They’ve existed since before the advent of recorded human history.
They rely on ancient women’s wisdom and herbal preparations.
If they weren’t safe, the human species would no longer exist.
They provide a service that many women want.
Women know their own bodies. If women feel they are safe, then they are safe.
Am I talking about homebirth midwives or back alley abortionists? Can’t tell the difference, can you?
If we are licensing homebirth midwives (CPMs, LMs), why shouldn’t we license back alley abortionists, too? After all, it takes less education and training to end a pregnancy than to bring it to a successful conclusion.
Many women want the service that back alley abortionists provide. Moreover, it is dogma in the world of homebirth that if women feel safe, they are safe. Does that make back alley abortionists safe?
Of course not!
We know that back alley abortionists are deadly. Before the advent of safe surgical abortions, women died in droves attempting to end unwanted pregnancies. Even today, when women don’t have access to safe surgical abortion, they continue to die in droves. The reliance on ancient women’s wisdom and herbal preparations leads to serious illness and death. Even so, the deadly results at the hands of back alley abortionists have had no impact on whether our species exists; a tremendous number of women can die before population growth slows or stops.
So why shouldn’t we license back alley abortionists? Try to think of a reason that doesn’t apply equally to American homebirth midwives. You’ll be hard pressed to do so.
American homebirth advocacy is all about mistruths, half truths and outright lies. That’s pretty obvious when it comes to the blatant lie that homebirth is as safe as hospital birth, the blatant lie that childbirth interventions kill women and babies, and the blatant lie that obstetricians don’t follow scientific evidence. Therefore, homebirth advocates are increasingly applying their mistruths, half truths and outright lies to claims about women’s reproductive freedom.
Consider the following quote from Gina Crosley-Corcoran, The Feminist Breeder:
Anyone reading it might think that women are prevented from giving birth where they want and attended by whom they want. Nothing could be further from the truth. There are no restrictions, have never been any restrictions, nor will there ever be any restrictions on women choosing to give birth at home. Want to risk your baby’s life at homebirth? Go right ahead; no one will stop you. The restrictions that exist apply only to who can call herself a midwife, what training a midwife might need, and who can charge for providing midwifery services. But when you are trying to scare women, a lie is ever so much better than the truth.
And when it comes to lies, there’s none much bigger than this whopper, also courtesy of Gina.
While I appreciate the implicit acknowledgement that homebirth is far more dangerous than hospital birth, I find the underlying premise to be moronic. Just because a woman thinks something is safe does not make it safe. This is a classic example of the magical thinking that animates the “reasoning” of so many homebirth advocates. Magical thinking does not refer to magic; rather it refers to the belief that one’s thoughts have the power to change reality. For example, a small child may imagine that the reason his sister fell down and hurt herself is because he was angry at her and wished that something bad would happen.
You might think that the adults in the homebirth movement would have matured beyond magical thinking, but you would be wrong. Magical thinking (in the form of beliefs and birth affirmations) rests on the premise that grown women can change reality with their thoughts. Hence Gina’s extraordinarily inane claim that “the safest choice for any women is what SHE feels is right for her body.”
Really?
If a woman believes that smoking is the safest choice for her, does that make it safe? No.
If a woman believes that not using a seatbelt is the safest choice for her, does that make it safe? Of course not.
If a woman believes that a back alley abortionist is a safe healthcare provider, does that make back alley abortion safe. Obviously not.
I bet you can see where this is going:
If a woman believes that a homebirth midwife is a safe healthcare provider, does that make homebirth safe? Only a fool would think it does.
The idea that the choice to have homebirth is an issue of reproductive freedom makes as much sense as claiming that the choice to have a back alley abortion is an issue of reproductive freedom, in other words, no sense at all.
But as the evidence mounts that American homebirth midwives have an extraordinarily high rate of deadly outcomes, the reproductive freedom argument is looking like a much better bet than the safety argument.
What’s the difference between an American homebirth midwife and a back alley abortionist?
Absolutely nothing.
Slightly OT, but my partner was born in Bangladesh. Before he moved to the UK and met me, he accidentally got his then-girlfriend pregnant. She decided to have an abortion. This was a decade ago, and I don’t want to denigrate Bangladesh, so I must stress that things have probably improved drastically since then, but back then getting an abortion in Bangladesh meant going to the house of an older woman who would ‘treat’ you with some herbs and a coathanger. To make matters worse, she couldn’t tell anyone else (apart from my partner) that she’d had an abortion lest the local religious fundie nutjobs decide to ‘make an example’ or her, so she had to suffer the pain of a backstreet abortion with little support. My partner still cries when he remembers the pain she went through. Had she decided to continue with the pregnancy, she would probably have had a homebirth – not through choice; even in ‘state-run’ hospitals, the rich got seen in minutes for a sniffle whilst the poor died in the hospitals’ corridors. Vaccination schedules were also rather slapdash in their administration to the poor. His experience makes us very grateful for the medical care available to us and we cannot understand why people in developed countries refuse medical care which is freely available to them whilst millions in developing countries are clamouring for basic medical care. Although the aforementioned religious fundie nutjobs are apparently making people in developing countries refuse polio vaccines for no other reason than because conspiracy …
http://squatbirthjournal.org/wp-content/uploads/2014/04/spring2014online.pdf Check this out (page 18)…they want home abortion…and not just the pills women take at home that are safe, but midwife-performed MVA and herbs…..oh…the stupid….endanger more women…biohazards…etc.
My favorite line is: “It does us no good to rank some abortions as more worthy of advocacy and others simply unworthy of detailed discussion.”
Personally, I’d prefer to advocate for abortions that don’t kill women. Or cause sepsis that puts them in the ICU and renders them permanently sterile. Unlike a cohosh, parsley and mistoprolol blend designed by an amateur, or a home vacuum extraction, at up to 14 weeks, date not carefully confirmed, with a provider who learned about asepsis in a book and probably cleaned instruments in a kitchen sink.
And home miscarriage management. Which might be OK, for an early natural miscarriage where the bleeding never gets too bad. If you’re going to start “helping,” though, don’t you at least want an ultrasound first, so you don’t end up terminating a viable pregnancy?
No, the answer to abortion restrictions is not to give the anti-abortions legislators more fodder by encouraging amateurs to go out killing women.
Oh, I know. It’s a slap in the face to legit abortion providers who have to micromanage their employees and practices for every little thing. The people who end up in the hospital with sepsis, who get rid of that? Usually….tada…an OBGYN!
Wow! This might be the most biased piece of literature I’ve read. It is not soundly supported by evidence and is mostly a bunch of crap.
Why not post something useful?
“Why not post something useful?”
Good question “Scientist”. If you know all about this “evidence”, please show us. Otherwise you’re just blowing smoke to make yourself feel better.
Come on scientist, you can do better than that, surely. Challenge a fact, give an alternative view, anything?
So you have not read all the posts about not shaming formula feeding moms? Or the posts about the dangers of not vaccinating your children? You’ve not read the posts about the dangers of lying about the statistics when it comes to homebirth deaths as well as the dangers of considering every complication a variation of normal?
Many of the posters here are doctors, nurses and midwives who are committed to actually providing evidence based care for women during what can be the most dangerous time of their lives. We’ve also got several mothers who’s children were hurt by the homebirth midwifery system.
No one is afraid to call someone out respectfully when beliefs are wrong and no one is asked to bury their child twice. I’d say that is posting something useful.
“So, Ms. Crosley-Corcoran, the pro-choice and feminist movements are calling. We’d like you to stop using “feminist” to describe anti-choice, anti-women and anti-feminist activities. You keep using that word, I do not think it means what you think it means.”
http://groundedparents.com/2014/06/27/please-stop-calling-yourself-a-feminist/
And this is why I love this blog. If Dr. Amy has something controversial to say, she just puts it on out there and then backs it up soundly. None of this “all opinions are equally correct!” crap I see on so many blogs. Kudos!
As the United States of America progresses to a government subsidized health care system, birth-workers must galvanize so as not to be written out of decision making policies. Lay midwives want their share of the pie!
Here’s an idea Amy, how about stop stalking women’s facebooks,twitter and blogs and focus on YOUR LIFE and what YOU DO and get over yourself. YOU are not GOD. You DON’T know everything. You talk about blatant lies and mistruths and you are the biggest offender. Just because you graduated obstetrics 40 years ago doesn’t make you the authority on women, the authority on babies or the authority on obstetrics. You are merely the authority on your sad, pathetic life where you believe you are centre, and that what you say goes. You are the one with your fingers in your ears going ‘ Na Na in not listening, I am right! ‘. Focus on your own back yard.
.
Here’s an idea, Louise. Instead of whining about what I write, why not rebut it if you can?
LOL to one of these fools actually rebutting anything you say. HA
Louise, The difference between this blog and the likes of mothering.com is that your comments dont get deleted nor will you be banned from the site. I see plenty of women badly let down by the woo of ” natural birth ” and finding this site was a breath of fresh air . Perhaps you need to get back to the earthy smells of non-hatted babies & ” other ways of knowing” .Dr Amy provides a valulable resource for women who want to genuinely learn about the inherent risks of childbirth .
Ok, we’ll stop as soon as you do.
Since she is trying to tell people the real dangers of home birth with a lay midwife she is doing what she does. How can you counter lies when you don’t see them?
louise
“Just because you graduated obstetrics 40 years ago doesn’t make you the authority on women”
2014 (this year) – 1984 (see sidebar profile) = 30 years.
Learn some math.
“Focus on your own back yard.”
Follow your own advice. Perhaps if you folks did that, this website would not need to exist.
I’m the one with more than 40 years “in the field”. I graduated and began working in L&D in 1967. [Retired in 2012] And, in the main, I agree with Dr. Amy: direct entry midwifery is basically unregulated and therefore dangerous in the US; homebirth is equally so because DE midwives are too often incompetent loose cannons, there is no infrastructure for rapid transfer, no means of forcing compliance with safety protocols.
I’ve done home births in the UK, where the situation was entirely different, but the statistics indicate that even so, the risks are higher than in hospital birth. Bottom line therefore is that home birth means a greater chance of maternal/fetal death or morbidity: do you want to risk it?
I would venture that Dr. Amy has much better things to do than stalk TFB for her latest string of narcissistic, dangerous stupidity. But her devoted readers, both those you see as commenters here, as well as the lurkers, send her stuff they run across that is especially ridiculous. Unfortunately, Gina is frequently a source of the ridiculous, so she finds herself written about here often.
One example of a lie or mistruth? One example where Dr Amy claimed she was God or that she knows everything? Or that what she says goes?
You realise you make the same arguments I was making to my parents when I desperately wanted something when I was 10yo. The best I got out of those exchanges was that I needed to learn how to make better arguments.
There is major lack of common sense and logic going on up there in this personally insulting comment that states how someone is guilty of “not listening” and not being up-to-date in regard to their professional knowledge and expertise, while at the same time scolding that same person for following via all of the modern media outlets the issues related to their professional area of expertise.
A study of how adhering to NCB cult worldview impairs capability for rational thought and factual argumentation is in order methinks.
And why is an obgyn’s knowledge out of date after 40 years post-college (or 30, who’s counting hey? and less again if you take out the time actually in practise etc), but a midwife’s knowledge isn’t?
Especially if the midwife didn’t even go to college in the first place.
Actually, there’s a really good reason for that. NCB-cult midwives rely on traditional knowledge and intuition, which changes very little with the decades, while doctors (and real midwives) rely on studying a base of knowledge built through science and research, which changes constantly.
Hence, a traditional midwife trained 30 or 40 years ago is no more or less outdated than one trained this year. Older doctors, on the other hand, some of their training is outdated as medicine has advanced considerably since they graduated. Fortunately, medical societies prepare practice bulletins and CME to help them keep up with the changes.
A midwife that trained 30-40 years ago wasn’t being trained in lotus birth, placenta enscapulation, seaweed “suturing”, standing up to give birth, birth balls, water births etc. None of the current “traditional knowledge” of NCB is traditional midwifery, it’s “traditional” alt-med hippy crap.
If you look at paintings of women in childbirth, even in the earliest times, they show the woman lying.in.bed. With other women standing around. Not outdoors; no children running in and out; no bathtubs. THAT’S traditional midwifery.
Louise, have no care, dearest. Dr Amy is the first one to acknowledge that her surgical skills are not what they used to be. But since you wouldn’t go to a doctor and lie under the surgical knife even if your baby is suffocating inside you (you’ll rely on mommy cuddles to preserve their brain function instead), Dr Amy’s backyard is no concern of yours. It isn’t like you’ll ever find your way there, so it shouldn’t matter to you.
Louise, rather than focusing on how Dr. Amy hurt your little heart space in some way or another, perhaps you could try to redirect your focus to the FACTS that exist on the NCB movement, home birth, and the state of midwifery in the U.S…
Now, I’m wondering if you’d like to shed some light on the “blatant lies and mistruths” that Dr. Amy herself is creating, according to your comments. What are these, exactly? Care to elaborate?
The evidence is not on your side, I’m afraid, so like so many others we see parachuting on in here to holler “Your MEEEEEEN”, we’ll see you flounce on out of here as quickly as you dropped in.
They usually spell it like that, too (Your [sic] MEEEEN)
She didn’t say she was. But she’s had more education and training than CPMs with (maybe) a high school diploma, (maybe) a humanities degree and a months-long apprenticeship or online coursework. She’s had more education and training than a “public health scholar” who’s not done with her degree. And she’s certainly had more education and training than all the online mommies who think that looking something up on Google is “research.”
I can understand why you would disagree with the viewpoints on this site.
I can understand why you would object to the tone on this site.
However,
I do understand how you can claim that Dr. Amy is stalking Gina.
Stalking is when you invade people’s private life and track their
movements. It’s invasive. It is not stalking to read and comment on
“women’s posts on Facebook, twitter, and blogs.” All of these are public
forums for making public comments. And Gina isn’t even posting as Gina;
she posts as “The Feminist Breeder,” an active blog with an agenda and
strong voice. She’s already in the public discussion. Interacting with
her is hardly invading her private life.
By the same principle,
you are welcome to comment on your own blog about things that Dr. Amy
says. You can even go into the comments section and rail against what
participants here have to say. We might not like it, but we’re fair
game, because we posted our opinions publicly.
Historically, didn’t midwives also provide abortions?
Yes, and I am sure that was part of why they were persecuted in the first place. Giving women any control over reproduction was a huge no no- and still is to some!
They still do – they are just called stillbirths now.
Well, I think there is a difference between back alley abortionists and US homebirth midwives. I don’t know anyone who would go running to a back alley abortionist for an abortion because I think everyone can agree it’s unsafe. I don’t believe there’s a group of back alley abortionists making up numbers about the safety of what they do (or maybe there is, I’m not familiar with the practice of back alley abortionists). And I might be wrong about this, but would a back alley abortionist not be held accountable for killing a woman?
So much this.
Sadly, there are women who have go to a back alley abortionist, because they are so desperate to end their pregnancies and there are no safe, legal, feasible options for them in their area.
And pro-choicers did not rally around Kermit Gosnell and raise money for his bail and legal defense.
Gina is on a screed? Perhaps she’s unaware of the definition of screed:
“a long speech or piece of writing, typically one regarded as tedious.”
https://www.facebook.com/thefeministbreeder/posts/10152176917192727
Well, it is tedious.
For example:
“Some people think if they sign up for a hospital birth, they are guaranteed an epidural and a healthy baby. Way too many babies have been born on the WAY to the hospital for that to be a guarantee.”
So the problem with planning a hospital birth and hoping for pain management is that you might not get to the hospital in time?
As opposed to, what? Birthing at home and having a zero percent chance of getting an epidural?
And if I have precipitous labor, how can I guarantee my homebirth midwife will arrive on time? Might as well be the car.
Plus, you have to pay the midwife in advance, not so the hospital.
She seems to believe that opining that women who choose to do crazy birth stunts is the same as taking away their choice to do crazy birth stunts. In Gina’s world, you have to actively SUPPORT all choices otherwise you are anti choice—you are with her or you are against her. She can’t seem to get her head around the idea that someone can be all in favor of a woman having autonomy and the freedom to make whatever choices she wants, no matter how stupid, and that same person can still personally be opposed to the actual choice itself. This is not a really difficult concept to my mind, but I guess some people are total morons.
Excellent point. Gina’s “reasoning” is the equivalent of the Ku Klux Klan claiming that their free speech rights are violated when people condemn what they say. I’m a passionate believer in free speech and therefore I support the right of hate groups to march, and debate, but that is perfectly compatible with condemning them for their despicable rhetoric.
Similarly reproductive autonomy means that women have the right to give birth outdoors on a reality TV show. Condemning it as dangerous and narcissistic does not violate reproductive autonomy.
absolutely right. We’ve gone past the point of wanting people to accept our choices; people are now demanding that people applaud their choices. It’s not enough that your pediatrician keeps you on as a client even though you won’t vaccinate; it’s now imperative you get a pat on the back for your choice. It’s seriously disturbing. Go give birth in a field if you want to, but don’t expect a medal for it
So true: it’s the same line of thinking that implies that disagreeing with someone is the same as silencing them.
On a mission? A crusade? A venture? Not a screed, Gina; that’s not the word you want. You plonkerdoodle.
And the truth comes out! The operative word in Gina’s statement is FEELS, (“the safest choice for any woman is what she feels is right for her body”). That’s what this has ALWAYS been about for homebirthers. Feelings. Not evidence, not data, not outcomes. Oh, sure, they try to say they have evidence based practice on their side, but when the numbers show otherwise, it really doesn’t matter. Because a home birth feels more healing. Because a HBAC feels right. Because a midwife feels so much more caring. Well, Gina, how does it FEEL to lose a baby? You lucked out, but Gavin’s mom didn’t. Wren’s mom didn’t. The list goes on. I hope that someday you FEEL remorse for the lies you pass off as truth.
The Onion gets it right, yet again:
http://www.theonion.com/articles/the-pros-and-cons-of-natural-childbirth,36366/?utm_source=Facebook&utm_medium=SocialMarketing&utm_campaign=LinkPreview:1:Default
Right on about the doula screwing up the Apgar…
Love it! Especially this Pro: “Constant edge-of-seat excitement over not having medical professionals at the ready should there be any complication whatsoever.” And this Con: “Baby doesn’t give a shit one way or another.”
They’re wrong about the epidural though: one of the points of an epidural is that the baby doesn’t receive a significant amount of drug and therefore doesn’t enter the world buzzed.
Gina writes, “Thank you to all those people who recognize that the safest choice for any woman is what she feels is right for her body …”
I just asked me OB if my hospital allows maternal request c/s. The answer was that she does not perform them, and she doesn’t think the other OBs do, either. However, she could ask.
So, if I were to push this issue, citing my right to give birth any way I want, is that my right? Gina wouldn’t berate me for my selfishness? She wouldn’t tell me to listen to my doctor. Right?
An aside, I am not currently planning to press the issue.
I did ask, however. And because I know many people are critical anyone contemplating this topic… and also because I love drawing comments out of the doctors and scientists on this site … I will explain what circumstances prompted my query.
My husband and I had just gone over an article published last year about counseling women about maternal request c/s. The impression we got from the evidence presented (as lay people, we are NOT in medicine) was that it seemed possible that a planned c/s might be marginally safer in my case. It sounded to us like a planned c/s would lower my risk for hemorrhage and pelvic floor damage/incontinence/etc. It also sounded like it would remove risks to the baby that attend vaginal birth. So, we thought, “Hey, that is pretty good. What are the risks?”
The risks to me seemed to be: the risks that ordinarily attend surgery (infection, etc) and greater risk of complications in future pregnancies. But, we’ve already determined that there will be no more pregnancies after baby #2. So that leaves the usual risks of surgery.
The biggest risk to the baby seemed to be respiratory problems; but I can’t help but wonder if that’s related to prematurity or other problems in the c/s group.
The emotional reason I asked are really that I’m not that fixated on the risks to me. I’m more fixated on the fact that with baby #1, the delivery was rough. He had to be resuscitated and required monitoring by the NICU. Everything was fine; our “experience” reflects that fact that when vaginal delivery goes all wrong, wonderful medical care can bring everyone through it healthy and whole. But… I’ve always felt bad the poor kid had such a crummy first week.
So, we asked. Sue us. :p
I think it’s a great question. And you are certainly within your rights to request one. What you found is true from what I read, too, that c-sections are better for the baby and probably your vagina as well.
Let us know the answer. You can also look at the blog listed to the right Cesarean Debate and I think there is a Cesarean by Choice Facebook page.
I loved my planned CS. I had it in Japan… They’d never have agreed here. I think it should be an option if the mom is willing to accept the risks.
Specifically, a c-section without labor increases the risk of TTN, especially if the baby is also early term. However, TTN is a short-term problem, it just requires a few days of treatment and/or monitoring until it goes away. It isn’t like the more serious lung issues that affect preemies, and it isn’t as bad as the sort of thing that can happen to the baby when vaginal birth goes wrong.
Yeah, the first T stands for Transient.
My baby had TTN. I get the sense that TTN is the diagnosis if they rule other more serious causes of respiratory distress out, and that ruling out (and the treatment necessary for TTN itself) takes a bit of time and a distressing NICU stay, blood draws to check for infection, beeps and monitors when you’re trying to breastfeed, etc.Obviously, this is to be weighed against the benefits of a c-section, but it would definitely be one factor for me in deciding for or against a c-section.
Does induced labor (at 40 wks or more) still count as labor in this instance? My boy (induced at 40wk + 1) was still “floating” even when I was at 7cm (when we all agreed to throw in the towel), so while I was “in labor”, the contractions were clearly ineffective. We’re doing a RCS with this one in a few weeks, just 2 days shy of 40wk.
Yes, my maternal request c-section (also known as my hell-no to VBAC) ended with a baby that had TTTN. He was on oxygen for 24 hours and has been fine since then. In my experience the risk of TTTN was small-fry compared to the risks of another labour attempt.
It’s the Cesarean by Choice Awareness Network – and my blog (Awaiting Juno) might also have some useful info.
MRCS is a good thing to have the option to do, and to be honest, I think they should be widely available and discussed as an option.
I read the thread where GCG made her asinine statements, and many people on there (several, clearly regulars here, but some not) tried to explain that no one is restricting a woman’s right to give birth where she wants. Whenever Gina or one of her flunkies took their fingers out of their ears long enough to answer, they would comment about homebirth midwives being illegal in some states. And then, the sensible commentors would return with “yeah, because practicing medicine wo/a license SHOULD be restricted.”
So it seems Gina and most of her crew aren’t willing to go as far as unassisted childbirth and feel they have a right to have an attendant. True, but in some cases the legal attendants are in the hospital, so if a woman in a state where homebirth midwifery is illegal is insisting on a LEGAL attendant, especially one that might take insurance, then yes, her birth choices are restricted. But, hey she can always choose to go wo/ an illegal midwife! There’s no law against that, and its probably just as safe, or safer than a CPM-attended homebirth anyway.
Ugh, do these women even listen to themselves?
I can’t get someone to help me do something most of society thinks is a bad idea! Help, help, I’m being repressed!
My favorite part is that when I asked Gina direct questions she pretended that she was Harry Potter with a Cloak of Invisibilty. She thought that if she could ban me from seeing her posts, she was protected from challenge. Of course, I can see them anyway merely by logging out, and she made herself look foolish.
I wonder what her blocked list must look like. There have to be thousands of people on there at this point.
Quote right. Let’s not forget that the Cloak of Invisibility failed Harry quite spectacularly a few times when he least expected it.
Gina could have taken care to remember that, at least.
But having a friend over is legal, right? It’s the money, and also possibly fraud by claiming to be a medical provider, I thought.
I mean if Ina May herself says “I don’t have any medical training and I’m not charging you.” is there any state in which it would be illegal for her to be at the residence of a woman in labor?
Sure I’d be fine with that. Now find any lay birth attendant that will work for free. I’m happy to volunteer but my transfer rate is 100%.
Precisely. Home birth is and should remain legal, minimally-trained amateurs charging money to attend home births should not be. Heck, the regulations for haircutting work the same way! You want to trim your bangs in the bathroom sink? Go to it. You want to advertise a business of going to people’s houses to cut their hair? That’s another matter entirely.
There is one notable difference. Back alley abortionists aren’t raising money and lobbying Congress to license back abortionists.
They also don’t have a ridiculous “Sisters in Chains” network.
I wonder if Katie McCall would allow some persecuted abortionist on her site?
No way. Conflict of interests. Given the rate homebirth babies die compared to hospital born babies, homebirth midwives are trying to take over abortionists’ business.
Another difference – safer alternatives to CPMs for childbirth are more widely available in the US than safer alternatives to back-alley abortionists.
The most obvious difference? That an abortionist promises your pregnancy will end with no baby at home, and the CPM tells you it’s not her fault when your pregnancy ends with no baby to take home.
Both work in unsanitary conditions (e.g. waterbirth, ungloved midwives, flesh-eating bacteria in the vagina incident), both get paid in advance, and both leave a trainwreck behind so real medical professionals can clean up the mess. Yep, same thing.
I FEEL safer with my children not in boosters or carseats!
To be fair, I think a more appropriate statement would be, “I FEEL safer holding my children while we drive”
I would personally argue that some ABO clinics are about as safe as non accredited birth centers. They get cited for extreme safety violations pretty regularly. There is also a movement for women to have ‘unassisted ABO’ by ordering Misoprostol online, even skipping Mifepristone. I will also add here that PP is the *only* place in women’s health where the person I see before the CNM or MD does not even have to be a Medical Assistant. Their workers only have to have a HS degree. Which leads to the crazy incident LiveAction just caught on tape where a 15 year old was being coached on BDSM by a non-licensed person nonetheless wearing scrubs in a medical office.
They get cited for extreme safety violations pretty regularly.
Have you ever heard the term “TRAP laws”? Clinics that perform abortions get cited for “safety violations” like having closets that are 32.5 instead of 33 inches in depth. The point is to make it difficult for practitioners to provide abortions and encourage more women to go to unsafe providers.
I have heard that term, but have you read the actual citations? They get cited for unclean instruments, fetal waste improperly disposed, etc. You don’t get cited for TRAP laws on safety inspections, those are laws put in place in order to make things like emergency transport easier or to get clinics to close, depending on which side you are on. But the safety violations that shock me are medical in nature.
Saying that ABO clinics can’t follow out patient surgical center regulations or women will go to unsafe practitioners is actually a little like saying that if twin or breech restrictions are put in place, women will do these births unassisted.
Who says that women’s health clinics don’t follow outpatient surgical center regulations? Again, citation needed.
They don’t, they tried to make them and they cried TRAP.
Citation: http://healthland.time.com/2013/07/03/texas-abortion-bill-is-there-a-medical-case-for-more-regulation-of-outpatient-procedures/
Remember Wendy Davis? The tampon throwing? This was part of what that bill wanted to require, as well as admitting privileges at local hospitals.
Another article: 15 years since some facilities had been inspected: http://www.huffingtonpost.com/2012/01/20/illinois-abortion-clinic-_n_1219897.html
I am sure Dr. Amy didn’t mean for this to become about the ABO industry, so I am happy to discuss this another time, but my point was just that these facilities do get cited for safety regulations somewhat more that hospitals & other doctors offices. It is your decision whether you think that is politically motivated or actually true.
And the recent drive to force such clinics to come up to standard was fought against hard.
(Also not wanting to be political, just saying I’ve seen the same info you have, elsewhere. I fall down a lot of internet rabbit holes in the name of research.)
Right, I didn’t. So why did you immediately jump in to derail the discussion and promote your personal views about abortion?
Because they aren’t my personal views, it is another area of women’s health where ideology trumps safety. I am sorry you seem to be under the spell of that ideology and don’t seem able to understand that the ABO industry is held to a LOWER standard than other areas of women’s health . . . If you didn’t think a post with a hanger would involve some discussion of that industry, well you had to have realized that . . .
Obviously they are your personal view. Otherwise you’d be able to present scientific evidence to back them up.
You’ve been gulled by anti-abortion propaganda and you have no idea about the safety issues in performing abortions.
yes, ideology trumps safety in abortion rights … but it is YOUR ideology that is trumping safety. If we wanted safe abortions, there would be government-funded early term abortions offered in every hospital, just like any other kind of surgery, and reasonable requirements for free-standing clinics. But it is the anti-abortion forces that have increasingly pushed abortion providers to the edge. NOT planned parenthood.
Why does the government have to fund abortions for them to be safe?
And FYI, the government DOES fund Planned Parenthood and they bill Medicaid all day long. So much so that you might even consider Planned Parenthood a quasi governmental service. It would absolutely not survive without state money.
Why shouldn’t PP bill Medicaid or any other insurer for the medical services it provides?
They have been convicted of Medicaid Fraud. Read about the P-Mail fiasco. (Where they were mailing out BCP on an opt OUT basis & billing all the while)
Here’s a take on that situation that you probably haven’t read:
http://www.theguardian.com/commentisfree/2013/aug/09/anti-abortion-lawfare-planned-parenthood
They settled because of the prohibitive legal costs of going to trial. It’s not an admission of guilt. Filing bogus but expensive lawsuits against PP is part of a multi-pronged attempt to drive them out of business and keep women from being able to access abortion services. The “whistleblower” in this case received over a million dollars.
You have not said a single truthful thing on this thread. The Hyde Amendment, for example, bars federal funds from being used to pay for abortions. Planned Parenthood provides more than just abortions – they provide a vast array of health care services. The movements to defund Planned Parenthood have resulted in millions of women being left without health care. And citing to LiveAction really undermines your credibility for anything you have to say on this subject.
IIRC, abortions account for all of 3% of Planned Parenthood’s activities. And as others have noted, the Hyde Amendment bans federal funds from paying for abortions. The things that PP bills medicaid for are NOT abortions.
Oh my gog. They bill Medicaid for CANCER SCREENINGS. This saves government and taxpayer money. Not detecting cancer early costs a lot more money, and who do you imagine picks up the bill?
For future reference, when you try to cite evidence, you should really aim higher– like scientific articles from respected journals, not media sources. Media sources are basically useless in the US because 90 percent of the media (including radio and book and newspaper and magazine publishing as well as television) is owned by the same five for-profit corporations
Ugh, did you see what happened in MA this week? With the overturned buffer zone law?
They aren’t your personal views? Are you serious? You’ve done nothing but cite skewed statistics and propaganda from the anti-abortion side, which other commenters have offered evidence otherwise, and now you want is to think it’s not a personal view? Unbelievable.
Whether or not it’s true that abortion clinics have more or worse violations, the answer is to focus on providing safe, legal abortion services for women. Not to close down abortion clinics. The fact that some abortion clinics and practioners are incredibly sketchy (eg Gosnell) is a direct result of the anti-abortion movements’ successful push to marginalize abortion providers. The correct analogy to homebirth here would be if the political establishment were trying to outlaw births in the hospital, then complaining that homebirths were risky!
Excellent points!!
BULLSHIT- You are the QUEEN of DERAILING.
Like, every single thread you start, and just about every damn comment. I know, this is a dead horse I am beating here, but knock it off already.
I think you may have fallen for the propaganda. The article you cite points out that the law that Davis blocked would have required abortion clinics to have monitoring equipment much in excess of the equipment required for clinics performing procedures of equivalent risk. If we required every dermatologist who wants to perform liquid nitrogen mole removal to have as extensive monitoring equipment as, say, outpatient surgical centers that perform liposuction or colonoscopy, we’d soon find ourselves with fewer wart removal options. Especially if admitting privileges to local hospitals were required and the majority of local hospitals were run by an organization that believed that dermatology was evil and if it was god’s will that you die of skin cancer then it is wrong to thwart that will.
Most organizations that are “pro-life” actively advocate killing pregnant women if they have problems during their pregnancies. Several women have died because of such laws and attitudes and there have been quite a number of near misses. I’ve seen several patients come damn close to dying because of abortion laws that made it difficult to treat their issues. I’m sorry if their survival annoys you, but I’d rather they lived than not.
You are really comparing wart removal to D&C?!?
Most abortions aren’t D&C, but vacuum aspiration. And yeah, they are about as low-risk as wart removal. Certainly FAR lower risk than carrying to term.
As a woman I call absolute BS on the idea that a procedure that inserts implements into my uterus is as low risk as applying something to my skin with a cue tip.
How does being a woman qualify you to determine risk?
So once we ensure that abortion clinics are performing at the highest standards of safety, I’m sure you’ll be fine with them, right?
I believe women deserve access to the highest standards of informed consent & an end to the euphemisms. You abort an Embryo or a Fetus, not a Blastocycst, not a Zygote, not a Clump of Cells, you don’t ‘gently remove the produuuucts of conception’.
Beyond that I believe they deserve the highest standards of safety. Not a ProChoice Volunteer discussing a medical procedure, not a HS Degree Assistant giving an Informed Consent discussion. Not a hotel room.
And I believe that they should be a medical service we pay for as women, at least a nominal amount. There is a cost to those who do them, in terms of risk, and also emotional impact.
Beyond that I will always think that there are better options & long for a world where all children are accepted, but it is also something that has always existed in society & that women always seek, so I do think it can ever be ended.
I do think forced abortions can be ended though. And I believe gendercide can be reduced through legal protections for women & education of societies, as well as policies. As well as abortions forced by parents & partners & the economic draft into abortion. I hope to see all of those end in my lifetime.
I mean do not think they can be ended.
Being a woman qualifies me to call ‘BS’. I basically call BS on Guttmacher too. They are the research arm of PP, their divorce was recent & messy. Plus Guttmacher was highly controversial & the organization still bears his name.
Ok, I’ll bite. What’s your beef with Guttmacher?
Well, I’m a woman too, and I say you’re wrong. What are you going to do, tell me I’m less a woman than you? Not fucking likely. Your “other ways of knowing” BS is just as BS here as the NCB stuff. Reality doesn’t care what you ‘feel’.
Being a woman means I get to control my body. I get to decide who uses it and how and when. If I don’t want to incubate a fetus, I don’t have to. That’s what my “womanly intuition” tells me. My womanly intuition also tells me that you’re making things up instead of following the facts. How’re you going to argue that?
I think we can all agree on informed consent, correct terminology, and access to safe care in an appropriate location.
People already pay for abortions.
I think you’ll find across the board agreement that forced abortions are bad things. Even at Planned Parenthood!
What is “the economic draft into abortion”?
I definitely think forced abortions are bad! But you know, there are a lot of things which I think are OK for a person to decide to do, but if someone else forces you to do it, that person is wrong. Matter of fact, as I see it, a huge portion of human activities fall in that category.
Let’s not talk about US regulations and practices of forced abortion and gendercide in the same discussion. Unless you have proof that the latter are rampantly practiced in the United States (and maybe it is, I don’t know. That’s why I ask for evidence), it belongs in a separate discussion about abortion, abortions with completely different motivations and actors. We’re talking about abortions provided in the United States, sought out legally by women exercising their right to privacy.
And short of it simply not being correct terminology, it’s hard to take your call for the end of euphemisms seriously. Fine. Call it a fetus, call it a fricking baby for all I care – it isn’t going to change the situation. And actually, with some forms of abortion, like the morning after-type pills, you may actually be terminating a “clump of cells” that have yet to reach the stage of embryo.
Ok, let’s talk about abortion and the “reality” of it.
The majority of abortions occur before or during the 8th week of pregnancy. The 8 week old embryo has no stationary neurons. There is absolutely zero chance that it suffers during abortion or is in any way aware. It has no more mental ability than an unfertilized egg. There are tumors that have more mature neurons in them.
Abortion and cancer: The risk does not exist. It’s a myth. There is no increase in breast cancer risk with abortion. There is, however, a decrease in uterine cancer.
Children. Children should be wanted. IMHO, one of the most deeply immoral thing a person can do to their child is to have that child when the parent is not in a position to raise the child. Children should not be born simply because the parents were too lazy to do anything to prevent or stop a pregnancy that they didn’t want. An embryo doesn’t suffer in abortion but a child certainly does suffer if s/he is abused. A child suffers when s/he knows that s/he was not wanted, does not bring joy to the parents, does not please the parents–even if the parents aren’t abusive, do step up and provide for the child. Only a malicious person who delights in the suffering of others would demand that someone have a child just because they became pregnant. Unfortunately, the world is full of people with that kind of malice.
This is so excellent. Thanks for posting it.
Exactly what degree is it that you think Medical Assistants have? I have published about this, so I call BS back.
Have you ever poured liquid nitrogen on yourself? I have, lots of times. And when I didn’t mean to, I got one hell of a burn. Holding a LN2-soaked q-tip against your skin – you’d better know exactly when to stop. And it HURTS.
The analogy holds pretty well between outpatient (early stage) abortion and outpatient wart removal.
There are several office procedures you can have done that are somewhat invasive. Fallopian tube coils, uterine ablation, endometrial biopsy, iud placement, etc.
Because you’re a woman and you feel a certain way, that’s how it is, huh? Do you know how crazy you sounded there?
You are AGAIN missing the point, which I’m beginning to think IS your point.
Are you missing the point deliberately? Still, if it’ll make you feel better, how about comparing it to a MOHS procedure. Now what’s your excuse?
And do you know what the end result of the new Texas restrictions was?
Zero change in the abortion rate. Substantial increase in second-trimester abortions. Lose, lose, lose.
http://www.huffingtonpost.com/2014/04/03/back-alley-abortions_n_5065301.html
Here’s an article about that….
Well, those zealots don’t actually give a shit about the actual results on real life people. They are too busy polishing up their ideaology.
Just like Mississippi, they over-regulate abortion and force women to see services out of state or hundreds of miles away. By the time they come up with the money and time needed to travel to another state they need a 2 nd trimester abortion. I think it is more dangerous to force these clinics to close and force women to have children they do not want and cannot provide for as opposed to a wanted or needed abortion.
Forgive my stupidity, but what is the acronym: ABO? I know it is “abortions” but I can’t figure out the ABO, are those 3 words?
That is just how medical providers abbreviate abortion.
thank you. I was twisting my brain trying to figure it out: Abortions By Obstetricians? Abortions Below the Ocean? Abortions Because…Oxen? So, not an acronym then.
No. TAB is the acronym.
As opposed to SAB (spontaneous abortion, or miscarriage). What does the T stand for?
‘Therapeutic’, as it’s a medical procedure.
EAB is the acronym I usually see. SAB and EAB. Spontaneous and elective.
In the UK it’s called TOP – termination of pregnancy.
Amy M “but what is the acronym: ABO”
I’ve been wondering how Ellen Mary confused the blood groups with abortions.
Be intellectually honest, please. There is a large, ongoing effort to restrict access to abortion by layering on “regulations” that don’t improve patient care and by adding all sorts of hurdles for both women and providers. This has NOTHING to do with safety. The anti-choice crowd is pretty honest about what they are trying to do. Stop pretending otherwise.
Anti-choice it itself an intellectually dishonest term. If you really turned your critical eye on the practices of the ABO industry you would see exactly what I am talking about. I mean we KNOW that ABO doctors travel state to state, use hotel rooms, etc.
Gosnell was not caused by anti choicers. And PA closed him for Opiate prescriptions, despite many complaints over the years.
You can save that nonsense for someone gullible enough to believe it, Ellen Mary.
The irony is that the biggest booster of back alley abortionists are people who try to institute bogus health regulations. There is ZERO evidence that the regulations pushed by Republicans do anything to improve the health of women; they merely improve the incomes of back alley abortionists.
Anti-choice is far more intellectually honest than “pro-life.” Anti-choice means being against women having choice in reproductive healthcare options, which is absolutely an accurate description of the antiabortion movement. One would assume that pro-life means in favor of life at all stages of development, but a majority of those who oppose abortion are also against supplemental nutrition programs, workplace protections, immigration reform, environmental regulation, gun control, and universal health care. A majority of those who oppose abortion generally favor aggressive foreign policy and militarism in general. And very few of those opposed to abortion offer to adopt children unless they’re white newborns. If you were truly pro-life, you’d stop focusing on abortion and work instead on creating a world where abortions are unnecessary.
Again, as mentioned before – it’s been shown nicely in that Washington University study that giving women access to free, high-quality birth control (particularly reversible implants, which take the burden of compliance off of the woman) reduces the number of unwanted pregnancies and abortions. I will believe the ‘pro-life’ crowd’s statements that they want to reduce the abortion rate (and that they’re actually pro-life) the moment that free birth control becomes a primary plank in their platform.
Amen!
That is a just sterotype. And if you are for welfare programs & generally up with people, and against war but for abortion, would that be similarly inconsistent. They just released an ABORTION ROM COM. I think it is safe to say some are *pro abortion* in this world. It is even a tool of state control & gendercide on this Earth, as well as the most severe human rights abuse known on Earth, forced abortion. #FengJianMei
We get it; you oppose abortion. Just own your own views and stop pretending that they have anything to do with safety.
That’s the funny thing – I definitely ‘oppose abortion’ in the sense that I consider the fact that a woman ends up wanting or needing one is a failure down the line – of birth control, of social services, of prenatal care, of our ability to control the developmental process and genetic abnormalities, etc etc. And I don’t think women should bear the burden of these failures. We don’t live in an ideal world, so we need to allow woman proper acess to safe abortions (with safety determined by doctors in the relevant field, not politicians) as we work towards a better world and try to make the _demand_ rare.
It’s not a stereotype when the numbers and the voting records of anti-abortion politicians bear it out. It’s also not inconsistent to be in favor of social programs and still think that abortion is a personal decision that is the woman’s right to choose.
And you’re changing the subject. Your contention, to which I was responding, was that “anti choice” wasn’t a fair label. You have yet to present a good argument as to why it’s not. Mentioning that there’s ONE romantic comedy where the protagonist has an abortion (as opposed to how many where she keeps the baby? For Keeps? Stella? Knocked Up? Raising Arizona? Baby Boom? Three Men and a Baby? Juno?) has NOTHING to do with the accuracy of the term “anti choice.”
Sure there are people who are pro-abortion. What does that have to do with anti-choice being a better label for someone like you? Being pro-choice in the US is not the same as being in favor of forced abortions in China. And being against forced abortions in China does not automatically make somebody either anti choice OR pro life.
Do you have a compelling reason why we shouldn’t use the term anti-choice for someone who is against reproductive choice, or not?
Yes, god forbid there be a movie that features abortion as a theme. It isn’t an experience that millions of women have in their lives and doesn’t deserve any place in art or culture. It should just be one of those subjects that we consign to the closet, with only hushed negative references.
“Shmashmortion”
I sort of agree. Anti-choice is less precise than anti-women, which is a far more adeguate term, since most anti-women’s crew seem to regard women as having less rights on bodily autonomy than a corpse.
Of course some people are – GASP – pro-abortion! I am; in every case when a girl or woman wants one, I’m pro-abortion. Every time.
You don’t understand the term pro-choice, do you? In favor of choice. Forcing a woman to have an abortion is just as bad as not allowing her to get one- both take away her choice. There isn’t a single person who is pro-choice who approves of China forcing women to have abortions against their will.
The appropriate term for you is indeed anti-choice. I will also accept pro-forced birth and fetus fetishist. But you are absolutely not pro-life if you think a fetus trumps a woman’s life.
Hmm, I wonder why physicians might feel compelled to travel to places that have been wiped clean of abortion services thanks to the anti-abortion regulations? They must really like to kill babies. Or like to exploit the situation for financial gain. I’m sure it has nothing to do with the desire (however impractical and unsafe the expression) to reach women who have been shut out.
Gosnell was not caused by anti choicers
Oh? After the scandal concerning Gosnell broke, a number of women who were his patients were quoted as saying that they knew that his clinic was dangerous but they couldn’t face the harassment that they would have received at Planned Parenthood or other safe provider and so decided to take their chances with Gosnell. For that matter, why didn’t the “pro-life” movement ever protest Gosnell’s clinic, which was known to provide abortions? Perhaps because their primary motivation is to punish women and they felt that he already had that covered?
Dr Amy, you know Ellen MAry, always taking one aspect of a post and expounding where it no longer is relevant and always arguing against anything someone else says. I haven’t even read further, but I am totally sure she will go off on some unrelated abortion rant and is probably anti abortion. Which means, anti woman’s bodily autonomy.
Agreed.
I don’t think anyone is saying can’t follow regulations. They can (and should) be held to high safety standards, but those with a political agenda make it purposefully difficult. As a result, clinics are not as safe as they could be, or they are forced to close and women turn to even more unsafe options.
That is not comparable to your example of homebirth restriction. Homebirth is inherently less safe. You can’t make it as safe as a hospital birth. Clinics can be safe options but have people purposefully making them less safe. Regulating birth providers points the woman to safer options (while still giving her the right to forfeit those safer options if she chooses). Politically motivated groups have regulated/restricted clinics to make them less safe, leading the woman to more dangerous options or no options at all.
Women are as safe having these births at home with a lay midwife as having them in a back of a cab assisted by a random untrained person like a cab driver. There are heaps of stories around how lay midwives refused to transport when mother requested it, would not call emergency services, transported patient to a further away hospital and wasted time, there was even one I think where midwife tried to physically prevent mother being driven to hospital by blocking the exit with her car. My guess is that if there was no weekend birth warrior posing as someone qualified and assuming authority that mothers who choose unassisted childbirth and lay people who attend such births would likely dial 911 or transfer sooner and experience better outcomes than when there is a quack there telling them to ignore signs of imminent danger who appears to know what she is doing.
Source? Citation needed.
There was a New Yorker article several months back about an abortion provider here in Pennsylvania who had continued to practice for years despite poor practices. After Kermit Gosnell (who was known to be unsafe, and had been overlooked by successive administrations of both parties because he only served poor minority women) they enacted new regulations to make abortion “safer.” They closed down a lot of clinics, but not Brigham’s. I think that was pretty much the proof that these laws are not really about safety.
Bingo.
FWIW, the local gossip on Gosnell is that he was ignored BECAUSE he was known to be unsafe. That way if and when the story came out, the “pro-life” governor could claim that this was proof that he needed greater power to shut down clinics that provide abortion and if it didn’t come out, it would punish women for having abortions by endangering them, which was also something that he wanted. So win-win from his point of view.
Um, LiveAction is a pro-life organization. I’m going to take anything that they “expose” with a grain of salt. Give me links from independent sources who have verified their footage was indeed to be interpreted as was presented, and I’ll be more likely to accept it. Anti-abortion activists and politicians have relentlessly driven abortion providers and clinics into a corner, until few options exist. All in the name of “safety”. It’s a great strategy, but disingenuous nonetheless.
You have brought up these claims about Planned Parenthhod’s staffing before. However, you consistently ignore very reasonable responses to that claim from me and other people on this board. These include:
1) You assume that the people who do intake and rooming at all of your doctors’ appointments are MA’s or CNA’s, but this is generally not required by law. Lots of people assume those folks are nurses, too, but that doesn’t make it true. Even if it is true of your providers, that does not make it true of every medIcal practice. I am a health researcher who spends time in actual medical practices doing my research, I can attest to the fact that not everyone who does that work has a certification.
2) You invest far more meaning in those certifications than experts do. That is because those certifications have totally unpredictable meanings. In a lot of places, those certifications are gained as part of vo-tech programs that offer high school diplomas but take students out of regular science courses. In some others, they are attainable by passing a four- week class that is offered from a for- profit “educational” facility. In other places, the certifications are new enough that you have lots of knowledgeable and experienced people who are not certified because they have been doing the job longer than the
3) Others have linked to materials indicating that Planned Parenthood is requiring those certifications for the people they hire in that role now.
4) you don’t provide links to support this anecdote.
5) planned parenthood sees a lot of very poor patients and is chronically underfunded. There’s whole libraries full of research that shows that underfunded facilities serving poor patients receive more scrutiny, and struggle to provide high quality care. Given the limitations, Planned Parenthood usually does extremely well on performance indicators compared to facilities that serve the same populations. We should probably change the health funding scheme to eliminate economic disparities in care, but until we do, we cannot pretend they do not matter. Planned Parenthood locations also provide a whole range of women’s health services, including affordable cancer screening, so ideological attacks on them are often directly linked to depriving poor women of these services which lead to higher systemic taxpayer costs to treat cancers that are not caught early enough.
There is also a movement for women to have ‘unassisted ABO’ by ordering Misoprostol online, even skipping Mifepristone.
A “movement”? As in “a group of people working together to advance their shared political, social, or artistic ideas”? Sorry, but no. What you are describing is just another manifestation of the desperate and unsafe measures women often take because anti-abortionists actively do everything possible to eliminate access to safe, legal abortion. Put the blame for that where it belongs.
Frankly, misoprostol, even not under a doctor’s guidance, probably leads to fewer maternal deaths than many other desperate measures women take. I have only heard of this being done in countries where abortion is banned.
Ironically Gina spends lots of time harping against elective csections. The article wasn’t even about banning birth in nature, just that a TV show on it was a terrible idea.
Having the right to choose the location for the birth of your child doesn’t prevent others from criticizing that choice. I support having the right to choose, but I won’t support unsafe choices.
That’s my thought exactly. I completely respect a woman’s autonomy to do as she pleases.
In turn she must respect MY autonomy to express my opinion that she is being an idiot.
I hate this whole conflation of “respect” with never criticising anything ever, because feminism. It is using the guise of feminism to silence dissent, which is distinctly not feminist.
I totally agree. I can respect a woman’s autonomy and not respect or support (another buzzword as in “Women should stop the Mommy Wars and all support each other!” ) her actual choice. OR–not even care about her actual choice! Why does she need my support? Aside from vaccinations, I truly do not care how other women give birth and raise their children–not my business. I do not have to support them. I shouldn’t be a big mean jerk if they make different choices than I do, but I don’t have to support them.
I’m not sure I’d go as far as “no difference”. I can see at least one difference: Back alley abortionists almost never claim to be safer than OBs who perform abortions.