During oral arguments in Dobbs v. Jackson Women’s Health Organization, Associate Justice Amy Coney Barrett suggested that now that all 50 states have “safe haven” laws that allow mothers to relinquish parental rights after birth, the burdens of parenthood discussed in Roe and Casey are irrelevant, and the decisions are obsolete. Putting aside the surprisingly callous assumption that giving up a baby is not burdensome, Barrett’s argument ignores the physical and psychological effects of pregnancy, labor and childbirth.

“Pregnancy is not a benign condition,” said Dr. Warren M. Hern, director of the Boulder Abortion Clinic. “Women die from pregnancy.”

In 2019, 754 women died from pregnancy-related causes in the U.S. Another 50,000 to 60,000 women each year suffer severe harm to their health due to pregnancy, labor and childbirth.

“They die from hemorrhage, infection, pre-eclampsia (which can lead to fatal seizures), obstructed labor, amniotic fluid embolism, thromboembolism, a ruptured uterus, retained placenta, hydatidiform mole, choriocarcinoma,” Hern explained, “and many other causes that fill the obstetrics textbooks.”

The United States has the worst rate of maternal deaths in the developed world and has been increasing in recent years. The maternal mortality rate for 2019 (20.1 deaths per 100,000 live births) was significantly higher than the rate for 2018 (17.4), and almost twice the rate of the U.K. (9.2).

“Pregnancy itself poses a ‘serious health risk,’” said Hern. “A woman’s life and health are at risk from the moment that a pregnancy exists in her body, whether she wants to be pregnant or not.”

Death related to childbirth is particularly acute for young women, low-income women and women of color. Black women are three times more likely to die from a pregnancy-related cause than white women.

“There are factors that put some women at higher-than-average risk of death from pregnancy,” said Hern, including “age (to be an early adolescent is more dangerous), high blood pressure, many previous pregnancies, diabetes, obesity, a history of cesarean delivery, uterine abnormalities, a scarred cervix, a placenta previa (in which the placenta covers the cervix). A placenta previa can result in sudden, catastrophic hemorrhage that is fatal, and it can require a cesarean delivery—which carries its own risks—since a normal vaginal delivery is impossible.”

Even if uncomplicated, pregnancy takes a tremendous toll on the human body. Pregnancy can cause nausea, fatigue, tender and swollen breasts, constipation, body aches, dizziness, sleep problems, heartburn and indigestion, hemorrhoids, itching, leg cramps, numb or tingling hands, swelling, urinary frequency or leaking, varicose veins, and carpal tunnel syndrome. Pregnancy takes over the entire body, affecting your cardiovascular system, kidneys, respiratory system, gastrointestinal system, skin, hormones, liver and metabolism. It increases blood volume by about 50 percent and depletes calcium out of the pregnant woman’s bones.

Pregnancy, labor and childbirth are uncomfortable, painful and damaging to the mental health of many women. Research shows that 12.4 percent of U.S. women reported severe depression during pregnancy, while 13.4 percent of pregnant women experience postpartum depression. Another study showed high levels of anxiety among pregnant and postpartum women: 35 percent during pregnancy, 17 percent immediately after childbirth and 20 percent six weeks postpartum.

Despite these many risks, patients are not informed about the dangers of pregnancy and childbirth, says Dr. Deb Oyer of Cedar River Clinics in the Seattle area of Washington state.

“People don’t know how dangerous pregnancy and giving birth is,” said Oyer. “While we go into this vast amount of information on informed consent for abortion, no one gets informed consent for having a baby. When you come in for your first obstetric appointment at eight weeks, your doctor does not sit you down and say, you might die and here are your choices.”

Why are women warned in lurid detail about the minimal risks of abortion, but not told a word about the tremendous risks of continuing a pregnancy?

“You should be getting actual informed consent at a time when you can still end the pregnancy safely,” said Oyer. “Informed consent includes telling patients about the risks, benefits and alternatives. The risk of having a baby, even with no medical issues, even being young and healthy, is so much greater than the risk of having an abortion.”

The Supreme Court is now considering whether to allow states to ban abortion. If they overturn Roe v. Wade, 26 states are likely to ban abortion and large swaths of the country in the South and Midwest will not have legal access to abortion. Many states will force women to continue a pregnancy and endure its dangers. Legal abortion protects women not only from the dangers of illegal abortion, but also from the dangers of pregnancy and childbirth if they don’t want to assume these tremendous risks.

“Legal abortion has reduced deaths of women from unsafe abortion to almost zero and has had important positive effects on other aspects of maternal and child health,” said Hern. “It has been one of the greatest public health successes in the history of medicine.”

How to decide about pregnancy.