The Family Doctor Training to Provide Abortions Post-Roe

The day the Supreme Court tossed out Roe v. Wade, Dr. Elizabeth Fleming of western Pennsylvania called for fellow physicians in her state and others where abortion is still legal to help meet the demand from where it is banned.

“I don’t know how to perform abortions, but I’m willing to learn,” she tweeted under the name “Dr. Fleming, Appalachian medicine woman” on Friday. “Should we have, like, a volunteer Rosie the Riveter type movement among physicians? A volunteer physician abortion corps?”

Fleming serves an area bordering two states: Ohio, where abortion is now outlawed, and West Virginia, where a special session of the legislature will consider whether an 1848 law making it a felony applies in the absence of Roe.

“Ohio and West Virginia are knocking on western PA’s door,” she noted.

Over the weekend, Fleming took a brief course on administering medical abortions. She also read a guide written by an obstetrician for family medicine physicians who want to add abortion services to what their office provides.

“One of the sections is about bomb threats,” she reported. “Patient counseling, supplies, staff training. And bomb threats.”

On Monday morning, the undeterred 43-year-old mother of four faxed an FDA form to a pharmaceutical company to order Mifepristone, the first of the two necessary drugs combined to induce an abortion. She will be able obtain the other, less regulated drug through her usual medical supply firm.

“Once I get the medicine, then I’ll start,” she told The Daily Beast.

She was seeing indications online that other doctors were beginning to respond to the anticipated need much as they had at the peak of COVID, when they volunteered to step outside their usual areas of practice to work in the ICUs.

“There’s a bunch of family medicine physicians on Twitter now giving each other links on how to do the training and stuff,” Fleming told The Daily Beast. “There does seem to be a little movement picking up.”

Fleming has also tried reaching out to the American Academy of Family Physicians (AAFP) to provide interested doctors training in providing abortions.

“Most training obviously occurs like in residency,” she said. “But there are procedure clinics for practicing physicians where we learn other procedures, like knee injections, or different things. So I mean they could set up procedure clinics for doctors who are wanting to learn it.”

In the meantime, Fleming has begun reading up on manual vacuum aspiration, a procedure that is presently part of the training in some emergency medicine residencies. She figures it could also be taught to community doctors.

“Simple,” she said. “Low risk.”

Her practice includes two offices on either side of Pennsylvania’s political chasm. The patients in suburban and largely blue Verona outside Pittsburgh reacted to the overturning of Roe v. Wade as she would have expected. They knew it was coming, but they were still shocked when it did.

“One of them was crying,” Fleming said. “I was like, ‘Any questions?’ She’s like, ‘I can’t think. I have no idea if I have any questions for you.’”

The surprise was at the other office, in Grove City, which serves largely red rural patients.

“The most common opinion I heard was that, ‘I’m personally against abortion, but I don’t want the government telling me what to do,’” she recalled. “Kind of the same attitude of, ‘I don’t want the government to take my guns’ is ‘I don’t want the government telling me or telling my wife what to do with her body.’”

She says they turned angry when they learned the ban could affect ectopic pregnancies and in vitro fertilization and cancer treatments.

“They were livid,” she said.

But they are still given to believing conspiracy theories. One of them had lost a spouse to COVID-19 and still told Fleming the virus wasn’t real. She is unsure how the abortion issue might affect their votes in the upcoming election for governor between abortion-rights supporter Democrat Josh Shapiro and far-right Republican Doug Mastriano, who supports a ban at six weeks with no exceptions, not even for rape or incest or the life of the mother.

“Our legislature is crazy and they will definitely ban abortion in a second,” Fleming noted.

Fleming figures that she would not have been a doctor in the first place first place were it not for an abortion. She says she was raped in her first year at medical school and was still suffering from the psychological after-effects in the third, when she became pregnant as the result of a birth-control failure during a consensual relationship.

“I had two kids at the time,” she said “I had PTSD from a rape… There was just no way I was gonna graduate medical school and there was no way my mental health was gonna survive that.”

She subsequently married a conservative Catholic and for a time ascribed to his faith.

“We believed abortion and all forms of contraception and sterilization were wrong,” she recalled, then predicted, “They 100 percent are coming for contraception very soon. And they are 100 percent convinced in their hearts they are saving lives and doing God’s will.”

She had two more children. Her personal beliefs then took a different turn.

“I left the marriage in 2019, and then once I got out, my mind kind of cleared,” she recalled.

On Sunday, as Fleming was preparing to order the Mifepristone and begin offering abortions, women were posting pictures online of their unplanned babies. She tweeted a photo of her youngest child, taken when he was around 6 months old. She was then in the last year of residency while moonlighting on a second job.

“My unplanned baby,” she now wrote. “Who the fuck cares? If you’re in Ohio or West Virginia, western PA medical community is here for you. We will make sure no woman is denied the choice of what to do with her body. This baby’s mama just became a proud abortion provider.”

The baby she made the choice to have is now 6.

“I don’t know what will be said to my children when [her ex-husband] finds out that I’m gonna start offering abortions,” Fleming told The Daily Beast. “It’s not gonna be pretty. But oh well.”

And along with offering abortions, she will continue forming alliances online with other doctors who are fiercely determined to address the health emergency triggered by the Supreme Court decision. She noted on Twitter that less than 10 percent of the nation’s doctors were women when Roe v. Wade became law in 1973. The current number is nearly 40 percent. More than half of all medical students are women.

“Shit is going to get real real,” the Appalachian medicine woman said. “We survived medical training. We are not genteel.”

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