Article on late term abortion Dr.

iVillage Member
Registered: 03-26-2003
Article on late term abortion Dr.
44
Mon, 06-18-2007 - 8:19am

I found this article to be a prochoice article, but very eye-opening and very interesting...and yes, very bothersome. I hope you all will read it and am interested in your points of view....Sue

End of the Road

News: In the twilight of his career, one of the oldest living late-term abortion doctors tells all.

By Rebecca Paley

September/October 2003 Issue

Partial Truths
The term 'partial birth abortion' is purposefully vague, but could be interpreted to include both dilation and evacuation (D&E) and dilation and extraction (D&X) methods. A (free) Salon article parses the differences between the two and makes the point that the widely reviled D&X method is actually safer. D&X abortions are available at only 31 sites nationwide, according to the Alan Guttmacher Institute.

The text of the bill banning "partial birth" abortions, H.R. 760, is available via Thomas, the Library of Congress legislative search engine. The text of the 2000 Supreme Court decision striking down a similar Nebraska state law banning D&X abortions, along with legal briefs filed in the case, is available via FindLaw.

Finally, Medical Students for Choice tries to remedy the problem of the graying (and vanishing) of abortion providers.

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Dr. William Rashbaum, a New York City gynecologist and one of the pre-eminent and longest-practicing providers of second-trimester abortions in the United States, is not known as easygoing, and upon returning from a day of operations he erupts at the question of why one of his patients that afternoon, a 14-year-old rape victim, waited so long for an abortion. That's the one question he can't stand. Witness to myriad women in their most intimate and dire moments, this elderly doctor, dressed in an outfit of khaki pants, bow tie, and red-striped oxford shirt, all reminiscent of a prep-school student, is fiercely protective of those in need of his services and has absolutely no patience for those doubting their motivations. "You want to criticize her?" he barks in a loud voice made louder by a case of partial deafness. "She is the cutest little girl you ever saw. She is not a woman; she is a child."

Sitting in his small windowless office, chockablock with civic and medical awards, the doctor resembles an absent-minded professor or perhaps a sardonic Christmas elf. His head is crowned by salt-and-pepper locks. Under unruly eyebrows, his eyes quickly vacillate from soft to stern, depending on whether he likes what he hears. At 76, Rashbaum, who's been performing abortions since the practice became legal, has a right to his opinions and isn't afraid of voicing them in stripped-down language more befitting a salty stock trader than a physician at the heart of the most controversial health concern facing women.

At an age when most doctors have long since forgone the operating room and office hours, he has kept up his work, albeit at an understandably slower pace. Where once he did upwards of 25 second-trimester abortions on Saturdays alone, the doctor now performs less than half of that number each week. After 30 years, Rashbaum still doesn't sleep well the nights before his operating days. He frets over the physical welfare of his patients. And his own; some people might want to kill him because of what he does. It's a constant fight and, he says, "I am running out of steam."

Trained in an era when doctors were considered gods, Rashbaum is gruff, confrontational, and downright abrasive. He flaunts medical conventions at will, rankling nurses and orderlies, if it serves his needs. When the orderlies take too long in preparing his operating room between procedures, he goes in and embarrasses them into efficiency by helping to clean up. He boasts, "They turn my room over much faster than any other room." First- and second-year ob/gyn residents dread his cases. "It was always a fight about who had to do them,"

relates a former intern. Cases such as his are certainly the most technically difficult of all abortions. As pregnancy moves closer to 24 weeks (the upper legal limit in most states, with rare exceptions made to preserve a woman's life or health), the risk to the patient increases, even with the preferred meth-

od for second-trimester abortions -- dilation and evacuation, or D&E for short. During the procedure, in which both vacuum and surgical instruments are used, the fetus is

either removed in pieces or delivered more or less intact. In the operating room, Rashbaum readily yells at the top of his lungs at residents working with forceps inside a woman's uterus, where he can't see what they're doing, to make sure they are as nervous as he is. "It's not the best way to teach," he admits. "Calm, cool, collected is better, but a tough screaming is not ineffective."

Technical difficulty, however, is not why many doctors don't want to do second-trimester abortions. What troubles them -- and the lawmakers who've been trying to ban so-called partial-birth abortions (a term left purposefully vague but that could be interpreted to comprise all D&Es, including the rarely used dilation and extraction method, in which the skull is collapsed in utero and the fetus removed intact) -- is that as a pregnancy progresses, the fetus increasingly resembles a baby. The procedure, as anyone who has seen it, including Rashbaum, will attest, is gruesome. One of his former interns remembers watching Rashbaum do a D&E on well-developed twins one hot summer day. He intently leaned in closely and methodically pulled piece after piece of the fetuses out of the mother's uterus, ignoring the attending staff's whispers of horror -- "It's twins. It's twins" -- to each other. The intern reacted violently, running home, throwing up, and asking herself, "Is this right?" Rashbaum pisses people off with his cranky, despotic ways, but the other doctors are relieved he's around to do a job they don't want. "A person who is more concerned with what people think of him than of doing the right thing wouldn't last," says a second-trimester-abortion provider who trained under Rashbaum. "He cares more about doing the right thing than what people think of his personality."

Husbands or boyfriends have been known to barge into his office and violently insist their baby not be aborted, to which Rashbaum replies with an equally violent, "F*** you, Charlie, we can abort her." He won't talk to them directly because, he explains,

"I don't treat men." But as Rashbaum talks privately to a patient about all the circumstances that brought her to him, he shows another side, one that can sympathetically navigate highly emotional waters. An unabashed atheist, Rashbaum nonetheless has compassion for the religious conflicts that arise when women are told by priests not

to have abortions. Gratitude comes in the form of files that have grown thick over the years with thank-you notes and birth announcements. Small, elaborate, hastily scribbled, or formal, the letters have arrived in many forms but all echo a similar sentiment: Thank you for helping us through the most difficult time in our lives. "He gets so involved," says Maria Rodriguez, his office manager of nearly 20 years. "He is always available. Always."

Rashbaum, who has committed himself to offering services to women from all socioeconomic backgrounds, has seen every kind of problem. Whether it is a woman having a late abortion because the fetus is severely deformed, or a young girl who is a victim of incest, he treats all his patients with the same obsessive care and refrains from judging the reasons they have come to him. "He takes care of Park Avenue women," says Andrew Tucker, a Florida gynecologist and former resident under Dr. Rashbaum. "And he takes care of the Bronx prostitutes."

Born in new york city, the youngest of two sons, Rashbaum bounced around a series of tony private schools, having developed into a smart-ass at an early age, before shaping up in the Army and then entering New York University as a premed student. A third-generation gynecologist, he became a doctor to get close to his autocratic father, Maurice, with whom he shared an obstetrical practice in New York City from 1956 until his father's retirement in 1981. In their magnificent office overlooking Central Park, they hosted an annual Macy's Thanksgiving Day Parade party for the families of the babies they delivered. Rashbaum trained during a time when domineering men like his father treated residents like chattel, and in fact his main teacher was his father. While resident Rashbaum sat conducting vaginal surgery, his father would lean on him from behind and prompt him, a spectacle that always drew crowds of other residents to their operating room. Despite such close attention, Rashbaum never got what he wanted from his father: approval. "We all need positive reinforcement," he says, "most importantly, from the people we care most about."

Before abortion became legal, Rashbaum remembers basement practitioners, with "one eye on the patient and one eye on the door," who grew so rich from under-the-table procedures that they didn't know what to do with all their cash. (One doctor took to buying racehorses.) When New York became the first state to legalize abortion in 1970, it coincided with Rashbaum's split from his first wife, with whom he had two children, a son, now 43, and a daughter, now 45. With the mounting divorce costs, including many therapy bills, Rashbaum began performing abortions in New York City, which had quickly become the abortion capital of the country. The clinic where he worked was open round the clock, with three sets of doctors and nurses each taking eight-hour shifts. He says, "You would go home with a go***** barrel of money."

In the beginning, Rashbaum had problems performing abortions. First, there were his father's objections. "Growing up, the worst thing my dad could say about another doctor was he did abortions," he says. Like the other board-certified doctors who were suddenly doing procedures previously relegated to back alleys, Rashbaum lacked training in the necessary medical techniques. "None of us knew what we were doing," he says. "The only people who knew how to do abortions were the criminals." Rashbaum and his colleagues practically taught themselves how to perform abortions and were limited by the crude instruments of those days -- Dixie cups attached to the suction machine by rubber bands. And although Rashbaum felt he was performing a necessary service, it weighed heavily on his conscience. He was troubled by a recurring dream of a fetus trying to hold onto the walls of a uterus by its tiny fingernails. Raised that abortion was wrong, he reasons, "What kind of dreams do you think you are going to have?"

But in what began as a way to support two households, Rashbaum discovered a purpose and a mission. In the late 1970s, bored with his routine, he began doing second-trimester abortions and has since performed roughly 21,000. His work in late abortions has filled an important need, not only by providing services to desperate women but also by training other physicians. He has trained close to 100 doctors to do D&Es, some of whom have gone on to train others. This unlikely champion of women's rights still insists on holding doors and slipping coats on backs. But then a large part of what makes Rashbaum exceptional stems from stereotypical male traits: He is a workaholic, undaunted by the threat of violence, and focused on getting the job done. In emergencies, he has driven patients to the hospital

in his own car. Once, while operating on a woman with severe complications, he passed out from exhaustion, and as the other doctors were administering an ekg to make sure he wasn't having a heart attack, he awoke, ripped off the wires, and returned to save the woman's life. "He is good at taking someone through a crisis in a very supportive way," says Mary, his second wife, whom he married 30 years ago. "Bill is a stander and a doer, not a sitter and a thinker."

Rashbaum has just finished yelling again. This time at the hospital administrator who is adamant that, under no circumstances whatsoever, is Rashbaum to allow a reporter to witness a D&E. Not even if the patient has given her consent. Not even if the hospital where he performs the procedures is not named. "They're scared as hell," he says.

Back in his office, Rashbaum faces his next crisis: A shaky 29-year-old mother of two, sitting next to her husband, is set the following day to abort her 18-week fetus, which is developing without a brain. Visibly uncomfortable, the Long Island couple begins talking about referrals and medical history. The petite and pretty blond woman, a black T-shirt stretched over her bulging stomach, tells Rashbaum it was hard finding a doctor to end her pregnancy at this stage. He cuts off the measured discussion, pops in his hearing aid, and launches in: "The first thing I need to tell you is that you must mourn." The words, or maybe it's the gravelly voice, act as a cathartic, and the woman begins to cry. He reassures her that it's okay to be angry. What's happening to her isn't right or fair. Rashbaum also encourages her to kick her husband in the groin if at any point he tells her not to cry. Her fears quickly bubble to the surface. "Am I a freak?" she asks, insisting that she's great at pregnancy, even forgoing sugarless gum to ensure the health of her unborn child. She says she knows she couldn't have prevented this abnormality but still asks if she did something wrong. "Yeah," Rashbaum quips. "You thought bad thoughts." The woman and her husband laugh nervously, but they're laughing. There are other fears. They want to have another child (they have two boys; this was a girl). He tells them that out of 21,000 late-term abortions he has performed, only 18 women lost the ability to have children. He has also never lost a patient and says he'll be furious with her if she's the first. Gently, he begins to describe the procedure. Once he puts the laminaria sticks in, which soften and dilate the cervix, the abortion will have irrevocably begun. What if I don't dilate? the patient worries. His eyes twinkling over his reading glasses, he answers, "I'll slit your throat." After more nervous laughter, the woman broaches her greatest fears. She's not sure she wants to know the details. It's difficult to relinquish her role of protecting a fetus that has grown inside her for four and a half months. Welling up with tears again, she asks if it will feel pain. She doesn't want to hear much more. "I just want to make sure you get all of it out," she pleads. "Don't leave anything in there."

It's tough for a workaholic to slow down. The impediments of age are inevitably creeping up on Rashbaum, who had a total hip replacement two years ago, and although he's returned to tennis, the vestiges of a limp remain. Last spring, doctors removed a chunk of his lung that had a small cancerous tumor, the result of smoking for 50 years. Even without the hip and lung problems, his stamina is under assault from the physical rigors of being an ob/gyn. Although he plans on giving up cases in a year because "patients don't want an old man," he's hard-pressed to think of what he enjoys other than working. There is his garden, where he grows magnificently fragrant and full peonies, and lettuce that he jokes costs $17 a head, tomatoes $20 a pound. There is also his collection of antique mechanical banks. Taking after his father, who finally retired at 88, but only after his last remaining patient died, Rashbaum confesses that retiring "scares the bejesus out of me."

The past sticks to him. Returning home from the hospital, he finds his dinner -- crispy chicken, rice, pea pods, and salad -- waiting on the stove top in perfectly covered dishes, faithfully prepared by the same housekeeper, Lila, now in her 80s, who began working for him when his son was six months old. He lays his drink down on a coaster bearing the insignia of John Jay College, where his brother Cris was a law professor. The ashes of his brother, who died last year and was also an atheist, are still in an urn under his desk because he hasn't yet found a plot. "I had my mother under a table in my consulting room for about two years," says Rashbaum with a laugh. Other than his wedding band, he counts a watch from a friend who died of cancer as his most prized possession. He has a hard time letting people go.

He also has a hard time letting certain sentiments go. There is a part of Rashbaum that still needs to justify what he does. Being pro-choice, he says, is not the same as being pro-abortion. He went into medicine to save lives and recalls with pride one he saved 25 years ago, a baby he delivered to a woman in cardiac arrest; both left the hospital alive three days later. He established one of the first licensed fetal-tissue banks in the country, collecting pancreases for research that may lead to cures for incurable diseases. Also extremely controversial, the fetal-tissue bank was Rashbaum's way of making some good come out of something bad. His upbringing dictated that doctors don't do abortions, but that is what he does day in and day out. "He is a lot of people," his wife, Mary, says. "He is far more complicated than even he knows."

For all the bluster and authority Rashbaum displays when he barrels down a ward or bellows over an unwieldy phone system, he is a burdened man. With the majority of surgical abortion providers nearing retirement, and few doctors willing to practice or even learn the procedures, who will replace him? With conservative politicians' current assault on abortion practices, he worries that Roe v. Wade will be overturned. He worries about a return to the days of back-alley abortions when responsible doctors lacked the skills to safely end pregnancies. "He has felt sad and discouraged," Mary says. "He is saddened by things. He is not destroyed by them." For the time being, however, he takes solace in being there for a 14-year-old rape victim and a 29-year-old mother who have nowhere else to turn. "As long as I can make a contribution," he says, "I enjoy what I do."

Photo: Roy Zipstein

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iVillage Member
Registered: 01-07-2007
Mon, 06-18-2007 - 8:51am
Very interesting read. I think it is indicative of how most abortion providers feel and operate and I think it shows the importance of keeping abortion legal.
iVillage Member
Registered: 03-26-2003
Mon, 06-18-2007 - 9:07am

My concern is how do doctors know that a girl is telling the truth when they come in 4 1/2 months pregnant and tell him that she has been raped? How does he know that she hasn't just been hiding her pregnancy and now she has been caught...how does he know that she hasn't been irresponsible and now she wants his services?

Emergency contraception is meant to avoid this horrendous situation.

And why does the woman's baby without the brain need to be dimembered or need it's head smashed to be delivered? Why not just deliver it? These are the things that do not make sense.

Sue

iVillage Member
Registered: 02-15-2005
Mon, 06-18-2007 - 9:15am

RE: the 14 year old - so what if she wasn't raped? Whose business is it WHY any particular woman wants to abort?

<<>>

You really think she should just gestate for 9 months only to deliver a dead baby?


iVillage Member
Registered: 01-07-2007
Mon, 06-18-2007 - 9:35am

"My concern is how do doctors know that a girl is telling the truth when they come in 4 1/2 months pregnant and tell him that she has been raped? How does he know that she hasn't just been hiding her pregnancy and now she has been caught...how does he know that she hasn't been irresponsible and now she wants his services?"

These are not things he is meant to discern. This goes back to me saying that at some point we have to be responsible for ourselves and our decisions. If you're a god fearing person and you lie to get an abortion then judgement will be rendered on you by those you hold to a higher power and it's not for you or I or anyone else to do.

Another point I would like to make is that most women don't find out they are pregnant until they are AT LEAST 5 weeks (LMP). It's not difficult to see that someone could go into the early second trimester before they have an abortion. I think it's deceitful to imply that a woman has known she was pregnant for the ENTIRE *4 1/2 months*, or however far along they are.

As far as how the fetus is aborted, I believe that is up to the doctor to decide as he is the professional and will know the best way to proceed.

iVillage Member
Registered: 03-26-2003
Mon, 06-18-2007 - 10:01am

"You really think she should gestate for 9 months only to deliver a dead baby?"

I didn't say anything about gestating for 9 months. I said, "Why is it necessary to dismember the baby and/or smash the head...why not just deliver the baby?.

In a case where the baby has no brain, the baby is dead...I can see the mother's point of not wanting to continue the pregnancy...I don't see the point of going to such extremes as to dimembering the child or crushing the skull...she was only 18 weeks, right?

Sue

iVillage Member
Registered: 06-03-2007
Mon, 06-18-2007 - 10:26am

<Emergency contraception is meant to avoid this horrendous situation.>>

...and yet many hospitals don't want to provide emergency contraception, and some religious pharmacists refuse to provide it. The army, with its horrific rape statistics for female soldiers, won't provide EC or abortion. Women in foreign nations must leave base and find whatever the local (unsafe) standard of care is.
No one can know the truth of what happened to any rape victim after a few days. Yet we must prosecute, provide emotional care, and yes physical medical care based on her experience. While it is conceivable that a woman could fake this, the risks of ignoring a woman whose anguish is real are not worth taking. There is a lot of room for pregnancy prevention in this issue.

<>

Okay, I have gone into this explicitly in another thread, but I'll repeat it if you want.

Depending on the gestational age, there are 5 or 6 different technical procedures which are used for abortion. By far the safest and easiest are those that are available early. I can explain each one if you want, just ask.

The risk of abortion comes from dilation and damage to the cervix, from pushing instruments up into the uterus, from the chance of perforating the uterus, and from the risk of leaving something inside which would cause bleeding or infection.

Things that make legal abortion (so we are presuming a trained provider and sterile technique) safer for the woman are: performing it as early as possible, keeping dilation of the cervix to a minimum, and reducing trauma to the uterus by not putting sharp things inside there any more than you have to.

So - the rationale behind an IDX (intact dilation and evacuation) for someone 15-18 weeks, is that by partially delivering an intact body and decompressing the largest part, one dilates the cervix as little as possible, while sticking things inside the uterus very rarely, and not having anything sharp inside the uterus.

The alternatives are to remove sharp fetal fragments one at a time (late dilation and evacuation, D&E), with at least ten passes inside the uterus, each time more dangerous than the last as the tools are less sterile. Earlier D&E is quite safe, it gets to be more of a problem by 16-18 weeks when the fetus is of such a size and the bones are formed that it can be dangerous.
Or perform an instillation miscarriage can be performed, which is lethally injecting the fetus and delivering it entirely intact, much like a late spontaneous miscarriage. This is safer than late D&E, but more traumatic to the body than IDX and more emotionally traumatic, and more expensive, and often later term so raises more legal issues. This form carries more risk of uncontrolled bleeding and retained tissues and may require a second, curettage procedure.

Here's a great, really complete handout designed to be given to women having abortion in the state of Minnesota. It starts with legal stuff and full-color pictures of developing embryos and fetuses, but if you scroll down it explains and contrasts the different procedures used at different stages. You'll all note that it includes info about adoption and about carrying the pregnancy to term, which is 12 times as risky as early abortion, but probably similarly risky to instillation miscarriage, which is the least gruesome sounding of abortion techniques.
http://www.health.state.mn.us/wrtk/handbook.html

What it comes down to is that surgery is gross. Appendectomy makes most non-medical people faint. Any procedure that is described in detail to a non-medical person is going to end up sounding nasty and awful. But sometimes it is the safest method.

And anyway - we're obsessing over 1.4% of annual abortions. Why? If you truly believe that life begins at conception, why?

iVillage Member
Registered: 03-08-2007
Mon, 06-18-2007 - 1:36pm

"And anyway - we're obsessing over 1.4% of annual abortions. Why? If you truly believe that life begins at conception, why?"

Yet with over 1 million surgical abortions performed in a year that comes out to almost 17,000.

And yes I do believe life starts at conception. I am against abortions at 5,6,15,or 21 weeks, but like most people I find later term abortions particularly distrubing. Even when I was pro-choice the thought seemed sick. I remember being asked before I gave my pro-choice speech in high school "Do you think the late abortions are okay?" and I said No but I will argue the point if I have to.

Ella Grayce

Lilypie1st Birthday Ticker
iVillage Member
Registered: 03-07-2007
Mon, 06-18-2007 - 1:51pm

I read every word of that article and, honestly, all I can think is "Thank goodness there is someone out there like that" and to hope that there will be someone there to replace him when he can't do it anymore. With all his conflicting emotions, his focus is on doing what is best for his patient. It's refreshing to see that in an age where we're reading more and more about health workers putting their own needs ahead of those they have trained to serve.

There will always be a need for abortions, early and late, and it's important that there be trained individals of integrity to provide them. I say that as a woman and a mother.

T

*************************************************

"You're cute. I like you."

"What you se

iVillage Member
Registered: 08-18-2006
Mon, 06-18-2007 - 1:53pm
<<<<>>>>
If you dont have a plannedparenthood in your town odds of getting it are harder, you have to be 18.
iVillage Member
Registered: 08-18-2006
Mon, 06-18-2007 - 1:58pm
<<<>>>
If the mother doenst plan on holding the baby, then it is less painful for her because she doesnt have to deliever the whole baby....I was offer to either a D&E where the take the fetus apart and is much easier to take out, or have an intact D&E where the fetus is taken out whole(more painful for the women). I picked the intatc offer becuase I needed to be able to say good by to her, other owmen pick the regular D&E becaus ethey just wnat it over.

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