This Is What It’s Like to Terminate a Pregnancy in Your 40s

The pregnancy was unexpected—as were my conflicting and complex emotions as I navigated the healthcare system through miscarriage and a medical abortion.

The pharmacist leaned towards the Plexiglass and rolled a pill bottle in her latex-gloved hands.

“So, you should definitely take this with food,” she said. “There’s a chance of stomach upset otherwise. I need to confirm, however—there’s no chance that you could be pregnant?”

I stared at her sharply. “I am pregnant. My doctor prescribed this to terminate the pregnancy.”

“Oh,” the pharmacist said. “It’s not for your stomach ulcers?”

No, I most certainly didn’t have stomach ulcers. After three miserable weeks of repeated ultrasounds, blood tests and unhappy consults with my doctor, it was clear that I had gestated a non-viable pregnancy. Now, I had finally obtained a prescription for misoprostol, which is one-half of the medications used to induce a medical abortion. It induces cramps to empty the uterus. (It is also prescribed, I noted icily to the pharmacist, as a vaginal suppository, so unlikely to upset the stomach.)

The other, mifepristone, is generally taken first, to block the hormones that sustain the pregnancy. Given the current American political climate, after the overturning of Roe v. Wade—including the fact that earlier this year, a Texas court brazenly overruled the FDA’s approval of mifepristone, describing it as “starving the unborn human”—this duo of medications has been in the headlines lately. But like all good Canadian feminists, my rage at American developments was edged with uncomfortable gratitude. How lucky I am to live in Canada, I told myself, where terminating a pregnancy is just a normal part of our healthcare, I thought.

Cue the unexpected pregnancy. I was 43 years old and, at that point, I had been pregnant twice, with two excellent children—now teenagers—to show for it. At 15 and 17, respectively, they represented pregnancies borne of a different epoch. I was in my 20s last time, and pregnancy, as a concept and an experience, had been uncomplicated for me. I expected this one to be the same, even as I felt surprised and a bit daunted by the prospect of having a young child again.

It’s only now, looking back, that I know how naïve this assumption was.

This time, I was told mine was a geriatric pregnancy. The risk of complications was high. Yet I expected the ultrasound at eight weeks to be routine, even so. My partner and I drove to a clinic on the outskirts of town, where very pregnant women sat in the waiting room, wincing with full bladders. When it was our turn in the darkened ultrasound room, I quickly noted the mood growing grim. The young ultrasound pushed her screen away from my view. Unnerved by her obviously distressed expressions and reactions, I engaged idiotic small talk. Mostly, this consisted of inadvertently pointed questions probing her discomfort. “Will we get to hear the heartbeat?” “Why isn’t the screen that I can see turned on?” “Does the doctor come to talk to everyone after they review the scans?” She wouldn’t say much.

(Related: Inside the Battle for Better Abortion Access In New Brunswick)

Soon enough, the doctor did come out. I was back in street clothes and feeling fraught. The lights were still down. My partner sat in a chair in the shadows, just a little too far away to hold my hand. The gestational sac was measuring small, the radiologist announced, and there was no heartbeat. I must have calculated the date of my last menstrual period wrong. We should go back to my family doctor and have my hCG levels monitored. Come back for another scan in two weeks.

“Is there,” I ventured, “a chance that the pregnancy might be nonviable?” Mine, as I was constantly being reminded, was a geriatric pregnancy. I had read the geriatric stats—this was not exactly unforeseeable.

“I didn’t say that,” he snapped. I should keep a positive attitude, he advised.

As we left the examination room, the tech cryptically remarked, “I’m sorry I can’t say more.”

“What does that mean?” I asked my partner in the car, as a rainstorm sent wet rivulets down the windshield. “That she saw something she couldn’t say, but that the doctor confirmed? Or that she knows something the doctor doesn’t?”

I called the walk-in clinic we’ve been using as our family doctor about the need for more testing. (I was still waiting for a referral to my OB-GYN to go through.) Like the radiologist, the walk-in doctor was upbeat. This didn’t mean anything, necessarily, he said. Plenty of pregnancies start this way and end with a healthy baby. But he never asked a basic question: how much I wanted to be pregnant in the first place.

My children were not young anymore, and my partner’s son was 15. It would be, as other women my age put it, “quite the lifestyle change.” But the rest of the world preferred only to offer their congratulations. For all the doctors and nurses and ultrasound techs I encountered, it was inconceivable that someone like me, who had spent most of her adult life as a single-parent caregiver, might feel ambivalent about being tethered to a small human again. And no one ever asked me how I was doing.

I learned that unless you are marching off to the abortion clinic, the medical system assumes you are ardently pro-pregnancy.

For the next two weeks, I had my blood drawn every other day to monitor whether my hCG levels were rising, falling or plateauing. And every other other day, I got test results. My phone would ring with my doctor’s number flashing across the screen, and I would scurry to an empty boardroom at work, close the door, and stare out the window onto a bleak, late-winter Edmonton streetscape as I braced myself. And yet, the message was still—over and over again—that I should just keep waiting. This isn’t totally out of the norm, they would say. It might still turn out okay.

For the follow-up ultrasound, we went to a different clinic. The tech working this time was in her 50s. This was a relief. I assumed that she was inured to all potential horrors of her profession.

“Just so you know,” I announced pre-emptively, “we’re not expecting good news.” I talked openly about wanting certainty more than a positive outcome. I was okay with it, I claimed, with forced sunniness. But inside, I resented that I felt more responsible for the tech’s reactions and emotions than my own.

She nodded, but as the scan progressed, her face saddened. The clinic radiologist also came to chat, as we expected, and let us know that they still couldn’t detect a heartbeat.

“Okay,” I said. “I know this isn’t exactly your area of expertise, but can I conclude this pregnancy is not viable? If so, I would like to ask my doctor for a termination.”

He hesitated. It wasn’t his area, it was true. But this radiologist also insisted that I be hopeful. It hadn’t quite been two weeks since the last ultrasound. We shouldn’t have come in so early, he said.

At the next appointment with my family doctor, I asked, point-blank, for a medical termination.

“Ah,” he said, squeamishly. “I’m not sure I’m allowed to do that.”

“But abortion is legal. Why wouldn’t this be permitted?”

“I’ll have to consult my colleagues. I’ll get back to you.”

Spoiler: He did not get back to me.

So, I remained pregnant. My hCG levels had plateaued, but they weren’t falling either. I learned later that medically, this was a “silent miscarriage,” where the fetus is no longer viable but the body continues to produce hormones to sustain the pregnancy. Unmanaged, this can put women at risk for haemorrhage and infection that can lead to sepsis or death.

Faced with the loss of a pregnancy I wanted—however ambivalently—and frustrated by the lack of clarity from my healthcare providers, I stopped being so careful about little things. I ate runny egg yolks. I went for runs and ran until I was breathless. I was empty. I was not empty. In fact, I was still 15 pounds above my normal weight. None of my clothes fit—save for, cruelly, one pair of maternity jeans that I wore to work every day.

After waiting for what felt like ages, I got my long-awaited OB-GYN consult. I love my OB-GYN (and can never understand why it’s so hard to see her), so I was relieved to finally tell her my tale. “Listen,” I confessed. “I’m okay with a 93 percent chance this isn’t going to work out. I don’t need complete certainty. I just want it to be over.”

Unlike the other doctors, she laughed.

“Oh no,” she trilled cheerfully. “This is absolutely not viable. It’s zero percent. Zero. Don’t feel bad.” I trusted her and felt immediate relief from her certainty and pragmatic reaction.

But I also felt bad for women whose pregnancies were being overseen by the other doctors I had left behind—who would never get this kind of support. In fact, I felt scared that they might not receive the care they needed.

My wonderful OB told me that I had three options: I could simply wait; we could terminate medically (with my hormone levels plateaued, just misoprostol would be necessary); or we could schedule a dilation and curettage (which is a day surgery). Waiting could take weeks, she said. It carried an increased risk of haemorrhaging and infection when I finally did miscarry. (None of the doctors touting prolonged hopefulness had mentioned this.) I could also have the surgery, but that involved general anaesthetic. She thought misoprostol would be easiest and safest. I would be supervised by the Early Pregnancy Assessment Program at the Lois Hole Hospital for Women in Edmonton, which supports women going through pregnancy loss. I was to take the pills at home, but they would call me periodically to ensure I was safe.

So, the next day, I paid for the medication. It was surprisingly cheap. I did wonder, as I left the pharmacy, why I would be mistaken for a person with ulcers. But overall, it was an unpleasant but not insurmountable weekend.

Still, all the nurses who gently oversaw my use of misoprostol assumed it was a planned pregnancy. The grief counsellor I was assigned through the pregnancy loss clinic did, too—absolutely every last person assumed a particular pro-life, ready-and-willing-to-have-this-baby trajectory. There was no space for my own terrors — about a life spent caregiving, about the heightened risks of birth defects as an older mom, which could mean carrying a child who would ask even more of me than my previous children had. By the end of the ordeal, the attitudes and assumptions felt less suffocating, but still utterly oblivious.

Later, a friend desperate for children told me about miscarrying donor-egg twins in an emergency room. She was in awe that I had had the privilege of a grief counsellor to listen to me cry and to suggest avenues of mourning she would have appreciated, but that I had felt were inane or misplaced, like naming “the baby.” My friend had had no such support, while her loss, to me, seemed much larger and vital. This was additionally confounding and distressing. The common thread, for both of us, is that we were not offered the support we needed.

My grief was complicated. I felt so very sad, but I also felt that I had been betrayed by a perinatal system intent on treating all women as if we had all chosen pregnancy and were, surely, enthusiastic child-bearers. A specialist doctor shouldn’t have had to swoop in in order for me to feel seen. All care providers should be willing to set their personal ethics aside and prioritize the mother’s mental and physical health.

The lack of recognition for me and my feelings about the pregnancy made me feel lesser-than, or like a vessel and nothing more. But it also meant I had been temporarily pushed into a higher-stakes terrain of risky medical complications, where I could have suffered even more—and dangerously so.

Next: The True Cost of an Abortion in Canada, According to an Expert

Originally Published in Best Health Canada