My patient Sherry is 24, pregnant, and the mother of a 7-month-old son. Although her pregnancy was not planned, Sherry and her husband were excited to have a little brother or sister for their boy. Then Sherry’s early ultrasound showed she had twins. She and her husband spent several weeks eagerly anticipating the growth of their family. But the next ultrasound showed that the twins were conjoined, or Siamese. The babies were joined at the head, sharing a brain, and at the chest, sharing a heart. They have had two spines, four arms, and four legs. It would be impossible to separate them. If they survived after birth, it would only be for a few minutes. One heart can’t keep two bodies alive. The risk of stillbirth was also very high.

One heart can’t keep two bodies alive.

Nineteen weeks into her pregnancy, Sherry told me she was depressed. She would wake up every morning wondering if today will be the day her babies will die inside her. How would she deliver them? She knew that she would probably need a cesarean section because their combined size might make them too large for the birth canal. Sherry then imagines carrying the twins for another four and a half months. She sees herself delivering stillborns or watching her babies die minutes after their birth. Sherry had to decide whether to continue her pregnancy.

An abortion might give her and her husband some emotional relief, and she might not need surgery to remove them. But because Sherry’s insurance would not pay for her abortion, she had to worry about money on top of her other fears. She was on Medicaid, which would cover the twins’ delivery, alive or dead, but not an abortion—fetal abnormality isn’t enough to get around the Hyde Amendment. Although the abortion would be less expensive in a clinic, Sherry would have to go to a hospital since she could need surgery. She would be responsible for the entire bill of at least $10,000 to cover the operating room, anesthesia, medication, and other fees. This expense would destroy her family’s financial well-being.

Sherry could carry her babies to term who cannot and will not live, or she could have an abortion and possibly bankrupt her family.

Sherry could carry her babies to term who cannot and will not live, or she could have an abortion and possibly bankrupt her family. Sherry’s pregnancy is medically rare, but her dilemma about money is all too familiar. When a woman doesn’t have insurance coverage for abortion, she and her family suffer.