A High-Risk Pregnancy Doctor on Patient Care, Abortion and What’s at Risk
11.30.17

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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