The patient was 19 years old and wearing a short summer dress with open sandals. By her count she was five months pregnant. She laid down on the examination table and what followed was either an argument for or against abortion, depending on your point of view. She was being seen in a Latin American country where abortion is illegal except in cases of rape or danger to the mother.
This particular public hospital, in a large urban area, averages about 30 deliveries a day—almost 10,000 annually—but for the first time this year the number of "abortos espontaneos" is approaching the number of live births. In fact there is nothing very spontaneous about many of them. Like the patient in the next bed, the 19-year-old bought a drug on the black market to terminate her pregnancy. The area of the hospital where the young woman was being treated was a spillover from the main emergency room. In this particular case the 19-year-old had barely laid down on the exam table when there was a gush of blood, and out came the fetus.
The 19-year-old tried to get up, to be with the child she thought she didn't want. A nurse, suddenly at bedside, was telling her to lie back down. "Ay, my baby!" the almost-mom cried out.
"Varon," the RN told her, "it's a boy."
The nurse lifted up the fetus in a gloved hand for the young woman to see. "Look," she said, "it's too small"— in other words, too small to be viable.
The intern kicked over a stool and started the legrado, a D&C in English, the scraping out of the uterine walls to remove clotted blood and tissue and fetal material after an abortion, spontaneous or otherwise. That's all they'd been doing in spillover the last couple of days, it seemed, not deliveries, just legrados. The lady in the next bed was a legrado too.
Technically it was illegal taking the pills to abort as these patients had done, and one of the aides told me that in some hospitals there was a government official present, a kind of notary, to identify moms for criminal charges later. But nobody like that was in spillover. "Ay, my baby!" the almost-mom called out again.
Because the patient stays were so short before the moms and almost-moms were sent upstairs to a ward, or sent home, you only saw snapshots of the treatment. Put together, snapshots like these were supposed to make a picture of labor practices in this hospital, in this culture. At least that was the purpose of my visit—to get a portrait of childbirth in Latin America for my nursing studies. Of course that never really happened. No big picture developed. Trying to put together the scenes in spillover was like going from room to room in a hotel and looking out all the windows and expecting to synthesize what you saw into a complete view of a new city. It just never happened. Still, there were some patterns.
Like the 19-year-old, a lot of the didn't-want-to-be moms who showed up at the emergency department seemed to have chosen the fifth month to terminate their pregnancies. It made you wonder what was special about the second trimester, as opposed to our court-imposed standard in the United States, the first trimester. Maybe five months was when the women really started to show and being pregnant could no longer be kept secret.
Suddenly a baby ceased to be a pleasant abstract concept and became instead an issue of buying food and missing sleep, washing clothes and paying school fees. For the fetus, the fifth month is also critical—the sense of hearing develops and theoretically he or she can hear mom and dad, which leads to those stories in later years about how the kid learned to enjoy Beethoven or speak Chinese or whatever. The fetus's movements become more coordinated too at five months. Perhaps it was the stronger kicks that frightened this young woman, warning her of embarrassment or unwanted responsibilities down the road.
Almost all the women who had chosen not to go through with their pregnancy had also chosen the same means: Cytotec, or a knock-off of Cytotec, an anti-ulcer drug that has the added effect of emptying the uterus. These women had paid a high price on the local black market, a dollar a pill. But to get out of trouble, that's what was required—a few dollars and a trip to the emergency room. The pope had just visited nearby Brazil and his message on the subject of abortion had been a big NO. Nobody who joined in on the chatter later at the nurse's station seemed to be challenging the church directly, but people were still talking like something wasn't right and they weren't sure exactly what it was.
In the local newspaper there had been a story about this hospital and the climbing rate of legrados and the story quoted doctors starting to use the p-word, provocado, as in "aborto provocado," instead of the euphemism of "aborto espontaneo" still being used in a lot of the charting. The newspaper had picked two recent days at random, and on the first there were 27 live births, either by vagina or C-section and 17 abortions either spontaneous or provoked, and on the second day 20 live births and 13 abortions. Just the year before the hospital had averaged only five abortos a day. It made you angry at the politicians for not recognizing the reality of unwanted pregnancy, but it also made you a little disappointed in the 19-year-old in the other room, because if she could find Cytotec on the black market she and her missing partner should have been able to find a condom at the corner pharmacy.
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