Abortion- What's Love Got to do with it?

Photo by B.D. Colen

I want to talk about abortion in Haiti. But first here are two true stories.

In my practice in Richmond, I saw the midwifery patients most of their pregnancy visits, referring them to and consulting with a physician for anything that was not normal or was concerning. Because of this, I got to know my patients quite well and could not help but deeply care about their lives and what the new baby and birth would mean for them.

One day one of my patients arrived for a routine visit and had an unusually high blood pressure and 4+ protein in her urine. Christy looked completely normal and had no other symptoms except perhaps a mild headache. But these are cardinal signs of preeclampsia, a killer of women all over the world as it can lead to kidney failure, brain swelling that leads to seizures, and death. No one knows what causes preeclampsia. There are some things that can be done to treat the symptoms but inevitably the only cure is to end the pregnancy.  This is upsetting to the woman, frightening news to get, but in this case it was especially frightening because she was only 28 weeks pregnant and ending the pregnancy now meant her baby's life was at risk. The hospital where I worked did not have the necessary equipment and the experts to keep a baby alive who was less than 32 weeks gestation so she was sent to another hospital where the baby could get the necessary help if needed. 

I went home that afternoon hoping that Christy would be able to get steroid injections over a 24 hour period that would help her baby's lungs mature and give it a better chance of survival. The next morning I learned that when Christy arrived at the hospital her lab worked showed that she was in critical condition, could have a stroke or seizure at any time, and her kidneys were barely putting out any urine. An emergency C-section was performed and the baby went to the Level 3 nursery immediately. Christy rapidly started to get better. Her baby received the very best of care possible for babies who are premature and even though she had not had time to get the steroid injections they were able to help her baby breathe until she was able to do it on her own weeks later.  Christy and that baby are still alive today.

Here is a similar story in Haiti. Josette was a midwife trained by Midwives For Haiti who worked full-time at the hospital in Hinche. I had barely arrived in Hinche on a Saturday afternoon when I was told that she wanted to see me. I went out onto the porch to meet her and found her barely recognizable. Her face and hands and feet were very swollen. She was obviously pregnant. 

Josette came with a note from one of the Haitian obstetricians saying that she needed to be on bedrest because her blood pressure was high and she had protein in her urine. She wanted me to know why she would not be at work the following week. When I saw the note, saw her lab results, and saw her, I was scared for her but when I heard that she was only 27-28 weeks along in her pregnancy, I was aghast. Nowhere in Haiti does a baby of that age have a good chance of making it if born that early.  She assured me she would go on bedrest, drink plenty of water,  and pay attention to signs of increasing problems like not urinating very much, headache or confusion. She also assured me that another midwife who lived near her would take her blood pressure twice a day.

Josette knew she was in grave danger. Over the years of working at St. Therese she has seen a lot of death of both mothers and babies. She had fought for their lives. She knew she could die, too. Stupidly, I asked Josette if she knew that most likely the baby would need to be born soon. Of course, she knew. We hugged and prayed. I wanted to keep tabs on her so we made sure we had her phone number before she went home to bed. 

But the very next day, she was put in the hospital because her blood pressure was in stroke range. That was Sunday. We do have betamethasone in Haiti which can help mature the baby's lungs so Josette got 2 injections 12 hours apart as prescribed. We needed time. Every day that baby could stay in there the better its chances were at survival. She also started getting Labetalol, a drug that would help keep her blood pressure under control.

Monday night we were so concerned that we were standing by her bedside and Dr. Eads was giving her boluses of Lebetalol in her IV, retaking her blood pressure, giving her more and more and the blood pressure would not come down. We were very fearful she would start having seizures or have a stroke. So late at night we left her in the the hands of another midwife with strict instructions on keeping her dosed throughout the night. We drove to where the Haitian doctor lived, got him out of bed and had a discussion outside beside our vehicle about what he planned to do about Josette. 

This doctor had worked with Josette for years and cared a great deal that she have a good outcome for her pregnancy. He was scared about what would happen to Josette if we did not end the pregnancy and he was scared about what would happen to the baby if we did end the pregnancy. The two doctors agreed to give her that night at least and confer in the morning about what to do. The next morning, Josette was sluggish and her blood pressure was 180/120 even with medications. She was in grave danger. The doctor was very busy and did not do the C-Section until late afternoon. Josette did fine with the C-section and immediately started to get better. 

But her baby did not have a Level 3 nursery and the staff did not have the equipment or training to save a baby that young and the baby died very soon after birth. We were all heartbroken. But we knew the C-section had saved Josette's life. Today, Josette is alive and well and takes good care of the one other child she had before this pregnancy.

What do these two stories have to do with abortion? They point to the fact that every day doctors are making life and death decisions for their pregnant patients that have enormous consequences and that sometimes means they have to choose between one life or another.  The choice is one life or two deaths.

I think of these two stories when I think how ignorant most people are about pregnancy, birth, and why there is a mother dying every two minutes across the world from complications of pregnancy. Because of what I have witnessed in Haiti, I am keenly aware that birth control saves lives, that a lot of sex happens without consent, that in many places women's lives are cheap, that where you were born and who you have around you can determine whether you will live or die before, during, or after pregnancy.

Abortion is illegal in Haiti. I think it would be hard to find any medical professional willing to perform the procedure. But abortion happens frequently in Haiti- probably daily- because I know one hospital that sees the aftermath several times a week. There is a medication that people can buy on the black market (on the street) anywhere in Haiti that induces abortion at any time during a pregnancy. Legally buying that drug in Haiti at a drugstore is very difficult.

(This causes problems for organizations like Midwives For Haiti and other health care organizations who want to use it exclusively for treatment of post-partum hemorrhage (PPH). Postpartum hemorrhage is the second most frequent killer of pregnant women in Haiti and is number one in many countries in Africa and Asia. It is no discriminator based on religion, race, or wealth.)

I remember one 13 year-old brought in by her father for pain and bleeding following an induced abortion by this medication. My student and I found the dead baby, estimated to be about 18-20 weeks gestational age, between her legs, still in the amniotic sac and still attached to its cord.  I wondered if her father gave her the medication or if he was the father of the baby. Within an hour after we had removed the placenta he walked her home, refusing any birth control method.

I remember a mentally impaired woman brought in by her sister.  The midwives said she comes in every year or so with an induced abortion because the men in her village use her for sex all the time. We spent weeks trying to figure out a place for her to go besides back to her village. Because of the lack of any social services in Haiti we struggled to find a safe place for a grown woman with mental impairment. Then one day she and her sister disappeared. With an IUD in place she would not get pregnant again but I still think of the hell her life must be.

For women in Haiti there are terrible things that make them consider abortion.  The inability to feed themselves or the children they already have, the loss of financial support from the father or from family, rape and abuse. They feel there is no other option. And sometimes when we see the 80+ children in the feeding center with their distended bellies and no energy to even feed themselves we get a hint as to why women in Haiti choose abortion. Watching your child die slowly from lack of food is a terrible thing.

So what do women in Haiti need in order to stop abortion from happening? It isn’t religion because faith is strong in Haiti.  Women call on Jesus daily for food for their children, to be delivered from sexual abuse, to escape their terrible lives. They are calling “Jesu, Jesu” as we deliver their babies, dead or alive and we are trying to be Christ-like to them. What we are unable to give them is food for their families, years of consistent birth control, and locks and security in their homes. Living in a mud house or a house made of tarps is invitation to sexual abuse. If we had all these things to give them, plus easy adoption to loving homes (finding “loving” is part of why it is not “easy”) there would be no abortions in Haiti.

Unplanned and unwanted pregnancies occur even with the best birth control. However, the abortion rate in the USA dropped 25% after the Affordable Care Act  (CDC records), largely due to increased access to birth control.   It dropped 40% in Colorado when birth control became totally free. Now we are facing repeal of the Affordable Care Act in exchange for one that considers a pregnancy or a previous C-section a pre-existing condition that insurance companies can choose not to cover.

I have heard people say things like, “She shouldn’t have more children until she can take care of the ones she’s got” and “She shouldn’t have sex if she can’t afford birth control”.  This ignores that sex often happens without choice for a large number of women. And it ignores that even women who are in loving supportive relationships have unplanned pregnancies. I am one of the millions of women who had an unplanned pregnancy. But it was not unwanted because I knew I could gladly care for and love another child. And I had everything that most Haitian women do not have. 

Haiti proves that laws outlawing abortion do not end abortion. There IS logic to giving women love, support, food, shelter, birth control, and medical insurance. I love my granddaughters so much and hope they never feel so desperate they even think about an abortion.  But if all abortions are outlawed they will be afraid to enter the hospital with life-threatening bleeding for miscarriages and ectopics and the doctors will be afraid to treat them for fear of being investigated for causing the bleeding. I fear for my granddaughters when or if they have a miscarriage (1 in 4 pregnancies end that way) or if they have an ectopic pregnancy that has to be removed to save their lives. Will they be put in jail, will their doctors be put in jail, will all their medical records get scrutinized by lawyers who do not even know what an ectopic pregnancy is or how to treat it? 

I think pro-life and pro-choice Americans should sit together and figure out how to decrease abortions in this country. Because women and mothers are valuable. Because love has everything to do with it.