One morning last July, Kate Dineen sat in the kitchen of her Boston home awaiting the results of a fetal MRI. She was 33 weeks pregnant and had been feeling mild abdominal pain, but there was no real reason to be worried ― the scan was merely a precaution.
So when a pediatric neurologist told her via Zoom that her son had suffered a catastrophic stroke, it was an utter shock. There was a 50 percent chance he would die before birth, the doctor said. If the baby survived, he could perish at any time. If he lived, it would mean years of pain and suffering.
Dineen and her husband, Alex Lawton, immediately knew what they wanted to do: Go to Massachusetts General Hospital, where Dineen had been receiving care, and have the pregnancy aborted. But doctors there would not do that, citing limitations of a new state law that allows for abortions 24 weeks after the start of pregnancy.
“You may still be able to explore termination,” Dineen vividly remembers being told, “if you are able to travel.”
What followed was an ordeal that no one should ever have to go through: The couple drove 500 miles to a clinic in Maryland ― one of a handful in the country that perform late-in-pregnancy abortions ― paid about $10,000 out of pocket for the procedure (and travel costs), and returned to Boston, where Dineen had to endure 40 hours of labor to deliver a fetus that had been aborted by lethal injection.
If the Supreme Court overturns Roe v. Wade, paving the way for at least 26 states to ban or severely restrict the procedure, many other women across the country will face their own version of this horror story: having to travel a long distance for an abortion ― even if they live in a state where the procedure remains legal.
Anticipating that Roe may get struck down, the Massachusetts Legislature passed a law in December 2020 to protect and expand abortion access. Governor Charlie Baker vetoed the measure, but legislators overrode it. The so-called Roe Act codified abortion rights and allows women to terminate pregnancies beyond 24 weeks under certain conditions, such as in cases of lethal fetal anomalies.
But as Dineen discovered, her interpretation of what constituted a deadly condition was at odds with Mass. General’s. Doctors at the renowned hospital told her they couldn’t perform the procedure if there was a chance the fetus could live outside the womb. Still, Dineen said, they didn’t disagree with her decision to seek an abortion and even set up an appointment at a clinic in Washington, D.C. It was Mass. General’s way of offering her a choice.
Mass. General declined comment on Dineen’s case, citing patient confidentiality.
Dineen, however, felt her doctors failed to adhere to the spirit of the new law, stripping her of the right to an abortion in Massachusetts. She is sharing her story because she doesn’t want other women who live here to have a false sense of security. Indeed, her case makes it clear that more must be done to protect reproductive rights, even in the bluest of states.
Dineen, 39, also knows that as terrible as her situation was, she and her husband were fortunate: They had the means to travel and to pay for the procedure themselves. Many families don’t.
“Massachusetts cannot be sending patients out of state,” she said. “The only thing worse would have been if I were unable to access care and therefore forced to watch my son suffer.”
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The vast majority of abortions in Massachusetts occur in the first eight weeks of pregnancy, according to the Massachusetts Registry of Vital Records and Statistics. Less than 1 percent take place after 24 weeks. In Massachusetts, only three abortions after 24 weeks were performed in 2020, out of 16,452, according to the most recent data available.
Women seeking abortions late in their pregnancy call it a “no choice choice.” They are wanted pregnancies that have taken a sudden turn for the worse, such as a medical diagnosis that would leave a child with virtually no quality of life — unable, for example, to walk or talk, and exist without pain.
Dineen, an executive at a Boston business advocacy group, was already a mother. She had an uneventful first pregnancy and gave birth to a healthy baby boy at Mass. General in November 2019. By the fall of 2020, she was pregnant again.
At a routine ultrasound in her 20th week, the doctor looked at Dineen’s scan and said: “How does perfect sound?”
“That sounds great,” she replied.
But three months later, her stomach began to ache. She asked for another ultrasound to make sure everything was OK. Her doctors noticed the baby’s brain ventricles were slightly enlarged and ordered an MRI to get a more detailed look.
Up until 24 weeks from the start of a pregnancy, a woman can choose an abortion at Mass. General, according to Dr. Jeffrey Ecker, the hospital’s chief of the department of obstetrics and gynecology.
In the case of a woman seeking an abortion after that period, the hospital convenes a committee of obstetricians, pediatricians, nurses, legal counsel, and others to review whether a pregnancy qualifies for termination under the Roe Act, which allows for an abortion to preserve the patient’s life, or the patient’s physical or mental health, or because of a lethal fetal anomaly or a fetal condition that is incompatible with sustained life outside the uterus.
“It is a thoughtful, formal body,” Ecker said. “When someone is interested in pursuing an abortion beyond 24 weeks from the start of a pregnancy, for example for a lethal fetal abnormality, it needs to fit within that context.”
Dineen wrote a lengthy letter to Ecker in February about how the hospital could have better handled her case. Ecker told me he can’t talk about an individual patient. Dineen allows that she received good care from Mass. General doctors, but she questions the Boston teaching hospital’s interpretation of the Roe Act.
Ecker said the hospital respects a woman’s right to choose and noted that some of its doctors and midwives testified in favor of the Roe Act on Beacon Hill. He also stressed that Mass. General does perform abortions. He said few, if any, have taken place after 24 weeks since the passage of the Roe Act.
If patients and advocacy groups believe the law “isn’t embracing the full scope of care intended,” he said, “then that would be an opportunity to advocate for the Legislature to rewrite things.”
Advocates don’t want to rewrite the rules, but they would like the state to issue guidance on abortions after 24 weeks. They say the legislation was intended to give clinicians the flexibility to determine which medical conditions warranted late-stage procedures.
In practice, hospitals are being too conservative, not respecting the needs of patients facing predicaments such as Dineen’s, said Rebecca Hart Holder, executive director of Reproductive Equity Now.
“I appreciate that hospitals are trying to follow the law, but I remain frustrated by stories like Kate’s,” said Hart Holder. “Regulations that give hospitals comfort that their clinicians are following guidance issued by the executive branch when implementing the Roe Act would go a long way in alleviating whatever concerns they have about the law.”
Hart Holder is looking to the next governor to create a such regulatory framework.
“It was not the intention of the Legislature that people travel out of state for care,” she added. “That’s even more important today, given the prospect of Roe falling.”
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Two days after receiving the devastating diagnosis, Dineen and Lawton set off on the eight-hour drive to the CARE Clinic in Bethesda, Md. Dineen did not want to wait for the later appointment Mass. General had made for her in Washington because she was worried about going into labor prematurely.
The couple, who had left their toddler with family members, planned to show up at CARE Clinic when it opened on Sunday morning to beg for an appointment. The strategy worked.
Dr. LeRoy “Lee” Carhart agreed to perform the procedure the next day.
She stayed in Maryland another day for observation, and then returned to Boston to deliver the lifeless baby at Mass. General. During the long drive, Dineen said, she felt a sense of relief, but also profound loss. She still had a big belly, but her son was no longer kicking like he had throughout most of the pregnancy.
After nearly two days of labor, she gave birth to Edward “Teddy” Lee Dineen-Lawton. He arrived, beautiful and silent, at 5 pounds, 8 ounces, and was quickly swaddled by nurses. The couple spent several hours with Teddy, tenderly cradling him and making impressions of his tiny feet and hands.
In the letter she wrote to Mass. General’s Ecker, Dineen explained that his “middle name is Lee to honor Dr. Carhart, who gave him peace when my doctors at MGH could not.”
Dineen’s situation may seem too unusual by itself to warrant a re-examination of how doctors are implementing the state’s Roe law, but she said the fact that it can happen at all is unacceptable.
“It’s rare until it’s you,” she said recently, sitting by her husband in the dining nook of their condo. “Everybody should care about the fact that for pregnant women in Massachusetts, at a certain point in their pregnancy, they no longer have bodily autonomy. They’re an incubator, and the state is forcing them to carry a pregnancy that they don’t want to carry and they don’t feel good about carrying.”
The couple is considering trying to have another child. They’ve gone through a battery of tests, and doctors are confident Dineen can have a healthy pregnancy.
But it is impossible for her to chase the worst-case scenario from her thoughts: Roe v. Wade is thrown out and the abortion clinics still open become inundated, unable to accommodate an emergency.
“What if this happened again,” she said, “and we couldn’t access care?”
Shirley Leung is a Business columnist. She can be reached at firstname.lastname@example.org.