pregnancy

I’m a Harvard undergraduate and just found out that I’m pregnant. I haven’t decided what I want to do yet and was wondering, what options are available for me?

AKG: Thanks so much for sharing your question! While SL is often a forum to talk about sex, sexuality, and relationships, we get that this aspect of reproductive health is sometimes left out of the conversation. Seeking information about options is a big step, and only the person experiencing the pregnancy is able to say what will work best for them and their wellbeing. Very generally, there are three choices you can make:

  • Abortion: ending the pregnancy

  • Adoption: continuing the pregnancy but placing the child(ren) with someone else permanently

  • Parenting: giving birth and raising the child(ren)

Depending on your identities, background, experiences, and future goals, any of these may be an option.

ML: Thanks for submitting this question! As college students, we are often inundated with information about preventative sexual health, but rarely talk about what happens when these events occur. While pregnancy may or may not have been a part of your plan here at Harvard, there are a multitude of services to help you through this experience regardless of the option you choose.

AKG: I agree, ML. Unintended pregnancies account for about 45% of all pregnancies in the US. Because this is a common experience, there are many places to get support and information out there to help folks walk through the decision-making process. A favorite service would be the All Options hotline (1-888-493-0092), which provides “unconditional, judgment-free support for people in all of their decisions, feelings, and experiences with pregnancy, parenting, abortion, and adoption.”

ML: Each state has different laws, policies, timelines, and procedure options. Because of this variety, we’re only going to take a bird’s eye view of methods. For more information about what may be available in your state, please check out the websites at the end.

AKG: Thanks, ML! So, let’s talk about one option: abortion. According to data from 2014, about one in four women will have an abortion by the age of 45. While it is a common procedure, the decision is personal.

The two ways to end a pregnancy in Massachusetts are medical abortion and surgical abortion. Medical abortion is available the first 10 weeks after the first day of a missed period. It’s a two step process where someone would take the first dosage generally at a medical provider’s office, and then they are able to take the second medication at home, usually within two days of the first one. Many folks report feeling severe menstrual cramps and experiencing bleeding or spotting that can be heavier than their normal period. This means that it may be helpful to have support with you including a friend or someone from Boston Abortion Support Collective (BASC) and/or take a break from your normal routine.

Surgical abortion in Massachusetts is available generally until 23 weeks after conception, though there are select instances where abortion may be performed past this point. There are two types of surgical abortions; both are in-clinic procedures that happen at Planned Parenthood League of Massachusetts in Boston, Women’s Health Services in Brookline, and at some area hospitals. Some clinics require that someone else picks you up from the appointment, so know that it may be necessary to have a friend or a member of BASC with you.

At Harvard, if you are covered through the Student Health Insurance Plan, and electing for a surgical abortion, you will be expected to pay a $75 copayment. A medical abortion should be entirely covered. If you have private insurance, but it will not cover an abortion or you do not wish to ask your insurance company if they’ll cover it, the student health fee (which all undergraduates pay) will provide a $350 voucher. The Eastern Massachusetts Abortion (EMA) Fund is also available should you require additional financial or additional support.

ML: Thank you, AKG. It’s very important to understand the different routes one can take should pregnancy not be a choice you want to make. If abortion is not an option or not the right choice for you, adoption is another route you can take. Through either a private or public adoption agency, you will be guided through the process of choosing caregivers. You will want to speak with an adoption counselor that you can find through your medical provider to learn more about agency-specific procedures and state particular rights; however, a broad overview is that you can choose to have an open or closed adoption. An open adoption is where you can choose to receive some information about the child and their family as they grow up, whereas a closed adoption would involve receiving little to no information post-delivery.

One option for talking to an adoption counselor is the National Pro-Choice Adoption Collaborative, a non-discriminatory, secular, non-profit agency that aims to provide unbiased information about adoption and services related to adoption nationwide. Like All Options, it’s another place to have a conversation with someone outside of your immediate environment to talk through the options that you have.

AKG: If you will be going through the birth process, HUHS can provide OB/GYN services to you, and the birth will take place at Mount Auburn Hospital. Undergraduates are able to live in the Harvard dorms while pregnant. However, if you choose to carry out the pregnancy and parent the child(ren) then you will not be permitted to remain in the dorms. In Cambridge, there are a number of resources and daycares that offer services, although pricing and availability may vary.

ML: While the breadth of information presented above provides a snapshot of your options should you find out that you’re pregnant, there is more information available about each option. It is important to note that each person’s experience will be different, and that there is no one right choice or answer to this question.

Mentioned Services:

My partner and I are considering pregnancy; I’m nervous about the process of giving birth. What does it usually look like to go through a labor and delivery?

RC: That is a great question!  For each person/process, it may go differently.  In this post, unlike most, I am actually going to be writing as the IRL or Context Expert and will speak from my own experience delivering two babies.  As AG mentioned in a prior week’s post, 45% of pregnancies in the United States are unplanned.  That was certainly true of both of mine.  One of the most important things that my partner and I had to consider upon finding out that we were pregnant was where we hoped to deliver.

AG: There are many different options when thinking about the birthing process that you want to have. First, you may decide where you would like to give birth: in a hospital, at home, or in some other location (for example, a birthing suite). Depending on the state, home births are generally attended by midwives; some people choose to include doulas, pets, children, relatives, and/or friends in the process as well. If you choose to give birth in the hospital, you can either give birth vaginally or via a caesarian section. People will make these decisions for many different reasons and it’s important to consult with a healthcare provider in the process.

RC:  Many providers offer the option of completing a birth plan, which lays out the ideal labor and delivery and often includes details about back-up preferences.  These may include questions about epidurals, c-sections, music, choice of lighting, people in the room.  I did write one for the birth of my first child--many of the elements I named went somewhat as I had hoped; some did not.  With my second labor and delivery, I made sure that I had clearly communicated about my wants, needs, and non-negotiables with my partner and birth team in advance, so felt that my process would be honored without a formal birth plan.  Again, for each person and each process, it may look different.  Please note, if, at any point, complications arise, your birthing team will be able to advise you regarding the best ways to ensure the safety of you and your baby(ies).

AG: Typically during the third trimester of pregnancy (and as early as the second trimester), people may experience something called Braxton Hicks contractions, which are basically the uterus “practicing” for the birthing process. They are generally infrequent/irregular in pattern (unlike actual labor), and for some the sensation may be intense.

RC:  One of my favorite takeaways from one of the books about mindful birthing that I read before my first child was born offered a different framework for thinking about contractions and the accompanying sensations.  Rather than describing the muscular contractions as painful or not painful, the book offered that we use the language of strong versus less strong sensation.  This does not add a value judgement or prime our brains to anticipate the physical sensation as anything other that whatever it is in the moment.  I found this really helpful; as an athletic person who really enjoys noticing what’s happening in my body, this reframe allowed me to observe and delight in the activation of a muscle I had never used in that way before.

AG: The process of actual labor can be mapped onto several stages, which correlate with the dilation of the cervix (it is considered fully dilated at 10 centimeters) and what is happening with the baby. The first stage of labor can be broken into early (the cervix is 0-3 cm dilated), active (3-7 cm), and transitional phases (7-10 cm). As these phases progress, contractions often become more frequent and more intense. The water may (or may not) break anytime within this first stage of labor.

RC:  With my first child, born on January 1st, we were celebrating New Year’s when my contractions began.  A friend actually decided he wanted to be responsible for tracking them, which was great!  They began around 8:30 pm on December 31st and after ringing in the new year, everyone left, my partner and I went to sleep, and I slept until 5:30 am, at which point the intensity and frequency of the contractions kept me from sleeping.  I don’t think I called any of our birth team until 8:30 or 9 that morning.  It’s important to note that there is no set timeline for the duration of a labor and delivery.  In both mine, my water didn’t break until much later in the process.  With my second, my water broke as I delivered. Some people report that they didn’t notice their water breaking at all, later to discover that it had.

AG: After the cervix is dilated to 10 cm the “active” stage of labor begins. In this stage, the person generally feels compelled to push so that the baby(ies) can move from the uterus through the vaginal canal, in the cases of vaginal birth. You may have heard people talk about episiotomies; routine episiotomies are no longer recommended, although they may be medically necessary in some cases.

RC: After the (last) baby moves through the vaginal canal, which is often called delivery, the last stage of the birth process begins: the delivery of the placenta.  In some cultures, people eat some of their placenta, other folks may choose to get it encapsulated in pill form, others may choose to bury it under a beloved plant, and still others may dispose of it.   

AG: At this point the delivery is complete! It’s often really helpful to ensure that the baby and the delivering parent have enough support to navigate a new phase of life. It’s also important to note that both parents (in a two parent dynamic) may experience a range of emotions and likely both will benefit from screening for depression and anxiety during this time.

RC:  While we have outlined a lot of technical information in a linear manner, it’s really important to note that everyone’s experiences of labor and delivery are different and may include a number of factors, people, babies, etc. that aren’t explicitly named in this post.  I also want to make sure that, as the IRL writer, I note that each labor and delivery involves risk and may not go as intended.  That was certainly true for me; there are risk factors for different populations that are really important to note and consider as one goes through this process.  It’s especially important to call out in this space the health disparities that women of color face when growing and delivering babies in America.  Serena Williams’s experience is a high-profile example of exactly that.  

My partner and I just found out that we are pregnant. We both want to be parents, but I read somewhere that pregnancy can add stress to relationships.  What are some things we should look out for?

AG: Thanks for the question! Pregnancy can be a big change for an individual, a relationship, and/or a family system. It’s important to first remember that every person may experience this differently. For some, pregnancy can be a source of intimacy and excitement. For others, it can add stress and uncertainty. For many, it can be some combination of all of these feelings and many others! In this blog post we will address some common themes. We want to note, though, that these may not apply to everybody and that this is far from comprehensive.

RC:  As a person who has now gone through this process twice, my observation of my own experiences is that each pregnancy felt different.  Something that folks often talk about, regardless of how familiar this process is to them, is an experience of navigating a future in which there is less certainty than before.  This is sometimes accompanied by an increase in anxiety or feelings of (in some ways) lacking control.  I want to note, this is partly due to changes in neurobiology; when pregnant and/or parenting, our brains actually redirect resources to increase our ability to respond quickly and effectively to primal threats.  While this was a crucial adaptive strategy, it can make things feel hard or overwhelming in the modern world.  Often people express feeling better able to manage this when in open dialogue with their supportive people.

AG: In part because of these changes, patterns of communication may be impacted. People may feel that they are experiencing parts of the pregnancy and parts of the relationship differently, and that they may not be on the same page. Also, it isn’t uncommon for people to feel that the relationship is no longer the main priority as it might have previously been. People who choose to be parents may be redirecting emotional energy toward the growing baby that was once focused on the relationship and adapting to this shift can be confusing. Naming these feelings to your people can be helpful, if that feels like an option.   

RC:  It’s important to flag that, especially in partnered relationships that are characterized by imbalanced dynamics of power and control, increases in interpersonal violence have been documented.  This often, but certainly not always, correlates with a “mistimed” or unplanned pregnancy.  In relationships with a history of physical violence, pregnancy often correlates to an increase in homicide.  There is little accessible data that speaks to interpersonal violence within broader family systems.  

Often a relatively accessible place for folks to raise concerns during pregnancy is during prenatal visits with a medical professional.  In the US, medical providers are required to screen for interpersonal violence during the course of a prenatal relationship and should ask those questions without any partner(s) present.  If you have any concerns about your well-being, please know that local and federal resources are available.  The National Domestic Violence Hotline or a local Interpersonal Violence agency may be a good place to begin.  OSAPR (Harvard), Transition House (Cambridge), Casa Myrna (Boston), Reach Beyond Domestic Violence (Waltham), The Network/ La Red (Boston), Fenway Health (Boston) or Respond (Somerville) are some of the resources available locally.

AG: Thanks Ramsey for noting all of that. And while it’s certainly true that pregnancy can add stresses on relationships, it can also be a really big source of excitement!  For people that are choosing to carry the pregnancy to term and/or to parent, the thought of bringing a new human into the world can bring up many emotions, experiences, and reactions and some may feel that it gives them a different perspective on things.  Whatever your experience, we hope that you feel equipped to navigate the process in a way that feels right for you.  Please know you are always welcome to reach out with any more questions!  Our email is: harvard.sexual.literacy@gmail.com.

Ramsey Champagne,

OSAPR Community Advocate

AG

Student

 

What are some situations in which a person can get pregnant? For example, I’ve heard you can get pregnant from pre-cum, is that really true?

AA: Thanks so much for asking about different situations in which pregnancy can occur. Speaking really broadly, pregnancy can occur entirely accidentally or through a more intentional process.

LM: At its most basic, pregnancy happens when a sperm fertilizes an egg and the fertilized egg implants in the uterus. There is a window of a few days during the menstrual cycle when an egg is receptive to fertilization, so if a sperm reaches the egg in this timeframe, pregnancy is likely to occur. However, sperm can also hang around in the uterus and fallopian tubes for up to 6 days, so there is a fairly broad window in which fertilization can physically occur.

AA: Regarding the example that you mentioned in your question, generally pre-cum does not contain sperm but there have been some rarer cases of pre-cum containing some sperm. Because of this, if you are trying to avoid pregnancy, the withdrawal method should not be used as a form of contraception. There are many more effective strategies, which we will go into detail about next week.

LM: For those who are trying to get pregnant, the process may range from tracking ovulation to looking for a sperm or egg donor to using in-vitro fertilization. Surrogacy is also an option, although there have been a number of conversations in the public discourse about the ways in which this process, when not done carefully, can offload labor and potential physical complications onto already marginalized or at-risk female-bodied people.

AA: While historically our understandings of pregnancy through the medical model have characterized the egg as passive and the sperm as active, there is new research that indicates that the egg may play a much more active role in the process of fertilization and implantation.

Over the next few weeks, we’ll be discussing a series of questions surrounding various facets of pregnancy, so stay tuned!

Amanda Ayers, Health Educator

LM, Student