If our writer had an ectopic pregnancy today, instead of 2017, she might not be able to receive a life-saving abortion.
The pain wakes me at 3 a.m. It feels like a two-by-four pressing against my pelvis. I breathe through my nose and try to wait it out, hunched over like a Salvador Dalí clock. Probably nothing, I think. After all, that’s what I’ve been told at doctor appointments for years now: Cramps are common. Take a Motrin. A Midol. An Aleve. Have you tried mindfulness?
Years earlier, I had been diagnosed with endometriosis; pelvic pain is a hallmark of the disease, but it had rarely been this sharp, this insistent. Cramps are common, I remind myself as another onslaught arrives. But then another voice whispers in my ear: Yes, but this is different. You’re seven weeks pregnant.
My husband and I were late to start “trying,” and the trying had been difficult—with multiple failed rounds of IVF before I got pregnant the old-fashioned way. What we didn’t know then, in early August 2017, was that this was a small triumph. That more challenging times were to come—for us, personally, in the ensuing weeks, and also, five years down the track, for any American who became pregnant, or cared for someone who did.
For close to 50 years, Americans had a constitutional right to elective abortion. But the reproductive protection Roe v. Wade afforded women was ruptured on June 24, 2022, when the Supreme Court announced its decision in the case of Dobbs v. Jackson Women’s Health Organization. Since Dobbs returned the decision to restrict or protect abortion to state legislatures, a rapid-fire series of bans, amendments, and provisions have been announced—a flurry of legal activity that continues to develop at a dizzying pace.
Running parallel to the rapidly changing laws has been an alarming number of reports of pregnant women experiencing complications being turned away from hospitals, so doctors don’t risk legal jeopardy by treating them. As lawmakers intrude ever further into private medical decisions, what’s getting lost in the abstractions of abortion debates is the living, breathing trauma of pregnancy complications—what it feels like to show up at an emergency room in dire condition. Politicians have no place in that setting.
It’s a slow Thursday in mid-August 2017 when we arrive at Mount Sinai Hospital in Miami Beach at four in the morning. The emergency room is cold, bright, and unwelcoming. I’m ushered through to an examination bay from the waiting room. A triage nurse takes my vitals.
“Are you usually this pale?” she asks.
I shake my head, shivering. The nurse’s demeanor changes. She doesn’t take her eyes off me as she runs through a checklist of questions: Have I had tubal surgery before? No. But other pelvic surgeries for endometriosis, yes. Have I ever used an IUD? Had a genital infection? Do I smoke? No, no, and no. Have you experienced infertility? Yes.
Then she asks, “Have you ever had an ectopic pregnancy?”
I look up at my husband, and he reaches for my hand. “No,” I answer. “But…”
When the fertility specialist had confirmed I was pregnant, she’d warned that an ectopic pregnancy could be a possibility, tipped off by my low progesterone levels—a sign that the pregnancy was not progressing as it should.
The word “ectopic” comes from ectopia in modern Latin, “the presence of tissue, cells, etc. in an abnormal place.” In Greek—ektopos—it is simply, “out of place.”
According to the American College of Obstetricians and Gynecologists, an ectopic pregnancy occurs when a fertilized egg implants and grows in a location that cannot support the pregnancy. In more than 90 percent of cases, this occurs in a fallopian tube, but the cells can also implant in the abdominal cavity, cervix, ovary, or in a cesarean scar. An ectopic pregnancy is more than a doomed pregnancy, though. As the errant pregnancy grows, it can cause the structure where it’s implanted to burst. Major internal bleeding may result; it is a life-threatening emergency that requires urgent surgery. The situation is considered rare—about one in every 30,000 pregnancies are ectopic—but when it is suspected, time is of the essence.
While medical sources may not use this word, the treatment for an ectopic pregnancy is an abortion. Whether that is an injection of methotrexate, which stops cells from growing, or surgery to remove part or all of the fallopian tube where the embryo has implanted, the procedure is a deliberate act to end a pregnancy—though one that was never viable.
The nurse wraps a blood pressure cuff around my arm. “Seventy-one over 48,” she says in a clipped voice.
That’s really low, I think. The walls have begun to tilt. I go to stand but I stumble and the nurse lunges forward to catch me.
Just after 5 a.m., I have an ultrasound. The technician sees me wince in pain but quickly averts her gaze. She won’t tell me what she sees when I ask. When the ER doctor gets the report, he furrows his brow.
“There’s no sign of an embryo in your uterus,” he says. “If this pregnancy is ectopic, it could rupture.” He glances at us, briefly. “Internal bleeding.”
The feeling that I might faint teeters on the edge of my consciousness. “So, what happens now?” my husband asks, his face a mask of worry.
We’d googled ectopic pregnancies; we knew the treatments. We would deal with the loss, the dashed hopes, later. What mattered right now was avoiding the sudden rupture of tissue, the resultant flood of internal bleeding. The watch-and-wait approach the fertility specialist and obstetrician had taken until this point was no longer an option.
Imagine a case, however, where “watch and wait” was what emergency room doctors advised when a pregnant woman like me came into the ER in pain, feeling like she was about to faint. This is what has been reported around the country since the fall of Roe v. Wade. “First, do no harm” is an adage most of us are familiar with; our doctors take an oath to put their patients first. Now, though, politics has inserted itself into the medical conversation.
Since June 2022, OB-GYNs in a number of states with Republican-led statehouses have reported delays in treatment for women who have come to emergency rooms or their doctor’s offices with pregnancy complications. Women suffering from ectopic pregnancies, miscarriages, fetal abnormalities, infections, irregular bleeding, premature rupture of membranes, and the effects of self-managed abortions have been turned away from ERs and told nothing can be done for them, to come back if things “get bad.”
Most abortion laws do not lay out a definition of “worsening symptoms” or account for the shades of pain and distress a woman can encounter in these situations. How bad is bad? In some cases, care has been delayed until a doctor, at the risk of losing his license or of prosecution and imprisonment, was certain that the patient was in a life-threatening situation.
On what planet could a patient at risk of bleeding into their insides be allowed to walk out the doors of a hospital? Apparently, in the United States of America in 2024, we are living on it.
On the morning of August 17, 2017, just before 6 a.m., I’m lying on an ER gurney, riding the waves of pain, the rises and sudden dips in my body temperature. A rotation of doctors, nurses, and interns crowd around me, blocking my view of my husband, who sits on a chair behind them, ashen-faced. When I complain of feeling dizzy, I’m given IV fluids. My blood pressure drops to 45/20. A doctor calls the blood bank to ask for two units of O-negative, STAT.
At 6:24 a.m., he calls the OB chief, who tells the ER team to prep me for surgery. The suspected diagnosis is a ruptured ectopic pregnancy, and they need to get me to the OR fast.
I don’t know it at the time, but I’m hypotensive, a state that can lead to life-threatening shock; a lack of oxygen reaching the brain and other organs. The blood hasn’t arrived, so a doctor tells a nurse to run to the blood bank to get it.
I am in a critical state for 40 minutes. I’m given two units of blood. The chief of obstetrics arrives, wearing a bow tie. Suddenly I’m being wheeled down a hallway towards the operating room, my husband’s pale face retreating from view.
In the ambulatory surgery center, new faces in blue scrubs and hairnets swiftly prepare me for surgery. I’m lifted from the gurney onto the operating table, which makes my whole body hurt. I feel like I’m hyperventilating. The anesthesiologist puts a mask over my face and tells me it’s oxygen, tells me to breathe. I’m gasping shallow breaths as the doctor strokes my hand. “Deep breaths, deep breaths,” he says.
Hurried activity is going on around me and I’m desperately trying to take it all in, even as I fight the sleepy feeling that’s taking me over. I notice panicked faces, and blue-gowned figures rush towards me. Has my blood pressure crashed again? What will happen if…
The last thing I remember is a rapid-fire mental roll call of the friends and family in my life. In the space of a second, I’ve accounted for all of them and assured myself that everyone I love knows that I love them. I try to keep my eyes open, to see what the doctors are about to do—but I’m out.
According to UC Davis Health, the low rate of deaths associated with ectopic pregnancies in the U.S. is a benefit of having “relatively excellent access to care, compared to many developing countries.”
In America, we have access to emergency medical systems, to blood banks (for transfusions, like the one I received), and to emergency surgery for life-saving care when needed. What happens, though, when we don’t? When doctors’ hands are tied by their hospital’s legal departments—which are hamstrung by their state’s lawmakers, most of whom have no medical training, and in some cases no basic grasp of science? What happens when access to care is further eroded by ignorance and extreme political agendas? For many women, abortion, miscarriage, and ectopic pregnancies are traumatic enough without this additional level of uninformed state intervention and legal complication.
In a 2016 study, medical researchers in London investigated emotional distress in women after early pregnancy loss and found that a large number of women who experienced a miscarriage or ectopic pregnancy fulfilled the diagnostic criteria for probable post-traumatic stress disorder (PTSD), as well as moderate-to-severe anxiety and depression.
Despite my dire condition in the ER, my surgery was routine because medical staff responded swiftly. I stayed in the hospital for almost 48 hours, under close supervision because my blood pressure kept dropping. I went home with an enormous bruise on my hip and flank, caused by the internal bleeding. My arms and hands were purple and yellow from the IV needles giving me fluids and blood. I was stiff and sore for weeks—shell-shocked.
At my follow-up appointment two weeks after the surgery, the bow-tied OB chief who’d operated on me did a gentle exam. Afterwards, I got dressed and thanked him for saving my life. “You were fine once I got in there and stopped the bleeding,” he said, with a reassuring touch of my hand.
As it turns out, the words “first do no harm” do not appear in the Hippocratic oath—neither the original nor the modern version more commonly taken by medical students today. The latter does, however, include the phrases, “most especially must I tread with care in matters of life and death,” and “Above all, I must not play at God.” We trust our doctors to make the right decisions.
When senators and members of the House of Representatives take their oaths of office, they solemnly swear to support and defend the Constitution of the United States against all enemies, foreign and domestic.
As a U.S. citizen with a uterus, it began to feel, in 2022, like Republican lawmakers had come to consider their own countrywomen to be enemies. Why else would they be so forcefully enacting laws that display such clear disregard for women’s physical and mental well-being?
I believe everyone has the right to receive healthcare, and that decisions about healthcare should take place between a patient and her doctor. The truth of what happens when pregnancy complications put a woman’s life on the line does not unfold in the chambers of state capitols. It takes place in doctor’s offices and behind the privacy curtains of hospital emergency rooms, where doctors should be free—and encouraged—to do what they are trained to do without delay or fear of retribution.
Five weeks after Roe v. Wade was overturned, I lay on a hospital gurney in a blue gown and cap, waiting for my doctor to take me in for a scheduled hysterectomy. Decades of pelvic pain had culminated in a diagnosis of adenomyosis, a condition where tissue that normally lines the uterus grows into the muscular wall of the uterus. Symptoms include heavy menstrual bleeding, cramps, backache, and fatigue. A hysterectomy is the only cure.
I never did get pregnant again, and making the choice to have a hysterectomy and put an end to the trying was complicated. There was a gradual acceptance of loss and a growing desire to be free of pain. What I never expected to be part of that cocktail of emotion was an overwhelming sense of relief. As I prepared to say goodbye to my fertility and hopes of being a mother, I was also relieved that my body could no longer be subject to the whims of uninformed male politicians. Republican lawmakers couldn’t control my uterus if I didn’t have one.
Unfortunately, it wouldn’t take long for this relief to turn into rage. I am no longer at risk of dying from pregnancy complications or delays in receiving medical care because of abortion bans. But my friends and neighbors in Florida and many other states—women who might not even know they’re pregnant at six weeks—are.
My students, college-aged women, must navigate their early adult lives knowing that getting pregnant could result in them being forced to break the law. Getting pregnant could, in fact, put their lives at risk. I think of the terror I’d feel if I’d had a daughter. This is immediately followed by another ripple of relief, then fury that politicians have intruded even here, into my private musing about motherhood.
My hysterectomy was meant to take place at noon. I was prepped for surgery and ready to go when the minutes began to tick by. Ten minutes, then 30. A medical resident came by and let me know that my surgeon had been called to the hospital’s emergency room for a consult; then that my surgery had been pushed back and she needed to scrub up to operate on a young woman suffering a ruptured ectopic pregnancy.
“I know you guys understand,” she said. “I’ll be with you as soon as I can.”
“Of course,” I said, with a lump in my throat. “Go. Take good care of her.”
In the cubicle next to ours, medical staff swiftly prepared the young woman for the surgery that would save her life. My husband and I listened in silence. We were happy to wait for my surgery. We let the doctors do their work.
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by Rebecca Wallwork
Rebecca Wallwork is the author of New Kids on the Block’s Hangin’ Tough, part of Bloomsbury’s 33 1/3 series on influential albums. She began her career transcribing cassette tapes at Interview, and her work has also appeared in The Washington Post, Rolling Stone,WSJ Magazine, and many others. She is based in Miami Beach but grew up in Sydney, Australia—where she camped out for NKOTB tickets when she was 15. She’s a Joe girl.
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