@@Ask me anything: Abortion Provider Edition

[wanderingback]

I'm an old poster that took a break. Hi! Last weekend I decided to take a break from facebook, and then found myself lurking here, haha. Hope all are doing well!

Awhile back someone was trying to be well meaning, but made a comment about people who get abortions that made me cringe, so I wanted to do an AMA as an abortion physician. Then, today someone at work mentioned there was an abortion scene on a tv show that was so unrealistic and horrible, so it made me think of the AMA abortion edition again. I'm still early in my career, but hopefully I can clear up any misconceptions or demystify abortion/reproductive healthcare in general. 

I know things seem dismal, but just know there are a lot of us out there fighting for everyone's reproductive rights.

I'm off for the afternoon so ask away!

Bumped - added a new post at the end. We all need to be prepared for if/when Roe vs Wade falls :/

[BlondeSpiders]

I don't have any questions for you, but I just wanted to say, keep fighting the good fight!

[jamaicam]

Just wanted to say thanks!

I had a surgical abortion when I was 20. Purely because I didn't want a kid at that time. Because the condom slipped and the morning after pill didn't work. And because I was 20 and clueless, I didn't realise until 11 weeks.

And I also had one when I was 23. Using the pill. I was 6 weeks along and once again didn't want a child.

I am thrilled with my decisions. I have zero regrets. They were right for me. Would I have been fine having a kid on either of those times - yes. I had just finished my degree. My parents would have helped. I was in the UK with a good social security system. But I didn't want a kid. And that's enough.

So thank you to people like you who are ensuring that other women can make the same choice that I did.

[secretlyevil]

Are there protesters outside your office every day?

[suburbanzookeeper]

Just wanted to pop in and say thanks (and hope you stick around!).

[simpsongal]

I realize you said you're newer, but do you know if there's been a much higher use of pills to induce abortion in the past few years, whether on site or taken at home, versus other procedures?

Was there anything that's surprised you about your career? or your patients?

Thank you for what you do every day!

[Deleted]

Being new, what has surprised you the most in your line of work?

[calamity]

Glad to see you back, you do such important work!

[wambam]

What is the most helpful thing people can do to support abortion providers?

[penguingrrl]

Glad to see you back, and just wanted to thank you for the work you do!

[wanderingback]

Aug 13, 2019 14:19:12 GMT -5 jamaicam said:

Just wanted to say thanks!

I had a surgical abortion when I was 20. Purely because I didn't want a kid at that time. Because the condom slipped and the morning after pill didn't work. And because I was 20 and clueless, I didn't realise until 11 weeks.

And I also had one when I was 23. Using the pill. I was 6 weeks along and once again didn't want a child.

I am thrilled with my decisions. I have zero regrets. They were right for me. Would I have been fine having a kid on either of those times - yes. I had just finished my degree. My parents would have helped. I was in the UK with a good social security system. But I didn't want a kid. And that's enough.

So thank you to people like you who are ensuring that other women can make the same choice that I did.

Thank you for sharing your story. 

[Jalapeñomel]

Hi! So glad to have you back, and I’m glad you are able to give women the healthcare they deserve. Thank you so much. Seriously.

[wanderingback]

Aug 13, 2019 14:19:20 GMT -5 secretlyevil said:

Are there protesters outside your office every day?

Thankfully I work in a VERY progressive area. I'm new to this area and will be working at a couple of different places and so far have not encountered any protestors. The place I work the most hours is a "normal" health center, so I don't think most people know that abortion is done there, so I doubt I'll encounter any protestors there thankfully. Other places there can be protestors, but not all the time. There is security to help mitigate that.

In residency 1 place I trained there were protestors there every single day, typically the same ones.

[jamaicam]

Hold on. I was being slow. I have just figured out who this is. Welcome back! I missed you

[wanderingback]

Aug 13, 2019 14:27:57 GMT -5 simpsongal said:

I realize you said you're newer, but do you know if there's been a much higher use of pills to induce abortion in the past few years, whether on site or taken at home, versus other procedures?

Was there anything that's surprised you about your career? or your patients?

Thank you for what you do every day!

Mifeprostone was approved by the FDA for abortion in 2000. The typical combo for med abortion is mifepristone and misoprostol. So good news is that it was FDA approved so the rates of its usage have gone up, the bad news is that it is still VERY VERY regulated. I think at this point about 30% of abortions are done using the pill in the US. We are working on trying to get the FDA to drop the REMS classification for mife so that it'll be much more available to use, but I'm not sure if that'll happen anytime soon. So unless you order the pills online (there are legit sites to do that), then you have to get mife at a specific doctor's office. There's a lot of red tape to go through for offices to get mife. So yes overall it's use has gone up.

Well I never even imagined going to med school, let alone being in this line of work, so I guess my entire career has been a surprise. A wonderful surprise.

As far as patients go I can't think of anything super surprising off the top of me head, but I will reiterate that it's not just a talking point to say that EVERY type of person gets an abortion, it really is true. Yesterday I was looking out in the waiting room and it was multi-racial, multi-ethnic, multi-religion, multi-age. Obviously there are averages and yes poor, young, people of color are more likely to get an abortion (hmm I wonder why?), but on an average day I see people from EVERY single walk of life. 

[kadams767]

I'm glad to see you back and glad to see your career is continuing on a good path!

Your thoughts on mifeprostone are interesting. Do you see a lot of people with complications from it? I had a medical abortion about 10 years ago and found it to be a very straightforward process and I was happy I was able to do most of the process at home. I've always wondered if the simplicity of mine was common or if I've just been cavalier about the real side effects/complications rate.

[wanderingback]

Aug 13, 2019 14:30:55 GMT -5 @heyitsme said:

Being new, what has surprised you the most in your line of work?

I somewhat just answered that below in regards to seeing people from every walk of life. I knew it by reading about it, but seeing it on a daily basis really solidified how important it is to keep access safe and legal for EVERYONE.

I guess going in to it overall I didn't know exactly what to expect, so I didn't have too many surprises. But looking back now and reading/hearing what people say about abortion is in regards to the patients who have abortions later in the 2nd trimester or 3rd trimester. I'm only trained up to 16w, but have helped with procedures up to 24w based on my state's laws. As far as I know most of the procedures I've participated in have not been for fetal demise. So yes there are patients who choose to terminate at 24w "for no reason" and that's ok. 

You definitely find yourself asking ethical questions and that's ok. But I guess surprisingly for me I really feel that anyone should be able to access abortion to 24w and beyond for whatever reason they need. 

[pixy0stix]

Welcome back!

[wanderingback]

Aug 13, 2019 14:31:28 GMT -5 wambam said:

What is the most helpful thing people can do to support abortion providers?

Hmm good question. Let me think on that one....

[wanderingback]

Aug 13, 2019 14:50:28 GMT -5 jamaicam said:

Hold on. I was being slow. I have just figured out who this is. Welcome back! I missed you

I'm still not sophisticated enough to figure out how to put gifs/memes in here. Hi!

[Vespasia]

No questions yet but I was just thinking about you the other day and I am very happy to see you wanderingback . Both for the insight you bring to this important topic and for the travel threads. I had to plan a trip to South Africa without your input and it was rough. 

[wanderingback]

Aug 13, 2019 14:57:21 GMT -5 kadams767 said:

I'm glad to see you back and glad to see your career is continuing on a good path!

Your thoughts on mifeprostone are interesting. Do you see a lot of people with complications from it? I had a medical abortion about 10 years ago and found it to be a very straightforward process and I was happy I was able to do most of the process at home. I've always wondered if the simplicity of mine was common or if I've just been cavalier about the real side effects/complications rate.

Abortion in general is VERY VERY safe. That's true for both the meds and the procedure.
The med ab complication rate is something like 0.5%. 

The biggest thing we worry about and see most often is the continuation of pregnancy. Depending on how far along you are the completion rate I believe is 88-96% (don't quote me on those exact numbers! it's around that range). So that's the biggest complication. If that happens, depending on a few different factors can do another dose of misoprostol to try to complete the abortion or just go ahead and do the procedure. I've seen that happen a few times in my young career. 

Otherwise, I haven't seen any other complications. I think some patients do get a little more nausea, vomiting and cramping then they might expect although we try to counsel them as best we can to know what to experience. So some do end up going to the ER for that, but that's not considered a complication since that's how the meds are supposed to work. 

[mbcdefg]

Welcome back

[wildrice]

Welcome back! I hope we can avoid doing anything that inspires you to leave again

Two things I've always wondered, based on my own personal experience having a surgical abortion. One, is it medically necessary to do an ultrasound if the decision to terminate has already been made, or is that one of those BS rules that is supposed to sway women to keep the pregnancy? Two, is there a medical reason why an abortion cannot be performed earlier than 6 weeks?

[kadams767]

Aug 13, 2019 15:06:25 GMT -5 wanderingback said:

Aug 13, 2019 14:57:21 GMT -5 kadams767 said:

I'm glad to see you back and glad to see your career is continuing on a good path!

Your thoughts on mifeprostone are interesting. Do you see a lot of people with complications from it? I had a medical abortion about 10 years ago and found it to be a very straightforward process and I was happy I was able to do most of the process at home. I've always wondered if the simplicity of mine was common or if I've just been cavalier about the real side effects/complications rate.

Abortion in general is VERY VERY safe. That's true for both the meds and the procedure.
The med ab complication rate is something like 0.5%. 

The biggest thing we worry about and see most often is the continuation of pregnancy. Depending on how far along you are the completion rate I believe is 88-96% (don't quote me on those exact numbers! it's around that range). So that's the biggest complication. If that happens, depending on a few different factors can do another dose of misoprostol to try to complete the abortion or just go ahead and do the procedure. I've seen that happen a few times in my young career. 

Otherwise, I haven't seen any other complications. I think some patients do get a little more nausea, vomiting and cramping then they might expect although we try to counsel them as best we can to know what to experience. So some do end up going to the ER for that, but that's not considered a complication since that's how the meds are supposed to work. 

Thanks.  This is very consistent with my experience.  I had no actual complications, thankfully, but yes, the nausea was quite bad for a few days.  

[msmerymac]

Heeeeeeey! How have you been? Welcome back. Hope you stick around or at least pop in from time to time.

I remember you said you wanted to go into abortion care back when you were a reg, so I'm really glad that's the path you chose! You're doing great work.

[wanderingback]

Aug 13, 2019 15:09:21 GMT -5 wildrice said:

Welcome back! I hope we can avoid doing anything that inspires you to leave again

Two things I've always wondered, based on my own personal experience having a surgical abortion. One, is it medically necessary to do an ultrasound if the decision to terminate has already been made, or is that one of those BS rules that is supposed to sway women to keep the pregnancy? Two, is there a medical reason why an abortion cannot be performed earlier than 6 weeks?

Doing an US is medical standard of care.
Reason to do it is for a few reasons. To determine if a patient is pregnant, location of pregnancy and the gestational age of the fetus.

Just the other day the tech did the US, didn't find a pregnancy (which isn't uncommon), patient took a pregnancy test and it came back negative. So she avoided getting a procedure that she obviously didn't need.

It's good to know the location of the pregnancy in order to rule out ectopic. If we can't see the pregnancy on US and the pregnancy test is positive and they're not having any signs of an ectopic pregnancy, we'll still do the procedure/empty the uterus. If we still don't see anything that resembles the pregnancy after we look at the tissue, after the procedure we'll collect their blood to measure their hcg, then again 48 hours later. We have to ensure that the hcg is going down appropriately to ensure that it's not an ongoing pregnancy or an ectopic pregnancy.

Lastly, US is used for gestational age of the fetus. The procedure is slightly different and different equipment might be used for different gestational ages. Different equipment can be used up to 9-10 weeks depending on the provider and then different equipment can be used from 9/10-16 weeks. I'm only going to be doing abortions up to 15w6d because the procedure can be done differently after that. So I would need to know if someone was further along as I wouldn't feel comfortable doing the procedure much past that gestational age. Also, in order to comply with state law we need to accurately document the gestational age so that we are never performing any procedures after the state law allows. 

Abortions are performed before 6 weeks, I guess clinic policy might vary slightly. Sometimes if the pregnancy is super early like 4-5 weeks then will counsel patients a little different. After every procedure we look at the tissue to make sure everything is removed that needs to be removed (there are different things we're looking for based on the gestational age). At 4-5 weeks obviously it's super early so sometimes it's hard to see what you need to see in the tissue to ensure the abortion isn't complete. So sometimes will do a repeat trans vaginal US afterwards to see if we can tell the pregnancy is no longer there or will again collect the hcg and follow for 48 hours to ensure it's going down appropriately. But to avoid all those possible extra steps some clinics might say that they don't want to do procedures before 6 weeks (none of this applies to the medication abortion, you can do it as early as they want). After 6 weeks 99.9% of the time we can see what we need to see and it's not difficult to ensure that the abortion is complete right after the procedure. 

[mcsangel2]

I don't know what state you are in, but have you had any patients come in from out of state where access to the procedure is more limited?

[redheadbaker]

Welcome back! And thank you for the work you do.

[wanderingback]

Aug 13, 2019 15:55:44 GMT -5 mcsangel2 said:

I don't know what state you are in, but have you had any patients come in from out of state where access to the procedure is more limited?

Well I just started in this state, but access is decent in the surrounding states as well. However, I am near borders, so it'll probably happen. Even in decent access areas scheduling can still be somewhat difficult and some states have "waiting periods" so it makes people shop around. 

I did electives during residency for my training in a couple of different states. And yes it was pretty common to get people from out of state, especially in 1 city where I trained. We would get patients pretty regularly from 3-4 different states.