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A Week in the Life: An OB/GYN Who Provides Abortions

‘Only the pregnant person can know what continuing or ending a pregnancy means to them.’ First in an occasional series.

andrea bennett 1 Jun 2022TheTyee.ca

andrea bennett is managing editor of The Tyee.

Today, The Tyee starts an occasional series that covers a day — or a week — in a person’s work life. We’ll be speaking with people in blue-, white- and pink-collar professions, about what they find stressful and joyful, and how current labour and cultural climates are affecting their work lives.

Why? Because we often live in our own bubbles, with people who have jobs like our own and, often, similar lives. Getting to know other people, including what they do and how they feel about their work, can help us get out of those bubbles and understand each other’s worlds.

Our first interview subject is an obstetrician gynecologist who provides a full range of reproductive health care, including medical and surgical abortions, in B.C.

Like many abortion providers, she is selective about when and with whom she shares that she provides abortions. This is because doctors who provide abortions in Canada still regularly face stigma, harassment, threats — and sometimes even life-threatening attacks like shootings and the firebombing of clinics.

The following interview has been edited for length and clarity.

What does a normal week look like for you? When do your days start and end?

One of the things I love about my job is the variety. I provide clinical work as an obstetrician gynecologist. I teach medical students, residents, nurses and midwives. I conduct research, and I participate in administrative work in my health authority. So I enjoy that no week looks exactly like the other week. Most days, I get up at about 6 a.m. I'll check my emails and work on my research. My clinical work starts at about 7:45 or 9 a.m., depending on whether I'm in the operating room or on call or working in my office. My clinic days end somewhere between 4 and 6 p.m. Unless I'm on call, which is a 24-hour shift. On some of the afternoon or early evenings I have meetings related to my research or my administrative work.

Your on-call work, is that baby delivery?

Yes. I'm a general obstetrician gynecologist. I do everything from delivering babies to hysterectomies.

About how many patients do you see on a daily basis?

On an office day, I would say I see up to 20 patients per day. It's usually a nice mix of old people, young people, obstetrical patients, which is people who are pregnant, gynecological patients, which might be a wide variety of people there for prolapse, pain, cancer, infertility or contraception, all sorts of things; surgical patients, non-surgical patients. When I'm operating, I perform between four and seven surgeries a day. And then on-call can be quite variable, we see patients on labour and delivery, for deliveries or for assessments, and we see patients who come to the emergency department for various concerns.

The surgeries you perform — does that include performing C-sections?

Yes.

I had a scheduled C-section. When my kid, who is now four, was in utero, she was breech, and very resistant to turning. I gave birth at a hospital known for their amazing level of care. An OB/GYN tried a procedure to turn her, but she did not want to turn. It seemed like I’d be taking on more risk than her if we went for a planned C-section, and she’d be taking more risk if we waited until I went into labour to see what happened. It was so nice to be able to talk it through. I felt like I got to make the decision based on what was best for me and for my kid, who arrived into the world safe and healthy, but with a much larger head than her tiny body.

It's nice when one has a good experience that way.

How many of the patients you're seeing have come to you for an abortion?

About 30 per cent of my practice is contraception and abortion care, which oftentimes goes hand in hand, and I would say about half of those are for abortion. And in addition, just because the word “abortion” can refer to a sort of wider range of people — I do see multiple patients per week with a desired pregnancy that is complicated by either a pregnancy loss or by fetal or maternal problems that then might lead to an abortion, in addition to patients who present primarily with an undesired pregnancy.

Do you have a sense of the breakdown between what percentage of those patients seeking an abortion are taking Mifegymiso, a medication that induces abortion, versus what percentage are needing a surgical intervention?

There will be a difference between the general population and who I see in my referral practice. So for people in general, we know now based on some research that in Canada, almost 28 per cent of abortions are done with first-trimester medication abortion, and less than 10 per cent of abortions are in the second trimester. With the arrival of mifepristone in Canada in 2017, the proportion of first-trimester medication abortions has increased from four to almost 28 per cent of abortions across Canada.

It's important to note that the number of abortions have not increased. The difference is rather in the share of abortions that are medical abortions versus other types of abortion, like surgical abortion.

As an obstetrician gynecologist who performs first and second trimester medical and surgical abortion, the patients I see tend to be more often either second trimester patients or patients who, for various reasons, want or need a surgical termination of pregnancy. First-trimester medical abortion is done by a lot of my colleagues in the community who are family doctors.

My colleague Moira Wyton just wrote a piece about abortion access in B.C. She wrote that all five surgical abortion sites are clustered in southern B.C. — in Vancouver, Victoria and Kelowna, and if people are seeking surgical abortions, and they reside outside of those areas, they have to travel to receive that care.

I think one of the challenges might be to actually know where exactly the providers are, because a lot of providers aren't advertising their services. If you go by just what is available online, then you certainly don't see the full range of where surgical abortions might be available.

We're talking anonymously today. Which feels connected. Could you explain why abortion providers in B.C. don't necessarily provide that information publicly?

This is something that is informed by the research that I'm involved in, as well as by my personal experience and the experience of other abortion providers I know. In Canada, 12 per cent of providers who participated in our research reported harassment mostly in the form of picketing where they work. There are additional providers who are worried about stigma and therefore are somewhat selective in who they tell about their work in their personal or in their professional lives, or to which degree they would advertise their services on a website, for example. More so in the U.S. than in Canada, but there are still concerns around harassment either at your workplace or at your home.

I have become much more open about my work in the years that I have been here, in my professional circles. But in terms of publicly advertising, or publicly speaking to you, there's definitely still some concerns depending on who reads the story, and what kind of harassment we could experience afterwards. That’s a safety concern.

What are the most stressful things you deal with on a daily basis?

It can be stressful to find a sustainable work-life balance. It can be challenging to accommodate all the oftentimes urgent patient referrals directed to my office and to provide the care patients need, while protecting time for other aspects of my life. The shortage of family physicians in our province has intensified that pressure. A lot of patients I see do not have a family doctor, meaning that there’s been less pre-triaging to know how urgent they are, so I need to fast-track a lot more patients. And also the followup is not as easy to share, because there’s no family doctor. That's definitely a stressful aspect.

Are those clients coming in from walk-in clinics?

Walk-in clinics, the ER and telehealth services. Telehealth services are better than no care, but kind of by definition the patients haven't been examined. So I don't know how worrisome their exam might be.

What are the most joyful or meaningful things you experience at work?

My profession allows me to experience human interconnectedness. I consider it an incredible privilege to be with people during existential moments of their lives: sexuality, conception or infertility, pregnancy, birth or miscarriage, menopause, cancer, and also abortion: moments of beginning and end. This is what led me to go into obstetrics and gynaecology. These meaningful transitions have become an almost daily work experience. I feel drawn to be with and help patients through these experiences.

Do you think people have a good sense of what you do for a living? What do you think people who aren’t familiar with your job would find surprising, or have incorrect assumptions about?

Most people close to me have a good sense of what I do for a living. Some people outside of medicine don’t have a good sense of what all an obstetrician and gynecologist does — that it’s delivering babies, but also doing hysterectomy or prolapse surgery or doing abortion care. And as I mentioned a little bit earlier, I'm very mindful about who I specifically tell about my abortion care as part of my work, due to concerns around stigma and personal safety, which are shared by many abortion providers, including myself.

Is there anything you wish that people who are anti-abortion could understand, or better understand, about what you do?

Abortion is a safe and essential health-care service that may save a pregnant person’s life. It is legal in Canada and covered by our health-care system. Only the pregnant person can know what continuing or ending a pregnancy means to them and their family.

Abortion provision for many providers is a conscience-based decision. While an abortion, to me, means the end of a potential life, the embryo or fetus, at the same time it is an affirmation of the pregnant person's life, depending on their situation, either literally their life or figuratively supporting their right to control their body and future life.

What do you think about the current attempt in the States to overturn Roe v. Wade? When these political flare-ups happen, does it have an impact on your ability to provide care? Have you needed to seek out extra precautionary measures to shield your identity, or make sure you can move safely between your home and work?

It is very upsetting to see how the right to abortion is being endangered in the States. Making abortion illegal means that patients possibly need to continue a pregnancy that they don't want to have or that endangers their health.

As the Turnaway study has shown, abortion does not harm women and women remain confident in their decision to have had an abortion. Being denied an abortion reduced families’ financial security and safety.

International data, including the WHO, show that when abortion is not legal and available, people will turn to unsafe, illegal abortions, which are associated with more risks than a safe abortion that is provided within the health-care system.

So these are all very worrisome possible consequences. And at the same time, I'm very grateful that in Canada, our law and government and health-care system support abortion as an essential health-care service. I do not foresee this being negatively impacted by the U.S. abortion debate.

But the attacks on abortion in the States might create uncertainty when people are seeking abortion care as to whether it's safe or available, especially due to the misinformation that is being distributed. It might make people feel more stigmatized or fuel the opinions of people who are anti-choice.

It will be really important that we do all we can to keep abortion care accessible and safe as an essential health-care service.

If you have a suggestion for which professions we should profile for this series, send us ideas at abennett[at]thetyee.ca.  [Tyee]

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