Maternal Mental Health - GoodTherapy

Maternal mental health was not always on the radar of things to address for many behavioral health providers in our nation. In 2020, the world view has shifted, and the mental health of mothers (and parents in general) is increasingly important to the behavioral health community. More and more providers are exploring mental health disorders in women who are pregnant, are new mothers, or are experienced mothers and how their mental health impacts that of their children. According to the World Health Organization, roughly 10% of pregnant women and 13% of women who have just given birth experience a mental disorder, primarily depression, leading to an inability to properly function and impacting the growth and development of their children. Below are some of the common types and causes of Maternal Mental Health Disorders and how managing one or more of those disorders can impact a child.

Common Types of Maternal Mental Health Disorders

1) Depression /Postpartum Depression

Depression is the most common maternal mental health issue experienced by mothers across the globe. While many mothers experience varying types of depression in their lives, the number one most experienced form is postpartum depression. Up to 80% of women will experience postpartum depression to some degree after childbirth. Symptoms of this maternal mental health disorder include weepiness, impatience, irritability, restlessness, fatigue, insomnia, sadness, intrusive thoughts, or the inability to stay focused. 

2) Anxiety Disorder

Another common paternal and maternal mental health issue experienced by parents are anxiety disorders. This is often experienced as intense/excessive worry and fear about everyday situations. Some mothers experience this due to fear of harm coming to their children or for other reasons outside of motherhood. Regardless of the reason, increased anxiety can impact a parent’s decision-making and the ability to assess certain situations as well as other processes when raising a child.

3) Obsessive-Compulsive Disorder

Obsessive-compulsive disorder is categorized as a pattern of unwanted thoughts, fears, and obsessions that lead an individual to experience certain compulsions that interfere with daily life and are often exacerbated by increased stress levels. For a parent that is now responsible for a helpless child, the obsessive-compulsive disorder can be experienced as a result and desire to keep harm away from the child. It could lead to incessant cleanliness habits, repetitive phrasing or actions, mental compulsions, and more.

4) PTSD

Anther maternal mental health disorder that is common in the United States is Post-traumatic Stress Disorder or PTSD. PTSD can be brought on from several experiences but is most commonly experienced by mothers who went through a traumatic child-birthing process. Otherwise known as birth-trauma, this form of PTSD is often a result of fear experienced during childbirth that harm is going to come to you or your child, or the realization of those fears (high-risk births).

 The Impact of Paternal and Maternal Mental Health on Children

During the formative years of a child’s life, the mental health of a mother or parent has a huge impact on the child’s behavioral and mental health. A parent who is managing some type of paternal or maternal mental health disorder can sometimes have a decreased ability to manage, respond, and react to their child in a way that promotes stability, growth, and development. Left unaddressed, paternal/maternal mental health disorders can become dangerous, impacting the child.

Untreated paternal or maternal mental health can have several significant impacts on the emotional and behavioral health of a child, such as:

Seeking treatment for your paternal or maternal mental health disorder(s) is essential to decreasing the risk that your child experiences any of these consequences. If you believe you are experiencing depression, anxiety, or any other form of mental health disorder, you should consult with a behavioral health provider. To learn more about a provider near you, click here to begin your search.

Can Marijuana Use During Pregnancy Harm a Baby

INFOGRAPHIC TEXT: CAN MARIJUANA USE DURING PREGNANCY HARM A BABY?

In the U.S., 4% of pregnant women report using cannabis in the last month.

During pregnancy, up to 30% of THC (marijuana’s active ingredient) can reach the baby.

Research shows a child exposed to THC in the womb or through breast milk is more likely to:

However, it’s difficult to say whether THC exposure causes these issues or if it occurs alongside other contributing factors such as parental alcohol use.

In some states, women who expose their children to marijuana in utero may be required to get substance abuse treatment.

References:

  1. Can marijuana use during and after pregnancy harm the baby? (2018). National Institute of Health. Retrieved from https://bit.ly/2H0O8bl
  2. Is it safe to use marijuana during pregnancy? (2017). Retrieved from https://bit.ly/2S0ydTb
  3. Some pregnant women don’t believe cannabis is harmful to their fetus. (2019, January 21). ScienceDaily. Retrieved from https://bit.ly/2R6DNPp

A couple of expecting parents both wake up with nauseaCouvade Syndrome: When Expectant Dads Get Pregnancy Symptoms

January 16, 2019 • By Zawn Villines

Couvade syndrome is a condition in which men with pregnant partners begin to experience symptoms of pregnancy. The causes of Couvade syndrome aren’t fully understood, though several theories exist. This condition has not been recognized as either a medical or mental health issue.

WHAT is Couvade Syndrome (SYMPATHY PREGNANCIES)?

Couvade syndrome or sympathy pregnancy occurs when a pregnant woman’s partner experiences pregnancy symptoms. Called Couvade syndrome when it occurs in men, it might also be referred to as pregnant dad syndrome, male pregnancy experience, or sympathetic pregnancy.

Though symptoms can vary, they usually involve some combination of the following:

Symptoms of this condition usually appear in the first trimester, around the third month of pregnancy. They improve temporarily during the second trimester, in most cases, and return in the third trimester. Once the baby is born, symptoms typically disappear.

SYMPATHY PREGNANCY VS. PHANTOM PREGNANCY

A similar condition called pseudocyesis, or phantom pregnancy, might be confused with Couvade syndrome. However, pseudocyesis has been recognized as a mental health issue. It’s listed in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a somatic symptom disorder.

Pseudocyesis, a somewhat rare condition, occurs more commonly in Africa than in Europe or America. Women with this condition become convinced they are pregnant when they are not. They may show pregnancy symptoms such as:

Research has suggested several potential causes for phantom pregnancies. Some cases may result from a strong desire to become pregnant, hence why it occurs more commonly among couples experiencing infertility. Other cases may occur due to an intense fear of becoming pregnant. Some studies have suggested pseudocyesis may develop within the context of depression and its accompanying endocrine changes.

WHAT CAUSES COUVADE SYNDROME?

A number of theories attempt to explain how Couvade syndrome develops. One or more of these factors may contribute to the occurrence of Couvade syndrome, though medical experts still don’t know why some men develop the condition.

Somatization

Somatic symptoms are real physical symptoms that result from emotional distress. It’s common for new parents to feel anxiety or stress about the birth of their child, no matter how excited or happy they feel. It’s believed that feelings of anxiety or stress may lead to somatic symptoms resembling those of pregnancy.

Becoming a parent also marks a change in an adult’s role in society. This can also lead to feelings of stress and anxiety, whether a person realizes it or not. Researchers have suggested some men manifest pregnancy symptoms as a way of unconsciously dealing with how they feel about their new responsibilities and the changes they’ll experience.

Changes in hormone levels

Some research has shown men whose partners are pregnant may experience hormone changes, such as decreased testosterone and increased estradiol. It’s possible these hormonal changes could contribute to many symptoms of Couvade syndrome.

Feelings of attachment

Men who are more involved with a partner’s pregnancy and have more fetal involvement (listening to the heartbeat, feeling movement, and so on) may be more likely to experience pregnancy symptoms. Participating in pregnancy-related events and being involved in childbirth preparations may lead some men to feel closer to their unborn child and identify more strongly with the role of father. This may lead to sympathy pregnancy symptoms, according to some experts.

Psychosocial causes

Some doctors believe Couvade syndrome relates to mental health. Common explanations for symptoms include:

However, these are only potential theories, and none have been proven through research.

HOW COMMON IS COUVADE SYNDROME?

Men all over the world experience Couvade syndrome. Studies have found varying rates in different parts of the world, but the most recent statistics suggest Couvade syndrome occurs in about 25% to 52% of men in the United States who have pregnant partners. Though Couvade syndrome appears fairly common, studies on the condition to date have focused on the male partners of women who are pregnant. Very little research has looked at Couvade syndrome in LGBTQ+ couples.

Men all over the world experience Couvade syndrome.

While it’s possible to experience severe symptoms, many have only a few mild symptoms. Since symptoms disappear after childbirth in nearly all cases, this condition could go mostly unnoticed. But some men may feel confused, concerned, or otherwise distressed about their symptoms. Health care professionals have found it can help to briefly explain the condition to men who experience distress and let them know Couvade syndrome isn’t unusual. It may also be reassuring to know Couvade syndrome is often described as a reaction to the changes pregnancy and parenthood bring, not a sign of a mental health issue or other concern.

CAN COUVADE SYNDROME BE TREATED?

Because symptoms resolve on their own and don’t generally pose a threat or cause harm, there’s no specific treatment recommended for men who have Couvade syndrome. However, there are several strategies that can help ease symptoms.

Some men find meditation, yoga, and similar approaches help them feel more relaxed. Therapy may help people who experience depression or anxiety symptoms as part of Couvade syndrome. It can also treat preexisting diagnoses which have been exacerbated by stress.

Medication, including herbal remedies, can help treat physical symptoms like nausea or pain. Some men might experience sympathy labor pains, which medication can also help with.

Remember that you aren’t alone. If you’re struggling with your feelings about parenthood, or experiencing symptoms you don’t understand, a trained therapist can help you work through them. Reach out today!

Couvade Syndrome and Sympethic Pregnacies FAQS

References:

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association. 327.
  2. Brennan, A., Ayers, S., Ahmed, H., & Marshall-Lucette, S. (2007). A critical review of the Couvade syndrome: The pregnant male. Journal of Reproductive and Infant Psychology, 25(3), 173-189. Retrieved from http://psycnet.apa.org/record/2007-11728-002
  3. Devi, A. M., & Chanu, M. P. (2015). Couvade syndrome. International Journal of Nursing Education and Research, 3(3). Retrieved from https://www.researchgate.net/profile/Akoijam_Devi2/publication/286313694_7_IJNER_165_–28-05-2015DE/links/5667b26c08aea62726ee986a/7-IJNER-165–28-05-2015DE.pdf
  4. Hall-Flavin, D. K. (2016, August 25). What can you tell me about couvade? Can men really experience sympathetic pregnancy symptoms? Retrieved from https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/expert-answers/couvade-syndrome/faq-20058047
  5. Ibekwe, P. C., & Achor, J. U. (2008). Psychosocial and cultural aspects of pseudocyesis. Indian Journal of Psychiatry, 50(2). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2738334
  6. Klein, H. (1991). Couvade syndrome: Male counterpart to pregnancy. International Journal of Psychiatry in Medicine, 21(1), 57-69. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/2066258
  7. Piechowski-Jozwiak, B., & Bogousslavsky, J. (2018). Couvade syndrome – custom, behavior, or disease? Frontiers of Neurology and Neuroscience, 42(1), 51-58. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29151091
  8. Tarín, J. J., Hermenegildo, C., García-Pérez, M. A., & Cano, A. (2013). Endocrinology and physiology of pseudocyesis. Reproductive Biology and Endocrinology, 11(39). Retrieved from https://rbej.biomedcentral.com/articles/10.1186/1477-7827-11-39

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View of pregnant woman through window. She is looking down sadly.Pregnancy is often considered a joyous and exciting time. But sometimes life has other plans. Death, natural disasters, and other changes can lead to grief or trauma at any stage of life. Grief can be an unwelcome visitor in a time often filled with anticipation. It also comes with a long list of symptoms that tend to be unpleasant.

It is normal to worry about how grief may affect pregnancy. Here are some things to consider if you find yourself grieving during these crucial nine months.

Grief and Mental Health During Pregnancy

Grief is not the same as depression, but the two can share some symptoms. A person affected by grief during pregnancy may have a different experience than someone working through a mental health issue like depression. This article specifically addresses grief. But is it important to be able to distinguish between the effects of each condition. There are different approaches to managing grief and depression. Pinpointing what you experience may better help you address it: [fat_widget_right]

Causes of Grief During Pregnancy

Miscarriage may come to mind when the topics of pregnancy and grief are discussed. This life event is indeed a source of grief worth acknowledging. But it is not the only reason for someone to experience grief during a pregnancy. Some sources of grief may have nothing to do with the pregnancy and still affect it.

Other causes of grief can include:

Health complications for the mother or child during pregnancy can also cause grief. Any of these can effect physical symptoms that could impact a pregnancy. These life events may start a shock reaction in the body. Shock can affect pregnancy in a way similar to grief or stress.

How Grief Affects Pregnancy

Grief can affect pregnancy through its impact on hormone balance and production. Pregnancy already has an effect on hormones. When pregnancy and grief take place at the same time, hormonal changes may have more extreme effects.

The impact of grief can be varied, but there are some common patterns. Grief can cause an imbalance in serotonin production. It also raises the body’s cortisol, or stress hormone, levels. Fetuses can be susceptible to these changes. Disruptions in regular chemical production may have effects that last throughout a pregnancy. In extreme cases, these effects may impact the child’s life later on.

Grief can also worsen symptoms that typically come with pregnancy. These could include aches and pains, sleep issues, and digestive problems. Combined with a sudden loss, these symptoms may become more intense. If you are worried about any these symptoms, consult your health care provider.

Potential Risks of Grief During Pregnancy

Some symptoms of grief may increase certain risks associated with pregnancy. Most of these risks only occur if the grief is severe. Some of these risks include:

These risks may sound scary, but they are still relatively uncommon. There are also many ways to reduce the effects of grief. Learning to manage grief in healthy ways while honoring the grieving period may help. Good coping strategies can reduce the effects of grief on a pregnancy.

Can Grief Be a Positive Influence?

Grief does not only increase the risks of pregnancy. A little stress may actually promote a positive outcome. A 2006 study found that mothers who reported stress or symptoms of grief during pregnancy had children with more advanced motor skills and development. The sample population for this study was small and focused on low-risk pregnancies. Deep or sudden grief brought on by a series of traumatic events did not factor into this study.

Studies like these may still provide hope for those going through grief and pregnancy at the same time. Keeping up with medical appointments, working with a therapist, and using healthy skills to cope with grief may prove beneficial. Doing these things can continue to increase a child’s chances for a healthy and happy future.

How to Cope with Grief During Pregnancy

One of the best ways to maintain a healthy pregnancy during the grief period is to care for oneself. Reach out to your support network and practice regular self-care. These habits can help reduce stress and bring comfort when feelings of grief are intense. They may also provide a nurturing environment for the baby throughout the pregnancy.

Some methods of coping with grief during pregnancy include:

There is one thing it may help to avoid if you are grieving and pregnant: worry. Obsessing over whether grief may affect a pregnancy is likely to cause further stress. Increased stress may worsen symptoms and make pregnancy more difficult. If you are struggling with feelings of grief or stress during pregnancy, talking to a therapist or counselor can help. They can teach you skills to manage grief and address any anxiety you may experience about your pregnancy.

Practicing self-care may facilitate a healthy pregnancy whether grief is present or not. It is not necessary or even natural to feel gleefully happy throughout an entire pregnancy. But managing strong or negative emotions may lead to less stress and more balance.

References:

  1. Black, S. E., Devereux, P. J., & Salvanes, K. G. (2014). Does grief transfer across generations? In-utero deaths and outcomes. IZA. Retrieved from http://ftp.iza.org/dp8043.pdf
  2. Dealing with grief during pregnancy. (n.d.). Pregnancy Magazine. Retrieved from https://www.pregnancymagazine.com/mom/dealing-with-grief-during-pregnancy
  3. DiPietro, J. A., Novak, M. F. S. X., Costigan, K. A., Atella, L. D., & Reusing, S. P. (2006, May 9). Maternal psychological distress during pregnancy in relation to child development at age two. Child Development, 3(77), 573-587. doi: 10.1111/j.1467-8624.2006.00891.x
  4. Glover, V. (2013, August 6). Effects of prenatal stress can affect children into adulthood. The Conversation. Retrieved from http://theconversation.com/effects-of-prenatal-stress-can-affect-children-into-adulthood-16332
  5. Glover, V. (2011). The effects of prenatal stress on child behavioural and cognitive outcomes start at the beginning. Retrieved from http://www.child-encyclopedia.com/stress-and-pregnancy-prenatal-and-perinatal/according-experts/effects-prenatal-stress-child
  6. Oberlander, T. F. (2012). Fetal serotonin signaling: Setting pathways for early childhood development and behavior. Journal of Adolescent Health, 2(51), S9-S16. doi: 10.1016/j.jadohealth.2012.04.009
  7. Rettner, R. (2013, March 27). Stress in pregnancy boosts stillbirth risk. Retrieved from https://www.livescience.com/28229-pregnancy-stress-stillbirth.html

Parent and teen, both with long hair, sit on porch looking out into field. Rear view photoYou have discovered your teenage daughter is pregnant. Suddenly, teenage pregnancy is no longer just part of a dramatic storyline in a television show, or something that happens to someone else’s child. It’s now a part of your life.

You are likely reeling. This was not part of your dream for your daughter. Maybe you were a young parent yourself and envisioned your daughter’s life as being different. Maybe this is totally outside of your experience or expectations.

Breathe.

It’s not surprising that you’re feeling a powerful mix of emotions and picturing a thousand awful and stereotypical outcomes. Anger, disappointment, fear, worry, embarrassment, and grief are common (and normal!) responses. Along with these emotions, solutions are probably also leaping into your mind.

Keep breathing.

How You Can Support Your Daughter

At this moment in time, parenting your child from a place of love and reason is absolutely critical. You have the potential to be a powerful guide to your daughter—just maybe not in the way you might think. Many parents have the impulse to overpower their daughter’s wishes and impose their will on the situation. This impulse is typically rooted in love and concern. But your strongest ability to help your daughter lies in your relationship with her. This is deceptively simple-sounding, as doing so is anything but easy. Most parents do not initially find themselves here.

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The purpose of this article is not to push any agenda or argue that any one choice is better than another. It is not to explain the ins and outs of abortion, parenting, or adoption. My goal here is to help you learn how to give your daughter the support she needs to make the best and most thoughtful decision she can.

If I’m being honest, this article is about you. Yes, the you that is reeling. This is not your decision, neither legally nor ethically. The decision of what to do about her pregnancy affects your daughter’s life, possibly far into the future. She needs to deeply consider herself, her values, and her goals, and she needs to make–and own—her decision thoughtfully. The more careful care and consideration goes into your daughter’s decision, the more likely it is that her plan will reduce potentially negative impact.

You have your opinions, your values, your experience, and your wisdom. These are valuable. And certainly, you want an opportunity to share these with your daughter. But that will take a relationship. Not the “I’m your parent, and you will do as I say if you are living under my roof,” kind of relationship, but the “I won’t always agree with you, but I will stand beside you and hold your hand and be here when you need me,” kind of relationship.

If you are not currently on the best terms with your daughter, developing this relationship might require some backing up and rebuilding of trust and openness. Some families will benefit from the support of a professional therapist to get there. Just remember, this is an adult issue. Yes, your daughter may still be a child, and she will always be your child. But if you treat her as a misbehaving kid, you are unlikely to be invited to her table. Even if you were able to influence her decision or make the choice for her, there is great potential for a lasting negative impact on both your daughter and your relationship with her. You are important, a critically important figure in her life, but how you approach her determines if she will hear you.

This isn’t the time to talk about abstinence, birth control, or what either of you did wrong. It doesn’t matter how you found out or what you think of the father (unless there are legal issues). Simply be thankful that you now know, and shift into relationship mode ASAP. Your initial reaction may be anger, and you may want to scold and lecture. But this is not the time. It’s time to let your daughter tell you what happened from a place of safety, concern, and information gathering.

The biggest and most important thing is to focus on helping your teen think clearly about herself and her choices. There is no easy decision, and there is no one right decision. But the decision must be her decision.

What you are all facing is big. Really big. But your overarching parenting goals and your goals for your teen haven’t changed. You still want her to be okay. You want her to be healthy and happy, for her to function in the world, and for her to be able to work toward a bright future. Her pregnancy doesn’t change any of that, though it may adjust your vision of her future.

The biggest and most important thing is to focus on helping your teen think clearly about herself and her choices. There is no easy decision, and there is no one right decision. But the decision must be her decision.

Making a decision of this magnitude can be a cognitive stretch for many teens, and your guidance through the process is imperative. We all know it’s extremely difficult, if not impossible, to get a teenager to do what you want if they are not on board. You may get compliance on the surface (when you’re watching), but you lose the opportunity to really be heard. I have seen too many teens respond to their parent’s ultimatums by continuing on the same path, completely outside of their parent’s sight and guidance. In other words, if you forbid her to see her boyfriend again (barring legal issues), she will find a way to see him. She might move out. She might just do what she wants in secret. Either way, the goal of protecting her can end up putting her in an even more dangerous situation. Your daughter can only benefit from your help and wisdom if you maintain your relationship with her.

In a nutshell, your teen needs you to get hold of yourself. This might sound harsh, but you can’t be helpful to her until you do. Find a way to tell her you’re there for her and trust her ability to think this through—even if you have doubts. Yes, your feelings are real and need to be felt and processed. But getting stuck in anger or resentment won’t help anyone.

Talk to your partner, a friend, a therapist, or all of the above. Take time to cry and grieve. Then go back to your teen, ready to help her grasp the lasting implication of pregnancy and model and support good decision-making. When you are calm and able to think rationally, you can help your child do the same. If you don’t feel able to provide calm guidance, I encourage you to seek support for your daughter from a therapist or trusted adult.

Looking to the Future

Mapping a plan for the future can be calming. Surveying the scene and gathering information is a good place to begin this process. A good first step is to make a doctor’s appointment. Your teen needs to be seen by a doctor whether she chooses to terminate the pregnancy or not. Finding out how far along she is and getting detailed information about prenatal care can help her understand her options and begin prioritizing health and self-care practices.

Ask her about her goals, values, feelings, and fears, and hear what she has to say. Listen with compassion, even if you disagree. Get a sense of her understanding of the choices she has made to that point and of her options for the future. Help her access factual, unbiased resources that can answer her questions.

Though I encourage you to avoid focusing on why your daughter got pregnant, it’s still worth considering the following personal factors. These can indicate that parenting may be more difficult, the grief of adoption more traumatic, and the need for specialized attention and professional help greater.

Have I seen teens with many things working against them parent successfully? Most certainly. What those teens had in common was support, either in their home or from some other source, and a powerful inner resilience and drive.

Now, back to you. What are you able and willing to do to support your daughter if she plans to parent? Do you have the time, resources, and desire to help? Are you able to provide support while she finishes school and goes to college? Can your personality lend itself to seeking the delicate balance of empowering her as a mother, supporting her as a teen and as a teen parent, while still parenting her as your daughter? These are not easy questions. Answering them requires soul-searching and perhaps some uncomfortable honesty. But it is essential you honestly evaluate what you are and are not able to do so your daughter can consider this information when making her decision.

Both you and your child may experience some measure of grief. Grief if the pregnancy is ended, grief if the child is placed for adoption, and grief for a childhood altered if your child chooses to raise the baby. It will likely help both of you to know your child made the best, most informed decision she could. Explore ways to process this grief, and create space to do so. There may not be any customs or rituals in our culture that make a space for this sort of pain, but that does not make it any less real. Rather, it becomes even more important to work through this pain with intention. When grief goes unresolved, suffering may be greater, and there may be an increased desire to cope by finding something to mask or fill that painful space. This “something” may be a positive coping mechanism, but it could also be something harmful such as substance abuse or risky behavior.

You may be also wondering how you can help your daughter prevent another pregnancy. Grounding her until she is 30 is not a good strategy. Instead, I encourage you to help her learn to set appropriate boundaries, find a no-nonsense birth control plan (offer guidance, but this decision should also be hers), and practice ongoing open communication.

This is not the end of her world, or yours. There will be joy again.

I believe in you both.

Person in shadow looking out high window into cloudy skyEditor’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.”

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