Abortion, a doctor's story
by Elizabeth Kaye: 1988
She's the surgeon, a healer, a counselor. She cried when
she delivered her first baby. But there's another aspect to her
practice she does abortions.
She is 35 years old and she is a doctor, a gifted practitioner
who understands the exacting discipline of medicine and the
uncharitable meanderings of the human heart.
Her specialty is on obstetrics and gynecology. The first
births she attended made her weep with joy. Since then, she has
performed about 500 abortions. She sees no dichotomy in that.
Even now, when she describes the baby being born, she gets tears
in her eyes. Describing abortion to anyone other than colleagues
or patience is another thing, and something she vowed, on a night many
years ago, to avoid.
She had been at a party, when a man began questioning her about
the procedure. She tried to evade his questions but she was
young, and he was insistent, demanding that she be specific, and
graphic. Later that evening he got drunk. She was talking
to someone else. He glared at her and began shouting, "Don't
listen to her. She tears up babies."
When she recently agreed to discuss what she calls "the most
loaded issue there is," it was with the stipulation that she not be
identified, and in the hope that women might benefit from what she has
to say. As any opinions are, hers are founded not only in ideas
but also in feelings that are directly related to experiences in her
When she was 20 she nearly died from a ruptured tubo-ovarian
abscess, caused by a Dalkon shield, and intrauterine contraceptive
device commonly used in the early '70s. She was a premed student
then, staunch and idealistic, absolutely determined to become a
doctor. In the time she lost to illness, she found an empathy
that no trading could have provided. "I really understood what it
was to be a patient, how disruptive and painful and frightening it
could be. I identified with women not understanding what's
happening with their bodies because they aren't told and don't know to
While in the hospital, she had consented to undergo a surgical
procedure known as an exploratory laparotomy. Before surgery, she
told a nurse and she knew from premed courses her leave she was not to
be having a hysterectomy. The nurse gave her a peculiar
look. "I'd better get your doctor," she said. Only then did
the doctor explained that what she had actually given him permission to
do was to go inside, see what was wrong, and remove anything that might
cause a problem-- including her uterus, if necessary. It wasn't
necessary, as it turned out.
Still, the experience permanently influenced her approach to
medicine. "There's a tremendous need and opportunity to educate," she
says. " Even the most sophisticated women often have no idea what is
happening under that drape over their knees. When a woman comes
in for an annual exam it's nice to be able to teach them, to have
diagrams and say, ' This is what a pelvic is, this is what we're
looking for in a Pap smear.' "
The same instructive methods apply when she does an abortion an
operation, she prefers to call a pregnancy termination, for the word
abortion strikes her as needlessly judgmental seeming to apply that a
pregnancy that should have continued to has been stopped. In her
view, one of the most significant aspects of a termination is the
patient psychological preparation. “If a woman is really
well-educated in advance about what to it's going to be like, how long
it will take, what is going to happen to her, you can help her and not
startle of her in any way.”
The conversation that follows was not easy for her.
“It required a lot of emotional energy to decide whether or not I
could do it, how I've really felt about it, whether I could let down
all the things the done to handle this over the years and to reach my
current philosophy. It's like I build up all the stuff and now on
supposed to let it down.”
impulse to become a doctor was based on a desire to heal, to make
well. Did learning to do pregnancy terminations seem opposed to
Not at all. I saw them of something I needed to know how
to do because I consider them part of a woman's total health care that
I’m committed to making available in a safe way.
Which presupposes you believe that there are times when a pregnancy should be terminated.
It presupposes that there are times when that choice will be
made and I am the facilitator of that if I choose to do it.
Have you ever chosen not to do one?
On occasion. There was a woman--she was not my
patient--who came into my office angry and started complaining about
the office itself, and the woman at the reception desk, and I
immediately started to feel angry myself. ‘And I said you know we
don't have a very good interaction here. I don't think it would
be a good idea for me to take care of you.” She said, “But
you just have to. I just took the whole afternoon off from work
and now I'm here and you have to do this.” And I just said,
“I don't have to do anything. I'm going to find you another
doctor. Excuse me.” And I left. In other words,
I do have a choice and if it's someone I don't have rapport with or if
I think her affect is totally bizarre or that she doesn't know what she
is doing, I won't do it . I'm not just hands that people can put
instance of a woman coming to you for a pregnancy termination who, as
you put it, didn't know what she was doing.
With one woman, who was actually my associates patient, I
noticed that every time she had an appointment she would panic and
either come late or cancel and rescheduled. She went on for two
weeks like that and it was getting late--and at some point we just
decided that she was not someone we wanted to take care of. She
had really serious psychopathology, she wasn't your average
neurotic--she had major borderline psychotic issues that were triggered
by this pregnancy. Adoption would probably be a better option for
somebody like that. You just don't want to go into surgery was
someone who's going to change her mind at that point because it is an
intervention--if you leave things alone, the pregnancy is going to go
ahead. But if she can't even decide before that point, then
abortion is not a good option.
What are more typical cases?
The average patient is in the first trimester of
pregnancy. She misses her period at six weeks, thinks it over,
and comes in around the eighth week, which is a fairly safe time.
It's actually a lot safer than having a baby in terms of the risk of
mortality and concerns like that. She has the procedure, there
are no complications, and she comes back and says she feels very
relieved and goes on with her life. My experience has also been
that usually once they make up their minds, they want to do it in a
fairly short period of time. Once they know, they know, and they
want to be done with it.
What if it isn't clear cut? What if a woman is extremely conflicted about whether to terminate her pregnancy?
Nobody feels great about it. Most women usually have lot
of conflict. One woman came in for abortion and then told her
husband had called just before she left, and said, “Don't do it,
let's have the baby.” So we did an o.b. interview, and then
she rescheduled a week later to terminate the pregnancy. And even
though she was relaxed and sure when she came in, I'm sure that there
was a lot of arguments over the dinner table and a lot of soul
Would you counsel a woman not to terminate?
I've helped women realize they don't want to do it, but I
haven't ever said don't do it--I have sometimes said I wouldn't do the
procedure for them because I didn't feel comfortable enough that they
had formed their opinion about it.
Have you ever told someone that you thought they should go ahead and have the baby?
I think I would do that with a friend. I wouldn't do it
with a patient. I don't feel it's my right to force--to even have
opinions about what's right for them.
Then how do you see your role in this process?
My role is to make sure that they’re is sure as they can
be. If you let them talk, they reach their own conclusions.
So I usually just listen... if you listen, people tell you what's going
What if it became clear to you that a woman is in a state of conflict that goes far beyond the norm?
One woman came in and made an appointment to interview me to be
her obstetrician and then started asking me about abortion and it just
didn't jibe. As we talked it became apparent that she really
needed to sort out her feelings about the pregnancy.
And how did you help her do that?
I said, “You don't seem to have made up your mind about
this,” and she cried and said, “No I really haven't.
I really want this baby, but my husband doesn't. I don't know
what to do.” Then I told her how much time she had during which
it was still safe to terminate to become clear about what she really
wanted. This particular woman ultimately decided to keep the
If a woman
does decide to terminate, what is her state of mind once your action in
the room, ready to start the procedure?
Patients are sedated and kind of sleepy and easily relieved that
they’re there. They usually have very supportive
significant others who come with them for the procedure. If they
don't, I always have a staff person come in and hold their hands and
talk to them while it's going on. The main thing is a sense of
relief that it's over because the anticipation is usually worse than
And what about your mood?
I don't know what my mood is.
Do you allow yourself to have a mood?
I don't think I do. I look at it strictly technically,
making sure that I'm as certain as I can be that she's prepared, that
she's relaxed, that she knows what's going on, doing my best to make
sure that she won't have to come back for a repeat procedure. I
do feel glad that women can come to me and feel safe and be well taken
What are the most difficult situations you ever been involved in?
When I had been in practice about a year and a half, my best
friend got pregnant. Initially she had thought that she would
keep the pregnancy and I had talked to her during that stage, trying to
imagine her with the child. It would have meant major
modifications in everything she and her boyfriend were doing, but they
decided it was worth it--and then decided it wasn't. They
realized the time was not right.
She came all the way across the country to have an abortion and
asked me to do it because she really trusted me. Initially I was
going to, but I decided that I really didn't want to be attached to
that lost. Because she was going to marry this man, and I didn't
want to go through the years with that... I don't know, like Lady
Macbeth... that blood on my hands. To be a participant in what I knew
was a really hard decision for them. I did go to the abortion with
them, with her and her fiance I held her hand through the
procedure. And it was really difficult. It felt
different. It made me realize that I have something that I do: I
have a distancing thing that I do when I’m the doctor doing the
procedure. But in this case it was no longer a procedure.
It was them. And this potentially being that ceased to exist in
that very room. I don't usually think that way about it. I
don't think I allowed myself to think that way. But I couldn't do
that with her. It was just different.
Was this the first time you had allowed yourself to be fully aware of what was going on?
Well, I've thought it through in the abstract. But this
made me cry. Afterward we all did. We were sort of laughing
and crying. We were all said. Yet we all knew it was
definitely the right thing to do.
something is that sat and yet that right all you can conclude is that
sometimes bad things need to happen, that they're part of reality.
I agree with that. But I think doctors often deal with
that idea by not dealing with it--by not allowing ourselves to become
totally absorber in it, by not allowing ourselves to be the women on
the table in every case. Because she couldn't do it. You
couldn't handle it. You have to distance yourself. But
don't want to end up sounding like a pro-life advocate...
the terminations are difficult isn't an argument for the pro-life
movement. It doesn't mean they shouldn't be done, it just means
they're hard to do.
Without distancing yourself. Yes. But it's hard to
do any medical procedure without distancing yourself. Hard to cut
open an abdomen or do brain surgery.
And you don't have to be a right-to-life advocate to feel some uneasiness and misgivings about abortion.
But I want to be professional about it. I want to say its
another procedure I do, like a hysterectomy or a removal of a
cyst. And I don't like to talk about how it's done or what it
looks like, or all that gory stuff of the pro-life people splash on
huge posters outside clinics.
don’t you think it's valid to say that abortion should be
available to women, but that doesn't mean there's not sorrow in it?
There should be sorrow in it. I like people to acknowledge
that this is a heavy-duty thing, that it's a very heavy, responsible
choice the people have to make. People should acknowledge that
some time during the process.
Have you had experiences where you have done an abortion and really sensed the sadness?
A friend of a friend of mine came in. She's a very aware person,
in a profession where she gives all lot of other people advice, and she
really had thought carefully about it. She was late in coming to
me and rescheduled a couple of times--all those little messages that
she was very ambivalent--and I talked to her at length because I was
afraid she would change her mind when it was too late. I wanted
to be sure she was clear, and she was clear. We had discussed all
the options. But it was a hard choice. And she was
said. And it was awful.
Awful for both her and you?
Yes. But you know, there are lots of children in the world, and
studies have shown that there are far fewer repercussions from an early
pregnancy termination then there are from rearing an wanted
child. So it away, it's incredibly compassionate to terminate a
pregnancy and not bring a child into a set up where the parents might
resent the child.
I agree. But the underlying fear in a termination must be that later a woman will feel she made a mistake.
I don't think people make mistakes. I don't believe in the
mistakes. People do what they do, and there's a whole set of
things that has led them to that point.
I have a couple of fertility patients who have had terminations
in the past, and they can't get pregnant now and--they're just beating
their heads against the wall. They say, “Oh, if I'd only
known that that was going to be my only chance. That's a sad
thing. But the reality is still that at the time, that was the
choice that they needed to make. It's a tough one.
How do you feel about women who repeatedly have abortions?
If someone took it lightly or dismissed it or came in five or
six times, I think I would start to have difficulty, as much as I would
dislike myself for feeling that way. Because that woman is as
much entitled as anyone else. But I start to the problems with
that. That doesn't happen often if patients are counseled.
the things most people have trouble with are second-trimester
abortions. I would think many people have a different attitude
about a pregnancy that's gone on to that point.
Luckily. Because I have trouble with that, too.
Although the women's having them tend to be very, very young--a sixteen
year old who just can't believe this has happened to her and finally
calls her big sister who brings her to a doctor. By then, she's
four months pregnant.
And by then it's a different issue. It's a different thing being taken out of you.
Is it really?
Well, once its baby-shaped, it does seem different, yes.
Except, if you look under the microscope its baby-shaped pretty
early. That's the question: What are you really doing, and how do
you make a cutoff at any point?
How do you?
You can't. If women are going to have reproductive
freedom, then it's up to them to choose what form it will take.
That is what’s nice about Catholicism, which teaches that the
whole thing is wrong no matter what. Because when you start
drawing these arbitrary lines, saying contraception is okay but
abortion is bad... or abortion is okay but it's not okay once you can
feel the baby move... or abortion is okay for women who were raped or
if the baby's abnormal, once you get involved in that, it's a big,
saying that a woman either does or doesn't have control over her
reproductive life. And you either except that or you don't.
And you allow no graduations in how you think about it?
I allow them, but I feel bad for allowing them. I feel
guilty for allowing them. Obviously I formed my own opinions, and
certain other opinions can make me a little uncomfortable or angry, but
then I get angry with myself because I'm making value judgments when
the issue to me is very clear.
And is what?
That women should be allowed to choose.
may be impossible to establish a cutoff point, but I think individual
cases might feel their own cut off point. A woman might feel that
if she stays pregnant into the second trimester, she must want the baby
or simply feel what it's just too late to terminate at that time.
Unfortunately not everybody thinks that way.
When you do a termination, you have to look at the matter that you've removed?
And what is the like for you?
Well, first of all, in the first trimester there's basically
nothing to see. There's placenta tissue. You don't see a
fetus that early. You just make sure that it looks like you've
got all of the... it's called products of conception... you want to be
sure that you got it, though you can usually tell as you do the
termination. You could feel the uterine cavity shrinking.
Then you double check the tissue to make sure it looks like pregnancy
But after three months you can see something that is baby shaped?
Yes. At four months from a woman's lost period it's
probably about 3 inches big. And to be sure you have the whole
fetus, you have to look at it.
That must be painful. Or is it just scientific?
( Doesn't answer for a moment. ) There are certain blocks there.
Yes, I imagine that would be painful. It requires the ultimate
detachment which I have not mastered.
The biggest problem was second trimesters is that the risk goes
up substantially. It's an almost totally different
procedure. You're dealing with a large, soft uterus that can be
perforated easily, and you’re the best hands with someone who
does them regularly. I stopped.
obviously have a very different feeling about terminations in the first
trimester as opposed to termination's after that, and you don't think
you should have it.
( Doesn't respond. )
Well, maybe there really is a difference between placental tissue and an inch-long baby.
Fetus. It's not a baby until it comes out. Or we
like to think of it that way. You know, if you start getting into
what second-trimester fetuses looks like, that's where the
right-to-life people really jump on the wagon.
I guess the
issue is when you think life begins, and that's an impossible
debate. People see it so differently, and I doubt its
The question of whether or not there's a right to abortion is
not even legislatable because the right exists, and if you don't
let women do it legally they'll stick a coat hanger in their
uterus. So they obviously think they have a right.
bottom line, isn't it? And when you look at a fetus under a microscope,
that's probably when you most need to remind yourself of what you just
Of the alternative. Yes. I live with that
awareness. And I hear about all the time. One doctor who
knew I was doing this interview said, “Don't forget to mention
that my grandmother died in 1930 after an illegal
abortion.” Probably her uterus was perforated and she got
peritonitis. They didn't have antibiotics then, so she suffered
and eventually died. This is been going on for centuries.
I trained with a woman who was just a few years older than I,
who was trained before abortion was legal. And she saw women
rolling into the emergency room with perforated uterus, and
17-year-olds dying on the spot. People who saw that it believe so
strongly in abortion and are very committed to making it available.
And I really worry that abortion will be made illegal
again. The right-to-life people are very powerful. What
really makes me sick is this concept that if you make it illegal, it
will stop happening.
It seems to
me that the strength of your position comes from the fact that though
you really have to pull yourself together to look at a fetus under the
microscope, you're still committed to making abortions available
because you believe that it's the right thing to do.
What's right is hard to define sometimes. But you have to
go with what you think about it. There's nothing else you can go by.
How do you feel about becoming pregnant yourself?
I want to have children, and especially after what I've been
through medically I was so terrified I wouldn't be able to. I
certainly didn't want to put my fertility at any futher risk. So
for a while I went crazy with my birth control. I was really
careful because I didn't ever want to have to decide. I knew it
wasn't time to have a baby, but if I had gotten pregnant I think that I
would have been so grateful to know I was fertile. I think.
But you don't know till you get there.
What if you were there? Your single. You have a demanding job. If you got pregnant what would you do?
Oh God. It would be so hard.
(Web site editor's note: Education is the key)
This article was written by Elizabeth Kaye a free-lance writer based in New York City in 1988.
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