January 27, 2023

Jewel is a college student in her early 20s living in Texas. When her doctor confirmed she was pregnant, Jewel panicked. She knew it wasn’t the right time for her to have a baby and that abortion was illegal in her state.

Luckily, Jewel had resources. After doing her research, she packed a bag and flew to New York City, where her sister lives. From there, the two women visited one of us — Joan Fleischman, a family doctor who has been performing abortions in her small New York City practice for over 20 years.

Jewel, who asked to be identified by her middle name, told Dr. Fleischman on her experiences in Texas. Members of the medical staff “were trying to push for a happy pregnancy while I was unhappy and crying,” she said. Jewel felt her doctor was afraid to even discuss other options because the doctor feared losing her license.

dr Fleischman performed an ultrasound that dated the pregnancy between five and six weeks. She discussed Jewel’s options and, after confirming that Jewel wished to terminate the pregnancy, performed a manual uterine aspiration. This method uses a portable device and takes a few minutes in a typical exam room.

dr Fleischman then performed a routine tissue exam. To do this, the fabric is rinsed with water through a fine sieve. She identified decidual tissue, or uterine lining, and an amniotic sac, visual evidence of pregnancy. At this stage of pregnancy, the embryo is usually not visible to the naked eye.

Afterwards, she offered to show Jewel the tissues of the early pregnancy. Jewel said Dr. Fleischman that it wasn’t what she expected. “I thought you were going to bring something shaped like a little fetus or something, and it wasn’t at all,” Jewel said.

Primary care physicians like us who perform early abortions in our offices have long known that the pregnancy tissue we remove does not look what most people expect. After Roe v. Wade last summer in Dobbs v. Jackson Women’s Health Organization was overthrown and abortion was banned in more than a dozen states, we felt it was important to release this information and share the images we saw with a wider audience.

Addressing medical misinformation related to early pregnancy is important to us, since approximately 80 percent of abortions in the United States occur at week 9 or earlier. So many of the images people see about abortion come from anti-abortionists who have spent decades promoting misleading fetal images to further their cause.

Last fall, as members of the MYA (My Abortion) Network, a physician-led organization dedicated to educating people about abortion and expanding early abortion services into primary care, we launched a multimedia project to provide accurate information about to provide early pregnancy tissue after abortion.

The Guardian published our first photos on October 19; They went viral, popped up in the media and shared widely on social media.

Many people, even those who support abortion rights, didn’t believe the photos were accurate. Some insisted that we had intentionally removed the embryos before taking the photos. The images did not match those often seen in embryology textbooks, magnified on ultrasound, or used in anti-abortion propaganda; These enlarged images are not what you see with the naked eye after an abortion. A Stanford gynecological pathologist validated our photos, but many people could not believe that the images were presented unaltered.

The vitriol did not surprise us. We knew we were in for a pushback. Although we have long felt comfortable showing our patients the pregnancy tissue after an abortion, we gave serious thought before publishing the images on our website. We didn’t want our message to undermine our unwavering support for patients who make this decision at a later date when a visible embryo or fetus is present.

We also realized that people taking abortion pills or having miscarriages might find the images confusing because they don’t show the blood being drained from the body. And of course, someone who miscarried after a desired pregnancy might feel significant sadness while looking at the photos.

However, showing these images is essential to counteract misinformation, not only for patients but also for our colleagues. dr Jeffrey Levine is Professor of Family Medicine and Director of Reproductive and Gender Health Programs at Rutgers Robert Wood Johnson Medical School. He has taught abortion care to fellows, residents, and medical students for nearly two decades.

“When we examine the tissue after an operation, everyone is always surprised. They expect to see an embryo, fetus or at least some body parts,” he told us, describing the students’ experience as “underpowered”.

But our primary daily work is of course with the patients. And when our patients look at the tissue, they often realize how much guilt, or even shame, they have internalized at society’s judgment in making this deeply personal choice.

Relief was how Jewel saw the pregnancy tissue. “I was really scared by all the horror stories and the trauma. The fear of coming here was worse than actually going through it,” she told Dr. Fleischman.

In many ways, medical care related to abortion has never been easier. And we know that abortion is an important part of primary care and could be widespread in mainstream practice settings — if the Dobbs decision hadn’t suddenly put many of our colleagues in states across the country at risk.

Instead, we find ourselves in a country divided by politics rather than the plight of patients. Ensuring that our patients, colleagues and the general public have clear, objective information about abortion is critical to ensuring patients receive the treatment they deserve.

Erika Bliss, Joan Fleischman, and Michele Gomez are family physicians and co-founders of the MYA Network. This article originally appeared in The New York Times.

Leave a Reply

Your email address will not be published. Required fields are marked *