When Abortion Is Sacred
Thirteen weeks into my twin pregnancy, I had to make the devastating decision to terminate one baby while remaining pregnant with the other
It was the spring of 2016, the day after my birthday, and the little window finally said “Pregnant.” Excited as we were, it took a few weeks to set up a doctor’s appointment. I hadn’t remembered being so sick, so nauseous, so tired the last time. No matter, I thought, it must be because I’m a bit older.
We turned up for our first appointment at the nine-week mark, and I was nervous. Uncharacteristically so. As we waited for the ultrasound, I sat there clutching myself. “Do you have a big apartment?” the doctor asked casually. “Yes, we moved about a year ago and have much more space,” I answered matter-of-factly—as if it were another typical New York question about whether the trains had been running that day. “Good,” she replied. “Because you’re having twins.”
Panic set in. “But we conceived naturally, we didn’t use IVF. How could this be?” and “We can’t handle twins — we already have two kids with my son and my stepson.” It felt overwhelming. We left the office and aimlessly wandered the streets. My husband looked at me and said, “I love you so much.” And he cried.
We spent the next weeks processing the news. I began to tell people I was expecting, but saved the abundant nature of the pregnancy for those closest to us. One evening, I saw a stranger with twin toddlers on the train and confided in her about my situation. “You can do it,” she assured me, and even offered to help. I slowly started to get my head around it and began to smile when I looked down at my belly. What a wonder, I thought. When I told my 90-year-old grandmother, her joy swallowed my anxiety. “We can do this,” I told my husband. “And I know it will be a boy and a girl.”
Two weeks later, I was driving to work when my phone rang. I pulled over and heard a doctor’s stilted voice. “We have a problem. There is a chromosomal abnormality. You need to do invasive testing. Can you make it in an hour? I’m sending you to a specialist.” My husband was in Europe on a trip he had planned months before. He hadn’t wanted to travel because of how sick this pregnancy had left me — double the hormones, double the nausea — but we figured once the twins came neither of us would have this kind of opportunity for a long time, so he might as well.
Somehow, I managed to get myself to the doctor’s office. As the medical assistant took my blood pressure, I started to cry. “Now you’re making me cry,” she said gently. She said she would pray for me. The genetic counselor explained that one or both of my twin babies likely had Trisomy 18, a severe developmental disorder that causes most babies to die during pregnancy or before they reach their first birthday.
Finally, I met my new high-risk doctor. She did an ultrasound and looked carefully at each baby. “Twin A has a cystic hygroma,” she said, and showed me how one baby had a bizarre growth behind its neck. While the blood test alone wasn’t conclusive, with the visible swelling in the ultrasound there was mounting evidence of a serious problem. With complete precision, and in high heel patent leather stilettos to boot, she stuck two large needles into me and sucked out cells from each placenta. I went home.
Alone with my son, my husband across the ocean, I was devastated. “I feel so alone,” I told my husband on the phone. My three-year-old overheard and said, “You’re not alone, Mommy. I’m with you.”
Two days later, my new doctor called. “It’s what we thought. Twin A has Trisomy 18. They’re fraternal twins and the other baby is perfectly fine—no chromosomal abnormalities.” I felt relieved and even happy for a minute since I knew now that at least Twin B was going to make it. “Can you tell me the gender?” She hedged, encouraging me to leave it alone. But I needed to know, I said. “Twin A is a girl. Twin B is a boy.”
Somehow, knowing I was right about the gender pushed me over the edge. My husband flew home and found me much worse off than when he had left. I had spent days crying, barely getting out of bed. My mother had come to town to take care of my son so that I could lose myself under the covers.
A few days later, I returned to the doctor. It was my husband’s first time meeting the new specialist, so she explained all of the possibilities. I could terminate now because the earlier we do an invasive procedure, the less risk there is for the other twin. Or, I could wait and hope the baby miscarries on her own, to avoid the procedure altogether. I could try to deliver them both, but she would most likely die in my arms moments after birth, or, in very rare cases, she could survive with serious birth defects and live a short and very compromised life. If I waited too long and she miscarried midway through the pregnancy it could endanger Twin B. I didn’t have the answer.
In the ultrasound, the hygroma had grown. She seemed sicker. Although we said we were ready to terminate, my doctor intuited our sadness and confusion. She gently suggested we wait. “Maybe she’ll naturally miscarry, and then we won’t have to terminate. Come back in a week.”
I spent the next seven days deep in thought about this triangulated relationship between my twins and me. Each of us was affecting the other two. If I only had the sick twin, I thought, I’d give her more time. But I had to worry about the impact on my healthy twin of a late-term miscarriage. And the pregnancy was also affecting me — it was draining my body to carry them both. We were three, I thought. I liked being the three of us. My belly had a whole family inside. How amazing was that? I wrote a song and sang it to my sick baby. And then I wrote one for my healthy baby to reassure him that we’d be happy together if it turned out to be just the two of us. It seemed so sad, suddenly, to have just one baby. I walked through the woods and sang him the song. Once we were three, but now it’s just you and me.
I had to carry them both to term: one dead, one alive.
The week passed and we were back, just over 13 weeks into the pregnancy. This time the swelling seemed to surround her entire little body. It looked like a halo. She’s beautiful, I said to my husband. Twin B was already growing much faster. “We’re ready,” I told the doctor. As she prepared me for the termination, my husband and I clutched arms and laid our heads together. We brought candles and some music, sheltering ourselves in the dulcet baritones of Leonard Cohen. Before she injected the needle, my husband recited a prayer that we had constructed together: Brucha at rachamama, she’ozeret lanu livchor chaim. Blessed are you, Holy mother of mercy, who helps us to choose life.
The potassium chloride entered my womb, and I shook with a pain elemental to my very being. I started to shake and sob. “Stay with me just a few minutes longer, Erika,” the doctor pleaded. When the needle came out, she finished up and quickly exited the room, leaving me with my husband and unspeakable grief.
One of the things that seemed to shock people most when they understood what I had been through was that there was no way to actually remove Twin A from my body. If my body released one baby, this would endanger the other, who needed to stay inside. As a result, I had to carry them both to term: one dead, one alive.
I wasn’t prepared for the waves of grief that would overtake me. I knew I should be grateful that I still had one healthy baby. And in fact, as he grew and started to show me his playful nature, making me laugh during meetings at work when he decided to flip inside me, the joy would start to gnaw at the grief. But when I wasn’t looking, the pain was suddenly upon me, and I would start wailing, and my husband would beg me to stop screaming that I had a dead baby inside my body. He didn’t want the kids to hear, he would say, but I don’t think he could bear to hear it himself.
The decisions I had to make over the course of that time touched on an internal privacy that I never knew existed until the first time I was pregnant, and even more so with this second tragic-and-beautiful pregnancy. I shared it with my husband, but ultimately it rested inside my own abyss, touching every wall of my being, and excluding everything and everyone outside of my womb. I remember feeling an almost exaggerated sense of gratitude toward both my husband and my doctor for the respect they showed me throughout the process—understanding that this was my internal universe and my decision to make.
I spent the next months nurturing one life while grieving another. Life and death in one womb, I thought. What a tremendous privilege to be a woman, to be so close to the elements, to understand the truth of beginnings and endings, and the indivisibility of relationships. How we are born and how we die in relationship with one another.
I wrote this essay when I was seven months pregnant, as a way to process my sadness and prepare for what I hoped would be a joyful birth. As the Supreme Court gets ready to hear June Medical Services v. Russo — the latest attempt to undo Roe v. Wade — I am at a loss for words when I see women being forced into an adversarial relationship with their own bodies, as an increasing number of new laws seek to do.
To bring a child into the world is to be so deeply connected to another being that you share everything you’ve ever called your own — your own abdomen, your own breathing, your own food, your own space and safety in the world. And that is only the start of the mother-child relationship. I can’t imagine what it would feel like if I was brought through the most difficult moments of birth and motherhood against my will, or if I had to fear my doctor, or if I had to rush my decision to meet some arbitrary deadline.
After I gave birth, I asked to see the remains of my baby that were still attached to the placenta. I gently touched her, while nursing my son for the first time. That was the only moment I would ever be the mother of twins.