This Essay Isn’t Your Business

None of this is any of your business.

Yet here we are, 50 years after the United States government told people who can become pregnant, yes, your health care matters and you get to make your own medical decisions, even when you become pregnant, and you can keep those decisions private. In June 2022, five justices on the Supreme Court said, “Just kidding,” and now we strip our stories naked, expose the blood and the bone and all the parts that we would prefer to keep to ourselves just to prove that pregnant people deserve autonomy and appropriate medical care, like anyone else facing a medical condition that can result in a wide variety of health consequences. Legislators race to regulate one part of a pregnancy’s outcome while failing to notice or refusing to see that whole, living people already have significant medical stakes in what happens. I never planned to write about this, but with this singular choice removed from me, from my daughter, from everyone’s loved ones who can become pregnant, other choices have been removed and threatened as well. We must speak; we must write. So here we go.


I never expected my body to cooperate when it was time to have kids. I would have welcomed cooperation, of course: to have purposeful but fun sex with my husband, take a pregnancy test and boom! Joy, baby shower, and birth of a perfect child. Our little family would then pick up our new SUV, gather our golden retriever and drive to the park for a lifetime of sunny-day picnics.

But I knew better. After years of battling with frustration and uncertainty while my health deteriorated, I was finally diagnosed with Crohn’s Disease and chronic migraines. So I wasn’t surprised later when my body didn’t get pregnant. My husband and I set out to find other ways to become parents.

We were interested in both infertility measures and adoption as means of building a family, but the adoption agencies wouldn’t talk to us until we’d “given up” on the infertility treatments, so we temporarily shelved our adoption plans. From the outset, I mentally prepared myself to have to go all the way to in vitro fertilization (IVF). We tried fertility drugs, progressed to intrauterine insemination, and then we did indeed land eventually at IVF. But even IVF wasn’t that simple.

The sperm needed a little help breaking through the barriers of the eggs, so Dr. D, our infertility doctor, recommended IVF with intracytoplasmic sperm injection (ICSI), wherein an individual sperm is injected into an individual, healthy-looking egg. The resulting embryos are then monitored for healthy development prior to implantation. We began well: my ovaries responded to the hormone injections to stimulate egg development. They responded so well, in fact, that I developed the rare ovarian hyperstimulation syndrome, which meant that the successful blastocysts (embryos develop into the blastocyst stage on day five or six) couldn’t be implanted right away after harvest and insemination because my body had to recover — in bed for at least a week, and no implantation until a future cycle. Dr. D. froze all the healthy blastocysts: from a total of 31 good eggs, 12 blastocysts made it to the frozen stage.

Two months and another round of hormone injections later, I was ready: Dr. D thawed a straw of three or four blastocysts, selected the one that looked healthiest the following morning, then implanted the blastocyst in my uterus. We began the every-other-day ritual of checking my HcG hormone levels via blood draws to determine if the blastocyst had attached to my uterine wall, which would mean I was pregnant.

Dr. D’s phone call to tell us I was pregnant was possibly the happiest twenty minutes of my life. It was the holiday season then, and I’d never felt seasonal joy like I did with a new life beginning inside me. Crossing the street from my office to get lunch one day, I thought, “I’m a mother already.” It was a premature thought, but it was my secret, and I reveled in it. Peace on Earth and good will to all.

I began to bleed on Christmas Eve, first a little, which I knew wasn’t unusual, but then a lot, and it began to hurt. It got worse, and because we didn’t know any better, we went to the emergency room, where I bled and cramped and passed clots for seven hours before they sent me home with instructions to take Tylenol and use a heating pad while waiting for the miscarriage to end.

Eight days later, the blood was lighter, but the cramps were not. My husband and I tried to ease the emotional pain of the miscarriage by traveling to New York City for a previously planned holiday trip. We thought we’d try to use at least a few of our show tickets and visit a couple of planned restaurants, but mostly I just lay in the hotel bed, watching the snow fall on a hushed city during an unexpected storm as I bled and buckled every couple of minutes at the sensation that something was trying to tear out my uterus from the inside.

When we returned home, Dr. D. said, “Your body hasn’t expelled all the contents of the pregnancy. We call this a ‘missed abortion.’ You can wait a few more days if you want, but there’s an increased risk of going septic if you do. The alternative is we can schedule you right now for a D&E and avoid that risk.”

I knew what “going septic” meant, and I chose the dilation and evacuation. When I awoke from the procedure, I heard newborns crying. I’d never been delirious from anesthetic before, and I asked a nurse about the sound.

“That’s the babies who were just born via c-section. The recovery area for cesareans is just on the other side of the nurses’ station, right over there.” She pointed.

I closed my eyes and curled into myself, trying not to listen. At least the physical pain was at an end — for now.

A few months later, Dr. D said we could try again. There were more hormone injections for me, more crossed fingers for both me and my husband. The doctor thawed another straw of frozen blastocysts, and she selected the two healthiest-looking for implantation — two because we’d decided to improve our odds. The HcG monitoring began again.

The first photograph of my son in his baby book is of the two microscopic blastocysts, just prior to implantation. I don’t know which of the blastocysts is him. The other faded away; it simply didn’t take, which is common and why IVF implantation is often completed with more than one blastocyst. I cherish that photo; it’s miraculous to me that those tiny clusters of cells — one of which would become my son — was captured in a way I can see forever.

But I didn’t mourn the cluster of cells that didn’t attach. They were not, to me or my husband, a baby, but rather, a potential that didn’t pan out. When they were placed inside me, I wasn’t pregnant. The blastocysts were a question, not an answer.

Aside from seven weeks of morning sickness so bad that I ate nothing but gingerbread from Whole Foods and I was at times unable to leave my bed, my pregnancy was uneventful. I read a small library’s worth of pregnancy and parenting books, ate a healthier diet than I’d ever consumed in my life (once I made it past the morning sickness), and baby-proofed every door, socket and toilet in the house. Doctors decided to induce labor at 41 weeks, and I went into the hospital the night before the induction to prep for the birth.


I’ll pause now and tell you: if you’re pregnant and believe fervently in birth plans, stop reading. If you are uncomfortable with graphic details, stop reading. And if you believe the consequences of what happens in labor and delivery are quickly resolved and you don’t wish to have those views challenged, stop reading. Unless, of course, you are a legislator: then before you blithely vote on any bill that would take away a person’s agency over their future, please keep your eyes wide open and read on. Because you need to know what your vote can mean.

I crafted my birth plan with care and posted it on my delivery room door, by my bed and placed it in my file: epidural: yes; episiotomy — the surgical cut made at the opening of the vagina to make it easier for the baby to pass through — no, unless absolutely necessary. If any concerns cropped up during labor and delivery, then the doctors were not to worry: give me a cesarean section. I’d had worse abdominal surgery and recovered from it, and I was less afraid of a c-section than I was of vaginal birth, which everyone I knew and every book, movie and TV show assured me was one of the most painful experiences a person could ever have. I was going to devote the rest of my life to this kid; I was fine missing the “full birth experience” and the searing pain that went with it. Everyone ending up healthy and happy was my only goal.

I should have torn that birth plan to shreds upon walking into the hospital.

I never had a contraction without the aid of Pitocin, which they began early in the morning. Even after they’d raised the dosage to the maximum level, the contractions felt like uncomfortable aches. Nurses kept coming into the room, asking if I wanted my epidural.

“Not yet,” I answered repeatedly. “I’m still okay.”

“You don’t have to be a hero.”

“I’m not. It really doesn’t hurt much.”

They scurried away, puzzled.

The weak contractions were accompanied by fetal heart rate decelerations, and they placed an oxygen mask on my face early in the day. If I’d known more then, I’d have demanded a c-section by noon. But I didn’t know the risks to my baby and thus to myself that the decelerations suggested, so I simply trusted the medical team.

Eventually, a nurse told me I could miss the window for my epidural, so I agreed to it despite still not having any serious contractions. Early in the evening, the doctor broke my water for me, and we soon progressed to the delivery.

I pushed, and it wasn’t long before the doctor told me, “I see the head!” An hour later, I was still pushing, oxygen mask still on my face, and the baby was in the exact same position. My obstetrician’s shift ended, and her partner — the senior physician in the practice, who had been delivering babies for more than 20 years — took over. I pushed for fifteen more minutes, and she said, a bit too cheerfully, “Okay, I think we’re going to move this to the operating room — just in case. All right?”

I was too exhausted even to ask questions.

They wheeled my bed into the OR, and I resumed pushing. The doctor coached, my husband held my hand, and nothing changed. The doctor cut an episiotomy, but it wasn’t enough. Then she told me she was going to have to use forceps, the tool we’d been told in childbirth class was only ever employed to guide a baby out from the birth canal, never to pull.

I nodded. Whatever. I couldn’t feel anything as a result of the epidural. Just get the baby out.

After two hours of pushing, I finally heard the words, “It’s a boy!” He was nine pounds, seven ounces, and he was born with a broken collarbone.

I wish I could say I got to hold my son right after he was born. I think they showed him to me before they took him to clean off and then hand to my husband, but I’m not certain. They’d administered some anesthesia before the final push, and what I remember is a hazy flurry of activity to remove the afterbirth and then the doctor beginning to try to repair the damage where my son had just emerged.

“I’m sorry,” she said over and over and over as she sewed me up for the next hour and a half. “I’m so, so, so, so sorry.” As my fog began to clear, that’s the one thing I most clearly recall. The doctor apologizing, again and again.

I couldn’t imagine what she was apologizing for. I’d had the world’s best epidural, thanks to my anesthesiologist, so I couldn’t feel anything. (Whoever and wherever you are, Dr. Anesthesiologist, I will always love you.)

When the epidural wore off a few hours later, I understood.

A fourth-degree laceration is the one they tell you about in childbirth classes, but then they wave it off because it is rare and a frightening topic of conversation amongst a group of people about to give birth. In a fourth-degree laceration, the tear in the vagina extends into its muscles, into the muscles of the anal sphincter and into the lining of the rectum. It’s as if someone screamed at you, “I’m going to tear you a new one,” and then they actually did. It feels like someone has ripped the skin and muscles in the most delicate area of your anatomy into pieces, sanded the raw edges and then rubbed them with salt. Risk factors for this type of laceration include an episiotomy, use of forceps, and having a large baby.

This laceration was my most significant tear, but hardly the only one. Later, at my six-week exam, we would discover another injury as well: a bruised coccyx bone.

When I left the hospital two days after my son’s birth, I couldn’t sit, stand, walk, lie down, move or remain stationary without blazing pain. I was petrified to have my first bowel movement. I was unable to care for my son, except to nurse him. We had almost no family or other help, so it was up to my husband to take care of both our son and me. And our son posed his own challenges.

We call it colic when we speak of it now, but only because we have no other name for it. Our son cried constantly, unless he was asleep, and he only slept for a few hours at a time at most, preferably after he’d been driven all around the Washington Beltway in the middle of the night. (My husband learned that the Outer Loop of the Washington Beltway is one mile longer than the Inner Loop, in case you’ve ever wondered about that.) I remember my baby’s first five minutes of waking time when he wasn’t crying. He was two months old.

When my son was nine weeks old, I left the house for the first time other than to go to the doctor’s office. I still couldn’t sit or stand without pain — that would take two more months. I took him to a new moms’ group at the hospital, where women recounted the activities they engaged in with their babies: getting together with friends, dining out, going to parks, traveling. My eyes filled.

“How have you done these things?” I asked when it was my turn to speak. I hadn’t realized other women resumed their lives just days after giving birth. Weren’t they in pain? Weren’t they exhausted from their babies’ constant crying and their consequent near total lack of sleep?

In the months and years to come, I would learn how many things went wrong in my delivery. First, I discovered that the decelerations throughout my labor signaled a potentially dangerous situation for my baby, and the medical team probably should have performed a cesarean section — especially given my openness to one in the event of any problems. (Only recently did another doctor explain to me that perhaps the obstetrician was reluctant to perform a c-section because of the possibility of scarring and adhesions from my earlier abdominal surgery. It took twenty years for a doctor to address this with me — and this was in casual conversation with a non-obstetrician.) Second, an overheard conversation in an elevator revealed that my doctor had not only used the forceps to pull my son out of the birth canal, but she had pulled “the hardest I’ve ever pulled in my life.” Another medical professional speculated that my son may have suffered significant pain or discomfort from this, but of course, this is forever unknowable as a matter of fact. Finally, I learned that a broken collarbone is not an uncommon childbirth injury, especially for a large baby. But more disturbingly, I learned that when it is too late to conduct a c-section because the baby is too far along in the birth canal, the delivering physician will sometimes deliberately perform a maneuver that breaks the baby’s collarbone in order to deliver the child. (That none of these revelations were shared with me by my doctors or other medical personnel involved in the birth of my son raises a disturbing set of concerns about the lack of information shared with those giving birth and/or the information shared with women about their own health care. But that is beyond the scope of this essay.)

My baby was born in December, and by the end of April, our family of three began to live something approaching a normal life. My birth story, however, was not over.


After four months of pain, I had no interest whatsoever in sex. I was, frankly, terrified of anything going near my vagina. I tried not to think about what happens during the sex act. I was held together by sutures; what if having sex caused me to split apart again?

My husband was patient, but by the time the baby was six months old, even I felt that it had been too long. The first time, I held my breath. When I didn’t cleave in two or disintegrate, I exhaled, and this final piece of our lives was returned to us.

But my periods were another story. Periods often change after childbirth, and mine, always heavy, grew to gushing. As my son transformed into a toddler, my periods became so heavy that I couldn’t leave the house for a day or two each month. Tampons were useless, and I had to go to the bathroom every half-hour or so to change the thickest pads available. Some months I thought it would be easiest if I spent those days sitting on the toilet, letting the blood run into the bowl. But of course, you can’t take care of a toddler that way.

I begged my new ob/gyn for a solution.

“I’d recommend an IUD. It will greatly reduce the bleeding. And as a side effect: highly effective birth control!”

The insertion of the IUD would be easy, he told me. I would feel a pinch. There might be irregular spotting for perhaps up to a year, but then my body would settle into regular, lighter periods for the remaining four years of the IUD’s life.

“Great,” I said. “It sounds perfect.”

The “pinch” was like a poke with a red-hot cattle prod from inside my body, but it lasted only a second. “That was not a pinch!”

“But it’s over. You’re fine now, right?”

I was.

The IUD delivered lighter periods as promised, which was liberating, but the irregularity lasted for five years, which was annoying. I never knew when I might get my period. I wore a pantiliner almost every day for most of the five years in case the blood started flowing. At the end of the term, I told my ob/gyn I wanted to try something else, and he suggested cryoablation, which destroys the lining of the uterus by freezing it.

“You must be absolutely certain you don’t want any more children before we do this,” he said.

We had already adopted our second child, a baby girl born in South Korea. We had our two kids and we were done. “One hundred percent. Let’s do it.”

The procedure went well. There were no complications. My periods became manageable. And that, I thought, was that.

I really ought to have known better by then.

A few years later, I developed a bladder prolapse. This happens after childbirth sometimes, particularly a traumatic one where the pelvic floor is damaged or otherwise weakened. My ob/gyn recommended exercises to strengthen my pelvic floor. He suggested a number of remedies and therapies, none of which worked. Over a period of several years, my bladder kept dropping. And then one July, immediately following sex, the prolapse began to hurt.

Bladder prolapses can sometimes exist “even outside the body” with no discomfort to the patient, I was told. (Many years later, I still find that statement hard to believe.) My prolapse had indeed extended so low inside my vagina that it was almost peeking outside of my body and pulling other organs away from their ordinary location, and in my case, it was causing me intense, constant pain. It was like the worst UTI I’d ever had, every minute of every day. I begged the urologist for a solution. After trying a number of doctors’ suggestions, the only fix left was surgery.

Surgery to correct a prolapse like mine is multifaceted and requires a minimum of six weeks of recovery time. The urologist and her gynecological surgical partner worked together to perform a hysterectomy, removing my Fallopian tubes along with my uterus. They tacked up my bladder, my vagina, and my rectum and sewed them back into position. Finally, they strengthened my pelvic floor, incorporating a small piece of mesh.

The six weeks of recovery was necessary. And for a few months after that, all was well. But then my bladder began to drop once again.


Today, I am the mother of a 21-year-old son and an 18-year-old daughter. Was everything I went through to get here worth it? My family is the best thing in my life, so my answer is unequivocally yes. But I’m not the same person I was 21 years ago, and I don’t just mean because of my loving, beautiful family. Physically, I’m someone who sits with care on hard chairs and benches, because if I forget and plop down on a rigid surface, it’s likely to hurt, given that I’m sitting right on my bladder. I’m prone to UTIs, which is common for people with prolapses. I only drink one caffeine drink per day, I drink almost no alcohol, I try to avoid lifting heavy objects. When I have sex with my husband, there is always a little part of my brain that wonders if this will be the time that brings unbearable pain again, and there are multiple other little ways my day is interrupted, nearly every day, by the effects of my misplaced anatomy. My prolapse continues to drop, so I’ve established a relationship with a urogynecologist in the event that if or when the current situation becomes intolerable, I can call him as an existing patient and undergo another significant surgery, trying once more to effect a long-lasting repair.


So why did I tell you all of this? Why share all these painful and bloody details if given a this-or-that choice, I would go through it again to have my son?

I tell you this because this is what childbirth can be. This is one woman’s picture of health care, needed and delivered, as a result of wanting and having a baby. It’s not all pregnant people, nor all childbirths. Not all deliveries are traumatic, nor do they leave effects that last or require care for a lifetime.

But these things do happen. Women — and anyone who can become pregnant — can have babies, and this capability is part of the total of who we are. Our reproductive systems are integrated into the rest of our bodies; they are not separate — something that can be regulated and legislated into a divided existence like line items in a budget. Every part affects the whole, and everyone who gets pregnant brings their own body — their own medical history — to their pregnancy. And what happens as a result of that pregnancy may affect many other parts of her body, possibly for the rest of her life.

I never planned to write this story. It’s my private business.

But it’s critical to understand: reproductive health care isn’t just about a baby, although it’s certainly about that. It’s also about a human being’s health, and in my case, it’s about my health for the rest of my life.


Image: Revision by Daniel Lobo, licensed through CC 2.0.

Tracy Hahn-Burkett
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