Amanda D'Angelo and husband James honeymooned in Hawaii in 2021. The rainbow is widely regarded as a symbol of having a living child after losing one during pregnancy. (Courtesy Amanda D'Angelo)

Amanda D’Angelo only had a few weeks to get used to the idea that she was going to be a twin mom, before her eight-week scan revealed one had died.

It’s a relatively common occurrence early on in twin pregnancies, and while it was upsetting, she took comfort in still being pregnant. She went on her honeymoon with her husband to Hawaii in July 2021, and the newlyweds smiled for a photo on the beach with a double rainbow behind them — a rainbow being the widely regarded symbol of having a living child after losing one during pregnancy.

She didn’t know just how symbolic that rainbow would become until a few weeks later.

D’Angelo went to a clinic in Manchester, New Hampshire, for a routine 12-week scan on her lunch break, without her husband, James, who had to work. But when the ultrasound technician began looking in detail, she told D’Angelo, “I don’t like the look of the head.”

The technician went to talk to the doctor, and D’Angelo was left alone in silence for about 20 minutes, staring up at an orange-brown overhead light, repeating to herself, “There’s no way two bad things can happen.”

Before and after Dobbs, questions of ‘when and where’ affect abortion access

The doctor’s look said it all. ‘“I wish I was meeting you on better terms,’” she recalled him saying. She started to cry.

“I was beside myself.”

The connection of mental health and abortion is a talking point used by anti-abortion and abortion rights advocates alike, for different reasons. Research shows that most women do not experience significant emotional harm after an abortion and do not regret the decision, and those denied an abortion are more likely to have anxiety, low self-esteem, and fewer aspirational goals for the future.

For mothers whose pregnancies have been diagnosed with fetal anomalies, there is a high risk of traumatic stress and depression at the time of the diagnosis and over time.

D’Angelo’s doctor told her the fetus suffered a defect of a neural tube that never closed, leading to a condition called anencephaly, where the skull and large sections of the brain do not form. The condition affects 1 in 4,600 pregnancies, according to the Centers for Disease Control and Prevention. Many cases end in miscarriage or stillbirth. Those that make it to delivery die shortly afterward. It’s more common in females, which is what D’Angelo was carrying.

“I knew right away I mentally could not handle carrying a baby that was going to die,” D’Angelo said. “I knew that prolonging the suffering for myself and for her was not going to be a good environment.”

She walked out of the appointment in a daze, along the skywalk at the hospital to the parking garage.

“I kept looking over the edge, and I remember thinking, ‘I could just throw myself off of here right now,’” D’Angelo said. “What made me stop, and cry even harder, was that my husband would have no answers as to why I did that.”

Abortion stigma still exists in places like New England

A study from Saint Martin’s University in 2022 showed about 2.4 million deaths occur every year in utero or by stillbirth, which is four times greater than the annual number of deaths from cancer. That type of loss was not recognized by many health care professionals as an emotional trauma prior to 1970, the research said, but is now considered a traumatic event that can lead to post-traumatic stress disorder. Symptoms can be debilitating, and include depression, substance abuse and suicidal ideation.

D’Angelo’s diagnosis came nearly a year before the U.S. Supreme Court’s Dobbs decision to overturn Roe and return the right to regulate abortion to the states. In New Hampshire, access to abortion is legal until 24 weeks. Both sides of the abortion rights debate have tried to change that, but as recently as Feb. 1, members of the state’s General Court are in a stalemate. Representatives voted on a proposed constitutional amendment that would have asked voters to guarantee a right to abortion until 24 weeks, but it needed 226 votes to pass and received 193.

A competing bill would have banned abortion after a fetus has reached 15 days of gestation, which is before a menstrual period is considered “late” if gestational age is counted from the last menstrual period. Representatives voted 363-11 to indefinitely postpone the bill, according to the New Hampshire Bulletin.

Unlike in 14 other states, D’Angelo’s doctor was free to refer her to another clinic for termination. Within a week, she was able to get an appointment at a Dartmouth facility in Lebanon, New Hampshire, about an hour and a half away, at almost 14 weeks. Her husband didn’t question the decision, she said, and gave his full support.

She acknowledged she lives in an area of the country where abortion access is widely available, but said that doesn’t stop societal stigma. A 2020 study of 4,000 abortion patients found nearly two-thirds thought people would look down on them if they knew they had an abortion. A 2012 survey of college students in New England found 87% of participants agreed there is a stigma around women who have abortions, and 23% felt they had to withhold their beliefs about abortion from people they were closest to.

“In New England, a lot of places are very liberal and open about abortion, but that doesn’t mean there aren’t a ton of people around here that judge someone for that,” D’Angelo said.

Although in favor of abortion rights, she called herself the black sheep of a family where her father was very religious and conservative, including vehement stances against abortion.

“It was definitely something in the back of my mind, that religious guilt and knowing they would judge me over this,” she said.

Termination allowed her to go on to have a living child

Following her termination, D’Angelo said her obstetrician referred her to a perinatal therapist, and that therapy helped her feel prepared to try again a few months later. By December of that year, D’Angelo was pregnant with her now 18-month-old son, Jacob — her rainbow baby. He was due about a week after the year anniversary of her abortion.

During her pregnancy with Jacob, the Dobbs ruling happened in June 2022. She worried for every person whose mental health might go by the wayside during a termination experience because they couldn’t receive care first for their physical health.

“It makes me so upset and distraught for these women and families and what they’re facing, because I know how I felt in that situation, I felt very alone,” she said.

By sharing her story, D’Angelo said she hopes to increase understanding of why people need abortions.

“I cannot let this just go on and have people think that people just get abortions left and right,” she said. “Even if that’s the case, who is that for you to judge? But also, it happens to people who are trying to start families and want to have a baby.”

If she had been forced to carry the pregnancy to term, D’Angelo said she is unsure if she would have made it through her suicidal thoughts to be able to go on and have her son.

“I hope middle-of-the-road people that are undecided, and people who are conservative, look at this and say, ‘Oh my gosh, this is a really hard situation, and I don’t know what I would do in their situation,’” D’Angelo said. “And I hope they realize a woman’s mental health does matter. A woman’s health matters in general.”