life after roe

I, Too, Have a Human Form

In Justice Alito’s draft opinion, the pregnant body is erased.

Photo: Sylvester Malimu / EyeEm/Getty Images
Photo: Sylvester Malimu / EyeEm/Getty Images

“The [Mississippi] legislature then found that at five or six weeks’ gestational age an ‘unborn human being’s heart begins beating;’ at eight weeks the ‘unborn human being begins to move in the womb;’ at nine weeks ‘all basic physiological functions are present;’ at ten weeks ‘vital organs begin to function,’ and ‘[h]air, fingernails, and toenails begin to form;’ at eleven weeks ‘an unborn human being’s diaphragm is developing,’ and he or she ‘may move about freely in the womb;’ and at twelve weeks the ‘unborn human being’ has ‘taken on the human form in all relevant respects.’” Justice Samuel Alito, draft opinion in Dobbs v. Jackson Women’s Health Organization.

I , too, have taken on the human form in all relevant respects, although I couldn’t find mention of it in Alito’s draft opinion. At five or six weeks’ gestation of this pregnancy, my second, my heart began to pump an extra 40 or 50 percent blood volume, leaving me dizzy and breathless; at eight weeks, the waves of nausea were near-unbearable, though I wasn’t among those whose illness requires them to be hospitalized for IV fluids; at ten weeks, I, too, had fingernails, but they were breaking thanks to gushing hormones; at 11 weeks, I was still short of breath and gripped by a fatigue that felt like a hand pressing down on my chest. So far, I am having an easy pregnancy, and I chose it.

There is almost no part of the human body that does not transform in pregnancy. One way or another, your flesh will be torn asunder, whether what you are carrying feels like an invited guest or an invader. Pregnancy can make your gums swell and bleed; sores can mushroom in your mouth; your teeth can loosen or erode. Some people will have pica, the inexplicable desire to eat clay, chalk, or laundry starch. Others have hot flashes. Pregnancy hormones can also cause constipation, gas, mood swings. They can relax the valve between the stomach and the esophagus, allowing stomach acid to bubble up into the esophagus and causing heartburn. You know about the vomit and the constant peeing, but did you know the shape of your eyeballs and the size of your feet might change? These are the minor signs, however much their accumulation can estrange you from the person you once were. Your blood is no longer your own, as it begins to carry the imprint of fetal DNA.

You might have to stop taking certain medications you need or be told erroneously by a doctor that you have to. Your pregnancy might be complicated by a preexisting condition, or you may develop a new one, such as gestational diabetes, simply because you are pregnant. And, of course, you may die, something already likelier in the United States than other rich countries before the rate rose dramatically in 2020. (You are much likelier to die from giving birth than having an abortion.) This, too, is nowhere to be found in Alito’s draft opinion that would conscript thousands, maybe millions, into unwanted service. There is room for the Mississippi legislature’s hosannas to every organ a fetus grows but not a word for those of us who must actively give of ourselves to make them. These experiences of pregnancy and birth can be beautiful or hideous or both at the same time, but to disappear them is to disappear us. However our pregnancies end, our bodies will not be the same.

According to the American College of Obstetricians and Gynecologists’ Your Pregnancy and Childbirth, “By your fourth month of pregnancy, most of your energy will come back. But many women begin to feel tired again in the last months of pregnancy.” By my math, that’s approximately 1.5 months in which you supposedly do not feel tired, although if you already have a child, as I do, or children, exhaustion is the baseline. When sleep does come, nightmares are common; approved insomnia medication made me wake up screaming from stillbirth nightmares, so I stopped sleeping much.

Around weeks 17 to 20, the hormone relaxin slackens the joints around your pelvis, the better for a baby to split you apart on its way out. That same lubricating force can warp joints, too, or even shatter bones. I still can’t sit on a hard surface for long because of how my tailbone tipped during the last round.

At 20 weeks, you begin to be at risk of preeclampsia, a risk that will follow you even after you give birth, characterized by abnormally high blood pressure and organ injury. It can attack the kidney, liver, brain, eyes, and placenta, often bringing with it headaches, changes in vision, and filling the lungs with fluid. It can cause stroke, seizures, or internal bleeding of the liver. It can kill you.

By 28 weeks, you can develop sciatica, thanks to the pressure of the uterus on the sciatic nerve, or pubic symphysis dysfunction, which can make it painful to even get out of bed. At this point, heavy vaginal bleeding could be a warning sign for placenta previa — the placenta growing over where a baby would exit — or placental abruption, which is premature separation that can cause severe pain and bleeding. Some women will need blood transfusions or an emergency delivery, possibly a C-section.

By week 29, the uterus is crowding out your other internal organs, compressing your lungs. Leg cramps may wake you up at night. Hemorrhoids may cluster around your anus, which the ACOG says “usually get worse right after delivery.” An average newborn weighs about seven and a half pounds in the U.S.; the ACOG book says “women are advised to gain 25 to 35 pounds,” including the growth of an entirely new organ, the placenta. The weight on the pelvic floor, especially at the end, may cause you to leak urine starting during pregnancy, even when just bending and lifting. You may develop diastasis recti, in which your abdominal muscles weaken and separate, which can, months later, lead to people asking you if you’re still pregnant.

In a dozen years of reporting on it, I have read so many grisly, skewed descriptions of abortion, including in judicial opinions, alongside claims that it universally traumatizes women. For almost as long, really until just before I experienced it, I had only the vaguest idea of what birth might be like except the unsettling memory of being told you could poop on the hospital bed. The physical and mental trauma that is unnervingly common during and after giving birth is rarely accounted for in public.

First comes labor. At least one in five American births begin with inductions of labor, whether for health indications, a point in pregnancy when a provider requires it, or on request; this can result in infection, and it doesn’t always work. Opening your cervix before it does so on its own can involve medication, using a catheter with a balloon that, as it inflates, dilates the cervix, or inserting rods that will swell as they absorb fluids. Labor induction has risks, too: infection or, rarely, rupture. And it doesn’t always work. The ACOG says a first labor can last 12 to 18 hours, but it can last much longer; early labor alone can stretch 20 hours. Contractions cause reverberating pain through your body, speeding up and growing in intensity. You might opt for epidural pain relief, which helps a lot of people rest or tolerate the pain, but it doesn’t always work as intended, and there are trade-offs, including making labor longer. A deemed failure to progress, or other reasons like the size, position, or health of the baby, can lead a doctor to recommend a cesarean birth.

To “progress” means the cervix must dilate from the diameter of a cheerio (one centimeter) to that of a cantaloupe (ten centimeters). Only then can you push, a strenuous effort that can take hours. A systematic review published in the British Medical Journal in 2015 declares that “more than 85% of women having a vaginal birth suffer some perineal trauma,” which can range from the relatively minor first-degree tear to the rarer fourth-degree tear, which extends from the vagina through “perineal, anal muscles, and into the rectum.” Such injury is more likely if a doctor uses forceps or a vacuum to “assist” in getting the baby out. A doctor may also choose to perform an episiotomy, slicing from vagina to perineum on the theory that a controlled cut will prevent worse damage from a tear. Recent studies suggest this is rarely needed or beneficial, but even now, some hospitals (such as New York–Presbyterian in Flushing) have recent rates as high as 40 percent for all vaginal births. You might get stitches for the tearing, which may or may not leave your body feeling Frankenstein-like. (Some obstetricians have referred to adding an extra stitch as the “husband stitch,” which can actually cause a person severe pain during sex.) Delivering a head, then shoulders, then the rest of the body is not the end; the placenta must be delivered, which can take 30 minutes or more. In the hours after birth, you are still at risk for hemorrhage. Your uterus will keep contracting even after the placenta is delivered, for weeks even.

Or you may have a cesarean birth, which comprise just under a third of births in the U.S. A doctor makes an incision in your skin, the wall of your abdomen, and your uterus. Like any surgery, this carries risks: blood loss or clots, bowel or bladder injury, allergic reactions. It may be a while before you can get out of bed; you are told not to carry anything heavier than your baby. An incision can take weeks to heal, can feel numb for months or years to come, and may become infected.

“Fascia, which wraps around the organs and is embedded in their walls, can be stretched, torn, and damaged in both vaginal and C-section deliveries, which can mean organs moving around, slipping into places they shouldn’t be,” writes Angela Garbes in her book Like a Mother. “This condition is called prolapse and it might manifest a few weeks, years, or even decades after you give birth. It can sometimes require surgery to repair” and can come with pain during sex or exercise and both urinary and fecal incontinence. A cross-sectional, nationally representative study found that 23.7 percent of American women had at least one pelvic-floor disorder; multiple studies show an association between giving birth vaginally (compared to having a cesarean) and pelvic-floor prolapse. A rectocele is when your rectal muscles collapse and may even protrude through the vagina. In rare cases, an infant’s head or shoulders can break your pelvis or tailbone on the way out.

You will bleed, often for weeks, and emit discharge of different colors. It may be hard to walk or urinate or sit down. Whether or not you plan to breastfeed, your breasts will likely be swollen and painful; if you do breastfeed, which can add up to an entire 40-hour workweek in the beginning, your nipples may crack or bleed. You may experience postpartum depression, or you may have already experienced a version of it in pregnancy; estimates of its prevalence range from one in eight to one in five women.

None of the above accounts for how the medical system treats you or what it costs; what happens to your relationships, your work, your life plans; whether you wanted any of this at all. Not to worry. By way of explaining that Roe is no longer needed, Alito nods to arguments, made by Amy Coney Barrett at oral argument, that “states have increasingly adopted ‘safe haven’ laws, which generally allow women to drop off babies anonymously.” The promise is that with that deposit, it can be like none of this ever happened. We already know they prefer to pretend you never existed.

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I, Too, Have a Human Form