Abortion Providers

[Soleil9]

Hi everyone,

I have been perousing the Medical Students for Choice website. I see from their documents that there is a lack of abortion training in medical schools and residency programs. What has been your experience?

Personally, I don't wish to become an "abortion provider" per se (like at a clinic), but do expect and wish to be able to offer the service to mypatients as the need arises. Will I get the training that I need?

I'm asking because I am thinking about being a coordinator for our local chapter of MS for Choice. I'm justdebating whether or not to do it, as I don't think of myself as a stereo-typical pro-choicer... My beliefs are that an abortion for contraceptive perposes should be a last resort, and that our focus instead should be prevention and education.... But that also abortions are a necessary part of ob/gyn care....

I guess the website just turned me off because they kept referring to the need to train "abortion providers". Are "Abortion Providers" docs that work in clinics? Or are they any OB/GYN who has training in giving abortions? Maybe I'm just getting hung up on the terminology... Any thoughts?

Thanks!!!

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[AtYourCervix]

please do it. as much as we "abortion providers" loath the procedure itself and the title, we do it because its what our patients demand. and women deserve to have their full range of options executed safely and without judgment. make your decision based on what your patients desire...not on an often misunderstood stigma. believe it or not, you end up feeling good about it because you provide a needed service. youre making a difference...good work.

 

[megkudos1]

I wouldn't get to hung up on the terminology.

By "abortion providers" Med Students for Choice means doctors that do abortions as a part of their practice, not just docs who work in abortion clinics. There is a great need for ALL medical students to be educated and put reproductive health services including contraception and abortion care into mainstream medical education and residency training so all patients have access to quality care.

Having been very involved with MS4C for the last 4 years of medical school, I can assure you that the national leadership and members are dedicated to providing women patients with a full range of reproductive health services including contraception and abortion care.

I hope you'll get involved. MSFC is an extremely well run organization of people who are really committed to women's health care.

 

[dnw826]

I have been interested in this as well since I took my friend to a clinic ages ago. I think that it is vitally important for more people to learn and to appreciate. I am actually reading Cider House Rules right now, very good book. I think that it strengthens my stance. Is there a seperate internship/residency year required, or is this included in your residency if you request the knowledge?

 

[LADoc00]

please do it. as much as we "abortion providers" loath the procedure itself and the title, we do it because its what our patients demand. good work.

You practice medicine based on what patients' "demand"?? Whaha? Umm what med school and training program did you attend so I can promptly crap on it.

Ummm basically you said you hate (loath) what you DO as a profession and essentially do what people demand. Wow, I knew Obgyn wasnt great but that outright SUCKS.

 

[LADoc00]

Also, wanted to bounce some thoughts off the old abortion providers on SDN because frankly Ive always been curious. For years as a pathologist I get your leftovers, these cheesecloth looking abortion bags with squishy parts. Basically you see NOTHING of this, but Im there shifting through the muck occasionally finding an arm or leg or miniature heart etc. you get the picture. But of course I chose this and the origin of the word pathology is actually pathos logos or the study of suffering (and not disease as people think) so Im a little wierd to begin with....enough of the rambling...on occasion, I have gotten BIG suckers, Im talking 6-8 month fetuses for TABs (or in path lingo therapeutic abortion, tho you have to admit it sure as hell wasnt therapeutic for the fetus), these freak me the hell out like nothing else does. Sometimes they come in cut to heck too, and Im there putting em back together like humpty dumpty...now, please succintly, how can you do that and then go home and cuddle your kids with the same hands...just curious. Im NOT judging, just curious how the old mind is working there. Because Im there in the lab in near PTSD over the whole damn thing........

 

[Leukocyte]

Deleted

 

[LADoc00]

I do not want to make this into a pro-life/pro-"choice" debate, but I just do not understand one thing....

When pro-"choice" people talk about "women haveing full control over their bodies", well, how is an embyo/fetus/baby part of a "woman's own body"? Is it not that the fetus is 50% mother 50% father? I see the fetus as its own body, not part of the mother's body, nor part of the father's body.

I am considering Ob/Gyn, but I will never perform an abotion unless the mother's life is at the brink of death.

I just want to know who the hell is gonna pay my shrink bill when I have nervous breakdown from seeing all the hacked up feti.

 

[Leukocyte]

Deleted.

 

[Leukocyte]

Deleted.

 

[Poety]

I just want to know who the hell is gonna pay my shrink bill when I have nervous breakdown from seeing all the hacked up feti.

I'll treat ya LA

 

[LADoc00]

I'll treat ya LA

Thanks for the love. I actually had one kinda traumatizing dream about an aborted evil Chuckie type fetus that came back alive to reek its revenge and attacked me...do you recommend drinking a stiff cocktail for nightmares or does that make it worse??

 

[florida_hokie]

I too am interested in hearing a response to LA's question if anyone is willing to provide one. Different perspectives only help us to see the full picture.

 

[LADoc00]

I too am interested in hearing a response to LA's question if anyone is willing to provide one. Different perspectives only help us to see the full picture.

I find the OBs that do actually perform TABs (aka tabbies, tabithas, POCs, pockies, D&Cs, D&Es, IUCs etc. the dozen different codenames they are sent to pathology under, basically for therapeutic abortions) never in a million years would ever have the balls to sit down with their colleagues in path or whatever and talk it about. Its a huge culture of silence, and a very isolating one as well. You also get pigeonholed, Dr. X sending in more tabbies becomes the Tabby Doc or the POCster. The scorn they get from the rest of medical community is pretty damn intense, I was at a big city public hospital and couldnt believe it....definitely something to think about.

Now you wont be reading that on Medical Students for Choice whatever!!!

 

[tiredmom]

LADoc -
What kind of exams are done on the POCs? Most of my experience has been at a faith based facility that didn't perform ABs, only D&Cs for missed or incomplete abs... I guess I thought it was just for disposal. I understand the trauma involved - even seeing the bags after d&cs for missed abs has really bothered me. I won't be performing abortions in my practice.

 

[LADoc00]

LADoc -
What kind of exams are done on the POCs? Most of my experience has been at a faith based facility that didn't perform ABs, only D&Cs for missed or incomplete abs... I guess I thought it was just for disposal. I understand the trauma involved - even seeing the bags after d&cs for missed abs has really bothered me. I won't be performing abortions in my practice.

Depends on clinical scenario, if its a tabby POC then I shift through the fetus parts and put in what I think I need to see, which typically followed a format: a bit of placenta for dating, a bit cord or membrane and I always threw something from the actual fetus I could readily find which was either the hand or foot, the limbs tend be yanked off in a big D+E and readily float to the surface, while the torso and head will sink to the bottom.

 

[tiredmom]

Yuck...thanks for the visual!

 

[Poety]

Depends on clinical scenario, if its a tabby POC then I shift through the fetus parts and put in what I think I need to see, which typically followed a format: a bit of placenta for dating, a bit cord or membrane and I always threw something from the actual fetus I could readily find which was either the hand or foot, the limbs tend be yanked off in a big D+E and readily float to the surface, while the torso and head will sink to the bottom.

now I'm going to need a shrink

 

[pruritis_ani]

You practice medicine based on what patients' "demand"?? Whaha? Umm what med school and training program did you attend so I can promptly crap on it.

Ummm basically you said you hate (loath) what you DO as a profession and essentially do what people demand. Wow, I knew Obgyn wasnt great but that outright SUCKS.

Well, LADoc, all of us in patient care do what our patients "demand". As MD's, our job is to gather information, come up with an accurate diagnosis, provide information on the availble therapy or lack thereof, and then TO DO WHAT THE PATIENT WANTS! Don't know what school you went to that shuns the idea of patient autonomy, but I think that is pretty deserving of a huge, steaming pile of crap.

We would do well to rememeber that we are all in the service of our patients, not the other way around.

By no means does that mean that a doctor who is fundamentally opposed to a certain therapy (ie abortion) should be required to do it. But, the patient has a right to access and information about all possible modalities, and guided to an appropriate caregiver where the patient can recieve the care she wants....

So, if you don't want to do the path exams on POC's, don't do them. If you don't want to perfom the TABs, don't do them. But, the doctors that provide this service do it because they care for the patient. And doctors that put their own values above those of the patient, and look down on others that truly care...well, let's just say those doctors are the ones that should be recieving the scorn of the community.

I am all for different views and opinions on different subjects, but to scorn somebody for simply taking care of a patient in need is a sick thing. It is not like these doctors wake up in the morning looking forward to a schedule full of TAB. It is a less than ideal solution, and not a pleasant thing for anybody involved. But, that does not make it a "bad" thing, or something deserving of scorn.

 

[3dtp]

Well, LADoc, all of us in patient care do what our patients "demand". As MD's, our job is to gather information, come up with an accurate diagnosis, provide information on the availble therapy or lack thereof, and then TO DO WHAT THE PATIENT WANTS! Don't know what school you went to that shuns the idea of patient autonomy, but I think that is pretty deserving of a huge, steaming pile of crap.

We would do well to rememeber that we are all in the service of our patients, not the other way around.

By no means does that mean that a doctor who is fundamentally opposed to a certain therapy (ie abortion) should be required to do it. But, the patient has a right to access and information about all possible modalities, and guided to an appropriate caregiver where the patient can recieve the care she wants....

So, if you don't want to do the path exams on POC's, don't do them. If you don't want to perfom the TABs, don't do them. But, the doctors that provide this service do it because they care for the patient. And doctors that put their own values above those of the patient, and look down on others that truly care...well, let's just say those doctors are the ones that should be recieving the scorn of the community.

I am all for different views and opinions on different subjects, but to scorn somebody for simply taking care of a patient in need is a sick thing. It is not like these doctors wake up in the morning looking forward to a schedule full of TAB. It is a less than ideal solution, and not a pleasant thing for anybody involved. But, that does not make it a "bad" thing, or something deserving of scorn.

This is not quite true. We are under no obligation to provide ineffective care, or futile medical care or care that could be harmful to the patient. Even if the patient WANTS it.

Most honest OB-Gyns who have performed an abortion, for whatever reason will admit in their more reflective moments that an abortion is killing babies. I think killing babies is a bad thing.

After the TAB/VTP (voluntary termination of pregnancy), at certain best unnamed clinics, the OB will examine the aborted baby and put the pieces back together to make sure they got it all. See LADoc's description for the gory details. After I saw what really goes on, I went home and cried. I decided that if this is what it took to be a gynecologist, I couldn't/wouldn't do it. My program offered me the option of covering a clinic so someone else could cover my responsibilities but I couldn't even do that, knowing I would provide an opportunity for someone else. I decided to leave OB for another specialty, in large part because of this. Another thought about this, the informed consent and counselling session were more like, ok, lets get it done, since you're here. We give more counselling and information to a potential tubal case than an abortion. There are also late consequences of VTP. A woman who has had an abortion, even an early 2nd TM AB has a Relative Risk of 2.67x the likelihood of incompetent cervix in the 2nd TM and miscarriage (for which John Edwards will sue the OB for wrongful death) in future pregnancies over women who have not. These were not discussed in any detail.

Poety, where's your couch?

 

[MacGyver]

The problem i have with MS4C and NARAL is that they want med students and residents to be FORCED to observe/train in abortions.

Thats absolute BS.

Ob/gyn residency should have abortion training STRICTLY FOR THOSE WHO WANT IT. But the activists at MS4C and NARAL thats not good enough. They want their dogma forced down our throats

 

[Leukocyte]

During my third year, I saw a 26 year old "patient" who had 9 (nine) prior abortions. She was coming in to have her tenth done. My chief resident at that time was a 40 year old African American southern baptist. During the exam, she (my cheif resident) made the "patient" watch the U/S screen and said to her "look, this is his heart beating", "look how he is moving his little arms and legs". She made the "patient" cry, but the "patient" still went on to sign the consent form.

Yes, this "patient's" ORGASM is more important than the life of her babies.

I could respond to pruritis-ani's offensive post, but I would rather not. I do not need to raise my blood pressure over a post like this.

 

[pruritis_ani]

This is not quite true. We are under no obligation to provide ineffective care, or futile medical care or care that could be harmful to the patient. Even if the patient WANTS it.

You are under no obligation to provide ANY care. You are under obligation to inform the patient of all available care, and to send them to a provider who will help them.

All medical care has a potential for harm, nothing is completely safe. Using the above argument against abortion is a bit nonsensical.

Most honest OB-Gyns who have performed an abortion, for whatever reason will admit in their more reflective moments that an abortion is killing babies. I think killing babies is a bad thing.

So, you define an honest Ob-Gyn as one that agrees with your views?

After the TAB/VTP (voluntary termination of pregnancy), at certain best unnamed clinics, the OB will examine the aborted baby and put the pieces back together to make sure they got it all. See LADoc's description for the gory details. After I saw what really goes on, I went home and cried. I decided that if this is what it took to be a gynecologist, I couldn't/wouldn't do it. My program offered me the option of covering a clinic so someone else could cover my responsibilities but I couldn't even do that, knowing I would provide an opportunity for someone else. I decided to leave OB for another specialty, in large part because of this. Another thought about this, the informed consent and counselling session were more like, ok, lets get it done, since you're here. We give more counselling and information to a potential tubal case than an abortion. There are also late consequences of VTP. A woman who has had an abortion, even an early 2nd TM AB has a Relative Risk of 2.67x the likelihood of incompetent cervix in the 2nd TM and miscarriage (for which John Edwards will sue the OB for wrongful death) in future pregnancies over women who have not. These were not discussed in any detail.

Poety, where's your couch?

Sorry that you were exposed to what appears to be inadequate informed consent. It seems as though Ob-Gyn was not for you due to some strong personal beliefs, and it appears that you made a decision that is right for you. I agree that consent should be thorough and complete for ALL medical procedures, so a patient can maintain autonomy, and make the choice that is the best for them. All procedures have complications and risks, and it is the patients decision as to whether the risks are worth taking for the outcome desired.

 

[pruritis_ani]

The problem i have with MS4C and NARAL is that they want med students and residents to be FORCED to observe/train in abortions.

Thats absolute BS.

Ob/gyn residency should have abortion training STRICTLY FOR THOSE WHO WANT IT. But the activists at MS4C and NARAL thats not good enough. They want their dogma forced down our throats

I agree that it is BS to have something forced down your throat. The idea of forcing somebody to observe or participate in an abortion is as repellant to me as is the idea of forcing beliefs on somebody by limiting access to abortions.

I have not been aware that MS4C was this militant about it, and it certainly would turn me off a bit toward the organization if I could verify that this was the stance.

 

[pruritis_ani]

During my third year, I saw a 26 year old "patient" who had 9 (nine) prior abortions. She was coming in to have her tenth done. My chief resident at that time was a 40 year old African American southern baptist. During the exam, she (my cheif resident) made the "patient" watch the U/S screen and said to her "look, this is his heart beating", "look how he is moving his little arms and legs". She made the "patient" cry, but the "patient" still went on to sign the consent form.

Yes, this "patient's" ORGASM is more important than the life of her babies.

I could respond to pruritis-ani's offensive post, but I would rather not. I do not need to raise my blood pressure over a post like this.

Sorry if you found my post offensive. I was personally offended by LAdocs post, and felt it deserved a reply. It was not meant to be offensive, but rather show that as MD's we are in the service of our patients, and that they have the ultimate say.

The scenario you mention above is a tragic failure. The patient appears to have made some very sad choices as far as taking responsibility for her actions. We can find stories like that in all specialties of medicine (ie the pateint smoking through the trache, the diabetic that refuses to change eating habits, the cirrhotic that continues to drink). But, I think that you would agree that the answer in all of the above cases is not to refuse care to everyone. I mean, we can't stop resecting laryngeal cancer because some of the patients continue to smoke, can we? So, it is a bit of a strech to use that as an argument against abortion...

(btw, even given the above circumstances, I don't think that excuses the chief resident's behavior. It is not ok to attempt to browbeat a patient in order to get her to go along with your beliefs...by no means should we simply say "sure, here is your abortion", it is absolutely appropriate to inform her in a very firm manner about the added medical risks she faces, and to strongly advocate better contraception...but, the methods employed by the resident were inappropriate)

No matter where we go, we have non-compliant patients, that frustrate us beyond belief. In Ob/Gyn, we are cursed with the occasional patient that views a TAB as birth control. It is not any more fun for us to deal with that patient than it is for you. But, for every one of those types of patients, we have several whose partner or protection has failed them, and these patients are deserving of compasionatte, non-judgemental care or at least direction to somebody who can provide that care.

 

[LADoc00]

I didnt post that stuff to pass judgemet although as a MD I feel I have no neccessity to do what patients' "demand". The day I do that and become nothing more than a whored out Stabucks barista, I will leave....

But I do think I have a unique perspective, well all pathologists. We are the silent boatmen over the Styx, looking at the all the crazy shiat society does, watching, recording, counting baby limbs, counting knife wounds, counting surgical stiches, eyeballs, measuring rotting ulcers, sampling dead hearts. I went to a job interview where the pathologist told me his first day on the job in a small rural county there was a plane crash, he spent 10 hours piling chunks of flesh up, comparing the skin tones and telling the police "yeah this little pile of flesh over here was their 10 yer old daughter.." cRaZy. Of course I love it, I cant really do anything else.

Im not judging the abortion providers, as you said its not a "bad thing" to them. It is here, and I deal with it. But imagine looking back on a life of such work, what might you be thinking each day you crawl closer to my autopsy table? Just a provocative thought, heck I might even cut your hands too and submit sections of them, just like a POC. You know, complete the circle of life and all.

 

[pruritis_ani]

I didnt post that stuff to pass judgemet although as a MD I feel I have no neccessity to do what patients' "demand". The day I do that and become nothing more than a whored out Stabucks barista, I will leave....

But I do think I have a unique perspective, well all pathologists. We are the silent boatmen over the Styx, looking at the all the crazy shiat society does, watching, recording, counting baby limbs, counting knife wounds, counting surgical stiches, eyeballs, measuring rotting ulcers, sampling dead hearts. I went to a job interview where the pathologist told me his first day on the job in a small rural county there was a plane crash, he spent 10 hours piling chunks of flesh up, comparing the skin tones and telling the police "yeah this little pile of flesh over here was their 10 yer old daughter.." cRaZy. Of course I love it, I cant really do anything else.

Im not judging the abortion providers, as you said its not a "bad thing" to them. It is here, and I deal with it. But imagine looking back on a life of such work, what might you be thinking each day you crawl closer to my autopsy table? Just a provocative thought, heck I might even cut your hands too and submit sections of them, just like a POC. You know, complete the circle of life and all.

I can understand that what you do may provide an entirely different perspective. It is not something that many of us could do, so hats off to you for it!

As for the Starbucks barista...well, I think it is very important for all of us to remember that we are here to serve the patient. Of course we need to offer guidance, make accurate diagnoses, educate and inform...but, at the end of the day, the patient always decides what is to be done, or at the very least decides who is to make the decision for him/her. If the patient "demands" that we treat the malignancy, we do it. If they demand to be sent home under hospice care, we do it as well. If a woman "demands" a mammoplasty, a plastic surgeon will provide her that service.

It would be a great thing if the world were without violence, without disease, without unwanted pregnancy...but, as docs we are stuck on the front lines, often forced to face things that we never hoped to see. Sucks to be us, eh?

I would love it if our world was a place that didn't have any need for abortion. But, unfortunately, that is not the world we live in today.

 

[tiredmom]

I'm planning on including in my patient information/discussion at the new patient visit that I do not perform abortions. It makes sense to say it upfront. I'm not sure the breakdown, but most of my experience has been that the doctors who provide abortions get pigeon-holed into providing mainly abortions. I had always thought that was because they wanted it that way, but this thread makes me think it might be society's doing instead.
I don't think it's fair to say that doctors who don't provide abortions should be looked down upon in scorn. If I believe its wrong, I won't do it. If someone comes in and wants a referral, I would sit down and have a talk first. Please note I said talk, not browbeat. But just like telling a 110 lb pt that that they don't need bariatric surgery or the housewife who swears she needs Xanax 'cause all the other housewives need it to calm their nerves - you have to sometimes not give into the patient right away. I will give the referral, but not unless we've talked first.
My only experience with MS4C was pretty obnoxious. They showed up to a lecture sponsored by the pro-life student group, sat en masse, ate the free food, and proceeded in an organized fashion to interrupt the speaker with questions every 2-3 minutes. It was offensive. That may just be the folks at my school, but it seemed pretty militant to me.
So, for those folks who use TABs for birth contol (I, too, have seen multiple women with 7-9 previous abortions in their late 20's) - what do you think about a limit on the number of TABs someone could have? That might persuade some to consider a less risky way to PREVENT pregnancy?

 

[pruritis_ani]

Tiredmom, I think you have a very reasonable approach to the issue. I agree that it is very appropriate to offer counseling, education and information to the patient. It seems that you recognize that there is a difference between providing medical information to help a patient make an informed choice and trying to convince a patient to buy into a belief that an abortion is wrong. There are certainly going to be very different ways of offering counseling, influenced heavily by our beliefs, but that is ok with me as long as we remember that the patient should decide without being goaded or bullied into something.

I am not a huge fan of anybody being "militant" about anything, and obnoxious MS4C members are not excluded from that. I am very, very adamant about my pro-choice stance as well, from a legislation standpoint. If there is ever a discussion about outlawing abortion, I am right in there as loud as I can be. But, part of being pro-choice is recognizing that somebody may choose to be pro-life as well. I just wish that everybody was free to do what they believe is right, without imposing anything on others.

As for a limit on TABs...in theory, that sounds great. But, I think it is tough to defend ethically...I mean, how are you going to decide what number of abortions is too many? And, if 10 are "wrong" and illegal, than why couldn't you say the same thing about 1? I certainly do not think that TAB is reasonable birth control, but in that I think abortion is about a women's right to decide what risks to take with her body, I think that legislating the number of abortions is just too slippery a slope to start on.

 

[3dtp]

please do it. as much as we "abortion providers" loath the procedure itself and the title, we do it because its what our patients demand. and women deserve to have their full range of options executed safely and without judgment. make your decision based on what your patients desire...not on an often misunderstood stigma. believe it or not, you end up feeling good about it because you provide a needed service. youre making a difference...good work.

Some of my patients desire narcotics, in copious quantities. Others benzodiazepines. As I am not in primary care, it would be unwise to do what my patients desire. It would harm them, and it would certainly violate the "First Do No Harm" mandate of medicine. I can and do refer them to their primary referring doc, but the bottom line is, their primary doc has refused them as well.

Next, pruritis suggested that the resident was wrong to show the ultrasound. I disagree. One of the elements of informed consent is understanding the procedure and the risks as well as the benefits. Certainly there is risk to the baby, or products of conception if you must. The ultrasound demonstrates what those actually entail. We disagree on this as well.

Finally, when I was sitting on the beach pondering my future, I came to the conclusion that if I were approached to provide an abortion, I would handle it very similarly to tiredmom. My approach included discussing family planning with all new patients and all NOBs. The key question was "Is this a planned pregnancy?" If not, "What type of birth control were you using and how were you using it?" Then we have the what are you going to do to prevent the next one until you're ready discussion, complete with all the options. I'd be willing to put IUDs in for free if it'd prevent an abortion in the future. But no one left the office without a contraceptive plan or at least without full contraceptive counselling which was repeated in the 3rd TM. No one left the hospital post-partum after an unplanned pregnancy without an RX for Plan B, instructions on how to obtain free/cheap contraception from the county health clinic.

If someone came in requesting an abortion, I would gently explain that I am unable to help them with an abortion as a procedure I do not do, my office is philosophically unable to help them obtain an abortion, but such information is readily available from the telephone directory and other sources, and they will be happy to help them, in the meantime, until you decide otherwise, you're carrying a baby, so let's plan on taking care of you and your baby. If you do decide to seek other options, we will be happy to continue your care.

Personally, I'd be very nervous, knowing what I know now about caring for a multi-gravid para zero who has had multiple VTPs and would include in my initial assessment a consent that the patient acknowledges she is at much higher risk for incompetent cervix/miscarriage prior to 25 weeks because they have had prior abortions and would probably refer such patients out categorically to the MFM people since I wouldn't want the liability.

 

[pruritis_ani]

Some of my patients desire narcotics, in copious quantities. Others benzodiazepines. As I am not in primary care, it would be unwise to do what my patients desire. It would harm them, and it would certainly violate the "First Do No Harm" mandate of medicine. I can and do refer them to their primary referring doc, but the bottom line is, their primary doc has refused them as well.

One thing to decline an illegal activity, such as drug seeking. Another thing to seek a legal therapy which you disagree with.

Next, pruritis suggested that the resident was wrong to show the ultrasound. I disagree. One of the elements of informed consent is understanding the procedure and the risks as well as the benefits. Certainly there is risk to the baby, or products of conception if you must. The ultrasound demonstrates what those actually entail. We disagree on this as well.

I never said it was wrong to show the ultrasound. I did say it was wrong to reduce a patient to tears in an attempt to convince her to do something she does not want to do (ie keep the baby) simply because you happen to disagree with it.

Finally, when I was sitting on the beach pondering my future, I came to the conclusion that if I were approached to provide an abortion, I would handle it very similarly to tiredmom. My approach included discussing family planning with all new patients and all NOBs. The key question was "Is this a planned pregnancy?" If not, "What type of birth control were you using and how were you using it?" Then we have the what are you going to do to prevent the next one until you're ready discussion, complete with all the options. I'd be willing to put IUDs in for free if it'd prevent an abortion in the future. But no one left the office without a contraceptive plan or at least without full contraceptive counselling which was repeated in the 3rd TM. No one left the hospital post-partum after an unplanned pregnancy without an RX for Plan B, instructions on how to obtain free/cheap contraception from the county health clinic.

If someone came in requesting an abortion, I would gently explain that I am unable to help them with an abortion as a procedure I do not do, my office is philosophically unable to help them obtain an abortion, but such information is readily available from the telephone directory and other sources, and they will be happy to help them, in the meantime, until you decide otherwise, you're carrying a baby, so let's plan on taking care of you and your baby. If you do decide to seek other options, we will be happy to continue your care.

Personally, I'd be very nervous, knowing what I know now about caring for a multi-gravid para zero who has had multiple VTPs and would include in my initial assessment a consent that the patient acknowledges she is at much higher risk for incompetent cervix/miscarriage prior to 25 weeks because they have had prior abortions and would probably refer such patients out categorically to the MFM people since I wouldn't want the liability.

All of this sounds reasonable to me. If you disagree with something, great. I personally think the right thing to do is to refer directly, but I can accept the indirect method that you prefer.

Again, pro-life or pro-choice doesn't really matter to me. Unless you attempt to force ALL of us to accept your views....making abortion illegal is just as repugnant to me as a law requiring abortion after you have two children would be.

 

[fomites]

Depends on clinical scenario, if its a tabby POC then I shift through the fetus parts and put in what I think I need to see, which typically followed a format: a bit of placenta for dating, a bit cord or membrane and I always threw something from the actual fetus I could readily find which was either the hand or foot, the limbs tend be yanked off in a big D+E and readily float to the surface, while the torso and head will sink to the bottom.

oh no you dii'nt.

in med school we had to spend time at an abortion clinic. It was the most traumatic freaking thing ever. Was not prepared for the whole experience and seeing the limbs and feet floating about in that bloody mess. I hope I never see another one or have to do another. Counting dismembered body parts was disturbing. why the F did they make us do that?! I wish I had never seen that!

 

[Leukocyte]

Deleted

 

[Poety]

This is not quite true. We are under no obligation to provide ineffective care, or futile medical care or care that could be harmful to the patient. Even if the patient WANTS it.

Most honest OB-Gyns who have performed an abortion, for whatever reason will admit in their more reflective moments that an abortion is killing babies. I think killing babies is a bad thing.

After the TAB/VTP (voluntary termination of pregnancy), at certain best unnamed clinics, the OB will examine the aborted baby and put the pieces back together to make sure they got it all. See LADoc's description for the gory details. After I saw what really goes on, I went home and cried. I decided that if this is what it took to be a gynecologist, I couldn't/wouldn't do it. My program offered me the option of covering a clinic so someone else could cover my responsibilities but I couldn't even do that, knowing I would provide an opportunity for someone else. I decided to leave OB for another specialty, in large part because of this. Another thought about this, the informed consent and counselling session were more like, ok, lets get it done, since you're here. We give more counselling and information to a potential tubal case than an abortion. There are also late consequences of VTP. A woman who has had an abortion, even an early 2nd TM AB has a Relative Risk of 2.67x the likelihood of incompetent cervix in the 2nd TM and miscarriage (for which John Edwards will sue the OB for wrongful death) in future pregnancies over women who have not. These were not discussed in any detail.

Poety, where's your couch?

I'm on it right now, you can't fit

 

[Poety]

Sorry if you found my post offensive. I was personally offended by LAdocs post, and felt it deserved a reply. It was not meant to be offensive, but rather show that as MD's we are in the service of our patients, and that they have the ultimate say.

The scenario you mention above is a tragic failure. The patient appears to have made some very sad choices as far as taking responsibility for her actions. We can find stories like that in all specialties of medicine (ie the pateint smoking through the trache, the diabetic that refuses to change eating habits, the cirrhotic that continues to drink). But, I think that you would agree that the answer in all of the above cases is not to refuse care to everyone. I mean, we can't stop resecting laryngeal cancer because some of the patients continue to smoke, can we? So, it is a bit of a strech to use that as an argument against abortion...

(btw, even given the above circumstances, I don't think that excuses the chief resident's behavior. It is not ok to attempt to browbeat a patient in order to get her to go along with your beliefs...by no means should we simply say "sure, here is your abortion", it is absolutely appropriate to inform her in a very firm manner about the added medical risks she faces, and to strongly advocate better contraception...but, the methods employed by the resident were inappropriate)

No matter where we go, we have non-compliant patients, that frustrate us beyond belief. In Ob/Gyn, we are cursed with the occasional patient that views a TAB as birth control. It is not any more fun for us to deal with that patient than it is for you. But, for every one of those types of patients, we have several whose partner or protection has failed them, and these patients are deserving of compasionatte, non-judgemental care or at least direction to somebody who can provide that care.

I'd argue here that there is a difference. A woman coming in for repeated abortions and someone actually doing them over and over, is not the same as someone continuing to smoke through a trach, or an alcoholic with cirrhosis. Here, we're talking about affecting another life, depending on your views about when a fetus is an actual life or not.

And I think more docs SHOULD imploy their morals and beliefs - its scary that we're so damn PC we won't even tell a patient what our own convictions are? Doctors are human - when you lose that sense of humanity and become this robot that just "does what the patient said to do" wouldn't you think you're the one whos at the most risk of giving subpar care? We have feelings, emotions and beliefs for a reason.

 

[pruritis_ani]

I'd argue here that there is a difference. A woman coming in for repeated abortions and someone actually doing them over and over, is not the same as someone continuing to smoke through a trach, or an alcoholic with cirrhosis. Here, we're talking about affecting another life, depending on your views about when a fetus is an actual life or not.

The "life vs no life" debate has been played out 1,000,000 times. Not interested in going through it again. I used this comparison, because what we have are people going through a medical procedure repeatedly due to some choices that most of us cannot understand. None of us like it, but there are plenty of other examples in medicine of people doing stupid things that hurt themselves (and others), and they do it over and over and over and over....

And I think more docs SHOULD imploy their morals and beliefs - its scary that we're so damn PC we won't even tell a patient what our own convictions are? Doctors are human - when you lose that sense of humanity and become this robot that just "does what the patient said to do" wouldn't you think you're the one whos at the most risk of giving subpar care? We have feelings, emotions and beliefs for a reason.

Nobody said anything about hiding morals and beliefs. I have said all along that we certainly have as much right to these beliefs as a patient. I just do not think it is appropriate to attempt to manipulate patients to act in accordance with our morals.

I don't know where you get the idea that just doing what the patient says will make you a robot. Ethically, there is NO DOUBT that we are there to do what the patient wants, and nothing else. Ethically, we are also bound to provide the best information we have. But, our direction should be guided by the best medical science we can offer, coupled with compassion and empathy. It is not right to try to abuse our position in order to impose our moral beliefs on the patient! An example outside of abortion....Jehova's Witness patients and blood products. We know that they don't want blood. We have to tell them that this choice may wind up costing their life, and go along with their wishes. I think we would all agree that in this case it is inappropriate to attempt to subvert this person's beliefs. To me, that right to chose applies to all of medicine, and includes the right to make the choice without facing the wrath of a phycisian who disagrees with those views.

Have a frank discussion when you get a new patient. That is a great idea. But, when that woman knows your stance, and still walks into your office seeking a termination, realize that she obviously has different views about it, and do not use this as an opportunity to prosetylize.

 

[Poety]

The "life vs no life" debate has been played out 1,000,000 times. Not interested in going through it again. I used this comparison, because what we have are people going through a medical procedure repeatedly due to some choices that most of us cannot understand. None of us like it, but there are plenty of other examples in medicine of people doing stupid things that hurt themselves (and others), and they do it over and over and over and over....



Nobody said anything about hiding morals and beliefs. I have said all along that we certainly have as much right to these beliefs as a patient. I just do not think it is appropriate to attempt to manipulate patients to act in accordance with our morals.

I don't know where you get the idea that just doing what the patient says will make you a robot. Ethically, there is NO DOUBT that we are there to do what the patient wants, and nothing else. Ethically, we are also bound to provide the best information we have. But, our direction should be guided by the best medical science we can offer, coupled with compassion and empathy. It is not right to try to abuse our position in order to impose our moral beliefs on the patient! An example outside of abortion....Jehova's Witness patients and blood products. We know that they don't want blood. We have to tell them that this choice may wind up costing their life, and go along with their wishes. I think we would all agree that in this case it is inappropriate to attempt to subvert this person's beliefs. To me, that right to chose applies to all of medicine, and includes the right to make the choice without facing the wrath of a phycisian who disagrees with those views.

Have a frank discussion when you get a new patient. That is a great idea. But, when that woman knows your stance, and still walks into your office seeking a termination, realize that she obviously has different views about it, and do not use this as an opportunity to prosetylize.

I see your points, but even on the Jehovah thing, the courts override them in the case of children. I'm merely saying that I have issues with women getting ab's for birth control and I'm wondering what can be done to stop this. I know here in the south it wouldn't be unheard of to have a doc do as that chief did in the previous story - would I do it? Probably so, and perhaps the woman cried out of guilt, not because of what was said by the chief? (I don't know though)

I'm not for pushing beliefs on someone, (although I think its a good thing to share whatever your beliefs may be with whomever you choose) just preventing abuse of "procedures", and believe me, I'm a feminist to the core, but there are some things that really push the envelope. To me, multiple ab's are one of them - and it really does need to be prevented or stopped. When is it no longer the womans choice? Perhaps she needs to be sterilized or something (ducks and runs ) but I mean come on, you've seen them, so have I the 20 y.o. g8p0 with all 8 of those being ab's I mean, what if a law was passed stating that there was a limit of 2 ab's done by choice - perhaps women would USE THE CONTRACEPTION then if they thought they'd have to have the child?

What would you propose as a solution to this? I think these peopel really are taking advantage of their "right to choose" don't you?

 

[calot's 3angle]

The problem i have with MS4C and NARAL is that they want med students and residents to be FORCED to observe/train in abortions.

Thats absolute BS.

Ob/gyn residency should have abortion training STRICTLY FOR THOSE WHO WANT IT. But the activists at MS4C and NARAL thats not good enough. They want their dogma forced down our throats

As a member of MS4C during all my years in medical school, I can say that they certainly do not believe that anyone should be forced to observe/train in abortions. Their goal is to raise awareness of the lack of abortion providers in this country and to help faciliate the training of medical students and residents in abortion provision by making sure that schools have curricula in place so that future doctors may get this training should they desire it. Because it is a difficult and controversial topic, many medical schools do not even spend the time to cover the topic, not to mention that a D&C is a procedure not always used for elective abortions. The whole idea behind choice and keeping abortion legal is so that dogma isn't forced down people's throats.

 

[pruritis_ani]

I see your points, but even on the Jehovah thing, the courts override them in the case of children. I'm merely saying that I have issues with women getting ab's for birth control and I'm wondering what can be done to stop this. I know here in the south it wouldn't be unheard of to have a doc do as that chief did in the previous story - would I do it? Probably so, and perhaps the woman cried out of guilt, not because of what was said by the chief? (I don't know though)

Well, call me crazy, but I do not think it is right to be the impetus that causes a patient to cry out of guilt. My job as a physician is to comfort and help. If something comes up that I am fundamentally opposed to, I would certainly not take the opportunity to spout off my beliefs in an attempt to coerce the patient, or to change their views. When a patient comes for care, we are obligated to do the best we can, and refer when appropriate.

I'm not for pushing beliefs on someone, (although I think its a good thing to share whatever your beliefs may be with whomever you choose) just preventing abuse of "procedures", and believe me, I'm a feminist to the core, but there are some things that really push the envelope. To me, multiple ab's are one of them - and it really does need to be prevented or stopped. When is it no longer the womans choice? Perhaps she needs to be sterilized or something (ducks and runs ) but I mean come on, you've seen them, so have I the 20 y.o. g8p0 with all 8 of those being ab's I mean, what if a law was passed stating that there was a limit of 2 ab's done by choice - perhaps women would USE THE CONTRACEPTION then if they thought they'd have to have the child?

What would you propose as a solution to this? I think these peopel really are taking advantage of their "right to choose" don't you?

I think of us have issues with TAB as birth control. Many of us have issues with the many different ways patients have of being self destructive. However, I don't see a way to limit the number of abortions and allow women to maintain freedom.

The answer is better education and birth control. But, there will always be women that refuse this, just as there will always be smokers and crack heads.

 

[Poety]

Well, call me crazy, but I do not think it is right to be the impetus that causes a patient to cry out of guilt. My job as a physician is to comfort and help. If something comes up that I am fundamentally opposed to, I would certainly not take the opportunity to spout off my beliefs in an attempt to coerce the patient, or to change their views. When a patient comes for care, we are obligated to do the best we can, and refer when appropriate.



I think of us have issues with TAB as birth control. Many of us have issues with the many different ways patients have of being self destructive. However, I don't see a way to limit the number of abortions and allow women to maintain freedom.

The answer is better education and birth control. But, there will always be women that refuse this, just as there will always be smokers and crack heads.

Its interesting, OB definitely attracts a certain kind - its almost like a brainwashing type of field where by the end, you either believe as all the ob's do, or you don't go into the field.

I think some ob's tend to get a bit holier than thou with their ideas on "I service the patient, etc etc" which in all reality is just an excuse to abandon their own thought process and go along with the ACOGOG (or whatever those initials are) establishment.

I already know theres no winning this argument so I won't try. Clearly, education and birth control isn't winning this war either.

We see differently - completely, so we'll just leave it at that.

On a last note, don't assume you're better than me (or that chief) because of what I would choose to do with a patient - thats a thin line to cross for sure and one a few practioners - particularly in your field need to be careful about crossing repeatedly - it may just bite you in the butt later on.

Bye bye.

 

[pruritis_ani]

Its interesting, OB definitely attracts a certain kind - its almost like a brainwashing type of field where by the end, you either believe as all the ob's do, or you don't go into the field.

I think some ob's tend to get a bit holier than thou with their ideas on "I service the patient, etc etc" which in all reality is just an excuse to abandon their own thought process and go along with the ACOGOG (or whatever those initials are) establishment.

I already know theres no winning this argument so I won't try. Clearly, education and birth control isn't winning this war either.

We see differently - completely, so we'll just leave it at that.

On a last note, don't assume you're better than me (or that chief) because of what I would choose to do with a patient - thats a thin line to cross for sure and one a few practioners - particularly in your field need to be careful about crossing repeatedly - it may just bite you in the butt later on.

Bye bye.

I don't mean to put off a "holier than thou" attitude, and if I do, then I apologize. As far as following ACOG, or whatever you are implying...well, for medicine, I follow current evidence based practice. For my patients, I offer support and compassion, as well as the best medicine and surgery I can practice. Additionally, I try to be empathetic and non judgemental toward their views, especially when they may differ from mine And in my life, I try to be as true to my personal beliefs as possible.

I am not sure where you get that I am abandoning my own thought process. I simpy am acutely aware that there are certain beliefs that I may have that I have no business attempting to impart on a patient.

I don't think I am better than you or the chief at all. I simply think that as far as patient care comes, the patients do not deserve to be browbeaten by we that care for them. I do not think that using our positions as doctors to leverage the patient is appropriate. If you don't believe in abortion, by all means don't do them. Let your patients know how they feel at the first visit, so they know to look elsewhere for TABs. All that is great stuff, and no problem at all.

But, when they come in vulnerable, and seeking care...well, that is not the time to impart your unsolicited anti-abortion stance. Compare that to a long time smoker coming in with an apical mass...is that the right time to say, "Hey, you shouldn't have smoked"???

 

[pruritis_ani]

Its interesting, OB definitely attracts a certain kind - its almost like a brainwashing type of field where by the end, you either believe as all the ob's do, or you don't go into the field.

I think some ob's tend to get a bit holier than thou with their ideas on "I service the patient, etc etc" which in all reality is just an excuse to abandon their own thought process and go along with the ACOGOG (or whatever those initials are) establishment.

I already know theres no winning this argument so I won't try. Clearly, education and birth control isn't winning this war either.

We see differently - completely, so we'll just leave it at that.

On a last note, don't assume you're better than me (or that chief) because of what I would choose to do with a patient - thats a thin line to cross for sure and one a few practioners - particularly in your field need to be careful about crossing repeatedly - it may just bite you in the butt later on.

Bye bye.

I don't mean to put off a "holier than thou" attitude, and if I do, then I apologize. As far as following ACOG, or whatever you are implying...well, for medicine, I follow current evidence based practice. For my patients, I offer support and compassion, as well as the best medicine and surgery I can practice. Additionally, I try to be empathetic and non judgemental toward their views, especially when they may differ from mine And in my life, I try to be as true to my personal beliefs as possible.

I am not sure where you get that I am abandoning my own thought process. I simpy am acutely aware that there are certain beliefs that I may have that I have no business attempting to impart on a patient.

I don't think I am better than you or the chief at all. I simply think that as far as patient care comes, the patients do not deserve to be browbeaten by we that care for them. I do not think that using our positions as doctors to leverage the patient is appropriate. If you don't believe in abortion, by all means don't do them. Let your patients know how they feel at the first visit, so they know to look elsewhere for TABs. All that is great stuff, and no problem at all.

But, when they come in vulnerable, and seeking care...well, that is not the time to impart your unsolicited anti-abortion stance. Compare that to a long time smoker coming in with an apical mass...is that the right time to say, "Hey, you shouldn't have smoked"???

I can certainlly agree to disagree on our philosophy. I can also gladly accept your choice in providing only the care you are comfortable with. The only thing I hope you reconsider is the timing of asserting your position.


(btw...brainwashing? Really? All Ob's think alike??? Hmmm. Not sure what you get this from, but if you even read THIS thread, it is pretty clear that there are many, many different views on many issues in the field. My program is actually very conservative, doesn't offer TABs, and my views differ from a good majority of those that work and live in my area....I bet they wish they could brainwash me! )

 

[Poety]

I don't mean to put off a "holier than thou" attitude, and if I do, then I apologize. As far as following ACOG, or whatever you are implying...well, for medicine, I follow current evidence based practice. For my patients, I offer support and compassion, as well as the best medicine and surgery I can practice. Additionally, I try to be empathetic and non judgemental toward their views, especially when they may differ from mine And in my life, I try to be as true to my personal beliefs as possible.

I am not sure where you get that I am abandoning my own thought process. I simpy am acutely aware that there are certain beliefs that I may have that I have no business attempting to impart on a patient.

I don't think I am better than you or the chief at all. I simply think that as far as patient care comes, the patients do not deserve to be browbeaten by we that care for them. I do not think that using our positions as doctors to leverage the patient is appropriate. If you don't believe in abortion, by all means don't do them. Let your patients know how they feel at the first visit, so they know to look elsewhere for TABs. All that is great stuff, and no problem at all.

But, when they come in vulnerable, and seeking care...well, that is not the time to impart your unsolicited anti-abortion stance. Compare that to a long time smoker coming in with an apical mass...is that the right time to say, "Hey, you shouldn't have smoked"???

I can certainlly agree to disagree on our philosophy. I can also gladly accept your choice in providing only the care you are comfortable with. The only thing I hope you reconsider is the timing of asserting your position.

Well, I would have to be honest with the patient and say (oh, I'm also going into psych so this is interesting isn't it? I did consider ob) exactly what another poster said earlier on. In that I can't provide them a place to go, and that I'm against it (which would be the reason why). I don't think I would give any unsolicited advice, afterall they came there seeking my services, and I'd have to give them my reason for not providing it.

I do see your point, and for the women out there that are going to get an abortion no matter what someone else says/does/fill in the blank - then safe providers MUST be there, we definitely agree on that 100%. Again, I just think its abused and perhaps my view is skewed by the patient population I saw which was an inner city, ultra urban, predominately poor neighborhood.

So we agree more than we thought .... and btw - I smoked for years and still light one up now and again when the beer gets flowing

 

[pruritis_ani]

Well, I would have to be honest with the patient and say (oh, I'm also going into psych so this is interesting isn't it? I did consider ob) exactly what another poster said earlier on. In that I can't provide them a place to go, and that I'm against it (which would be the reason why). I don't think I would give any unsolicited advice, afterall they came there seeking my services, and I'd have to give them my reason for not providing it.

I do see your point, and for the women out there that are going to get an abortion no matter what someone else says/does/fill in the blank - then safe providers MUST be there, we definitely agree on that 100%. Again, I just think its abused and perhaps my view is skewed by the patient population I saw which was an inner city, ultra urban, predominately poor neighborhood.

So we agree more than we thought .... and btw - I smoked for years and still light one up now and again when the beer gets flowing

I think we DO actually agree, for the most part. Just tough to convey accurately on a message board...it sucks when people abuse the system, be it via too many TABs, or going to the ER for a 3 week old rash at 2AM. But, these problems aren't likely to be solved in our lifetime, so we gotta do the best we can for our patients, and assume the best of everybody.

But, smoking! Oh, say it ain't so, Poety!!!

 

[Poety]

I think we DO actually agree, for the most part. Just tough to convey accurately on a message board...it sucks when people abuse the system, be it via too many TABs, or going to the ER for a 3 week old rash at 2AM. But, these problems aren't likely to be solved in our lifetime, so we gotta do the best we can for our patients, and assume the best of everybody.

But, smoking! Oh, say it ain't so, Poety!!!

I know I know pffft

 

[Flea girl]

Just something for you all to chew on...One of my good friends adopted a child via foster adopted 9 years ago. The child was born addicted to crack and the biological mother had 6 other children. All the other children were taken way and in foster care. This was a person who chose to get pregnant because if she was pregnant she received welfare benefits...i.e. money for her crack. The mother continued to use crack among other drugs during the whole duration of her pregnancy. Now compare that to a person who is using TAB for BC, as some of the other posters were using as examples. Chose the lesser of the 2 evils. Now my friend’s child has a lot of problems but she is a great, wonderful, loving, patient person. What gets me is that there are so many children like her son but they are stuck in foster care because nobody wants to adopt them because they are not white and perfect. Like in politics, sometimes you have to choose what you believe to be the lesser of the two evils.

 

[Flea girl]

Just something for you all to chew on...One of my good friends adopted a child via foster adopted 9 years ago. The child was born addicted to crack and the biological mother had 6 other children. All the other children were taken way and in foster care. This was a person who chose to get pregnant because if she was pregnant she received welfare benefits...i.e. money for her crack. The mother continued to use crack among other drugs during the whole duration of her pregnancy. Now compare that to a person who is using TAB for BC, as some of the other posters were using as examples. Chose the lesser of the 2 evils. Now my friend’s child has a lot of problems but she is a great, wonderful, loving, patient person. What gets me is that there are so many children like her son but they are stuck in foster care because nobody wants to adopt them because they are not white and perfect. Like in politics, sometimes you have to choose what you believe to be the lesser of the two evils.

 

[Poety]

Just something for you all to chew on...One of my good friends adopted a child via foster adopted 9 years ago. The child was born addicted to crack and the biological mother had 6 other children. All the other children were taken way and in foster care. This was a person who chose to get pregnant because if she was pregnant she received welfare benefits...i.e. money for her crack. The mother continued to use crack among other drugs during the whole duration of her pregnancy. Now compare that to a person who is using TAB for BC, as some of the other posters were using as examples. Chose the lesser of the 2 evils. Now my friend’s child has a lot of problems but she is a great, wonderful, loving, patient person. What gets me is that there are so many children like her son but they are stuck in foster care because nobody wants to adopt them because they are not white and perfect. Like in politics, sometimes you have to choose what you believe to be the lesser of the two evils.

This is why I'm for mandatory birth control

 

[Flea girl]

This is why I'm for mandatory birth control

But remember there is a fine thin between dictatorship and free will. As the old saying goes "The road to hell is paved with good intentions". I think you would have to look at the chinese's one child policy and see what the ramifications that have resulted from that. There are no easy solutions, none of the alternatives are perfect. We can find fault with all of them. No matter what anyone says, this issue is not black and white.

 

[Poety]

But remember there is a fine thin between dictatorship and free will. As the old saying goes "The road to hell is paved with good intentions". I think you would have to look at the chinese's one child policy and see what the ramifications that have resulted from that. There are no easy solutions, none of the alternatives are perfect. We can find fault with all of them. No matter what anyone says, this issue is not black and white.

ofcourse, I was being a bit facetious couldn't we just lock em all up though? that way they wouldn't get pregnant again <whips the dictator whip> whaaPaaa!