This week’s ruling by California’s Supreme Court that crises pregnancy centers can omit information from their counseling of pregnant women has many well documented outcomes. The primary goals of these centers are to deter women from accessing abortion care and to restrict their rights to autonomous reproductive healthcare decisions. In cities like the one I am living in there are enormous billboards, bus signs, and benches covered in ads for these centers. They read, “Don’t harm your baby! We can help!”, “Free Ultrasounds!”, and “Free Prenatal counseling, we will help you with your decision.” Women are lured to these centers through promises of seemingly unbiased guidance and support. These centers have been found guilty of, and defend their right to omit information about the availability of birth control and access to abortion care (including Plan B medication). They have proudly affirmed that they often tell women they are further along in pregnancy than they are. This helps convince women that they are not eligible for an abortion. It also causes them to imagine a fetus that is more like a baby than a few cells to make it emotionally harder to decide to terminate.
What no one talks about is what happens next if a woman decides to keep her baby. As a midwife in the South I have received these women into care many weeks after their first visit to one of these clinics. Most of them receive regular prenatal care from the clinics. However:
- If they miss any appointments, they are kicked out of care and left to fend for themselves.
- Sometimes they do not want to relinquish their baby for adoption through the clinic agency and they are harassed and pursued by agency representatives who prey on their vulnerability and try to shame them into submission.
- Sometimes women come to a place where they embrace the idea of motherhood and want to do all they can to prepare and learn about birth and parenting. Their newfound power is threatening to the relationship with the crises center and they are pushed away from resources.
- Sometimes they are violently ill from the pregnancy and ignored completely as long they remain pregnant. Their health really does not matter as long as the vessel of their body continues to carry the pregnancy.
I’m sure somebody out there has documented all of the pathways these pregnancies and women can take—they are varied and many, with complexities and layers we dissect and maneuver through with individuals who wind up in our care. I have sat in stunned silence on my own after these visits many times because the level of depravity and lack of compassion that rises up from these centers and the staff and providers who work in them is frankly unfathomable. It is a lifetime movie gone horribly terribly wrong but it’s no movie—these are very real lives with very real consequences.
What I never heard about, and I wager very few have considered, is this scenario: A woman goes to a clinic for a free ultrasound and prenatal assessment. She may or may not have ever considered abortion. She may be happy about the pregnancy or ambivalent or miserable. She arrives at the crises clinic not knowing the date of her last menstrual period. They do an ultrasound, give her a due date and print out an image for her to take home. They put the little black and white photo into a small white envelope with illustrations of a real baby, looking happy and fat and healthy, surrounded by blue and pink ribbons.
These are the questions we must ask:
- Is the due date they gave her accurate or is it based on dating that will ensure she will not receive access to abortion care in her area?
- Is the image they give her of her own baby or one who is more developed than the one she carries?
- Do they explain how she can access Medicaid, social services, housing, job training, or food for herself and her baby or do they only share resources that exist in their clinic and lead to adoption by a family that pays hefty fees to that same agency?
- What do we need to unwind to discover her true wishes? She comes to us over-exposed to the subtle and brutal art of shame, devaluing, and tinkered religious ideology all driven straight into her most vulnerable fears and emotions.
I know no one has ever come into our office from this care knowing what resources they have the right to access. Most don’t know they can easily sign up for Medicaid which will guarantee them perinatal healthcare at a variety of locations. I don’t know which clinics give the right dates and which give falsified dates.
But here’s what I want to share in this post: When the only ultrasound a woman has gives her a certain due date, and she does not know when her last period was, that is the only and best information we have to work with. Keep in mind that when a woman comes in late to care with no known date of her last menstrual period and no early ultrasound, we do an ultrasound and measurement of fundal height immediately and work off of that information. A baby who measures 33 weeks by ultrasound and fundal height will be approached as a 33 week old baby. A baby who measures 33 weeks when the early crises clinic ultrasound says it should measure 37 will not. For that baby, with a prior early ultrasound who measures small for that date, here is what we wonder:
- Why is this baby so small?
- Why isn’t this baby growing as it should be?
- How long can we afford to keep this baby inside to try to prove interval growth before we are compromising it?
- Can we prevent harm from intrauterine growth retardation or another syndrome, disorder, or anomaly by causing an early delivery?
- Will we cause harm by causing an early delivery of a normal healthy 33 or 34-week-old fetus who would have done perfectly had it been allowed to stay inside and finish growing for a few more weeks?
There is no easy answer to these questions. We use technology to try to measure and assess the actual size of the baby, the flow of blood from the placenta to the baby, anything that is measurable, is measured. But all of our measurements are relative to the first and best known date of any pregnancy. Normal and abnormal interval growth can vary by just enough to give no good answers. We do the best we can. We use all of the power in the maternal-fetal medicine world to try to make the right decision. Sometimes we will get it right, and sometimes we will get it all wrong.
From the March of Dimes:
- The average cost of a NICU stay for each baby born too early is $55,000. The average cost of a hospital stay for a normal birth is just over $4,000.
- Babies born too early are at high risk for disabilities and developmental delays including physical, thinking, communicating, social and self-help skills.
- Day-to-day life for the parent(s) and family is completely disrupted during and after the NICU stay as they navigate interventions and attend appointments and therapies.
- Parent(s) spend hours in the NICU, and then at therapies, away from their other children and often lose their jobs.
- The NICU stay can last for months, and often the facility is located miles from home.
- There is tremendous emotional, physical, and financial stress with premature birth
Families deserve access to healthcare information, research, and guidance that leads to shared-decision making with their provider. The presentation of options that utilize provider skills and local resources to best serve a patient’s needs for their life is a fundamental right.
The cost of lying to patients is high in all directions—for negligent prenatal care, for the delivery of shame as a tool of coercion, for leading a woman to believe that there is help and then abandoning her if she asks questions or changes her mind, for the mother who is induced for a too-small baby who was really just fine but now faces a life of developmental challenges. Frankly the cost of stress to the multitude of providers who gather around a woman and her unborn baby struggling to make the right decisions with bad information is high, too. Yet these clinics are never held to account for those costs. And now the government has decided that they should be encouraged to carry on and pursue their right to lie which supersedes the rights of the mother and the baby to the truth and of society to the health of its most vulnerable people. Money and power are on the side of these clinics, but justice is not. It is one more unjust and unnecessary barrier for those most at risk for adverse outcomes.
A question just crossed my mind and I will close with it: What would happen to our maternal child outcomes if all of the resources being poured into these clinics, all of the concern, time of staff and providers, and faith-based communities was instead poured into the delivery of services designed to promote the good health of these women regardless of what their decision might be about their pregnancy and future?