Tuesday, May 19, 2015

Dilation and Evacuation - the best very bad, horrible, awful choice

Apologies in advance for a mostly stream of consciousness post....

Because I'm so far along (17 weeks when we do the procedure) the best (i.e. safest and easiest) option for termination is dilation and evacuation (D&E).  I'll note that it is currently illegal in Kansas, which is major bullshit, because you know who knows better than a woman and her doctor what the best medical course of action is?  Exactly: a bunch of dumb as shit state legislators.  (Along the same lines, Texas has banned abortions after 20 weeks—you know, when many people first find out that their child has a serious disability.  http://www.slate.com/articles/health_and_science/medical_examiner/2013/07/texas_abortion_ban_after_20_weeks_prenatal_testing_reveals_birth_defects.html)

The doctor explained the basic details of the D&E procedure to us on Friday when we got our diagnosis, but it was a bit of a blur.  (I was crying uncontrollably.)  The doctors are wonderful and followed-up Saturday to check on us and provided more information, when I could process a little better.  And we got even more information on Monday.  We'll know even more on Wednesday when we meet with the doctor who is going to do the procedure.

I've never had an abortion before.  (Well, other than the methotrexate shot after my ectopic pregnancy, but that doesn't really count.... Although if you're a fanatical pro-lifer you'd ban that too and just shrug your shoulders when women die carrying non-viable pregnancies.)  Even though I have long been very pro-choice, I have to admit I was not super familiar with the details of an abortion, and specifically a D&E.  And the reality is not pretty.  (What I have learned does not change my opinion on abortion, but it makes me feel even sorrier for any woman who feels like her best/only option is to terminate an otherwise healthy pregnancy, especially in the second trimester.)

For early terminations, doctors can do a one-day procedure called a D&C (dilation and curettage, used until about 14 weeks).  For later ones, it's necessary to do a D&E.  A D&E is a two-part procedure.  Before we even start in my state (not one of the more restrictive ones), you have to sign a form and then wait 24 hours.  For the first step of the medical process 24 hours later, a doctor puts something described as "kelp-like" in your cervix to soften things up.  The second step, the day after that, is the actual medical procedure where the doctor removes the fetus and the placenta.


Because our baby is alive, it's pretty scary/sad because part of the process involves actually ending the baby's life.  For people who just really, really want to bring a life into the world, that can be pretty hard to swallow, especially when your instinct is to protect your children above all else.  My husband, especially, is having a really hard time with it (although he logically agrees it's the right choice). 

One of our biggest concerns in deciding what to do is understanding whether the baby can feel pain, because that would be horrible.  But I have been repeatedly assured by multiple doctors and what I have read that is not risk.  A fetus does not react to stimulus until 15 weeks, and is apparently unable to process pain until at least 20:


(After 20 weeks, when there's an argument that babies could feel something, doctors will often kill the baby by sticking a needle in it and injecting something.  But apparently that's dangerous for the mom so they do not do that before 20 weeks.  Abortions are generally not available much past 24 weeks.  Yes, this is all really terrible.) 

Our baby will only be 17 weeks when we do the procedure, and is also missing the part of the brain that processes pain.  So both of those assurances help us know that the baby will not be scared / in pain.  (When I told my mom another option was to actually deliver the baby early, she seemed to think maybe that was the more humane route... until I pointed out that in that case the baby would just die during labor / right after birth when its organs shut down.  It's hard to see how suffocating is the more humane route.)  

We've really struggled with this decision (we've cried a lot thinking about this part of the process), but believe it's the safest route for me and for the baby there is no difference if we terminate now or deliver later.  This is the right decision.  I'm sure of it.  This baby cannot live, and carrying it to term will not change that.  (I've read 90-98% of women who receive a diagnosis of anencephaly choose to terminate the pregnancy.)  But that still does not make this an easy decision. 

I want to understand what I'm in for, so I have been reading other women's stories about their D&Es.  If you want a good long cry, go here:


Many of these stories are by women who wanted their babies, but like us found out sometime in the second trimester that their beloved little ones were not viable or otherwise had severe issues.  (The fact that our baby is not viable has also made this easier.  I can't imagine having to do this knowing the baby could live, just with a severe physical or mental disability.)  That's sad enough on its own, but then a number of these women had to deal with other issues, like having to drive hours or fly across state lines to get the treatment they needed, or having insurance refuse to pay because it was not "medically necessary," or facing judgment from their care providers or others, or being forced to go to a clinic (God bless Planned Parenthood) only to have some protestor get in their face.  In that respect, I'm so lucky that I live in an urban area and can go to a hospital and not travel far distances for care and walk through protest lines, that this will be covered by insurance (minus my insurance deductible), etc.

One thing we have been struggling with is whether, and to what extent, it's appropriate to grieve this loss.  Specifically, should we give her a name (at least between the two of us)?  Can we ask for her to be cremated, and take her ashes?  Can the doctors give us a footprint to remember her?  (I think the answer is no, because of the violence of the medical procedure.)  Would it be strange / unhealthy for us to provide a blanket to wrap her remains?  I just don’t know.  I'm tempted to do all of these things.  My husband's instinct is that because we are choosing to end her life, we don't get to pretend she's our precious little baby girl and do any of these things.  I don't agree--even if I carried her to term, we would be delivering her knowing she was going to die soon after (or be stillborn) but there would be no question we would have the right to do all of these things.  We don't love her any less because of this choice, or deserve to mourn her any less.

I called my OB's office and they said footprints / handprints were not possible (no surprise) but that we could send something small to be with her and if we wanted we could request cremation.  In light of that, I did make her a small blanket.

Even writing this is making me cry.  This is a horrible situation, and I feel for any women (or man) who has experienced anything like this.

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