Challenging Pregnancy

A Journey through the Politics and Science of Healthcare in America

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Pub Date 05 Apr 2022 | Archive Date 02 Mar 2022
University of Iowa Press, University Of Iowa Press

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Health / Pregnancy / Current Events / Politics
In Challenging Pregnancy, Genevieve Grabman recounts being pregnant with identical twins whose circulatory systems were connected in a rare condition called twin-to-twin transfusion syndrome. Doctors couldn’t “unfuse” the fetuses because one twin also had several other confounding problems: selective intrauterine growth restriction, a two-vessel umbilical cord, a marginal cord insertion, and, possibly, a parasitic triplet.

Ultimately, national anti-abortion politics—not medicine or her own choices—determined the outcome of Grabman’s pregnancy. At every juncture, anti-abortion politics limited the care available to her, the doctors and hospitals willing to treat her, the tools doctors could use, and the words her doctors could say. Although she asked for aggressive treatment to save at least one baby, hospital ethics boards blocked all able doctors from helping her.

Challenging Pregnancy is about Grabman’s harrowing pregnancy and the science and politics of maternal healthcare in the United States, where every person must self-advocate for the desired outcome of their own pregnancy.
Health / Pregnancy / Current Events / Politics
In Challenging Pregnancy, Genevieve Grabman recounts being pregnant with identical twins whose circulatory systems were connected in a rare condition...

Advance Praise

“A compelling read that educates the reader and exposes the harms caused when our medical system treats women like vessels.”—Julie F. Kay, coauthor, Controlling Women: What We Must Do Now to Save Reproductive Freedom

Challenging Pregnancy interweaves the story of one very complicated pregnancy with the political environment that determined its course. It thereby makes a compelling argument for autonomy and privacy in the patient-physician relationship. Our work is directly impacted by national and state laws, institutional policies, and the availability of experts in fields related to abortion and its intersection with complicated pregnancies. Readers will not only see the overriding political concerns but also the personal turmoil. It is a reminder there is a story behind every ‘case’ and each of these stories hold value, meaning, and can change the way we view the world.”—Kathryn Marko, M.D., FACOG, George Washington University

“A compelling read that educates the reader and exposes the harms caused when our medical system treats women like vessels.”—Julie F. Kay, coauthor, Controlling Women: What We Must Do Now to Save...

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Featured Reviews

Challenging Pregnancy is an apt title for this informative work. Genevieve Grabman’s second pregnancy was a nightmare of complications and medical roadblocks. Early in the pregnancy, her twin boys were discovered to be identical, mono-di twins. This is rare and risky since it can lead to twin to twin transfusion syndrome, a condition where blood flows unevenly between the twins. When this happens, it can result in growth restriction for one of the babies. Any of these conditions can be devastating. Grabman had them all.

In her increasingly desperate attempts to save the lives of the twins, Grabman runs into the brick wall of abortion laws. Laser surgery to separate the babies’ tangled blood vessels was cancelled due to laws prohibiting fetal surgery that could cause miscarriage. Surgery to reduce the pregnancy so that the larger twin could survive was also not an option. Grabman must face the death of one baby, both babies and possibly her own.

No matter what your personal beliefs are, abortion is a complex issue. Grabman argues “that allowing doctors and patients to control decision making around reproduction may save the lives of those who are not seeking an abortion but who require cutting-edge care for an unanticipated and difficult pregnancy.” The is a compelling and thought-provoking book. 5 stars.

Thank you to NetGalley, University of Iowa Press and Genevieve Grabman for this ARC.

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I’m pretty terrible at being pregnant. I start barfing about ten seconds after sperm meets egg, and I had to be hospitalized twice during my pregnancy with my son (not quite so bad with my daughter, but I still had to be medicated the entire time). But for all the issues I had with both of my pregnancies, the babies were never in danger and I’m truly grateful for that. But those pregnancies left me with both a fascination for all that can go wrong for both parties during a pregnancy and the unnecessarily complexities and sometimes deadly consequences the American healthcare system likes to heap upon pregnant people (would you like to hear how my insurance company wouldn’t pay for medication to keep me out of the hospital, but it would pay for hospitalization? And how during my second pregnancy, it wouldn’t pay for medication at all? I’m still incredibly angry about all of this.) This is why Challenging Pregnancy: A Journey through the Politics and Science of Healthcare in America by Genevieve Grabman (University of Iowa Press, 2022) caught my eye on NetGalley. A quick tap of the request button and it was added to my kindle in just a few days. Much thanks to NetGalley, University of Iowa Press, and Genevieve Grabman for the opportunity to read this thoroughly engaging account of the author’s medically complex pregnancy and the system that stood in the way of solutions every step of the way.
What doctors first suspected to be a blighted ovum turned out to be a set of twins, shocking Genevieve Grabman. And things would only grow more complicated. The twins were soon diagnosed with a complicated condition known as twin-to-twin transfusion syndrome (TTTS), for which the outcomes for both babies and mother are often not good (death for all three is a distinct possibility, along with lifelong neurological problems for the babies). Alongside of this, the smaller twin was suffering from sIUGR, or selective intrauterine growth restriction and a dangerous two-vessel umbilical cord (which was only tenuously attached to the placenta), both boys had heart defects- basically, a lot of what could go wrong did.
Ms. Grabman’s degree in public health and her experience as a lawyer helped her navigate the often difficult-to-understand research articles about the serious medical conditions she and the twins were experiencing, giving her a massive advantage over most other people dealing with similar problems, but even with these advantages, she ran up against the wall of politics. Anti-abortion legislation heavily limits what treatments are available to pregnant women in the US, and time and time again, Ms. Grabman found that what she wanted for her pregnancy and what was considered best practice and safest in a medical sense wasn’t allowed, in favor of more dangerous procedures with worse outcomes, thanks to anti-choice politicians.
Woven throughout Ms. Grabman’s tense and frustrating narrative are facts and statistics about the dire landscape that is American maternal healthcare. For every 100,000 live births in the US, 17.4 mothers die, a statistic that is the highest out of the fourteen most-developed countries. Women’s lives are sacrificed on the altar of politics, and outcomes are decried in favor of placating the religious right. Twin-to-twin transfusion system statistically has a particularly poor outcome (along with suffering from a dearth of good research), and readers will come away from this book with a fresh horror of not only the dangers of such a complex medical condition, but also for the ease of which politicians are willing to disregard medical necessity (for children and mothers they have no stake in caring for) for ideals.
This is a moving, intense narrative. I appreciated Ms. Grabman’s attention to detail in terms of the research available, and her acknowledgement that if she found accessing proper medical care difficult, with her degrees and knowledge of reproductive law, how much more difficult and stressful is it to navigate the medical system for women with potentially deadly conditions who have less education, less ability to read the scientific studies, and fewer qualifications that mark them as someone to take seriously for the researchers and doctors she contacted?
Challenging Pregnancy will have readers questioning everything they thought they knew about the American healthcare system, abortion politics, and what the true consequences are for voting for candidates who call themselves pro-life.

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I absolutely loved this book! It was the perfect mix of informational/nonfiction, within the context of a personal story, in a somewhat hybrid memoir type style. Each chapter included multiple informative topics with a significant number of citations and data, while also connecting to the story of the author and her twin pregnancy with very rare complications. It is very clear that the topic is well researched and the author is very knowledgeable in not just her own personal medical history but also the current scientific understandings of the illnesses her fetuses were suffering while in the womb. The author explained difficult concepts very clearly and quoted medical journals and other resources when necessary, but also was personal enough without being narrowed down to her experience only. If you’re interested in women’s reproductive rights and how one might navigate the complex hospital system fighting as both an individual person and the mother of two unborn children at the same time, this is the book for you! Thanks so much Netgalley and the publisher for giving me the opportunity to read and review this wonderful book!

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This is such an important book and topic in today’s society. This book blends a compelling narrative with the important facts surrounding the abortion debate. This was a great mix of educational material and narrative. I would love to see this book be required reading for anyone taking a vote on a women’s right to choose.

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