Transcript
Into America
The Right to Life
Trymaine Lee: Please be advised, this episode contains some graphic moments, as well as a discussion of suicidal ideations.
What does it mean to have the right to life?
For some, it means putting an unborn fetus above all else, even if it could mean ending the life of the person who created it. That contradiction, that space between whose life is worthy of saving and whose isn’t, has been caught up in a political firestorm for decades.
Women are already risking their own lives to bring life into the world, and this is even more true for Black women. According to the Centers for Disease Control, Black women are three times more likely to suffer from complications with pregnancy and childbirth than White women, and they’re more likely to die or nearly die from these complications, regardless of income.
You might remember a few years ago when Serena Williams shared her story of nearly dying after delivering her baby girl.
Archival Recording: She says holding her baby the first time was an amazing feeling, but the next day, everything went bad. Serena had trouble breathing. She knew it was a sign of blood clots she had suffered before. So she guided her doctors on how to save her life.
Lee: Black women are more ignored by health care providers, face barriers to prenatal treatment, and they’re often carrying the toxic burden of intergenerational trauma that makes a healthy pregnancy more difficult to achieve.
Now, doctors and advocates say this disparity is going to get even worse.
Archival Recording: Supreme Court overturning Roe. Abortion is no longer the law of the land. It’s up to the states.
Archival Recording: The landmark decision from the United States Supreme Court, which has ended constitutional protections for abortion that had been in place for nearly 50 years.
Lee: Since the Supreme Court overturned Roe v. Wade, 14 states have made abortion illegal at any stage of pregnancy, with very few exceptions made. Georgia only allows it in the first six weeks of pregnancy, when most people still don’t know they’re pregnant.
And while the Supreme Court has upheld broad access to the abortion pill, mifepristone, for now, conservative lawmakers across the country are pushing to further clamp down on reproductive rights. And that means more chances for things to go wrong. Within these bans, there are exceptions where an abortion can be performed to save the life of the mother, but the situation must be dire before a doctor can step in.
Archival Recording: Laws in Texas ban doctors from performing abortions, except when a medical emergency endangers a person’s life or major bodily function. Those who violate the law could face up to life in prison.
Lee: The vague language around these laws and the subjectivity of what dire even is has left doctors confused, and pregnant people, especially Black pregnant people, in danger.
People like Anya Cook.
Anya Cook: I was in the hospital for six days. Yeah, six days, because I kept bleeding.
Lee: Anya’s home state of Florida currently bans abortion after 15 weeks with nearly no exceptions. That 15-week ban is in effect even as it’s being challenged in the courts. And if it’s upheld, there’s an even more stringent law waiting in the wings as Republican Governor Ron DeSantis recently signed a new law that will reduce that window to just six weeks.
Cook: They are really trying to kill us. And at this point, they are really trying to kill us.
Lee: I’m Trymaine Lee and this is “Into America.”
Black life is fragile, and strict abortion bans are putting even more lives at risk. Today, the story of one woman desperate to become a mother who nearly lost her life when she was turned away from the hospital after serious complications with her pregnancy, and an OB-GYN, and why these stories are only going to get worse.
Cook: Always? I can’t think of a time that I wasn’t thinking about being a mom. Always. Yeah.
Lee: This is Anya Cook.
Cook: A mother does everything and anything for her children. Simple as that. You have to protect their well-being. You have to grow them to be responsible, kind, loving people in this world because we need more of that.
Lee: How much of that has to do with your relationship with your own mother? Like, what was the impulse for that? It just was always there?
Cook: Yeah, always. I’m the oldest daughter of six. So, well, I would say seven, there’s seven of us, really. But I have always had a mothering, nurturing characteristics, and I want to be a mother. That is, I literally left my career just to become a mother.
Lee: And his family came to the US from Jamaica when she was just 6. And South Florida has been her home ever since. It’s where she met Derick, the love of her life, and the two got married in 2019. They started trying for a baby exactly one year later.
My man couldn’t get a year and a day? He got a year and a week?
Cook: No, I was not going to give you a year and a day. We’re going to do this now. At that point, I was like, OK, I’m like, I’m over 30-years-old. I need to get this done.
And sure enough, we got pregnant that first time. And —
Lee: Wow.
Cook: — we were so, so lucky. And that happiness that we enjoyed in that moment, man, I wish I could bring myself back to that.
Lee: Because the happiness didn’t last long.
Cook: I had the miscarriage, I would say, about two weeks later. And for me to be pregnant for such a short amount of time, I was like, OK, you know, I wasn’t expecting to not have that baby. I was so shocked, but I kind of felt it.
And it started, little did I know, a long line of miscarriages. And as they started to progress and as each one happened, I just became so numb to it. Yeah, so, so numb.
Lee: How many miscarriages have you had?
Cook: OK. So I think this is the first time I’m going to say this out loud to anyone besides my family. I’ve had 17 miscarriages in two years.
Lee: Wow.
Cook: Yeah.
Lee: One in five pregnancies end in miscarriage, but only half a percent of women trying for a baby experience three losses in a row. And for Anya to go through 17, it was devastating.
So she started making some changes. The biggest, she quit her job as a property manager, which could be really stressful. She and Derick decided it was just too much. She also looked for a support network.
Cook: So I went on Facebook like everybody does when they’re trying to see if they’re the only person that’s going through this. And I started searching. The first group I joined was the Black Woman’s Fertility Group.
Lee: Anya felt it was important to talk with other Black women going through the same issues. They could just understand each other. That’s where she met Shanae, another woman with Jamaican roots in South Florida who had also had a series of miscarriages.
Cook: So when I saw Shanae made a post, for some reason, I could just tell just by the way she was speaking in the post, I was like, no, she’s Jamaican because that’s where I’m from. So I messaged her and I was like, lady, please take time with the people them. Take time with them.
And she started laughing and she’s like, girl, they’re not understanding. I’m trying to just ask a simple question. And I was like, just hold on. I got you.
Lee: Anya and Shanae became fast friends and they both decided to do IVF, in vitro fertilization. Sometimes it can help people get through a pregnancy without miscarrying. They ended up getting implanted within a few weeks of each other back in August.
Cook: I just knew it was going to work. I had never had a pregnancy that got that far along to where I heard a heartbeat. And when I tell you that moment for me and my husband, it was amazing. I will never forget that moment. That was the first time I felt like I had the joy back, through all the miscarriages that I had. I felt like, OK, I think I might be actually having this baby.
Lee: They found out they were having a girl and started calling their unborn baby, Bunny. But all those earlier losses still weighed on Anya.
Cook: Pregnancy after infertility is already nerve wracking no matter how many miscarriages you had. And when I tell you it was so hard to be positive, it was racking my brain every single day. I was fighting myself every single day, every single week.
When you count and you say, OK, here’s nine weeks, here’s ten weeks. Oh, 12 weeks, 13 weeks. Oh, man, I’m out of the first trimester. All right. Boom. I’m good, right?
So that 15th week, that Sunday, I woke my husband up and I looked at him and I said, baby, I feel like I want to go look at cribs today. We went looking at Pottery Barn cribs and Restoration Hardware cribs.
And it was such an amazing day. My belly was showing. I had a nicely cute little outfit on with my sandals. I saw other pregnant women. It was a beautiful day in South Florida.
Lee: A few days later, on December 21, Anna and Derick shared the good news with their families. They made a whole day of it, going to support their knees in a local parade and had dinner at TGI Friday’s. But then as they left the restaurant and headed out to the car, Anya felt like someone had thrown a bucket of water on her.
Cook: I said, babe, for real? Somebody threw water on me. So, he said, babe, there’s nobody behind you, and I have nothing in my hand. So I looked at him and I just in that moment I said, OK.
And I looked at my hand and I just started feeling like a gushing sensation coming out of me and every step I took, I started feeling water coming out of me.
Lee: They rushed to the hospital, but Anya had to wait 45 excruciatingly long minutes before she got taken back for an ultrasound. She was 16 weeks pregnant.
Cook: We went back downstairs and the doctor came in and I said, is my baby OK? He said, I’m not sure, sweetie.
I said, what do you mean you’re not sure? Does she have her heartbeat? And he said, yes, she still has her heartbeat. I said, OK, so she’s going to be OK, or what is happening to me because I don’t know what’s happening.
And then he explained to me, he said, it looks like a tear. And I said, a tear? He said, what you’re having is a premature rupture of your membrane. I said, what is that? So he said, your water broke.
Lee: The doctor diagnosed Anya with a condition called PPROM, the preterm premature rupture of the membranes. Like the doctor said, it’s when your water breaks. But before 37 weeks, when the fetus is full term, it’s nearly impossible for the fetus to survive without amniotic fluid. So, if the mother doesn’t go into labor on her own, generally, an OB-GYN will induce labor.
But when PPROM happens before 23 weeks, generally considered the marker of viability for the fetus, the chances that the baby can survive outside the womb are extremely low.
Cook: I said, OK, so what does that mean? Is she going to be OK? And he said, she is not going to be OK. You’re going to deliver her.
I said, so what? When am I going to deliver her? And he said, we’re not sure it can happen tonight or it can happen tomorrow.
So I looked at my husband and I said, baby, I’m going to have to stay here. So the doctor said, no, you’re not staying. You’re not staying at the hospital.
Lee: Where are you supposed to go?
Cook: That’s exactly what I asked him.
Lee: Right.
Cook: When he said that, I was so anxious, like I didn’t hear him at first.
Lee: PPROM isn’t only dangerous to the fetus. It’s also dangerous to the woman carrying it. There’s a substantial risk of infection and hemorrhage. That’s why it’s common practice for OBs to offer termination if the pregnancy is under 23 weeks.
But the danger doesn’t often present itself right away. And Anya didn’t get the option to terminate.
Cook: I said, hold on, let me understand this. So my water broke. I’m a whole pregnant woman and I’m in a hospital. I’m about to deliver this child.
And you’re telling me I can’t deliver her here? He said, no. I said, so you can’t induce me? He said, no.
I said, why? Oh, damn. Let me guess. Roe v. Wade?
And he told me, and he straight up told me, he said, I’m so sorry, sweetie. If I induce you or if I admit you, I have to prove to the law that I was right.
And you are over 15 weeks of pregnancy. I will lose my license. I could possibly be arrested and the hospital will definitely be in trouble.
Lee: Before this moment, you find yourself in this really precarious, dangerous position. Had you considered the law and how it might possibly affect you?
Cook: Of course. Of course. I had to consider that I was a woman that was going to get pregnant at some point. I had to consider that.
And at that point, because I live in Florida, my governor decided that he was going to not allow abortions after 15 weeks. Why at that point, now that I’m thinking about this, this is this is really twisted and demented at that point, why am I having to say to myself, Lord, if I am to miscarry this baby, let me miscarry before the 15th week or let something happen before the 15th week all because of somebody else I never even met?
Lee: So even if a doctor wants to do what they believe is the right thing, by the law, they restrict and they can face all of that.
Cook: Correct. So at this point, the doctors, they’re held by their necks as well. They have no options. You can’t, and you always hear about this oath that doctors have to save a life. Their responsibility is to the life of their patient.
If I’m here as your patient, you’re telling me there’s a chance that I might die and you’re still going to make me walk out of here?
Lee: Without options, Anya and Derick were sent home alone. After so much loss, this was almost too much to bear.
Cook: At that point, I had already accepted that I was going to die.
Lee: You really truly, felt that you were going to die?
Cook: Whether it was from an infection, whether it was from delivering this baby and not having medical care at that point, or whether by harming myself, I just knew I was because this can’t be happening to me. This can’t be happening to me.
And I had a hair appointment that next morning. Now, a lot of people won’t understand this, but I have locks. And my hair is way past my knees. I don’t want to put that pressure on my mom to go figure out how to find somebody to do my hair after I’m dead from such a traumatic loss.
So I went to the hair salon. She groomed my hair, which took about three hours, and right before I was about to go sit under the dryer something just said go use the bathroom.
Lee: That’s the moment that Anya went into labor.
Cook: So in the bathroom and I sat down, and I heard my grandmother’s voice. And she said, Annie (ph), you’re going to have to push. And I said to her, OK. So I put my hands on my knees, and it wasn’t even hard to do. I just literally just felt my body just release and just woo (ph). And I heard my own daughter hit that water.
Lee: Anya called Derick, who was waiting in their truck outside. Derick rushed in, shielding her from what was in the toilet. And as he dialed 911 and Anya called her O.B., another person stepped up to help.
Cook: A nurse just so happened to be in that hair salon and she ran to the door. And when she looked at me and she said, I’m here to help you. And I said, I’m so sorry. She said, don’t you apologize to me.
This is a Black woman. She said, don’t you apologize to me. I’m here to help you. I’m here for you.
Lee: The nurse noticed Anya was losing a lot of blood.
Cook: So then the nurse comes in, she grabs a bunch of paper towel and she puts it under me and she says, Anya, you’re bleeding a lot. I said, I know. She said, what I need you to do is I need you to tense up your body. Hold that blood in if you can. Hold it.
Lee: Finally, the ambulance came and the paramedics rushed Anya to the hospital.
Cook: I’m in my second emergency room in two days, and I’m going to tell you what I need from you, because my daughter’s already gone to this point, and now I’m bleeding out. What I was exactly afraid of the night before is exactly what’s happening right now.
Lee: They took Anya to surgery immediately. The next day, the doctor told her that she had lost half the blood in her body.
Anya later learned the very same day that she delivered Bunny, her friend Shanae had also been diagnosed with PPROM. And just like Anya, Shanae was also stuck struggling to get help. Here’s Shanae from an interview on MSNBC with my colleague Katie Phang.
Kate Phang: Shanae, you also had PPROM.
Shanae Smith-Cunning: Yes.
Phang: The same condition, same situation where the hospital didn’t help you.
Smith-Cunningham: On the same day.
Phang: On the same day, as your friend Anya.
Smith-Cunningham: On the same day as my friend. Yeah.
Phang: And the doctors wouldn’t help you either, right?
Smith-Cunningham: Yes. My daughter was inside of me for 10 days. I went there three times and a third time has (ph) been called Memorial Hospital. And it was a different conversation. And I thought, OK, at least they would accept us.
When we went there, it was the same thing. And at that time I was four-centimeter dilated and they sent me home.
Lee: The fact that both Anya and Shanae had complications from PPROM, it’s not a coincidence. Black women have the highest risk of PPROM. They experience it at twice the rate of white women. So with termination off the table for many women who suffer PPROM during their pregnancies, Black women are more likely to suffer the dangerous consequences from these strict abortion bans.
How much of this, and I know it’s layered and complicated, how much f this do you put at the feet of this law and the people who support this law and the inability of the House to do anything?
Cook: One hundred percent of this because at the end of the day, my husband is not a medical professional, and he wouldn’t know, nor anybody would have known what to do in that situation. If that nurse was not there to tell me to tense up my body, the ambulance, the paramedics told me at that moment, ma’am, if you can’t make it to Coral Springs, you are bleeding out.
If that doctor would have admitted me the night before, Trymaine, I would have been OK. I would have been OK.
I would have lost my daughter still. I would have had some kind of complication, but I would have been OK. If that law was not in place, that doctor could have taken care of everything that first night, and I wouldn’t have to be in the hospital for six days.
Lee: Six days after that you were in the hospital for —
Cook: I was in the hospital for six days. Yeah, six days because I kept bleeding. Oh, man. I just don’t understand. They are really trying to kill us. They are really trying to kill us.
And at this point, I don’t even know. I’m so happy I’ve never met this Ron DeSantis because if I ever met him, I don’t know what I would say to this man. I don’t know what I would do to him because you made a decision that almost killed me.
Lee: When we come back, an OB-GYN on disparities in maternal health and why these abortion laws are making matters even worse.
Lee: Dr. Henderson, how are you doing?
Zsakeba Henderson: I’m doing very well, thank you.
Lee: Dr. Zsakeba Henderson is an obstetrician-gynecologist and an expert on maternal health. She’s also my cousin.
Or as I like to call you cuz. So what’s up, cuz?
Henderson: I’m great, cuz.
Lee: Cuz, that’s what’s up.
This is very cool. I’ve been waiting to have a conversation with you about all this stuff for a long time, so I’m glad we could finally make it happen.
Henderson: I am, too. This is so important.
Lee: Keba lives in Georgia, which bans abortion after six weeks into a pregnancy. She doesn’t practice medicine anymore. She’s on the advocacy side now as a senior advisor for the National Institute for Children’s Health Quality. Her work focuses on improving the health outcomes of mothers and babies throughout the country, especially for Black families.
But she spent years as an OB-GYN at Morehouse School of Medicine in Grady Hospital in Atlanta, working with Black women and delivering their babies.
Henderson: To have someone who looks like you is so important. We have evidence that shows that when you have a clinician that looks like you, your outcomes tend to be better.
Lee: She also spent some time in a public health program of the Centers for Disease Control in Atlanta, where she focused on maternal health and mortality on a bigger scale.
Henderson: And when I initially started my work at CDC, part of my job was working as part of the pregnancy mortality surveillance system and literally reviewing hundreds of death certificates of all the mothers in our country who died.
Lee: Seeing all those death certificates changed Keba. The magnitude of what she was seeing convinced her to leave her practice and become an advocate.
Henderson: And it really opened my eyes to the reality of how the numbers translate to real people. Like, it’s one thing when you see the statistics. It’s a whole other thing when you’re looking at these death certificates and you see these individual people, people who had lives, people who had families, you know, who are mothers, sisters, daughters, someone’s partner. And it makes it very real.
Lee: I asked Keba about what happened to Anya Cook, how she suffered from PPROM, early water breaking at 16 weeks. Keba says Black women are about 50 percent more likely to have any kind of pre-term birth from PPROM or other conditions that also disproportionately impact Black women, like preeclampsia.
So, Keba has treated many women in Anya’s situation where their water breaks before the baby can survive outside the womb, and she would usually be able to give them three options. One, induction, where they administer medication that starts labor; two, an operative termination, where they surgically removed the fetus. Because this is happening before the fetus is viable, both of these are technically abortions.
The last option, the only one Anya was given, is called expectant management.
Henderson: Or basically just waiting. So, waiting for the mom to go into labor, waiting for her to pass the pregnancy on her own. And the problems with that is that only about 50 percent of mothers go into labor on their own within a week.
And then there is an increased risk of potential complications. They are increased risk of infection and increased risk of severe bleeding, and as much as possible, there are also complications mentally. Like we often discount the mental impact and the trauma of having a baby that will not survive.
So when considering these options, you know, we have to consider the impact mentally that having a non-viable pregnancy would have on a mom.
Lee: So in one hand, if a woman finds herself in a situation of the three options, one could be surgically terminating. The other is giving birth to a stillborn child. That sounds like an incredibly difficult set of options there. Have you had to face that with actual patients? Have you had to give them that option?
Henderson: Absolutely, yes.
Lee: Wow.
Henderson: And it’s very difficult.
One of the most memorable experiences of a patient that I had that almost lost, mom survived, her baby did not, actually happened when I was pregnant with my first daughter. And I can’t help when I, you know, do this work, I can’t help but think back on that.
It was very traumatic. And being in a situation where potentially losing a mom and actually losing a baby and putting myself in that situation, what if this were me or someone else that I love and it becomes very personal.
Lee: It’s already a difficult and painful situation. But now these strict abortion laws across the country are taking away two of these options. And as Anya and Shanae’s cases show, there are dangerous consequences.
Henderson: So the problem with the laws is that the laws are generally around the fact of whether there’s a heartbeat. But although the fetus may be alive, it’s previable and, especially in cases where this very early gestation, the chances of survival are pretty much nil.
So, we’re forcing patients to the only option of expectant management, which carries a higher risk than a procedure to terminate what’s already inevitable and to, you know, help a mother move on and avoid potential risks.
And the other gray areas and nuances around the exceptions, around when something is at risk or threatens the mother’s life, we’re along in a (ph) slippery slope. As a clinician, can I make the decision that this threatens a mother’s life? Is it if she’s 30 percent more likely to die, 50 percent, 70 percent, 100 percent?
Lee: Yeah.
Henderson: You know, there isn’t, you know, some sort of calculator that doctors have that say, oh, this woman is 50 percent likely to die now, so I need to intervene.
Lee: It’s all subjective anyway.
Henderson: It’s very subjective. And you can wait to a certain level and one mother may develop a fever, and it’s very clear that she has infection and you need to deliver. Others, it may be more, more subtle. And then by the time you respond, you’ve already gone over the cliff and she’s sick and has septic and at risk of dying.
And it’s unfortunate that, you know, death should be the only goal that we’re trying to avoid. And it puts clinicians in a very difficult position and puts them at very high risk of having to depend on the judgment of the legal system that has no understanding of the clinical implications and the nuance around the decisions that have to be made.
So many clinicians are put in a very difficult space. And there are some legislators that are saying that the law is clear and it’s the doctors that are trying to politicize this and just not treat patients as a political thing. And that’s not true. It’s like docs are trying to do the best that they can within the letter of the law, which is very vague and not black and white.
Lee: Could you imagine if you were practicing, and you have a young expectant mother who’s going through PPROM and you know the choices that would help save her life or make her life difficult or pose a greater risk to her life, do you have a sense of what you might do?
Henderson: Yeah, I have to admit, I tell my husband this all the time. I say, honey, you know, I would be in jail.
Lee: I love you and the kids, but mama’s getting locked up. Yeah.
Now that you know you’re on the advocacy side, you can be vocal and intentional about what you’re doing. Do you feel heartened by the work that you’re doing and the work that so many of your counterparts are doing advocating on behalf of Black women’s health?
Henderson: Absolutely, especially this whole reproductive justice movement. I think it’s very powerful helping, you know, really return the power and autonomy back to mothers. There needs to be more accountability with our health systems. There needs to be more accountability for the disrespect and mistreatment that patients receive.
And there needs to be more accountability on listening and trusting that women know their bodies way better than any clinical provider ever can. And if something is wrong, something may be wrong, and we need to trust them and listen to them and make sure that they get the attention that they need.
Lee: That’s advice that Anya is definitely going to take as she keeps fighting for herself and for Bunny.
Where do you go from here? I mean, are you still trying to get pregnant?
Cook: I am. I am. I will be having another IVF transfer very, very soon. I’ve opened myself up to the world at this point because I will not be quiet about this. What happened to me can possibly happen to me again.
And I want to make sure that everyone knows that this can possibly happen and that I want my baby. I’m fighting to have my baby. I didn’t go in there wanting to have an abortion. I needed an abortion to save my life.
I’m here fighting. I’m here fighting. And I want the world to see.
Lee: What has gotten you to the point where you were contemplating ending your life to now standing on your feet and fighting to go through this process again? What got you out of that place? What was the difference? Because you almost, you know, after that, you had that thought and then it almost killed you anyway.
Cook: Right?
Lee: What got you out of it?
Cook: Right? When I tell you, my husband, you can’t look at a man like that, to look at him and see what he’s been through for me and prayed the way he has prayed for me, bargain his own life to God for me, and then take your life?
I love my daughter. I love her and I miss her so much, but I don’t need to die for her. I don’t need to die for her.
And I felt her say that to me in so many ways because she was such a fighter. So what I look like not fighting for her. I have to fight. That’s it.
Trymaine, when I tell you my daughter was a fighter, she is still fighting. And I can’t let her die in vain. I have to fight. I have to fight, and I have to fight with all hope and joy.
Lee: There is joy. There’s joy in this. This is —
Cook: There is joy. There is so much joy in this. There’s so much joy.
I’m sitting here talking to you. I wasn’t going to be here. You understand? I was not supposed to be here.
And God said, not today. There is bigger out there for you. You need to stand up for these women.
So I’m not going to stop. They can’t shut me up about it. And I will continue to fight to have my baby.
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“Into America” is produced by Isabel Angell, Allison Bailey, Mike Brown, Aaron Dalton and Max Jacobs. Original music is by Hannis Brown. Our executive producer is Aisha Turner.
I’m Trymaine Lee. We’ll be back next Thursday.