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Can Doctors Learn To Perform Abortions Without Actually Doing One?

When residents are learning to do D and Cs, they usually do them in the hospital, and the patient is often asleep, Rosenfeld pointed out. But most abortions in this country take place in outpatient clinics.

At the clinics, patients get a local anesthetic or none at all. That makes the abortion safer for the patient, but it requires more skill on the part of the doctor, according to Rosenfeld and other experts.

“Time is a big factor, and causing as least pain as possible, and having a very gentle touch,” Rosenfeld said. “But all that is learned.”

Residents won’t have competence in performing abortions until they do dozens of outpatient abortions, Rosenfeld said.

“Nobody would ever say that about a cesarean delivery or a regular delivery: ‘Well, OK, you just saw one or two, so you can just do them,’ ” he said. “Lots of time you’ll have uterine abnormalities and you’re not going to know unless you’ve done many procedures what to do with a uterine abnormality.”

There’s one more intangible, but critical, experience residents get from abortion training, many doctors say.

Jane summed it up this way: “Every woman has a different story and a different reason why she chooses to end her pregnancy.”

Hearing those stories from patients is crucial to a an OB-GYN’s professional development, said Dr. Jody Steinauer, an OB-GYN professor and researcher at the Bixby Center for Global Reproductive Health at UCSF.

The experience teaches valuable bedside skills like compassion, empathy and political awareness.

“When they spend time in a setting that provides abortion care, they have real epiphanies,” Steinauer said. “They become more aware of their biases. They’re surprised that more than half of women having abortion are already mothers, for example.”

Steinauer’s research also shows that OB-GYNs who have access to training during their medical residencies are more likely to provide abortion later in their careers.

But some doctors question the need for more training, saying if residents really want abortion skills they can leave Texas to acquire them, and then come back to the state to practice.

Other OB-GYNs, like Dr. Donna Harrison, executive director of the American Association of Pro-Life Obstetricians & Gynecologists, condemn the entire concept. Harrison believes abortion is killing an unborn child.

“It should not be part of any kind of medical training to do elective, induced abortions,” she said.

Residents have always been able to “opt out” of abortion training if they have moral or religious objections, Harrison acknowledged. But some residents might feel pressured to do the rotation, she said, and they could end up indoctrinated with the view that elective abortion is OK.

“If you do a procedure that you have moral qualms with, there’s a kind of desensitization that goes on,” Harrison said. “The attempt to force residents to participate in abortion is an attempt to desensitize those residents, so they will have less ability to think clearly about what that procedure is actually about.”

But Freedman, the medical sociologist, disagreed that abortion training amounts to indoctrination.

“If you look at medicine in general, how many things do we do to teach people empathy, sensitivity, compassion about a lot of things?” she asked.

Doctors will always have patients whose life decisions they privately disagree with, Freedman said, but it doesn’t help the patient when doctors judge them or withhold a treatment or procedure.

“Things happen to people that they don’t want, health-wise, all the time,” she said. “We just need doctors to know how to do this.”

According to a national survey, 97 percent of OB-GYNs have had a patient who wanted an abortion. But only 14 percent of those doctors actually provide abortions.

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This story is part of a partnership that includes Houston Public Media, NPR and Kaiser Health News, a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

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