“And the Winner is…”

My own ‘Jane Roe’ story occurred early in my career as a Registered Nurse. I worked in a Labor and Delivery unit where abortions were performed. In 1975, the State of Ohio legal limit to electively terminate a pregnancy was 20 weeks.

Abortion practice in that unit consisted of the doctor injecting saline into the uterus to stimulate contractions and cause the death of the fetus. We nurses were then left to manage the delivery of the fetus and placenta. They were weighed and then placed in a cardboard bucket labeled ‘products of conception.’

In comes a classmate of mine from nursing school for an abortion. For reasons I do not know, I was assigned to her care. As a new nurse, I asked a more experienced one to help me estimate ‘Jane’s gestational size, as I was not convinced that she was less than or equal to 20 weeks’ along. Nurses who participate in abortion care become skilled in this estimate, as a 20-week pregnancy extends to the top of the uterus reaching the woman’s navel. ‘Jane’s uterus was at least 2 fingers above her navel, leading us to suspect that she was somewhere between 24 and 26 weeks’ pregnant.

At that time, no one, especially nurses, dared challenge a physician’s judgment and orders; nurses had no say in what they were forced to do. This physician injected saline into ‘Jane’s’ uterus, labor began. Five hours later, a 1½-pound baby was born alive and breathing. We were appalled, angry, and helpless.

Remember this is 1975. By the 1990’s, that baby would immediately be admitted to the neonatal intensive care unit with some chance of survival, though with all the attendant consequences of premature birth: risks of brain damage, blindness, developmental handicaps, and other effects. Instead, we watched the baby attempt to breathe for over an hour.

Maybe it was the combination of knowing ‘Jane’ and the devastating experience of my role in her abortion that made me reconsider my role. I remained pro-abortion with no reservations. However, I was intensely angry at the physician who lied about her gestational stage, and by association, how could I trust what any physician performing abortions would do? Two years was enough, and I left to become a certified nurse-midwife.

Midwifery is not only about the short-term joy of catching babies. It is the totality of women’s primary healthcare: annual screening exams (including assessment of their other health conditions), contraception, sexually transmitted diseases, menopause, and other reproductive health issues. The big one being unexpected pregnancy.

In the US, almost half of pregnancies are unexpected. Many unexpected pregnancies become welcomed and wanted. Other women experience a true crisis as they face the profound impact pregnancy will have on their lives. In my experience, no woman took this decision cavalierly.

Unexpected pregnancy is in large part the result of pharmaceutical companies’ aggressive marketing campaigns to convince women that a given method is fail-safe. But unexpected pregnancy can occur even when women have carefully and conscientiously practiced their contraceptive method. For example, pharmaceutical companies tout theoretical failure, and that user failure is the cause of an unexpected pregnancy. The former is taken at face value, say 97%. The remaining 3% of unexpected pregnancies are considered ‘breakthrough pregnancies.’ Yet women are almost always blamed for an unexpected ‘breakthrough’ pregnancy because y providers assume that the women failed to use the method properly. Three percent, as is 97% are illusions concocted in a laboratory—we have been sold a bill of bad goods.

The real moral crisis is tragic in a different way than is abortion. We—providers, healthcare systems and pharmaceutical companies—have failed women. Women’s healthcare providers almost universally will say (if asked), ‘this method is 97% effective,’ and obscure that ‘there is a 3+ percent chance you could get pregnant with this method.’ Nor do we consistently and fully take the time to explain how to use a contraceptive method correctly and consistently.

Here is where abortion and the reality of faulty contraception intersect. If women’s healthcare providers would be honest about the possibility of unexpected pregnancy, and/or inform women that combining two methods would significantly reduce unwanted pregnancy, the rate of elective abortion would diminish. Two complementary methods depend on whether a woman can afford two, when many cannot afford even one. Our current failure solves very little other than maybe, just maybe, protecting some women—particularly poor women, women of color, and those at least some resources—from compulsory pregnancy and birth. Carrying a pregnancy to birth to is more dangerous, and medication abortion is significantly safer than ending an early pregnancy. The US maternal mortality rate is significantly higher than that of first-trimester (4-15 weeks) abortions. So then, what does the fall of Roe v. Wade (and for that matter The Handmaid’s Tale teach us?

The Supreme Court decision will be announced later this month. It will satisfy no one. So, for anti-abortion and pro-abortion people, and, most importantly women in need, it still won’t be enough.

Nobody wins

862 words

Brief Bio: Jo Anne P Davis, BSN, RN, MSN, PhD, CNM (retired) attended the University of Cincinnati (BSN), St Louis University (MS in Midwifery), and Vanderbilt University (PhD in Nursing Science). For 25 years, Dr. Davis has practiced full-scope midwifery in a variety of settings, including home birth, academic medical centers, and community hospitals. Her teaching career includes Yale University, New York University, and Georgetown University. She lives in Northside.

Originally published on Saturday, June 28 in the Cincinnati Enquirer:https://www.cincinnati.com/story/opinion/2022/06/25/opinion-reducing-unexpected-pregnancies-would-diminish-rate-abortions/7690941001/