Editor’s note: The account that follows may be upsetting for some readers. Names were changed to protect confidentiality.

I was reflecting on a recent party we hosted and thought my friend Heather would enjoy a couple photos from the gathering. There was one of her chasing her toddler son around with a plate of food, another of her sipping from a wine glass full of grape juice. She was relaxed into her second trimester, answering all the usual questions from our guests: a boy, due in May, first trimester was uncomfortable but not terrible, totally different pregnancy from her first, totally excited.

She joked about the whole “we’re pregnant vs. I’m pregnant” debate with her husband Jeff, who had stopped drinking and even gained “baby weight.”

Her family used to live near us. They recently moved to a larger home with the plan of having another child. Just a few days earlier, she had asked me where we bought our Murphy bed. I assumed they were getting ready for family visits after the baby’s arrival.

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Her text response to my pictures came about a minute later and stopped me in my tracks.

“Got the worst news with the baby. I can’t talk. No words.”

Tears pooled in my eyes. I replied that we love her and are praying for her. We can talk when she’s ready.

Then my phone vibrated with another message: “He won’t survive. I have to get a procedure. It won’t be till next week.”

Heather and Jeff’s joy had turned to horror. And then the other part of her message sunk in: she had to wait a week. How would she manage being pregnant for a whole week knowing she would never meet the baby inside her? I imagined every day was too much to bear.

I contacted my friend who is an operating room nurse specializing in emergency and gynecological procedures. I knew many of my questions were unanswerable, but I hoped she could help me with a few. What kind of procedure was Heather going to have? What will her recovery be like? Should I offer to have her son come stay with us?

My friend explained that if the fetus is no longer alive, labor would most likely be induced and Heather would have to deliver her deceased baby vaginally, just as for a live birth. I recalled my own experience with labor; the idea of going through all of the pain, contractions, and emotions to knowingly deliver a lifeless baby was sad beyond measure.

“If the baby isn’t dead,” she went on, “She will likely have a D & E—dilation and evacuation.” She would be under general anesthesia, with more cramping and bleeding in recovery.

She finished by expressing her deepest condolences. “Physical recovery shouldn’t be too bad,” she said, “but losing a wanted pregnancy is going to be so tough. My love to her.”

Eventually, Heather was ready to tell me what happened, and she asked me to write about it. Here are five things she specifically wanted me to share:

1. “When you call it a procedure, you separate yourself from it. It’s an abortion. And it’s not a dirty word.”

Heather’s baby was alive when she and Jeff went to her routine 20-week ultrasound. She noticed the technician was unusually quiet. When the technician brought in a doctor to examine the scan, they knew something was wrong.

Heather asked if the large mass she saw on the monitor was her bladder. “No,” the doctor said. “That’s his bladder.” It was larger than his head. His body was not processing urine properly, and the bladder was almost the only thing they could see.

As she was lying on the table in a dark room with warm gel on her pregnant belly, the doctor began discussing their options.

If she continued with the pregnancy, the baby would require experimental surgery in utero. In the unlikely event he survived the pregnancy, he would require multiple surgeries, including kidney and lung transplants. If he did not survive the pregnancy, she would labor and deliver her deceased baby.

If she continued with the pregnancy, the baby would require experimental surgery in utero. In the unlikely event he survived the pregnancy, he would require multiple surgeries, including kidney and lung transplants. If he did not survive the pregnancy, she would labor and deliver her deceased baby.

Or she could terminate the pregnancy—have a late-term abortion. As my friend who works in the OR explained, at 21 weeks this would be a D & E.

The doctor assured Heather and Jeff that a fetus does not experience pain until 24 weeks. In a few short weeks, their baby would feel the pain of his condition, of in utero surgeries, and of organ transplants should he survive birth.

Jeff asked all of the questions while Heather laid there and cried. She could barely speak, but she knew she was not going to put anyone she loved through that. She had always been pro-choice, but never thought she would have to make the choice herself.

She was going to have a late-term abortion.

2. “If I hadn’t been able to get the abortion, I don’t think I’d be here.”

Heather described being pregnant with her baby for a full week, knowing he was going to die.

“When you’re pregnant, you become aware of everything you do. ‘How will this or that affect the baby?’ ” She said she didn’t drink that week because she didn’t want to hurt him. But she could hardly bring herself to eat or sleep.

During that week, Heather tried to straighten her hips so it didn’t look like she walked like a pregnant woman. She wore Jeff’s clothes and jackets, slinking around the few times she went outside because she couldn’t handle someone saying, “You’re pregnant!”

President Trump took office the day after her abortion. “I was bleeding, cramping, heartbroken,” she said. “I was hearing all the rhetoric about lawmakers trying to ban this procedure.”

She believes if she wasn’t able to end her pregnancy when and how she did, she wouldn’t be alive today.

“If someone had taken that right away from me, I would have walked in front of a bus. It’s inhumane to force a woman to continue with a pregnancy,” she said. “I could not have done it for another four to five months, letting him grow inside me knowing he was doomed. That week was a lifetime.”

3. “It was the saddest moment of my life. The kindness and compassion of others meant the world to me.”

When she arrived at the hospital, Heather saw someone she knew from work. She was crying, and grateful that person did not try to say hello.

Her doctor scheduled the abortion over email. He personally escorted her through the hospital, and allowed her to wait in his office so she didn’t have to sit in a waiting room full of pregnant women.

Heather tried to keep her emotions in check when she entered the operating room alone. But when it came time to climb onto the table, she wept.

She told the anesthesiologist, “I don’t want to be here. I don’t want to be going through this.” Her doctor hugged her, and the anesthesiologist whispered in her ear that she was going to give her extra anxiety medication to help her through.

She told me she felt grateful to have had paid time off from work, and her insurance covered the abortion without question.

4. “It wasn’t a decision that was just for me. It was for him, too. I made the decision of a mother.”

Heather was at work when she was notified of the autopsy results in her online chart. She didn’t want to look at it, but she needed to know. She felt like she was the only person who ever knew her baby.

Seeing those autopsy results, the heartbreaking truth settled on Heather. No matter what “options” they had, he was not meant to be.

According to the autopsy, parts of his body were critically underdeveloped, including his lungs. His kidneys were not functioning at all. Other parts of his body were severely deformed because of a lack of amniotic fluid. He would not have survived without drastic measures, and even if all those measures were maximized, he was unlikely to live.

Heather described lying awake at night during that week before the abortion, thinking about being separated from her baby.

“I didn’t want him to live for an hour and then die. Or to get organ transplants and die. I didn’t want to make him suffer like that. I was going to be a mom to my kid. I made the right choice for my son.”

Seeing those autopsy results, the heartbreaking truth settled on Heather. No matter what “options” they had, he was not meant to be.

5. “I still talk to him.”

Before that 20-week ultrasound, Heather had an image of her baby as a star in the distance, and she was beckoning him to come closer. Now she says, “I still picture him as that star, but I just keep saying goodbye.”

She doesn’t want his memory to be only of sadness. She tries to focus on the times when she felt so happy to have him in her life.

Jeff got a tattoo in honor of his son—a turtle representing Mother, though it looks like a water baby or a baby in a boat, which is how they will remember him.

Heather and Jeff plan to have another child. But as of now, she considers herself to be the mother of two boys.

“His name was Everett,” she said. “And I love him.”

Despite using protection, you have gotten pregnant; naturally, you are shocked. You are not happy with your boyfriend, he is not a person you want to parent with, and you’re wondering if you even want (or have) to tell him that you are pregnant in the first place. You seem to indicate that your relationship doesn’t promise the stability—emotional and financial—that a child needs and deserves. You are worried but very clear-headed and caring in your analysis of the issues involved in your pregnancy.

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You ask whether you are within your rights to terminate your pregnancy and not tell your boyfriend. As you might know, abortion has been legal in the United States since 1973, when the Supreme Court ruled in Roe v. Wade that women have the right to abort prior to the viability of the fetus. I am not an attorney and nothing I write in this space should be construed as legal advice, but as far as I can tell the Roe v. Wade ruling doesn’t spell out paternal rights, and a little online research suggests that there are no barriers to you making this decision on your own, without your boyfriend’s consent or awareness (Planned Parenthood v. Danforth in 1976 addressed consent, and Planned Parenthood v. Casey in 1992 addressed awareness). Again, do not take anything I’ve written here as gospel. Your question is one that an attorney can and should answer definitively, possibly even over the phone. Please call one. You might also refer to Planned Parenthood, which would either be able to answer your questions or point you to resources that can.

Beyond the legalities, you ask “should it matter” whether your boyfriend knows about your desire to have an abortion. That’s a difficult question that only you can answer.

You do not indicate your age, nor do you ask whether your parents need to know, but for the record, according to Planned Parenthood’s website, there is no parental involvement requirement in New York for persons under 18. (Some states may require one or both parents to consent to an abortion or be informed of it, a requirement that can be waived by a judge.)

Beyond the legalities, you ask “should it matter” whether your boyfriend knows about your desire to have an abortion. That’s a difficult question that only you can answer. The fact you’re grappling with the ethics of it all is a sign, to me, that you are proceeding carefully and thoughtfully.

It seems to me that one of the questions you might be asking yourself is what it means to be a woman in the United States in 2015. There’s a book called Our Bodies, Ourselves, first published in 1973 and updated every few years—the latest edition was released in 2011. You might take a look at it and see if it helps you find peace. The book supports women taking ownership of their bodies, which seems to be one of the many issues you are struggling with.

You ask for reassurance that you are not a “bad person.” You don’t seem like a bad person to me. You seem like a worried and scared young woman who is in a bad spot and trying to figure out the best way out of it. I think you would benefit greatly from speaking to a counselor or therapist who can help guide you through some of the more challenging internal quandaries you face. You write, correctly, that it’s your body and your future that you have to consider when making important life-changing decisions. I salute your warm, level-headed, and thoughtful approach to finding your way.

Good luck! I’m with you in spirit.

Respectfully,
Lynn

In my practice, I see many mothers who have lost their only children during pregnancy or early infancy. They show up at my office struggling with grief and feelings of isolation. Some also grapple with infertility and the prospect of never being a mother to a living child.

Many of these mothers have been to multiple therapists or support groups, yet their search for adequate support continues. They report feeling like outsiders in support groups where other women talk about their living children or who are pregnant again after experiencing a loss. They talk about struggling to find a therapist who understands the unique experience of being a mother without living children.

Again and again, these mothers share feelings of invisibility and isolation and the intense grief of having empty arms with no children to fill them. More than anything, they want someone to acknowledge the pain of their loss.

Having an awareness of the unique experience of being a mother without living children is vital in supporting these women. Here are some things therapists should consider when supporting a mother without living children.

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There Is No Guarantee of a ‘Rainbow Baby’

It’s common in the world of pregnancy loss to hear talk about “rainbow babies” (babies born after loss). Often there’s an assumption that moms who have experienced loss will go on to have such babies. Many support groups include discussion of mothers desperately trying to get pregnant again.

I call the idea that another baby will fix a woman’s grief the “myth of the rainbow fix.” Even if a mother goes on to have a living child, it won’t replace the baby she lost or miraculously cure her grief.

More importantly, not all moms who have experienced loss have the option to have another child. Many moms are dealing with the knowledge that they physically or emotionally can’t have another baby. Others tried for years and are struggling with infertility. For many, the baby they lost was a “miracle baby” after years of apparent infertility and trying. Some have accepted that they may never have another pregnancy and have been on adoption waiting lists for years.

Not every mother who loses her child to stillbirth or miscarriage will have another child. Making the assumption that they can or will may be detrimental to the emotional health of these mothers.

Many Need Reassurance That They Are Indeed Mothers

Many mothers who have lost their only baby struggle with whether they are “allowed” to claim the title of mother. Their idea of what it means to be a mother has been suddenly and unexpectedly altered. Being able to claim the identity of mother even though their baby did not survive can be a valuable piece of the healing process.

It’s important to work with these women to redefine what “mother” and “mothering” means to them now that their baby is no longer physically here. In what tangible and intangible ways can they continue to mother their child?

Early Loss Does Not Mean a Lesser Loss

Far too often when a mother loses a baby early in pregnancy or has an ectopic pregnancy, her loss experience is minimized. Many women whose babies died in their first trimesters often feel that their grief is dismissed or invalidated through statements like, “It was so early,” “You didn’t really know it yet,” or, “You just found out you were pregnant, so try not to get too down.”

However, for many women the love and attachment come the moment they know they are pregnant. For others, the attachment and love were formed long before the pregnancy occurred, through years of trying to get pregnant, fertility treatments, or planning to become a mother.

Depth of love has no basis in time.

Questions about Children May Be Difficult to Answer

Many intake assessments and initial sessions for any kind of medical or mental health provider include the question, “Do you have any children?” or “How many children do you have?” For those who haven’t lost a child, this probably seems like a simple and straightforward question. For those who have lost one or more children, it’s often not so simple. Internal debate immediately comes up:

Do I say yes and explain?

Do I say yes, but then what if they ask how old he/she is?

Do I have the energy to go through the story all over again?

Maybe I should just say no, but I always feel so guilty when I do that.

What is his/her reaction going to be if I say I have a child but he/she is dead?

I want to acknowledge my child, but I don’t want to deal with discomfort and that awkward silence.

Gah, I hate this question!

For therapists, I don’t know that there is a good solution for the pain and uncertainty questions like this bring up. However, asking about living children and deceased children separately may make the situation more comfortable for mothers and help them feel more accepted.

Nothing therapists can say or do will completely take away the grief and pain a woman feels after the death of a baby. We can’t fix the ache of not having a living child to hold, raise, and love. As professionals and compassionate human beings, however, we can be more aware and sensitive to the unique experience of being a mother without a living child. Support without judgment or assumptions can go a long way toward healing, not just for these mothers but for anyone in pain.