Therapeutic

--This hub is an excerpt from the non-fiction book I'm writing about my experiences in childbirth as a traveling nurse. This hub may be disturbing for some. All names have been changed.

In medicine, abortions are defined in one of two ways, either as spontaneous, which is a miscarriage in lay terms, or therapeutic, which is voluntary termination of pregnancy, induced for a particular reason. The reason can be for maternal safety, it can be an unwanted pregnancy, or there can be complications with the fetus so severe that they would be incompatible with life upon delivery. In effect, the mother may or may not carry the baby to term, but will deliver a baby that can not survive outside the womb.

Prior to knowing this, the word therapeutic made me think of massage, or other spa treatments. I thought of therapies as things that heal, and it was difficult for me to equate abortion with healing. I’ve known, personally, and clinically, women who’ve had abortions due to their life circumstances, and the words they used to describe abortion typically have nothing to do with healing. In their voices I hear angst, guilt, regret and sometimes shame. I’ve yet to hear anyone be grateful for the abortion that healed her.

Be that as it may, the term used is therapeutic, and my first experience with a therapeutic abortion came during my first year as a nurse. From the report I’d received at the beginning of my shift, this young mother, in her early twenties, had recently lost a child to SIDs and now, at about twenty weeks gestation, it had been confirmed that the baby she was carrying was anencephalic. This condition is a spontaneous mishap of certain pregnancies, with very few predictors. For some baffling reason the neural tube does not close the way that it’s supposed to in the first month of pregnancy, and therefore, most of the brain does not develop. Anencephalic babies usually die immediately upon birth, but depending on which part of the brain is intact they can live an hour, a day, perhaps a week. Serial ultrasounds are performed to confirm this, and the diagnosis is not made lightly. Therefore, the option to end the pregnancy is given to the mother and her partner. Counseling is often performed, and discussions of how the medical team would go about ending the pregnancy are initiated. After much debate, Laura had made the excrutiating decision to end her pregnancy.

Her son’s name was James. Laura’s labor had gone on for quite a while, prior to my becoming her nurse. It was unknown whether or not her son was still alive inside her. Her boyfriend was at her bedside, deadly silent, as if his speaking or moving would make things worse. I thought, initially that his silence was due to his fear, but I was to later learn that despite the medical counseling, he had disagreed with the decision to end this pregnancy. He believed his child’s mother had given up on their child too quickly. Tangled brown hair, thick glasses stained with tears, Laura sat in bed waiting for the son who would never hold her hand.

I would have given an appendage not to have been this woman’s nurse. I had little experience with grief, and felt inept. I felt awkward, and clumsy, and frankly, I was afraid of her. What would I say to her? What shouldn’t I say? What if I cried? What would the baby look like when it came? Her grief was a militant pestilence in my eyes, and there was part of me that was afraid to catch it.

She didn’t want to see him when he came out, she made that clear, and I knew I wanted to do what she wanted. The literature on grieving fetal loss says you should always at least try and look at your baby, and preferably hold your baby. However, Laura’s decision was certain, and I didn’t dare try to convince her otherwise.

About 30 minutes after medicine in her IV for pain, Laura put on her nurse call light, and I went to her room.

Her face was stuffed in her pillow, and she said into it, “Something’s there.” pointing between her legs.

I called for help. With all the grace I could manage, I clamped and cut the shoestring-like umbillical cord and wrapped the tiny boy in a receiving blanket. I passed the baby to another nurse who was taking him to the room where we did the first pictures for the baby. When the resident appeared, she worked the placenta out, and assessed the bleeding. Laura was physically very stable, and the resident gave her genuine condolences, and I was left in the remaining silence to begin Laura’s recovery.

Normally in labor and delivery, the recovery period for a vaginal delivery is about an hour or two depending on the facility, and for the mother, it involves taking blood pressures, keeping pain and nausea in control, and monitoring for hemmorhaging. This word, recovery, in Laura’s case seemed a cruel joke. How would she ever recover from this?

The silence between Laura and her boyfriend was deafening. It was the sound of this decision, and this birth tearing them apart. As their young, and very inexperienced nurse, I was rendered helpless. I knew that we didn’t have a painkiller strong enough to give to her for her kind of pain. But I would’ve walked miles if it would’ve meant this wouldn’t have happened to her. I didn’t know her before that day, but her pain and grief were so profound to me, that it was physically painful. I went to get her juice.

When I left the room, my stomach and chest hurt. After getting her juice, and trying not to do anything wrong, I met up with the nurse who took James.

James was alive.

The expectation was that he wouldn’t be alive at birth, or would die soon after birth, but 30 minutes after birth he remained alive. He was anencephalic as diagnosed, but the part of his brain that had matured was keeping his heart going. Otherwise, his head was shaped classic to an anencephalic baby, and he had no other signs of life. He was tiny, barely a pound. I looked at him. His facial features were just barely distinguishable, but he had perfect tiny hands, and perfect tiny feet with a 10 count for both. I had so much charting to do, and the unit was bustling, but at this moment, I stayed at James’side and sobbed. I wondered why I had chosen to do this profession? I was so angry this happened to this family.

Apparently, Laura’s family found out that James still had a heartbeat and reported this to her. This was water and sunlight to the seed of doubt in Laura, and every mother who makes this decision in this type of situations’ heart. The seed of doubt that begged the question, could the doctors have been wrong?

The doctor’s had not been wrong, this little boy was obviously anencephalic, but it didn’t stop his mother from roaming the halls, and asking where her son was. Her nightgown was slightly bloody, she was pale and her face was stained with tears. Her tangled hair had taken on a life of it’s own, and her walking down the hall asking nurses to tell where we were keeping her son was a scene from a horror film. Only this film was on permanent play with no fast-forward, and no pause.

I did my best to calm Laura down, while she stood in the hallway demanding a cat scan be done on her tiny little boy. She was suddenly angry that we were not trying to save his life. One of the residents came over at the commotion, and explained it better than I could at the time. The baby was too tiny, he didn’t have much brain tissue, and that she’d made the right decision. There was just a small portion of his brain that was keeping his heart going, but he was not suffering, and he would pass away soon.

Laura was not comforted by any of this, but had calmed down enough to return to her room where she cried violently.

I went back to the small room where James was and sobbed again. I wanted it to make sense and knew it couldn’t. I wanted to be transported to a world where this would not happen to this or any other baby.

James died about 4 hours after he was born. The nurses and I grieved together, and comforted each other. We worked to bring some measure of comfort to Laura and her family. We gave her brochures, and had her sign more forms than I hadd ever presented to a patient before. We did our best to be therapeutic.