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A Third-Year Medical Student Discusses Her Views On Abortion In The Washington Post

The abortion “issue” is such a hot topic that I have never written about it on this blog until today. I hope I won’t regret that decision but I felt it was appropriate to respond to this medical student’s essay – and the ~560+ comments that follow it – as a physician who has witnessed (but never performed) about 100 abortions. Let me explain.

During my Emergency Medicine training I was required to perform a certain number of intubations and abdominal ultrasound scans. My residency training program offered rotations in Ob/Gyn and at a local Planned Parenthood center. The senior residents told me that the best way to fulfill my intubation requirements was to assist with the Ob/Gyn OR procedures because the patients were young, healthy, and generally uncomplicated. At the time I was really excited by the opportunity to get the experience I needed – in as short a time as possible. I used to hang out in an Ob/Gyn operating room asking if I could assist the anesthesiologist with the intubations. Once they got to know and trust me, I could intubate about 6 patients in a day – an opportunity otherwise hard to come by as all the new anesthesiology residents were vying to practice intubation themselves.

One of the Ob/Gyns who used the OR (where I got my intubation experience) scheduled some abortions of fetuses that were at the border of viable – as old as 23 weeks. That made me quite uncomfortable, and I know that there were other staff (and several nurses) who refused to work with that physician. However, as squirmy as I felt, I thought it was important for me to see first hand what the procedure entailed… because otherwise I’d have to rely on anecdotes and second-hand opinions to draw my own conclusions. I wanted to see this for myself.

I’ll never forget the day I witnessed the first late-ish term abortion. I was preparing my intubation equipment – fidgeting with the Mac size 4 blade, making sure the light worked, when the physician brought the patient into the room on a gurney. The woman’s abdomen was very pregnant, and the Ob/Gyn was stroking her hair and whispering reassuring things to her. The anesthesiologist made small talk with the patient, explaining the nuts and bolts of the anesthesia – the oxygen mask – the propofol – the intubation. I stayed out of the patient’s line of sight and allowed the Ob/Gyn and her resident to spend some final moments with her. The scene was both tense, and yet supportive of the patient.

I initiated rapid sequence intubation with the assistance of the anesthesiologist, and then moved to get the ultrasound machine to visualize the uterus and its contents. Much to my discomfort the fetus was fairly large – and was moving around normally, even sucking its thumb at one point. I asked the Ob/Gyn resident why the fetus was being aborted since it didn’t appear to have any structural abnormalities. She responded that the mother simply didn’t want to have the baby, and had wrestled with the idea of abortion for a long time before she made her final decision.

The rest of the procedure is a bit of a blur – with details too graphic to describe here. But suffice it to say that the resident performing the dilatation and curettage had a fairly difficult time removing the fetus through the cervix, and had to resort to eliminating it in smaller parts, rather than a whole. It was very sad and it took a long time to make sure that the uterus was fully evacuated. I decided that I couldn’t watch another one of these procedures.

The rest of my female abdominal ultrasound experience was obtained at a Planned Parenthood center where very early abortions were performed. Generally, this consisted of suctioning out a tiny yolk sac (and “products of conception”) – without much of a recognizable fetus in the midst. Although these procedures were certainly emotional, they were somewhat less troubling than the later term dilatation and curettage.

What I didn’t expect, however, was that of the approximately 100 abortions I witnessed – none (to my knowledge) of the women requesting them were rape victims, nor was there a life-threatening birth defect in the fetus. Usually the reason they gave was psychological, emotional, or financial – “I just can’t afford to raise a child” or “This is not a good time for me to be pregnant” or “I don’t want this baby” or “I don’t want another baby” or “This was an accident, and I don’t want it to ruin my life.”

I did my very best to adopt an attitude much like the one that the author of the Washington Post article did – “It’s not for me to judge the validity of someone else’s reasons for wanting an abortion… They’re going to do it anyway so physicians need to make sure they’re safe… Women have the right to choose…”

But the reality was that those attitudes didn’t prepare me for the emotional turmoil inherent in the process of abortion. It’s sadder than I thought, more difficult than I thought… and the impact is farther reaching than I imagined. Studies estimate that about 1/3 of US women have an abortion at some point in their lives – that’s a heavy emotional burden that many women carry in silence.

In my opinion women should have the right to choose to have an abortion, but I’d hope that they also consider their right to choose to give their baby up for adoption as well. Some believe that an abortion is “easier” than giving up a baby for adoption – but I’m not so sure that’s the case from an emotional perspective. As far as rape victims or women who are carrying a moribund fetus – the decision to abort may well be emotionally less damaging. But for the majority of women who have abortions for less clear reasons (reasons like the ones I witnessed), I’d really encourage them to consider adoption as an option. Obviously, these decisions are intensely personal and have to be made on a case-by-case basis – and women should be supported either way.

As scientific and rational as I wanted to be about the procedure, I am still troubled by what I experienced as a witness to various abortions. Though I might have “entered the abortion conversation” as the third-year medical student did – after witnessing quite a few, I have a deeper appreciation for the emotional complexity of abortion, and a desire to help women avoid them if at all possible. I wonder if the author of the Washington Post article will change her perspective after she’s witnessed a few of the procedures?


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9 Responses to “A Third-Year Medical Student Discusses Her Views On Abortion In The Washington Post”

  1. Julia says:

    Thank you for the inside look at early and late term abortion. My thoughts on adoption have always been very positive. I know many people who are adopted or have adopted siblings and they love their families and have had very fortunate experiences. However I recently read Ann Fessler's book 'The Girls Who Went Away' which discusses adoption before Roe V. Wade. Story after story in her book tells of women who have suffered life-long trauma from giving away their babies. Their stories are not necessarily representative of women who give their children up for adoption now as many of them were forced and manipulated by parents and social workers to “do the right thing” rather than keep their babies themselves. But I came away from the book under no doubts that adoption can be very damaging for some birth parents. Obviously abortion is an integral and important part of reproductive health care, but the best way to reduce the need for it is to provide accurate health information and easily affordable and accessible contraception.

  2. Julia says:

    Thank you for the inside look at early and late term abortion. My thoughts on adoption have always been very positive. I know many people who are adopted or have adopted siblings and they love their families and have had very fortunate experiences. However I recently read Ann Fessler's book 'The Girls Who Went Away' which discusses adoption before Roe V. Wade. Story after story in her book tells of women who have suffered life-long trauma from giving away their babies. Their stories are not necessarily representative of women who give their children up for adoption now as many of them were forced and manipulated by parents and social workers to “do the right thing” rather than keep their babies themselves. But I came away from the book under no doubts that adoption can be very damaging for some birth parents. Obviously abortion is an integral and important part of reproductive health care, but the best way to reduce the need for it is to provide accurate health information and easily affordable and accessible contraception.

  3. Let me preface this by saying I'm currently a third year medical student on my OB-GYN rotation. I've seen and assisted on a signficant number of abortions by D/C (for the sake of discusison let's leave it at double digits but not triple digits), I've also seen (watched, but did not scrub) a small number of D&E, and D&X procedures.

    I have had the rare-for-a-med-student (at least at my institution) of following a patient from clinic, to abortion, to followup visit at clinic, as well as seeing a number of clinic patients before, or after abortion.

    It is absolutely an emotionally complicated issue. This goes for the physician, the patient, and any staff involved.

    Still, I think seeing a snapshot of a patient in preop is perhaps a biasing experience. Seeing your patient agonize of the decision in clinic changes things as well. Seeing someone unsure what to do, making decisions that alter the course of their life no matter what choice they make. It is it's own complicated, chaotic situation.

    Seeing your patient in followup provides yet another perspective. Some patients agonize. Some patients are relieved (this an understatement, but I lack a concise way to summarize their feelings). Some rationalize, intellectualize, and otherwise grieve. But few of the women I've talked to regret the decision they made – whether it was to carry to term or to abort.

    Whether that is after the fact, with cognitive dissonance making the decision for them or not, I don't know.

    I'm not criticizing the perspective you offer, just pointing out that the issue is often much more nuanced than an explanation that a patient can give in a short time in preop/postop.

    I agree that adoption should be offered more often, with more explanation. I think though, that is a failing of some training programs, which don't teach enough about adoption as an option.

    I came into medical school with a pro-choice perspective to begin with. My experience on this rotation has reinforced this for me personally. I know other people have reacted differently, with some horrified pro-choice individuals moving towards pro life, and some pro-life moving towards pro choice.

    What can't be denied is that this discussion is much more complex than those on the far right or far left would have us believe.

  4. Light says:

    Human beings have a gift for making things complicated and for rationalisation.Every person who reads this page began as a small collection of cells in a womb and was allowed to live.
    Yes there is now technology available today and even funding to help kill a child in the womb more efficently but the nature of the act remains unchanged.It is an action which goes against every natural instinct in a woman's nature The natural instinct is to nurture and protect the young.
    Dr Val has written an honest account of her personal experience and people do agonise over the decision because of social pressure and their own fear.It takes great courage to resist the pressure to have an abortion particularly if you are poor and have no one to help you.Doing what is right is not always easy in our selfish society but killing a baby is never the solution It is always a death sentence for the babe and often a life sentence for the mother.

  5. Light says:

    Human beings have a gift for making things complicated and for rationalisation.Every person who reads this page began as a small collection of cells in a womb and was allowed to live.
    Yes there is now technology available today and even funding to help kill a child in the womb more efficently but the nature of the act remains unchanged.It is an action which goes against every natural instinct in a woman's nature The natural instinct is to nurture and protect the young.
    Dr Val has written an honest account of her personal experience and people do agonise over the decision because of social pressure and their own fear.It takes great courage to resist the pressure to have an abortion particularly if you are poor and have no one to help you.Doing what is right is not always easy in our selfish society but killing a baby is never the solution It is always a death sentence for the babe and often a life sentence for the mother.

  6. Ideologic positions just aren't tenable on this subject. They ignore the greater complexity of the issue in favor of making a simplistic statement that can easily be used to moralise.

    The use of scientific words like “A small collection of cells” is just a little distractor, to make it seem like science supports a particular interpretation of events here. This isn't the case. The question “When does life begin” is a political, or sociologic question, not a scientific one. Acting like science backs you up is deceptive, and just not helpful to the subject.

    Dr Val wrote a beautiful post, that expresses a point of view not entirely different than yours, yet she did so with cognizance of just how complex and difficult it is.

    You have taken all that is beautiful in her post and razored it away with a quick “human beings have a gift for making things complicated and for rationalisation” which is, ironically, a rationalization rather than a discussion of the facts.

    Reasonable people can disagree on the pro choice or pro life position. However reasonable people must also drop ideology, and absolutes like “never the solution,” which merely indicates a lack of empathy, and a lack of understanding reality.

  7. Ideologic positions just aren't tenable on this subject. They ignore the greater complexity of the issue in favor of making a simplistic statement that can easily be used to moralise.

    The use of scientific words like “A small collection of cells” is just a little distractor, to make it seem like science supports a particular interpretation of events here. This isn't the case. The question “When does life begin” is a political, or sociologic question, not a scientific one. Acting like science backs you up is deceptive, and just not helpful to the subject.

    Dr Val wrote a beautiful post, that expresses a point of view not entirely different than yours, yet she did so with cognizance of just how complex and difficult it is.

    You have taken all that is beautiful in her post and razored it away with a quick “human beings have a gift for making things complicated and for rationalisation” which is, ironically, a rationalization rather than a discussion of the facts.

    Reasonable people can disagree on the pro choice or pro life position. However reasonable people must also drop ideology, and absolutes like “never the solution,” which merely indicates a lack of empathy, and a lack of understanding reality.

  8. Light says:

    Here is something to ponder which goes beyond ideology and is simply showing something real and tangible as to mu lack of empathy you do not know me personally so I wonder how you can make this character assessment? I think there are moral absolutes there is such a thing as right and wrong but I have every sympathy for any persons facing sorrow or trouble in life nor do I personally judge any other human being because Jesus has warned us all against judging one another. You have dismissed me as lacking empathy and ridicule my post that is your right I believe in freedom of speech but I don't believe we have the freedom to kill an innocent in the womb who has comitted no crime against anyone.
    http://www.dailymail.co.uk/sciencetech/article-...

  9. Light says:

    Here is something to ponder which goes beyond ideology and is simply showing something real and tangible as to mu lack of empathy you do not know me personally so I wonder how you can make this character assessment? I think there are moral absolutes there is such a thing as right and wrong but I have every sympathy for any persons facing sorrow or trouble in life nor do I personally judge any other human being because Jesus has warned us all against judging one another. You have dismissed me as lacking empathy and ridicule my post that is your right I believe in freedom of speech but I don't believe we have the freedom to kill an innocent in the womb who has comitted no crime against anyone.
    http://www.dailymail.co.uk/sciencetech/article-...

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