"Your test was positive; there's microcephaly. The baby looks unwell. Is this a pregnancy you want to move forward with?"

It's a conversation Christine Curry, MD, PhD, has rehearsed over and over. The ob-gyn is South Florida's go-to doctor for pregnant patients with the Zika virus. While the symptoms for adults who test positive for Zika are usually just rashes or red eyes, for pregnant women, the virus can be devastating. It was recently confirmed that Zika can cause microcephaly, a birth defect where a baby's head is smaller than average, often because their brain hasn't developed properly, along with other severe birth defects.

In December 2015, faculty members at the University of Miami Hospital met to address the then-mysterious virus that was spreading quickly in South America. The link to birth defects was still speculative then, but to prepare for questions or concerns from their international patients, the staff decided one doctor should take the lead.

Dr. Curry, a 36-year-old about a year into her job at the hospital, raised her hand.

"I have an interest in infectious disease — I have a PhD from the microbiology and immunology department at Loyola [University Chicago] — and so I said I'd be happy to take the lead on this, not really knowing what that meant or where that would go," Dr. Curry says.

In just seven months, Zika has exploded into a global public health emergency, according to the World Health Organization. As of May 20, the Centers for Disease Control and Prevention are monitoring 279 pregnant women with confirmed or suspected Zika virus infections in the U.S, according to the New York Times. The CDC reports that fewer than a dozen women in the U.S. have had miscarriages or had babies born with birth defects due to Zika. But this week, the first baby with Zika-related microcephaly was born in Florida.

A mom in Brazil with her baby, who has microcephaly. Getty Images

Since that December meeting, Dr. Curry has treated about a dozen pregnant women who have tested positive for the virus. The hospital recommends all pregnant women who have traveled to a Zika-affected area in the last 12 weeks get tested, regardless of whether they feel sick. "The vast majority of patients are asymptomatic. They are often surprised by their positive test," says Dr. Curry, who uses a combination of blood and urine tests to determine a diagnosis.

Dr. Curry is the one who breaks the news that they have Zika, the one who describes how this could affect their babies, the one who explains their options in English, Spanish, or Haitian Creole. The virus is so new, she's sometimes learning along with her patients. "It's not uncommon for a patient to ask a question I've never thought of," Dr. Curry says. "You just have a sort of contract with your patients like, 'Listen, this is new. This is new to you, this is new to me, and this is something that isn't in my textbook.'"

She's also the one who delivers the baby — or she can terminate the pregnancy.

If a patient has Zika, she says, "We go through their test together, then we talk about how far along they are in pregnancy and what their options are, depending on what trimester they're in." In the first trimester, usually it's impossible to tell if there are any problems with the fetus, so a patient must decide blindly if she wants to proceed with a pregnancy that could show symptoms later on.

A woman in the first trimester may look at that risk situation and say, 'I want none of this.'

"A woman in the first trimester may look at that risk situation and say, 'I want none of this. This is really difficult for me. I'm not willing to wait another couple months to see if a problem develops. I would like to terminate this pregnancy,'" says Dr. Curry. "Or she may say, 'OK, we don't yet know if this is a 1 percent chance or a 25 percent chance, let's wait a couple months and see what happens.' It's a very personal decision."

During the second trimester, at about 18 to 20 weeks, Dr. Curry performs an anatomy ultrasound, and that's usually the first time microcephaly can be diagnosed. But a normal ultrasound at this point does not guarantee that the fetus will continue to grow without defect. "There are some women who have been infected in the first trimester, and it's not until later that some of these findings manifest," says Dr. Curry. In Florida, women have the option of having an abortion up until 24 weeks, giving these women about a month after this ultrasound appointment to make a decision about the future of their pregnancy. They often ask Dr. Curry for advice. "It's an intense conversation," she says.

A lot of her counseling is administrative. With many of her patients coming from outside of the U.S. — from countries like Honduras, Haiti and Brazil, where Zika is active and abortion is illegal — she teaches them how the U.S. health-care system operates, what abortion laws they need to be aware of, and what paperwork they'll need. "Many of them don't know that [terminating a pregnancy] is necessarily their right," she says.

Centers for Disease Control and Prevention

If microcephaly is detected in the third trimester, it's too late to terminate the pregnancy in Florida (some other places do allow late-term abortions), so the conversations turn to delivery and childbirth. The patient will come in every four to six weeks for an ultrasound to monitor the baby's development, as opposed to just a single ultrasound in the third trimester for a typical pregnancy.

"It's all of the fun things about preparing for childbirth — prenatal classes, birthing classes — but also making sure that mom is not paralyzed with fear about the pregnancy, because many of these babies will be born normally," Dr. Curry says. "If there's ever a sign that a problem developing, it's all about honesty and transparency and just being available for the patient. Some patients do become nervous but, for the most part, they're like, 'OK, if there's nothing I can do about it, we're in it together.'"

Dr. Curry says she's delivered babies to women who have tested positive for Zika, but declines to say how many or to comment on their health.

Kids with microcephaly can have developmental delays, problems with movement and balance, seizures, as well as vision and feeding problems, according to the CDC. The problems range from mild to severe, and can last a lifetime. Microcephaly can require around-the-clock care for the child and can, in worst cases, be life-threatening — but it isn't always. One Brazilian journalist with microcephaly spoke to the BBC about her life earlier this year, saying she's faced seizures and breathing problems, but has grown up to go to university and write a book about her life.

"Microcephaly is a box of surprises. You may suffer from serious problems or you may not," Ana Carolina Caceres explained. "What I recommend to mothers or pregnant women is that they remain calm. Microcephaly is an ugly name but it's not an evil monster."

Some patients do become nervous but, for the most part, they're like, 'OK, if there's nothing I can do about it, we're in it together.'

As the number of positive tests keep ticking up and the headlines multiply, patient concern grows. Women ask Dr. Curry: What does this mean for the planning of my family? Should I avoid pregnancy for a while? Should I get pregnant right now before it spreads further?

Dr. Curry says all she can do is echo the CDC's warning: "We anticipate that Zika will get to the United States. Hospitals, clinics, etc., need to start educating patients preemptively about what we know about Zika, what is the effect on the baby, and what can you do to prevent mosquito bites."

Her patients with Zika, meanwhile, anxiously bring in clippings of news articles, and recite concerns and rumors from their parents, cousins, aunts, and uncles. Dr. Curry plays the role of fact-checker and sympathetic ear, telling them there's no question too small. Being a Zika-focused ob-gyn is, Dr. Curry says, as much about relating to her patients as it is about treating them. "It's sitting and talking or drawing pictures and making other ways to communicate so that they can then take back to their families and discuss."

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Kate Storey Esquire Writer-at-Large Kate Storey is a Writer-at-Large for Esquire covering culture, politics, and style.

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