*Trigger Warning
The world of termination for medical reasons (TFMR) is not well talked about or understood- unless you are in it. TFMR is the experience of ending a wanted pregnancy due to the health of the pregnant person or a fatal or life-limiting diagnosis for the baby.
As a mental health provider who specializes in trauma and grief, I never anticipated how I would get a front-row seat to the complexities of this world until I was in it.
My 20-week ultrasound led my partner and me down a path where we needed to consider TFMR for the compassionate care of our daughter. We walked the path of TFMR up to the point of making travel plans to a surrounding state (since abortion was not legal in our state at the time). After an inpatient hospital stay as our “Hail Mary” attempt at saving our daughter, we thankfully had a miraculous turn of events, and our daughter was born with minimal health concerns.
I cannot unsee what I saw through that process. The gaps in trauma-informed care and the gaps in public understanding that impact parents forced into making this devastating decision. I felt compelled to shift my career to provide care and support to individuals who have experienced trauma or grief through their reproductive experiences.
If TFMR was better understood, perinatal palliative care would more frequently include support for TFMR families. Imagine the impact of having a social worker or case manager to walk families through this process from initial diagnosis through the postpartum period. Because this is not typical, TFMR families typically experience a lapse in care.
Lapses in societal understanding of TFMR impacts the emotional toll on TFMR families. It is important to understand that these are chosen pregnancies. Parents often have dreams and a future planned for their unborn child. Having to choose TFMR goes against the expectations for a wanted pregnancy. Because of this, grief can feel different when you are forced into the situation where you must choose. In my own personal experience, had things not changed, termination would have been the option that would have offered the least suffering to our daughter, and to me, there was no other choice.
The gaps in after-care support are not readily available for TFMR families. Sure, there is still the 6-week OB check, but who is routinely calling to check on how TFMR folks are coping with their milk coming in? Or how they are coping emotionally with postpartum cramping or bleeding? Or postpartum mood and anxiety disorder symptoms? TFMR families can be left to navigate the world post-termination independently, instead of with support from community due to these gaps.
Finally, I see huge gaps in folks having the option for TFMR based on finances and legal barriers. For individuals to not have a choice for their health or their child’s health due to these factors is bizarre in our first world advancements. There is a clear call for societal understanding of TFMR if this is still the state of society.
There are certain things that I wish were common knowledge after my experience and witnessing other’s experiences with TFMR. TFMR parents are making an impossible choice. For those in the process of considering TFMR, they have the right to ask as many questions as necessary, to get all the necessary information, and to get a second opinion. They have a right to honest conversations about all the possible outcomes; what would life look like for their child, what would death look like for their child, what termination options are available and what would those experiences be like for them/their child. Parents who chose TFMR have a right to grieve. This is infant loss. It is important to understand the gravity of the loss when a parent is the one making that decision based on health care needs. They have a right to name their baby. They have a right to ashes and to memorialize their loss if possible. Keeping mementos from the pregnancy may be helpful. They have a right to talk about their child, their experiences with fetal medicine, and with termination with a non-judgmental support network.
TFMR needs to be talked about more. There needs to be a greater understanding throughout society so that individuals facing TFMR aren’t making health care decisions based on societal or legal concerns. TFMR is healthcare, and that needs to be normalized so women can get the care they need. We need more societal understanding to be able to support these families and the grief they are experiencing.
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