Dr. D’s Blog

In regards to the safety issue, of course I take precautions.  But nobody took more precautions than Dr. Tiller.  Ours is not the only profession that faces dangers.  Much like the soldier in the field, the cop on the beat, and the firemen racing into a burning building, we work in spite of the danger for the common good.  I haven’t been intimidated for the past thirty-five years, and I won’t be now.

My biggest frustration is with the inappropriate behavior of the anti-abortion fanatics.  I fully respect their first amendment rights to express their opinions, even in front of my office.  However, violent actions, harassment, obnoxious language, and threatening behavior go beyond those rights, and accomplish little to change any patient’s mind about having an abortion.  We live in a democracy where there are well established mechanisms to effect social change.  Instead of making fools of themselves in front of our clinics, they should be concentrating their efforts on campaigning for and electing politicians who favor their cause.  Although they have had recent set backs in the political arena, they have managed to get waiting periods and parental consent requirements passed in the majority of states in this country.  Other politically maneuvered anti-abortion measures that significantly impact on access to abortion services include restricted funding and targeted restrictions against abortion clinics at the state level.  Of course, those of us providing abortions would much rather see no restrictive laws.  I would however rather see these issues debated and decided in an intelligent and civilized manner in the political arena than by religious fanatics screaming radical nonsense in front of my office.  I and my fellow abortion providers do what we do because we are sensitive to the needs of our patients, our country, and our world.  I sincerely believe in the service that I provide. I also respect those who have opposing views, but have little understanding of those who express these views through extreme language or violent behavior.

And so we move on.  Tomorrow I will go to my office.  Most likely the protesters will be there screaming at me as usual—and I will ignore them, as usual. My patients will come through the door in spite of the protesters. Nothing seems to change, except when the nasty rhetoric turns to violent action.  I think of my friend Dr. Tiller often these days.  He, in spite of formidable pressure, would not give in; and neither will I.

For more visit http://www.swjc.net

It has been almost two month since Dr. George Tiller was murdered.  I haven’t written about this horrible tragedy until now because I have had difficulty coming to terms with it.  Dr. Tiller was not only a fellow abortion provider, but a personal friend.  He was targeted by right wing religious and political zealots because he provided second trimester and late term abortions.  Many physicians and their staffs who are involved with abortion services have experienced some degree of harassment from anti-abortion protestors.  In the thirty-five years that I have been providing abortion services, I have experienced my share of these incidents.  Although my clinic has been firebombed, blockaded, received multiple bomb threats, had all its windows broken and is picketed almost daily, I haven’t had to deal with the intensity and persistence of anti-abortion activity that Dr. Tiller experienced. It is a tribute to his courage and commitment that he persevered.  I remember a conversation I had with him last year.  We were pondering about the right time to retire.  We both agreed that as long as we were able to maintain our skills, we would continue to work.

I am often asked why we continue to provide abortions when facing this type of pressure and risk to our safety.  I was trained by physicians who worked when abortion was still not legal. They described the frustration they felt attempting to save the lives of the many patients they saw in ER’s and hospital wards who had resorted out of desperation to back alley abortions.  They saw many patients die or become infertile and felt that it was part of our mission as physicians to assure that this wouldn’t continue.  One has only to look to those countries in the world where abortion is still illegal to see the mortality and morbidity that still occurs.  Abortion providers work to assure that those conditions never return to this country.

In regards to the safety issue, of course I take precautions.  But nobody took more precautions than Dr. Tiller.  Ours is not the only profession that faces dangers.  Much like the soldier in the field, the cop on the beat, and the firemen racing into a burning building, we work in spite of the danger for the common good.  I haven’t been intimidated for the past thirty-five years, and I won’t be now.

More to this Blog in the next week or so. In the meantime you can visit: http://www.sjwc.net for more information.

For most patients, medical abortion is well tolerated.  The bleeding and cramping is like a bad menstrual period with patients changing their pads every 1 to 3 hours at its worst for about 4 hours.  The cramping for most patients is relieved with over the counter medications like ibuprofen or Aleve.  For some, the bleeding can be heavier with severe cramping requiring stronger narcotic pain pills for relief.  During the clinical trials, we surveyed patients as to their tolerance of this abortion method.  Over 75% indicated that if they were to have another abortion, they would have it done medically rather than surgically.

Medical abortion is an option that is available up to 8 to 9 menstrual weeks, but is not for all patients.  In my practice, 15% of patients choose it.  Many of my patients are not candidates for medical abortion because they are over 8 to 9 weeks.  Others prefer the one day convenience of the surgical abortion, and the comfort of IV sedation.  I am happy to have both medical and surgical abortions as options that are available for my patients.  More information on abortion services can by found at this website:  http://www.sjwc.net/.

Before the French Abortion Pill (RU486/Mifiprex) became available in the United States, medical abortions were performed using a cancer therapy drug called Methotrexate that interferes with the uptake of folate to the developing early pregnancy (before any fetal form) and a prostaglandin medicine (Misoprostol) used to contract the uterus to expel the pregnancy tissue.

Using these two medications, I assisted approximately 100 patients with medical abortions.  I was impressed with how well patients tolerated this approach to early abortion and how, when successful, it avoided the invasive aspects to the surgical approach to abortion.  However, this particular combination of medication required a five-day wait between taking the Methotrexate (an injection) and the Misoprostol.

There was also an unacceptable high failure rate of up to 15 to 25% requiring a repeat dose of Misoprostol or a D&C to complete the abortion.  Although I was comfortable with medical abortion as an option for my patients, I was frustrated with the waiting period and unacceptable failure rate.

The French Abortion Pill, which was being used in Europe for many years, offers advantages over Methotrexate when used with Misoprostol.  RU486 is a pill, not an injection, and the waiting period between the two medications is only one or two days.  The success rate approaches 98%.  It first became available in the United States by way of clinical trials which paved the way for ultimate FDA approval of RU486.

I participated in those trials for two years during which I became convinced that medical abortion with RU486 was a valid and beneficial approach to early abortion.  Patients prefer it because it avoids surgery.  It also offers an approach that they perceive as more “natural”, and is able to be completed in the privacy and comfort of their own homes.

I am now an advocate for medical abortions, and in fact have participated in several training sessions to help other abortion providers learn how to introduce it to their practice.

For more information you can go here: www.sjwc.net

For those who might be interested, I am writing on my observations on medical abortion from a physician’s viewpoint.  I myself had to undergo a transition period before I became comfortable with medical abortions.  Over ten years ago, just as medical abortions were being introduced in the United States, and after several patients had requested this approach, I decided to seriously consider this option for early abortions for my patients.

As an abortion provider in my fifties who had been trained that spontaneous abortions should always be completed by D&C to assure no remaining tissue was left in the uterus to serve as a source of bleeding and/or infection, it took a drastic change in philosophy to then turn around to assist to medically induce a miscarriage with no intention to complete it by D&C.  The knowledge that estimates of up to a quarter to a third of all pregnancies end in early spontaneous miscarriages often perceived as late menstrual periods, and hardly ever requiring a D&C, helped me accept the concept of medically inducing a miscarriage.

I was also motivated to seriously consider this option for my patients by the positive feedback I was hearing from other abortion providers who were performing medical abortions, and from patients who had experienced them.

More to this story in an few days. Thank you for reading this post.

Dr. D

For more information you can go here: www.sjwc.net


  • Mignon C: Dr. D, Thank you. Good insight. Med Student
  • Interested Citizen: Dr. Dee, I have been searching all over for a blog on abortion, but only from the medical perspective and that is written by a doctor that is in th

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