Today I am 24 weeks pregnant.
That makes me officially six months pregnant: a big, momentous number. I’m in the glorious honeymoon phase of the second trimester, where I look obviously pregnant – pregnant enough to be offered seats on the subway and cooed at by strangers – but haven’t yet arrived at the notorious discomfort of the late third trimester. I’ve even been accused of “glowing.” It’s a special, exciting time.
I have lived in this pregnant body for half a year, and before 2018 is over I will be a mother.
But this is a bittersweet and terrifying milestone, because as of today, my body no longer belongs to me.
24 weeks is the point of no return. From now on, I do not have the right to end my pregnancy for any reason except an actual danger to my life.
To be clear, mine is a very wanted pregnancy, entered into intentionally and with joy. From the moment I saw that second pink line, I have never wanted anything other than to be the mother of the child this pregnancy will produce. I am not now, nor have I ever been, in search of an abortion.
I don’t and didn't want an abortion. But I might have.
My privileged circumstances mean I’m not at risk of suddenly becoming homeless or being unable to financially support a baby. My wonderful husband of ten years does not subject me to domestic violence. I am unlikely to have to flee a war zone and become a refugee. But there is still so much that could have gone wrong – that could still go wrong.
My fetus could have had a chromosomal defect like Trisomy 18 or a hereditary disease like Tay-Sachs. I could have – could still – come down with Zika or measles, causing terrible damage to my fetus’s brain. Random mutations could have given me a fetus without a heart or lungs or a spine. In any of those circumstances, I would have scheduled an abortion and ended this very wanted pregnancy without a moment’s hesitation.
I am very lucky; as far as modern medicine can discern, my fetus and I are perfectly healthy. But I didn’t know that until just two weeks ago, when I received the final results of my amniocentesis and detailed anatomy scan. Had I lived in a state with a 20-week abortion ban, by the time I could have found out something was wrong, it would already have been too late to do anything about it. (This is the part no one prepares you for — that you have to get more than halfway through the pregnancy before you can know whether you’re having a healthy baby.) When I got back my amnio results, I called my parents and said, “It’s official. I’m having a baby in December, not an abortion next week.”
I never wanted or needed an abortion, but I can honestly say I may never have decided to get pregnant if I didn’t have the option.
Now that option is gone. As of today, I am playing for keeps, leaping without a net. The only way out is through.
I live in New York, where state law prohibits abortion after 24 weeks (except to save the mother’s life). And New Yorkers are the lucky ones. Our state’s abortion laws are among the least restrictive in the country, which is why women travel here from other states and even other countries to access the abortion care they are denied at home.
For the first six months (at least on paper) pregnant women in New York retain the right to bodily autonomy. If – for any reason – a woman no longer wants to be pregnant, the law protects her choice to opt out.
But all that changes at 24 weeks. At 24 weeks, a fetus is considered “viable,” and there the mother’s abortion rights end. The Supreme Court held in Roe v. Wade that a state cannot place the interests of the fetus above those of the mother until viability. But as of 24 weeks, many states have put in place laws that preserve the life of the fetus against the wishes of the woman carrying it, as long as the consequences to her, however catastrophic, are still less severe than death.
You might think that makes perfect sense, because once the fetus is viable, a woman can end her pregnancy by removing the fetus alive instead of killing it. The woman gets her body back, the baby gets to live — everybody wins. And if that were the case, there would indeed be a kind of moral consistency to the law.
But that’s not how it works at all, because a 24-week fetus is really viable only on paper.
24 weeks is considered the cutoff for viability because that is when the chances of survival creep just above 50%. Probability of survival is 25% at 22 weeks, 42% at 23 weeks, and 57% at 24 weeks. But not until 29 weeks of gestation, when the lungs have developed enough that a newborn would not require a respirator to breathe, do the chances of survival finally reach 90%.
And, crucially, it is only after the 30th week that the risks of long-term brain damage begin to substantially subside.
A fetus delivered at 24 weeks might be slightly more likely than not to survive, but their chances of ever living a healthy, normal life remain vanishingly small. The parents of such babies often face the heartbreaking choice of keeping their brain-dead child alive on a ventilator, or withdrawing care and allowing them to die.
Which is why no doctor or hospital in the country would honor a pregnant woman’s request to voluntarily end her pregnancy at 24 weeks by inducing labor or performing a C-section.
What the 24 week cutoff means, therefore, is that the final four months of pregnancy are not optional. No matter what happens to a pregnant woman in those four months, as long as it isn’t literally killing her, she has to endure until the end.
And it’s not just a matter of time. Weeks 25–40 of pregnancy are difficult and dangerous. Complications can range from the “merely” cosmetic (not just stretch marks and saggy boobs, but possibly-permanent skin discoloration and facial paralysis), to pain so severe it confines women to wheelchairs and beds, to life-threatening embolism, prenatal depression (also life-threatening), and debilitating injury to muscles and joints.
Birth, of course, is even more dangerous. The WHO estimates that 830 women die every day from preventable causes relating to pregnancy and childbirth, and that’s down 44% since 1990. Even in the United States in the twenty-first century, childbirth is the sixth most common cause of death among women age 20 to 34. Preventable complications like the ones that killed Erica Garner and nearly killed Beyonce and Serena Williams have been increasingly spotlighted. Less discussed are the shockingly common complications that live in the realm of taboo: pelvic pain and pelvic floor disorders, urinary incontinence, loss of sexual function. And of course there’s the risk of potentially life-threatening postpartum depression and anxiety.
The risks involved in carrying a pregnancy from 24 weeks to term and through labor and delivery are significant.
I chose to assume these risks when I decided to get pregnant, and I have made that choice again every day since. But from today forward, the choice is no longer mine.
Again, I don’t want an abortion. But it is terrifying to think that no matter how severe the consequences, as long as I am not literally dying, I have no way out. Not once the fetus has a slightly greater than 50/50 chance of surviving birth to live a life that is likely to be painful, impaired, and very short.
As I write this, everything is perfect. My fetus is healthy and so am I. My husband and I are beyond excited to become parents in December.
But between now and then stretches a vast expanse of the unknown and unknowable. And from now on, it’s not me at the controls, and it’s not my doctor either. It’s the state, which is within its rights to treat me as nothing more than the expendable vessel that carries the precious cargo.