Wednesday, April 11, 2007

On Being Pregnant and Pro-Choice

Now that it's public knowledge that I am pregnant, I am finally able to write the post on being pregnant and pro-choice that I have wanted to for months. Early in my pregnancy an acquaintance (a man) asked me if I was still so staunchly pro-choice now that I was pregnant and had seen the ultrasound (this was at 11 weeks). I am going to be charitable and assume that it was an innocent question, but I assure you that it was absolutely relevant to me that it was a "he" asking the question. My response was: I have never in my whole life been more committed to widening and expanding reproductive freedom for women, including the option of abortion.

There are lots of reasons why being pregnant has only strenghtened my commitment to a reproductive freedom, but I will focus specifically on my recent experience. I am 36 years old (almost 37). When you get pregnant at my age, physicians will routinely remind you of the risk ratio for having a child with some chromosomal defects (either Down Syndrome (Trisomy-21), Trisomy-18, or Trisomy-13), which is 1/210 for Down's and 1/100 for any genetic abnormality. Now granted, these are not horrible odds, but they are what they are. I should also note that these genetic defects can occur for any pregnant woman. The latter two are really horrible, while Down Syndrome babies can live wonderful lives, lives that will, nonetheless require a great deal of resources from parents (and if parents are older it becomes another sort of moral issue if they die leaving the child without the support he or she needs).

Given the higher incident of genetic abnormalities at my age, physicians should offer you the option of getting a triple-screen, quad-screen, amniocentesis, and/or high risk ultrasound. The first three options need to be performed and results back before the 24th week in order to give the mother all possible options of what to do with the results (meaning she can opt to terminate the pregnancy, join a support group, etc.) My physician, however, made two serious errors with my pre-natal care. First, he forgot to order the triple-screen on the lab form (even though I signed a waiver that I wanted one) and secondly, he forgot to discuss with me the option of amniocentesis. When he realized this, I was already further along than 6 months, meaning that I would not have the option to terminate a pregnancy should I find out that I was carrying a child with severe genetic anomalies.

Now I don't think that my physician made these mistakes on purpose. And, I am a highly educated consumer of healthcare and I didn't catch these problems earlier. But, I wonder what happens to women who are not as empowered to advocate for themselves in pre-natal care (who don't have access to pre-natal care) or, worse, who have a physician who denies them pre-natal testing options out of religious convictions (and does not tell the patient he has done so).

Pregnancy is a time of lots of uncertainty and joy. Women ought to be able to rely on physicians to be honest, competent, and sensitive to the life-changing experience they are going through. Instead, many of them face this period in a highly charged political landscape where physicians or hospitals might impose their own religious convictions on mothers-to-be, denying her any right to be part of crucial decisions that will affect her life forever and thereby denying her basic right to human dignity. The only people who should be involved in decisions of what to do with a pregnancy, whether it is a healthy one or a high risk one, are the parents, and more particularly the mother carrying the child.

Another way in which my commitment to reproductive freedom has been strengthen is that I now prioritize the mother's choice far more than the father's. The reason for this is how risky pregnancy can be for a mother's life and well-being. While I have not (knock on wood) succumb to anything like cancer or other life-threatening illnesses during pregnancy, I did have a taste of viral gastro-enteritis while pregnant. The ER doctor made it clear to me that part of the reason I was suffering so acutely with this virus was because the fetus was getting all the resources that otherwise would help me better fend off the illness. Now, consider a pregnant mother who gets cancer. A perinatologist posed that exact scenario to me recently (I had asked him what sorts of cases face his ethics board). Should you treat the woman with cancer, even though there is a risk to the fetus? Should the woman terminate the pregnancy to improve her own chances of survival? These are very crucial, difficult decisions that need to be made. And, the only person who should be making the decision to get chemo or terminate a pregnancy is the mother. It is not up to the physician, the father, the hospital board or any other party to decide that a pregnant woman cannot get chemo, if she has made the decision to treat her cancer. Likewise, it is not up to the physician, father, or hospital board to overrule a pregnant woman's choice to forgo chemo in order to maximize the health or her child (even if this also poses risks to the fetus).

Pregnant women are not mere envelopes, plowed fields, or incubators; they are moral persons who are endowed with inalienable rights to make decisions about their pregnancy free of unwarranted interference. If you want to debate this issue, then focus on what counts as warranted interference with a pregnant woman's autonomy.