Loretta
An early morning breeze passed through the loosely assembled group, and the cottonwood trees rustled overhead. Loretta looked upward to watch the bright yellow leaves she had loved since childhood. She was tired from being the center of attention, but she also felt wonderfully happy and serene.
The Blessingway ceremony had lasted two full days and nights and was in honor of her pregnancy. The women pampered her from head to toe, brushing her long hair until it shined and massaging her feet with blue corn pollen.
Her mother, Rita, had insisted on inviting the medicine man and the Wise Women to their house for the traditional blessings and prayers once she found out Loretta was pregnant. Loretta was hesitant because her Navajo was rusty, but she’d remembered enough.
She had learned Navajo from her grandmother, her shimá, but hadn’t spoken it in the ten years since her death in 1985. They were standing with the group just outside her grandmother’s eight-sided hogan, across from the newer house where Loretta had grown up. Loretta felt her shimá’s spirit watching over them.
After the ceremony was over, everyone remained for a few minutes, silent as they watched the rising sun slowly light up the canyons of Red Mesa to the west. Loretta thought about her grandmother who started having babies when she was only sixteen and ended up having twelve in all. Her mother was the youngest, born when her shimá was 43 years old.
In her grandmother’s time, the Navajo were still anxious to replace the thousands they had lost on the Long Walk of the 1860s. The women of that era had so many children that there was much less pressure on women now. Loretta was just getting started at the age of twenty-six.
As the group dispersed, her mother walked over and put her hands on Loretta’s shoulders. She said, “May you walk with beauty before you, beauty behind you, beauty below you and beauty above you.”
Loretta nodded and gave her a hug, “I haven’t heard those words since my puberty ceremony, my kinaalda. I guess I’m now officially a woman.”
Her mother asked, “Are you going to find a doctor in Shiprock or Farmington?”
Loretta said, “I’ve got an appointment in Shiprock.”
“Don’t you have medical insurance with your job at the chemical plant? You should go see a real doctor in Farmington, not those freebie ones in Shiprock.”
“I don’t have insurance since I only work part-time. Anyway, the doctors in Shiprock are the real thing. The reason it’s free is because America agreed to take care of us in the treaty. The U.S. government pays them.”
Rita crossed her arms and said, “But maybe not very well. I heard the doctors there don’t do such a good job. You get what you pay for. Even the medicine man gets paid well.”
*
The next week, Loretta had her first prenatal visit at the Shiprock clinic. She immediately liked the midwife, Vicky, who was down-to-earth, explained things well and had an easy smile. Loretta was excited to hear the baby’s heart when the Daptone was placed on her stomach.
When her husband, Tony, got home from work that night, Loretta told him that she’d heard the baby’s heartbeat, and it sounded like a galloping horse. He put his ear against her stomach and then laughed and said he only heard it growling like a dog.
When she had the second prenatal visit, the baby’s heart sounded even stronger. Vicky said everything looked good and ordered more routine bloodwork.
*
A few days later, Loretta got a call from the clinic. Vicky explained that one of the results was elevated, so they needed her to come in soon for an ultrasound to investigate further.
Loretta was worried so she talked to a friend of hers who had recently given birth. Her friend said not to worry, that the doctors always ordered lots of tests. She added that the best moment in her pregnancy was when she first saw her baby kicking on the ultrasound screen.
Loretta remembered what the medicine man said at the Blessingway ceremony, be careful about negative thoughts. She told herself to be positive instead and to look forward to seeing her baby kick. Tony said he hoped they could give her a picture.
The ultrasound was done in the main hospital across the parking lot from the trailer they used for the obstetrics clinic. It was easy to get lost inside the hospital building because there weren’t many signs, but the friendly Navajo people on staff gave her helpful directions.
The ultrasound technician was an older Anglo woman who looked serious and didn’t say much during the procedure. Loretta tried to make out the baby on the fuzzy black and white screen and asked if it was kicking. The technician didn’t look over but gave a curt nod.
There was a call from the clinic the next day. They told Loretta that she needed to see the doctor before the end of the week to go over the ultrasound results. She had a sudden chill of apprehension. Why would she be talking to the doctor instead of Vicky unless there was something really wrong? Negative thoughts now took control.
Loretta wanted someone to come with her to the clinic. She asked Tony if he could come, but he’d been sick earlier in the year and his boss wouldn’t allow more days off work at the feed store. She also decided against asking her mother, who didn’t trust Shiprock Hospital. She picked up the keys and drove to the hospital on her own.
Loretta felt sad when she opened the door to the obstetrics trailer and saw the other pregnant women inside. They looked as happy as she’d been before all this started.
Soon afterwards, the doctor appeared and asked Loretta to come into the exam room. The doctor was a blonde woman, in her mid-thirties. She was dressed casually in jeans without the usual doctor’s white coat. She thumbed through the pages in the chart and found the ultrasound results. Loretta noticed that she took a deep breath before starting to explain the situation.
She said, “One of your blood test results, called an AFP or alpha-fetoprotein, was abnormal, so we ordered an ultrasound because we were worried about a problem with the baby. During development, there’s something called the neural tube that closes and covers the baby’s spinal cord and brain. Sometimes it doesn’t close correctly. This can happen anywhere from the tip of the spine all the way up to the brain, and when it does, it causes an abnormal AFP, which allows us to detect things early. Unfortunately, the ultrasound shows the area that’s affected with your baby is the brain, and that makes it a much more serious problem. The baby has something called anencephaly, which means that his skull hasn’t formed properly. Without the skull to protect it, the brain doesn’t form properly either.”
The doctor paused for a minute. Loretta was stunned and silent.
The doctor continued, “I’m so sorry this has happened to you. Babies with anencephaly have such severe abnormalities that they almost all die, either before birth or within a few hours or days after birth. Their brains are undeveloped enough so that we don’t think they suffer or feel any pain.”
Loretta stared straight ahead and tried to slow down her breathing.
The doctor said, “I know this has got to be incredibly difficult to hear. Do you have any questions so far?”
Loretta shook her head no.
“Because of risks for the mother, we usually recommend termination, ending the pregnancy, soon after the diagnosis is made. Otherwise, you could end up with too much fluid in the sac around the baby causing painful distension of your stomach or an unnecessary Cesarean section for a baby that has no chance of surviving. You’re only 18 weeks, which gives us a little more time to think about things and make decisions.”
She asked, “Is there anyone here with you? We could call them in from the waiting room.”
Loretta again shook her head. She said, “Nobody could come with me. I don’t have any questions so if you’re done explaining, I’d like to leave. I need to talk to my family.”
The doctor said, “Of course.”
She handed Loretta a slip of paper with her name and number printed on it. “I go by my first name, Maryann. If you think of any questions or anything I can help you with, please call me. You could also drop by the clinic anytime and ask for me at the front. I’m almost always here. Stop by the desk before you go, and we’ll make an appointment for you to come back in a week. In the meantime, I’ll do some research on my end about your options.”
When Loretta stood up, she saw that Maryann had tears in her eyes. Loretta felt too numb to cry. She made the appointment, then stumbled out the clinic door.
She broke down as soon as she got back inside the car and rested her head on the steering wheel wondering what to do. She straightened up and wiped her eyes when a woman walked by on the driver’s side and looked concerned. Loretta started the car and tried to concentrate.
She knew she needed to go and see her mother, even though her house was more than thirty miles from the hospital. Loretta was so distracted by her racing thoughts that she arrived at Rita’s house before she knew it.
Loretta started crying again when she opened the unlocked door. Her mother ran over to hug her and asked, “What’s the matter?”
Loretta said, “They told me at Shiprock my baby is going to die because his brain is all messed up.”
Her mother said, “How could they know that already? You’re just halfway through the pregnancy. They have to be wrong!”
“They looked with the ultrasound and saw it. The doctor said it would be safer to end the pregnancy now because there’s no chance my baby will live, and I might have problems myself if I don’t.”
“I told you not to go to those doctors at Shiprock. I’m going to call the medicine man right now, and he’ll come to the house, tell us what’s really going on, and take care of it.”
After the call, her mother made a pot of herbal tea for them both. The medicine man arrived within the hour, and Loretta explained the situation to him as best she could, though she had forgotten some of the technical terms.
He asked, “What’s the machine like that shows the doctors the baby?”
Loretta said, “They put jelly on your stomach and press down on it from the outside with a kind of camera. It lets them see all the way through the skin to the baby. My friend watched her baby kicking on the TV screen, but the woman doing my test was too busy to show me anything.”
The medicine man had Loretta lie down and put his hand on the blue check shirt covering her stomach. He then closed his eyes and sang several Navajo chants that she couldn’t understand. After about twenty minutes, he stopped and told her to sit up again.
He said, “I tried, but I think they could be right at Shiprock. There’s something wrong with the baby, and it seems pretty serious. You need to go back to the hospital.”
Loretta said, “I’m scheduled to go back next week.”
He nodded and said, “You should go and see what they can do to help you.”
*
The next week, Rita went with Loretta to Shiprock for her appointment. Rita, Loretta and Tony had all agreed that if the doctors were sure about the problems with the baby, it was best to terminate the pregnancy. Loretta didn’t think she could go another five months carrying a baby she knew was going to die.
This time, the nurse took them back to the doctor’s office. Maryann introduced herself to Rita and sat down in the chair beside Loretta.
Maryann said, “I’m glad you have your mother with you today.”
Rita said, “Doctor, are you sure about what’s happening with the baby? We wouldn’t want to do anything if there was a chance you could be wrong.”
Maryann said, “No, there’s no chance the diagnosis is wrong. This problem is easy to see with the ultrasound, and once it’s happened, it can’t be reversed.”
Loretta said, “If there’s no chance the baby will live, I want to stop the pregnancy.”
Maryann said, “I think that’s a good decision. Otherwise, you might have some serious problems during the pregnancy. The procedure you need is one that we don’t do here in Shiprock. It involves staying in the hospital the night before and having the surgery to end the pregnancy the next morning. You’ll be put to sleep during it, and when you wake up it will be all over. You should be able to go home soon afterwards.”
She continued, “I’ll call the other Indian Health Service hospitals in the area and find the closest one for you.”
Rita said, “The closest would be good because I’ll have to save up for gas money to get us there.”
Loretta asked, “Will I be in pain after it’s over?”
Maryann said, “You may have some cramping, but you shouldn’t have too much discomfort. I think you’ll be fine on the ride home.”
*
Maryann phoned Loretta the next day.
She said, “Things are more complicated than I thought. The Indian Health Service is funded by the Federal Government, and the Feds are prohibited from helping with termination of a pregnancy, even in a case like this where the baby won’t survive. This means we’ll have to find another type of hospital to help you, but it may take me a few days for me to figure it out. The procedure would cost hundreds of dollars in a private hospital, but the state-funded ones are supposed to provide a certain amount of care for people who can’t afford it.”
Loretta asked, “Why do the Feds pay for the blood test and the ultrasound if they don’t want to do anything about it when the results are bad?”
Maryann said, “That’s a good question and hard for me to understand too. Would Albuquerque be too far to go if we found a doctor there?”
“We could ask friends and try to get the gas money to make it there and back. I guess my mom could sleep in the car while I’m in the hospital.”
Maryann said, “I’ve made another appointment here for you on Friday morning at 10 so we can go over everything. Is that okay?”
Loretta sighed, “Okay, I guess I can ask for another day off from work.”
*
That Friday at the office, the doctor had more bad news for Loretta and Rita.
She said, “This isn’t a great situation. I’ve found a doctor in Albuquerque who can help you, but it’s tricky because you haven’t been a regular patient at their obstetrics clinic. The only way it will work is for you to be admitted through the Emergency Room.”
Loretta asked, “How could I do that if I’m not having an emergency?”
Maryann said, “Unfortunately, you’re going to have to tell them you’re in terrible pain. Then you need to ask to see the doctor in the clinic whom I’ve contacted. I’ve written down her name and number for you and a list of the days that she’s available in the clinic.”
Rita said, “We’re not driving all the way to Albuquerque just to tell lies. We don’t lie in our culture. We have a saying, ‘If you cut the tree, it will fall on you.’”
The doctor replied softly, “I can’t think of any other way to do it.”
Loretta said, “Well, I agree with my mother, and I’m not doing it. White people did a lot of lying to the Indians, and we suffered, but we swore we wouldn’t take up that evil ourselves. We’ll have to use our old ways since this way has failed us.”
Loretta and Rita walked out.
When they got back in the car, Rita said, “They do all this early testing. They tell you bad news. They tell you it could be dangerous to stay pregnant. But they can’t do anything about it unless you agree to go to another hospital and tell lies. These are the worst doctors I’ve ever heard of.”
Loretta said, “I want to spend the night with you and see the medicine man tomorrow. I know he can’t solve the problem with the baby, but maybe he’ll be able to make me feel a little better. I’m going to need help to make it through this pregnancy.”
The medicine man came the next morning. He gave Loretta medicinal tea, burned cedar and chanted healing prayers. She felt better afterwards, and they made plans for her to see him weekly. It made her feel calmer, but only for the first month.
The following month, recurring nightmares about the baby’s birth made it impossible for Loretta to sleep. She had difficulty driving to and from work, and she stopped cooking meals because she had no appetite. Tony tried warming up beans and fried hamburger meat, but the smell made her nauseated instead of hungry.
Loretta had to quit work a month later because her stomach became so distended, stretched so tight she found it difficult to sit, let alone to sleep. She thought it must be the buildup of fluid around the baby the doctor had warned her about. Tony wasn’t sleeping much either. He massaged her back at night and kept a heating pad underneath it.
Two weeks after that, the baby stopped moving. Loretta felt relieved the baby was probably no longer suffering, but she wondered if her own suffering would ever end. Her mother told her to be brave and wait a few days to see if she went into labor.
Contractions fortunately started before the end of the week. They went on for hours and became so painful that Loretta nearly lost consciousness. That night, Tony and Rita took her to Shiprock Hospital.
*
Loretta’s midwife, Vicky, was on-call at the hospital. She checked for the fetal heartbeat with the monitor, but there was none, confirming what Loretta already knew. Vicky then checked Loretta’s cervix. She looked worried afterwards and said she needed to call the doctor.
Vicky called Maryann at home. She said, “I have Loretta here on the ward in active labor. Her baby is anencephalic and now 32 weeks gestation. She has severe polyhydramnios, and I can’t find a fetal heartbeat. Her cervix is 4 centimeters dilated but I also can’t feel any presenting part.”
The doctor came into the room a few minutes later pushing an ultrasound machine in front of her. She introduced herself to Tony and nodded to Rita, who sat next to Loretta.
She said, “Loretta, I need to do another ultrasound to check the position of the baby.”
After a few minutes, she said, “The baby has died and is in an upside-down position, so it can’t come out vaginally. We need to do a Cesarean section.”
Loretta signed the consent and looked away. The doctor asked gently, “Do you want to see the baby afterwards? It’s possible, but the body will have to stay at the hospital. That’s a requirement with abnormalities like this.”
Loretta, visibly shaking, quietly said no, and reached for her mother’s hand.
Maryann left to prepare for the operation.
Rita turned to Vicky and said, “We’d like the placenta. The medicine man said we should bury it under the cottonwood tree next to my mother’s hogan when we have the Healing Ceremony.”
Vicky replied, “I’ll make sure we give it to you before you go home. You’ve all been through a difficult time, and we want to help any way we can.”
Loretta looked over at Rita and Tony and said, “I’ve got a strong circle around me. I may never be the same as I was before this happened, but we’ll get through it somehow.”
Loretta was unable to terminate her pregnancy due to the Hyde Amendment, passed in 1980, which prohibits the use of federal funds to pay for abortion except in cases of incest or rape or to save the life of the woman. To this day, the Hyde Amendment bars the Indian Health Service from performing abortions, even when the fetus cannot survive.
~