As a Mental Health Therapist Working with Women with Infertility, a Post-Roe America Terrifies Me
Updated: Jun 25, 2022
If any of you are like me, you have been closely watching and waiting for updates on the status of Roe vs. Wade. A leaked opinion from the Supreme Court made massive airwaves in spring, suggesting the overturning of the historic case which decided that fundamentally gave women access to abortion care within the first two trimesters of pregnancy. I had my thoughts on it, but found the topic starting to come up in my individual and group sessions from when Texas passed their new law. Well today, it has been made official. The "law of the land" for nearly 50 years has been overturned. While many thought that abortion care and abortion access were already matters of "decided law," the current US Supreme Court has made the decision to go against this precedent. As a mental health therapist who works with women who have issues with fertility, I am extremely concerned of what a post-Roe America is going to shape up to be.
Here's an interesting fact, 1 in 4 women will experience a miscarriage during their reproductive years. Not all pregnancies result in a healthy, live birth. While some may spontaneously miscarry and their bodies will push out all of the fetal tissue, there are occurrences where they may elect for a medical procedure to remove the embryo/fetus to try to find out what may have contributed to the loss. In some cases, the safest way to remove the fetal tissue is through undergoing surgery. This medical intervention has been commonly labeled by insurance companies as abortion. People may think that this does not line up to their thoughts on abortion as the developing child has already ceased developing. However, it is important to bring attention to the various aspects of abortion care. Especially in light of medical providers being the common targets of laws restricting abortion in the conservative-leaning states. How much documentation will these providers have to show to prove that the fetus had already passed prior to the surgery to show they were not "aiding" in an abortion? For people I have worked with, it is not uncommon for repeat or recurrent miscarriages to be a reason to seek out fertility care. While the person may have no problems conceiving, they have trouble carrying to term.
Another complication that is not unusual with the population I work with is ectopic pregnancies. Ectopic pregnancies occur when the embryo (the fertilized egg) implants into the tissue of the fallopian tube, instead of the lining of the uterus. This is typically considered a medical emergency. Depending on how soon the ectopic pregnancy is discovered, there may be options for terminating the pregnancy. Some can simply take oral medication and others may require surgery. Either way, the term that is used for this circumstance is the same- it is an abortion. There are times when fertility treatments are utilized and the resulting pregnancy is ectopic. Unfortunately, there have been some states that are trying to argue whether an ectopic pregnancy exists. This is another case I wonder how much documentation a doctor will have to provide to feel "safe" enough to proceed with treating the patient to prevent an ectopic pregnancy from progressing to an unsafe stage of the fallopian tube rupturing and the patient suffering from internal bleeding.
Lastly, I want to bring up is the fact that there are times that an embryo is conceived and it is non-viable, but may progress far into gestation and in some cases may reach full term. I will not go into details about all these scenarios, but this is the place that I find myself most concerned for the population I work with. These couples desire children to the depths of their souls. However, some have had to make the heartbreaking decision to terminate a pregnancy that was not going to produce a healthy child that would live past birth. Are these people monsters? Absolutely not. But because abortion is so polarizing, many are shamed by family and friends for "killing" a child. In fact, many of these parents saw terminating the pregnancy as the more humane way of saying good-bye to the child. Ask anyone in this situation about their experience, and you will hear that it was not the decision they wanted to make. They want to have a healthy child, but fate brought them a load of cruelty that they have to navigate and learn how to heal from.
As a therapist, I strongly believe in autonomy, informed consent, and partnership in the person's care. Restricting abortion access may also have fallout implications when it comes to couples' ability to access fertility services, such as in-vitro fertilization (IVF). Oklahoma recently passed a law that restricts abortions at the time of conception. Many fertility clinics are currently scrambling to figure out the implications of what this means for fertilized embryos sitting in their labs in states with extremely restrictive laws. Will patients be able to make informed medical choices regarding what to do with their leftover embryos after they get to a place of having the family they want? Will their choice for services like IVF become limited to going out of state if they cannot make informed choices that are medically safe? In the past, it was not unusual for fertility clinics that provided IVF to transfer a large number of embryos into the uterus to hope for more chances of success, however, more fertility clinics are opting for a smaller number of embryos for transfer to prevent the risk of women carrying multiple babies, which has a higher risk of complications to the health of the mother and outcome for the pregnancy. This also helps to prevent the need for selective reduction, another form of aborting fetuses. However, will clinics be forced to transfer a large number of embryos based on state law? Another question that looms is for embryos that are tested and deemed not suitable for transfer, will patients be required to transfer them? These are the questions that are currently being discussed, and none of them have clear answers. So as a therapist, all I can imagine is the level of angst and anxiety this is producing for thousands (if not millions) across the United States right now.
Abortion care is needed at times. Restricting and/or trying to regulate access to this aspect of health care will have far-reaching mental health implications, but also (and I'd argue more importantly) will have major implications for healthcare for birthing people. A decision for requiring an abortion should remain between a patient and their medical provider. I've hit on only a select few instances where they come about, but there are many more. As a therapist I do not seek to judge people, I seek to support them by making sure they have all of the information needed to make an informed decision they can live with. If a person is coming to see me because they are emotionally hurting, shaming them is not going to bring about healing. Rather, showing compassion while being present for their story helps to start the process of restoring them to themselves. I recognize that abortion is a touchy issue. As a therapist, I cannot help thinking about the mental health implications that overturning this case will cause.