The outburst of a doctor who performs legal abortions in the US – 07/18/2023 – Health

Shelly Tien sneaks into the waiting room wearing jeans, a T-shirt, and sneakers, as if she’s just another patient arriving at the clinic that morning for an abortion.

After going through the door that leads to the offices, the obstetrician-gynecologist wears a purple lab coat and crocs to face the appointments with 40 patients scheduled on the day’s agenda.

Eleven of them will undergo a legal abortion.

Specializing in maternal-fetal medicine, Tien practices in Jacksonville, a city in northern Florida.

Last year, she traveled to states like Alabama and Oklahoma to provide abortion services to patients who live in places that prohibit or severely restrict termination of pregnancy.

The map of access to abortion has changed in the United States since June of last year, when the Supreme Court eliminated the national protection of this right and delegated to state governments the power to protect or prohibit it.

To help fill the gap caused by a lack of clinics and doctors who specialize in the procedure, Tien has become one of 50 doctors traveling across the United States to perform abortions, according to the National Abortion Federation.

‘paralyzing effect’

The laws that punish abortion present doctors with the dilemma of discarding or delaying the procedure to prevent complications or avoid unwanted pregnancy, even if it is the best way to treat a patient, explains Tien.

“The new laws have had a chilling effect on doctors and caregivers,” she says during a break between appointments.

“Who will take care of patients if they persecute us for having abortions?” he asks from his office, where letters and cards his patients wrote him on colored paper to thank him for the support he gave them during their abortions hang on the wall.

“Our medical oath and our ethical obligation is to provide care based on scientific evidence,” he says. “But they are putting us in a very difficult position if the consequences of our decisions are imprisonment or loss of our license.”

States that prohibit abortion allow few exceptions, such as allowing the procedure in cases of rape, incest, or when the life of the mother or fetus is at risk.

In Idaho, for example, health care providers sued the state’s attorney general over a legal position that seeks to prevent doctors from referring patients to other states that have abortion services.

In Texas, health professionals can be prosecuted, as well as family members, friends or anyone who helps a patient terminate a pregnancy.

“Doctors will delay or perhaps even deny care for fear that their interventions will be misinterpreted under the law and inconsistent with such limited exemptions,” Tien says over a biscuit, her breakfast that morning.

“It is a non-negotiable dilemma between the obligation to provide timely treatment and respecting laws that do not take into account the many nuances of medical practice.”

Dilemmas

During his travels to other states, Tien has discovered that under new abortion restrictions, his colleagues are afraid to deal with bleeding from a pregnant woman during the work shift.

Bleeding can occur at any time during pregnancy, warns the specialist. However, the form of management depends on the week of pregnancy in which the patient is.

“If a woman is close to her due date and has heavy bleeding, the conversation is easy: we recommend giving birth. But if the bleeding is significant at week 8, 12, 16 or 20, what do we do?”, he asks.

“We are going to recommend an abortion to save this woman’s life.”

Tien says another conversation that has been taking place in secret among doctors in clinics and hospitals across the United States is what to do if a pregnant woman’s water breaks.

“Many doctors have told me that they are afraid of having to see a patient with this type of complication while on duty. And they won’t be able to advise them on the standard of care for fear of being misunderstood.”

In addition to unwanted pregnancies, Tien points out that abortion is a recommended treatment for patients facing medical complications that put their survival and that of the fetus at risk.

Patients’ fear

Not only doctors travel. So do patients, who are forced to seek abortion services in states where the procedure is legal or permitted later in pregnancy.

“I’ve had patients ask me, ‘Am I going to be arrested for having an abortion?'” says Tien.

Most of the more restrictive states are concentrated in the south of the country, some on or near the Florida border.

The clinic where Tien has been working for three years in Jacksonville belongs to Planned Parenthood, an NGO that has the largest network of health centers dedicated to abortion, reproductive health, sex education and family planning services in the United States.

Jacksonville is the closest Planned Parenthood center to eight of the 14 states in the country that imposed the most abortion restrictions last year.

Amid the bans, last year the clinic saw patients from Alabama, Georgia, Mississippi, Missouri, Oklahoma, Tennessee and Texas, explains Jessica Wannemacher, manager of the health center.

The health team wants the clinic to be a welcoming and inclusive space, with portraits of trans and homosexual couples on the walls of the waiting room and messages that claim women’s right to decide about their bodies.

Outside the clinic, however, Florida’s policies foster hostility toward people who seek and perform abortions.

Governor Ron DeSantis, presidential candidate in the 2024 elections, passed a law that prohibits the termination of pregnancy after the sixth week of pregnancy, a measure that Tien and other experts consider an absolute prohibition, since many women do not know they are pregnant at that time .

The Florida Supreme Court has yet to rule on this rule. Meanwhile, abortion is legal in the state until the 15th week of pregnancy.

If abortion is finally banned after week six in Florida, Shelly Tien will consider moving to another state.