This is what it's like for a GP to tell someone they're pregnant

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Deputy Opposition Leader Tanya Plibersek has today announced a Labor government would improve access to safe, legal ways to end a pregnancy. Writer and GP, Melanie Cheng, knows all too well the importance of choice. "When a pregnancy is unwanted it’s almost always because the arrival of a baby would cause significant financial, emotional and psychological distress..."

Video above: Nikki 's struggle to decide whether to abort her pregnancy when she was 16. Meet more teen parents here.

When I order a test on a patient, I usually have a pretty good idea what the patient wants the result to be. They don’t want cancer. They don’t want a fracture. They don’t want high cholesterol or diabetes. Not so with the pregnancy test. Unlike other investigations in medicine, the result does not indicate the presence or absence of disease. Sometimes I have no idea how a woman is going to react. I once informed a patient that her pregnancy test was ‘negative’ only to have her look at me with a blank face – what, exactly, is your idea of a negative result? her expression seemed to say.

People like absolutes. I’ve heard colleagues joke that ‘you can’t be a little bit pregnant’. But I would argue that you can. With my first pregnancy, I walked into my 10 week antenatal appointment happily pregnant, only to walk out, an hour later, with one less heartbeat. At five weeks I’d had what the medical profession refers to as a missed abortion. For over a month I’d gone about my daily business believing my baby was doubling in size inside me, when in reality, my baby wasn’t growing at all. My hormone levels had dropped and the foetal heart had stopped beating, but I’d had no bleeding. My body had not yet done what it should have done. There was still a small sac clinging to my uterus. I was in a state of limbo somewhere between pregnancy and non-pregnancy – a half-pregnancy, if you will. The procedure I later underwent to empty the contents of my uterus – a dilation and curettage – is strikingly similar to a surgical termination of pregnancy.

Pregnancy tests mean different things to different women. I can see one patient on her seventh cycle of IVF for whom a negative pregnancy test is the final, brutal blow in a long battle with infertility, and fifteen minutes later I can come face to face with a university student for whom an unexpected pregnancy signifies an abrupt end to all of her hopes and dreams. Emotions run high and they’re not always what I, or even the woman, expect them to be. A patient can miscarry while waiting for a termination and feel profoundly sad about her loss – the outcome may be the same, but the decision has been taken out of her hands. The miscarriage, like the pregnancy before it, is a reminder of her lack of control in matters of life and death.

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New laws in the US restricting access to abortion have women in NSW worried.
New laws in the US restricting access to abortion have women in NSW worried.

The decision to proceed with a termination is rarely an easy one. A lot of women keep it a secret. Many worry about complications. Some agonise that when they are finally ready to start a family, they’ll be unable to achieve one. They fear punishment through some terrible and ironic twist of fate.

In 2018, pregnancy and motherhood still loom large in our collective conscience. For many, pregnancy maintains its long-held status as something spiritual and mystical. This was never more evident to me than during my own two pregnancies. I was shocked by the amount of unsolicited attention and advice I received from complete strangers. People came up to me in the supermarket and rubbed their hands all over my belly. Patients predicted the sex of my unborn child based on how much weight I was carrying. Most people meant well but their advice was rarely evidence-based.

Because no mother – even one who is being taunted by voices inside her head – wants to admit to the world that she isn’t coping.

There’s no doubt that pregnancy can be beautiful, but it can also be risky. The first birth I attended during my medical training came as a shock – I hadn’t prepared myself for how much distress the woman would be in, how much bodily fluid there would be, how dusky the baby would look in those first few seconds before he opened his mouth and screamed. I was not emotionally connected to the couples and I didn’t share their post-birth euphoria. I left those delivery suites traumatised, determined to delay my own plans for a family.

Over the past few decades in the developed world, the dangers of pregnancy and labour have been dramatically reduced, but pregnant women remain a uniquely vulnerable subset of our population. For one thing, pregnancy is a state of immunosuppression – a necessary physiological change, which prevents a woman’s body from attacking the cells of her baby, but which also makes her more susceptible to serious complications from everyday viruses. And it’s not just infections – certain conditions like venous thromboembolism, high blood pressure and diabetes are also more common in pregnancy. That’s not to mention the risks of the delivery itself, which have been minimised in countries like Australia, but which are not and never will be zero.

And that’s just the physical complications. Pregnant women are also highly susceptible to mental health disorders. Peri-natal Anxiety and Depression Australia (PANDA) quotes the risk of anxiety and depression as 1 in 10 in the antenatal period and 1 in 7 in the six months immediately after delivery. So long as we view pregnancy as something mysterious and magical, we risk ignoring these cold, hard, confronting facts.

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Watch Dateline's special episode, America's War On Abortion, On Demand.

I’ll never forget the time I accompanied a psychiatrist to visit a patient with post-partum psychosis. More than anything I remember the woman’s eyes – scared, frantic, lost – and the lies she told us. Because no mother – even one who is being taunted by voices inside her head – wants to admit to the world that she isn’t coping. I was a young medical student then. I was single. I didn’t have children. Now, as the mother of a four-year-old and a seven-year-old, I know the joy of a cuddle and the delight of a spontaneous and heartfelt declaration of love. But I also know the daily grind of parenting. I understand that exhausted, helpless feeling we get after a string of bad nights. I can relate to the seeming relentlessness of meal-time and bath-time and bedtime routines. I know what it’s like to look down at the red face of a four-month-old when they’re in the midst of a particularly brutal sleep regression, and to feel terrified by your own emotions – that flash of frustrated rage and the hours of guilt that follow it. And I’m a mother with a supportive partner and family, who wanted her pregnancies and suffered only mild and fleeting episodes of post-natal blues. I can’t imagine what it might have been like if I hadn’t wanted children.

It’s worth pointing out that an unwanted pregnancy is not the same as an unplanned pregnancy. Many pregnancies are unexpected; that doesn’t mean they’re unwanted. My own conception was described as a ‘happy surprise’ by my parents. Sometimes after the initial shock, the woman rethinks her plans for the future and decides that she does, in fact, have space in her life for a child. By contrast, when a pregnancy is unwanted it’s almost always because the arrival of a baby would cause significant financial, emotional and psychological distress to that particular woman at that particular time.

My work has taught me to live with uncertainty and to never make assumptions. Life is messy. The waters are murky. What’s right for one woman may be detrimental for another woman. It’s not my job to tell patients what to do, but to help them make informed choices. The key word here is choice. The other important word is freedom.

This is an extract from the book Choice Words - a timely collection of stories, essays, rants and raves from high profile women that seeks to demystify abortion and its surrounding stigma.

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