In New Zealand, abortions have to be performed in a licenced clinic or hospital and are regarded as a "core health service". The Abortion Supervisory Committee's Report for 2003, admitted to continuing concerns about workforce recruitment and retention.It is recognised that performing abortions has certain psychological effects on the doctors and medical staff. This could be termed a variant of Post-Abortion Syndrome.
- As a result of the increased number of prostaglandin abortions being carried out, nursing staff are refusing assist.
- They find that they cannot cope with these PGTOPS, particularly when done for non-medical reasons."
- Abortion is seen as a tedious, assembly-line, marginally respectable occupation, that demands little from the doctor, technically or ethically.
- There are new opportunities and challenges obstretrics and foetology, that draw students away from abortion.
- A US study showed that almost all professionals involved in abortion work, reacted with more or less negative feelings.
Rachel MacNair, Ph.D, writing in 2003, found that published information was rare and embarked on her own research. We summarise her findings below.
In contrast to New Zealand, abortion in the United States is an "industry" in its own right. Most abortion clinics are run as a franchise business and have to be competitive in terms of pricing and costs. Their profitability is based on processing as many women as possible.
In New Zealand, abortions have to be performed in a licenced clinic or hospital and are regarded as a "core health service" by local district health boards. In hospitals, doctors and nurses are rostered on a daily or weekly list to perform TOPs (terminations of pregnancy). In the dedicated clinics such as Epsom Day, AMAC, and Lyndhurst, all staff are committed to providing abortion services.
NZ Hospital Staff Reluctance with Second Trimester Abortions
A February 2003 briefing paper to the Auckland District Health Board, from its Community and Public Health Advisory Committee, discussed the provision of second trimester (limited to women who were 13 to 20 weeks pregnant) abortion services and noted: "In addition, we informed the Minister (of Health) that she should be aware that clinical staff are reluctant to perform second trimester abortions, particularly social terminations."
The Dilation and Evacuation procedure requires the surgeon to manually dismember the baby with sharp instruments and crush the head, all the while removing the body parts into a dish. Clinical staff have to re-assemble the body parts like a jigsaw puzzle, to ensure that all human remains are removed from the womb.
The Abortion Supervisory Committee's Report for 2003, admitted to continuing concerns about workforce recruitment and retention.The Abortion Supervisory Committee's Report for 2003, admitted to continuing concerns about workforce recruitment and retention.
The Level J Unit at Wellington Hospital (replaced the old Parkview free-standing clinic) and Lyndhurst Clinic in Christchurch, had to recruit overseas doctors and nurses because there were not enough NZ graduates prepared to do the work.
Dr M.G.Laney, Clinical Director of Gynaecology Services at Christchurch Women's Hospital, sent a letter dated 10th May, 2001, to Christchurch and Canterbury GPs, advising of problems with late referrals:
"A higher than acceptable percentage of patients are being referred late, when the pregnancy is quite advanced. These women are more difficult to operate on, and some are too advanced and require prostaglandin termination of pregnancy (PGTOPS). This is an unpleasant procedure for staff and patients alike.
Nursing staff find that they cannot cope with these PGTOPS, particularly when done for non-medical reasons."As a result of the increased number of PGTOPS that we are being asked to carry out, we are losing competent and highly regarded nursing staff. They find that they cannot cope with these PGTOPS, particularly when done for non-medical reasons."
A prostaglandin abortion involves the doctor first killing the baby by injecting urea into the uterus. Prostaglandin chemicals induce labour, which can take between 12 and 36 hours to complete. Clinical staff have to assist the woman through the final stages of labour where she delivers an intact dead baby, and then oversee its disposal.
Why Doctors are moving away from Abortion
In the United States, most of the abortionists are reaching retirement age and there is concern among providers about the emerging shortage of younger doctors prepared to be involved.
Dr Bernard Nathanson, former director of the world's largest abortion clinic in New York, personally performed over 15,000 abortions, and in his book The Hand of God, addresses this issue.
Abortion is a tedious, assembly-line, marginally respectable occupation, that demands little from the doctor, technically or ethically.He describes abortion as a tedious, assembly-line, marginally respectable occupation, that demands little from the doctor, technically or ethically. Most meet their patient on the operating table when her legs are lifted into the stirrups. There is little or no contact afterwards.
He ask rhetorically if this is what the conscientious, dedicated OG-GYN, who has spent many years in training wants to do. "The deliberate destruction of a living, demonstrably human being, is a practice anathema to all but the most morally insouciant (unconcerned) physicians, and can justifiably be described as bearing low prestige in the medical community."
"Abortion is surgically unchallenging work that hardly fits within the classic bounds and aspirations of young physicians in training. Residents in obstetrical training programs have made it known to their mentors that they prefer not to waste their valuable training time, carrying out a destructive procedure that is now largely confined to the shadowy fringes of medical practice - abortion clinics."
According to Nathanson, advances in fetology and training in increasingly sophisticated ultrasound technology has given medical students new insights and greater appreciation of the unborn baby. In addition, there are new opportunities and challenges in the speciality, that draw students away from abortion.
Previous Research on Abortion Staff
Rachel MacNair is the director of the Institute for Integrated Social Analysis in Kansas City, and author of Perpetration-Induced Traumatic Stress: the Psychological Consequences of Killing (Paeger, 2002), which examines several groups that kill, including war veterans and executioners.
She found that very little study has been done on the doctors, nurses, counsellors and other staff in abortion facilities. Only two scientific studies that look at a large number of people have been carried out by researchers who do not work in abortion: M.Such-Baer's in Social Casework 1974, and K.Roe in Social Science and Medicine in 1989.
Both studies were done by people in favour of legal abortion, yet they both note the high prevalence of symptoms that fit the condition now called PTSD"Both studies were done by people in favour of legal abortion, yet they both note the high prevalence of symptoms that fit the condition now called Post-Traumatic Stress Disorder. The 1974 study (before the term was adopted) noted: "obsessional thinking about abortion, depression, fatigue, anger, lowered self-esteem, and identity conflicts were prominent. The symptom complex was considered a ‘transient reactive disorder', similar to combat fatigue."
"The other study listed similar symptoms: ‘Ambivalent periods were characterized by a variety of otherwise uncharacteristic feelings and behaviour, including withdrawal from colleagues, resistance to going to work, lack of energy, impatience with clients, and an overall sense of uneasiness. Nightmares, images that could not be shaken, and preoccupation were commonly reported. Also common was the deep and lonely privacy within which practitioners had grappled with their ambivalence."
MacNair considered that the most obvious remedy would be emotional support groups for the doctors, nurses and counsellors. However, when she contacted groups like the National Abortion Federation, the National Coalition of Abortion Providers and the National Abortion and Reproductive Rights Action League (NARAL), they clearly wanted to be helpful but had no lists or knowledge of any emotional support groups.
"Yet as far back as 1974, a scholarly article entitled ‘Professional staff reaction to abortion work' in the journal Social Casework had recommended this be done, saying: ‘Social work tools, ranging from group sessions to consultation, can be applied in order to help other staff members to express and work through their negative emotional reactions. Some studies have attested to the positive result of group sessions with nursing personnel.'"
The notion that the nurses, doctors, counsellors and others who work in the abortion field have qualms about the work they do is a well-kept secret."The reaction to the work itself is examined in an article in American Medical News, published by the American Medical Association, which reports on a meeting of the National Abortion Federation. It says that the discussions ‘illuminate a rarely heard side of the abortion debate: the conflicting feelings that plague many providers. The notion that the nurses, doctors, counsellors and others who work in the abortion field have qualms about the work they do is a well-kept secret." (Gianelli, 1993)
"Among the stories: a nurse who had worked in a clinic for less than a year, said her most troubling moments came not in the procedure room, but afterwards. Many times, she said, women who had just had abortions would lie in the recovery room and cry, ‘I've just killed my baby. I've just killed my baby.' I don't know what to say to these women, the nurse told the group. Part of me thinks, maybe they're right."
"A doctor in New Mexico admitted that he was sometimes surprised by the anger a late-term abortion can arouse in him. On the one hand, the physician said, he is angry at the woman. ‘But paradoxically, I have angry feelings at myself for feeling good about grasping the calvaria (the top of the baby's head), for feeling good about doing a technically good procedure which destroys a fetus, kills a baby."
Degrees of Negativity
‘...almost all professionals involved in abortion work, reacted with more or less negative feelings.'"Such-Baer's 1974 study in America, reported that ‘almost all professionals involved in abortion work, reacted with more or less negative feelings.' Those who have contact with the fetal remains have more negative feelings than those who do not, and their response varied little: ‘All emotional reactions were unanimously extremely negative.'
"The largest published study involved interviews with 130 abortion workers in San Francisco between January 1984 and March 1985. The authors did not expect to find what they found.
"Particularly striking was the fact that discomfort with abortion clients or procedures, was reported by practitioners who strongly supported rights and expressed strong commitment to their work. This preliminary finding suggested that even those who support a woman's right to terminate a pregnancy, may be struggling with an important tension between their formal beliefs and the situated experience of their abortion work."
The stress seems to grow as the unborn child develops. "As the pregnancy advances, the idea of abortion becomes more and more repugnant to a lot of people, medical personnel included," an abortion doctor, Dr Don Sloan, noted in a book that vigorously asserts the need for legal abortion. In attempting to cope: "Clinicians try to divorce themselves from the method."
"Want to do abortion? Pay the price. There is an old saying in medicine. If you want to work in the kitchen, you may have to break an egg. The stove gets hot. Prepare to get burned."After describing the procedure in graphic detail, including the need to check the body parts to make sure every part of the fetus has been removed from the uterus, he concluded: "Want to do abortion? Pay the price. There is an old saying in medicine. If you want to work in the kitchen, you may have to break an egg. The stove gets hot. Prepare to get burned." (Don Sloan and P.Hartz, Abortion: A Doctor's Perspective, A Woman's Dilemma, 1992)
Late-term abortions pose "an unusual dilemma," said Warren Hern, an abortion specialist, in a paper given to the Association of Planned Parenthood Physicians. The doctors and nurses who do it have "strong personal reservations about participating in an operation which they view as destructive and violent." He explained their reactions:
The sensations of dismember- ment flow through the forceps like an electric current.‘Some part of our cultural and biological heritage recoils at a destructive operation on a form that is similar to our own, even while we may know that the act has a positive effect for the living person. No one who has not performed this procedure, can know what it is like, or what it means. But having performed it, we are bewildered by the possibilities of interpretation. We have reached a point in this particular technology where there is no denial of an act of destruction by the operator. It is before one's eyes. The sensations of dismemberment flow through the forceps like an electric current. The more we seem to solve the problem, the more intractable it becomes.'
(W.Hern and B.Corrigan, What About Us? Staff Reactions to the D&E Procedure, paper presented October 26, 1978)
Dreams about Abortion
Many of those who stopped doing abortions, became convinced that it was wrong through experiencing harrowing dreams.According to Rachel MacNair, reports vary about the numbers of clinic staff who suffer from abortion-related nightmares. Many of those who stopped doing abortions, became convinced that it was wrong through experiencing harrowing dreams. A paper by Hern and Horrigan concluded that the more direct the physical and visual involvement (nurses and doctors), the more stress experienced.
Rachel MacNair is the author of 'Achieving Peace in the Abortion War' which can be read online.