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Hospital offers help for women who want to halt abortions

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A Chicago medical center has become one of the nation's first Roman Catholic hospitals to adopt a practice of halting second-trimester abortions for women who change their minds after the multiday medical procedure has begun.

Working with two anti-abortion groups, Resurrection Medical Center, the largest hospital of one of Chicago's largest Catholic health care systems, has put in place a practice that when a woman arrives in the emergency room with an activist seeking to stop a second-trimester abortion, she should be treated immediately. Since October, four women have arrived at the hospital seeking to halt their abortions, and three of them had their abortions stopped.

Members of the anti-abortion alliance — made up of the hospital, the Pro-Life Action League and The Women's Center — tout the practice as a model for all Catholic hospitals. The hospitals have been under the microscope since December, when the bishop of Phoenix stripped one facility of its Catholic affiliation because doctors there terminated a pregnancy to save the life of the mother.

Resurrection's decision to work with activists to halt abortions, which is unprecedented in the Chicago area, is "part of who we are," said Sister Donna Marie Wolowicki, Resurrection's chief executive officer. "Catholic health care is to reach out to people and help them in their need. Of course, it's vital to be true to the ethics we believe in. Holding life sacred is a big piece of what we believe."

While Wolowicki and other staff at Resurrection believe the hospital is saving lives, helping women and upholding Catholic doctrine, abortion providers worry that anti-abortion activists are pushing a woman to pursue a rare and uncharted medical procedure that heightens risks during pregnancy for both the woman and the fetus and could result in premature labor or miscarriage.

The chance to stop a second-trimester abortion exists because it is a two- or three-day procedure. On the first day, doctors insert a dilator, often bundles of dried seaweed called laminaria, to soften a woman's cervix. The woman returns a second day so doctors either can insert more laminaria or another dilator, or remove the fetus and complete the abortion.

If a woman changes her mind after the dilator has been inserted and seeks to reverse the process, doctors can remove the laminaria. Ideally, the cervix will close naturally so the pregnancy can continue. But that's not always the case.

Undoing abortions in a hospital forbidden to do them in the first place has prompted concern that the hospital's zeal to take the correct Catholic course of action conflicts with the proper way to implement a medical procedure.

"It's much more complicated. It's changing the chemistry of the cervix," said Dr. Cassing Hammond, an associate professor of obstetrics and gynecology at Northwestern University's Feinberg School of Medicine. "The interventions that might be required are unclear."

Though many abortion providers warn women about the gamble of interrupting an abortion procedure, patients often are assured they can change their minds.

"Women requesting an abortion at Family Planning Associates Medical Group have the absolute right to change their mind at any time regarding their decision to complete the abortion procedure," said Dr. Steve Lichtenberg, medical director of Family Planning Associates on Elston Avenue near Cicero Avenue. "We have staff on call 24 hours a day, and are prepared to remove laminaria at our facility day or night, in the event that a patient reverses her decision to complete the abortion procedure."

But advocates for the Pro-Life Action League and The Women's Center insist that abortion providers aggressively dissuade women from interrupting the procedure. Advocates believe it's important for anti-abortion "sidewalk counselors" to offer a woman a medical alternative before she gets too far along, regardless of the risks.

"I think if we're truly going to have choice, then we need to make sure all choices are available and allow them to know that that procedure is reversible," said Peg Brunk, director of client services at The Women's Center.

Doctors and nurses at Resurrection say the hospital's new practice addresses both concerns. The hospital now has a uniform code in place to inform a woman of all the risks, treat her as a high-risk pregnancy and track outcomes. The protocol also includes a step to make sure a woman escorted to the emergency room by a stranger hasn't been coerced.

Since October, three women have arrived at Resurrection where obstetricians removed the laminaria before it was too late. Doctors sent a fourth woman home when she told them during a private consultation that she felt pressured by the sidewalk counselor and wanted to continue the abortion.

"Because these people have been through a lot, many times they don't have the support in their decision-making, so they make decisions very quickly and oftentimes don't think of all the consequences," Wolowicki said. "When the counselors meet them, sometimes this is the first person that's really shown an interest in them and they respond to that quickly and come in. ... The most important piece ethically is that we are respectful of the woman and we respect her ability to make her decision."

When a patient decides to halt an abortion and has the laminaria removed, the patient is given antibiotics to ward off infections in the uterine membrane when the cervix is dilated. Some doctors worry that such women run a higher risk of premature labor and miscarriage.

The opportunity to stop a second-trimester abortion, which doctors have known was possible for decades, is so rare that few medical studies exist.

A study out of Tel Aviv University in Israel based on 21 women who chose to have laminaria removed between 1978 and 1990 showed that four of them reconsidered again and had the laminaria replaced to complete the abortion. Two had premature deliveries, and one had a miscarriage. The remaining 14 continued their pregnancies to term.

Another report out of New York University in 2009 showed two out of four cases where women had laminaria removed ended with premature deliveries in which the baby did not survive.

Dr. Shu Boung Chan, attending physician in Resurrection's emergency department and research director for the emergency department, acknowledged the lack of literature, but he said the benefits of the procedure to the fetus far outweigh the risks. The uncertainty about those risks is why the hospital should have a protocol to better track outcomes and give the patient as much information and consistency as possible, he said.

Doctors and nurses at Resurrection say it's also necessary to make sure patients are getting what they want.

In October, a sidewalk counselor convinced a woman at a bus stop outside Family Planning Associates that her abortion could be stopped.

When she brought the woman to the emergency room, doctors declined to remove the laminaria that had been inserted hours earlier. When the patient started to waver, the activist called lawyers and Wolowicki intervened.

In the end, the woman did not have the laminaria removed and presumably went on to get the abortion.

"We are challenged with things we don't agree with all the time," said Donna Evans, a nurse who was in the emergency room when the woman opted to leave. "Sometimes, it's just doubt or regret. (The private conversation) pays off all the time because the patient gets what they want."

That incident prompted Wolowicki and administrators at the Pro-Life Action League and The Women's Center to come up with a way to prevent confusion in the future.

"We do have to recognize that true choice means opening up the conversation to include information and education and having enough respect for the women to allow them to be exposed to all of that," Brunk said.

A 28-year-old Little Village woman who had her abortion halted last month said she is grateful that a "pushy" priest waiting outside the clinic the day she started her procedure offered her and her boyfriend a ride home. The Women's Center put the Tribune in touch with the woman.

"Thank God this man stopped us," said the woman, who spoke on the condition of anonymity. "He saved the life of my baby and maybe he saved my life too."

mbrachear@tribune.com

Copyright © 2014, Los Angeles Times
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