
    There are other countries where abortion is legal that will retain the knowledge. While that might be a little more dificult to access that Dr Hem doesn’t have young doctors to train suggests that access to training on American soil isn’t the problem, it’s more that not many doctors want to train to perform the difficult late term abortions. And who can blame them given the culture around abortion in most of the states?

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