~~ recommended by larrymotuz ~~
Introduction by larrymotuz:
Though this article is distinctly Canadian and heartfelt, it points to how 'framing' terminology -- abortion vs pregnancy termination -- should matter. Her line that Canada does not have 'abortion legislation' anymore than 'hip surgery' legislation hit the nail on the head for me.
The extensive fetal anatomy scan usually happens at around 20 weeks’ gestation, once the heart, lungs, brain, etc. have had more time to develop and can be accurately assessed via ultrasound. Therefore, in some cases, it can be impossible to diagnose abnormalities until a person is at least 20 weeks pregnant, sometimes more. Additionally, a lot of these cases may present as normal earlier on in pregnancy, giving little to no indication that anything is wrong.
So just how common is pregnancy termination?
One in 45 pregnancies. One in 50 pregnancies. One in 55 pregnancies. These are some of the statistics people who experienced pregnancy termination were told by their doctors. The prevalence of TFMR is currently not well documented, so finding precise statistics can be a challenge. According to a 2023 study published in Women’s Health Reports, major congenital fetal abnormalities occur in three to four per cent of all pregnancies and are typically detected in the second and third trimesters.
Of those pregnancies in which major fetal abnormalities are discovered, 70 to 95 per cent end in TFMR. When compared with stillbirths and infant death, TFMRs are three times more likely. In other words, although some of the conditions diagnosed in utero may be exceedingly rare, as was the case for us, TFMRs are far from anomalies."
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I could simply tell people ‘I lost the baby.’ But lying didn’t feel right
There’s a crucial and painful part of the abortion conversation that’s being ignored
It had been weeks of waiting. Weeks of mystery. A battery of tests. Ultrasounds. Blood requisitions. Amniocentesis. Ever since complications were flagged at my 20-week anatomy scan, it had started to feel more like we were living through a Netflix thriller than my first pregnancy.
One day we’d receive promising news and I’d add a portable white noise machine to our registry. The next day, we’d receive devastating news and I’d contemplate cancelling our childbirth education class. We had a team of medical experts following our case: genetic counsellors, a perinatologist, a pediatrician, radiologists and other specialists. There were consultations, appointments, late-night phone calls.
Maternal-fetal medicine became our full-time job … on top of full-time jobs. I wanted to talk breast pads, not chromosomes. We lived in this kind of agonizing limbo for weeks. Every time we’d receive new test results, I’d do my own research, wade through medical journals, and join a host of online support groups, desperately trying to piece together the maybes of my baby’s world in utero.
Embryonic life has been under a more intense spotlight since last summer’s historic overturn of Roe v. Wade in America. In the year since, there has been a tidal wave of press coverage on abortion. Many of us Canadians had a jurisprudence awakening when we learned that our system was actually quite different from the States.
Abortion rights in Canada are not enshrined explicitly in our Constitution. The Canadian media reminded us that we don’t actually have a law about abortion at all. In the same way we don’t have laws pertaining to hip surgery. Abortions in Canada are considered health care.
Some Canadian headlines were more inflammatory, implying we might not be as safe in Canada as we thought. A few Canadian politicians cried for abortion legislation. Many critics rallied against the idea. Other articles highlighted unequal access to abortion in Canada. Amidst all the hot takes from Canada, and the endless stream of depressing headlines from our southern neighbour, I couldn’t help but notice a crucial part of the abortion conversation that was being ignored.
Why was no one talking about pregnancy termination?
Pregnancy termination, commonly referred to as termination for medical reasons (TFMR), is typically when a wanted pregnancy is ended due to medical abnormalities with the fetus and/or medical complications with the person carrying the fetus. Many people experiencing pregnancy terminations need far more complex care than medical or surgical abortions, as in many cases, pregnancies can be much further along.
The extensive fetal anatomy scan usually happens at around 20 weeks’ gestation, once the heart, lungs, brain, etc. have had more time to develop and can be accurately assessed via ultrasound. Therefore, in some cases, it can be impossible to diagnose abnormalities until a person is at least 20 weeks pregnant, sometimes more. Additionally, a lot of these cases may present as normal earlier on in pregnancy, giving little to no indication that anything is wrong.
So just how common is pregnancy termination?
One in 45 pregnancies. One in 50 pregnancies. One in 55 pregnancies. These are some of the statistics people who experienced pregnancy termination were told by their doctors. The prevalence of TFMR is currently not well documented, so finding precise statistics can be a challenge. According to a 2023 study published in Women’s Health Reports, major congenital fetal abnormalities occur in three to four per cent of all pregnancies and are typically detected in the second and third trimesters.
Of those pregnancies in which major fetal abnormalities are discovered, 70 to 95 per cent end in TFMR. When compared with stillbirths and infant death, TFMRs are three times more likely. In other words, although some of the conditions diagnosed in utero may be exceedingly rare, as was the case for us, TFMRs are far from anomalies.
My husband and I answered a litany of questions about our family history. Were my husband and I related? How did our grandparents die? Did our siblings have birth defects? We still had no sense of whether what had been discovered was mild or severe. Up until 20 weeks pregnant, all our tests were perfectly normal. Ten weeks ago, I had blissfully wondered if we were having a boy or a girl. Now I wondered … How many operations would our child need? What were the success rates? Would our baby be compatible with life? We needed to do more tests to be sure. More waiting. And more waiting meant more pregnant.
Now 22 weeks pregnant, my baby was actively kicking inside me. I decided to remain hopeful. I researched infant CPR courses. We accepted a used high chair from friends. I hired a doula. For a moment, things felt normal. Then my phone rang.
“This isn’t the news you want to hear,” my midwife said. It was 5:35 p.m. Our hypnobirthing class was to start at 6 p.m. The first round of results from my amniocentesis had come back. My midwife explained the results were positive for chromosomal abnormalities. She couldn’t go into detail, because this type of diagnosis was beyond her scope of practice. We would have to wait to speak with a geneticist. The call ended. I was numb.
Due to COVID-19 restrictions, my husband and I received our baby’s diagnosis over Zoom. The doctor used his hands to demonstrate parts of the body and our baby’s abnormality. We listened with our now routine laser focus. Eyes wide. Barely blinking.
We had become astute medical students. Seemingly every day for the past few weeks, we adjusted to complex ever-changing diagnostic information: hormonal disorders, cognitive function, rare chromosomal abnormalities. The geneticist mentioned an MRI. We could opt for more tests to solidify the diagnosis. We said yes without hesitation. But that would mean more waiting. More limbo. More uncertainty.
We had to be sure. In this case, surer than sure. In the meantime, we’d continue to speak to specialists about what this type of diagnosis meant. The more we learned, the grimmer our situation became.
Quality of life for our child was a priority for us. As we took in the facts and statistics from doctors, we carefully ran through each stage of life for our future baby, child, then adult. We considered the mental health of our future child. I considered my own mental health and my husband’s. I saw the collapse of my entire would-be family. I saw the suffering of my baby both physically and emotionally and I knew in my heart that blind love was not the answer. I needed to protect my baby. But what did that look like? The answer here was not so easy. Especially not at 24 weeks pregnant.
When the MRI was finally complete, I could almost make out my baby’s face through the foggy black and white images. I felt shaken. The doctors confirmed it was what they suspected. So, what did we want to do? After weeks of thinking about our choice we decided to take three final days — one last weekend — to contemplate and seek guidance from loved ones. Monday morning, through tears, I made the hardest phone call of my life. “This is a good decision,” the doctor said.
Then it hit me. I needed an abortion.
I called my best friend in a panic. I’d never had an abortion before. I had no idea what to expect. We started researching abortion clinics in Toronto. Certain clinics had cutoffs. “How far along are you?” my friend asked. At 24 weeks I was well past the medical abortion option, with a common 10-week cutoff. A surgical abortion might be my only option. More frantic late-night phone calls. More Google searching. “I found a clinic,” my friend said. “You have to go tomorrow.”
A carefully unmarked clinic in the city’s east end was my only option. Its website advertised surgical abortions up to 24 weeks’ gestation.
I was welcomed into a homely office by a gentle doctor wearing a scrub cap with dancing uteruses. There was a giant framed picture of the iconic feminist activist, Angela Davis, on the wall and thankfully no protesters out front. This was the abortion promised land that our brothers and sisters in many U.S. states can now only dream of, or if they have the funds, travel to.
“You’re too far along,” said the doctor. “At this stage, there is too much risk.” I was stunned. The abortion clinic couldn’t help me. I would have to go to the hospital.
In Canada, abortion access is largely dependent on geography. Access varies province to province from zero surgical abortion clinics in Nova Scotia’s Cape Breton to B.C.’s inclusive CARE Program.
When it comes to TFMRs and complex abortion care across Canada there is also variation clinic to clinic and hospital to hospital. Some hospitals, like the Women’s Wellness Program at Prince County Hospital in P.E.I., can only accommodate abortions up to 12 weeks. Other provinces, such as New Brunswick, have no publicly funded abortion clinics at all, meaning you either pay out-of-pocket for private care or admit yourself to the hospital. Not exactly the discreet option many of us have come to expect and hope for.
The levels of care differ not because of legislation (remember abortion in Canada is not legislated) but vary based on physician training, hospital/clinic infrastructure and provincial resources.
On June 13, 2021, at 12:44 a.m. in the labour and delivery unit at a Toronto hospital, I gave birth to my stillborn son. Thankfully my pregnancy termination care was both accessible and respectful, aside from having to wait an additional week for a room designated for people in my circumstance. Dr. Bev Young, psychiatrist and co-founder of BRIA — a Canadian virtual mental health clinic for women across the reproductive life stages — says: “Often what they will do in hospitals is give TFMR patients a private room, so they have that time with their baby, their partner and family members. The best way to grieve is with your baby there.”
Inside our very own hospital room, I held my stillborn son for hours, something I flat out rejected and could not remotely comprehend in the weeks leading up to this unimaginable tragedy. Just days before, the thought of holding my stillborn son at 26 weeks’ gestation seemed more like punishment than a psychological balm.
“There are people who go into this and think, ‘Oh no, I don’t want to see the baby, I don’t want to form an emotional attachment, just take the baby from me,’ ” says Young. “But the truth is, you already have an emotional attachment. That baby has been growing inside you.” In the end, having experienced the transformative power of birth colliding with grief, I knew I needed to hold my baby. And to this day, I’m thankful I made that choice.
“It’s important for closure,” Young explains of the importance of spending time with your baby, when possible, post-birth for those experiencing TFMR. “To be able to hold the baby and spend time with the baby. To have a healthy goodbye … It’s amazing how you’re in that situation and you realize, ‘Wow, this isn’t scary, this is my child and I’m actually able to spend time with my child.’ For those who choose not to, there is a lot of guilt afterwards. There is less closure. It’s a very powerful experience. It’s very sad. But grief is good. You have to go through the grief, not around it.”
In the raw hours after giving birth, I could not for the life of me find my way back to rationality, to all the facts and statistics and measured outcomes we had studied in the previous weeks that led to our impossible decision. My heart was broken. I was frantic. My skin was gone. My bones, my muscles, the structures that once held me disintegrated. It was the nurses, my husband, my mother and my sisters who held me up. Without them, I would have slipped away.
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