I don’t think people realy realize how horrifically wrong pregnancies can go. I work exclusively with preserving high risk pregnancies a a facility that delivers a huge number of babies per year, and I am firmly pro-choice. We do, however, end some pregnancies.
It may have already been pointed out that most women make their first OB appoitment around 8 - 10 weeks gestation. They get their first ultrasound and some labs done at this visit.
When something really wrong is detected either through lab work or the early ultrasound, the families are usually referred to the next level of care- perhaps a ‘level 2’ ulstrasound with a radiologist who would need to return the reports to the ordering OB-GYN. Maybe some labs need to be repeated or other labworks ordered. If an abnormality is confirmed, the OB will then most likely refer the family for a consult with a perinatologist. At least, this is the way it occurs in my large city. All of this can take anywhere from a couple of days to a couple of weeks. The reports come quickly, but the appointments…not so much.
The original OB could alternately refer the family for a direct visit with a perinatologist (who can do the level 2 ultrasound), but perinatoligists are not available everywhere and are notoriously hard to get in with quickly. As you might imagine, most visits with a high risk perinatologist are considered urgent. It would really help if all pregnant women would live in a big city with lots af medical resources… but they don’t.
Anyway, it would not be unusual for these evaluations and referrals to take a couple of or even several weeks. There may be further testing, second opinions and even a genetic consult included. It’s not totally unusual for a family to ‘fire’ a Doc that gives them bad news and that is a serious time waster. In the meantime, the family is left to consider all that they have learned about whatever problem they have encountered and need some time to both assimilate the information and decide what to do about it. You are pretty much well into your second trimester by now.
By the time the family reaches me at the hospital, often between 18 and 24 weeks, they have ususally decided to proceed with the pregancy and hope for the best. Pregnancies with gross (a medical term) fetal anomolies often end spontanously and prior to term. My role would to be to check to see if the fetus is alive anywhere from one to several times a day and monitor for labor, bleeding, leaking, etc. and support the family. Many of the patients I have who present in this situation expect to deliver a baby who will die at birth or shortly thereafter. We get babies without brains, babies without kidneys, twin-to-twin transfusion syndrome, hydrops, chromosomal abnormalities, holopresencephaly, etc. (All our gastroschesis babies get surgery if possible.) I have never seen a harlequin baby, but I’m sure my facility has. Sometimes these sick babies live for a while- an hour, a day, a week, a month, but most seem to die sooner as opposed to later.
Did you know that insurance sometimes doesn’t want to cover these hospital stays because the fetus is either too early gestation-wise or non-viable?
We don’t perform elective terminations, but we do some medical inductions. Most of our early deliveries are for PIH, and most deliver after 24 weeks so the baby goes to the NICU, but some just can’t make it there.
Other cases I was involved with included a diabetic in kidney failure and a fetus with cystic hygroma- two different cases. The diabetic was pre-viable gestation-wise and would not have survived the pregnancy so I don’t suppose there was anything elective about it.
They baby with the hygroma should have weighed about a pound at that gestation, but we removed 4 liters of fluid from the baby using amniocentesis supplies so the mother could have a vaginal delivery. This poor baby was jusr a mass of lymphatic fluid bubbles. This family didn’t feel they could carry to fetus to term when it was doomed to die any minute anyway. The baby was too large to deliver vaginally already and since this was the woman’s first pregnancy, she wanted to avoid a c-section. I cannot find any fault with the decision to deliver.
(Probably the number one reason for our early deliveries is PIH followed by incompetent cervix and/or preterm labor. We like our babies to be greater than 28 weeks gestation, but that’s not always possible. )
Now, I’m sure some other families choose to terminate, but I don’t see those families since I’m hospital based. I really can’t find fault with their decision to give up.
After delivery, it the baby is presentable at all and if the family wishes, we invite in the photographer (they are professionals and work for free on a voluntary basis- bless them), and make a memory box (each one unique, no two alike), provide clothing (made by church lady sewing circles- bless them as well) and begin funeral arrangements if the family desires and gestation indicates. I transport the baby back and forth from the morgue as the family requests which has it’s own unique difficulties with clothing, shrouds, seepage and moving about in a somewhat public space.
I enjoy my job and consider it a priviledge to be allowed to help at what is sometimes the worst period of time in someone’s life. If a family wants to ‘go for it’ and carry the pregnancy as far as possilbe, I will help them to do that. If they feel like they just can’t go on, I will suport them in this decision as well.
I didn’t even talk about my own 23 weeker- the $740,000 baby.
I have noticed that very few of Tiller’s patients have been willing to tell their stories. I think this is an indication of how painful the experience has been to them.