I Had A D&C

I huddled in my bathrobe on a towel and tried not to look at the trail of blood I’d left around the living room.

Three weeks after my oldest child was born, I woke up in a pool of my own blood. I don’t recommend it.

Up to that point, I’d had very little lochia, the normal postpartum discharge. That, it turned out, was because a chunk of retained placenta had been “plugging” my cervix until my uterus finally reached capacity and started hemorrhaging.

All I knew at the time was that our bed was soaked with blood and I was still passing large clots as I stood next to it, panicking. My husband awoke to me chanting, "Shit, shit, shit!" with increasing volume. It wasn’t until the 911 operator explicitly asked if I was on blood thinners that it occurred to me to mention that I was.

Waiting for the EMTs to show up, I huddled in my bathrobe on a towel and tried not to look at the trail of blood I’d left around the living room. When they arrived, someone took my vitals while someone else tried to estimate my blood loss by measuring the puddle in the bedroom.

Someone quizzed my husband on our insurance, which is obviously a column of swear words all by itself.

I told him and the baby that I loved them several times, because by this point I was fairly sure that I was going to die.

It wasn’t until I’d been in the ER almost an hour and my spouse was able to ascertain my place in the patient hierarchy (below heart attack; above strep throat) that I realized I was probably going to be okay.

I was lucky. Despite having had retained placenta for an unusually long time, I hadn’t developed further complications. As soon as the ER staff figured out what the problem was, one of the on-call OBGYNs was contacted and she arrived promptly, able and willing to perform an emergency dilation and curettage (D&C) that stopped the bleeding and allowed my uterus to contract back to its non-pregnant state.

The insurance that the EMTs had so assiduously investigated covered the procedure. I was home and back on my feet by mid-afternoon.

Getting a competent professional who will provide appropriate care shouldn’t be a matter of luck, but when it comes to a D&C in the US, it absolutely is. Many providers never learn to perform a D&C, which involves dilating the cervix and scraping the uterine wall clean of tissue, because of its use for surgical abortion as well as retained placenta and incomplete or “missed” miscarriage.

Miscarrying people can find themselves, like Mikki Kendall, in the hands of a provider who values a non-viable fetus over a pregnant person.

Some of them die.

We don’t allow physicians to withhold blood transfusions due to personal philosophical objections, but when it comes to a common, safe procedure that can be used to terminate pregnancy, suddenly different rules apply.

Every abortion ban is a ban on a procedure, and every one of those procedures saves lives. In a smaller, more remote facility, it doesn’t matter if a person comes in hemorrhaging from retained placenta or a miscarriage. If a D&C is subject to complicated legal restrictions (who decides when a pregnancy or miscarriage becomes life-threatening?), or if it’s perfectly legal but no one in a 100-mile radius ever learned how to do one (quite possibly out of fear of domestic terrorism), that person may die.

The subjective nature of “life-threatening” is also leveraged by for-profit insurers. Our own plan, I discovered, makes no exception for permanent injury or disability, only imminent death; it is fairly typical in this regard. My D&C was covered because it didn’t involve a fetus at all; it was considered “postnatal care.”

A couple of months later, I saw the OBGYN who performed my D&C for an IUD insertion. She insisted on a separate consultation appointment, which she spent pontificating on how terrible it would be if I were to get pregnant again too soon -- for the fetus, who would be at increased risk of low birth weight and other problems, and for my existing infant, who would suffer for my reduced milk supply.

She didn’t mention what a complete disaster it would be for me, the recently pregnant person, even though my pregnancy had been both high-risk and mundanely miserable in myriad ways.

“If I somehow got pregnant right now,” I finally interrupted her, “I would get an abortion.”

There was a very short pause. She resumed her litany of reasons that I needed the IUD that I already wanted.

There is something wrong when an OBGYN will not even acknowledge a patient’s stated willingness to obtain an abortion in the event of an unwanted pregnancy. There is something wrong with a movement that only tells abortion stories where the alternative was instant death.

It’s true that death and injury are relevant to the discussion. Pregnancy is ten times more likely to result in the death of the pregnant person than an abortion. It can be temporarily or permanently physically disabling. It carries a dramatically increased risk of mental illness up to a year postpartum.

Everyone, progressives included, seems to want to label abortion as a “hard choice,” but we know that fewer than 0.5% of abortion recipients experience any complications. Abortion often resolves, instantly, physical symptoms such as nausea and exhaustion. While some individuals will regret having an abortion, just as some people regret having children, the most common emotional reaction to abortion is relief.

People who don’t want to be pregnant feel good when they’re not pregnant any more.

When people do feel negative emotions, they are more often related to abortion stigma than abortion itself. People fear that others might find out, and what they might think if they did -- despite the fact that over a million abortions were performed in 2011, and about 30% of women in the US will have had one by age 45 (gendered language in the link).

When I mentioned my D&C on Facebook recently, I was asked for a definition. People don’t know about a surgical procedure that is almost four times as common as appendectomy.

But people don’t want to hear about easy abortions. They also don’t want to hear about hard births.

At six months postpartum, I was diagnosed with post-traumatic stress disorder (PTSD). Waking up in a pool of blood in that first month didn’t help, but it wasn’t the central trauma: the doctor who attended my delivery repeatedly forced interventions against my stated wishes.

She cornered me in the bathroom and explained in great detail how she was going to “get that baby out” by any means she deemed necessary, as I shrank into a corner trying to get away from her, hobbled by the IV cart. She forced me onto my back when I tried to squat to push and told me to be quiet when I screamed.

The hospital portion of my first labor lasted less than 24 hours and it is with me still, two years after the initial PTSD diagnosis. My second pregnancy, though carefully planned, provoked numerous flashbacks, including one during delivery. I cannot imagine what it would be like to be forced to carry an unwanted pregnancy to term, every moment a violation of one’s personhood.

Pregnant people are routinely granted less autonomy in this country than we give to corpses. Without my express consent, my organs cannot be harvested to save actual living humans even after I am dead. However, as a pregnant person in Wisconsin I would be forcibly kept alive in a vegetative state in express contradiction of my legally recorded wishes -- all of my organs essentially donated to a potential human against my will.

Actual pregnant people seeking abortion here are subject to a 24-hour waiting period and an invasive transvaginal ultrasound: a state-mandated assault.

Since 2000, the number of states with multiple major restrictions on abortion has doubled, from 13 to 27. I have two children who might become pregnant some day, and the thought that they might be forced to stay that way against their wishes terrifies me.

When we talk about abortion in terms of “harm to the pregnant person,” we have to understand this: Taking away someone’s control over their own body is harm. Being treated as less than a person does lasting damage. My wanted pregnancies were debilitating.

Forced birth is torture.

I have never had an abortion because I have never needed one, for much the same reason I have never had an appendectomy. Appendectomies are good for the people who need them, and so are abortions. And every wanted abortion is, by definition, a necessary one.

Thanks to Dr. Jenny Higgins, with whom I worked as a teaching assistant for UW-Madison’s Women’s Health course, and to Mikki Kendall, who empathized with me over Twitter after my postpartum hemorrhage and whose online posts about postpartum depression helped me take the first steps to get help.