She knew she was supposed to be careful about getting pregnant, although truthfully she didn’t think it could happen because of her blood pressure and kidney problems. The nurses at the county clinic started her on the pill, but her blood pressure went all crazy. They asked her to come back on a Wednesday night when the doctor was there. The doctor asked lots of questions and spent a lot of time with her. It was nice to see a doctor care so much.

The Wednesday night clinic was where the nurses sent you when they needed the doctor’s help. It took two buses to get to that clinic and she had to wait an hour after it closed for her boyfriend to get off of work so he could pick her up, but she went because the nurses were so insistent.

The doctor (so young, she looked right out of medical school) asked her to stop the pill, something about the estrogen. The doctor tried to talk her into an IUD. Said it was the safest thing. But it sounded scary and some ladies at church said it caused abortion, so she wasn’t so sure about that.

Eventually she agreed to the Depo-Provera shot. Made her bleed all over the place for a while, but after a couple of shots she stopped getting her period altogether so that was okay.

Her boyfriend got a job in a new city, so they moved. She didn’t have a car, and even if she did she couldn’t afford the gas money to go back to the county clinic where she used to get her Depo shot. The nurses there were very nice and she was sure they would have looked the other way seeing she now lived in a different county. But they told her about Planned Parenthood. She could get her Depo there. She was so excited when she realized it was only six blocks from her apartment.

When she called to make an appointment for her Pap and Depo she was told Planned Parenthood couldn’t accept her Medicaid. Wasn’t allowed to accept Medicaid. Some law. “But I don’t want an abortion,” she said.

“Doesn’t matter,’ the receptionist said. “The government of Texas refuses to let any state tax dollars go to Planned Parenthood. You’ll have to pay for the visit and your Depo, but we do have a way to reduce the price for you.”

Even then it was a lot of money. More than she had right now. She called several doctors, but no one accepted Medicaid. “Doesn’t pay enough to cover our expenses,” they said.

And then one thing sort of led to another. She got a job at the Wal-Mart, but only part-time, so no health benefits. She needed the money to pay for her blood pressure pill. And food. Her boyfriend’s job wasn’t as many hours as they’d hoped. She bought condoms when she had the money, but stopped after a while. Deep down she had always thought she couldn’t get pregnant. The doctor at the county clinic told her not to count on it. The doctor said she had delivered many women who never believed they could get pregnant.

The sound of the doctors at her door brought her back to the here and now. She went to the emergency room the night before with the worst headache she had ever had. The look on the emergency doctor’s face when he saw her blood pressure was almost comical. And the swelling, he’d wanted to know how long it had been that bad.

He told her she was probably six months along. That she had something called preeclampsia. Her kidneys couldn’t handle the stress of being pregnant. When they got her to labor and delivery the OB said she needed to have the baby. As soon as possible. It didn’t matter that she was so early. She could have a stroke and her kidneys might fail. They told her that her baby had a 60-70% chance of surviving.

Her headache was a little better. The medication to bring down her blood pressure helped. The contractions hurt, but they weren’t that bad. She listened closely to the doctors at the door. They were talking about her ultrasound. She thought the lady who was doing the scan had taken a long time. She’d even called someone over to look at the screen. Something about not enough fluid so it was hard to see.

Only one doctor came in. A lady. She walked like she was in charge. She pulled up a chair. Her face looked a lot softer up close. “Your ultrasound has some findings and I need to talk with you about them. We know the fluid is low. We knew that from the initial scan we did last night. We talked about that this morning. But this latest ultrasound is more detailed and gives us more information. Your baby is smaller than expected. That could be from your blood pressure, but there is something else. Some problems with the bones in the skull. You were taking a blood pressure medication and it looks as if there are some birth defects.” The doctor paused.

“What does that mean for my baby?” She thought it sounded odd to say those words, my baby, out loud. A baby she didn’t even know she was carrying until yesterday. A baby she thought she could never have.

And that’s when she started to cry.

Jennifer Gunter is an obstetrician-gynecologist and author of The Preemie Primer. She blogs at her self-titled site, Dr. Jen Gunter.