How can I determine what my health provider's stance on abortion is?
May 22, 2014 6:42 PM   Subscribe

I'm concerned about going in pregnant to my regular health provider without an understanding of what I might be up against if it turns out I might need an abortion.

So, I've been thinking about this a bit. There is a round of testing you do early in a pregnancy to look for fetal abnormalities/genetic issues. What I don't know is what would my health provider council me or allow me to do in the case of a severe issue with the fetus. If I "elected" to abort due to a serious issue, would I have to go off on my own and seek an abortion or would my medical provider provide me with one?

If I am being seen in a facility not obviously religious in foundation, in a state where abortion is legal, what kind of treatments would I be offered?

I live in a liberal city in a state with legal abortion but it strikes me that I don't really know what my options are in these circumstances and if I'd be turned away from my health provider.

Looking for U.S. answers/anecdotes. I also know this is a touchy subject.
posted by anonymous to Health & Fitness (16 answers total)
Um, if I were wondering this, I would ask my health provider.
posted by feral_goldfish at 6:48 PM on May 22, 2014 [3 favorites]

So I went through this with my spouse at OHSU in Portland. We did amnio testing there and it included some consultation with someone who made it clear we were at a very late age, it was quite possible they'd find something and if so what kinds of tough decisions we were going to face.

We went through it, they took longer than normal on results, and found out our worst fears were true. It was some really bad chromosomal damage, stuff that sounded so awful it was easier to make the tough choice.

The staff at OHSU were amazing and super professional. We went from talking to a genetic testing person about the results directly to scheduling the abortion. Everything went as planned, and later on we found out my healthplan covered the expenses.

Never at any time did we discuss healthcare with anyone at the hospital, but I've been there for other reasons and they seem to keep a wall between finance and health providers so that no doctor has to ask about insurance or money ever.

There were no judgements from any staff either, everyone was super professional, understood this was a tough choice we made for our own reasons and was supportive of us through the entire thing. It was so important to us that we would have paid for it afterwards if that is what ended up happening, especially since if you get bad results they retest the samples to double check, and we were actually starting to run towards later term for our state and had to act quickly.
posted by mathowie at 6:50 PM on May 22, 2014 [17 favorites]

Could you contact Planned Parenthood just for a recommendation to a possibly abortion friendly doctor?
posted by aetg at 7:18 PM on May 22, 2014 [1 favorite]

If you ever have reason to consider an abortion but also have reason to believe your medical provider is not being honest or timely in assisting you with that decision, I recommend contacting Planned Parenthood, NARAL or a local prenatal genetic counselor. Specific details really depend on what area you live in and on the gestational age at the time the procedure is needed. Some OBs simply do not perform abortions (often related to lack of appropriate training or facilities) but have no problem helping in the necessary arrangements. Some medical centers simply will not have abortions per se performed on site due to complex issues having nothing to do with an institutional religious affiliation. Some OBs may outright lie to you about local or out of state options. Texas for instance will be quite different than OHSU which is really a great system, as mathowie attests.
posted by beaning at 7:23 PM on May 22, 2014

When you say your health care provider, do you mean your OB/GYN, or your insurance co? If it's the latter, it should be listed in your benefits description somewhere, or it's an easy enough call to make.

If you're asking about your doctor, the neutral way to phrase it is probably, "should it ever become necessary to terminate, is that something you handle?" There are a number of reasons where an abortion could become the healthiest choice should something go wrong during your pregnancy, which have nothing to do with you making a decision based on your own "election." How the doctor responds will give you an idea of whether to ask more specific questions, or start looking for another. It's worth noting that because the insurance costs and bureaucracy associated with providing abortions are so high, many pro-choice, understanding and sympathetic OB's do not provide them, even in areas where abortion's legality is not in any question. But assuming they are comfortable with the medical decision, they will be able to make that referral. Otherwise, if you are getting red flags from your provider, Planned Parenthood will also be able to help you out, as others have said.
posted by Mchelly at 7:33 PM on May 22, 2014 [1 favorite]

This should be easy enough to figure out by reading your policy. The last employer-provided health insurance policy I was on specifically covered (a certain number of?) abortions under the OBGYN care part of the plan. It was right in there along with prenatal care and well-woman exams.
posted by Sara C. at 7:33 PM on May 22, 2014

This is anecdotal, but outside a Catholic healthcare system I have never heard of anyone getting any pushback on bad amnio/nuchal/scan/genetic results. I kind of suspect that most obstetricians have seen some shit with regard to what can go wrong and as a general rule are not going to stand on any personal principles there.

But what you can ask, neutrally, is for them to tell you where they draw their line. I think you'll find some hesitation at a Downs-level situation, but Trisomy or other catastrophic genetic or developmental factors are not going to be a hard call for most physicians. But just ask, without showing your hand, and see what they say and see how you feel about it. Find another doctor if you are not comforted.

(I did know a couple who proceeded with a horrifying situation - anencephaly - in opposition to their doctor's leaning, maybe even mild pressure, toward termination. I think that is probably more common than you'd expect, as OBs are not sheltered from reality.)

If you're asking about insurance, again barring religious healthcare systems...this is horrible, but termination is a shitload cheaper than months or years of coverage for a severely disabled child. They just don't want to mess with elective abortion; once you have an excuse there's no barrier to coverage.
posted by Lyn Never at 7:37 PM on May 22, 2014 [2 favorites]

Regarding the insurance issues, y'all have had much better experience with insurance and abortion than my cohort. Remember, one of the big arguments about Obamacare was if abortion needed to be covered under all policies. IME, insurance may cover it for *this* indication but not *that* indication; at *this* of facility but not *that* one. So an abortion performed in hospital and necessitated by a tubal implantation or other risk to maternal health may be covered/reimbursable. But an abortion at a private facility for a fetal health condition may not be. And providers may or may not be in-network or even accept insurance. One of the most common reasons abortions get performed after 12 wks is the woman had to first raise the funds.
posted by beaning at 7:48 PM on May 22, 2014 [1 favorite]

Anecdotally, in one of my earlier prenatal visits, they discussed all the various test options and which ones they recommended for me, and the subject of abortion was subtly brought up. I don't remember exactly what was said, but it was something like "you may want to discuss with your spouse ahead of time about whether you'd be comfortable terminating the pregnancy, in case this test shows issues with the fetus." It was brief, but it was clear that they considered abortion a valid option, and my choice to make. (This is in Massachusetts.)

The tests turned out fine and my anecdote ends here, but I'd suggest asking your OB "what are my options if there are significant problems?" as a way to introduce the subject and see what they say. I'd also call Planned Parenthood as a backup, just in case you run into snags with your OB or don't feel entirely comfortable with their response.

If this is a wanted pregnancy and you don't have any known health issues that put the fetus at risk, you have a good chance of not needing to pursue this. Early pregnancy is scary and worries about something going terribly wrong are super common. The worst does happen, but most of the time it doesn't.

Good luck, and I hope the road ahead goes where you want it to.
posted by Metroid Baby at 7:49 PM on May 22, 2014 [1 favorite]

OB-GYNs deal with all of the issues that that specialty involves. If yours has a personal objection to abortion, you will very likely simply be referred elsewhere. I have never heard of a physician using some of the tactics that are used by some of the “pregnancy crisis centers.” Not that it could not happen, it’s just not common at all.
posted by yclipse at 8:15 PM on May 22, 2014 [1 favorite]

I asked up front with my doctors at the first visits, and switched from one doctor who was pro-life, even though termination was not an option for me personally. I basically said "What would happen if my pregnancy ended? Can you provide a D&C? What about prenatal screening and elective termination?" Then if they said that they would provide all that (I think the obgyn I liked the most couldn't do it in-house but recommended a hospital and would help arrange it), I explained that I did not want to do an elective termination unless my health was at-risk, and I would appreciate them not bringing that up as a choice when we were discussing the results of testing. (I've had D&Cs for miscarriages, and I am super pro-choice, but emotionally with my pregnancies I did not want to have to reaffirm my decision not to terminate electively while weeping in the doctor's office.)

None of the doctors I asked about this were surprised by my questions, and they just answered them directly and fully.

Do NOT ask the receptionist or nurses or assistants though. Get it directly from the doctor.
posted by viggorlijah at 8:28 PM on May 22, 2014 [6 favorites]

Where I live in rural WA (a state where abortion is legal) it is totally up to my local hospital to decide whether or not to allow certain medical procedures - and they've decreed that VBACs, gastric bypasses, and abortions, among other procedures, are all strictly prohibited. They're the only game in town, so what they say goes. So the OB/GYNs have to refer patients out to the nearest large city. None of this has anything to do with their own personal beliefs about abortion.
posted by hush at 9:01 PM on May 22, 2014 [2 favorites]

If you don't feel that you can discuss this issue openly with your doctor, then find a doctor you trust enough to have this conversation. You are a consumer, your doctor is a vendor. You should be on the same page with your doctor about these things.

Your other option is to go to Planned Parenthood for the preliminary stuff.

But, I know that on the forms I fill out at my doc, that they ask about pregnancies and abortions, and it's just part of the health assessment.

Google your doctor, see if anything weird comes up. If they support Planned Parenthood, awesome. If other things pop up, it may be time to change providers.
posted by Ruthless Bunny at 5:44 AM on May 23, 2014

N'thing to just ask. If you don't feel comfortable asking directly, you can try "What type of screening tests do you recommend for women of my age/risk profile?" If they are supportive of testing, then they will most likely be supportive of your choices.
posted by snickerdoodle at 8:05 AM on May 23, 2014

My GYN does not perform abortions in her office, but gives refferals to providers to her patients for tailored for various reasons (test results / not great life circumstance/ etc). She will refer to certain abortion providers based on thier "bedside mannor" for comforting patients depending on the issue(s) they face.
posted by WeekendJen at 8:52 AM on May 23, 2014

I have been to hell and back with health care provider problems in the last year. Talking to a provider seems like the place to start but open communication can create problems in ways that one cannot predict and that cannot be fixed. So, based on what I have learned in the past year, this is what I would do.

Ok, after writing out this War and Peace-length answer, the simple solution hit me.

Planned Parenthood
Look at their website site or drop by. Ask for a list of Planned Parenthood-friendly providers who take your insurance. If they don't have one, schedule an appointment to discuss your needs face-to-face with their nurse practitioner. Since you're not entirely comfortable with your current provider, and abortion is one reason for that, PP (family medicine, OB-GYN, internal medicine) is the best place to go for finding providers who shares your values.

You can then easily determine whether their referrals take your insurance.

If PP won't give you names, search for state advocacy groups like "pro-choice doctors" or something along those lines. Then see who's in your area and who takes your insurance.

Here is the War and Peace answer.

Web search-1
Otherwise use your health insurance website (a gold mine of information you can use-- because everyone takes your insurance.

1. Plug in your Group Number and Member ID to search for providers in your area. Get at least a dozen names-- the more the better. Make sure each has privileges at a hospital you'd feel ok with, and make sure that they are not all working at the same one or two hospitals. Your sample should include urban, suburban and rural locales, and different counties if practicable.

2. Read each site closely, including your provider's. If one doesn't have a website or page, either go back and pick another name or use to look them up.

3. As you read, look for words or phrases that strike you as vague or odd, especially ones related to services you might want or need. Look for repeated phrases, popular procedures, and you'll notice patterns.

4. Note the services and procedures they push and the ones they don't advertise.

5. Follow whatever links they have on their site.

6. If they have Facebook, look at who is actually "liking" things on their page.

7. Look at educational backgrounds and how many people work in the offices.

Now you have an idea of where your provider stands in relation to others in your city. You also know what you can expect of a provider in your area.

Web search-2 (optional)
Do the above for another city in your state and compare to the results of Web search-1. State licensing boards and state politics influence what providers do and how they pitch themselves to patients. It's important that you compare within your state, unless your plan allows you to out of state for health care, and you live somewhere where doing so makes sense.

Make some calls
Provider offices

1. Call some of these practices and find out which ones offer abortion. (Call in the afternoon when they aren't so busy).

a. After a few calls, you're going to find out which providers in which hospital systems are ok with this business and which ones aren't. Sure all hospitals are legally required to provide it, but policy on the ground can deliberately make things difficult.

b. You're probably not going to get any answers to the abortion question, but you might get lucky and get transferred to a medical assistant who will talk to you.

c. Now you know how to ask your questions in an effective way. Your web search probably raised other questions you want answered anyway, so you're not just calling up and asking about abortion right off the bat, even if that is what you really want to know.

2. Contact your own provider's office at this point. I wouldn't identify myself as a patient. Just ask about your doctor. Or ask a friend to call and inquire about the practice as a potential new patient.

Look up area hospitals
Look at hospital websites for clues about their attitude towards abortion. Phone calls to hospital bureaucracy, no matter the title, will likely lead nowhere.

Call your insurance company
Your health insurance company has a million different customer service departments. The ones staffed by actual nurses are the best. You don't want the "diagnose over the phone" line. You want the "wellness" line: general advice from a nurse. They might have some advice for you.

Now I doubt an OBGYN would put any euphemism for abortion on their website. You will probably find fertility treatments and hormone therapy. But I do think you can get a good sense of a provider's philosophy of care from this kind of research.

Communication is great in theory but mis-communication between yourself and a provider you don't know well can have dire consequences. Medicine is just like academia or politics or anything else with sharp lines between specialties, so it's really important to be on the same page from day one. That's not Alex Jones paranoia talking, that's the way it is (in my experience). With the health care system in shambles there's no margin for error when you're a patient.

I wish I had known all this years ago.

PM me if you'd like. Good luck.
posted by vincele at 7:10 PM on May 23, 2014 [1 favorite]

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