As a Mom and an Abortion Provider, I Knew What Was at Stake on November 8th

Maryl G. Sackeim, MD, MS

“Mommy, when are they cutting out your baby-grower?” my 6-year-old son asked me one morning after climbing into my bed, groggy and rubbing his eyes. It had been exactly three months since Roe Vs. Wade was overturned and my son was referring to the hysterectomy and bilateral salpingo-oopherectomy I was planning to undergo a few months later. He was simply looking forward to Mommy being on sick leave and therefore available some days to pick him up from school.

My son knew that my “baby-grower” was something that my colleagues had cut open twice to deliver him and his little brother by c-section. And although he is too young to understand what the BRCA1 mutation is or that my having it gives me a significantly elevated lifetime risk of breast and ovarian cancers and a slightly increased risk of a rare type of uterine cancer, he also seemed to intuit that for some reason that organ could hurt me. With his comment, I felt pride that he knew about reproductive organs, the existence of which have shaped so much of both my personal and professional identities. As both a doctor who delivers babies and a doctor who provides abortions, I have seen the uterus and ovaries create what is wanted and unwanted, what is healthy and what is sick, what may be hoped for or dreaded. As a parent who is also a patient, I have also felt the uterus and ovaries in their bipolar existence live within me. I have already had a bilateral mastectomy to prevent breast cancer, and I am planning this next surgery in-order to prevent ovarian and uterine cancers. I used in vitro fertilization technology (IVF) to genetically test the embryos that would later become my children to make sure that they would not also carry the BRCA1 mutation. These decisions have been difficult and painful, and they have been deeply personal; not all patients with this mutation would make the same choices. With my breasts, I lost the ability to ever try to breastfeed; when I lose my uterus and ovaries, I will go through menopause in my 30’s. Even though I have felt sad to give up pieces of me, I feel empowered by having the knowledge and resources to be able to make medical choices based on my own values.

When Roe vs. Wade got overturned in June, it put all reproductive decision-making on the line. In a day, patients found themselves in dire binds, sometimes pregnant but without the ability to make empowered choices. They had a baby-grower, with the potential for good and for bad, but unlike me, they didn’t get to decide what to do with it.

The threat to reproductive rights goes beyond abortion. Overturning Roe also put assisted reproductive technologies, like IVF, at risk and threatens the ability of women to use contraception to prevent pregnancy. It still seems far-fetched and frightening but the reality is clear: Individuals no longer have the constitutional right to privacy regarding reproductive autonomy; reproductive rights are dependent upon the state in which an individual lives. On November 8th, Californians decided to enshrine our state’s existing abortion rights into the state Constitution. As an OB/GYN doctor and patient with OB/GYN needs, nothing felt more important on that ballot. I have made choices about BRCA1 and my reproductive organs for myself and my children. By voting to pass Prop 1, we have ensured that the next generation, including my children, will have the same reproductive rights as we do.

An earlier version of this essay was published in the San Francisco Chronicle on 10/27/22.