The Disease of Nine Months: Caring for Women Before and After Roe

The woman sat across from me at my desk. She told me that she wanted to carry her pregnancy to term because she wanted so much to have a baby, but she couldn’t go on any longer. “I don’t feel pregnant. I feel poisoned.”

She was in her sixteenth week of pregnancy and vomiting constantly. She retched all day and all night even at the sight and smell of food. She couldn’t do her work. She couldn’t take care of her children. She had “hyperemesis gravidarum” — uncontrolled vomiting of pregnancy.

Another patient was brought to me by air ambulance from Rapid City, South Dakota for the same reason. She almost died during the flight. She was diabetic before pregnancy, and the constant vomiting of pregnancy caused her electrolyte balance to be so out of order it threatened her vital functions. This, too, was a desired pregnancy, but at 18 weeks, her doctors advised her to end the pregnancy and referred her to me. After starting her treatment, I had her hospitalized across the street from my office in order to stabilize her electrolytes and vital signs. Then I brought her back to my office and performed the abortion.

In his book, Liberty and Sexuality: The Right to Privacy and the Making of Roe v. Wade, David Garrow quotes a woman named Marsha who said, after discovering that she would have to continue a pregnancy because of the laws against abortion, “My feeling about the pregnancy was that a horrible cancer was growing in my body that would ruin my life.” She had serious medical issues that were exacerbated by the pregnancy.

A woman from northern Colorado, also with a desired pregnancy, was referred to me by her doctors because they discovered that the fetus was afflicted with Trisomy 13, which is lethal for the fetus, and it can cause malignant hypertension in the woman carrying the pregnancy. This patient had slightly elevated blood pressure when she arrived in my office, but soon after we started preliminary procedures, her blood pressure began to rise.

I admitted her to Boulder Community Hospital, where she went to the intensive care unit, but by 1 a.m., her blood pressure continued to rise and she stopped producing urine. At 3 a.m., I performed the emergency abortion procedure with the chief of obstetrics looking over my shoulder. There was no one else on the ob/gyn staff who had experience with or was trained to perform a mid-second-trimester dilation and evacuation (D&E) abortion. The patient recovered, but only after several more days in the intensive care unit.

On numerous occasions, we received patients from other states and from Canada who had a history of ruptured membranes at the 18th or 20th week of a desired pregnancy. Some patients were given antibiotics and some were not. Some were referred to me, and some found me with the help of family members. All these patients needed an immediate D&E abortion, which I performed.

One woman from Canada was several weeks from the time of her ruptured membranes until she reached me. She became septic immediately following the abortion procedure, which meant that she had a lethal infection brewing in her uterus before I began. I admitted her to the hospital where she received intravenous antibiotic treatment and survived what could have been a fatal sepsis.

In Ireland a few years ago, there was a famous case of a young Indian dentist who had ruptured membranes at about 20 weeks into a desired pregnancy, but she was denied an abortion there because the doctors could detect a fetal heartbeat. In spite of the fact that there was no hope of having a live birth and survival of this fetus, the woman’s pleas for treatment were ignored. Irish laws based in medieval Catholic religious beliefs would not permit her doctors to help her. She died.

In 1990, while on one of my research trips to the Peruvian Amazon where I have studied, lived with, and provided medical care for the Shipibo Indians since 1964, I arrived at a remote village on the upper Pisqui River and received some very bad news. A young woman who was 14 years old was taken down the river from the most remote village to another one where there was a traditional midwife to deliver her baby. But the girl had twins, and she died trying to deliver them. Both of the babies died too. This young woman suffered the fate of hundreds of millions of women all over the world who have died from pregnancy.

The Shipibo women are especially vulnerable because, for most of the time I have known them, they have lived under essentially pre-historic conditions that most humans have experienced in tribal societies for hundreds of thousands of years. But the danger for women is not confined to those living in pre-industrial societies.

The great French physician, François Mauriceau, who founded the medical specialty of obstetrics, called pregnancy “le maladie de neuf mois” (the disease of 9 months) in his classic 1668 treatise, Des maladies des femmes grosses et accouchées (“The diseases of women who are pregnant and in childbirth”). It is the first textbook of obstetrics, and it is an extraordinary work in both the literary and medical sense. Childbirth has been a chamber of horrors for many women. Mauriceau led the way to modern obstetrics.

Mauriceau’s great compassion and historic contribution to the welfare of women was impelled by his grief in watching his sister die in a pool of blood from a placental abruption as she was about to deliver her fifth child.

Eighty years later, Émilie du Châtelet, a French aristocrat and a brilliant scientist who was Voltaire’s lover, discovered at the age of 42 that she was pregnant. She knew she would die in childbirth. She worked frantically to complete her great work on mathematical physics and calculus by the end of her pregnancy. She finished her book and died a week later, after delivering her baby.

In my private medical practice specializing in abortion services, I see women every week who are at high risk of dying from pregnancy, including those who are ending a desired pregnancy for reasons of catastrophic complications.

A woman with a highly desired twin pregnancy came to me from another state following failure of her skilled physicians to succeed in treating the twin-to-twin transfusion syndrome that was likely to kill both twins and the woman as well. A week later, a woman with an advanced pregnancy and nearly complete placenta previa, like the one I attended in medical school, came to me from Texas because the fetus she was carrying had no kidneys and could not survive. Before I could complete all the preparations for her procedure, she began hemorrhaging and could have died in a few minutes. I stopped the bleeding and completed her procedure quickly with minimal blood loss.

What if she hadn’t been in my operating room with my experience, an intravenous line already in place, special instruments that I have designed for this purpose, and my skilled staff ready to save her life? She could have died in a few minutes.

Who is ready to tell me I can’t do this?

Warren Hern, MD, PhD, MPH, is a physician specializing in abortion services. He is the author of Abortion in the Age of Reason: A Doctor’s Account of Caring for Women Before and After Roe v. Wade, from which this piece was excerpted. London: Routledge Press, 2024. Copyright Warren Martin Hern.

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