Wednesday, October 12, 2016

Trust Me Trump, Nobody Wants to Have a Late Term Abortion

*Heads up: this is a long and sad post*

As Trump so callously tossed around the comment that doctors could casually and unemotionally “rip the baby from your womb literally days before its due date,” during the final presidential debate, I couldn’t help but feel my blood boil. The same way I feel every time I scroll past various misleading posts, pictures and articles online.

Trust me Trump, nobody wants to have a late term abortion. Contrary to what Trump and his supporters would want you to believe, most women who are faced with this choice are actually making one of the first and only selfless decisions as mothers that they’ll ever get to make for their baby, and it is excruciatingly painful and sad.

First of all, it is extremely uncommon for a woman to have a late-term abortion. Approximately 1% of abortions performed in the US are done after 20 weeks gestation. Many radical pro-lifers would lead a person to believe that late term abortions are gruesome “partial birth abortions,” however Federal law has prohibited partial birth abortion at any point of pregnancy since the law was passed in 2003.

Trump and his supporters make it seem like the week before a baby is due, the mother can just waltz into a doctors office and get herself an abortion just because. This is just simply not true. Besides being very difficult to obtain and being more expensive than the average person can afford, late term abortion is a difficult and invasive surgical procedure deeply affecting the mother both physically and emotionally. Most, if not all women faced with this dilemma are in the position because their baby is not viable outside of the womb, or the mother’s life is in significant danger.

In light of an enormous amount of misleading information online, I’d like to share the very personal story of my grandson Christopher, to give you an idea of exactly what it’s like to have a late term abortion, and how very heartbreaking it is for women to have to make that decision. 

My daughter Kara and her husband Frank waited the traditional 12 weeks before they told their friends and family that they were expecting their first baby, just to be on the safe side. Bursting with excitement, they made the big Facebook announcement with an adorable picture of the both of them holding a tiny Christmas stocking.

Everything was going so smoothly. Their appointments were normal and uneventful, the baby’s growth was on track. In the excitement of wanting to find out the sex of the baby before the traditional 20 week ultrasound, Kara and Frank decided at 18.5 weeks to go to an independent ultrasonographer, in which an elective 3D or 4D ultrasound is performed outside of the doctor's office.  Apparently, it's the new thing, a way to get a sneak peek, if you will, and potentially find out the baby's gender. They went on a Friday. They found out they were having a boy!

They were given a recording of their baby boy's strong heartbeat, a blue teddy bear, and several rather fuzzy ultrasound pictures.

Kara went straight home and made a Facebook gender reveal post. A boy! They wanted to share their news with everyone they knew. They bought a "coming home" outfit for their son, joyfully perusing the racks of the newborn section, registering for all of the things they imagined their son would get to use. They settled on a name. They started planning a nursery.

Monday morning, Kara received an unexpected call from her OB/GYN. The doctor’s office had been contacted by the independent ultrasound tech, who noticed that their baby's amniotic fluid seemed low. The doctor wanted her to come in for another ultrasound right away, they wanted to see for themselves what was going on. Kara started feeling the flutters of nervousness, along with the flutters of her baby boy actively moving around inside her, he was about the size of a mango at that point. They had been looking up and equating his size to fruit the entire pregnancy. A raspberry, a lemon, a mango..

She immediately googled low amniotic fluid, and she immediately regretted that decision. It didn't sound good. The majority of articles regarding low amniotic fluid at her stage of pregnancy were very grim. The amniotic fluid is very important for many reasons, it helps to cushion hard blows and jolts to your belly to protect the baby and allows your baby the freedom to move and develop. It maintains an even temperature, so even if you are very hot or very cold, your baby's temperature remains even.

Amniotic fluid also helps your baby develop lungs. While in the womb, your baby practices breathing by breathing in and out the fluid. The baby swallows and inhales the fluid and replaces the volume by urinating and exhaling.

Without the amniotic fluid, the baby's lungs would not develop properly, or at all. The doctor doing the ultrasound looked sad. He explained to Kara and Frank that their son's bladder was enlarged. They could see his kidneys, but were unable to determine why the bladder wasn't completely releasing fluid. His growth seemed to be on target otherwise. There was some amniotic fluid, in fact it looked like there was more fluid than there had been on the ultrasound pictures taken a few days earlier.  He referred them to a neonatal specialist in the area, where they would perform a more in-depth ultrasound.

They went home, defeated, but trying to hold on to a shred of hope. They thought that maybe if the fluid was at least getting out a little bit, he might be ok. Their appointment with the neonatal specialist would be in a few days. A few more days of feeling their baby boy moving, growing.

The appointment with the specialist was very thorough, and though there was very little amniotic fluid, they were able to perform an Amniocentesis test for further testing. The doctor confirmed that the baby wasn't releasing fluid, that there was likely a blockage in his urethra. The doctor called the condition LUTO or, Lower Urinary Tract Obstruction, a pretty rare birth defect that only occurs in 5-7,000 births, most commonly in males. It ultimately causes severe kidney damage and underdevelopment of the lungs.

Kara and Frank asked what the chances were to make it to a point where the baby could live outside of the womb. The doctor's opinion was that there was very little chance that the baby would survive pregnancy, but suggested they contact CHOP, the Children's Hospital of Philadelphia. If anyone could give them some hope, CHOP could. CHOP is one of the few hospitals in the country that specializes in fetal diagnoses and treatments. If there was a chance that the pregnancy was viable, that too much irreversible damage hadn't already been done, that there was a possibility for fetal corrective surgery, CHOP would accept their case.

CHOP reviewed their file, going over the tests that had been performed, and accepted their case for further review. Finally a bit of hope! And how lucky that the hospital was located within a few hours of their home. Maybe things were falling into place! How many people are lucky enough to live so close to a hospital that specializes in the specific defect that their baby had? They were mere hours from a multidisciplinary team of doctors who possessed the world's greatest collective experience treating fetuses and infants with congenital anomalies. A silver lining..

They set Kara up for more testing. Based on everything they reviewed, they agreed with the diagnoses of LUTO. The experts on LUTO were going to determine a course of action. Kara had to wait a few more days before her appointment at CHOP. She had officially reached 19.5 weeks, her baby was now about the size of a banana. As she lay in bed, feeling her son's movement, she imagined what life would be like for him. He would likely die within minutes of birth, suffocating from lack of air in his poorly formed lungs. She thought of the last ultrasound picture she saw of him, all folded up, hardly any space to move freely, his bladder as large as his head. She cried as she wondered if he was in pain. She was his mother, her job was to protect him from pain, and there was nothing she could do but wait.

But there were success stories. Stories where fetal surgery was performed, where specially trained surgeons would insert a shunt to drain the fluid from his bladder and repair the obstruction. Those stories were very few and far between, but Kara and Frank were willing to try anything to save their baby. He was already so loved.

The appointment at CHOP was mostly a lengthy, in depth ultrasound. It took hours. Kara and Frank were exhausted, physically and mentally. The past week and a half had been a nightmare. They just wanted answers. They just wanted an expert to tell them what to do, how to proceed. They were led to a room where they met with a Clinical Coordinator and a doctor specializing in fetal genetic disorders. 

The doctor was very matter of fact, but also, warm and kind. She said that in no uncertain terms would the baby live outside of the womb. He was already in renal failure, his lungs were underdeveloped and he was developing contractures in his limbs. Contractures happen when muscles, tendons and other tissues shorten and harden due to the inability to move, among other things. The doctor explained that Kara and Frank had two options; they could let the pregnancy progress and let nature take its course (a still birth, or immediate death upon delivery if the pregnancy went to term), or they could terminate the pregnancy.

The doctor spent a lot of time with them, going over the diagnosis, answering question, explaining things, she drew diagrams to help them understand. She assured them that their son wasn't in pain. They weren't rushed out, they were given the time that they needed. They thanked the doctor, and quietly left the hospital, making their way to their car. They didn't talk very much, both quietly processing what had just happened.

They had just been told that their baby boy was going to die, but it was up to them to decide when.

On the drive home, they called their OB/GYN to set up the appointment for termination. They decided that to carry the baby to term would be selfish of them, unfair to him. They made their first major decision together as parents, to let their baby go.

The procedure for terminating a pregnancy at this stage is called a D&E, or Dilation and Evacuation. It's the most common procedure used in second trimester abortions, or after second trimester miscarriages.

Kara's OB/GYN explained that they would inject the baby with a drug that would stop his heart, then they would insert medication to dilate her cervix at the office. After, she would go home to rest, returning early the next morning for the surgery in the hospital. Kara felt so grateful that her own doctor would be able to safely deliver her baby in a clean and sterile environment. She would be given general anesthesia and the baby would then be delivered vaginally. At no point would the baby suffer. It was very important to them that he would feel no pain. 

Kara and Frank were devastated that they had to make this decision. They wanted their baby. They wanted their baby whether he was sick or healthy. He was so very loved. But in gathering all of the information, they knew that their baby wouldn't just be sick, he'd die in pain, unable to breathe. As his parents, they made the selfless choice to spare him pain. 

The procedure went as planned, taking about 30 minutes. During the recovery period in the hospital, Kara’s doctor came to check on her, tearing up as he assured them, once again, that their baby didn’t feel any pain, he had passed away prior to the surgery, safe and warm and loved. They were released from the hospital, and Kara had to live the horrifying nightmare that all mothers have - she was wheeled out of the hospital without her baby in her arms. They drove home, exhausted, devastated, defeated... empty. They carried with them an envelope with their baby’s footprints. Kara didn't open the envelope, it was too painful to look at prints of his perfect, tiny feet.

There was a lot of crying, there were some, "why me?" moments. In a cruel twist, as is often the case, Kara's milk came in, a painful reminder that she was a mother, but she wasn't ever going to get to hold her baby, to look into his eyes as she lovingly fed him. 

As the days went by, friends and family quietly left messages of love and support, they sent gifts and flowers. It got a little easier to get up every day. Frank picked up their baby's remains. They cried as they realized that the first time they were holding their baby, they were holding him in a paper bag from the funeral home. They tucked his ashes in a special box that they keep on their dresser with the envelope of his footprints.

Small things remind them every day that they don't have their baby. A friend's pregnancy announcement, a co-worker's insensitive questions, seeing their niece taking her first steps... 

Kara and Frank didn't want to terminate their pregnancy, but they were lucky enough to have the option of doing so, of being able to make the best decision for their family. They were fortunate enough to live in a state where obtaining a second term abortion was possible. The thought of being forced to continue a pregnancy that would never result in the birth of a viable baby, or result in a baby born to quickly die from suffocation, was horrifying. 

Should they have been denied the right to allow their son a painless death?

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