Sarah Smith wanted to be pregnant.

Smith and her husband, who have lived in Lawrence since 2000, were already the parents of a toddler daughter when they discovered they were expecting a son in fall 2008. By January of the next year, however, Smith discovered that she had miscarried in the second trimester.

They had chosen the name Keller Joe.

“Keller is actually a name my husband picked,” Smith said. “It means small companion. I think it’s Gaelic. He liked that name.”

Miscarriage is a common event before 12 weeks gestation, with approximately 20% of recognized pregnancies ending spontaneously. Only 2-3% of pregnancies end unexpectedly in the second trimester, however, research shows.

In some cases, a pregnancy lost in the second trimester is treated with a surgical evacuation where the pregnancy is removed through the cervix while the patient is asleep. For others, including most women who have passed the 24-week mark, an OBGYN will induce labor with medication and deliver the pregnancy in a hospital or medical facility after one or two days.

“I went through the whole labor thing, which was not awesome,” Smith said. “That happened in January, so we were trying to get pregnant again after that loss.”

In spring 2009, Smith and her husband were happy to discover they were pregnant again, but their joy turned to worry when Smith began bleeding at about 5 weeks. Fearing the worst, they went to see their doctor, but blood tests and an ultrasound indicated that things were alright.

When the bleeding hadn’t stopped several days later, Smith was sent to Overland Park for further tests. There it was discovered that the embryo Smith was carrying had implanted in her fallopian tube and would not be viable. She was also facing grave danger without medical intervention.

“It’s literally either the (embryo) dies, or we both die,” she said. “Those are the two options. There’s no avenue where the (embryo) can live. There’s just no way.”

In a normal pregnancy, a fertilized egg attaches to the lining of the uterus. When an egg implants and grows anywhere outside of the uterus, it is called an ectopic pregnancy. Although they can occur in the abdomen, ovaries, cervix, or as part of a cesarian section scar, approximately 90% of ectopic pregnancies occur within a fallopian tube.

Regardless of its location, an ectopic pregnancy is never viable and is life-threatening to the mother. As an ectopic pregnancy grows, the structure in which it has implanted will eventually rupture, causing internal bleeding that requires emergency surgery.

In Smith’s case, doctors decided to treat her with a medication that would stop the cells from growing, which would end the pregnancy and allow Smith’s body to naturally absorb the tissue after several weeks.

“They give you a medication called methotrexate, which they use for fighting cancer,” she said. “It attacks rapidly growing tissue, which could be cancer or a pregnancy. And it works 98% of the time, but guess what …”

About four days after taking the medication, Smith began feeling ill and suffering stomach pains while at work, eventually causing her to lose consciousness. At the hospital, ultrasounds were useless because Smith’s abdomen was filled with more than a liter of blood.

“My tube had completely ruptured and was shredded,” she said. “They did surgery, and the tube couldn’t be saved.

“I was convinced that that was my sign that I wasn’t going to have any more kids. And that was hard because I really wanted another one.”

Smith and her husband fortunately were able to conceive again in July 2009, and since then, the family has grown to include three daughters and a son who now range in age from 8 to 14.

Thirteen years later, however, Smith said she still hesitates when someone asks her how many children she has. Her family has created a memorial to Keller, the pregnancy lost at 18 weeks, but the ectopic pregnancy feels more ephemeral.

“I’m really open, but there are definitely times where I just don’t want to talk about it,” she said “Like all of a sudden, my kids will start asking me questions about Keller and Beanie Baby — we named the other one Beanie Baby. Sometimes I’m just like, ‘I just don’t really want to talk about that right now.’ It’s not because it’s a secret or it’s taboo, it just brings up so many emotions that I just don’t always want to live through again.”

One thing Smith does not waver on is her desire to preserve reproductive rights, including a full range of health care options remaining available to women.

She said she couldn’t imagine what life might be like had she not been able to quickly access treatment in 2009.

“Can you imagine if that procedure was illegal,” she said. “I’d be dead, you know, I’d be dead. My husband would be a widower, my daughter wouldn’t have a mom, and three people that exist now wouldn’t exist, you know?”

Smith said she wanted to see the constitutional amendment currently on the ballot in Kansas’ Aug. 2 election be defeated. Smith has no desire to regulate the choices of other people, she said, but she would like to be given the same opportunity.

“Do whatever you want,” she said. “I don’t care. I don’t care what you do, but don’t tell me what I need to do. You know? Don’t tell me what my daughter needs to do.

“… I just want bodily autonomy. I want to decide what happens to my body.”

Andrea Albright (she/her), reporter, can be reached at aalbright (at) lawrencekstimes (dot) com. Read more of her work for the Times here. Check out her staff bio here.

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