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abortion

What you learn doing abortions after 20 weeks

Residency doesn’t prepare you for listening to someone you have never met pleading over the phone for help, their breathless desperation as they try to tell their sad story between sobs, intertwined with intimate details. They would say random, heart breaking things like, “What do we do with the crib?”

They were similar in many ways. A state with a 20 week ban on “elective” pregnancy terminations. The ultrasound that diagnosed the catastrophic collision of chromosomes performed too late. Often there was the suggestion that the doctor might have been offensively “pro-life,” the kind that orders the second trimester scans a little later than recommended for those women they know are pro-choice.

I didn’t set out to do post 20 week abortions, I just kind of ended up doing them because with each turn in medical school and residency it seemed no one else was. I was always pro-choice. I remember riding my ten speed to Dr. Henry Morgentaler’s clinic in Winnipeg to show support when I was 16. I hadn’t even been on a date or had sex so pregnancy and abortion were abstract, yet I knew women deserve autonomy. That we get to decide what happens to our bodies. My parents were very conservative in many ways, but they were very pro-choice so maybe it came from them. Our basement library was also filled with books by the likes of Margaret Atwood and Betty Friedan and so I read a lot of feminist literature and non-fiction growing up.

In medical school the lectures about abortion were given by men. That bothered me. I don’t think you have to be a woman to be a good OB/GYN, but I had hoped for equal representation. The same in my OB/GYN residency, only men did abortions and for any woman who thinks it’s weird for a man to be an OB/GYN let me say these men were full of empathy and kindness and were very skilled and there was nothing odd about them wanting to do OB/GYN. The subject interested them and they felt women deserved the best care. Basically, they thought about it just like I do.

Once in residency I remember rolling my eyes about someone who was past 20 weeks and needed an elective procedure. There a firm grip on my arm and a firmer lecture about privilege. Before the world was online some women were told by their doctors that abortion was illegal and they had no idea that not only was it legal in Ontario but also free. The delay explained by the time it took to find out through a network of whispers where to go and to raise the money for one bus ticket. I had the luxury of a basement library, two homes, music lessons, and trips to Europe growing up and I was going to judge someone who had to work two jobs to buy a bus ticket to travel alone for her abortion? A good doctor teaches you these things.

To learn abortion in my residency required going out of my way. That unspoken marginalization bothered me. The default should be learning the procedure, because otherwise there is a clandestine air. The other thing that troubled me was the only other people who went out of their way to learn were men. They thought as I did, that we should all just learn so we then can all be safe and offer good care.

After residency I figured I would offer my patients abortions and it would be just one part of my practice. I naively thought everyone would do that. I moved to Kansas to do a fellowship in infectious diseases and learned very quickly that unlike the Canadian Midwest in the American Midwest it was best to not discuss abortion and choice. I was shocked by the fact that there were four clinics for the state, but only two for later term.

Along the way people found out I had the mechanical skills. It probably started because I did a few dilation and evacuations on labor and delivery for women at 22 or 23 weeks with ruptured membranes, infections, and fetal demise. It’s technically a very hard procedure when there is an infection and helping a woman not need a hysterectomy to save her life is something only people who have learned how to do late-term abortions can do. It’s nerve wracking because with infection the uterus is like soft butter and you are using hard instruments. And it’s all by feel. In those days we didn’t use ultrasound.

I guess word quietly got out. Our clinic nurse, a kind soul and a ringer for Professor Sprout, pushed me a little to help this woman and then that one and so on. I didn’t know this would lead me to care for women who had almost no other options.

Many had been given Dr. Tiller’s name or told about Planned Parenthood, but if they had medical conditions they needed a hospital and that left me. Some didn’t want to go to Dr. Tiller or Planned Parenthood, often they were of the persuasion that believed abortion was wrong and obviously if you go to an abortion clinic everyone knows what you are doing. A hospital offers other potential explanations. Often they came because they had no money and I worked at a teaching hospital and we didn’t ask for cash up front, so maybe just maybe?

A later abortion is thousands and thousands of dollars so when people had nothing I would beg and plead with my anesthesia buddies and they would forget to turn in their billing slips. I wouldn’t charge and the hospital administrators often looked the other way. I don’t know if they were pro-choice, the billing truly sucked, the stories tugged at their hearts like they did mine, or they accepted my explanation that this was for resident education.

Several times there was no money for a funeral home to receive the body (they can charge hundreds of dollars), but a several hundred or more mile drive to get the body back home. It became my job to figure that out. I’m 28 or 29 and I’m scrambling to find a suitable box for a tiny body and convince the morgue that this is somehow okay. I’m pretty sure my genetic counselor gave people gas money from time to time.

If we did an induction the nurse would wrap the baby up ever so carefully for viewing, but sometimes the birth defects were so much that we presented hand prints and foot prints or a face carefully swaddled to show the chin or whatever part looked perfect. It takes a special kind of nurse to do this and they did it with such tenderness. However, as the doctor it was left to me to explain why we thought it best they not look. All the things no one knows how to do or wants to do are left to the doctor. Do you show a woman that her baby really is a cyclops? I know she knows because she told you between sobs when she called, or rather her husband did because she was crying so hard she couldn’t speak anymore. But is that the image I should lock in her brain for the rest of her life or the five toes? You just do the best you can. I like to think that my patients knew that.

At the time I was told we got all these out-of-state calls and desperate women because Kansas had a lax abortion law. The story was the previous chair of the department had been around for so long that he had done abortions for so many mistresses and delivered babies out-of-wedlock for so many daughters that he had massive coin in the political bank. I don’t have proof of that, but the laws were lax and it was to my hospital reporters came calling when there was a suggestion that Bob Dole had a girlfriend way back who had an abortion.

But times change and the former chief of the department was elderly and all those maybe secrets and those affected by them aged with him. A law was passed to prevent abortions at KU medical center unless the life of the woman was in jeopardy. It wasn’t a back door TRAP kind of law, it was a blatant “not here” tacked on to a funding bill. Want state funding, stop abortions. No one beats around the bush in Kansas.

Guess who gets to decide if a woman passes the Kansas state government’s test for being sick enough to die from her pregnancy? Not the cardiologist who calls at 3 a.m. in a panic or the nephrologist who breathlessly corners you in the hallway or the intensivist who tracks you down on your vacation. Not any of the people who manage the illness trying to kill the pregnant woman. Not me either, but the politician who crafted the mayhem via a three-way phone call set up by the hospital attorney. And yes he was shocked beyond belief that such a scenario existed. Politicians swallow the anti-abortion rhetoric so completely that they truly believe the health of the mother is just some pro-abortion lie doctors tell. Why couldn’t they just go somewhere else? Try explaining the idea that if a woman is sick enough she might die from her pregnancy that her abortion needs a skilled anesthesiologist, a blood bank, and an intensive care unit to someone with zero medical background.

But the law worked. Women were still sick, especially in the rural Midwest where many had no health insurance so medical conditions went unmanaged, but people learned to refuse the transfer. Not sick enough. Call us when she’s really dying. Abortions at KU stopped, but the need didn’t stop, just diverted elsewhere and possibly to less experienced hands.

Soon after I moved to another state where there were several skilled providers, some at hospitals, and so I gradually did fewer and fewer. I stopped doing abortions over 12 years ago along with deliveries. Partly because I wasn’t needed anymore, but mostly because of PTSD. Being around pregnant women is really hard for me given my terrible pregnancy outcome. It’s hard to explain, but my son died in a labor and delivery room and so the idea of having to go into onto labor and delivery makes me feel physically unwell. I don’t even like going to one to meet up with a friend for lunch.

What is it like doing late abortions? It’s mostly very sad because no one is there because they are happy. A wanted pregnancy causing serious physical harm, well, no one is happy they are sick or that they have to terminate their wanted pregnancy to live. I know these women were happy they met me and some even returned to be my patient. That always meant a lot. “You saved my life, how could I go to someone else?” What about a wanted pregnancy with severe malformations? No joy there either. Only a tiny minority are unwanted pregnancies and then the woman almost always wishes the pregnancy never happened and that she could have terminated sooner. Women who access abortion care after 20 weeks for what we call elective reasons are in that situation because of laws designed to restrict abortions.

Doing sad stuff is part of medicine, but add in the hoops you have to go through to learn abortion, the TRAP laws, the fear, and then the price that many have to charge to cover expenses and you get a very narrow field of providers. And it’s getting smaller.

What bothers me about abortion are the lies politicians and supposedly pro-life individuals tell others and themselves. That doctors make lots of money doing these procedures, that these are callous women who just decide on a whim at 22 weeks (no women ever decides any abortion on a whim), that there are other options, that women don’t try to do home abortions, that no one is sick enough to need an abortion, that laws reduce the need for abortion as if doctors are standing on the street corner offering two for one deals. These laws are built on an equal mix of privilege and lies.

Focusing on abortions after 20 weeks tells me that politicians have invested nothing in learning what that means. That forcing a woman to carry a fetus not compatible with life to term is kind. That serious intrauterine infections at 23 weeks don’t happen. That women have thought nothing about what they are doing. Let’s be clear, if you are truly “pro-life” you’d agree with these procedures because they save women. Not in an abstract way, but sometimes it is in a this-infection-is-killing-you-and-we-need-to-help-you-right-now kind of way.

The one thing I’ve learned from my experience is that efforts to stop abortion after 20 weeks are nothing about life or compassion or good medicine, it is simply wielding the misery of women (and those who love them) as a political tool.

 

 

I want to thank the woman who gave the interview to Jezebel about her experience with her abortion at 32 weeks. I am so sad that you had to fly out-of-state to have the hardest procedure you will have. I am so sorry it cost you so much money. Your story helps fight the narrative that abortion after 20 weeks is some abstract thing that no one needs.

 

 

Discussion

130 thoughts on “What you learn doing abortions after 20 weeks

  1. Thanks for putting this together. I never wanted kids and have never been pregnant, but I fully see the importance in voicing this issue so much more than it is to keep healthy and reasonable options available for women.

    Posted by Sheila K Liewald L.Ac. | June 22, 2016, 8:10 am
  2. Thank you for you work – it is absolutely essential.

    Posted by Ros | June 22, 2016, 8:45 am
  3. Blessings

    >

    Posted by petalsf | June 22, 2016, 9:03 am
  4. Thank you for this piece. The humanity with the real details is breathtaking and shocking. The political crap and toying with women is tragic, at best.
    I’m very sorry to hear about your ordeal.
    You’re a great beacon in the darkness, please don’t stop.

    Posted by Andersays | June 22, 2016, 9:15 am
  5. Reblogged this on andrewsaysblog and commented:
    A wonderful human piece from Dr. Jen Gunter. Go check out her blog for a treasure trove of good information, heartfelt advice, and fantastic writings.

    Posted by Andersays | June 22, 2016, 9:17 am
  6. The removal of women’s rights to medical care to save their lives is horribly sad. It scares me that they aren’t teaching abortion in med schools any more. In another couple decades, mothers will die and families will be destroyed.
    Young women need to speak up. They need to fight for their rights. They need to resist the brainwashing.

    Posted by Erin | June 22, 2016, 10:23 am
  7. I could well believe the story about the previous chief in Kansas. As they say in Ireland, “it’s not what you know, it’s not who you know, it’s what you know about who you know”.

    Posted by korhomme | June 22, 2016, 10:54 am
  8. Been following your blog for a long time – one of the best posts you ever wrote. Putting the human touch on a very sensitive topic. I have always thought that whether planned or unplanned, this procedure can NEVER be easy on the mother and being a man, I am glad I never had to make that decision or have to experience this. For the record – I am not some man who thinks he knows what’s best for women. Because I will never have to make this decision or experience it, who am I to say what’s right or wrong for that woman? T

    Posted by Lance | June 22, 2016, 12:53 pm
  9. Thank you for sharing. It really is a “the more you know” situation. Later abortions are not whims of crazy women. I read the Jezebel story last week. It still haunts me. Why must lawmakers make a horrible situation so much worse? It just shouldn’t be this way.

    Posted by Sara F (@fleetssara) | June 22, 2016, 1:09 pm
  10. Dr. Gunter, this article should be posted on every politician’s door so that s/he has to see it every day before going to work. Thank you again for your authoritative, experienced, and eloquent voice that won’t be silenced.

    Posted by bri65 | June 22, 2016, 1:59 pm
  11. Very powerful. Thank you for the hard work you have done. Just reinforces my decision to vote for those who are pro-choice.

    Posted by Jennifer | June 22, 2016, 3:32 pm
  12. Thank you for all you’ve done and still do, and for blogging about this incredibly painful topic. A friend of mine had to have an abortion at seven months because of one of those “fetus developing in a state incompatible with life” situations and some complications that were making my friend ill as well. Her doctors were kind and competent . Shortly after, our state passed one of those 20 week bans. If it had been only a few months later, her outcome would have been so much more grim. I think of her and all the women in situations like hers every time another state passes another abortion ban.

    Posted by tlryder | June 22, 2016, 4:57 pm
  13. Thank you. After losing our son to IUFD in a state where both my deceased son and I were treated far worse than cattle in the same state, your words resonate in a sacred, still corner of my soul.

    Posted by Cecelia Garrett | June 22, 2016, 9:09 pm
  14. Beautifully and sensitively written. Thank you. Here in South Africa, our laws are pretty permissive, but still, there are many OBGYN’s who do not do terminations at all, and some private hospitals still choose to restrict access. I have always felt like you, how do I not help my patient in need, even when it is a difficult and stressful procedure that I am asked to perform; how do I expect someone else ( a colleague) to do something I wouldn’t be prepared to do? SO thank you for your beautifully worded article.

    Posted by charliesbird | June 23, 2016, 12:18 am
  15. Very powerful. Thank you for the hard work you have done

    Posted by Joseph Nzuve Mutisya | June 23, 2016, 12:45 am
  16. Dr Gunter, Thank you for this eloquently written piece. This is my story. I lost my third child (a wanted pregnancy) in the delivery room 1 year ago. I was denied the right to seek abortion services due to GA’s laws. I spent several weeks in the hospital trying to save the life of my daughter, and was told at 23 weeks and 4 days that her condition was absolutely terminal and was sent home to “wait for the kicking to stop”. I was told it would be days, and I remained pregnant for 9 weeks more until I developed a rare condition that threatened my life, mirror syndrome at 31 weeks. The dangers of allowing my body to develop blood clotting disorders coupled with the needed surgery almost killed me, a mother of two healthy children at home. I received 8 blood transfusions and was transferred to the ICU.. It was an unimaginable horror and I felt so devalued as a human. I still grieve for my daughter, and I have spent this year regaining my strength and I am now ready to share my story to advocate that no woman should ever be forced to have this experience. Living with Grace
    Blog URL: http://snellingsfam.wordpress.com

    Posted by momzombiac | June 23, 2016, 8:12 am
  17. Thank you.

    Posted by Rich Greenway | June 23, 2016, 10:19 am
  18. Dr Gunter, I wonder if you’d be willing at some point to address some of the claims made in this piece:

    http://www.abortionfacts.com/facts/11

    It’s an argument against the claim that abortion is safer for women than childbirth. It appears to link to several journal articles and makes claims such as ectopic pregnancy being more common in women who have had abortions, and women who have abortions being more likely to have pregnancy complications.

    I really appreciate all your writing on abortion.

    Posted by Sophie | June 28, 2016, 6:58 am
    • That’s a source that claims ectopic pregnancies are “usually not fatal”. I think it’s pretty safe to say they don’t know what the f?!k they’re talking about. That part about “not fatal” is because a surgeon went in there and ENDED THE PREGNANCY.

      I literally do not trust anything else they have to say regardless of the fact they have footnotes. If they said the sky is blue at noon on a cloudless day I’d have to go outside and check.

      Anyway, even if they’re telling the truth about risk, the situation is so much more complicated than that when you’re pregnant and going “this cannot continue” for *whatever* reason. You’re not just making a decision for yourself–as they point out, you’re also making one for the fetus, but it’s not as simple as “do I let this fetus live or do I kill it”. There is life after pregnancy for those who make it to term. You have to think about that too. Being unthinking about how we procreate has caused a lot of problems. This is not so much a eugenics argument as it is a “don’t cause unnecessary suffering” argument–being born with brown eyes is not suffering, but being born with severe deformities or to a severely mentally ill mother *is*.

      Posted by Dana | October 20, 2016, 5:45 pm
  19. So none of these women had the procedure because the baby was was convenient or a lifestyle complication ? BS

    Posted by Tex | July 1, 2016, 7:08 am
  20. Wow. I’ve always been pro-choice but it’s always been simply because I believe women should have the ability to decide what they want or need. Thank you for this deep and heartfelt piece and your dedication.

    Posted by Ashley Frew | July 1, 2016, 7:10 am
  21. Thank you. I wish the world were filled with more caring and understanding people like you.

    Posted by Philippa Sonnichsen | July 1, 2016, 7:23 am
  22. Thanks for your thoughtful article from a Dr.’ standpoint. Sorry you had to live in Kansas for a bit, but maybe it gave you a bit of perspective on the abortion debate in this country. Believe it or not, abortion has single issue voters. In other words, there are people that vote only based on pro-life opinions. Thanks again.

    Posted by Mr. Bill | July 1, 2016, 7:36 am
  23. I can only tell you that I remain completely passionately ‘pro-life’. I have tried to write about this in my blog.

    Posted by theworldaccording2ellah | July 1, 2016, 7:59 am
  24. A great effort by you, Ms. Elizabeth.😇

    Posted by The Chandigarh Style💄 | July 1, 2016, 7:59 am
  25. I was born in New Zealand and after travelling and working all over the world I have come to live in the midwest and i am appalled at the way women and their medical needs are treated out here. They are the least emancipated, have no voice and seem so downtrodden. They are closing down womens clinics – CLOSING them. How can a country dare to voice an opinion on another countries record with women’s freedoms when they are closing down women’s clinics right here. I have no words. Politics has no place in this area. Thank you for your writing.. c

    Posted by Cecilia Mary Gunther | July 1, 2016, 11:49 am
  26. Thank you for writing this. I have always been pro-choice. I never wanted kids. I was almost raped when I was nine.

    Posted by jessicasblog45 | July 1, 2016, 11:52 am
  27. Dr.Gunter, thank you for sharing this but more importantly, for being there for those women. I too often despair at the depths that amoral people will go to feed their need for power. It is comforting that there are people such as yourself that go a long way to balancing things out.

    Posted by travelling crone | July 1, 2016, 12:01 pm
  28. Great to have someone in the “know” talk about this sad hard subject. Thank you.

    Posted by StarOfGrace | July 1, 2016, 1:26 pm
  29. I’m pro-choice, but have always thought late-term abortions were wrong. I never considered the fact that late term abortions can be necessary to save the mom. Thank you for educating me more!!!

    Posted by mercedesthayer | July 1, 2016, 1:54 pm
  30. While there are women who use abortion as a means of birth control, I believe wholeheartedly that the very large majority of women who have abortions do not make that decision nor take the situation lightly. I do not believe that a country that strongly believes in the death penalty and a lack of effective gun control should be fighting any woman’s right to make the best decision possible for her and her family. Until we start to value all human life, even the lives of those who have committed horrific crimes, this subject is closed since Roe v. Wade. That being said, sometimes the most moral thing to do is called abortion. Doctor, thank you for this post and for the work you have done to support women and their families in these difficult situations.

    Posted by maribethbatcho | July 1, 2016, 3:23 pm
  31. This is an incredible article and very powerful. Thank you for sharing.

    Posted by roseamyh | July 1, 2016, 4:03 pm
  32. Great ! I like very much!

    Posted by maurosalgado | July 1, 2016, 6:36 pm
  33. Powerful and informative. Thank you. May your tribe increase.

    Posted by LG | July 1, 2016, 10:32 pm
  34. This is an amazing post. Thank you for your courage and for using your skills and compassion to help women in need.

    Posted by lifeinthethe8tre | July 2, 2016, 7:41 am
  35. I’m so glad I took the time to read this piece. I have always been very anti late term abortion and today you taught me many things. Thank you.

    Posted by kaffe325 | July 2, 2016, 11:45 am
  36. Thank you for writing this. What many people fail to understand is that abortion is a very hard decision. It isn’t something that women and families come to lightly. The fear mongering surrounding abortion is very harmful. Women are being refused care essentially, because of ignorance. Politicians use abortion as political leverage when it is really a life and death situation.

    Posted by Catherine | July 2, 2016, 1:00 pm
  37. Most of our political types who use being anti-abortion as a means to be elected or to remain in office may know what they are saying is incorrect or an outright lie. I don’t think that the truth would change their position. If people, voters, and even some of the “religious types” would listen there could be some change for the better. As a senior white male I don’t want people who look like me making choices for my daughters or other females. At least two males have shown some intelligence and understanding. Thankfully both serve on the U S Supreme Court.

    Posted by Phil's Personal Perspectives | July 2, 2016, 1:43 pm
  38. Amazing article. People like you are so necessary. Thank you.

    Posted by Storymedic | July 2, 2016, 6:04 pm
  39. This is so important. So so important. Thank you.

    Posted by anonimusunnoan | July 2, 2016, 8:35 pm
  40. I am just a teenager, so I know little about the real world. All I can do is thank you for writing this article. I love seeing all of the comments, especially from those on the side who oppose this article’s context, yet still remain polite and reflective. I completely agree with you 100%. And the people out there who are rude to you about this, just slap them down with facts and truth. Ignorance enflames fear, and that is exactly what is being used for get anti-abortion laws passed that only harm every party involved. So thank you so much for sharing your story.

    Posted by cynicalteenagerblog | July 2, 2016, 10:07 pm
  41. An eye-opener for sure. No one ever seems interested in what the doctor actually thinks or feels having done or doing this procedure.
    Also, very sorry to hear of your personal loss.

    Posted by muffincatblog | July 3, 2016, 1:40 am
  42. Thanks for this, doc, and for your service in caring for women in all circumstances.

    Posted by Danielle | July 3, 2016, 3:59 am
  43. Thank you for voicing this. Im neither pro life or pro choice, im both

    Posted by realme86 | July 3, 2016, 6:18 am
  44. Agree agree agree. Thank you for an open mind.

    Posted by breakingthebubblesite | July 3, 2016, 6:22 am
  45. Couple should decide for abortion with in 4-6weeks because ealier d better,no complications &less costly.
    That late could even fatel, one can die even.
    So why to decied so late. Its foolishness.
    Sorry if i hurt anyone by my statment

    Posted by badaltahindustan | July 3, 2016, 7:44 am
    • Genetic anomalies can’t typically be diagnosed before 20 weeks – an ultrasound at 16-20 weeks identifies the issue then further confirmatory tests are needed, hence 21-23 weeks or sometimes later for the procedure.

      While abortion risks rise in the 2nd trimester the relative risk is still low and the procedure is safer than carrying a pregnancy to term.

      Posted by Dr. Jen Gunter | July 3, 2016, 9:52 am
    • Did you even read the article? Given your statement I am have to assume you decided to comment without taking the time to actually read the post. The only person you hurt is yourself by choosing to remain ill-informed.

      Posted by threadshredder | July 8, 2016, 10:53 am
      • I did read your article but in parts , i m sorry my dear i will read it full today after i finish seing my patients at night & then I will send my comments.

        Posted by badaltahindustan | July 9, 2016, 12:33 am
  46. love it

    Posted by Alex Moses | July 3, 2016, 7:58 am
  47. Dr. Gunter, firstly, thank you so much for all the work that you’ve done over the years to provide much-needed services to women who truly needed immediate medical care. your article is the most eye-opening, informative, honest, and straight forward, enlightening article ever written on late-term abortion. What can be done at this point with our local congressmen and representatives? I would love to see this piece placed into the hands of each and every member of Congress who are making at least $200,000 a year with extraordinary medical benefits, so they can see what they really are legislating on the behalf of women here in this country. Any suggestions that you may have or anyone else that reads my comment, I would greatly appreciate your feedback. I live in Rhode Island and would like to be able to do something on a grassroots level.

    Posted by irishezs | July 3, 2016, 10:13 am
  48. Truly well written, thank you.
    We all know that regarding such divisive topics people can become estranged from the true issue and end up fighting whichever side they find themselves on, which does nothing productive for the issue itself. So thank you for helping all those women, they are lucky to have had you as a doctor and thank you for writing something truly wonderful.

    Posted by Meagan | July 3, 2016, 10:17 am
  49. Moving piece of writing, truly enlightening. Cold hearted politicians shouldn’t be allowed to make such decisions or people on the road with board saying ‘Every life counts’ having no idea what the big picture is. But suffering mothers and experienced doctors should be allowed to make such decisions. It’s truly sad how many women suffer because of laws that make not much sense.

    Posted by Zaira Zafar | July 3, 2016, 11:41 am
  50. I think everyone needs to read this. This is truly amazing.

    Posted by itstrueiamamazing | July 3, 2016, 3:07 pm
  51. Thanks a lot for this article…aborting a child at any point of time is a huge loss to the mother,where the psychological counselors tell that it wasn’t really a baby but just a foetus.

    Posted by artemis800 | July 3, 2016, 6:37 pm
  52. Best!

    Posted by subhaniiii | July 3, 2016, 10:54 pm
  53. Thank you for this article, and all the best to you!

    Posted by mrsnephalem | July 4, 2016, 3:00 am
  54. I love this piece

    Posted by natureboy2016 | July 4, 2016, 10:15 am
  55. I live in a country where speaking of abortion is still taboo let alone legalizing it. Being pro-choice should always be an option, every women should have a choice! I only hope Malta will understand this eventually. Thanks for your post

    Posted by toshareblog | July 5, 2016, 3:22 am
  56. Very interesting and informative post

    Posted by lagconsults | July 5, 2016, 3:32 am
  57. Great article. It is truly painful to see somebody go through the horror of a late-term abortion, however it sometimes cannot be avoided. Thankfully, here in the UK, abortions aren’t as taboo as can be in America, but the social rules still apply. Women deserve the choice and the doctors should be able to decide whether it is medically safe for the procedure to go ahead, regardless of their opinion on the topic. It cannot be made by these Government figures. I’m glad that I took the time to read this, it is utterly astonishing how these government figures can make these decisions without a care in the world for the child or even the mother’s well being.

    Posted by liveandbelong | July 5, 2016, 10:47 am
  58. I think its time people sat down and tried to understand the meaning of ‘autonomy’

    Posted by pricillalove | July 5, 2016, 12:42 pm
  59. Try Con*** 😂

    Posted by subhaniiii | July 5, 2016, 1:59 pm
  60. Thank you. ❤

    Posted by chloe88blog | July 5, 2016, 8:07 pm
  61. What a great read, especially as is from someone who directly deals with the topic of abortion. Personally, I believe I am pro-life and pro-choice, however non the less, thank you for an unbiased, and forward post showing the truth about abortion. xx

    Posted by mattpaulgraham | July 6, 2016, 12:29 am
  62. Very enlightening! Thank you so much for sharing your story

    Posted by annafernanda | July 6, 2016, 2:29 am
  63. Great post and so meaningful. It saddens me that one way or the other, men and strangers get to decide what should happen in our lives and to us. I am strongly pro-choice. If God gave us a free mind, who are politicians to do otherwise??

    Posted by Kristina Steiner | July 6, 2016, 8:06 am
  64. I appreciate you included your own loss and subsequent PTSD triggered by pregnant women. My heart goes out to you. I have my own private motherhood losses. These are the things no one speaks of and we bury in our hearts just so we can function.
    I also have been an RN for 28 years. I have seen a lot of fetal loss, including medically needed late term abortion. I carry each woman and her story in a special place of reverence and love in my heart. Thank you for including kind words for nurse caregivers. Peace for you always.

    Posted by courageouspursuit | July 6, 2016, 11:15 am
  65. I was a prenatal genetic counselor for 20 years – thank you for this – and I sent several patients to Kansas – if they saw you – thank you for taking care of them.

    Posted by Renee | July 7, 2016, 9:53 pm
  66. Thank you.

    Posted by threadshredder | July 8, 2016, 10:55 am
  67. Thank you for sharing this. I was raised very conservative. My family just about fell over when I went to a feminist conference and started standing up for equal rights. I’ve always been pro-choice and I most definitely didn’t get it from my family. Thanks again. Feel free to visit my blog. Comment, like, or follow! I wish you all the best!

    Posted by msimperfectlyperfect | July 8, 2016, 4:52 pm
  68. Thank you for sharing your experiences. No woman makes the decision to have an abortion lightly or easily. If men could get pregnant, this wouldn’t even be an issue.

    Posted by mariner2mother | July 9, 2016, 7:33 pm
  69. A wonderful article. Thank you for writing it. I found it extremely moving and raw.

    Posted by sleepingwiththelighton | July 11, 2016, 12:10 am
  70. I can’t explain how much we take for granted. Where I live all hospital care is free, there are no abortion clinics (only hospitals), and no one is denied lifesaving care. We still have the issue of limited practitioners, there’s no promise that you won’t be transferred to a hospital in another city for your procedure, but you’ll get it.
    Reading this makes me grateful for what I have, and makes me realise how privileged I am. I can only hope that your politicians and lawmakers read what you have written and start fixing the problem… but we all know that even if they do read it, they won’t fix it. And that is sad.

    Posted by talianyx | July 11, 2016, 4:09 pm
  71. Personally i dont like the idea of abortion. but still nice read.

    Posted by ChinGum | July 13, 2016, 9:48 pm
    • Nobody likes it. Would you post a comment saying “I don’t like the idea of appendectomy” or “I dont like the idea of tonsillectomy”? Of course you wouldn’t, because the idea of “liking” a necessary medical or surgical procedure is ridiculous.

      Nobody wants to have an abortion, it’s not on anyone’s bucket list, it’s just something that needs to be done someone’s.

      Educate yourself.

      Posted by Boostick | October 23, 2016, 3:40 am
  72. I am so both so unfortunate to be one of the rarest of women whom has faced such a a life-changing/threatening terrible circumstance, but I am now bestowed the burden of educating others. Thank you to Dr. Gunter for talking about the unspoken injustice that so many women needlessly face. I am enjoying seeing the impact that this article has made on those who have read it and decided to comment.
    Here is a direct link to part of my story, for anyone who thinks this does not happen to real women who have or want children and are pro-choice. Trust that women will make the right choice for their families. I wrote this entry the day before my life-threatening condition finally allowed for the doctors in Georgia to deliver my baby Grace, whom never could have survived outside of me.
    https://snellingsfam.wordpress.com/2015/04/23/pregnant-prison/

    Posted by momzombiac | July 14, 2016, 12:03 pm
  73. So nice that some women get a “choice”. I lost all but one of my pregnancies. Pro-life? You bet.

    Posted by ccbarr | July 18, 2016, 10:53 am
    • I am sorry you have had the misfortune of losing wanted pregnancies. But how does taking away the right of other women to have abortions make your life better?’

      Posted by Madame Mildew | October 19, 2016, 9:18 pm
    • Blowing out other people’s candles won’t make yours burn brighter.

      You should get therapy. Wanting other women to die because of your loss is profoundly disturbing. Your losses are tragic, heartbreaking events, but when you’ve reached a point where you’re wishing death, illness, forced pregnancy and birth upon other women – then it’s time to seek professional help.,

      Posted by Boostick | October 23, 2016, 3:50 am
  74. Thanks for this… made me think of everything in a different perspective!

    Posted by mandy4200 | July 26, 2016, 8:24 pm
  75. Thank you for this piece. I learned a lot.

    Posted by lifelonglearning2012 | July 26, 2016, 9:02 pm
  76. Thank you soooooo much. I am one of these women and the doctor that helped me was so kind, so helpful. I want to thank you for all your work and for who you are. I needed that doctor so much and am forever grateful.

    Posted by dilillom | August 20, 2016, 9:03 am
  77. Dr Gunter, your writing is, on this as many other items I’ve read on your blog, truly excellent. You convey serious and highly emotive subjects with care, compassion and, only where appropriate, very welcome humour. As such you contribute greatly to an understanding of what those of us on the outside of this issue will never fully experience.

    The subject of abortion choice and sometimes pragmatic necessity is indeed something that, as a man, I’ll never fully appreciate. But I remain entirely Pro-Choice, if nothing else because of this. It will never be my decision. It can only ever be the client’s. That it is one determined by politics or bureaucracy indicates a woeful failure of democracy.

    The context of wider life choices are so complex and interwoven it makes no sense for others to make abortion or not decisions. It is personal, end of. There cannot be consensus, only consensus to allow informed choice. Of course that choice is never, ever, easy, but as with all difficult decisions it is probably best not to test or judge before or afterwards, regardless of outcome.

    The reports of Dr Tiller’s assault and then subsequent murder made, and still make, absolutely no sense at all and all the more chilling given the context. Thank you to all those who make a choice to enable abortion and thereby maintain options for women. If it were easy (practically, philosophically or psychologically) to carry out such procedures, once again, we probably wouldn’t need to be having these debates and discussions. It’s a difficult area and for that, when seeking to understand, good information such as this piece is all the more valuable.

    Posted by Miles Forsyth | August 24, 2016, 1:22 am
  78. HEY……!! I really thank you for sharing this useful blog on abortion. Most abortion in India is a mainly sex selective.

    Posted by Vardaan Hospital | September 27, 2016, 10:49 pm
  79. Thank you for sharing this.

    Posted by Samuel A. Hurley (@halfSpinDoctor) | October 20, 2016, 2:15 pm
  80. I think that there has probably been everything said in this blog, however I am so very grateful for the work that you do. It is not an easy choice for women in any way regarding these decisions. How could anyone think otherwise. The most disheartening decision and unforgiving reality especially when people who have no idea your life or situation make you out to be a criminal and without rights. My mother chose to have an abortion in the 1940’s and her story was devastating to me. She became pregnant on purpose by my Father. She wanted to know that she could get pregnant and that was the only way to know back then. No pregnancy tests then. Well, as far as I can tell, she and my Aunt went to Tiajuana to have the procedure and the doctor was not even going to wash his hands. My Mother went through with it and this was my education in birth control. It was brutal but I knew I would never go that route and grateful that she had the courage to tell me. She would not have done it had there been other alternatives. My Father was an only child. It was important back then to have children and a male child was usually preferred at some time to carry on the Family name. My sister was a surgical nurse and worked in clinics that were threatened by the religious right and mentally challenged people in the late 1970’s and early 80’s. To walk back to these indignities would be unconscionable. People have no right to judge or make decisions about anyone else’s rights except their own. They think they are saving the world but they are misguided and need to learn to respect and allow others to make their own decisions without judgement or guilt. Where the laws are made for ALL of us. Mind their own business. We have come too far to return to the dark ages. The cost has always been blood sweat and tears all the way around. I do not even know if my Father ever knew what had happened. My sister and I never had children. I was injured by the Dalkon Shield and was one in a hundred thousand women in the 1st class action suit ever. It was also devastating. My sister had endometriosis. My Father was so disappointed he surprised us one Christmas with the idea of having a surrogate have a child and my sister and I could raise it! We were mortified! It was a reaction to his own mortality and the death of his parents we decided, but it was very hurtful to the women in his family. (my Stepmom and Sister and I thought he had lost his mind) He did for a bit. I hope that for women going forward that they have all the safety and care from compassionate providers that they deserve. There are some out there that do not really care and seem to help them only grudgingly. It is shameful.
    Thank you……

    Posted by Diane Takayama | October 20, 2016, 4:30 pm
  81. what you wrote about, why isn’t it explained to the public this way I truly did not know why these late term abortions were being done and assumed it was she decided I don’t want to be a mother ! so since I have read this I feel awful because I cast judgement on these women and for that I am truly sorry I learned something today and I won’t forget it or cast judgement again your job was truly sad but rewarding thank you for posting this

    Posted by crystal martin | October 20, 2016, 6:40 pm
    • Crystal, thank you for your honest and endearing comment. I am not criticizing you. Just very surprised. Are ppl really taught that women go thru late abortions cos they suddenly decide they don’t want to have children? That idea is totally foreign to me.

      I am shocked that anyone can think that. That is why I ask were you taught that? By your church, your family, your political party, who? Cos pls, think about it. WHY would a woman go thru morning sickness, stock up on baby supplies, even throw baby showers, and decide, oh I’m bored, busy, whatever, think I’ll have this ripped outta me?

      Women are nurturers. Even those of us who opted not to have children and had early abortions, have feeling for women who have late abortions. PAINFUL. Emotionally and physically. It’s a horrible burden for women all their lives. Cos most want their babies. How could anyone think this way about WOMEN??

      I am so sad our country still lives in the dark ages. The whole world does. How can ppl really believe women just don’t want kids and wait til many weeks have passed? It’s FAR more dangerous to a women the longer she waits. Why would she do that? Other than these new laws and high costs often force women into waiting too long. But that’s not their choice.

      I too was surprised Hillary stated late abortion are for mother’s health. In most cases, it’s the baby who won’t make it to term. It’s the baby who will live hooked up for awhile before dying. Losing the baby via late abortion or early death (because Mother could not get an abortion) breaks their hearts.

      As someone who never wanted kids, I am crying now. Pls get to know some other women. Read online, the heartbreaking stories of miscarriages and abortions. One is out of her control, the other elective. Or is it? The two are more closely related than might be thought, I believe. In the fact it’s heartbreaking to most women.

      Thank you again for sharing your revelation and open mind and open heart. PLS share with others. Men and Women. Pls think better of your and my fellow women. May you always be healthy and never know anyone who went through this.

      Posted by jennylens | October 20, 2016, 9:54 pm
  82. Thank you. You are truely my hero.

    Posted by Malinda Halim | October 20, 2016, 8:38 pm
  83. First: As a woman who has had to have D&E’s because of miscarriages, there is definitely NO ripping. Second: My pregnacies were all difficult and my husband and I prayed constantly that we would not have to make the choice of me or the baby. He believed there really wasn’t a choice but to me it was one I didn’t know if I could sanely servive. But to have my husbands and my right to make that decision taken from us by a law would be even more horrific. Third: As the mother of a disabled child I can unequivocally say that the choice is not one any person wants to face and it’s never easy or taken lightly. I thank you for educating, and am sorry for your loss, and wish more Dr’s would educate and be educated. For those amazing woman who share their stories of heartbreak I thank you from the bottom of my heart. As I’m writing this I’m crying and I haven’t even gone into details and I know I was lucky and it could’ve been so much harder.

    Posted by JBrink | October 20, 2016, 8:47 pm
  84. I had an abortion. I think 1978 or 1979. I can never remember. What I do remember is a woman loudly and persistently moaning because she was having a late abortion. She was in so much pain. Late abortions are not fun nor easy. I also picked up on her sorrow.

    I have no regrets. I have always been very clear about not wanting children. And my doctor and mother told me I couldn’t get pregnant. Hmmm…. thankfully I live in LA and no hitches.

    I always had irregular periods. But a little voice said to me, go get checked. So I found out early.

    But abortion, early or late, is not an easy choice. It’s absolutely heart-breaking for women past the first stages. So sad.

    My late Mother was a registered nurse. Everyone should be better educated about our bodies. Esp women. Esp when politicians legislate our bodies.

    Thank you for your post here and Huffpo, Oct 10/20.

    Posted by jennylens | October 20, 2016, 8:53 pm
  85. Kudos, You are truly a Healer.

    Posted by Hal Matteson | October 21, 2016, 9:00 am
  86. Very powerful commentary. Thank you so much for all your hard work during your career.

    Posted by anotherboomerblog | October 21, 2016, 9:48 am
  87. Please read this. Abortion in no an evil thing selfish women do. It is a heartbreaking decision made with great sorrow and grief. My mother had to have an abortion because she was in such fragile health that her doctor said she could not survive her pregnancy, but all abortions were illegal. Her doctor found someone who was capable and qualified to do an abortion for her. What was the choice here? My parents were staunch Christians so what were they supposed to choose? If Mom died Dad would be left a widower with four motherless children; would this be a correct choice? They chose an abortion, an extremely difficult decision for them. But what else would you do if you were in this situation? Think about it personally. Think about you mom and dad, your sisters and brothers, the women in your life, the wives and mothers in your life. Be honest and real about your decision.

    Posted by Joy Mauser | October 21, 2016, 10:14 pm
  88. My daughter chose to be induced at 20 weeks due to severe anencephaly in her baby, there was no chance at survival as the baby had very little brain and not much more skull. She was treated with kindness, understanding and respect and the nurses took great care to wrap the baby so her little face was visible but the extent of her abnormality was not. I am thankful for Dr’said and nursing staff who see beyond a “this is right and that is wrong” mentality. God bless you.

    Posted by Dionne Bouknight | October 23, 2016, 5:59 am
  89. Just explain this to me: what happens to the baby when it’s being extracted? Extraction is such a benign word to use when explaining a dilation and extraction. Please explain what the “extraction” entails. The other reason I’m responding is this: I would like to see a study conducted on how women cope after they’ve had an abortion. In my research, the vast majority of women who are post abortive suffer from depression, suicide impulses, self mutilation, relationship problems, guilt, shame, sorrow, unable to forgive themselves, anger, anxiety, remorse, grief, alcohol abuse or drug abuse, sleep disturbances, nightmares, flashbacks and the list goes on and on! Do any of these woman have counseling available to them? No, they are expectd to walk boldly thru the doors yelling “I am woman hear me roar”, (well at least at Planned Parenthood they do) so when they don’t feel that way, they think something is wrong with them, hence the secrecy. The reason why women have a hard time dealing with what they have done is because as women we are hard wired to love, protect & nurture our off spring. Abortion is the exact antithesis of how we are hard wired. You can talk all you want about the medical side of abortion, “a woman having the right to do with her body what she sees fit”, for the health of the mother, but do you ever think about the ramifications and emotional affect the abortion has on the mother after wards? The baby isn’t the only one destroyed, the mother is too! I’m not talking from a place of judgement, I’m speaking from a place of experience. I had an abortion 18 years ago( I wanted that abortion, I told very few people what I planned to do, but I wanted that baby OUT of me) Planned Parenthood certainly didn’t try and stop me or give me any idea how this might affect me……I can’t begin to tell you how it affected my life, how it affected my relationships, how it affected my relationship with my two children , the flashbacks (the horribly rude Planned Parenthood doctor who performed the abortion…screaming “stop moving your legs!!!!)
    No one, especially Planned Parentood wants to talk about after……there are many on line blogs that are dedicated to post abortive women that enable them to share their story! 99% of their stories are like mine. Planned Parenthood knows about these blogs, so what do they do? They started their own blog or maybe it’s on their website “share your abortion story” like its a good thing. The most insidious story came from Gloria Steinem who was shown in a picture with her arms over her head in celebration. Her t-shirt read “I had an abortion”. As a Doctor, don’t you think it’s important to know what your patients go through after the fact and share with them what very well might happen to them? Don’t you think it’s important to share with them how this will affect them the rest of their life? I so wish Planned Parenthood had shared this info with me, because they do know. They just choose not to disclose the info; they certainly don’t want to lose any revenue…….

    Posted by Angie Snellenberger | October 27, 2016, 7:34 pm
    • That’s all been studied. Women cope just fine.

      Posted by Dr. Jen Gunter | October 27, 2016, 7:49 pm
    • So, Angie, because you are still hung up about your abortion, then nobody else should be able to have one? All women and girls should be forced to continue their pregnancies, no matter whar the situation, because the anti-choicers got inside your head? “I don’t want others to have a choice, because I regretr mine”. Sounds totally fair.

      The strongest predictor of mental health after an abortion was the woman’s mental health before it. It’s as simple as that. There is no evidence of lasting trauma, physical or mental, as a result of elective abortion. Given that some 50,000,000+ in the US have had at least one abortion, I think you’d notice if they were all psychologically decimated.

      You know what does have lasting, quantifiable, genuinely poor psychological, physical, and social outcomes? Forcing people to carry unwanted pregnancies to term, and then give birth. Everybody suffers in that scenario – parent, child, society.

      But, as mentally damaging as birthing and raising an unwanted child can be, the Ebola Gay-sized bringer of appalling mental health outcomes is – relinquishing a child for adoption. Forcing girls and women to continue with unwanted pregnancies in order to give up the baby for adoption is, unsurprisingly, associated with psychological problems..

      Tell me, Angie, how many “adoption agencies” inform girls and women of how devastating relinquishment can be? How many of these agencies divulge the tens of thousands of dollars they command for each child, precisely none of which goes to helping the person forced to carry said child?

      How many of these agencies insist upon girls and women undergoing extensive psychological testing and counseling (from an unbiased third-party provider), as opposed to essentially holding them captive in “mother and baby homes”, where they’re evangelised at, and indoctrinated into believing that this is for their benefit? How many agencies are there, to pick up the pieces, if someone (who has relinquished her child) regrets her decision, is traumatised by what has happened, and is wracked by grief?

      It’s sad that you regret your abortion, Angie, but there are trained therapists out there, who can get you the psychological help you need. Wouldn’t alleviating your mental health issues feel better than trying to deny everyone else bodily autonomy? Wouldn’t you feel more at peace if you weren’t hung up on some non-existent conspiracy to trick people into abortions, and seeing every mention of abortion rights as a personal dig at you? That’s no way to live, Angie. I hope you can get the help that you need to feel better.

      Posted by Boostick | October 28, 2016, 12:04 am
    • Angie I feel your post is very unfair, and for you to target this Dr due to your personal experience. Every single woman will experience their own situation differently. Have you ever sat and considered that you were the one who went to the clinic and asked them for their help, you were the one who made the decision to not continue the pregnancy – no one forced you to do it. Have you sat and considered how continuing with the pregnancy you were not prepared to have may have affected you emotionally, socially and financially at the age of 18? Have you considered how that may have actually affected you more?

      I feel for you Angie because you are clearly struggling to come to terms with the decision that you made, and looking to blame anyone to remove the responsibility from yourself.

      I can’t speak for the services in the US but the abortion care services I work in, in England ensure women are fully aware of the risk of psychological issues after the treatment and are offered counselling services if they feel they are struggling to come to terms with the decision they made after the event, however this is very rarely needed.

      I really do feel that you will benefit from some counselling and really do hope you find the help that you need.

      I wish you well.

      Posted by YourBodyYouDecide | October 28, 2016, 4:41 pm
    • Angie, put me in the group who is NOT regretful, depressed, suicidal and all that other crap. How did you conduct your survey? Oh yeah, after ALL the posts here, after A REAL DOCTOR shared her experiences, do you think you have a pony in this race?

      What do you bring to the table? You just reiterate REFUTED SCIENTIFIC EVIDENCE.

      How about you take care of YOUR life and stop worrying about an organism WHICH CANNOT FEEL and CANNOT THINK. Many do not have functioning organs. But YOU know better than science and real experiences? Ha ha ha ha.

      Posted by jennylens | October 30, 2016, 4:22 pm
  90. I have never read anything that captures the truth of abortion care any better. A wonderful post. I feel like you have written about my own personal beliefs and the lengths you will go to, to help a woman in desperate need. I work as a Nurse Practitioner in abortion care in England and so I can relate very much to much of what you have written.
    Thank You for your very honest post revealing the real truth and sensitivities about abortion care.

    Posted by YourBodyYouDecide | October 28, 2016, 4:24 pm
  91. Thank you for such an eye opening article… I wish there could be more levels of conversation instead of hateful rhetoric and name calling

    Posted by Robert Torres | October 30, 2016, 6:44 am
  92. One of my pregnancies screened positive for trisomy 13. By the time I got the results, was scheduled for an emergency amnio in a big city (our small town does not have this capability) and got the results, I was past 20 weeks. I did everything right, everything on schedule, and yet still, it was over 20 weeks. As you know, trisomy 13 has absolutely zero chance of making a healthy baby who could live to even toddler hood.

    Thank you for your thoughtful article. I’m so pissed off that we still have assholes like trump who think they have the right to enter into the exam room with me and my doctor!

    Posted by Erin mitchell | November 2, 2016, 10:08 pm
  93. Doctor, your warm heart infuses even such tragic narratives with loving compassion, wisdom and profound human understanding. As a man i am horrified -daily- by my gender’s woeful incapacity to empathise with the awesome responsibility of reproduction women withstand, even when things go swimmingly.
    Your writing is grounded, realistic and extremely moving. The moral and ethical considerations are clearly spelt out without drama, and the conclusion, stated so objectively, is inescapable.
    I was also very touched by the love expressed so copiously in the slew of intelligent comments.
    Thankyou for your service and for taking the time for superb blogging about your life. I am so sorry to hear of your own loss, which in some ways makes your work even more admirable.

    Posted by Michael Dunkley | December 5, 2016, 5:11 pm

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