49. Three Stories

Juanita is 17, pregnant with a second child, struggling as a single mother, working and trying to finish high school. I see her for an ultrasound to precisely date the pregnancy, important if she terminates.

Jane is 34; an 18 ultrasound showed a "Chiari II" syndrome, which means injury to the primitive brain due to a malformation of the skull (20% of these babies die in the first year because of respiratory failure; it's the primitve brain the controls breathing. There is also an injury to the spinal cord in the lower back; this child will never walk. She is hopeful that surgery within a few days after birth will release pressure on the brain.

Jasmine is 22, a life-long diabetic who experienced an epidode of diabetic keto-acidosis when she was a few weeks pregnant. Diabetes means that blood glucose can't enter cells; instead it stays in the blood, hence the high sugar levels of diabetes. The brain needs glucose but is the one organ that can't store it, so fats are broken down with ketones as a by-product. High levels of ketones are life-threatening. The risk of birth defects is high when DKA occurs in the first trimester.

Three women with extraordinarily difficult decision. Why should some old white guy from Ohio make this decision for them?