The “A” Word

In residency, pre-Dobbs, I took care of a patient who had an anencephalic pregnancy, meaning the fetus doesn’t have a developed head. There is no possibility of it living outside of the uterus, but it is living in the uterus and has a heartbeat. It’s alive, but can never survive on its own. 

The patient knew that this was the diagnosis and outcome. They had gone to the maternal fetal medicine doctors, the experts, and had that discussion about what they wanted to do next. At the time, pre-Dobbs, they could have gotten an abortion, but they felt like they wanted to carry this pregnancy. 

During pregnancy, the fetus is surrounded by amniotic fluid and the amount of fluid is regulated by the fetus. The way this happens is the fetus swallows the fluid, and then pees it out. But in an anencephalic pregnancy there is no formed head, so the fetus can’t swallow. As the fluid builds up, a condition called polyhydramnios develops.

In their third trimester, this patient came in feeling breathless. Their belly was huge: full of fluid that was pushing on their organs and making it hard to breathe. We decided it was time to induce, so we prepared to admit her.

Someone on the team asked, “Is this an abortion?” And suddenly everyone backed away. This was pre-Dobbs and everyone knew that this fetus was not going to live. It was always going to die. Yet no one wanted their name on the patient’s records, so I had to tell this patient that, “I’m sorry, we can’t do your induction today. No one is willing to do it for you.” 

Only after the team met with the ethics board and legal counsel, we got the okay to schedule the induction, days later.