The American Feminist

The American Feminist, Winter 1997-98

Abortion: A View From the Inside

Dr. A estimates that he performed 45,000 abortions during 15 years in practice. Although he no longer performs abortions, he continues to oppose making them illegal. He has agreed to an anonymous interview to give The American Feminist readers an insider's view based on his experience. The opinions he states are solely his own.

"If you're not ready to take the risk of pregnancy, then choose abstinence," recommends Dr. A, who says he wants to work with those on both sides of the debate to reduce the number of abortions significantly. He believes prevention is the best answer but has seen firsthand the obstacles to making contraception effective.

"OB/GYNs and family practitioners don't see the failures because many patients seeking abortion don't tell their doctors that they became pregnant and had an abortion," Dr. A said. "Half of all women seeking an abortion failed on birth control because they did not follow directions, but the other half failed because of their doctor." Most important, Dr. A asserts, "the cause of the unplanned pregnancy in most of these situations is that the medical relationship fails." For instance, patients may give incomplete infornation to their doctor about problems they are experiencing, and patients may not have been properly trained by their physician to take the Pill.

Surprisingly, most women have not been informed that antibiotics like ampicillin and tetracycline can interrupt the effectiveness of the Pill. Many women are unaware that they must take the Pill at the same time of day - every day - for it to be most effective. "Nurses on shift rotation, who are highly educated and motivated, are at high risk for failure because it is...extremely difficult for them to remember to take the Pill because their work throws them off," Dr. A says.

But nothing can be done for the woman who takes the Pill as directed, has intercourse, and then becomes sick with vomiting and diarrhea from the flu, says Dr. A. Because of the illness, she absorbs less of the Pill, effectively missing a dose. Ovulation resumes, the sperm continue to live for three to five days, and a few days later she conceives. Most important, Dr. A wants women to understand that "99 percent effective" means that one out a hundred women who use the Pill correctly will become pregnant in one year.

Abstinence is the "only effective course for teenagers," states Dr. A. "Adult women are experiencing huge contraception failure, so how do we expect teenagers to do any better?" Even though he is a physician, Dr. A admits that he has a problem, like many people, remembering to take blood-pressure medication on time, and occasionally misses a dose. For him, little damage results - but for many highly fertile couples, if just one birth-control pill is missed or taken late, pregnancy may result.

This former abortion doctor supports parental notification - rather than parental consent - for those teenagers seeking abortions, for a variety of reasons. He argues that parental consent might force a teenager to go out of state or use a fake license so that she won't have to get permission from a parent or guardian.

Ultimately Dr. A advocates a federal parental-notification law as the remedy. "Parents need to be given an opportunity to be supportive and help her prevent repeating risky behavior." More important, Dr. A adds, "Teens don't have money, and the cheapest clinic may not be the best. There are some bad doctors and some bad clinics. Others may wait too long and end up with a late-term - and more dangerous - abortion."

Follow-up care is another issue. One of his teenage post-abortion patients had a friend call to say she was hemorrhaging after her abortion, but the friend didn't give him much detailed information. When Dr. A called the patient at home her mother intercepted the call, telling him that her daughter had lost phone privileges so she could not come to the phone; privacy laws prevented him from disclosing that her daughter possibly needed to be taken to the hospital for follow-up care. As a result, he was unable to make appropriate recommendations or assessment of the girl's condition.

Hemorrhaging can either indicate a uterine atony or a perforation, which is a serious problem. (A uterine atony is a failure of the uterine muscle to contract adequately, which helps control bleeding after an abortion.) By causing muscle contractions, methergine can make the bleeding of the uterus stop, but that can give doctors a false sense of confidence. "If it is a perforation, surgery may be required," Dr. A said. The Centers for Disease Control and Prevention estimates that one in 500 women who undergo abortion in their first trimester will have her uterus perforated. Dr. A asserts that follow-up care can be problematic because some women are embarrassed to talk to their doctors about their abortion. One of his patients, who was 30 years old, died from a heart attack because she was too embarrassed to go to the hospital after her abortion - even though she was experiencing classic chest pains.

Dr. A also supports informed consent. For purposes of consistency, patients at his clinic listened to taped information. "When staff are required to relay the same information over and over and over again they become zombies...and some information is sure to be missed." After- care instructions must be in writing or easily accessed by a voice-mail system because most patients will remember very little oral instruction following surgery.

He believes that abortion clinics would be supportive of distributing information about resources to support continued pregnancy if it was presented in an accurate, non-judgmental, non-sectarian way.

Dr. A says that he wants to work toward making abortion rare. When asked why, he responded, "Abortion is a tragedy. There is no way around that, and I have never seen a woman who comes in to say, 'That was great.' To every woman it is scary, it costs money, and is often painful physically and emotionally. The job of a physician is to make people well and prevent illness and surgery. We should be working to prevent the need for an abortion."