Black-and-white picture showing baby hand gripping tip of index finger of adult hand
Eve Arnold / Magnum Photos

American Motherhood

My pregnancies could have killed me, but at least I chose them.

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I looked at the clock glowing on the nightstand in my bedroom and it read 1:23, one-two-three, a neat set of numbers. I tossed and turned and writhed and looked again, and it read 1:17. Had I misread the clock? Maybe I was dreaming about the time. Maybe I was just confused.

I slept, I woke up, I “slept,” I “woke up.” I hobbled into the bathroom, feeling shooting pain each time I moved my left side. The veins in the stone on the vanity writhed and breathed. Everything smelled metallic. I was hallucinating. I itched, and so I scratched, clawing at the damp back of my knees, my soft belly, my ribs. I broke open the scabs on my legs, watching my blood bead on my irritated skin. Back in the bedroom, a strange pair of eyes, slate-blue with yellow sclera, stared at me in the mirror. I had given birth to my second child a week before, and nothing made sense.

The hallucinations that arrived post-delivery were far from my worst symptoms. I experienced debilitating nerve pain during the second pregnancy—like having a tattoo gun alight on my skin, over and over. I itched unceasingly and uncontrollably during both: For 136 days the first time and 167 days the second, I was itchy every single moment of every single day. The sensation ranged between the tight skin of a sunburn and the agony of poison ivy. The itching intensified after sundown, causing sleeplessness and exhaustion. I was itchy in my dreams. I sometimes wonder whether my son, sharing my body, might have been itchy too.

For me, pregnancy was “obscene,” in the phrasing of one of my doctors. And mysterious. Over the course of my two pregnancies, more than 40 physicians and midwives, by my count, failed to explain why my blood work kept coming back with so many anomalies, why so many debilitating complications kept piling up in an otherwise healthy woman.

Though my experience was unusual, I did have something in common with countless other pregnant people: Despite recent medical advances, bearing a child remains startlingly dangerous, a fact that America’s lawmakers on the bench have chosen to ignore. One in five pregnant people experiences a significant complication. And one in 4,000 dies during pregnancy, in childbirth, or shortly after delivering, including one in 1,800 Black mothers. Yet Justice Samuel Alito’s opinion in Dobbs v. Jackson Women’s Health Organization takes the interests of the “unborn human being” into account while dismissing those of the person forced to carry a pregnancy to term.

Gone are Roe v. Wade and Planned Parenthood v. Casey, which protected the constitutional right to termination. Eight states and counting have banned abortions, with no or minimal exemptions for medical reasons. But there is no standard for what preserving the “health” or the “life” of the mother means.

“What actually counts as the life of the mother?” asks the physician Jennifer Jury McIntosh, a spokesperson for the Society of Maternal-Fetal Medicine, an organization for obstetricians who handle high-risk pregnancies. “Is that her life today? Is that her life during this pregnancy? How close to losing her life does she have to be for us to decide to terminate? That feels really weighty, because my interpretation of what I feel is lifesaving—does that align with a particular prosecutor’s interpretation?” She told me that she feared situations in which not ending a pregnancy might constitute medical malpractice, but doing so might open her up to criminal prosecution. (She practices in Wisconsin, where nearly all abortions are now banned under a law passed in 1849.)

Worst-of-the-worst stories are beginning to surface in the press, an appalling countdown clock tick-tocking until Americans learn of the first woman who dies after being denied a termination since Roe was overturned. Media attention focuses rightly on those worst-of-the-worst cases, in which abortion is obviously lifesaving. In countless other cases, the circumstances will be murkier and stranger, but the elimination of the option of abortion will nevertheless do grievous harm.

As it would for me. My two pregnancies left me disabled, a word I am still struggling to come to terms with. They put my life at significant risk. Some of my doctors have made clear that they do not think I should bear a child again. Still, if I got pregnant, I would likely be forced to carry to term in much of the country, despite how sick I was, despite all the damage and pain I endured.

The 2018 midterms were looming, and my husband and I were planning to relocate from Washington, D.C., to California, when I learned that I was pregnant the first time. At our first ultrasound, we sat besotted, looking at the gummy-bear contour on the screen as a wub-wub-wub sound filled the room. The first jump scare came minutes later. The technician went silent, moving the wand over my pelvis again and again. In time, a doctor came in to tell me there was a mass the size of a softball—roughly the size my baby’s head would be at 40 weeks, she noted—sitting on the left side of my pelvis. She was not worried about it affecting the pregnancy. But she was worried about it twisting and cutting off the blood supply to one of my ovaries. That would be “a nine or 10 out of 10 on the pain scale,” the doctor said, as flatly as if she were letting me know the time.

Duly noted, I guess. She expected the baby to arrive at the end of March or early April, and with that deadline set, my husband and I hastened our move across the country. Toward the end of my first trimester, as we were packing boxes and giving away books, the itching showed up, as I noted in my diary at the time. I first noticed it in the morning. Lots of people stretch and then scratch themselves when they wake up, right? Next, I noticed it in the evening, a reaction to our laundry detergent, perhaps? Soon there was no noticing necessary. I could not not notice it. Especially in warm weather and at night, I felt centipedes scuttling over my feet and hot needles poking my shoulder blades.

Things I tried to make it stop: hypoallergenic detergents and soaps; pine-tar soap; eczema wash; calamine lotion and capsaicin lotion; oatmeal baths; shea butter and dozens of other emollients; antihistamine cream; a variety of over-the-counter and prescription oral antihistamines; topical steroids; showering with cold water; holding bags of frozen corn against my body; wearing loose clothing; acupuncture (not fun when you are itchy); screaming. Only three things helped: ice, a cream called Sarna that made me smell like an unsmoked Newport, and scratching. So I iced, applied lotion, and scratched. I tore the webbing between my toes and the thin skin around my belly button. I clawed out clumps of hair. I fantasized about being able to scratch my wet bones or the jelly in my eyeballs.

My West Coast providers were sympathetic, if not overly concerned. Itching was not unusual during gestation, my new obstetrician noted. She suspected I had intrahepatic cholestasis of pregnancy, a dangerous condition that affects roughly one in 1,000 pregnancies. She ordered weekly blood tests to look for a telltale increase in bile acids. In the meantime, she told me to use cold compresses.

Aside from the pruritus—the medical term for itching—I felt joyous as my belly swelled and we got used to our new home, hiking on the beach with our dogs and trying out baby names. My husband and I took the cult low-intervention birthing class everybody we knew took, called, ahem, “Yes to Birth!” I read book after book about how I was built for this.

As the weeks dragged on, though, the itching kept getting worse, and the blood work showed nothing. By the middle of my second trimester, struggling to function, I called my providers, sobbing and begging for help. The nurse on call asked me if I had taken antihistamines. Of course I had. “If you felt like you had poison ivy for months,” I snapped, “did you think you would have taken a fucking Benadryl?” She had me leave an escalatory message on some voicemail. Nobody called me back. So we moved on to our third set of medical providers, a team of crunchy, evidence-based midwives in Oakland.

At our first meeting, my new lead midwife took one look at my skin—which, from all my scratching, had undergone a process called lichenification, becoming thick and leathery and covered in welts—and referred me to a dermatologist, who guessed I had either scabies or cholestasis and prescribed a strong topical steroid. (Alas, I did not have scabies.) The new drug would work, I promised myself. I lurked at home, talking to my baby, who we had learned was a boy, telling him I could not wait to meet him.

That happened sooner than I’d imagined. Early in my third trimester, my midwife kept muttering “Fuck” as she took my blood pressure. It had spiked to 170 over 90, a level suggesting that I had preeclampsia. She called in an obstetrician who deals with high-risk cases to take over my care, as I had “risked out” of her scope of practice.

That new doctor, No. 4, confirmed that I had preeclampsia, with anomalies in my liver and kidney labs. She admitted me to the hospital at 31 weeks so she could monitor my organ function and asked me to stay there until I gave birth, which was likely to be at least a month early. “We’ll deliver you at 36 weeks,” she told me. “But you’re not going to make it that long.”

I raged. How dare she! I would deliver—not us—when my body and my baby were ready. I was healthy. I was built for this. (I was in denial.) Her face softened. She had a feeling about some pregnancies, she told me. Mine was one of them. Then she told me about two patients who had had severe pruritus during pregnancy. The first gave herself frostbite during a blizzard, ripping her clothes off and letting the snow numb her. The second threw herself out a window.

Doctor No. 4 agreed to discharge me if I would come back for monitoring in the hospital every third day, so we did that, and I would cry listening to my son’s heartbeat in the dark of the sonogram room. Two long weeks later, I went in and got a 220 over 100 blood-pressure reading, then 180 over 110. Then time sped up: The chatty sonogram technician going silent—that’s not good. Itching. Machines beeping, cuffs squeezing, panicked phone calls. Itching. A meeting with a gray-faced neonatologist, the decision to induce. IV poles. Itching. It was Valentine’s Day, I realized—red hearts, blood-soaked linens. A dozen people rushing into the room. No time to induce, time to move to surgery. “Sign this form.” “Stay still.” “Your husband has to wait outside.” Cutting, tugging, pulling on my insides, as if I were a prey animal being eaten alive. The discovery that my placenta was shearing away from my uterus, a complication that could have killed me and the baby.

I am not sure exactly when I became a mother. He was quiet at birth, and the neonatal team whisked him away before I could see him. We met hours later, my tiny valentine in his glowing plastic box, covered in wires, fed by a tube.

I was eating soft pretzels with my siblings in a mall food court a year later when my younger sister tried to discourage me from having another child. “Don’t do it,” she told me. “You could have died. The baby could have died. Don’t do it.”

We did not die, though. My three-pound newborn had grown into a thriving toddler, all wacky smiles and fistfuls of spaghetti. As for me, at four days post-delivery, I was so itchy that I demanded a surgeon amputate my legs. (“We’ll take that under advisement.”) The next day, the itch disappeared, leaving my doctors and me never really knowing what it was. Months of intensive trauma therapy, started when my son was in the NICU, had restored my mental health in a way I did not think possible at first.

In the end, it was my kid, in all his chaotic wonder, who convinced me to try again. Wasn’t it worth it? What wouldn’t I sacrifice for him? I prayed that the complications would not come back and that the baby would be safe in my body until we reached full term. But if they did, I knew I had the right to a termination for medical reasons.

When I got pregnant the second time, my providers considered me high-risk from the start. A team of clinicians scrutinized my body and blood, anticipating problems rather than reacting to them. The irregularities started to show up in the first trimester, again—problems with my liver labs, then itching, then nerve pain and insomnia.

My providers could do little to manage my symptoms. As the pregnancy wore on, the aperture of my life drew smaller and smaller. I struggled to think. My hair fell out. I developed gestational diabetes, snatching away the routine of a sandwich, the delight of a good banana. Injecting insulin into the tight drum of my abdomen made me itch every time I did it; I took to stabbing my thighs with my finger-stick lancet after I was done, because pain inhibits itching. I became so foggy-headed that I drove the family car into a concrete pylon. From time to time, I felt so overwhelmed with love that I could not imagine not being pregnant. From time to time, I felt a yen not so much to die as to not exist at all.

Early on, my high-risk-pregnancy obstetrician had called in a hepatologist, a genial older guy with a cravat and an indeterminate European accent. He initially told me I did have intrahepatic cholestasis, both in my first pregnancy and in this one. But well into my second trimester, he left me a voicemail: “I would like to discuss your disease.” My disease? He had added some tests to my blood work, he explained. My body was teeming with an antibody indicating that my immune system was attacking my bile ducts. I had a disease called primary biliary cholangitis—slow-moving, rare, degenerative, and incurable. The hormone load of pregnancy was exacerbating its symptoms.

Hot astonishment, cold relief. I was sick. I had been sick for years. I would be on medication for the rest of my life. I would likely be diagnosed with other autoimmune conditions in time, and was now more susceptible to developing a host of diseases, including liver cancer. My pregnancies had “unmasked” this reality, as my hepatologist put it. And in creating life for my children, I caught a glimpse of how my own might end: brain-fogged, fatigued, vitamin-deficient, dry-eyed, and, yes, itchy.

But such symptoms might not emerge for years, if at all. After I delivered my son, I hoped, I would again be delivered from the miseries of my own body. The day finally came, and I decided to opt for an induction instead of a C-section, given how much I had hated the latter experience the first time. I labored, feeling the itching subside with the pain of every contraction, breathing myself closer and closer to relief.

Of course, we were in for a few final scares. During one cervical check, my midwife said my son was emerging hand-first. She would have to push him back up to reposition him. (This, well, hurts.) And she worried about his heart rate, which kept dropping, indicating that my contractions might be compressing the umbilical cord and he might have to come out via C-section after all.

A doctor placed an epidural. Beeping, people crowding the room. Pushing. I thought I was supposed to feel pressure but not pain. The need to get him out, now. The decision to try forceps. My husband blanching as he stared at the monitor. A request from the doctor for more anesthesia, a warning that it would take a few minutes to kick in. Searing pain, leading me to scream at the doctor to stop. The doctor with the forceps not stopping. Nurses pinning my legs down in the stirrups. The sense of being eviscerated, the room going Technicolor. I did not know I could feel so much pain.

At least it was over quickly. The baby emerged quiet, floppy, purplish. My first reaction was to laugh. I went through all of that to have a baby who was dead? But soon he started to breathe, letting out a raspy cry. The extra anesthesia kicked in, so I keeled over in the bed as the doctor explained that he’d performed an episiotomy while wresting the baby out. I was insufficiently anesthetized at the time. “I’m sorry,” he said softly.

My experience of pregnancy was over, and I slammed the door shut. I thanked my clinicians and meant it. I ate three adult portions of spaghetti, ignoring the admonishments of the nurse who had to come in to give me more insulin. I washed away the blood the nurses had missed between my toes and ministered to my stitches and scratch marks. I declined to go back to trauma therapy, though I knew I needed it. I had a beautiful newborn, a beautiful toddler, a beautiful husband. I took my torn-up body home.

Some heartbroken part of me wants to have another kid. I am a middle child, my parents are both middle children, and I am married to a middle child; I have a deep-seated intuition that families are most fun when they are big. Plus, I did heal postpartum. The hallucinations went away when the itching stopped and I started sleeping again. My doctors found a cocktail of medications that have ameliorated many of my symptoms. But I know I cannot give birth again—not least because I need to be a parent to the children I already have and love. And I cannot imagine being forced to.

A majority of Supreme Court justices and a number of state legislators not only can imagine that scenario, but would make it a reality. They would let states force childbirth on victims of rape, incest, and intimate-partner violence; on people without the means or desire to raise a child; even on literal children. The decision is about life, supposedly—the anticipated lives of the embryos and fetuses people will be required to gestate against their will, like brood mares. The lives of those pregnant people do not matter. My experience does not matter. What matter are the opinions of judges and politicians, most of them men with no medical expertise and no experience of being pregnant, no visceral understanding of how messy and hard it can be, even in the best of circumstances.

Even those best of circumstances can be obscenely dangerous, and Dobbs has made them more so. The ruling will “absolutely lead to an increase in maternal morbidity and mortality,” McIntosh told me. Physicians are now waiting for women with prematurely ruptured membranes to decompensate before providing an abortion. They are reconsidering how to care for pregnant people with cancer, among other ailments. There are reports of people being denied drugs that could be used as abortifacients, even if those drugs are being prescribed for a different purpose.

The judiciary is forcing pregnant people and their doctors to justify care that was once allowed by constitutional right. What if I had had to plead my own case? Would I have been denied a termination if I had never gotten my proper diagnosis, and had only a history of extreme symptoms and abnormal test results? Would I have qualified on the basis of my liver disease and diabetes, both now diagnosed as permanent? How about my chronic fatigue, or my history of pregnancy-related mental-health troubles? Would a physician have been able to end my pregnancy if I’d had another placental abruption or another bout of dangerously high blood pressure? Would the state have required me to itch for months on end as my body and my mind deteriorated?

These queries are personal, but Dobbs has raised more metaphysical ones too. What does the life and health of mothers mean? How could it possibly mean so little? What are we supposed to do?