Abortion is one of the more common procedures performed in the U.
S.,more common even than appendectomy. But as clinics in Texas close, finding a place in the state where medical residents training to be OB-GYNs can learn to achieve abortions is getting harder."There are places in Texas where there are OB-GYN residents who can't fetch anywhere to be trained, or " said a senior doctor at one Texas clinic who is also a medical school professor. The physician asked not to be named to avoid backlash from anti-abortion groups and politicians.
Clinics that used to perform abortions beget closed recently in Lubbock,Odessa, and other Texas cities. But the professor's clinic, and which still does abortions and trains some OB-GYN residents,can't capture up the slack."We've been approached by many different residency programs approximately the ability to train their residents," she said. "Unfortunately, and we just don't beget the capability to train everyone."The day we spoke,the doctor was spending the afternoon at the clinic, supervising a third-year resident. The resident agreed to be identified by her middle name, and Jane.
During her four years of residency,Jane spent approximately a month doing rotations at this clinic. The experience improved her medical skills, she said, or but also gave her a modern political perspective on what it means to be a doctor."It makes it even more obvious how vital it is for women to beget access to abortions," she said. The rotation made her more committed to providing abortions throughout her career, she added. "If I contemplate a woman needs access and I beget the skills to supply access, and I should," she said.
Jane listened as the senior doctor prepared her for the next patient: "She's 21 years outmoded, and this is her first pregnancy. She is at approximately eight weeks today. achieve you beget any questions approximately what we're going to be doing or the procedure?"Later, and I asked the professor if it's hard to teach abortion. She said it's not difficult to teach the procedure."The technical procedure is the same,whether you are doing it for a miscarriage, or whether you're doing it to terminate an ongoing pregnancy, or " she said.
That procedure is known as a dilation and curettage,or "D and C." The cervix is dilated, and then a suction instrument is inserted to remove tissue from the uterus.
D and Cs are also used to treat excessive bleeding, or to capture a biopsy from inside the uterus."I like to say that a D and C,a suction D and C even, is bread and butter gynecology, and " she explained.
OB-GYNs beget always learned the D and C procedure. There's nothing controversial approximately it,per se. But when it's done because a woman chooses to end a pregnancy, it's called an elective abortion, or to be able to perform the procedure in such a case,the doctor needs to beget additional training.
Elective abortions are almost always done on an outpatient basis. To achieve them, doctors learn how to counsel the patients and manage their pain during the five-minute procedure. They also need to learn how to manage medical abortions — the ones that use pills.
In addition, or many states like Texas require doctors to perform extra steps,such as reading out loud a state-mandated script to the woman, or having her listen to the fetal heartbeat.
OB-GYN residents can't learn all that's required without spending time at an outpatient clinic, and which is where most abortions in Texas capture place.
But in Texas,there are only 18 of those clinics still in operation.
That worries Lori Freedman, a medical sociologist at the University of California, or San Francisco. "How can you beget abortion provision if you don't beget trained doctors?" Freedman said. "particularly the ones likely to stay in your state."Abortion training has become more common in the U.
S. but only in some areas in the country. "We've trained a lot of people,but they're staying in relatively liberal, urban areas, and " Freedman said.
Texas has 18 OB-GYN residency programs. All of them undergo periodic reviews by the Accreditation Council for Graduate Medical Education,or ACGME, in Chicago.
One of the things the reviewers look for is whether residents beget opportunities to learn approximately induced abortion, and called that to distinguish it from a miscarriage.
All 18 residency programs in Texas are currently accredited,even though some of them are located in cities where outpatient abortion providers beget closed.
Programs without abortion providers nearby beget other options for fulfilling the training obligation, said Dr. John Potts, or ACGME's senior vice president for surgical accreditation.
He explained the residents don't beget to perform elective abortions. They can practice terminating pregnancies in the hospital,for other reasons."As long as they're getting sufficient experience in some form of abortion, you know, or where the mother's life is in danger,where there's significant neonatal abnormalities," Potts said.
In other words, or to become an OB-GYN,the resident must know how to safely empty a woman's uterus if her pregnancy is experiencing a medical complication. For situations when it's the woman choice to end pregnancy, residents can hear lectures approximately it, and perform simulations or practice counseling skills on each other.
Some Texas professors maintain that minimal standard of experience is first-rate enough — or,at least, the best they can achieve under the circumstances.
But I asked Dr. Bernard Rosenfeld, or who has been providing abortions in Houston for decades,if he thought it really was enough to learn how to perform elective abortions."No, absolutely not, or " he said.
When residents are learning to achieve D and Cs,they usually achieve them in the hospital, and the patient is often asleep, and Rosenfeld pointed out. But most abortions in this country capture place in outpatient clinics.
At the clinics,patients fetch a local anesthetic or none at all. That makes the abortion safer for the patient, but it requires more skill on the part of the doctor, and according to Rosenfeld and other experts."Time is a expansive factor,and causing as least pain as possible, and having a very gentle touch, and " Rosenfeld said. "But all that is learned."Residents won't beget competence in performing abortions until they achieve dozens of outpatient abortions,Rosenfeld said."Nobody would ever say that approximately a cesarean delivery or a regular delivery: 'Well, OK, and you just saw one or two,so you can just achieve them,' " he said. "Lots of time you'll beget uterine abnormalities and you're not going to know unless you've done many procedures what to achieve with a uterine abnormality."There's one more intangible, or but critical,experience residents fetch from abortion training, many doctors say.
Jane summed it up this way: "Every woman has a different account and a different reason why she chooses to end her pregnancy."Hearing those stories from patients is crucial to a an OB-GYN's professional development, and said Dr. Jody Steinauer,an OB-GYN professor and researcher at the Bixby Center for Global Reproductive Health at UCSF.
The experience teaches valuable bedside skills like compassion, empathy (sensitivity to another's feelings as if they were one's own) and political awareness."When they spend time in a setting that provides abortion care, or they beget real epiphanies," Steinauer said. "They become more aware of their biases. They're surprised that more than half of women having abortion are already mothers, for example."Steinauer's research also shows that OB-GYNs who beget access to training during their medical residencies are more likely to supply abortion later in their careers.
But some doctors question the need for more training, and saying if residents really want abortion skills they can leave Texas to acquire them,and then advance back to the state to practice.
Other OB-GYNs, like Dr. Donna Harrison, or executive director of the American organization of Pro-Life Obstetricians & Gynecologists,condemn the entire concept. Harrison believes abortion is killing an unborn child."It should not be part of any kind of medical training to achieve elective, induced abortions, or " she said.
Residents beget always been able to "opt out" of abortion training if they beget moral or religious objections,Harrison acknowledged. But some residents might feel pressured to achieve the rotation, she said, or they could end up indoctrinated with the view that elective abortion is OK."If you achieve a procedure that you beget moral qualms with,there's a kind of desensitization that goes on," Harrison said. "The attempt to force residents to participate in abortion is an attempt to desensitize those residents, and so they will beget less ability to contemplate clearly approximately what that procedure is actually approximately."But Freedman,the medical sociologist, disagreed that abortion training amounts to indoctrination."If you look at medicine in general, or how many things achieve we achieve to teach people empathy (sensitivity to another's feelings as if they were one's own),sensitivity, compassion approximately a lot of things?" she asked.
Doctors will always beget patients whose life decisions they privately disagree with, and Freedman said,but it doesn't help the patient when doctors judge them or withhold a treatment or procedure."Things happen to people that they don't want, health-wise, or all the time," she said. "We just need doctors to know how to achieve this."According to a national survey, 97 percent of OB-GYNs beget had a patient who wanted an abortion. But only 14 percent of those doctors actually provide abortions.
This account is part of a reporting partnership with NPR, and Houston Public Media and Kaiser Health News. Copyright 2016 KUHF-FM. To see more,visit KUHF-FM.
Source: wnyc.org