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.
I had a elective pill/prescription abortion about 5 years ago and although the majority of the cramping and bleeding was done in about 8 hours, but I was disappointed that when I still had tissue left that was slowly sloughing (not a medical word) away, that my OB/gyn wouldn't give me anything or do a DC to speed up the process. Due to tissue still being there, I had to wait about 6-8 weeks longer than I had planned to get my IUD inserted and when I asked my OB/gyn if there was anything to do, he said there was nothing to do but wait. Is that true or do you think he just didn't know much about non-surgical abortions and the medicines/recovery from them?
What is the most helpful thing people can do to support abortion providers?
Ok sorry for the delay. I thought of a couple of things.
In your state if you can stay up to date on legislation that is harming access, specifically legislation that targets physicians and other providers. TRAP laws (targeted regulation against providers) is a term that is used as legislators try to do any and everything they can to limit access. So if you hear of something going on in your state please contact your local and state government representatives.
Signing up to be an escort at a local clinic is also nice to see and makes me feel supported although I know escorts are there for patients. I always wear street clothes in to the clinic and don't interact with escorts as to not draw attention to myself, but it definitely makes me feel supported when I see the wonderful escorts on the front lines to help patients.
Lastly, planned parenthood is great, but there are a lot of smaller and independent clinics that need help and support financially. This keeps the doors open for patient care and so that people can keep their jobs. I was able to google this list of independent clinics in different states that the huffiest put out. I haven't vetted any of these places, so feel free to look at their websites on your own and decide if you'd want to support any of them financially. www.huffpost.com/entry/a-quick-guide-to-supporting-abortion-providers-who-need-it-most_n_5829c26ce4b060adb56f2321
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.
I had a elective pill/prescription abortion about 5 years ago and although the majority of the cramping and bleeding was done in about 8 hours, but I was disappointed that when I still had tissue left that was slowly sloughing (not a medical word) away, that my OB/gyn wouldn't give me anything or do a DC to speed up the process. Due to tissue still being there, I had to wait about 6-8 weeks longer than I had planned to get my IUD inserted and when I asked my OB/gyn if there was anything to do, he said there was nothing to do but wait. Is that true or do you think he just didn't know much about non-surgical abortions and the medicines/recovery from them?
Well without knowing exactly what was going on it's hard to say, but it sounds like the abortion was complete so there wouldn't be anything to do afterwards.
When we do an US afterwards we can tell if the pregnancy is complete and if there is anything retained that needs further management. Obviously the uterine lining will still be a little thick since there was just a pregnancy there and we counsel everyone that they can have bleeding for up to 4-6 weeks after the pill or the procedure. Just like after giving birth bleeding for several weeks can be an expected outcome, but of course everyone is different.
Reasons to do another dose of miso would be if there was still a fetus visible on US. Reason to do a uterine aspiration would be if there was still a fetus visible on US or if there was a lot of bleeding. We typically say if you're bleeding through 1-2 maxi pads in an hour then call us asap. If the bleeding was like a period/less than a period and there were no signs of anemia (light headed, dizzy, weak, etc), then would typically consider that normal and wouldn't do anything. Now if a patient called every other day and were really concerned, then yes I'd bring them back to the office, and figure out if something needed to be done.
As far as IUD being delayed, I actually just read an article about expulsion after medication abortion. I think years ago they were delayed thinking that if the uterine lining was thick then the IUD would be expelled. The research article I just read pretty much said that's not really true, if you make patients come back 4-8 weeks later they're more likely to get pregnant anyway during that waiting period, so you should just put the IUD in right after you confirm the abortion is complete, even if their uterine lining is still a little thick. So at the places I work that's what we typically do.
Post by goldengirlz on Aug 13, 2019 16:32:45 GMT -5
Welcome back!! And thank you for the work that you do. I’m grateful everyday for the providers who continue to offer this vital service to women and families who need/want it.
Post by downtoearth on Aug 13, 2019 16:33:18 GMT -5
wanderingback, that is a much better explanation that I got from the OB/gyn. I wish he would have been more clear. Especially considering that the abortion was due to a second pregnancy that I had while on birth control (first was on bc pill and second was while I was on NuvaRing).
What is the process for an abortion at 24 weeks? I’ve always been curious, but don’t want to google and get pics.
Disclaimers - I've only participated in up to 23w4d and only done them in the outpatient setting. I think some doctors do things a little differently.
So at that gestational age it's a 2 day procedure. The first day we'll insert these small straw like pieces in to the cervix to help dilate. Also, give some misoprostol vaginally to help soften the cervix. On the 2nd day the patient returns for the procedure. The straws are removed and the cervix is then dilated to the appropriate size using instruments. After that aspiration (suction instrument) is used to remove as much amniotic fluid as possible. After that instruments are used to remove the fetal parts. Usually use some more aspiration at the end and then the procedure is over. It can be a short procedure like 15 minutes anywhere up to an hour or so.
Post by chickadee77 on Aug 13, 2019 17:34:59 GMT -5
Thank you for what you do. I had a TFMR several years ago and I cannot speak highly enough about the care I received from the entire medical staff. No questions, really, just a huge thank you.
What is the process for an abortion at 24 weeks? I’ve always been curious, but don’t want to google and get pics.
Disclaimers - I've only participated in up to 23w4d and only done them in the outpatient setting. I think some doctors do things a little differently.
So at that gestational age it's a 2 day procedure. The first day we'll insert these small straw like pieces in to the cervix to help dilate. Also, give some misoprostol vaginally to help soften the cervix. On the 2nd day the patient returns for the procedure. The straws are removed and the cervix is then dilated to the appropriate size using instruments. After that aspiration (suction instrument) is used to remove as much amniotic fluid as possible. After that instruments are used to remove the fetal parts. Usually use some more aspiration at the end and then the procedure is over. It can be a short procedure like 15 minutes anywhere up to an hour or so.Â
When I had mine done at 24 weeks in the UK they performed a foeticide, where they gave my baby an injection in her heart to stop it beating. I then had to come back 2 days later to be induced, and I delivered vaginally. I was told at this late stage it was better for my health and future fertility.
Post by notsopicky on Aug 13, 2019 17:58:22 GMT -5
wanderingback, it's good to *see* you. I don't have any questions, but I wanted to say that I appreciate the work that you do. I acknowledge that in the climate today it has to be hard on the soul to weather the idiots out there who want to deny access/can't treat women like human beings. We need people like you in the world to provide this type of medical care to women who need/want it. I have my own story, and I don't know what I would have done in a situation where I didn't have access/choice/excellent medical care. I think of all the women in the state of Alabama for instance who have just been so screwed by all of the political, cloaked-in-the-shadow-of-religion bullshit and I feel devastated. Thank you too for the recommendations on how we can get involved/support women/medical providers.
Welcome back and thank you for the work you do. I stand with PP and escorts one day/week and once each month the pregnancy aid clinic across the street hosts a "Church of Planned Parenthood" where we also come to hold our pink and glittery signs. We're there not only for the patients but to support the staff and keep them energized and positive for the patients.
I had an abortion back in the late '80s. I was married with children. At the time, my ex-husband was newly disabled and I couldn't care for him, our existing children and be pregnant without one or more suffering, and without me suffering as well. So according to many it was a "convenient" abortion for "birth control" reasons but for me it was vital to my health, both physical and mental, as well as for the best interest of my family.
So, thank you for being someone that keeps those vital services available for women.
Disclaimers - I've only participated in up to 23w4d and only done them in the outpatient setting. I think some doctors do things a little differently.
So at that gestational age it's a 2 day procedure. The first day we'll insert these small straw like pieces in to the cervix to help dilate. Also, give some misoprostol vaginally to help soften the cervix. On the 2nd day the patient returns for the procedure. The straws are removed and the cervix is then dilated to the appropriate size using instruments. After that aspiration (suction instrument) is used to remove as much amniotic fluid as possible. After that instruments are used to remove the fetal parts. Usually use some more aspiration at the end and then the procedure is over. It can be a short procedure like 15 minutes anywhere up to an hour or so.
When I had mine done at 24 weeks in the UK they performed a foeticide, where they gave my baby an injection in her heart to stop it beating. I then had to come back 2 days later to be induced, and I delivered vaginally. I was told at this late stage it was better for my health and future fertility.
Welcome back! Glad to have you around again!
Thankfully abortion has been studied extensively and uncomplicated abortion (which most are) do not affect fertility AT ALL. That is one of those myths that antis try to put out there to try to stop people from having an abortion. So abortion in 2nd and 3rd trimester is very safe and will not change your fertility. Everyone's individual health (mental and physical) should be taken in to consideration though to determine the best process.
Hot damn! I'm so happy to see you here. Thank you for the work you're doing!
How many of your colleagues chose not to be abortion providers? Do they chose not to do it because they're anti-choice, due to safety concerns, liability issues, or something else?
When I had mine done at 24 weeks in the UK they performed a foeticide, where they gave my baby an injection in her heart to stop it beating. I then had to come back 2 days later to be induced, and I delivered vaginally. I was told at this late stage it was better for my health and future fertility.
Welcome back! Glad to have you around again!
Thankfully abortion has been studied extensively and uncomplicated abortion (which most are) do not affect fertility AT ALL. That is one of those myths that antis try to put out there to try to stop people from having an abortion. So abortion in 2nd and 3rd trimester is very safe and will not change your fertility. Everyone's individual health (mental and physical) should be taken in to consideration though to determine the best process.Â
To be clear, I never knew if they were referring to the fact that they would not perform a D&E at that late stage, which seemed to be NHS policy, or the fact that they preferred I be induced, rather than have a c-section. I was at one of London's best hospitals, and all of the doctors and midwives were supportive of the decision to terminate. I wish they had been able to do a D&E because I would much rather have been knocked out for the whole ordeal than have to go through the trauma of that injection, walking around with my deceased baby inside me for 2 days, then a labour that lasted 36 hours.
I don’t have any questions, but really appreciate your willingness to take on others’ questions, your forthrightness, and for providing this vital medics care to so many.
Hot damn! I'm so happy to see you here. Thank you for the work you're doing!
How many of your colleagues chose not to be abortion providers? Do they chose not to do it because they're anti-choice, due to safety concerns, liability issues, or something else?
I'm not sure how you define colleagues. In residency (I am not an ob/gyn trained, I'm board certified in a different speciality) out of several that I graduated with there was 1 other person who trained to be an abortion provider. A few of my attending physicians in residency had trained to be providers, but were no longer active in doing them. I think people choose not to do it for a variety of reasons, so I can't really say everyone's reasons.
One of the places where I work now at a general health clinic, I honestly am not sure everyone's reasons for not doing them is. I assume it's because they weren't trained to do them, since I'm in a very progressive area and they know our health clinic does them.
But the providers I know even in progressive areas are often afraid to tell their friends, family, other coworkers etc. I am "out" to everyone that I know and am close with. It can also create a headache for jobs and even loan forgiveness depending on the state you live in, so there are SO many reasons people would choose not to be an abortion provider, that I'm not sure I can even think of a most common reason anecdotally.
How often do women come in by themselves versus their partners versus a non-partner support person?
Hmm, I can't really say. At some places I trained and work the counselors did all the counseling stuff and no other person was allowed back with them, so I never knew if they had anyone with them and who they had with them. In the places where the counselors do all the counseling stuff they typically only tell us relevant facts, obviously we review their medical chart and make sure there are no red flags socially either, but I wouldn't exactly know what their support system is unless they bring it up.
1 clinic I trained they could bring a support person back in to the procedure room and in to the recovery room, so I would obviously be able to see if they had anyone with them if they chose to do so. Some people would have a friend or other relative and not a partner, but I can't really give a percentage. There are definitely plenty that seemed to be alone.
As long as you don't have any of the minimal sedation we tell patients they don't need anyone to come with them as they will typically feel pretty much back to normal within 30 minutes after the procedure while they relax in the recovery area.
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,.
I asked my now retired gyn (an abortion proviser) once where I would get an abortion if I needed one, and his comment was that I was never going to have to worry about access (white though sometimes perceived brown, affluent, progressive area of the state). He said that the place I'd had a breast lump removed would do it (they advertised gyn surgery on their website) or I could have one done at one of the local major medical centers (where a friend had had one). I often wonder if it should be more known that you don't have to (at least here) go to an "abortion clinic" for abortion care, or if this would result in protests and attacks at the providers' facility.
Yeah I think abortion should definitely be normalized so it'd be nice if it was openly advertised, but there are definitely all sorts of red tape that people typically have to jump through when it comes to that.
At the clinic I'm referring to we definitely tell all patients when it's relevant like during discussions about contraception, if they become pregnant and want to talk about options, during discussions about sexual history, etc, but it's definitely not advertised on the website. I would venture to guess that the marketing team would not be ok with it and then there are certainly other employees who are not ok with it.
At hospitals it can definitely be a huge deal and hospitals often don't want to openly get involved in the controversy. I know some abortion providers at hospitals essentially have to beg to have certain nurses and anesthesiologists staffed because others refuse to be involved in the cases (even if they're for fetal demise for example). So patient care can be greatly effected if they don't have the support team available at the time to do the procedure.
Hot damn! I'm so happy to see you here. Thank you for the work you're doing!
How many of your colleagues chose not to be abortion providers? Do they chose not to do it because they're anti-choice, due to safety concerns, liability issues, or something else?
I'm not sure how you define colleagues. In residency (I am not an ob/gyn trained, I'm board certified in a different speciality) out of several that I graduated with there was 1 other person who trained to be an abortion provider. A few of my attending physicians in residency had trained to be providers, but were no longer active in doing them. I think people choose not to do it for a variety of reasons, so I can't really say everyone's reasons.
One of the places where I work now at a general health clinic, I honestly am not sure everyone's reasons for not doing them is. I assume it's because they weren't trained to do them, since I'm in a very progressive area and they know our health clinic does them.
But the providers I know even in progressive areas are often afraid to tell their friends, family, other coworkers etc. I am "out" to everyone that I know and am close with. It can also create a headache for jobs and even loan forgiveness depending on the state you live in, so there are SO many reasons people would choose not to be an abortion provider, that I'm not sure I can even think of a most common reason anecdotally.
I was thinking your fellow med students/interns/residents since they're the future of access. I wasn't sure if you are an OB/GYN or not so that's why I left it kind of vague. You mentioned in another post about other professionals (nurses, anesthesiologists, etc.) who have to be on board. I didn't think about that.
Do they teach the procedures in medical school or do you rely on attendings to teach how to perform the different types/procedures?
I'm not sure how you define colleagues. In residency (I am not an ob/gyn trained, I'm board certified in a different speciality) out of several that I graduated with there was 1 other person who trained to be an abortion provider. A few of my attending physicians in residency had trained to be providers, but were no longer active in doing them. I think people choose not to do it for a variety of reasons, so I can't really say everyone's reasons.
One of the places where I work now at a general health clinic, I honestly am not sure everyone's reasons for not doing them is. I assume it's because they weren't trained to do them, since I'm in a very progressive area and they know our health clinic does them.
But the providers I know even in progressive areas are often afraid to tell their friends, family, other coworkers etc. I am "out" to everyone that I know and am close with. It can also create a headache for jobs and even loan forgiveness depending on the state you live in, so there are SO many reasons people would choose not to be an abortion provider, that I'm not sure I can even think of a most common reason anecdotally.
I was thinking your fellow med students/interns/residents since they're the future of access. I wasn't sure if you are an OB/GYN or not so that's why I left it kind of vague. You mentioned in another post about other professionals (nurses, anesthesiologists, etc.) who have to be on board. I didn't think about that.
Do they teach the procedures in medical school or do you rely on attendings to teach how to perform the different types/procedures?
Every med school is different, but at my school there was essentially no mention of abortion (that I can remember). However, where I work now like I mentioned before is a general clinic and we have med students rotate through for different rotations. Just last week we had a med student there for her first day and she got to see an abortion on her first day (the faculty asked if she wanted to be involved and she said yes). Like I said I'm in a very progressive area now, so I'm sure more med students are exposed to it then I was.
In residency there was no mention of abortion except for the lectures I gave about it, ha. My program was open to me doing electives (covered my malpractice, put in all the paperwork, etc), but there was definitely no general abortion information given to residents which was really a shame. There were definitely a few faculty who were antis (not in a very vocal way), so anytime abortion needed to be discussed I'd discuss it with another faculty. My desk was decorated with lots of prochoice stuff there though and no one gave me a hard time. Like I said above I'm open with everyone about what I do and my prochoice nature.
So yes for many people if you're interested in training you have to go out of your way to learn outside of your med school and residency. Some people learn during residency, but others don't train until they're finished residency and attendings. There are several programs/organizations that can help with this (I won't list names because not a safe place and all), so it is nice to have a supportive community to reach out to.
Welcome back!! I remember you saying you might want to go into women's health
I'm married, with children, and have the financial resources to care for another child but another pregnancy may have killed me. When birth control failed, and I was pregnant again, I had an abortion 3 years ago. I made the decision with my head and my heart. I don't regret what I did, but I do feel sadness.
I got a long counseling session before the procedure and the weeks after when I was not in a good place. The counselor told me that 1 in 3 women will have an abortion. There is a website with that name. It was really helpful to me to read women's stories shared there.
What is the most helpful thing people can do to support abortion providers?
Ok sorry for the delay. I thought of a couple of things.
In your state if you can stay up to date on legislation that is harming access, specifically legislation that targets physicians and other providers. TRAP laws (targeted regulation against providers) is a term that is used as legislators try to do any and everything they can to limit access. So if you hear of something going on in your state please contact your local and state government representatives.
Signing up to be an escort at a local clinic is also nice to see and makes me feel supported although I know escorts are there for patients. I always wear street clothes in to the clinic and don't interact with escorts as to not draw attention to myself, but it definitely makes me feel supported when I see the wonderful escorts on the front lines to help patients.
Lastly, planned parenthood is great, but there are a lot of smaller and independent clinics that need help and support financially. This keeps the doors open for patient care and so that people can keep their jobs. I was able to google this list of independent clinics in different states that the huffiest put out. I haven't vetted any of these places, so feel free to look at their websites on your own and decide if you'd want to support any of them financially. www.huffpost.com/entry/a-quick-guide-to-supporting-abortion-providers-who-need-it-most_n_5829c26ce4b060adb56f2321
Thank you so much for all of this! I am on the board for an abortion fund and also work our hotline and so many people don't know that independent clinics exist! I spend time helping people find clinics that are close to them and in my City we only have 2 planned Parenthoods that will provide abortions but we have 6 independent clinics.