The Supreme Court transformed the experience of being a woman in this country 49 years ago by guaranteeing women’s right to abortion, and as I write this in late June, the Supreme Court has again transformed women’s rights by canceling Roe vs. Wade.
I am troubled by this flashback, not only as a female physician who has cared for emergency room patients before and after abortion, but as a woman who has had an abortion.
I was born two years after the landmark Roe vs. Wade verdict and never experienced a culture in which women did not have autonomy over their reproductive health. I was 3 years old when the Pregnancy Discrimination Act made it illegal to ask questions about pregnancy in job interviews or to fire women for becoming pregnant. So I’ve never worked in a culture where I could legally be denied a job or fired because of my reproductive choices.
Nevertheless, my experiences as a pregnant woman in the labor market have taught me that being female and fertile is always a handicap.
I got pregnant in the middle of my residency. I had seen the reactions of the teachers and other residents to the pregnancies of two other residents in the classes in front of me. They were strong and respected residents, but their pregnancies caused moans and grunts. Who would cover their shifts? It was a running joke that neither of them should try to get pregnant again during residency because the imposition and hassle created by their first pregnancies was enough. As a married resident, I was also told that our program did not need another pregnant resident.
There is always some truth in humor.
I woke up bleeding and cramping 10 weeks into my first trimester, before I even told anyone at work I was pregnant. The bleeding and cramping had stopped by the time I got to my OB, but the ultrasound showed a heartless fetus that hadn’t developed for eight weeks. A rare blizzard in Virginia had stopped most elective surgeries that day, so my OB could rush me straight to the OR for an abortion before the “held-up products of conception” (I cried writing this ) cause complications.
Now Roe vs. Wade has been cancelled, an abortion like the one I had before I contracted endometritis or hemorrhage will be a thing of the past in places like Oklahoma where abortions can only be legal if they are necessary to save the life of the mother. How close to death must a patient be before doctors can help her without being criminalized?
I returned to work within 48 hours because I was lucky enough to have access to reproductive health care before any serious infection or bleeding occurred. I didn’t tell anyone, but my sense of loss must have been apparent. A participant had written an evaluation earlier in my residency saying that I was not assertive or confident enough. Another wrote one while I was dealing with my miscarriage that said I wasn’t happy enough.
Bringing feminine behavior to roles where accepted leadership styles are decidedly masculine means that women in the workplace often hear that we are not enough or too much. Pregnancy and its outcomes make it even harder for us to find that elusive window of righteousness, especially in male-dominated fields like emergency medicine.
I had my first son less than a year after my miscarriage. I worked until my doctors diagnosed me with preeclampsia. A few days before I was induced, pain shook my abdomen in the middle of the nurses’ station. I stopped waddling long enough to breathe and hold my belly about to burst.
The emergency department there that day told me to “just get out” because they didn’t want me to go into labor. He laughed saying that. Was this a really nice attempt to release me early from my shift, miscommunicated as a joke?
As I said, there is truth in humor.
No part of my pregnancy felt genuinely welcomed by my residency, let alone my maternity leave. One sunny afternoon, when Cole was just a week old, I was tending to his neonatal jaundice by undressing him outside for phototherapy when the school counselor from the house staff council called me. . She wanted to know why I wasn’t taking on my duties as co-chair of the house staff council. while I was on maternity leave. I returned to work weeks later and my program director told me that I had to do better in the volunteer position I had accepted in addition to my residency requirements in addition to juggling residency and care at a new born.
I tried to perform my residency duties as if I weren’t a new mom, and often went too long without pumping. A baby cried in one of the exam rooms during my shift, and my assistant’s eyes bulged when he pointed at my chest. I looked down to find that I had leaked through my top and had a wet circle on each breast. “You have to do something about it,” he said. He wasn’t wrong. It was I who was wrong to naively believe that my pregnancy would not be a professional liability.
Being pregnant in a culture plagued by gender discrimination is difficult. I never brought attention to my own struggles with being pregnant during residency because, like so many women, I didn’t want to cause any trouble. It’s like we women are damned if we do, damned if we don’t. At best, our pregnancies are perceived by professional colleagues as embarrassing inconveniences; at worst, they can handicap or even derail our careers.
Our pregnancies also compromise our health by putting us at risk for hemorrhage, HELLP syndrome, pulmonary embolism, postpartum cardiomyopathy and preeclampsia, to name a few. Yet the road is also difficult if we miscarry or make the heartbreaking choice to have an abortion. Abortions do not just subject us to medical risks, but to judgment, stigma, and now legal consequences, regardless of the circumstances surrounding them.
I have experienced some of the difficulties associated with abortion and childbearing, and I can attest that pregnancy is a challenge no matter which side of the double bind we face. But what challenges we face should be our decision. Unfortunately, our reproductive autonomy has been thrown into the purview of lawmakers. Thanks to the Supreme Court, we could soon see the government interfering in the practice of medicine, interfering in the patient-doctor relationship and potentially criminalizing care.
The American Medical Association sought to protect abortion in May with a statement on the Supreme Court’s draft opinion, then in June expressed outrage after deer has been overturned: “The American Medical Association is deeply troubled by the decision of the United States Supreme Court to overturn nearly half a century of precedent protecting patients’ right to essential reproductive health care – this which represents a gross indemnity of government intrusion into the medical examination room, a direct assault on the practice of medicine and the patient-physician relationship, and a flagrant violation of patients’ rights to sound reproductive health services on evidence. States that end legal abortion will not end abortion – they will end safe abortion, risking devastating consequences, including the lives of patients. (June 24, 2022; https://bit.ly/3NqxYJz.)
I get triggered when I think of state legislatures meddling in women’s private health decisions. I’ve spent my life seeing women criticized and corrected for never being the right combination of confidence and deference or joy and seriousness, and I’m bowled over by a potential flashback to a scenario where what we do with our wombs is also criticized and corrected. .
Why do we perpetuate rather than overcome the longstanding inequalities created by male hierarchies that dominate women? It pains me to think that maybe my granddaughter has less freedom than me. We cannot afford to backtrack on reproductive health or any other women’s rights issue for our daughters and our daughters’ daughters.