Abortions are Pro-Life
By Erika Werner, MD
I am a high-risk obstetrician. I fight every day to help women have healthy babies. For me, abortions represent failure - a failure of science, medicine, and public health to optimize maternal well-being. Yet, I routinely perform abortions, especially in the second trimester.
Why? Because I am pro-life. For me to not perform dilation and evacuations for my patients would lead to more ICU admissions, more hysterectomies, more transfusions, and ultimately more maternal deaths; more kids without moms. Too often abortion is politicized, and this truth is left out of the discussion.
Luckily for me, this obstetric reality became clear early in training. I had fabulous teachers, who taught me how to perform abortions and gave me a great respect for what women go through when making this decision. I was, perhaps, even luckier to have amazing mentors who understood when I struggled with whether to perform this procedure on my own. I also have been fortunate to work with many team members - nurses, anesthesiologists, and hospital administrators - at many different institutions who understand the importance of abortion and its usefulness in protecting women’s health.
As state legislatures restrict abortion access, I worry that women will die because they do not have access to what I know to be a life-saving procedure. During the course of my career I have met many women who never dreamed of undergoing an abortion; yet, it was an abortion that saved their life. For example, it was the middle of the night when I met Ms. X, a very kind, pregnant woman and her extended family. She had spent years trying to get pregnant and her family was thrilled when they heard the news. Ms. X has an uncomplicated pregnancy until about 20 weeks when she started to bleed unexpectedly. She soaked her pants before arriving at the hospital.
At the hospital, her cervix was found to already be dilated, suggesting she was in the process of losing the pregnancy. Her family gathered as her abdominal pain and bleeding continued. Her medical team discussed dilation and evacuation with her in the evening, but deeply religious, she declined any efforts to end the pregnancy. I was brought in as her bleeding continued and increased, and her heart rate climbed. It became increasingly clear that her life was at immediate risk. Through tears, and with her family’s urging, she agreed to let us intervene. Post-operatively, she needed a blood transfusion, but two days after her surgery, she and her family left the hospital grieving, but grateful she was alive.
We don’t entirely understand why some women have healthy, full-term pregnancies and others don’t. We can’t predict when certain complications will arise or who they will impact. But one thing is for sure: stories like this are not unusual.
Any obstetrician who performs abortions can tell you about a woman, like Ms. X, who stayed healthy because of a surgical procedure to end her pregnancy. While I dream of a day when I will not need to do abortions, for now they are a necessary procedure that ensures that all treatment options are available and that women can thrive in raising their children.
Most often during my career, I have met women who need abortions as strangers in the worst moments of their lives, when they are forced to choose between one loss or two. However, that was not the case with Ms. Y. I saw her after she delivered a child at only 17 weeks. During the consult, we both cried as she described how devastating the loss had been for her. She explained that in her next pregnancy, she wanted to do everything possible to get a term delivery. So early in her pregnancy I placed a stitch in her cervix and put her on progesterone, both interventions with evidence to reduce the risk of preterm birth. However, despite these efforts, at 21 weeks, Ms. Y arrived at the hospital with pressure. She was two centimeters dilated.
A team of physicians and nurses watched her overnight hoping that her dilation would stop, and her pregnancy would continue for the weeks needed for her fetus to survive outside the womb. The next morning, she seemed to be doing well, except for an increased white blood count, a sign of infection. Later that morning she developed a low-grade fever. By lunch, she complained of belly pain and shortly after that her water broke releasing a greenish fluid. She had an infection in her uterus and if she remained pregnant, would only get sicker.
We would not be able to both keep her healthy and her fetus in her uterus. We took out her cerclage and waited, as she wanted the process to be as natural and peaceful as possible. We put her on antibiotics and honored her choices. By dinner, she had a high fever and could not stop shaking from the temperature, but she was not dilating. She was becoming septic. While she desperately wanted a living child and a natural birth, her only choice was to end her pregnancy immediately or the infection that had already spread to her bloodstream would consume her. She asked us to perform her abortion.
She remained in the hospital on antibiotics, but later left alive with her uterus in place. Months later she sent me a thank you note. She was still grieving, but she was so grateful that she had received medical care that saved her life.
Without abortion access, Ms. X and Ms. Y would have lost their lives. The decision to terminate a pregnancy can be lifesaving and one that is best made by an informed woman in consultation with her health care provider.
