I'm an Ob-Gyn, And We Won't Go Back to the "Back Alley" Days Before Roe
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Two weeks ago marked a very dark day in our history. It was a day that I dreaded as a gynecologist and as a woman – the day that Roe v Wade would no longer be the law of the land has come. It's a surreal feeling to know that some of the work I do is illegal or will be shortly in many parts of the United States.
When I started my ob-gyn residency in 2011, walking into Walter Reed National Military Medical Center, I couldn't imagine that I'd one day be receiving frantic messages from people from all over the country, asking me what they should do if they need an abortion. But here we are, in the U.S. in 2022.
My colleagues in states like Texas, Missouri, and Louisiana have needed a friendly ear as they imagine a world where they can no longer provide the full scope of care that we are trained to provide. There is so much fear. We fear that patients will try to end their pregnancies by any means, without using safe, medically proven methods. We are scared of losing our licenses or even being jailed for providing patients care for life-threatening medical conditions like ectopic pregnancies. We fear of traumatizing patients that are already experiencing heartbreaking miscarriages by not being able to offer them D&C (dilation and curettage) procedures to avoid infection or other complications. There is so much uncertainty. It has been surreal.
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Many of us feel hopeless and dejected. We feel betrayed. We feel lost. A vital form of healthcare is being ripped away from a huge part of the population. But that doesn't mean we're going to stand down. We can and will continue to fight to ensure access.
And luckily, some action has already being taken in response: Today, President Joe Biden signed an executive order aimed at protecting access to abortion, adding that the court's decision to overturn Roe was "extreme" and "totally wrong." While details on how remain vague, his order pledges that the administration will "ensure the safety of patients, providers and third parties" who are delivering or receiving abortion services" and aims to expand access to birth control and emergency contraception.
Many of us feel hopeless and dejected. We feel betrayed. We feel lost. A vital form of healthcare is being ripped away from a huge part of the population... But that doesn't mean we're going to stand down. We can and will continue to fight to ensure access.
—heather irobunda, m.d.
We should not feel hopeless because there are still resources we can access — safely — in all 50 states in America. We do not need to return to a time of unsafe abortions. Many of us have heard the stories about women trying to end their pregnancies in kitchens or basements, in strange motels, or in 'back alley' clinics which became shorthand for these clandestine and dangerous procedures. If you have watched any news coverage of pro-abortion marches, you've seen the coat hanger signs, perhaps you know someone who got it as a tattoo. Many are scared that people with uteruses may utilize these means to end their pregnancies — but we don't need to go back to that.
In all 50 states, we have access to telemedicine. Through resources like abortionfinder.org, plannedparenthood.org, and threeforfreedom.com, you can find information to gain access to safe medical abortions, commonly referred to as the abortion pill. We have so much data and research to show that medical abortions, managed at home, are safe. Additionally, if there is a need for a surgical abortion procedure and there are none available in a particular state, there are provisions being made in many states to allow for people to get their healthcare where it is accessible. Several companies are making a statement by announcing that they'll support employees who need to travel out-of-state to access care (in InStyle's arena, this includes Gucci, Levi Strauss, and InStyle's own publisher, Dotdash Meredith). Abortion funds still offer mutual aid in the form of financial help to get people to their much-needed healthcare, and they're always a great first stop if you have money to donate.
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We will need to rely on each other now more than ever. Like many other times in human history when we've had to rely on our communities to care for those in need, we will rise to the occasion and take care of each other. We will not do it with coat hangers, we will do it with rideshares and a place to stay. We will do it by calling our representatives and demanding they act — to finally codify Roe as Federal law, to challenge the filibuster — to stand up for us, their constituents, as we fight to stand up for ourselves.
These new challenges will ensure that we are more proactive in our reproductive health care. Thankfully in all 50 states, there are many options for birth control that can be used to prevent pregnancy, which should be utilized. Options like birth control pills, subdermal implants (like Nexplanon), intrauterine devices (IUDs), and others should be offered and used to help ensure that people can choose when they want to start their families. (And yes, vasectomies can allow men to also play a role in preventing pregnancy and helping families create the lives they desire.)
We can't forget that we still have choices; we still have rights. Most of all, we still have each other.
In the last two weeks I've heard a lot of questions from patients and followers about what this reversal means. I've teamed up with InStyle to answer in an easily shareable format, below.
Should I be stockpiling emergency contraception or something like Plan B?
"No, you shouldn't stockpile it, however, having one or two Plan B or Ella pills (which are prescription-only), or that type of emergency contraception is really important because you want to be able to use any tool that you have available to prevent pregnancy if that's something that you don't want to happen. You want to be able to prevent it as soon as possible, so being on contraception in general if you are planning not to get pregnant is something that you should be considering...By stockpiling, you are decreasing the likelihood that other people can get these medications which they may need more than you, so I don't recommend hoarding it, but definitely having one or two pills is reasonable."
Will I be able to get birth control? What if I have a condition like PCOS or endometriosis where I use birth control to manage my symptoms?"
"For right now in all 50 states there are no limitations or restrictions on contraception or birth control like birth control pills, patches, rings, IUDs, or anything like that, at the moment. I don't know what the future will hold for us... but at the moment that is not an issue, you are able to get birth control wherever you live and however you want, if you can't have access to it by going to a doctor, medical provider, or clinic by you, you can also find it online."
Are nonviable pregnancies, things like miscarriages or ectopics, being affected by these abortion restrictions, or bans?
"The answer is yes, in some cases. Because the laws are really gray right now and don't give a lot of direction, [doctors] are finding it difficult to figure out whether they're able to treat certain pregnancy-related events — things like ectopic pregnancies or miscarriages, and so what's happening in some of these states is that we're seeing delays in care for people with things like ectopics or miscarriages because people are not sure if they're allowed to use the medications or the surgical techniques in order to resolve these issues. So for example, if it… somebody has an ectopic pregnancy, which is a [non-viable, life-threatening] pregnancy in the fallopian tube, and there is still a heartbeat, there are many states now that have bans on doing these abortions...So it's a moving topic, it's a moving issue, and hopefully, we'll have some more clarity in these states in the days to come, but definitely the weeks and months to come."
