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Universal Truths

It doesn’t matter which side of the abortion debate you are on — or wherever on the spectrum of opinion on the topic you fall — there are a few universal truths that must be noted:

  1. Everyone wants fewer abortions.
  2. Abortions will always be needed.
  3. When abortion care is legal and accessible, it is safe.

Everyone wants fewer abortions.

A woman who finds out she is unexpectedly pregnant faces one of the scariest and most difficult situations of her life. Chances are, she has taken several precautions to prevent having an unplanned pregnancy, yet no birth control method is perfect and remaining abstinent goes against human nature. She must consider every possible consequence of continuing the pregnancy — with or without rearing the child — and of discontinuing the pregnancy, as well. She must consider her current health, her family situation, her financial situation, and many other aspects of her life and the lives of loved ones to decide the best course of action. This is not something she ever wanted to face. She never wanted to consider having an abortion yet, despite having taken all precautions, not everything in this world works out the way we plan. Thus, what I mean by “everyone wants fewer abortions” is that, beginning with the woman who is facing an unplanned pregnancy, everyone wants fewer abortions. We must encourage and support comprehensive sexual health education and access to highly effective contraception (see Pregnancy and Birth Control 101) in order to lower the rate of abortion. The importance and benefits of doing so have been shown in a large study out of St. Louis, MO: The CHOICE Project.

Abortions will always be needed.

Mother Nature isn’t perfect. She, too, makes mistakes. When I see a patient experiencing a devastating miscarriage from a desired pregnancy, my heart breaks for her, and I do everything within my power to comfort her. When a pregnancy is desired, that pregnancy is a child riding their bike for the first time, getting on the bus for their first day of school, and going off to college the minute the “+” sign appears on the home pregnancy test. Having a miscarriage and losing a pregnancy can be devastating. When I encounter these women, I generally tell them the following:

This is not your fault, there was nothing you did or did not do to cause this. This is Mother Nature’s way of helping you to have a healthy pregnancy next time.

I explain to her that, when cells multiply and divide such as they do during pregnancy, that it is a very complex process that goes smoothly most of the time. Sometimes, however, something zigs when it should have zagged, and the blueprints are no good. A miscarriage is simply nature’s way of sparing a woman from continuing an abnormal pregnancy for 9 months. That said, Mother Nature is not perfect. She doesn’t always get it right, and an abnormal pregnancy might not result in a miscarriage. Women sometimes receive the devastating news that their pregnancies are abnormal and will not result in a birth of a child that will live long after delivery, or that the fetus may die while she is still pregnant. This is when women need an abortion. Women can become very ill during pregnancy if the pregnancy continues into the second and third trimesters, possibly risking their own lives as well as the well-being of the pregnancy or any future pregnancies. This is also when women need an abortion. Even in a perfect world with perfect birth control that works perfectly every time, history has shown that, whether out of need or desire, women will continue to seek and acquire abortions.

When abortion care is legal and accessible, it is safe.

I will not rehash the entire Gosnell trial here, but for the record, he is not an example of how abortion is or should be performed; he is a monster who is shunned by the entire medical community and should be punished for the atrocities he committed. Anyone desiring to make an example of him to portray how abortion care is provided may as well make an example of Dr. Mengele to portray how all medical researchers conduct scientific research. I will also not recount the horrific tragedies of maternal deaths before abortion became legal in this country in 1974, but you should read about it if you have not already. There is evidence, however, that when abortion is legal and accessible, women are safer. A modern day example of what really happens to women when abortion is illegal can be seen here, courtesy of Al Jazeera: Right to Life.

How do we reduce the need for abortions?

The answer is simple: we must provide pre-teens with comprehensive sex education and provide people of reproductive age with highly effective methods of contraception. We must reduce the number of unplanned pregnancies in this country, the percentage of which has been an incredibly high 49% for more than 20 years. When pregnancies are planned, not only are they are primed for being healthy, but they are also much less likely to result in abortion. We must work to ensure that the only abortions are those that are necessary (because Mother Nature cannot be controlled) and that those abortions are legal and accessible, thus making them safe.

End of Life Care Before It Begins

Question:

What would you do if a premature baby, so premature that it didn’t have working lungs yet, were suddenly born right in front of you?

A) I would give it comfort care until it passed away on its own.

B) I would put a tube down its throat for breathing and insert multiple needles into it to place lines for fluids and medicines knowing that there was a 99% chance it would die anyway and a 100% chance that it would be severely incapacitated, possibly vegetative, if it lived.

C) I don’t know because I’m neither a doctor nor a person who has ever had to face that situation.

This is the impossible question posed to a Planned Parenthood representative in the video posted below that has made its way around the Internet. There are a few things you should be aware of prior to watching it:

1) The Partial-Birth Abortion Ban Act of 2003 ensures that any physician who desires to continue practicing medicine will not allow a live birth of an aborted fetus.

2) Asking someone who is not a physician what they would do in a clinical scenario is like asking someone who is not a pilot what they would do if the right jet engine went out. It is unfair and akin to trying to squeeze water from a stone.

The video:

http://www.youtube.com/watch?feature=player_embedded&v=qEv1afKaLhA

This woman was not qualified to answer medical questions, regardless of how they are phrased. That being said, it was no wonder she was uncertain 1) what they were asking and 2) how to answer.

I, however, am qualified to answer their questions and I will.

During an abortion in the 2nd trimester, specifically after 22 weeks, it is general practice to perform feticide (injection of a lethal medicine into the amniotic cavity or into the fetal heart) to essentially euthanize the fetus prior to the dilation and evacuation (D&E) procedure. It is therefore not alive once the abortion procedure is started. This is routine practice due to the Partial-Birth Abortion Ban Act passed in 2003 and requires physicians to perform the invasive procedure of intra-amniotic injection (putting the woman at risk of injury and infection) prior to the D&E. That being said, for an abortion to be “botched” (which is an unprofessional and inappropriate term to use) and the “baby to be born alive” will not happen. It cannot happen if the physician wishes to stay out of jail and continue practicing medicine. The baby cannot be born alive during an abortion because of the Partial-Birth Abortion Ban Act. The entire discussion in this clip is moot.

I’ll tell you what I would do if this impossible scenario were to happen, however: I would do whatever the patient wanted me to. The newborn would be unable to make medical decisions for itself and therefore medical-decision making would legally fall to the parents. There comes a difficult legal area, however, and if the infant were able to survive outside of the womb (> 24 weeks), were able to be resuscitated, the pediatricians may presume control over the care of the newborn if its life were in danger due to the parents’ decision. This gets into a whole legal battle I am not qualified to speak to, however, as previously stated, the scenario of an incomplete abortion with the fetus being delivered alive would not happen.

Even in cases of 3rd trimester abortion, the fetus is euthanized. This is not only due to the Partial-Birth Abortion Ban Act, but it is also humane medicine. It would be very traumatic to the mother, father (if present), and caregivers (physicians, nurses, etc) if during the induction of the abortion the baby were born alive then left to die. How horrific! Despite popular opinion, we are not monsters. We are physicians who seek to minimize the trauma of this difficult decision. In the rare cases of 3rd trimester abortions that are most commonly performed because of severe, lethal fetal anomalies that would not allow the newborn to live for very long (and suffer significantly if/while it did live), the fetus is euthanized and therefore not born alive.

As an OB/Gyn who takes care of women who are young and old, pregnant and not pregnant, my responsibility is to my patient. In the case of a pregnant woman, my responsibility is to her. When a woman comes to me for an office visit and her pregnancy test is positive, my first response is: “How do you feel about that? If you are not sure, I want to talk to you about all of your options which include continuing the pregnancy and keeping the baby, continuing the pregnancy and giving the baby up for adoption, or terminating the pregnancy by having an abortion.” If she desires I care for her and her pregnancy, I will do so and provide her with the best prenatal care I can so that she can have a safe, healthy pregnancy and childbirth experience. If my pregnant patient wishes to have an abortion, I will perform that as well so that she may have a safe procedure and termination of her pregnancy. My responsibility is to provide safe, evidence-based, comprehensive medical care, and that is what I do.