When Freedom of Choice Doesn’t Respect Choice

A year ago, my husband and I badly wanted a baby. After years of no luck getting pregnant, including attempts at multiple methods of cycle tracking and ovulation-detecting, we swallowed our embarrassment and made an appointment with a fertility specialist. Through a series of appointments, we were told our chances of conceiving naturally were practically zero, and we made our decisions about how to proceed with IVF.

Then, disaster struck. A few months later, as I was working on losing some weight before IVF, I was diagnosed with a rare heart condition that made childbirth extremely risky.

And truly, the effect on my prospects of creating a family was the most devastating part of it all. Sitting in the hospital waiting for the doctors to confirm the diagnosis, that weighed more heavily on my mind than the possibility that I might have only 6 months to live or the life-altering treatments I faced.

Fast-forward another few months, and life dealt us another twist. Treatment for my condition had been going well — I was learning the routine of administering the medication, and I felt so, so much better than before. We resolved to explore with the doctors whether we could proceed with IVF anyway.

The next day, on essentially a hunch, my husband told me to take a pregnancy test — the last one left from the many ovulation kits we had bought the year before. To my complete disbelief, there were the two lines, clear as day.

I was already pregnant.

An aside here: When I received my diagnosis, I was advised to be on two forms of birth control. (That stills sounds so bleak, even as I think about it now.) I’m sure the doctors think we ignored that advice completely and were having at it irresponsibly like bunnies, relying entirely on the earlier infertility diagnosis. Truth is, we had decided not to use hormonal birth control for the time being, but would use condoms at least until my three month follow-up visit, allowing time to adjust to treatment and to confirm I was responding well.

Except once. There was just one time when we kind of got fed up with the condom routine and went with it.

So let that be a lesson to all teenagers out there: It really does take just one time to change your life.

So once my pregnancy was confirmed, we started seeing the doctors about how we were going to handle this.

I expected them to be very concerned about the risks. I expected them to tell us to consider an abortion. What I didn’t expect was how strongly they pushed the abortion.

Early in the process, I reflected on my good fortune to be in a liberal state where doctors would feel comfortable giving advice about and making available abortions. I mean, this was happening while the news reported legislators who view women as mere “hosts” for the fetus or want to protect doctors who conceal information that could lead women to choose abortion.

But I’ve started to wonder if the conversations would be better tempered by a greater respect for the unborn child within me.

My doctors were very clear: I was their patient, and their job is to see that I live a long and as-healthy-as-possible life. Nevermind, I suppose, the other things that make for a life worth living. Nevermind the potential life I harbored.

And while I don’t believe in withholding information that weighs in favor of a decision to terminate a pregnancy, I think my doctors overstated the case in the opposite direction, and that more liberal views about abortion freed them to do it. There were fishy gaps in their explanations — for example risks that loomed huge during pregnancy but somehow were not a concern at all normally, even though the mechanisms didn’t change. They acknowledged they had insufficient data to accurately predict the risk, yet they selectively chose factors in my case that they felt could justify claiming my risk level was greater than average. They casually urged alternatives — adoption, surrogacy — without acknowledging the difficulties that those paths also entail — because, I suppose, those are outside the realm of medical risks that it’s their job to stave off.

Here’s one example of an explanation we received that just seemed patently one-sided: They noted I have high blood pressure, which is always a risk factor. We pointed out that my blood pressure was on the low side of normal range now, a beneficial side effect of my medication. Oh, but the underlying etiology remains, my doctor responded, in a tone that ended the discussion. But let me ask this: What is the point of treating the symptom then? Before we knew about my heart condition, I was already taking medication to lower my blood pressure, in anticipation of getting pregnant. No one told me then that it didn’t matter because we hadn’t fixed the underlying problem.

We were also presented multiple times with the insulting analogy: “If you knew you had a 1 in 3 chance of being killed in a car crash driving home today, you wouldn’t go.” (As mentioned above, this implication that I have a 1/3 chance of dying is mostly made up.) My husband came up with a better one: A truck is barreling toward your child, who has no chance to survive without your intervention. If you jump in to try to save her, there’s a 1/3 chance the truck kills you both. What do you do?

It’s a hard question. There could be a lot of complicated considerations not mentioned in the scenario. But it’s not a place where a doctor should step in and be unequivocally choosing one path over another.

I understand it’s their job to look at the risks. I understand it’s their job to recommend courses that reduce the risks. I think it’s fair for them to expect patients to listen to their instructions, not just expect them to fix things after the fact.

But. (Always “but,” right?)

But, there’s a more balanced way to proceed than what my doctors did. There’s not walking into the exam room with a perfunctory “congratulations” and then spending 15 minutes trying to convince you to terminate the cause for congratulations. There’s not shading the information so much that I lose all respect for your judgment. To be clear, I’m not doubting the accuracy of any underlying information you can give me — which is limited given how rare my condition is — but I now question any interpretation or judgment you’ve applied to it. For example, my OB told me, in a serious tone completely unlike his normal cheerful demeanor, that my condition is the most risky of all conditions to have during pregnancy — more than cancer or anything else. Maybe he’s right. But also I believe that he would tell another high-risk patient that her condition is the riskiest, conveniently forgetting people like me, since we’re so rare anyway.

It was not a fun period of time. I was trying to adjust to the reality of being pregnant, trying to look forward to all the upsides, trying to do all the right things, while every visit a different doctor would make his pitch. There was no new information they could give us, no new reasons weighing for or against, just their professional opinion that I absolutely should terminate.

In the end, I wasn’t swayed. And finally, after a few weeks and our explicitly asking them when we would stop having this same conversation over and over, the doctors seemed to accept our stubbornness and actually start looking forward. (They make every step sound like such an imposition, considering this is what they’re paid to do.)

I’m not here to defend my decision. Nor am I here to say the doctors are wrong in their recommendation.

What I discovered, and what I hope I’ve conveyed, is that there is an anti-choice facet to the “pro-choice” side of the abortion debate. A facet that seeks to paint you as foolhardy and baby-crazy for taking on some risk to have a child. A facet that involves doctors imposing their views on you, just as much as anti-abortion doctors might.

I discovered that the concept of “mother’s life is in danger” is not black and white. I used to think that no matter how anti-abortion you may be, an exception to save the mother’s life is a no-brainer. What I never thought about before is that medicine is never black and white, never 100%. Medicine is full of miraculous survivals and disastrous turns for the worse. The question is never, “Will the mother die?” The question is, what level of risk of death is acceptable. 80%? 50%? 10%? And what if you don’t have enough data to even know?

At various points, I’ve wondered if it would be easier if my husband and I could use religion as a shield — whether the doctors would back off more quickly if they thought they were up against immovable tenets of belief, rather than the fact that we had done our own rational assessment and come to a different conclusion. And thus back to the feeling that maybe a little dose of “pro-life” tendencies could make the situation more balanced.