I did two abortions this morning (among other procedures) in our neighborhood family health center. The first was a 25-year-old professional woman who came in with her best friend, having been referred from her boutique practice that does IUDs but not abortions. She was pregnant with an IUD in place and had texted me yesterday evening, having gotten my cell number from her doctor, who did not understand that it is important to determine if a pregnancy with an IUD in place is in the uterus and is not ectopic (outside the uterus and in the fallopian tubes). We made a plan for her to come in first thing this morning. The patient was very nervous, but luckily her pregnancy was in the uterus and her IUD was in her cervix (in the wrong place). We removed both via manual aspiration. She chose to have a new IUD inserted, which we made sure was well positioned. Both woman and her friend were very grateful for the care, and we had a good discussion about the politics of abortion.
Later in the morning, we saw a 39-year-old woman from Sierra Leone who was a mother of three. Despite using condoms as contraception, she hadn’t had a period in seven weeks. I did an ultrasound and found that she had a large empty gestational sac of about 20 mm. While her English was better than my French, and verbal communication was a bit difficult, it was evident that she did not want to be pregnant, and we used the translation line for confirmation (which always makes me uncomfortable because I can’t tell if the translator is supportive or shaming the patient). I offered to wait for a definitive diagnosis of miscarriage, but she chose to have a manual vacuum aspiration. It only took a few minutes to do the procedure. I could see how relieved and grateful she was to be able to move on. Despite the language barriers, we were able to communicate through eye contact and handholding, and it felt wonderful to have helped her in the way that she wanted.
Despite the contrasts between both these situations, I got such a good feeling from both women. If only this could be a model for care everywhere – people from all walks of life obtaining abortions as easily as they get treated for strep throat, with no judgment and lots of support from doulas and physicians. To walk away unscathed when in need of an abortion is no small thing. I love this work. It is not that often in medicine that we get to really fix something.