Medical Examiner

I Always Told My Patients IUDs Were Over 99 Percent Effective. Then I Got Pregnant.

Overturning Roe v. Wade will make it dangerously difficult to navigate the unexpected.

Ultrasound image with the shadow of an IUD in the middle
Photo illustration by Natalie Matthews-Ramo/Slate. Photo by Reproductive Health Supplies Coalition/Unsplash.

What were you doing when the headlines broke about the leak of the Supreme Court’s draft opinion reversing Roe v. Wade? The news came out on a Monday night when I should have been home, putting my kids to bed and then lying still in their room until I heard the sounds of heavy breathing.

But I was not at home. Instead, I was in a hospital bed with antibiotics running into my arm, drenched in sweat and tears. Not 48 hours earlier, I had undergone an emergency surgery to extract an infected pregnancy from my uterus, a procedure that saved my life.

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It started like this: Five weeks earlier, I had woken up with a feeling of nausea familiar to me from my two prior pregnancies. When I took a pregnancy test, it was official: I had gotten pregnant despite an IUD. An ultrasound a few days later showed the T-shaped device stuck at the top of the uterus; the embryo, six weeks and six days old, was wedged below, in between the IUD and the cervix. The doctors offered me three choices: continue the pregnancy, terminate the pregnancy, or attempt IUD removal, which would likely end the pregnancy anyway.

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Although I am a doctor myself, I knew very little about pregnancies with IUDs. I work in primary care, and always counsel my patients that IUDs are more than 99 percent effective at preventing pregnancy. None of my patients has conceived with an IUD in place while in my care. I had not really considered what would happen if they—or I—did.

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Now, I frantically searched the internet and the medical literature. I learned that when the IUD is near the cervix and the patient wants to continue the pregnancy, the device should be removed as soon as possible. If it can’t be easily removed, it is typically left inside. Mine fell into this second category. I learned that some of these pregnancies end happily, with healthy babies photographed grasping the T-shaped devices like rattles in their tiny hands. Many result in miscarriages, and some in severe pregnancy complications.

Despite these risks, a smile crept across my face as I imagined an unexpected third child. I decided to let nature take its course: If it were meant to be, I would stay pregnant. If not, I would grieve the loss, give thanks for my two sweet kids, and return to the life my husband and I had planned for a family of four.

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My husband asked if there was any risk to my health. “No,” I replied, “the risk is to the baby, not to me.” Doctors can be very reassuring. That doesn’t mean we’re always right.

The first-trimester nausea, which had been manageable in my prior pregnancies, made me feel so ill that I canceled most of my clinics. I had intermittent bleeding, but each time my obstetrician placed an ultrasound probe on my belly, we could hear the reassuring whoosh of cardiac activity.

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At the end of April, six days before the Supreme Court leak and 10 weeks into the pregnancy, my temperature spiked to 102 degrees. My obstetrician knew we needed to look for infection of the uterus—one of the potential complications of having an IUD in place during pregnancy—so she pressed on my lower abdomen and moved my cervix around, which felt fine. She also got an ultrasound as well as blood and urine tests. They were all normal. A swab for flu and COVID was negative.

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I decided to wait the mystery sickness out, huddled under blankets, downing Tylenol between the sweats and chills, and monitoring my racing heartbeat. I tried to sip Gatorade. Sometimes I felt well enough to watch TV shows under the covers on my phone. My pregnancy nausea flared between fever spikes; I threw up repeatedly.

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When I wasn’t improving, I got more labs drawn. The results suggested infection but didn’t point to a particular diagnosis. My uterus seemed fine: I still had no pain when the doctors pushed on my belly, and there was no increase in the white blood cell count, as would typically be seen in a uterine infection. I went to the emergency room for further evaluation. The illness had lasted three days by this point, but I looked quite comfortable when I arrived in the ER thanks to a recent dose of Tylenol. With some IV fluid and nausea medication, I felt downright energetic. The only test that had come back positive was a swab for the common cold, though some blood tests suggested a more serious infection, which made the diagnosis inconclusive. Still, I hoped that maybe this whole thing would just pass. I was admitted to the hospital for observation and IV fluids, while my blood cultures incubated in the hospital lab.

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Then, 13 hours after my blood had been drawn, the machine monitoring my blood samples for bacterial growth sounded an alarm: a life-threatening staph infection was raging in my bloodstream. My doctors started IV antibiotics immediately. Antibiotics are necessary to treat bacterial infections, but sometimes medication alone is not enough. A key principle in treating infections is the idea of source control. If the bacteria are coming from a hard-to-reach location—such as an abscess or implanted device that antibiotics can’t easily penetrate—the infection rarely resolves without removing that source.

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But where was my source? I didn’t have any symptoms of a skin or urine infection. I had a chest X-ray to check for pneumonia; it came back all clear. When my doctors recommended a CT scan of the abdomen and pelvis, I was overwhelmed—was I ready to expose the embryo to that level of radiation? CT scans are supposed to be avoided during pregnancy. But only a CT scan could rule out another hidden source like an abscess of the liver or spleen, or even an infection spreading from the uterus into the pelvis.

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That scan turned up no other culprits. A single logical conclusion remained: The infection had to be caused by the IUD. In order to save my life, I needed to end the pregnancy immediately. In medicine, you don’t sit on a bloodstream infection. I was lucky I hadn’t gone into septic shock.

The overnight obstetrician came to my bedside at the beginning of his shift to explain the need for an urgent abortion, and I consented to the procedure. As the team wheeled my bed into the cold, bright operating room, I looked forward to anesthesia as a break from the day’s exhaustion and raw emotion. Once I was asleep, the doctors suctioned out my uterus and fished out the IUD.

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I woke up from surgery in a strange hell, spiking a fever of 105 degrees and shaking uncontrollably until my leg muscles spasmed. The medication to stop bleeding caused cramping that felt like labor, a cruel joke. Grief washed over me. I couldn’t sleep. I needed a blood transfusion.

In this aftermath, I learned that I did not technically have an abortion. The surgeon told me that there was no heartbeat at the start of the procedure and that my cervix had already begun to dilate for a so-called septic miscarriage. There had been a heartbeat earlier in the day, so my embryo must have died in the hours before the procedure. But if my diagnosis had been clear sooner, the unambiguous medical advice would have been to have an abortion as soon as possible.

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In many states, abortion may soon be legal only in instances like mine, instances where the pregnant patient’s life is at risk. But the road from being completely healthy to being gravely ill is not always long, and it is not always obvious while it is happening. Bodies that are young and healthy like mine can hide severe illness behind a strong heart and resilient physiology. We hide it so well we can fool ourselves and our doctors. We hide it until we are in grave danger, until time is running out, and, sometimes, until it is too late. When, exactly, is the moment when doctors can apply a “life of the mother” exception? The tipping point between life and death may only be clear in hindsight.

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Without Roe, would my doctors have been forced to await fetal death before treating my infection? For me, the fetal heartbeat stopped in time, but for others, it has stopped too late. Savita Halappanavar, a 31-year-old dentist, died from a septic miscarriage in Ireland in 2012. “Izabela,” a 30-year-old hairstylist, died this way just recently in Poland, in September 2021. Both women begged for lifesaving abortions and were denied, at least partially due to their doctors’ interpretations of the local laws and fears of prosecution. In an alternate scenario, my doctors might have seen my resilience and told me I wasn’t sick enough for them to operate.

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Now I am home, on medical leave, and although I am infusing antibiotics into a home IV line every eight hours, I am safe. The kids and I planted tomato seedlings this week. It’s hard for me to fathom that Roe will likely be overturned by the time the fruit ripens. I’ve always known that abortion saves lives, but I had thought that meticulous contraceptive use would keep me personally safe from the sort of crisis I experienced. Every contraceptive method has a failure rate, and no amount of “being careful” can protect everyone from an unintended pregnancy and the myriad ways it can jeopardize health and well-being. Abortion is one of the ways that we as doctors keep our patients safe; I don’t see how we will be able to “do no harm” in a post-Roe world.

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