The Explanation I Owe No One

Shelly M. Lewis, MD, FACOG

Our son, then 16 months old, was two days post-op from his first of two neurosurgery operations the day I had a positive pregnancy test last December. To say we weren't trying would be untrue, but we were very surprised to learn of a new pregnancy given the current events. Our son had been in and out of the hospital for two months and faced a horrendous medical saga. Excitement grew for the pregnancy: two August kiddos we would have.

I had my NIPT done. I was growing anxious for results to return and something inside was whispering to me it wasn't going to be reassuring. Sure enough, my gut was correct: I received that dreaded phone call from my obstetrician–gynecologist and good friend. High-risk trisomy 18 with 91% PPV. This news was devastating and unexpected. Two days later, I had a chorionic villi sampling done. Ultrasound findings confirmed the suspected diagnosis, showing large cystic hygroma and omphalocele, and the CVS returning two days later left zero doubt. At the end of that long week I had a D&C at 12 weeks of a fetus that had a beating heart and a very bleak future. It was the right decision for me and my husband and I have zero regrets.

Though I owe no one an explanation as to why I made this decision, I'll divulge it, because that's who I am (and now that our country has made it a point to invade my privacy, I'll respond with saying I've got nothing to hide). As a married couple my husband and I shared a unified opinion that we would not find joy in raising a child who would almost certainly die—a baby who would need constant medical care well beyond that of a healthy child. In fact, it would bring us severe distress. Nor did we desire to continue the pregnancy and accept the higher risks and mental anguish of management of a second- or third-trimester demise. After witnessing medical trauma with our son who went from COVID-19 with ear infection to ending up septic with meningitis complicated by hydrocephalus requiring with two brain surgeries, this was a clear-cut decision. This was a decision made by myself and my family, with guidance from my physician and own spiritual beliefs. Every patient deserves this very simple and incredibly personal decision path.

My abortion story perhaps gains more empathy than some, as it was associated with an abnormal pregnancy. However, any pregnancy that isn't welcomed or safe to continue for whatever reason is really the same as mine. No one other than the parents or parents of a pregnancy is solely responsible for the weight and stress of child-rearing. A few reasons people get abortions: failed contraception; poor access or financial barriers to contraception; sexual assault; fetal abnormalities; maternal medical complications; being financially, mentally, or socially unable to rear a child; having an unsupportive or abusive partner; or knowing that pregnancy and child rearing would drastically, negatively alter one's current life path. This is a short list. How privileged you must be if you've not found yourself on that list.

To anyone reading this story, thinking "I wouldn't do that if it were me," you cannot truly know that without living it. We all live to our own personal values and many people seeking an abortion may have never foreseen abortion being the right choice for them before being in that scenario.

Trigger bans are extremely harmful to patients, physicians, and society, especially in places like my home state of Tennessee. We all deserve better; we deserve education and choice. As obstetrician–gynecologists we are tasked to advocate against these abortion bans, no matter our personal beliefs that surround the sensitive topic. The evidence is clear: maternal morbidity and mortality increase with abortion bans. Let's pour out the support and respect for people whose life path involves pregnancy: our duty is keeping them safe, informed, educated, and empowered.

A memoir for my trisomy 18 pregnancy:

Farewell my dear son who I'll never meet. Your life was early marked for only defeat.

Our family continually learns that life's simply unfair: your condition, typically fatal and incredibly rare.

Though your heart beats and you've grown along, the ultrasound shows how many parts of you have gone wrong.

Some might decide to let you go on your time, but I can't do that my child knowing you will never shine.

To carry you inside only awaiting your demise, or bring you earth side to watch you slowly die. Either option destroys me and that is certainly not wise.

Some will label me cruel names, claim this is black and white.

I wish they’d go quiet and put an end to this unjust fight.

For a mom's choice for her womb is hers and hers alone.

A decision you can't possibly imagine unless you've been there on your own.

How foolish to think your values affirming that you unequivocally wouldn't, somehow equals I have no choice, under no circumstance shouldn't.

There's a place you will flourish, my child, you'll run, you’ll play, and you'll roam.

Last night God whispered, "I love you, daughter, go ahead and bring this one home."

—Shelly Lewis, MD, FACOG

Disclaimer: The thoughts and opinions observing Women in Medicine Month reflect experiences of individual ACOG members and do not represent official organizational opinions of ACOG.