“If a woman grows weary and at last dies from childbearing, it matters not. Let her only die from bearing; she is there to do it.”—Martin Luther.

When Martin Luther penned his now infamous words—”let her … die”—he was no doubt intimately familiar with death from pregnancy. In our ancestral environment, the average woman experienced ten to 15 pregnancies. Without modern antibiotics, cesarean sections, and drugs to stop hemorrhage, approximately one in ten women died of pregnancy, just as they do today in, for example, tribal Afghanistan.

When we think about side effects of pregnancy in the United States, we usually picture awkward inconveniences like gas, itching, swelling, or constipation—or sucky-but-transient symptoms like morning sickness, cramps, and backaches. Cheerful pregnancy websites provide reassurance about less familiar symptoms like vaginal discharge and hemorrhoids, and mommy blogs offer encouragement to post-partum women struggling to feel beautiful despite newly saggy breasts, lumpy butts, and lingering tummies. In fact, a whole website, The Shape of a Mother, provides a place for post-pregnancy women to share photos of their bodies and to support each other through the potential self-esteem hit.

For a woman who wants a baby, such inconveniences, miseries, and even permanent changes may feel like a modest price to pay, while for a teen or woman with an unwanted pregnancy, even temporary or cosmetic changes may be a daily reminder that her life has spun out of control in other, more serious, ways.

But even from the standpoint of physical health, transient or cosmetic changes are just the surface. For many women, whether their pregnancy is wanted or unwanted, planned or unplanned, the price of motherhood is far from temporary or superficial.

The religious right trumpets every abortion tragedy, and personal injury attorneys turn contraception-related harm into class-action suits, but the hard reality faced by reproductive-age women is that both abortion and contraception are vastly safer than full-term pregnancy. Childbearing is inherently dangerous, and it is time that the risks of pregnancy became a part of our national conversation about contraception and abortion.

The United Nations reports that on a global scale pregnancy is the most common cause of death for women age 15 to 19. In the United States, each year over 500 women die from complications of pregnancy, either before, during, or immediately after giving birth.

Former Microsoft manager and congressional candidate Darcy Burner could have been one of those women. Here is her story:

I have been pregnant twice. Both times were very much wanted and both times I nearly died. I spent eight days hospitalized the first time, and two weeks the second time. That was after ending the pregnancy and with the doctors trying to keep me alive.

In my first pregnancy was I got to 22 weeks and my cervix dilated and I developed a uterine strep infection. The body has no way to combat that, because the immune system doesn’t work in the uterus. There was nothing they could do but end the pregnancy and do IV antibiotics.

With my son Henry I had the incompetent cervix again. I had to go in every two weeks, and I was on strict bed rest for 20 of the 34 weeks as in I wasn’t allowed to sit up. They had done a cervical cerclage, but if there is too much pressure the tissue simply will tear.

Then, it was like everything that could go wrong did. I lost a bunch of weight. I had blood sugar regulation issues. Henry was originally a twin, but I lost the twin part way through the pregnancy. I would go in for my appointments, and at every appointment my obstetrician would say to me, Here’s what’s going on. It’s a risk to your life. Do you want to continue this or not risk your life further?

Ironically all the things we knew were going on were not the things that made me have to deliver him early. I managed to get to 34 weeks and then I developed severe preeclampsia. In two days I went from no signs—perfectly normal blood pressure—to having a very few hours to live unless we ended the pregnancy and probable long term consequences even if we did. My pregnancy had a happy ending because both Henry and I are here, but those were my decisions to make.

Burner’s experience made her a passionate believer that a woman’s pregnancy decisions should involve her family and her doctor. Period.

We knew in that first pregnancy that when we delivered at 22 weeks my developing baby wasn’t going to survive. But it was that or risk having me die. Terminating that pregnancy could be illegal under the bill recently introduced in the House of Representatives, which sets a gestational limit of 20 weeks—forcing law enforcement to second guess whether the danger to a woman’s life was acute enough to warrant the abortion. Mine was a wanted pregnancy that went catastrophically wrong. The idea that a politician would interfere in a crisis like that is absurd.

Burner is open about her story because so many women face hard decisions like hers.

My sister Tammy, when she was pregnant with her youngest started having internal bleeding because she had placenta previa. She had ongoing internal bleeding through the rest of the pregnancy. She spent most of the pregnancy literally looking gray. This was a wanted pregnancy, and she did everything she could to not have to end it. But as she was making that decision—she had two other kids. Why would some politician get to make that decision instead of her and her doctor?

My friend Amy got pregnant and developed severe preeclampsia at 22-23 weeks. If she hadn’t ended the pregnancy, she too would have died. Amy’s kind of preeclampsia developed slower than mine. Her OB told her that whatever happened she shouldn’t go to a Catholic hospital because a Catholic hospital could let her die rather than save her if she hadn’t reached term yet.

Preeclampsia is a common reason to need to end a pregnancy but not the only one. I personally know stories of ectopic pregnancies. I knew someone who developed leukemia part way through a pregnancy. The doctor said you can wait to start chemo, but there’s a much higher risk that you will die from leukemia. I cannot conceive of the idea that some man in Washington DC should get to make that decision for her.

There is this myth that the maternal mortality rate is zero. That isn’t true at all. Even with the best medical care it is thousands of women each year and without that care it is hundreds of thousands. The Right Wing has done this masterful job of portraying pregnancy termination as irresponsible women not wanting to take responsibility for their actions. That is a gross misrepresentation. There are lots and lots of reasons that women end pregnancies. To be blunt I would guess that very few are ended without some real thought. But at the end of the day those are medical decisions.

They are medical decisions, deeply emotional, and, as Burner’s story illustrates, deeply personal. The list of possible complications that can maim or kill goes on and on: anemia, arrhythmia, brainstem infarction, broken tailbone or ribs, cardiopulmonary arrest, diastasis recti, eclampsia, embolism, exacerbation of epilepsy, immunosuppression, infection, gestational diabetes, gestational trophoblastic disease, hemorrhage, hypoxemia, increased intracranial pressure, mitral valve stenosis, obstetric fistula, placental abruption, postpartum depression, prolapsed uterus, severe scarring, increased spousal abuse, third or fourth degree laceration,  thrombocytopenic purpura, peripartum cardiomyopathy, and more.

Don’t have a clue what many of those words mean? I can guarantee most members of the U.S. Congress don’t either. That is why a woman’s pregnancy needs to be managed by people who do.