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Tuesday, May 10, 2005



Sarah: You are wonderful, to say the least. Those are my ideas exactly. That's why I'm a Peer Educator. Check us out, I'm an Indiana Peer Educator-name's Sara.


I hope the second woman gets great counselling. In the U.S. I think the risks of FAS are a bit overblown. I did a lot of reading up on it before our adoption so we could make informed choices about what we were willing to take on in adopting, and the European sources were far less alarmist about drinking during pregnancy than the U.S. sources.


Well the answer to that is that so few doctors are any good at abortions[1] and pro-life groups put so much pressure on hospitals to limit services for women that even high-risk cases like this are better off being sent away to abortion clinics even though as you say, they don't have the depth of medical knowledge and extra support for patients on hand. Yes, there might be in-between cases where with very careful management, some high-risk pregnancies could continue with good outcomes that are currently terminated (I don't think it applies in this case, but neither you nor I are the consulting physicians in this woman's case), but to do that, you need integrated health systems that offer *ALL* services a patient might need. And that's become increasingly rare, unfortunately.



[1] You'll have to Google it, but several weeks ago there was a newspaper article in which a journalist told her terrible story of her fetus having died in utero and the struggle she had with doctors to get someone willing to do a second-trimester abortion which she opted over a Caeserean because it a) would preserve her fertility better and b) done carefully would enable a better understanding of why the fetus had died to be established.


I'm not attacking the woman. I'm just aware the too many doctors wash their hands of patients by chasing them to the local abortion clinic instead of either seeing them through the pregnancy or referring them to a specialist. If this woman's diabetes was such that pregnancy would knock her body so off-kilter, it just seems careless to send her to an outpatient facility. When I worked MH/MR, we'd actually spend a month making arrangements for one guy to have his teeth cleaned in a hospital because of his siezure disorder. He'd get a complete physical and blood workup and a visit to the neurologist beforehand. It was outpatient, but on the hospital premises in case anything went wrong. I just think that a pregnant woman with diabetes deserves the same level of care as a young developmenatlly-disabled man with a siezure disorder.

Ol Cranky


Lou did not say that the woman's life was imminently at risk when she presented for termination with *this* pregnancy, he said it was with her first pregnancy that she went into multi-organ failure (NOT pretty). The second pregnancy (the current one) increased her risk of a repeat of the first pregnancy, so the doctor ordered a therapeutic abortion. Apparently she was early enough in term and stable from a medical standpoint that a surgical abortion could safely be performed in an outpatient setting (there's also the possibility that an outpatient procedure was mandated by her insurance carrier).


There is a really great article about choice, conscience clauses, and reproductive rights here:


I think we need a lot more choices in this country, not fewer. Women need to be able to choose from a variety of options like bc, ec, abortion, sterilization, adoption (open and closed), and pregnancy. They need comprehensive sex education that is going to teach them about each of these things, in depth. I don't understand a pro-life movcement that isn't out there in the streets clammoring for ec, universal health care with no religious exceptions, and comprehensive sex education in schools. I don't understand why open adoptions are only availble in a handful of states. These things have been proven to reduce abortions. Isn't that what they want?


Christina: Pregnancy exacerbates diabetes and can put a marginal diabetic into diabetic ketoacidosis or hyperosmotic coma quite easily. By what we are told, that may have happened in this case. This woman nearly lost her eyesight, function of mutliple organs, and her life in her last attempt at pregnancy. She now has even less organ reserve and if she continued this pregnancy she would most likely end up blind and on dialysis at a minimum. The chances that a baby will be born healthy in that situation are too low to be measurable anyway.


I'm wondering why, if the diabetic woman's life was in danger, her doctor sent her to an outpatient facility instead of arranging an abortion in a hospital, where she could be treated more promptly and effectively should she suffer complications. Was this doctor really being honest with her, or just bailing out on her becuase he didn't want to risk the liability of trying to help her through a high-risk pregnancy?


I wish that birth control devices and proceedures were always covered by insurance, medicare, or maybe some day, universal health care. I really want to get a copper IUD, since I have no interest in having children in the next 10 years and a lot of interest in having sex. However its not covered by my insurance, and I don't have $400 lying around. I never would have needed my abortion if a dependable form of back up birth control would have been accessable to me... Maybe the woman cant get a tubal because she can't afford it, not because she's a bad person.

Ol Cranky


Lou didn't mention any other current co-morbidities, but the risks associated with surgical procedures increase with certain illnesses such as diabetes. From the history provided, she sounds as though she is not the most well-controlled diabetic (to say the least) and surgeons may well have deemed the risk:benefit ratio for this woman unsuitable for what is considered an elective procedure.

Anne Basso

I was curious if the first woman was counciled about sterilization. It's only natural that she would want a sexual relationship with her husband, but it must have been excrutiating to go in and have an abortion. If it's a danger to her health to be pregnant, perhaps a tubal would be in her best interests? Certainly safer for her physically than having to abort when accidents happen, and much easier on her emotionally.

Maura in VA

Thank you, thank you, thank you for the work you do and for highlighting these important examples of why CHOICE is so important. (Though I imagine that the first patient doesn't feel much like she has a choice...but at least she has a choice to save her life and health.)

The second example is a great illustration of the reality that you're not in the business of coercing abortions. Again, thank you for sharing your stories and educating others about the work you do.

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