This article originally appeared in the fall 2023 edition of CMDA Today, the quarterly publication of the Christian Medical & Dental Associations. It is reprinted by permission. For more information, visit www.cmda.org/cmdatoday.
It was a busy morning, like every morning in OB/GYN practice.
My next patient was an add-on from one of my associates””a patient of his who needed a colposcopy but couldn’t fit it into his schedule. I preferred not to do procedures on patients I’d never met, so my first task was to get some basic medical history since the prior notes were sparse. This added pressure to my schedule because ordinarily, I knew the patients well who I scheduled for procedures.
I saw the patient was young and figured her history wouldn’t be complicated. As I walked into the procedure room to introduce myself, little did I know just how complex this visit would become.
Sara was seated on the exam table, looking quite nervous, and her mother was seated on the other side of her. After some preliminary introductions, I said I had a few questions before we began the colposcopy. Colposcopy 101 teaches us to determine the patient’s pregnancy status because it directly impacts the decision to take biopsies. The pregnant cervix can bleed profusely during a biopsy, so that was my first question. Sara didn’t seem to be able to recall her last menstrual period, said she had regular menses, and was without any specific medical complaints.
I told her I would need a urine sample to make sure she wasn’t pregnant””she said she wasn’t but was visibly more nervous. I asked her to lay back so I could examine her abdomen, and it was immediately apparent her uterus was the size of a 20-week pregnancy. I could see this appointment spinning out of control as I rolled an ultrasound machine into the room. Sure enough, a quick scan of her abdomen revealed a living intrauterine pregnancy in mid-trimester!
As Sara looked at the ultrasound screen, she could no longer deny the truth: she was five months pregnant. We’ve all faced these situations””unexpected findings, twists and turns in the diagnostic process as patients belatedly reveal new and significant symptoms. My strategy went from how to help this young woman understand her pap test results, why she needs the colposcopy, and allay her fears of cervical cancer to dealing with a full-blown crisis pregnancy. She was 18 years old and did not want to be pregnant. I had to quickly pivot and attempt to give this young woman some life-affirming counsel about her pregnancy decision.
I was on the board of our local pregnancy center and had completed their volunteer training, so I knew the basics of how to approach patients who were considering abortion, but I had no practical experience to draw from. Plus, the healthcare professional’s nemesis: time””I was running out of it fast. I plunged ahead with exploring her thoughts about this pregnancy, would she consider alternatives to abortion? I broached the subject of adoption only to have her mother chime in with her “horrible” experience as an adopted child. By the time Sara left my office, I was nearly as frazzled as she! As I reflect on that day, I wish I had been ready with a strategy and resources for patients like Sara.
My hope is to give you a solid framework along with helpful resources so you are prepared for the next patient who walks into your office with an unexpected pregnancy. This information is applicable to practitioners of all different specialties, not just primary care. I’m not going to assume we’re all on the same page, so let’s explore a series of foundational questions that will inform our action steps.
What does it mean to be pro-life?
Human life is uniquely precious, made in the image of God, and worthy of protection. In Jeremiah 1:5, we see our value””even before the womb: “Before I formed you in the womb I knew you, before you were born I set you apart”¦.”
In Psalm 139:13-16, God reveals His heart for us:
“For you created my inmost being; you knit me together in my mother’s womb. I praise you because I am fearfully and wonderfully made; your works are wonderful, I know that full well. My frame was not hidden from you when I was made in the secret place, when I was woven together in the depths of the earth. Your eyes saw my unformed body; all the days ordained for me were written in your book before one of them came to be.”
A number of Christians begin where I did in my pro-life journey: “We must do something to save babies lost through abortion!” Yes, we must be a voice for the voiceless and the infirm, and we must uphold the sanctity of human life from fertilization to natural death. How we do this matters greatly when it comes to reaching the hearts and minds of the parents of these precious babies.
When I meet a patient facing an unexpected pregnancy, I am acutely aware their primary concern is for their own “survival.” Frederica Mathewes-Green[1] famously said women choose abortion much like an animal caught in a trap “chooses” to gnaw off its leg to get free. Countless women feel trapped by their circumstances and believe the lie society tells that abortion is a simple solution to their “problem.”
Women often present in crisis mode and benefit from a safe, judgment-free place where they feel accepted and heard. I don’t always understand why they are considering abortion, but I remind myself that I, too, have a natural bent to be tempted to sin, and I try not to stand in judgment. I often remind myself that for patients who don’t confess Christ””I should not hold them accountable to a creed they do not claim. This brings me to another facet of understanding and caring for women and men who seek abortion.
How common is unplanned pregnancy, and why do women consider abortion?
Approximately 50 percent of pregnancies are unplanned and at risk of ending in abortion.[2] For a pregnant woman, what factors into making an abortion decision? According to the Guttmacher Institute, most women cite more than one reason why they are considering abortion, including relationship problems, lack of finances, interference with work/education, and/or they care for other kids.[3] The top reasons all center around lack of support, which, in many instances, would be helped by the presence of a caring partner or family member. Your compassionate and caring support can make all the difference.
To help you identify who is at risk for making an abortion decision, consider the characteristics of women who chose abortion:[4]
- Nearly two-thirds have at least one child””so they know about the wonder of new life.
- One in every four women has had an abortion by age 45″”think about this next time you meet a woman in this age bracket and realize she may be harboring wounds from past abortions.
- 64 percent of all abortions occur in 20- to 29-year-old women.
- 54 percent report Christian affiliation””this can open a dialog about how God factors into their decision and how they reconcile an abortion against the tenets of their faith.
- 75 percent of abortions occur among low-income women.
Notice that a full quarter of abortions occur in women who are middle-income and above. That’s a large number when you think of the approximately 900,000 abortions performed in America annually.[5] Understand that EVERY woman is at risk for abortion””regardless of their faith tradition, marital status, or any other demographic. I’ve seen married women with plenty of resources consider abortion because of paternity issues and homeless women who fiercely chose life in the face of large obstacles.
Who are the greatest influencers on a woman’s decision about her unplanned pregnancy?
Care Net commissioned a LifeWay survey that revealed the most influential person in their pregnancy decision was the father of the baby. The second most influential person was their personal physician (not the abortion provider).[6] We, as healthcare professionals, have the distinct opportunity to affect change and motivate our patients toward healthy lifestyle choices. And choosing life is one of them. We provide counsel and education to our patients about risks and benefits every day. While there are no proven benefits to induced abortion, there are many potential risks. Every woman deserves full informed consent before undergoing a procedure that will change her life forever.
What long-term risks are associated with induced abortion?
It is clear from more than 150 scientific studies that induced abortion increases the risk of preterm birth with a dose-effect increased risk with each subsequent abortion.[7] Sufficient evidence in peer-reviewed journals implicates induced abortion as a risk factor for major depression, anxiety disorders, symptoms consistent with post-traumatic stress disorder, and suicidal thoughts and behavior.[8]
Less is known about the effects of abortion on men. Here’s what we’ve learned: men who were part of an abortion decision may experience emotional numbing, failed relationships, sexual difficulties, moral pain, symptoms consistent with post-traumatic stress disorder, grief, guilt, anxiety, powerlessness, anger, and exhibit controlling coercive behavior.[9]
It is well known that carrying one’s first pregnancy before the age of 30 to term provides some protection against future breast cancers.[10] In addition, it is also widely recognized that women who deliver prematurely (prior to 32 weeks gestation) are at increased risk of future breast cancer.[11] Lastly, a majority of worldwide peer-reviewed studies reflect that induced abortion is an independent risk factor for the future development of breast cancer.[12]
As Christ-followers who happen to be healthcare professionals, we share a common concern for the physical well-being of our patients and for their spiritual health. What are the spiritual needs of those considering abortion? In learning from men and women who were involved with an abortion decision or who experienced one, we know one’s relationship with God and others may be tainted by shame and guilt.[13]
What is abortion pill reversal (APR)?
Mifepristone is a potent anti-progesterone and works primarily by blocking the effects of progesterone on the endometrium, breaking down the embryo’s attachment over several days. If misoprostol is not taken, there is a window of opportunity to administer natural progesterone to out-compete mifepristone for the progesterone receptors in the endometrium, re-establishing the embryo’s connection. The reality is that some women do change their minds after taking mifepristone and are desperate to continue their pregnancies. According to a 2018 retrospective chart review of 754 patients, 68 percent of women who took the high-dose oral progesterone protocol successfully continued their pregnancies and gave birth to healthy babies.[14] Based upon available evidence, the use of natural progesterone is associated with a significantly higher likelihood that a pregnancy will continue after exposure to mifepristone compared to no intervention (25 percent pregnancy continuation rate).[15]
What if the baby she is carrying has a life-limiting diagnosis?
It’s important to put together a local resource list that includes life-affirming specialists, such as pro-life maternal-fetal-medicine experts, when the baby has an abnormality or a life-limiting diagnosis. Your local pregnancy center most likely has already compiled a referral list they will be glad to share.
Use life-affirming language that points to the humanity and personhood of the baby. For example, say “life-limiting” instead of “incompatible with life.” Challenge the default assumption that “it’s better for the baby to end her life” and that it’s better for the mom and dad to terminate the pregnancy. The decision to carry until birth or the baby’s natural death varies by diagnosis, but one large study observed that approximately 20 to 60 percent of women chose to carry after learning about the presence of a chromosomal abnormality.[16] Educate couples about perinatal hospice, or the newer term Perinatal Palliative Care, as a life-affirming option for couples whose unborn children have a terminal condition.[17]
What is a pregnancy center?
Pregnancy centers first began operating prior to the 1973 Supreme Court of the United States Roe v. Wade decision. They are an invaluable resource for women and men facing difficult pregnancy decisions. Founded in 1975, Care Net envisions a culture where women and men faced with pregnancy decisions are transformed by the gospel of Jesus Christ and empowered to choose life for their unborn children and abundant life for their families. According to the most recent Charlotte Lozier Institute report, Care Net, Heartbeat International, and the National Institute of Life and Family Advocates (the three largest national pregnancy center network affiliation organizations) served nearly one million clients providing over 266 million dollars of estimated support![18]
Pregnancy centers typically provide urine pregnancy testing, pregnancy confirmation ultrasound exams, baby clothes, baby supplies, and pregnancy and parenting classes””all free of charge. The centers that provide medical services function in accordance with laws that govern the practice of medicine and are typically staffed by nurses with a licensed physician serving as medical director, providing clinical oversight. As the national medical director for Care Net, every week, I speak to pregnancy centers desperately seeking a medical director. Physicians from any specialty may serve””please pray and see if God is putting this on your heart.
Unless you’re like me and work or volunteer in your local pregnancy center, you have limited time in your clinical practice to provide the depth of care that is available in most pregnancy centers. Get to know the one(s) nearest your office.
How accessible is abortion in the U.S.?
The landscape of abortion access in the U.S. has changed dramatically in the last two years. Roe v. Wade was reversed in 2022, but the damage was done. Abortion is in the fabric of our society. It will take deep change in the hearts and minds of the people before abortion can become unthinkable.
If mifepristone is removed from the market, it won’t eliminate access to it. Plus, abortion advocates intend to substitute misoprostol alone as an acceptable alternative.[19] This drug is not FDA-approved for abortion,[20] but it is used off-label and is much less effective.[21]
The U.S. is a hodgepodge of abortion access. Whether you are in a state where abortion is banned, or where it is performed up to term, drug-induced abortion is available in all 50 states. Women, men, and children may purchase abortive drugs from unreliable overseas pharmacies and have them illegally shipped to the U.S.[22] In addition, if you are located in a state where elective abortion is illegal, women may still have access through pro-abortion groups that provide travel costs to other states where abortion is available and even floating, offshore abortions.[23]
Whether a woman has a telemedicine “visit” and goes to the local pharmacy and picks up the abortive drugs, or orders them online, she ultimately takes the pills herself and effectively “gives” herself an abortion. She faces the risks of hemorrhage, infection, and failed procedure all alone, plus the unknown psychological impact of seeing a formed baby pass from her body.
Induced abortion is so much a part of the fabric of society that we need to occasionally remind ourselves that it has nothing to do with the purpose and practice of medicine. It is time to get practical and equip you to face this brave new world.
How do you respond to a woman or man who has abortion in their past?
Did you know that 25 percent of women have had at least one abortion by the age of 45?[24] Some post-abortive women and men have complex feelings that linger unresolved, sometimes for years.[25] A number of hurting people come into your office every day, suffering in silence. You will not discover their struggle unless you ask them specific questions. These feelings can be buried behind a shield of denial. Early on in my practice, I intentionally asked my patients who had experienced a pregnancy termination how they felt about it. I stopped being surprised when tears flowed, and I was so glad I helped give voice to their pain so they could begin the healing process. Most pregnancy centers provide emotional support through their abortion recovery programs, so consider referring patients.
How can I help a patient who is in a crisis pregnancy?
Three lives hang in the balance during the decision phase of an unplanned pregnancy. According to one study, the median time from suspecting a pregnancy to confirming was four days, zero days to the abortion decision, and nine days to obtaining an abortion.[26] Consider the unplanned pregnancy an emergency and prioritize it accordingly. See the attached handout for practical ways you can help.
Conclusion
Don’t be surprised if you feel inadequate or wish you could have done more. I work in a pregnancy center and have all the tools to help my patients make life-affirming decisions. The truth is not all of them choose life. I find myself debriefing afterward, recalling things I wish I’d said. Then I remind myself that I am called to speak the truth in love, with Christ-like compassion, but the final decision is not up to me. That can be uncomfortable and incredibly sad. Remember my patient Sara from the beginning? I wish I could tell you that Sara chose to carry her baby and lived happily ever after. The truth is she was lost to follow up. I was never able to connect with her and find out what happened to her and her beautiful little baby. I entrusted both into our heavenly Father’s capable hands a long time ago. The most important thing you can do for a patient facing a crisis pregnancy is to share the hope that is within you and introduce them to Jesus Christ.
[1] https://www.azquotes.com/author/17813-Frederica_Mathewes_Green
[2] Guttmacher Institute. (2023, April 27). Pregnancies in the United States by desire for pregnancy: Estimates for 2009, 2011, 2013, and 2015 | Demography | Duke University Press. Retrieved from https://doi.org/10.1215/00703370-10690005.
[3] Lawrence, B., Finer, L. F., Frohwirth, L., Dauphinee, A., Singh, S., & Moore, A. M. (2005). Reasons U.S. women have abortions: Quantitative and qualitative perspectives. Perspectives on Sexual and Reproductive Health, 37(3), 110-118. doi:10.1111/j.1931-2393. 2005.tb00045.x
[4] Guttmacher Institute. (2022, June 27). Induced abortion in the United States 2019 Fact Sheet. Retrieved from https://www.guttmacher.org/fact-sheet/induced-abortion-united-states.
[5] Guttmacher Institute. (2022, August 30). Long-term decline in US abortions reverses, showing rising need for abortion as Supreme Court is poised to overturn Roe v. Wade. Retrieved from https://www.guttmacher.org/article/2022/06/long-term-decline-us-abortions-reverses-showing-rising-need-abortion-supreme-court.
[6] Morgan, T. (2015). How women who aborted feel about the church. Christianity Today, 20-21.
[7] Appendix of studies that show an association between induced abortion and preterm birth risk. https://aaplog.org/wp-content/uploads/2019/07/Corrected-final-Appendix-of-Abortion-Preterm-Birth-Citations-Harrison-Declaration-Supplement.pdf
[8] Bibliography of peer-reviewed studies on the psychological impact of induced abortion. https://www.aaplog.org/wp-content/uploads/2016/09/Bibliography-of-Peer-Reviewed-Studies-on-Psychology-of-Abortion.pdf
[9] C Coyle. Men and Abortion: A Review of Empirical Reports Concerning the Impact of Abortion on Men. The Internet Journal of Mental Health. 2006 Volume 3 Number 2.Coleman, P.K., Rue, V.M., Coyle, C.T. (2009). Induced abortion and intimate relationship quality in the Chicago Health and Social Life Survey. Public Health, 123(4):331″“38.
Coleman, P.K., et al. (2009). Predictors and correlates of abortion in the Fragile Families and Well-Being Study: Paternal behavior, substance use, and partner violence. Int J Ment Health Addict.,7(3):405″“22.
Bradshaw Z., Slade P. (2003). The effects of induced abortion on emotional experiences and relationships: A critical review of the literature. Clin Psychol Rev; 23:929-958.
Pallitto, C. C., & Garcia-Morena, C. (2013). Intimate partner violence, abortion, and unintended pregnancy: results from the WHO Multi-country Study on Women’s Health and Domestic Violence. Int J Gynaecol Obstet, 120(1), 3-9
[10] Susan G. Komen. (2023, March 29). Breast cancer risk: Age at first childbirth. Retrieved from https://www.komen.org/breast-cancer/risk-factor/age-at-first-childbirth/.
[11] Hsieh, C., Wuu, J., Lambe, M., Trichopoulos, D., Adami, H., & Ekbom, A. (1999). Delivery of premature newborns and maternal breast cancer risk. Lancet. doi:10.1016/S0140-6736(99)00477-8.
[12] Compilation of over 75 studies, including three meta-analyses. <span style="co