This is part of a series of snapshots from post-Roe America.
It started as a joke. Jen was early in her first pregnancy, sitting with her husband after lunch. You know those gimmicky websites, he was saying, where you can name a star after someone and the person gets a certificate in the mail? What if, instead, we named our child after the biggest planet in the solar system?
He was kidding, but Jen kind of liked it. Jupiter. She liked the sound of it — and how awesome, to share a name with something so huge, encircled by so many moons. She hadn’t imagined herself as a mom. When they were looking at houses, she’d insisted on a yard for their dog; she hadn’t been thinking about room for kids. But then something in her shifted, and here they were, in their dining room, in a green-lawned Tennessee neighborhood, joking about what to call their first child. Jupiter was a perfect middle name — semi-secret, a nod to this wild gravitational pull.
Plus, it was funny. “It’s a gas planet, and little babies fart and poop a lot,” she said.
Their second kid’s middle name was going to be Mars, they decided. When she got pregnant again, she put it in her pregnancy app. It was the spring of 2022. Their daughter was one; Jen was 38, working in digital marketing. First and foremost, though, she saw herself as a mom. Fragments of DNA from the placenta were floating through her blood — and at week 10, her obstetrician’s office drew a sample to send to the lab.
She got the call at the end of a workday, sitting in her office at home. When she heard her doctor’s voice, she knew something was wrong; if everything had been fine, it would’ve been the nurse. Her obstetrician asked if this was a good time to talk.
Technicians had analyzed the genetic shreds drifting through her blood, tracing which bit came from which part of the genome. And one region kept on popping up, more than expected, suggesting there might be an issue, an extra chromosome.
Jen started Googling as her doctor spoke, attention spliced between phone call and screen. There was a high risk for trisomy 18, her obstetrician said. To make the fetus now growing in her, cells had had to multiply, divvying themselves up. Instead of making a clean break, two pieces of the genome might’ve gotten stuck together, leaving one cell with too many genes: An error that could then be passed on to other cells, like a poorly copied blueprint, muddling the architecture of brain, heart, and bone.
Jen took notes in her work notebook, beside to-do lists and client requests. There were so many unknowns. She was going to terminate if the high-risk score turned into a real diagnosis. That much she knew. She could hardly watch her daughter get blood drawn. “I can’t keep carrying a child I’m going to lose,” she said. “That’s just way too much pain.”
Her mom had gotten an abortion, back in China, when Jen was a kid. Jen had known about it since she was a teen. “If they’d had a second pregnancy and birth, under the one-child policy, both she and my dad would’ve lost their jobs,” she said. Plus, there would’ve been fines they knew they couldn’t afford. The choice wasn’t really theirs. Her mom bicycled to and from the hospital for the procedure on her own.
In Tennessee, the logistics wouldn’t be so simple. Here, the state imposed other sorts of reproductive controls. Jen wished for some middle ground, a place that took what she was going through seriously, where the procedure was neither required nor restricted, where it was met with neither a shrug nor a risk of being shamed, where the decision was truly hers.
This wasn’t a diagnosis, though. The error could have occurred a bit later in development, once the cells that would become the placenta had already split off from the embryo. It might just be the placenta. Everything might be fine after all.
From her office, she could see the rustling of leaves, a neighbor’s roof. She’d chosen this as her office for the quiet; you couldn’t hear the twice-a-day hubbub of kids pouring into and out of the elementary school across the street. She sat there in limbo, her mind buzzing with uncertainty, the endless ifs. If trisomy 18 was diagnosed. If the pregnancy didn’t end in a miscarriage. If the baby was born alive. If the baby lived a week. If the baby lived a year. If trisomy 18 was diagnosed. Downstairs, her daughter traversed the couch like an obstacle course, clambering over cushions and pillows.
Jen needed an amnio, an analysis of the genetic bits floating in her womb; those came from the fetus itself, sloughed off or peed out. That would yield a diagnosis. But she couldn’t get an amnio. Her amniotic sac wasn’t properly fused, and though the risks are usually low, in her case, the doctors worried that a needle might tent the membrane without pushing through, or that there might be a rupture. When she went in for scans, the ultrasound tech would linger, looking to see whether the layers had merged, and Jen could see the black empty space between them.
Once, early on, while squirting gel onto Jen’s stomach, a tech told Jen about having to make the same call for herself. Her prenatal scans had showed a series of cardiac defects. They’d require open-heart surgeries — not one, but several. She’d chosen to continue the pregnancy.
If that were the only problem, Jen thought, her inner calculus might be different.
Don’t let anyone question your decision, the tech said, moving the transducer over Jen’s belly. Unless they’re in your shoes, they aren’t going to understand.
By her next appointment, Roe v. Wade had been overturned. You know, I really thought of you, when I heard the news, the tech said.
On the screen, everything still looked normal.
Then, one day, it didn’t. It was week 16. Even without an amnio, there were signs — soft markers, they called them. The heart was growing at a strange angle. There were cysts on the brain. Beneath the bridge of the nose, where there should’ve been the whitish glint of a nasal bone, there was nothing, a dark spot of empty space.
She brought up termination with her maternal-fetal medicine specialist. I could go to jail, he said.
Before, he’d refer patients to a specific clinic, tell the doctors there: Hey, this is my patient, take good care of her. Now, although Tennessee law didn’t prevent that, he couldn’t, or wouldn’t. Jen only knew he had no information to give her. She felt lost. “You’re the person who’s supposed to take care of me,” she thought. “You’re the person who’s supposed to take care of my health.”
She couldn’t blame him, though. She knew it wasn’t his fault. She didn’t cry right then, in his office. She walked out, numb all the way home, past the highway on-ramp, past the vet where they took their dog, to their teal-painted house with the swinging bench on the front porch.
Panic would seize her as she lay in bed, watching the news. The anchor spoke of trigger laws and clinic closures. She wouldn’t be the only one looking toward the clinics that remained. What if she couldn’t get an appointment? She started making calls. It didn’t even seem worth trying providers in Tennessee. Her first thought was to look elsewhere. Missouri was out. She’d try Illinois, set a tentative date, just in case. She could always cancel. She still hadn’t had an amnio, there was still no diagnosis set in stone. “There’s always that ‘What if? What if the baby’s actually healthy?’” she said. It was irrational. She could see the signs on the ultrasound. But there was always some parental part of her that stayed hopeful, clinging to the chances, however small, that the high-risk result from her blood test was a false positive, that these soft markers didn’t actually mean what they probably meant.
She knew it wasn’t right, but sometimes she found herself envying people who had miscarriages. That way you didn’t have to choose. She joked with her doctor that they should just do an amnio; if it ended her pregnancy, at least she’d no longer be stuck in limbo.
She didn’t cancel the appointment. By week 18, she still couldn’t get an amnio, but her maternal-fetal medicine doctor was seeing more and more issues on ultrasound. Between her high-risk score on the screening test and all these abnormalities, that was enough for him to consider trisomy 18 a diagnosis. In her pregnancy app, she changed the middle name to Pluto. The planet that wasn’t. It was an attempt to make everything lighter than it felt.
They did that on the drive, too. They tried to pretend this was just another road trip. The time they’d driven from California to Tennessee with two pet baby tortoises, which ate shreds of lettuce and special tortoise pellets. The time they’d driven the twisty-turny roads to see family in Missouri, watching their border collie for telltale signs of carsickness.
This didn’t feel like luck, but she knew she was lucky. They had the $2,000 for this trip. They could be an exception in a way her parents couldn’t afford to be, when faced with the one-child policy. Her parents understood what she was going through. In fact, Jen had recently found out her mom had had a second abortion soon after arriving in the US; Jen’s dad was between jobs, and they just didn’t have the money to care for a second child. Jen could count on them. They were caring for her daughter while she and her husband were away. She was lucky: Nobody in her life would shame her, she wouldn’t lose friends or family over this, she didn’t have to keep this secret from the people she was close to.
Still, she didn’t want to broadcast it. She didn’t want her last name used in this article. It didn’t feel good, leaving Tennessee for medical care. Tennessee was home. She remembered her own sense of dislocation, moving around as a child. She wanted to give her kids stability, the hanging toddler swing on the front porch, where her daughter liked to bounce, the suspension slowly, slowly being overtaken by a morning glory. Tennessee was where their friends were, expecting babies around the same time.
After the injection, to stop the fetal cardiac activity, her blood pressure dropped, and she had to stay for monitoring. Then, her husband drove her to their hotel. The cramps were bad — the worst she’d ever felt — and she spent the day in bed, curled up with a heating pad. There was a brief window in the evening when she felt OK enough to eat something. There wasn’t much around. Her husband came back with Taco Bell. Around midnight, her water broke. She could barely walk the next morning. “But then, I don’t know what happened, as soon as I got to the clinic and sat down, my pain went away,” she said. It might’ve been the Xanax, or maybe whatever was going on inside her was coming to an end, or it could have been a mental state, the long months of limbo coming to a close.
The procedure itself was a blur. She knew this was the right decision. “Right after they released me, I told my husband, ‘You know, I feel good, I want to go home.’”
And they drove the five hours home. Afterward, the trisomy 18 diagnosis was confirmed by genetic testing. That provided some of the certainty she’d spent appointment after appointment waiting for. Still, there was grief. The loss would hit her at random moments. There seemed to be no logic to it. A TV show had a stillbirth scene, and she was fine, she didn’t cry. But then, unloading the dishwasher, her husband accidentally broke a mug that said “Mama,” and she lost it. She went to the doctor for a follow-up appointment, and she cried at the sight of the sonogram screen, showing what the gestational age would’ve been. The rest of the ultrasound wasn’t so bad, though: The familiar feeling of gel on her stomach, the sight of her uterus in grayscale. In a few months, after a few menstrual cycles, they’d start trying again.
This story is part of ongoing coverage of reproductive health care supported by a grant from the Commonwealth Fund.
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