I love babies. In fact, I’ve had three – three beautiful and adored babies. My first two babies were planned and expected, the second perfectly spaced so that I never had more than one in diapers. For six years, we were a well-manned and content family of four. Then, a few months shy of my 40th birthday, somewhere between packing school lunches, scheduling hockey practice carpools, catching early morning flights for my job, and supporting a husband who was returning mid-career to law school, life threw us a huge curveball. I discovered I was pregnant again.
Shocked, happy, scared, overwhelmed, and foreboding are all words I would use to describe those initial months of my third and unplanned pregnancy. Due to my age (the official clinical term is “Elderly Multigravida”, which ominously sounds like a terminal condition), I knew my body and the statistics were working strongly against me for a normal, healthy pregnancy and baby. I had even spent a whole semester in graduate school specifically studying perinatal epidemiology, so my “expert” knowledge of these potential outcomes was not encouraging. After consulting with my OB/GYN, who sweetly shed a tear with me during that initial visit, I was immediately referred to a perinatal genetics clinic to better understand my prenatal screening options. In the six years since my prior pregnancy, those tests were now vast and advanced, and I wanted to take full advantage of the information they provided.
The two weeks between that initial screening blood draw and our meeting with the genetics counselor to discuss the results were not pleasant ones for my husband and me. The “what-ifs” were overwhelming. What if the screening was positive for a debilitating or fatal genetic disorder? What if we, our marriage, or our finances were not strong enough to provide lifelong care to a child with disabilities? What if the screening incidentally indicated that I had cancer? What if my body could not carry this baby to full-term, and we spent months shuffling between a NICU and home or, even worse, experienced the tragedy of a stillborn baby? What if I was hospitalized or put on bed rest for complications, and I too quickly ran through my banked sick leave and paid maternity leave? What if this was my last chance to know that feeling of unbounded love as I held my precious newborn baby?
I was scared. We were already blessed with two bright, busy children. I was the primary breadwinner for our family. My husband wondered if he should withdraw from law school. We had not yet even told anyone other than our parents that I was pregnant again. Our emotional discussions about the possible outcomes were deeply personal, and any potential decisions were uncertain. I relied on my faith and prayed for divine guidance.
In the end, I was extremely lucky. I never faced a diagnosis that necessitated a choice. I use the term lucky, because I am well aware of the thousands of women each year who do not share my outcome. The genetic test results were normal; the follow-on screenings and anatomy scans were equally nerve-wracking, but also normal; and the remaining months of my “elderly” pregnancy were thankfully uneventful. Towards the end of 2016, I delivered a healthy baby girl who very obviously completes our family in every way.
However, I now think about how my experience would have been further complicated by Ohio’s new Down syndrome abortion ban, House Bill 214, which was passed by the General Assembly and recently signed into law by Governor Kasich, making Ohio the fourth state to ban abortions performed after a genetic screening test shows the fetus has or might have Down syndrome. This is the 20th restriction to abortion and reproductive health passed into law since Kasich took office in 2011.
This most recent law makes it criminally punishable for doctors who know of a prenatal Down syndrome diagnosis to perform an abortion. I wonder how this ban would have impacted my access to American College of Obstetricians and Gynecologist (ACOG)- and Society for Maternal-Fetal Medicine (SMFM)-endorsed prenatal diagnostic testing, the coverage of these screening tests by my insurance provider, my ability to use screening information to make decisions that are appropriate for my family and our personal circumstances, or those deeply personal conversations with my doctor and my ability to receive appropriate and safe care? These are the law’s consequences that are still unfolding, and I can think of a no more intrusive role of government in my family’s life or health care.
I also think about my uncomplicated third pregnancy and the role my prior comprehensive well-woman care, adequate prenatal care, and financial security played in ensuring a positive outcome. Despite my advanced maternal age, an absence of health risk factors commonly associated with socioeconomic status and race and ethnicity, as well as adequate birth spacing between previous pregnancies, significantly reduced my risk for pre-term birth, stillbirth, and maternal death. My ability to plan earlier pregnancies using affordable birth control, while building a career that provided financial security and access to comprehensive health care, provided a healthy environment for my later pregnancy and newborn baby.
If the goal of these abortion bans was truly to protect life, there would also be concerted efforts focused on evidence-based policies that prevent unplanned pregnancies through effective and affordable birth control, reduce infant mortality rates, and decrease the number of maternal deaths. Evidence also clearly points to the value and health benefits to Ohio’s women, families, and economy when there is adequate access to affordable preventative health care, family planning services and sex education, prenatal care, livable wages, quality childcare, paid family leave, and higher education. Yet, the legislative agenda of the Republican-controlled Ohio General Assembly does not include policies that advance these issues. Instead, it focuses on abortion bans, the defunding of health insurance coverage and access for women, and undermining the right of Ohio’s workers to negotiate fair wages and benefits.
My baby girl recently celebrated her first birthday. I often marvel that I get to experience the joy of another baby and that we ever considered life before her complete. I also think about her future as a young woman and wonder if her ability to make decisions about her own health and achieve economic security will equal those of her older brothers. I believe they will if our state legislature stops the bans on abortion and instead prioritizes the healthy lives and well-being of Ohio’s women and families.
ABOUT THE AUTHOR: Allison Russo, DrPH, MPH, is a public health policy expert and currently the Research Director for a health policy and finance consulting firm. She has authored numerous reports on a wide-range of health care issues including access to appropriate care by vulnerable populations, the determinants of health outcomes, and payment policy options that incentivize the delivery of high-quality care. She is an outspoken advocate for universal access to affordable and quality health care and lives in Columbus, Ohio.