Friday #Medthread—some long overdue physician-related advocacy and reflections especially with the #AlabamaAbortionBan and #GeorgiaAbortionBan.
For the record, and if you couldn’t clearly tell from my twitter feed, I am prochoice. CHOICE. As a woman and a physician... 1/x
Beyond “advocacy as a physician”, what is my experience providing care for women who choose to seek abortions? I’m not an OBgyn, so I can imagine folks saying, “how are you qualified to comment on this as a physician”... 2/x
And brief terminology interlude. Full disclaimer. . I say “women” but this not does ignore the fact that gender identity other than “woman” does exist amongst patients seeking & needing abortions—ex FTM, gender non binary, gender queer...but I will use “women” in this thread 3/x
As a hospitalist who mainly sees patients in an outpatient Pre-operative medicine clinic, what is my chance to intersect with care for women pursuing abortions??? 4/x
over the years I have met dozens of women in Pre-Op Clinic pursuing 1st, 2nd, and 3rd trimester terminations. If I’m seeing them for a pre-procedure evaluation, it means they’ve been referred to the hospital setting rather than proceed at a community ambulatory location 5/x
Why? In these circumstances, usually the woman has an underlying medical condition exacerbated during pregnancy. Maybe their birth control failed. Maybe the pregnancy was originally thought safe before she tried to conceive and now it’s abundantly clear that it’s not... 6/x
Maybe it’s a new medical condition caused by the pregnancy that is potentially life threatening... 7/x
Examples?
Congenital heart disease
New severe proteinuric kidney disease
Epilepsy that is now refractory to medications
8/x
Other times, the fetus has a congenital abnormality incompatible with life outside the womb, often not diagnosed until the 2nd trimester ultrasound that occurs around 20 weeks... so a D&E needs to be done in the OR with anesthesia support 9/x
THESE ARE NOT EASY DECISIONS. They ARE heartbreaking--and women deserve and have the right to be shepherded through them with skillful, compassionate, patient-centered, safe medical care... 10/x
It doesn't matter if it was a planned or unplanned pregnancy to me. I am hear to gather and assess the medical information to make sure these women get the best care from their OB and anesthesia teams 11/x
I first shared my thought on this in fall 2016 when Hillary Clinton said during one of the debates: "the kinds of cases that fall at the end of pregnancy are often the most heartbreaking, painful decisions for families to make...” 12/x
“...I have met with women who toward the end of their pregnancy, get the worst news one could get, that their health is in jeopardy if they continue to carry to term or that something terrible has happened or just been discovered about the pregnancy...” 13/x
“... I do not think the United States government should be stepping in and making those most personal of decisions. So you can regulate if you are doing so with the life and the health of the mother taken into account...” 14/x
“... This is one of the worst possible choices that any woman and her family has to make...I can tell you the government has no business in the decisions that women make with their families in accordance with their faith, with medical advice, & I will stand up for that right”16/x
One more time for those in the back, and regardless of the reason to CHOOSE an abortion—
“I will stand up for that right” 17/x
I was incredibly proud of Hillary Clinton's compassionate, respectful, medically-informed, privacy-minded remarks on 2nd and 3rd trimester abortions. That needs to be the norm not the exception, including for 1st trimester abortions and regardless of reason 18/x
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