Question

I am a 46 year-old professional woman and am happily married with three children - 17, 14 and 12 years old. I am also, unfortunately, six week pregnant and in shock. This is very much an unwanted development as I already have my family and am looking forward to retirement and enjoying life.

My first three children were delivered by c-section and my myometrium is very thin. I suffer from migraines and take Vioxx daily. I have also had problems with heart arrhythmias.

My ObGyn is a practicing Mormon, and it's hard to discuss my options with her. With the chances of delivering a healthy baby very slim, and my health - both mental and physical - wouldn't it be better to end the pregnancy? My husband and I are leaning this way, but need medical advice. Also, is there somewhere in the country that a woman like me can go to take care of this and be treated like a person, not a villain? These are not every day circumstances. I feel like I'm slowly dying.

Advice 1

It sounds like you have several medical conditions that could be worse with proceeding with pregnancy. A good place to start for additional information would be your local Planned Parenthood office.

Advice 2

The choice here is a personal one but from a medical standpoint you have a significantly increased risk of having a child with Down's syndrome. With all genetic considerations included the risk is probably about 5%. You are also at risk for uterine rupture, which is pretty much unpredictable until it happens late in the pregnancy. The Vioxx is probably not a serious risk in and of itself. If you were to choose to terminate the pregnancy this procedure is quite easy up until 12 weeks gestation. The ideal time is about 8-10 weeks.

If say, you lived in Utah and wanted to have it done elsewhere, say Seattle, you might give Planned Parenthood of Seattle a call (1-206-328-7734). There are also several private clinics offering services. Seattle has a very positive attitude and has supported women in this decision for many years.

You will also need to consider future birth control - a particular favorite among doctors is Lo-Ovral 1/20 which is frequently used in women in their 40s as an oral contraceptive option. Otherwise tubal ligation or vasectomy are also possible.

Advice 3

First of all, calm down. You still have options. The risk of a 46 or 47 year-old woman, who is otherwise in good health (you did not state exactly what kind of arrhythmias you had) of having a Down Syndrome affected baby is about 1 in 30. The other way of looking at this is that 29 times you would have a normal baby. This is what chorionic villus sampling and amniocentesis are for. The first decision you have to make is: if we knew this child were totally normal, would we want to have him/her?

If the answer is no, then there really is no reason in getting into a complicated argument if there are no circumstances under which you want the baby. Similarly, don't take the risk of these tests if you decide you will not terminate the pregnancy, even if the results indicate Down Syndrome or similar genetic problems. The medical complications of an "older" pregnancy can be managed, especially if there is a high risk OB-center near you.

What I am saying is the decision you have to make is not so much a medical one as it is whether you want/can tolerate an elective pregnancy termination (abortion) in a physical, emotional and spiritual sense. No one can make that decision but you. Don't complicate it with the "harsh medical realities" issues. Those are usually manageable. It's the other stuff that is difficult to come to grips with. And, yes, there are plenty of places around where you will not be treated as a villain. Start with Planned Parenthood and go from there. Similarly, if you decide to have the baby, it is not the end of it all (although your teens may act like it is!).

You are not dying, you have control, and you must focus on the essential questions and not get diverted all over the place because this is such an emotional time