A few years ago, when I was working inpatient as an oncology nurse, I performed an abortion. I gave an injection of methotrexate, a chemotherapy drug, to a woman with an ectopic pregnancy. The woman wasn’t a patient on our floor, but chemotherapy has to be given by a chemo-certified nurse, so I volunteered. My decision was partly political, but mostly practical: I wasn’t incredibly busy that day and ectopic pregnancies are life-threatening. If the woman’s pregnancy didn’t end soon, she could die.
Efforts to limit abortion rights have intensified following the election of Donald Trump, and here in Pennsylvania a bill banning abortions after 20 weeks of pregnancy is progressing through the Legislature. My issue with this bill, as with most efforts to limit access to abortion, is that it focuses on the fetus and ignores the pregnant woman. But you can’t have a pregnancy without a woman, so the woman’s point of view about the pregnancy matters, too.
Ectopic pregnancy is a good place to start this discussion because the symbiotic nature of pregnancy is made starkly clear in ectopic pregnancies. In a normal pregnancy, a fertilized egg implants in the pregnant woman’s uterus, which then stretches to accommodate the growing embryo. In an ectopic pregnancy, the fertilized egg implants outside the uterus, often in one of the fallopian tubes, which cannot stretch. The growing embryo eventually ruptures the fallopian tube, causing significant blood loss and infection, which endanger the woman’s life.
Timely medical intervention — like an injection of methotrexate to stimulate an abortion — can save the mother’s life, though the pregnancy will end regardless. These details matter because opponents of abortion often use the word “preborn” to describe gestating fetuses and describe abortion as murder of the innocent. The contrast between “choice” for a woman, and “murder” of a fetus, allows abortion opponents to claim the moral high ground for their side of the debate.
But that moral high ground is based on a false premise, because pregnancy is fundamentally a mother-baby dyad. Fetuses do not gestate in test tubes; they get nutrition, hydration and oxygen via the maternal umbilical cord and placenta. Amniotic fluid cushions the embryo as it develops and the mother’s body eliminates fetal waste. Fetuses are fully dependent on the women carrying them until they are born; the responsibility for bringing a new life into the world is heavy. In the case of ectopic pregnancy it could cost a woman her life.
Yet the centrality of women to successful child-bearing and child-rearing doesn’t get a lot of attention in the anti-abortion movement. If it did, then abortion protestors would argue as strenuously for free pre-natal care, paid maternity leave, and affordable day-care as they do against abortion.
Instead, restrictions on abortion, like the Pennsylvania 20-week abortion ban, offer pregnant women nothing but new barriers to their reproductive freedom. And this is fundamentally the problem with laws that aim to restrict or prohibit abortion: They view the fetus as morally separate from the pregnant woman despite its undeniable connection with her. Pregnant women are not “hosts,” as some abortion opponents in Oklahoma recently argued, and physiological and moral ownership are not easily teased apart, if they even can be.
Only the most rigid opponents of abortion would argue that my patient with the ectopic pregnancy should have been forced to continue it, endangering her own life for a pregnancy that could not be saved. And the patient herself was very aware of the dangerous situation she was in.
I went to her room focused on being empathic, open to her grief over a pregnancy that wasn’t meant to be. The patient’s mood was much different than I expected, though. She wasn’t grieving, but frustrated and worried, which made sense when I thought about it.
She was obese and had already received one injection of methotrexate that hadn’t worked. Being pregnant may initially have excited her, or not, but her foremost concern when I met her was her own survival. Her pregnancy had become a time bomb that I was there to defuse. She didn’t need my empathy; she needed the health care I was administering to save her life.
I imagine that all women seeking out an abortion feel some version of what she felt. I’ve never had an abortion, which means I’m lucky enough to have never needed one, but I am a mom and my pregnancies, though difficult, were marked by pleasant anticipation. Women who choose to medically end their pregnancies must be as filled with ambivalence or even dread as I was with hope. They must feel that the personal cost of having the pregnancy go to term, of being compelled to become mothers against their better judgment, is just too high.
Abortion opponents say, “It’s not a choice; it’s a baby.” But that’s just wrong. All pregnancies begin with and depend on a woman. And truly only that woman can decide if seeing her pregnancy through to the end is the right decision, because she is the physical and moral caretaker of her pregnancy, a pregnancy that would not even exist, and certainly couldn’t endure, without her.
Theresa Brown, a clinical nurse and writer, lives in Point Breeze. Her most recent book is “The Shift: One Nurse, Twelve Hours, Four Patients’ Lives” (theresabrownrn.com).