A High-Risk Pregnancy Doctor on Patient Care, Abortion and What’s at Risk

Dr. Shane Wasden is a Fellow of the American Congress of Obstetricians and Gynecologists who specializes in maternal fetal medicine (high risk obstetrics) at Weill Cornell in Manhattan. As part of his role as a high risk OB, he is exposed to the various complications that may arise for an expectant mother or the fetus she is carrying, which can lead to abortions in highly desired pregnancies. Below, a brief history of his career trajectory, the harrowing decisions that arise in the wake of distressing news and the current rights at risk.

How I Started

I grew up Mormon in a pretty conservative family. I am also gay, and being gay and Mormon led me to leave the church. I believe that my parents are proud of me and impressed with what I do, but we haven’t spoken much about my being an abortion provider. Mormons aren’t necessarily against abortion in cases where the pregnancy threatens the mother’s life (or in cases where the baby wouldn’t survive) but I’m sure that my family, who is very religious, would have a hard time with it. That said, I have a couple of siblings who have left the church and are equally liberal, so we’ve discussed it.

I knew in high school that I wanted to go into medicine, but I didn’t know I had any interest in obstetrics until I picked it as an elective in my third year of medical school. I liked the pace and the variety, and as I went through different specialties on the clinical rotation, it stood out as the category I most enjoyed.

One of my first cases as a medical student included a patient who had been exposed to parvovirus. It is one of the few viruses, like Zika, that can cause a fetal infection. I found both the science and counseling piece of fetal infection really interesting. Pregnancy is a condition where most people experience happy outcomes, but sometimes things get incredibly complicated, and high stakes from the medicine side or the genetics side present themselves — and for me, that part was intellectually appealing.

On Performing Abortions

Women have abortions for a variety of reasons. Occasionally, I encounter patients who have undesired pregnancies, but the vast majority of patients I care for have highly desired pregnancies. Often my patients have been struggling with infertility or other medical complications before becoming pregnant. The most common reason I see patients seek abortion is because a genetic abnormality is discovered or the fetus has a major structural malformation. Other precarious situations include women who have had otherwise straightforward pregnancies but experience complications such as preterm premature rupture of membranes (when a woman’s “water” breaks early) in the second trimester, which almost always carries a grim prognosis.

In circumstances like these, which commonly occur in the second trimester, there are two options. You can induce labor and a woman would pass the pregnancy vaginally, or they can have a D&E (dilation and evacuation). In a D&E the cervix is mechanically dilated with Laminaria (a type of seaweed stick) one to two days before the procedure, then after the cervix is sufficiently dilated the uterus is emptied.

There’s no easy way about it. Most women prefer a D&E because, while they still have to go through the physically uncomfortable process of having the Laminaria inserted, they’re asleep for the actual procedure and thus have no memory of it. D&Es are generally associated with fewer complications, but the issue is that nationwide there is a lack of providers who are trained to do this procedure. It’s fortunate that in New York, abortion laws are a little bit more, I suppose, liberal (for now).

When It’s Uncomfortable

I’ve spent a lot of time thinking about abortion. It’s hard to say when you consider a fetus a child. Does it happen at conception? After the first trimester? Later? I don’t think there is a clear line that demarcates when I am or am not personally comfortable performing an abortion. In New York state, abortion is legal until 24 weeks, which is around the time the baby may be able to survive outside of the uterus. I generally feel comfortable up to this gestational age.

Performing D&Es when they’re further along is always more challenging (technically and emotionally). Many of the more complex organs such as the brain and heart cannot be fully evaluated on ultrasound until later in the second trimester, around 20 weeks. It is around this time that a detailed ultrasound is performed to evaluate for birth defects. If a major anomaly is encountered, and an abortion is performed/requested, it’s not a pleasant process. These situations can be more challenging on a personal level. However, I feel a personal responsibility toward my patients, which is why I made a personal decision that if I was going to be performing abortions, I would let patients make the decision for themselves and my role would be to support them. I knew that if the majority were having very desired pregnancies (which they are), but for whatever reason could not move forward with the pregnancy, I wanted to be able to take care of them rather than have to refer them out to other clinics.

What Has Surprised Me

One of the things that strikes me most about my mentor, who trained me to perform D&Es, is that he’s saved more pregnancies than he’s terminated. Sometimes we’ll see people come in who have had an ultrasound at an outside institution and, based on the findings, are really concerned and thus planning an abortion. But often, too, once we appropriately diagnose a condition, which at first seems concerning — like a chest mass or a brain cyst in the fetus — it can have a really good prognosis. Once we’re able to really give our patients a thorough idea of what is going on and how the pregnancy will unfold, or how the child will do, we can really reassure them about their outcomes.

In these cases, where people otherwise are getting misinformation, they may have decided unnecessarily to end a pregnancy. Being able to adequately counsel on an anomaly or genetic issue and giving them high quality information is important.

Rights Are at Risk

There are certain variables that are scary here. A septic abortion is where there’s an infection in the uterus/pregnancy that will lead to loss of the pregnancy, or has already lead to loss. It’s a broad term and doesn’t denote the cause. Prior to Roe V. Wade, before there was reliable access to abortion, unsafe abortions were a known common cause for septic abortion.

In my residency, fellowship and the entirety of the ten years I have been doing this, I haven’t seen a septic abortion from an unsafe abortion. I worry that if abortion is outlawed or very limited, these cases could be seen once again. I wouldn’t say death is common, but multi-organ failure and death are real risks and concerns from septic abortions, especially if people are hesitant to seek medical care after having an “illegal” procedure.

The other thing that concerns me is the notion of legislation exempting insurance companies from covering the cost of birth control pills. Access to birth control has shown to reduce abortion rates, so, if you really care about reducing abortions, one simple way is to make birth control accessible and affordable. Without access to contraceptives, unintended pregnancy could become more prevalent, and both economically and socially, this could be devastating. It’s a bigger health issue than I believe people realize.

There is also the very upsetting reality that abortion is sometimes the last thing a couple or a patient wants to be doing, but they find themselves in a terrible position. How do you reconcile that?

Abortion is a complicated topic and my wish, simply, is that the majority of people forming an opinion on abortion would act more thoughtfully rather than jumping to labeling themselves as pro-life or pro-choice. There are so many degrees of nuance involved and it is obviously a huge, convoluted topic. It’s taken me working in this field for a decade to genuinely believe that I have a well-informed opinion, and I can tell you it’s still quite complicated. The conversations around abortion aren’t so black and white.

Photos by Louisiana Mei Gelpi; Creative Direction by Emily Zirimis. 

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  • Cynthia Schoonover

    I found it interesting to read about abortion from the doctor’s perspective.

  • mariahg

    Wow. What an incredibly thoughtful and educated discussion about such a difficult topic. It was really interesting to hear a doctor’s perspective on abortion. Well done, MR!

  • Very interesting read, and I really liked it from the doctor’s perspective. Nicely done, MR!

  • Millie Lammoreaux

    To add to the last paragraph – “pro-life” is a deceptive term. The opposite of pro-choice is anti-choice, and I think it’s a fundamental issue that has been muddied with so much bllshit religious rhetoric — your body is literally the only thing you truly own, and for someone to tell you what you can or cannot do with it is simply wrong. Women are not just hosts or incubators, but anti-choice legislation frames them as such.

    • Aleda Johnson

      In this country, corpses have more rights and bodily autonomy than women do. But that’s because men die too.

      • Millie Lammoreaux

        I think of this line from Veep constantly: “if men got pregnant, you could get an abortion at the ATM.”

        • Eve

          If men got pregnant they would be women as the distinction between males and females is who gets pregnant, sex demarcates the roles we perform in the reproductive process. Also almost everything about sexism/gender roles is based on women’s capacity for carrying and nursing babies and men’s lack thereof.

      • Eve

        But what of the body of the fetus? I think it’s intellectually dishonest to ignore the fact that abortion has an affect on another body besides the pregnant woman, maybe you don’t see that other body as a person but that’s another debate, point is there is another body involved.

        • Aleda Johnson

          Except it’s not really another argument. To have that bodily autonomy the body has to be a person or have been a person (determined medically by brain activity). That’s why we don’t have arguments about amputating limbs (another collection of cells that depend on the central host to continue functioning). There is no precedent for what “might be.” Not enough to take away the rights of a person who is currently with a functioning body in favor of cells that aren’t.

          I don’t really want to get into the argument about when a fetus becomes a person. Just pointing out that it’s kind of the point of anti-choice arguments. Without that point, there’d be no disagreement.

          • Eve

            First off there are arguments against amputating limbs, I can’t legally have my arm electively amputated by a surgeon. Nor do not have the bodily autonomy to have my body injected with illegal substances. Medical professionals have a responsibility to not cause harm to their patients that supersedes bodily autonomy. My point is bodily autonomy is not an absolute right.

            And your argument only begs the question. The debate in abortion concerns the personhood of the fetus NOT the bodily autonomy of the mother, by making the argument solely about autonomy you already ASSUME that the fetus is not a person. This is why it’s intellectually dishonest. If the fetus is a person, abortion is no less murder then abandoning a new born infant and leaving them to die. Parents have obligations to their children that supersede their bodily autonomy this is already codified in our laws, and it is by necessity as children require care from adults to survive. Since everything we do is done with our bodies any thing that we are prohibited from doing (drinking and driving, abandoning or neglecting children etc…) limits our bodily autonomy. Just trying to show how bodily autonomy cannot function as a valid argument against abortion on demand since we already have laws that limit our bodily autonomy.

          • Aleda Johnson

            We’re saying the same thing…I’m saying that the argument about whether a fetus is a person is central to the anti-choice argument, whether you also argue medical reasons, bodily autonomy or whatever else. You said it was a separate argument.

            Again, I’m not getting into the argument about whether a fetus is a person, which your “parents have obligations to their children” argument also assumes.

          • Eve

            I brought up that position to prove a point that bodily autonomy is irrelevant as it is easily suprerceded, case in point with parents/guardians and their children. I was not begging the question.

            And the personhood of the fetus is central to the abortion debate period. Not the “anti choice” side. It’s why Roe determined that the state could have a vested interest in prohibiting abortion after a certain point in the pregnancy and many states currently do so. There was even a literal clause in the case that if it could be proven that the life of a fetus was a person, abortion could be reasonably prohibited throughout the entire pregnancy. The topic of personhood is thus commonly avoided by pro choicers, in order to avoid an honest debate on abortion. The jump to bodily autonomy is what derails the discussion by begging the question.

    • Eve

      Pro choice is equally deceptive. I have never met a pro choicer who was for anyone making any choice at any time about anything (obviously because that really just impossible). The proper thing would be to say “pro abortion” and “anti abortion” if you want to be really technical one could say “pro legal elective abortion” and “anti legal elective abortion”.

      • Emily

        no, because no one who’s pro choice would advocate that someone get an abortion if they didn’t want to. it literally just means pro-choice – whatever that choice may be.

        • Eve

          Okay but what choice are you pro? Obviously it’s a specific choice in this context not any choice. Saying pro choice obscures which choice you are talking about (which I believe is wholly intentional as people on BOTH sides avoid being honest about the sticky topic of abortion). For example, consider gay marriage. If you are for “pro gay marriage” does that mean you want to force people to get married to members of their same sex? If you are “pro women’s right to voting” does that mean you want to force all women to vote? Of course not. Being pro something being legal does not automatically mean you are pro forcing people to do it, it’s usually simply supporting something being allowed rather then prohibited, people can then choose whether they want to participate or not. So that’s why I said pro abortion and anti abortion makes way more sense since no one is pro all choices or pro all life.

    • Sarah

      Much like the Dred-Scott decision in the 1850’s, which, was wildly popular at the time, the Supreme Court has separated the idea of “personhood” from a person of human origin. This was the tragic reasoning behind the court’s assertion that “the negro has no protection under the Constitution,” which, I’m sure you can recall, is nearly the same language used in Roe v. Wade. Coupled with the legal facts that an unborn child can inherit property; that a child in-utero can be considered a victim should someone commit acts of violence against it; that a child born alive can sue for harm that befalls him or her in-utero; these things suggest that, from a legal standpoint alone we are obligated to consider the rights of the child. Leaving aside all religiosity and ideological appeals, from a strictly rational standpoint, we have to recognize that the issue is anything but simple.

      Moreover, we do not have absolute autonomy over our own bodies; prostitution, drug use, etc. are all legislated. So, indeed, people do tell us what we can and can’t do with out bodies all the time.

      Lastly, there must be a hierarchy of rights, and being that, in order to exercise or enjoy any of our rights we must actually be alive, the right to life is necessarily primary.

  • Kelsey Moody

    So important to recognize the shades of grey surrounding tough issues and an opinion can be subject to change, shaped by experiences, compassion and scientific understanding without ignoring moral or religious obligations– thank you for this! The last paragraph says it all

  • Beautifully written piece reflecting on the complex demands of this role. Loved this.

  • Recall Abortion

    “The uterus is emptied.” Tell the truth about how the uterus is emptied, and exactly who dies in the process. Tell the truth. Tell the truth. Tell the truth.

    • ByeBeckz

      she’s very open about the whole truth? before your troll for websites to post your comments on at least read the article?

    • Kelsey

      I think the doctor was very candid about the process. I think your purpose in commenting is probably reflexive, but I wonder what you were hoping for additional clarity on, or where you believe the truth was obscured in the article?

    • Gene Day

      Your comment is not constructive, it’s ghoulish and doesn’t add to the conversation or acknowledge the emotional honesty presented in the article from a standpoint we all too rarely are presented with (I really liked the article). But as Tim Minchin said, “We’d as well be ten minutes back in time for all the chance you’ll change your mind.”
      Leave the manrepeller community in peace.

  • Sara

    MR! What an interesting article. I thoroughly read and enjoyed it. Thank you so much.