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After A Stay In The Psych Ward, I Had An Abortion To Save My Mental Health

Mental health conditions account for over 20% of pregnancy-related deaths in this country. I knew it wouldn’t be fair to my family to take the risk.

by Barrie Miskin

I’ve always been a late bloomer. I had my first kiss at age 17, my first date at 19, and at age 41, I had my first abortion.

In January 2017, I spent the 27th week of my pregnancy in a psychiatric ward. I had a rare, pregnancy related mental illness: depersonalization-derealization disorder. I had never heard of it. Unfortunately, neither had most of the doctors I was sent to see. It would be months before I found a doctor who could treat me and years before I would be able to fully heal.

My beautiful, healthy daughter was born one week early at the end of March via induction, just a few days before my 39th birthday. My OB-GYN and psychiatrist had thought it would be a good idea to induce labor so that with my daughter out of my body, I would be free to go on heavier medications to treat my mystery illness. Like it was the pregnancy that had been the problem all along.

There are many reasons to induce labor, but severe peripartum mental illness is not usually one of them. I had to shame myself again and again by recounting my story to strangers: residents on their rounds, nurses clocking into their shifts. As I spoke, the raised eyebrows and pursed lips on the doctors and nurses’ faces felt like silent recriminations. This is not the way a new life is supposed to begin.

A month after my daughter was born, I was hospitalized again. This time for three weeks. I missed the fifth through eighth weeks of her life — her first gummy smiles, her wide eyes as she started to pull her head up, all those hours I could have spent with my face buried in the soft folds of her neck. And when I got out of the hospital, I spent eight hours each day in an outpatient program until my daughter was 3 months old and my insurance coverage ran out.

After years of working with a (for the record, out of network) psychiatrist who specializes in dissociative disorders, excruciating exposure therapy, and hundreds of plastic, amber-colored pill bottles tossed in the recycling bin, I eventually recovered. But it was a long, winding and painful two years throughout which we were exhausted, broke, and gripping tight to a sense of hope like an ether, always slipping through our fingers and not quite real.

As I slowly healed and the old glimmers of myself started to appear, the return of my happiness had my husband more attracted to me than ever. Even with two full-time jobs and a toddler, we were having sex almost as often as we had during the first summer we had met. We were careful — sort of — using a loose rhythm method where we didn’t have sex when I was ovulating. I figured that at age 41, I probably wasn’t going to get pregnant that easily, anyway. Another pregnancy myth designed to cause panic and shame debunked: You can get pregnant after age 40. Or I did. Easily.

My illness is in remission now, but without treatment, it could easily snake its way back through my body and brain, upsetting my chemical balances enough that I’ll be tricked again into thinking the world would be better off without me in it.

I often joke that I’m on enough psychiatric medications now to kill an elephant, but it is true that I am on enough psychiatric medications to put a developing fetus at risk. And enough to pose a potentially fatal risk to myself if I were to discontinue taking them. My illness is in remission now, but without treatment, it could easily snake its way back through my body and brain, upsetting my chemical balances enough that I’ll be tricked again into thinking the world would be better off without me in it.

When I got pregnant this second time, I was on four different medications, two of which I wouldn’t be able to take during pregnancy, one (a benzodiazepine) that if I was trying to get pregnant, I should have gone off of months before. It wouldn’t be fair to any of us for me to take that risk of trying. Not to me, not to my husband, and especially not to our daughter. She needs her mom, healthy and present and whole.

Still, we were sad. When we daydreamed about what it might be like to have another, it was always a girl. Even so, we remained clear on our decision. We could only have one child. And she would be more than enough.

I was embarrassed by how little I knew about terminating a pregnancy. I stayed up for hours past my 2-year-old daughter’s bedtime, frantically Googling “how to get an abortion in New York City.” I posted on my local Facebook parent group, asking the fellow parents of Queens the best way to go about getting an abortion, since I was medically unable to have another child. I had to double-check with the group moderator to make sure my query wouldn’t offend anyone before posting. I also posted anonymously, fearing that if I revealed my identity, I would be publicly shamed. Parents on the message board routinely ask for referrals to the best OB-GYNs, physical therapists to restore their pelvic floor after giving birth, the best couples counselors to heal a fracturing partnership. They use their real names. An abortion is a routine medical procedure. But still, I knew my request was different. After all the Googling and kind advice from Facebook strangers, we made an appointment at a Planned Parenthood in downtown Brooklyn for the following weekend.

In the car on the way to the clinic, we were nervous and quiet. I had never been to a Planned Parenthood and had no idea what to expect. When we walked into the doors, it looked like I had imagined, which was not unlike the DMV. But the care I received there was nothing like I had imagined at all.

The procedure itself only ended up taking a few minutes, but the process to help me get through it took hours. I was never kept waiting, though. I moved from physical exams to meetings with doctors, counselors, and social workers, as the all-female staff gently guided me through each step, taking their time, making sure I was comfortable, informing me so that I wouldn’t need to feel afraid.

At Planned Parenthood, I was asked if it was OK to have an intern come in to observe the procedure and was made comfortable enough to confidently reply no.

At Planned Parenthood, every contact that was made with my body was explained and then had to be met with my approval. The speculum was going to be inserted; did it feel too cold? I was going to feel a scraping on my cervix; was the pressure OK? Was I comfortable with the nurse holding my hand and letting me squeeze hers back?

I saw my experience at the hospital in sharp relief: Induction steps were barked at me, sounding like a table read from a torture scene in Game of Thrones. A hook would be inserted into my vagina, up through my cervix, ripping into my amniotic sac until my water broke. Pitocin would be pumped into my veins to stretch out my cervix as wide and quick as it could go. And if that didn’t work fast enough? Time to cut open my abdomen and pull my daughter out. “OK,” I kept saying in a tiny whisper. “OK.” Acquiescing like anyone cared about my opinion at all.

At Planned Parenthood, during the actual procedure and afterward, I had a doula, a luxury I couldn’t afford during my pregnancy and birth. While the nurse held one hand, she held the other and coached me through breathing exercises, reminding me to focus on her words, on her face. When it was over, she wheeled me into the recovery room and gave me juice and cookies, waiting patiently with me like I was a child waiting for her mother at an after school program. Sweet and calm and cared for. “You’re all so nice here,” I murmured.

The stark contrast between the care I received for those few hours at Planned Parenthood and at the hospital when I gave birth hit me like a sucker punch. I don’t think I knew how traumatic my birthing experience was. I just thought that was how I, a mom in the throes of a mental-health crisis, deserved to be treated.

Mental health conditions account for more than 20% of pregnancy-related deaths in the United States, yet almost all states with health exceptions for abortions only limit the exceptions to physical health — even going so far as to specifically preclude emotional and psychological health conditions. Like your brain isn’t a part of your body at all.

Strangely enough, I learned, Alabama is the only state that includes mental-health concerns in its health exception, but before we celebrate the Yellowhammer State, I discovered that Alabama law does not allow physicians to determine what serious mental illnesses qualify for the health exceptions. “Who decides then?” I wondered, although in my mind’s eye, I already saw the answer: crepey-skinned men with red ties around their necks sipping bottled water at a conference table.

I didn’t feel depressed or sad or anxious. I didn’t ruminate on all the things I had done wrong. All I felt was lucky.

Another myth: Having an abortion will damage a woman’s mental health. Sometimes for years. Sometimes irreparably. Abortion will lead to substance abuse, depression, suicidal ideation. In fact, the myth should be flipped — the harm of being denied an abortion causes far more harm. Still, everyone in my corner — my psychiatrist, my husband, my parents — was on high alert. They quickly realized they didn’t need to be.

Back in our apartment after the abortion, still cocooned in the haze of twilight sedation, I dozed on our couch, my hand wrapped around the soft globe of my daughter’s belly, my face resting in the blond curls at the nape of her neck as she zoned out on Paw Patrol. I thought of how I get to live in the state of New York. Of how I got to Planned Parenthood before it became extinct. Of how I’ve had the privilege to continue to recover and heal. And I thought of the thousands of times I’ve second guessed myself, and all the regret I’ve felt in my life, but right then I knew, with a certainty that settled like a solid crystal weight in my core, that I would never regret this choice I made. I didn’t feel depressed or sad or anxious. I didn’t ruminate on all the things I had done wrong. All I felt, was lucky.

Barrie Miskin lives in Queens, New York. Her work has appeared in Hobart, Narratively, Write or Die and elsewhere, and she is the author of Hell Gate Bridge: A Memoir of Motherhood, Madness, and Hope.