Is it normal?

Fetal development is something I find fascinating, particularly the moral and ethical decision-making that results from our increased knowledge of fetal development and available prenatal testing. Working at the abortion clinic, these issues are frequently part of our conversations with women. While increased prenatal testing or research on how medications, drugs or alcohol affect a developing pregnancy give us a better idea about how to assess risk, it's still just information, just numbers. It doesn't shed that much light on those deeper questions of parenthood, mothering and when, if ever, is an abortion is the correct decision to make your own life.

Most women I meet with have pregnancies that happened unexpectedly and are reviewing their behavior to consider what they would have done differently, if only they'd known. Some women come with particular genetic counseling or diagnosis information, are trying to reconcile behaviors they know were not healthy for a developing pregnancy, like heavy drinking or the use of a particular medications.

“I've been on Paxil for three years and I didn't know I was pregnant. I read online that it causes birth defects.”

“I had a urinary tract infection and I didn't know my birth control pills wouldn't work with the antibiotic I was on. Then I turned 21 and I've pretty much been partying ever since. I had no idea I was pregnant.”

“The emergency room gave me an X-ray before the pregnancy test came back positive. They said it was an honest mistake, but that x-rays cause birth defects. Can you tell if it's normal?”

These discussions are rich ones. Often these women want to know for sure—is there something wrong with this pregnancy? I will give them my honest answer—in most cases, I don't know. In most cases, there's not really a way to know now at 5 or 10 weeks if this pregnancy is absolutely healthy due to, for instance, drinking or drug use. More sophisticated diagnostic tests are not available until later in the pregnancy, after which an abortion becomes much more difficult to obtain due to the limited number of skilled practitioners who provide second trimester abortions.

Continuing to limit the availability of second trimester abortions means that women who wait to get more advanced prenatal testing results will have fewer and fewer options, should they wait for amniocentesis testing or high definition diagnostic ultrasounds. My partner frowned which I mentioned this. “So they go through all this song-and-dance about informed consent for an abortion, but the information that could really be the most meaningful, like could this be a healthy baby, can only come after you're not allowed to have an abortion anymore?”

We can't tell at an early gestation if the medication you took actually will have an impact on this pregnancy, or if your antidepressants will affect the development. I can't tell you if you will have a child with a learning disability or with ADHD. I can't tell you at 7 weeks gestation when the pregnancy is the size of a blueberry or large grain of rice, if this will be a baby born with the bipolar disorder that your father, your sister and you struggle with. No one can.

Instead, I can talk to them about relative risk, what the realistic likelihood of an impaired outcome might be. I can refer them to genetic counseling, if that's appropriate. I can help them imagine a life becoming a parent to a child with special needs, but I can't answer that question of “is it normal?” or worse yet, “is this abortion the right thing to do?” What is normal? What does that actually mean to you? I will talk about the most recent research about of fetal alcohol syndrome or neonatal abstinence syndrome. I'll remind patients (and everyone else who uses the phrase, in fact) that there really is no such thing as a “crack baby.”

“This is about your family and you as a mother,” I'll tell her. “Only you know what you can handle and how you want to raise your family. You know in your heart the mother that you are capable of being and you know better than anyone else what level of risk you are comfortable taking on.” Often, what this woman is asking is “when is it a responsible time to bring life into the world?” and “am I a monster if, after searching my heart, I realize that I can not do that right now?” These are issues of faith, of practical support, of finances, family and, finally, the profound question of what we owe to the children we bring into the world. Do women have a responsibility to bring each and every pregnancy they have into the world? Do they have a responsibility to bring only healthy babies into the world? Only babies with the option of a self-sufficient life? Only babies who will have a high IQ? Only those who can hold down a steady job and support you in your old age?

Is it healthy? Is it normal? What a question. In most cases, I can't say if a fetus is “normal” and I know that this isn't what many couples want to hear. They may want to hear that an abortion is absolutely the right thing to do. It would be easier for them if this is what I said. Aren't I one of the experts in this area, after all? But I can't and I don't. That is for them to answer.

One woman I met with a few months ago had spent years caring for her brother, who had a profound cognitive disability. She had been a moderate drinker for the first few weeks, before she found out she was pregnant. While we discussed that the actual rate of risk for cognitive and behavioral difficulties associated with drinking, she replied that “Even a little bit of risk is too much for me right now. My parents are sick and my brother requires constant care. I love my brother, but I can't take even the littlest chance that I'd have another family member who would need that kind of care.”

Another woman I met with earlier this year was reliant on medications to control her seizures. Tearfully, she explained that she had always thought abortion was wrong, but that her doctor was quickly dismissive. He told her there was “no way she'd have a normal pregnancy.” When I asked more specific questions about what this meant, she realized that she really didn't know. She left our office after a sonogram and counseling session, deciding that she needed more information about the medications she was on. When she came back a week later for her abortion, she was much more at peace, with a fuller understanding of what it would be like to be off her medications and how the pills may impact the pregnancy she had at that time. I asked her how this information impacted her decision. “I'm not just trusting the doctor, “she said, “I'm trusting myself.”

-Nell

Comments

[brandi]

I aborted a baby because I couldnt know if the cocaine or heavy alchol would affect it. had I known I could have waited until the second trimester to test for certain things and if they were there I could have abortee, I would have had my child. I didnt know and I didnt want my decisions to affect someone for their entire life...sad the way things go..

[Brenda]

When I was 21 I was pregnant and I did a lot of cocaine and heavy drinking at the time, I think in part due to the fact that I had an abortion at 18 and deeply regreted it. Even though I regret that abortion, I did not have any other resources. And that is the problem. Women dont have abortions for fun but out of the neccesity. I was 18, living on my own since 17 a prostitute at the time with no family no car no money and scared every day. A lot of days I worried about how I would pay for food and then I found out I was pregnant. I thought about going home, to my drug addicted father and bi polar mother but that was not a viable option for me. Since I was 17 at the time and still a runaway I was scared if I went anywhere for help they would turn me in, and I simply couldnt go home. So at 21 I was married, a stripper with alot of problems. Me and my husband were on again off again and I was dancing for three years, since the day I turned 18 and didnt have to prostitute. I have been through alot in my life. I know have a normal life, with an almost two year old daughter and my ownb business. It took alot to get to this point, including abortions. To be honsest, there is not a day that goes by when I dont think about those babies and I have grieved in every sense of the word. It has been hard, very hard. I never had an abortion for fun, I had am abortion because I had no other options., because if they were out spending their time making resources available to women that were in situations like mine they simply wouldnt have to time to be on soap boxes or revivals with shirts on. Women like animals leave their children behinmd because they do not have the ways and means to care for them. If we could work to make resources available that would really be

[chaos]

I just wanted to add that continuing to limit the availability of second trimester abortions also means that women who have had fetal loss or a fetal demise have difficulty scheduling a D&E in a timely manner. Since it is essentially the same procedure those few that can perform it are very busy. There also appears to be a stigma to the procedure because only certain hospitals "have the capability" to perform it. Yet I am not sure this is totally true because if a woman comes in miscarrying they would have to perform the same kind of surgery. Whatever the issue is I don't feel trusted as a woman who's had a loss.

[Courtenay]

As someone who was on some VERY serious medication, and is still on meds that could affect a baby, I feel for people in this situation. I personally at this time have no problem with having an abortion, but I do recognize that if I were to become pregnant, my thoughts could change instantly. I really especially feel for the lady whose doctor told her "No way you'll have a normal kid". I had a psychiatrist who, at every appointment, would remind me "You're using BC, right? You're not going to get pregnant right now, right?" While also telling me I may never get off my medications :S