Question:
I have been seeking regular medical attention with my 16 week pregnancy,  including ultrasounds and blood work ups but my husband and I have decided we simply cannot continue with this pregnancy.
I am desperately worried my family doctor will not support my decision and judge me.  I live in Canada. I am in between seeing my family doctor and seeing an obstetrician for continued care.  Is there anyway I can avoid telling my family doctor the truth?  If I went back to him in a month or two after this is over, and told my family doctor that I had a miscarriage resulting in a D & C (which I have had before), is there any way he could find out the real truth?   Either through medical records, or can he inquire about or request the medical records?
Is there anything I could say to make my situation ‘believable’?  I fear being judged or scrutinized above all else.
Please help, I am losing sleep and am extremely upset about this situation.
Thank you
DJBM

Answer:
Dear J,
I support your decision to end your pregnancy if that is what you and your husband want to do.  There is no medical reason why your doctor would need to know whether you end the pregnancy  by abortion or natural miscarriage, so it is your choice whether you tell him about it.  He also coudn’t obtain your medical records without your permission.

The difficulty in creating a story has to do with how close of a relationship you have with him regarding your medical care.  If he is someone you would normally call if you started to have cramping and bleeding in your pregnancy, then there will be a question regarding why you didn’t call him.  Otherwise, you can simply say that you started to have cramping and heavy bleeding, and went to the ER.  You can describe what happened to you last time you went through this.  You would need a D&C for this stage of pregnancy.  If it helps, you could say this happened while you were visiting friends outside of the city where you live.

Given the issues of privacy and scrutiny you decribe, many women choose to come to New York City or go to another city for these kinds of services.

Good luck with your decision and getting the help you need,
Doctor Joan

As an abortion provider for the past 15 years, I find the day to day work in abortion care to be a more complex world.    Of course there are people set in their views.  But mostly, I see people being conflicted.  People are dealing with the experience of being in a position they never wanted to be in, and are having to make some difficult decisions.  I have seen women from all across the spectrum:  anti-choice advocates who need to end a pregnancy for themself, or with their daughter;  pro-choice advocates who find that they feel more conflicted about ending a pregnancy than they would have expected.   I have worked with doctors who are strong defenders of the right to have an abortion, who find it difficult to provide abortions once an embryo can be identified.  I have worked with people who felt one way yesterday, and another way today. 

It is hard to have healthy conflict when the world is filled with “right” and “wrong.”  For if we look at each other as human beings with different backgrounds, different politics, and different ways of seeing the world, we have to come to some agreement on how to proceed.  I see families with widely divergent views on the “right” answer, come to some agreement on how to make a decision and remain a family.  I believe it is important to create new kinds of conversation with each other as part of this process.  I hope that this blog, where we can talk about real life situations, can contribute to that conversation.

Imagine if abortion were offered as part of your regular family medical care.  If you needed an abortion, it would be available at your regular family doctor’s office, in a regular examination room.  The doctor would offer you early nonsurgical methods, the Abortion Pill, or the Aspiration Procedure.  The Aspiration Procedure would be completed on a regular examination room, like a pap smear, in less than 5 minutes. 

Is this too easy?  Some people think that if abortion were normalized, and less punitive, more women would choose to get abortions.  As a doctor who has completed abortions for over a decade, I don’t think so.  Unlike the perceptions created by people with extreme views, women do not take their decision to end a pregnancy lightly.  In fact, the same rate of abortion exists for countries that have legal and illegal abortion.  If a woman needs an abortion, she will find a way to get one.   But even in the United States, where abortion is a legal medical procedure, women often still feel like they completed a criminal act. 

It’s important for women to talk with each other about their abortions, and normalize the experience.  Otherwise, we are overdetermined by people who want to advocate a particular agenda and by a divisive political system.  It is important to learn from ordinary women who have had to make the decision to have an abortion as one of the many difficult decisions we have to make in our complex but ordinary lives.  Talking about abortion will help women get the kind of  high quality medical care that they need in the situation of an unwanted pregnancy.