Terminating for Maternal Health

This one’s for my mamas who had to end their pregnancy for YOUR OWN health, safety, and well-being.

It seems so obvious from the outside. Everyone who loves you is going to feel that it’s obvious. OF COURSE we save you first. But it’s harder when you’re the mother. I notice that you, my maternal-health mamas have the hardest time letting yourselves matter and letting yourselves be held in belonging in TFMR support space. I’m here to tell you: you’re worth saving.

Your life MATTERS.

Your safety MATTERS.

Mental health is whole health, and your health MATTERS.

YOU MATTER.

I'm just going to come out and say it: you matter more than your developing baby, no matter how loved and cherished that baby is. You are so important and the world would be an even more tragic place without you in it than it already is without your baby. Full stop.

Your friends know it.

Your family knows it.

I know it.

So why does this situation feel so uniquely lonesome and terrible?

Your situation is rare.

When the baby is truly robust and maternal problems arise in later dates of pregnancy, after that mythic "point of viability" then the standard of care shifts to ending the pregnancy by birthing the baby prematurely into NICU. If pregnancy is 40 weeks long, and your doctor would consider trying to save mother and baby after some # weeks in the 20s (24-27ish), remember that the first two weeks out of 40 you're not even pregnant yet, so we're basically talking the second half of pregnancy the standard of care is different for maternal health crisis than the first. Advances in medicine can help many (but not all!) women limp along for a few weeks to get to this coveted “safety” zone of delivery, at which point, all hands on deck to try to save the baby.

Half of your sisters of circumstance aren't here because they went for early induction of live birth to a team of specialists at the NICU. Some got lucky and left the hospital with a living child. Others got unlucky and their babies died in NICU, and they go on to join neonatal loss support groups.

Your sisters of circumstance are invisible to you.

Before or close to the mythic “point of viability,” many medical teams dealing with maternal health emergency use birth-to-hospice as the mode of termination. In the absence of lung-developing steroidal injections, there’s no way an ultrapreemie will survive Earthside and many consider nonintervention humane in this case. Women who go through this kind of loss often don't even know it’s a termination (see: Chrissy Teigan) so they don't seek TFMR support or share their story as the termination of pregnancy that it is. Some of them even testify against abortion access, which is whack, because early induction to hospice is the termination procedure that saved their life and health.

Furthermore, a lot of women who know they got an abortion don’t value themselves highly enough to count mental health crisis as the health emergency it is. The more time I spend in general abortion support spaces, the blurrier the lines get between “TFMR” and “abortion.” If your pregnancy is making you suicidal, that’s a maternal mental health crisis. If your HG brings your mind, body, and spirit to the the brink, that’s a maternal health crisis AND a mental health crisis.

Saving yourself is not allowed in a patriarchal construction of motherhood.

Patriarchal motherhood isn't about love and nurturance, it is about sacrifice. According to this wack standard, you aren’t a mother until you lose yourself to motherhood. The ultimate maternal accomplishment (culturally speaking) is to lay down your life for your child.

Often, you don't even realize you hold yourself to this death-seeking standard until your forbidden survival instincts kick in. You're not allowed to want to live. You're not allowed to want to keep your organs or your sanity or your health. No wonder it hurts extra much to tfmr for maternal health. You had to turn the entire paradigm inside out just to survive. That’s A LOT.

So, how to feel less lonely?

Look for the similarities with your other TFMR mamas, not the differences.

The health of baby and mother are intertwined. Inexorably linked! We don't know what would have happened to your baby if you didn't terminate, but the chances of complication to baby’s health were higher than in a healthy pregnancy. This is just as true for mental health crisis as it is for physiological crisis. (See postpartum psychosis). Likewise, those of us with fetal anomalies had inherently higher risk pregnancies for our own safety and mental health -- so you have more company than you think. We can not separate the health of the baby from the health of the mother when we are inhabiting the same physical body. We just can't.

In my case, my baby had brain anomalies. As soon as my baby was sick, my own health was tied into the bargain, and my pregnancy became a high-risk one FOR ME as well as for her. Her muscle tone was low. Her head could have swelled with hydrocephalus at any time, beyond deliverable proportions. In Boston, my team would only deliver her by c-section -- which is usually a beautiful form of birth when it delivers a healthy baby and mother, but in my case would have been pointless mutilation of my body for no good reason whatsoever. I did not want my body harmed in the name of bringing my child Earth-side just to die. Some would call that selfish. I call it self-preserving.

Know that we ALL make this choice to spare ourselves from suffering. It isn't as easy to talk about as "sparing my baby from suffering." Please be patient with the freshly bereaved who may be leaning very hard into selfless reasons, but I guarantee you, even for the most outwardly generous TFMR, self-preservation is part of the mix. I have come to appreciate that preservation was a major factor in my decision. Perhaps the most important piece. Yes, this is taboo. But that doesn't make it wrong.

I saved myself from suffering when I terminated my pregnancy. I saved myself from years and years of sleeplessness. I saved my body from the unrelenting stress of navigating life with a medically complex child. I saved my bones and ligaments from the physical strain of carrying an ever-larger child around who could not move herself. I saved my mind from breakdown. I saved my relationship from enormous stress. I saved myself. We all save ourselves. And that's ok! It's great actually. It's beautiful to see women stand up and save ourselves. So SO necessary.

I just want to wrap you in the biggest, warmest hug. I see you. It hurts so much to be in a group where most members have the luxury of hiding behind selflessness while you have to jump STRAIGHT INTO the truth of your self preservation. It hurts that you are lonely in your rarity. It hurts that your personal experience gets politicized over and over and over again by people who do not give one flying fuck about your health and life.

I do.

I care that you're here.

I care that you're well.

I hold your life and your safety as the most important thing in the world until you are ready to carry this level of dignity for yourself.

Here for you.