The nurse midwife paused before opening the door to the examining room and, pulling the outpatient folder out of the little plastic box on the wall, she flipped it open and scanned the cover sheet. A little box in the upper right hand corner of the sheet was labeled, "Reason for Visit." In it was the phrase, neatly handwritten by the office secretary, "Positive pregnancy test." The midwife glanced quickly through the chart. Long time patient, no real medical problems... Pap smears, birth control pill prescription renewals. Not much else. She gave a light knock on the door, and went in.
"Hi, Vicki, I'm Marla, the nurse midwife here at the office. How're you today?"
Vicki was sitting on the exam table, legs swinging over the side. She had not been told to change into an exam gown, so she sat there in her street clothes, swinging her legs back and forth. She studied the midwife, who was older, in her forties, maybe. Her eyes moved to the woman's wedding band, and then flicked back to the woman's face. Vicki didn't remember seeing the midwife before, but then, she didn't come to the doctor's office very much.
"Hi. Okay, I guess." Vicki kept swinging her legs.
The midwife pulled up a stool. "What can I do for you today?"
Swing, swing, the legs went back and forth. Vicki studied the way her kneecaps moved up and down with the motion. Then she said abruptly, "I have a positive pregnancy test."
The midwife's hesitation was nearly imperceptible. "Right," she said, looking again at the lab report paper clipped on the inside of the chart. Her clinical instinct told her to go slowly; after all, this patient hadn't scheduled an OB intake visit, as patients usually did when they found they were pregnant. "The one we ordered for you to obtain prior to your visit is positive. It's something the front desk does, helping you get the test ahead of time, to expedite the process."
"Yeah. So, I guess that means I'm pregnant for sure."
"That's generally what it means." Marla crossed her legs, deciding how to best move the interview onto a more fruitful path. "It's good enough for us to schedule the OB intake screen, go through the question list, and set up the first OB visit. Is that," Marla spoke carefully, "what you'd like to do?"
"But, I was on the birth control pill," Vicki said, ignoring the question.
"Did you miss any?"
"No. Honest. I'm really good about it. I didn't want to get pregnant."
Now we're getting somewhere, thought the midwife, mindful of the complexity of the emerging problem as well as the limited time she had to discuss it. Aloud, she said, "Birth control pills do fail from time to time. Any form of contraception can, even if practiced perfectly. What is it you'd like to do, now that you're pregnant?" Often the direct approach was the best.
"I don't know."
Bingo. Marla sat quietly in the silent room, an open, friendly expression on her face. After a pause, Vicki continued.
"I really don't know. I'm not married, I can't afford a baby, my boyfriend doesn't want it. He said..." Vicki stopped swinging her feet. She had become aware that she was banging her heels against the metal side of the table. "He said I should get an abortion."
Marla let the word hang in the air, dissipating through the room for a few seconds. Then she asked, "Is that what you want to do?"
Vicki just stared. The midwife continued gently. "Vicki, I understand your problem. It's not that uncommon, you know. You really have three choices. You could have the baby, and raise it yourself. You could have the baby, and put it up for adoption. We can put you in touch with agencies that would assist in that. Or, you could have an abortion."
"I don't know if I could put my baby up for adoption."
"Many young women in your position say that. Paradoxically," Marla continued gently and carefully, "sometimes the same young woman in a hard situation like yours who says she wouldn't put her baby up for adoption because she thinks it would be cruel, does choose to go through with an abortion."
Vicki thought about that for a moment. Her eyes were damp, glistening, but no tears came. She looked at Marla. "I guess that doesn't make much sense, does it?"
"No, it doesn't. Leastways, not to me. Vicki, do you want an abortion?"
"I... no. No, I don't want an abortion. You're right, it doesn't make sense. I don't see how I could part with my baby, put it up for adoption. It would be so hard for me. But, it would be the right thing to do, if... if the choice was that or abortion." Vicki gave a little nervous giggle. "I've been thinking about this. I really have. I even came in here mostly to ask for a referral, you know, to find out where to go to get one. An abortion, I mean. But every time I tell myself that's what I intend to do, I just... I just know that's the wrong thing to do. I just know it," she repeated. "It presses on my heart."
"Vicki," Marla leaned forward, "it's okay to want to keep your baby. That's a good thing, not a bad thing. I'm certainly not going to talk you out of it. But we need to discuss a few things. It will be hard, being pregnant, a single mom. Do you have any family here?"
Vicki shook her head. "No. I grew up here. But my folks are divorced, they've both moved out of state. I dunno why I stayed, I guess I just like it here."
"No brothers or sisters? Uncles or aunts?"
"No. Just me."
"How about your boyfriend?"
"He's the one who said I should have the abortion. I... " Vicki made an empty gesture with her hands. "I don't think he's gonna want to help very much. We're not very close. I don't know. I guess I don't know a lot of stuff." She gave another nervous little laugh.
"Where do you live?"
"With him. Up on 116. But... I think I'm going to be moving out."
"Where?"
"I dunno." Vicki had been looking at the floor; she suddenly looked up and smiled, but a genuine, gently mirthful smile. "Like I said, I guess I don't know a lot of stuff." Then, without really thinking about it, she blurted out, "Marla, do you think I should have an abortion?" Why am I asking her this? She's a complete stranger. But then, maybe it's okay. She's a doctor, after all, or a nurse midwife. Vicki wasn't real sure of the difference, but figured it didn't matter much.
Marla smiled back. "Vicki, I'm not supposed to make a recommendation one way or the other. I don't know about the legalities of it, but I know that the policy of this office is we're supposed to be neutral, and help with whatever choice you make. I'll tell you this, though." She looked slyly at Vicki. "I'm about to be a grandmother."
"You? You don't look that old. I mean..." Vicki looked a little embarrassed.
"That's alright. And, y' know, one's definition of old changes as one gets older." Marla thought about this for a moment. "Anyway, I'm about to be a grandmother, and my daughter - she's back in Massachusetts where we came from, my husband and I moved up here not too long ago after he retired - she's not much older than you."
"Well, that's nice. Congratulations." Vicki gave a little shrug, and looked at the floor. Why is she telling me this? I could care less.
"Vicki." Vicki looked up. Marla was still smiling slightly. "Vicki, I'm very thankful my daughter is having her baby, even though she's not married." Vicki raised her eyes. "Sure, I raised her to not fool around before marriage, my husband and I are pretty old fashioned that way. But she did, and now she's pregnant. You know what she told me, Vicki?"
Vicki shrugged, but she was listening.
"She told me she was sorry she made a mistake. But, she wasn't going to make the mistake worse, that she wasn't going to punish her child for the mistake she made by killing it. That's exactly what she told me"
"What's she gonna do?"
"We're not sure yet. She hasn't ruled out the possibility of adoption. She's just not sure yet. But, she says she knows she's not going to have an abortion, and the farther she's gone in her pregnancy, she more sure she's become."
"That's how I feel. The more I think about this, the surer I become. I just can't bring myself to have the abortion, even though it seems like it's the easier way. Having the baby is so frightening. I feel like I'm so alone." Vicki sighed. "I don't feel like I'm getting anywhere with this."
"That's because you're undecided as to what you want to do. I know it's a hard decision, and things seem pretty overwhelming right now. And, from what you've told me, you are pretty much alone. You're being realistic."
Vicki gave a wry little laugh. "So, being realistic, I should have the abortion, and get on with my life."
"No," Marla shook her head. "No, that's not what I mean at all. I mean this: you have a new life growing inside of you. You are responsible for that life." The midwife thought for a moment about her employer's "neutrality" policy. Well, she thought, it's not very specific. "You have some difficult decisions to make, decisions about the fate of that new life. You need to face your reality, Vicki. That's not the same thing as saying you should have an abortion."
Vicki contemplated the cracks in the linoleum. Her legs started swinging.
Marla spoke softly. "You don't need to make this decision today. Vicki, do you pray? Do you go to church?"
"Naw. My folks weren't religious."
For a moment Vicki thought she saw something pass across Marla's face. Sadness?
"Well, you need to think about things really carefully. You have time. If you decide to keep the child, we can follow your pregnancy here if you want, and when it comes time for you to have the baby, I or Dr. Marden will deliver you. If you are thinking about adoption, we can discuss that, and put you in touch with some agencies that can tell you more about it. If you decide to abort the baby," the midwife's tone was neutral, "we can tell you where to go to do that. But Vicki," Marla looked at Vicki with kindness and a hint of sadness in her eyes, "I hope you keep the baby."
Vicki was silent for a moment. Then she slid off the table. She looked at Marla again. "Thank you," was all she said, and then she left the room
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Copyright 2007 Timothy P. Collins
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