abortionpillnyc and Parkmed

Parkmed Physicians is a leader in women’s health care offering free pregnancy test, abortions, and full OBGYN services. This Blog is sponsored by Parkmed Physicians however it does not seek to give medical advice – for medical services you should consult your medical professional or call our office and make an appointment to meet with one of our doctors.

I am Heather MacGibbon, Ph.D. in Cinema Studies from NYC and author of Screening Choice: The Abortion Issue in American Film 1900-2000 (VDM Verlang 2009). I have been a counselor for women’s health clinics in the New York area for the past 12 years and a critic and scholar on the abortion issue in the US media for even longer. In this blog I will be keeping you updated on the current state of reproductive rights and advances in women’s health care.

As I am sure you are well aware – reproductive rights in the United States has come under heavy attack in recent months. It is hard to know where to start in looking at how things have gotten more contentious and complicated over the last year. What I can say definitively is that we are seeing as continuation of a three prong assault on the abortion rights: The Cultural War, The Legal Battle and Control of Access.

The hottest place in this battle currently is the control over access to safe and legal abortion care – which has spilled over into an attack on general reproductive health care for women. This includes both legal limitations on when a woman and her partner can choose to have abortion as well as limiting access through cutting funding.

Recent attacks on the legal front have come based on the argument that abortions beyond 20 weeks should be banned do to possible pain of the fetus. The most recent of these came last week in Iowa where a bill was passed by the largely republican senate to limit abortions in that state to less then 20 weeks into the pregnancy. This bill modeled after similar bills being considered in 15 states, one of which passed into law in Nebraska last year. A similar bill recently passed the Kansas legislature and is expected to be signed into law by Gov. Sam Brownback. Supporters state that these laws are based on research which notes that a fetus of 20 weeks or more has nerves and presumably could feel pain during the procedure.

These laws contradicts current scientific knowledge – as pointed out by Mark Rosen of the University of California, San Francisco, and co-author of a seminal 2005 review on fetal pain:

“The first brain pathways associated with pain perception "are not complete before approximately 29 weeks of gestation", so although fetuses develop brain wiring from about 23 weeks onwards, the connections are not there to enable them to experience pain. As pointed out there are very few instances when this comes up – and is part of a larger attack on all abortions bring allowed.” (Coghlan, Andy “Breifing: New Law Claims …” New Scientist April 16, 2010)

Despite the contradictions with accepted science lawmakers have forged ahead with these restrictions. This nullifies the complex issues facing women and their families. It also takes away from other – more pressing prenatal issues according to opponents.

 “Rep. Anesa Kajtazovic, a Waterloo Democrat, questioned why the body is debating an issue that has affected so few families compared to other maternity issues. Kajtazovic said just six abortions were performed in the state last year after 20 weeks of pregnancy, compared to 700 Iowa families that have experienced a miscarriage or stillbirth in the past year. "What's sad is that we have members in this body politicizing what is such a personal and difficult decision," Kajtazovic said.(Henderson, Kay Reuters on line Fri April 1, 2011 6:32 EDT)
Similar bills are also being passed in Oklahoma.
“The 94-28 vote Tuesday ( March 29, 2011)  by which the Kansas House approved a bill imposing tighter restrictions on abortions after the 21st week of pregnancy based on disputed claims that fetuses can feel pain. The House's vote was to accept the Senate's version of the bill and sent the measure to Gov. Sam Brownback .(Associated Press 03/29/11 1:58 PM)
These legal skirmishes  come on the heels of several bills being passed and signed, or expected to be signed by Arizona Gov. Jan Brewer which limit both which medical providers can perform abortion, but also the reasons that abortions can be provided.

“The law makes it a felony to knowingly perform or provide financing for an abortion sought because of the race or sex of the fetus or a parent’s race. The maximum punishment if convicted is 3.5 years in prison. Supporters said they wanted Arizona to prevent discrimination-based abortions, and they disagreed with opponents over whether there was evidence that race and sex selection-based agendas were actually occurring in Arizona. Critics said there was no evidence that selective abortions occur in Arizona, and doctors could face jail time if they lose a newly required affidavit that an abortion is not for selection purposes. “This law creates a highly unusual requirement that women state publicly their reason for choosing to terminate a pregnancy — a private decision they already made with their physician, partner and family,” Bryan Howard, chief executive officer of Planned Parenthood of Arizona, said in a statement.” (AP in New York Times March 31, 2011, on page A14 of the New York edition.)

These few legal attacks on abortion rights need to be seen in the larger context of the de funding of Planned Parenthood by the federal government which will severely limit not just abortion access – but access to cancer screening and general OB / GYN care provided by this organization. This and the other local and national legal limitations of different kinds are popping up encouraged by current anti choice environment of our current political scene.

In the coming weeks I will endeavor to highlight other legal and cultural attacks on reproductive rights as they happen.

An Informed Opinion Re The Neuhaus Hearings – How Much Suffering Is Enough?

As a long time patient advocate at several New York City Abortion Clinics I wanted to chime in with an opinion about these hearings. Over the years I have referred many patient to Dr Tiller’s clinic – while he was still alive – and never feared for the quality of care both medical and psychological that our patients received. The complaints being brought against Dr Neuhaus are just another attempt to defame the brave medical providers that perform abortions as a necessary and important part of women’s health care. These accusations are part of the ongoing battle by anti-choice groups to take away women’s rights to determine when and if they will have children.

My question to these groups is the following: How much suffering is enough? What you are trying to claim by attacking Dr Neuhaus is that her record keeping was not adequate – however standardized notes are common practice when it comes to psychiatric evaluation because the issues of patient confidentiality. Often when people are evaluated or in counseling notes are taken to provide basic information to professionals that need it –but the details remain between the patient and the doctor or psychologist doing the evaluation. Claiming that this is not appropriate standard of care is a questionable ploy.
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What is really being attacked here is whether a woman or girl in these cases – as suffered enough to be allowed to decide their reproductive fate. If it fair to ask a 10 year old girl, below the age of consent, to go through child birth which will change her life forever? Or does she only have rights if she is a victim of server trauma? I think that even anti-choice groups would have a hard time denying that these cases need to be examined carefully and the psychological harm to the woman or girl should be considered. Doctors, psychologists, social workers and counselors who make these assessments should be respected and commended for the difficult job they are performing. They should not be publically attacked and threatened with losing their licenses.

Aspiration: What to Expect the Day of Your Visit

When you schedule an appointment at Parkmed Physicians for an Aspiration Procedure you probably will have questions.

Our friendly and knowledgeable staff will try to answer your questions before you come in but hopefully the following summary will help ease your mind as well.

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When You Arrive:

 Our Office, located on the 6^th floor of  800 Second Ave, is a very secure building shared by medical offices and diplomatic embassies. When you enter the building you will be asked to produce a Photo ID in order to enter the premises. Any form of official Photo ID is fine: School ID, Work ID, DMV ID, Drivers License, and Pass Port.

When you arrive on the 6^th floor come to the lobby area and sign in at the front desk. We will ask you to fill out a set of registration forms including a detailed medical history, a demographics form and a HIPPA Privacy statement. These documents are used to ensure that you receive the highest quality medical treatment and are aware of your rights as a patient.

When you finish your forms you will be signed in by one of our Patient Facilitators. They will create a confidential chart for you in the electronic medical records system. They will review your medical history and information as well as answer questions regarding the consent forms and procedure information. You will be asked to read and sign the consent form at this time. You will also have the opportunity to discuss this form with the Nurse or Doctor before the procedure as well.

Once you are signed in, you will begin the testing phase of your visit. This phase lasted 45 – 60 minutes. We will do a urine pregnancy test to confirm the pregnancy. Then we will draw a small amount of blood to do a CBC and blood typing test before the procedure. These tests are important because they help is make sure that you are in good health and that it is safe to do the procedure. You blood type is important because if you have a negative RH factor you will need an additional medication. You will be informed if this is the case.

Once your test results and sonogram is complete the chart will be cleared for the procedure. If there are any concerns regarding your health that may affect the procedure a Patient Facilitator, Nurse, or Doctor will discuss these factors with you.

Once all your questions are answered your chart will be set up to go in for the procedure.

The Aspiration Procedure:

A nurse or medical assistant will call you and have you change into a sterile hospital gown and place your personal items in a bag that you can keep with you in the room at all times. Then you will be shown to the exam room and asked to have a seat on the exam table.

You will be introduced to your physician, nurses and the anesthesiologist. You will be given the choice to be awake or asleep during the Aspiration Procedure. Most people choose the aspiration procedure because it does not require anesthesia – however at Parkmed Physicians you comfort is very important to us. With this in mind we do provide general anesthesia for the Aspiration Procedure if you desire. Please let us know when you are scheduling your appointment if you would like to be asleep during the procedure because this effects the instructions you will be given to prepare for your visit.

The Doctor will ask you to lie back on the table with your feet in the stirrups just like you are having a regular pap smear performed. Once you are in position the doctor will perform a pelvic exam to check you vagina. They will then insert a speculum – the duck bill shaped device used to hold the vagina open during GYN examinations. The doctor will then swab you cervix with iodine to clean the area and give a series of injections, called a cervical block, to numb your uterus. Although your uterus will be number you will experience some cramping during the procedure.

The doctor will gently dilate your cervix. Once this is done they will insert a tub called a canulette through the cervix into the uterus. Once this is in place they will attach the canulette to a syringe like device which will be used to manually provide gentile suction and remove the pregnancy tissue. You will want to breathe slowly and deeply through your nose and mouth to help you relax during this procedure. The doctor and nurses will talk you through the steps so that you are as comfortable as possible. The Aspiration Procedure will take approximately 2-5 minutes.

Once the procedure is complete the doctor will remove the canulette and then the speculum from your vagina. They will place a sanitary pad on for you so that if you have post-operative bleeding you do not need to worry. Once they are certain you are ok you will be allowed to rest in the exam room or in the recovery area after the procedure for 30 – 45 minutes or longer depending on how you are feeling. The nurses will monitor your bleeding, blood pressure and temperature until they feel you are ok to leave. If you are asleep for the procedure you will need someone to escort you home at the end of your visit.

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Post Aspiration Instructions:

The instructions for care after an aspiration procedure are the similar to those for a m procedure. You will be given written and verbal instructions by the nursing staff before you leave our facility.

You will be given a prescription for antibiotics to help protect you from getting an infection while you cervix closes back down. You will also be asked not to insert anything into your vagina for 2 to 3 weeks after the procedure. This will keep extra bacteria from getting into your vagina which could infect your uterus. If you run fevers over 100 degrees during this time you should contact the office so that the doctor can evaluate the situation and possible have you come in for further treatment. You also want to avoid heavy exercise for two to three weeks after having an aspiration. While bleeding is normal after the procedure – and the amount is different for every woman – exercise like heavy lifting, running or working out at the gym can cause increased bleeding. If at any time in the two to three week period after the procedure you begin bleeding enough that you need to change maxi pads more then twice an hour you should contact the office immediately.

You may have some cramping as your uterus goes back to normal. You can take Ibuprofen, Tylenol or other over the counter pain relievers as long as they do not contain aspirin. Aspirin acts as a blood thinner and will cause extra bleeding. If you are on blood thinning medications please let the doctors know before your procedure so precautions can be taken to protect your health.

You Follow Up Visit:

You should have a check up 3 weeks after your procedure. You can book this appointment when you are signed in for the procedure to ensure that you get a good time and date that will be convenient for you. If you wish to return to your own OBGYN you can do so, but they may request that the tests from the visit are sent over. We will need a signed medical records release to send this information.

Aspiration Myths and Aspiration Facts

Aspiration Myths

Aspiration is a ‘non-surgical’ procedure different from most abortions done currently.
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False – The Aspiration Procedure (actually called Manual Vacuum Aspiration (MVA) is still a surgical procedure. It is almost identical to what most facilities currently call just the abortion procedure (Electrical Vacuum Aspiration) commonly performed at hospitals, clinics and doctors offices. The mechanisms of action and level of vacuum for the two methods are the same. The difference between them is how the equally gentile suction (PDF Page 9) used to remove the pregnancy in each case is produced. Both Electrical Vacuum Aspiration (EVA) and Manual Vacuum Aspiration procedure (MVP) differ significantly from the previously common practice of Dilation and Curettage (D &C).  While more invasive and difficult, D&C procedures are still performed in medical practices under special circumstances or when both electricity for Electrical Vacuum Aspiration and MVP equipment is not available.

At Parkmed Physicians our regular first trimester surgical procedure (EVA) does not involve curettage or ‘scraping’. Curettage is performed only in special circumstances and during second trimester abortions or when a sampling of the uterine lining is needed for diagnosis in a patient who is not pregnant.

The Aspiration Procedure (MVP) is recommended over the regular surgical abortion (EVA) when the patient wishes limited anesthesia during her procedure. The equipment for Electrical Vacuum Aspiration makes a whirring sound which for some increases the psychological discomfort of the patient. Manual Vacuum Aspiration is silent which studies have shown allows the patient to relax and experience less psychological discomfort (PDF Page 9) while being conscious for the entire procedure.

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The Majority of abortions preformed by doctors, clinics and hospitals are the more abrasive and complicated Dilation and Curettage (D&C) procedure.

False – In the United States, Canada, China, New Zealand, Singapore and other nations 97 % of First Trimester Abortions are preformed using Vacuum Aspiration (PDF Page 9). In the United States when doctor’s offices and clinics offer abortions they are primarily using the Electrical Vacuum Aspiration Procedure (EVA) which does not involve scraping or cutting.

Offices claiming that Manual Aspiration Procedures are a new and completely different type of abortion are misleading the public.

At Parkmed Physicians we wish to give a full and honest explanation of the differences between Manual Vacuum Aspiration, Electrical Vacuum Aspiration and Dilation & Curettage (D&C).

The Aspiration procedure is much safer than the regular abortion procedure.

False – The Manual Vacuum Aspiration Procedure is not safer then the Electrical Vacuum Aspiration Procedure. (PDF Page 12) Long term studies show that Vacuum Aspiration, whether electrically or manually produced, had only 9 patients in 10000 cases having any complications. This is less then one tenth of a percent.  (PDF Page 12)

The Aspiration Procedure is a completely new technique only made available recently by more exclusive medical practices.

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False – Vacuum Aspiration (Electrically Powered or Manually Produced) has been the safest and most regularly preformed method of First Trimester Abortion since its invention by Chinese Doctors in 1957.

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By the late 1960s and early 1970s training and use of Vacuum Aspiration spread first to Europe and then the United States. There is over 30 years of research (Page 10)  detailing over 400,000 cases in 50 different studies across more then two dozen countries showing the safety and effectiveness of Aspiration.

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These studies show that the aspiration procedure is on average 98 – 99 % effective with a lower the .05% rate of postoperative infection.

The Aspiration Procedure (MVA) is more effective than the Surgical (Electrical Vacuum Aspiration) Abortion Procedure.

False - In studies where both MVA and EVA were used since the mid to late 1980s, the two methods had similar rates of effectiveness (Page 10). In each case the procedures were 98- 99% effective.

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The Aspiration Procedure uses no anesthesia at all.

False: Many offices advertise the Aspiration procedure as not requiring anesthesia. This is inaccurate.  The Aspiration procedure is usually done with local anesthesia in order to numb the patient’s cervix when dilated. (Page 15) This helps minimized the cramping patients feel during the procedure. Most women do not require general anesthesia for the aspiration procedure. Studies show that because patients do not have to hear the noise generated by the machine used for Electrical Vacuum Aspiration they are better able to relax during the abortion procedure reducing the psychological experience of discomfort (Page 15).

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At Parkmed Physicians we understand that some women facing an abortion want general anesthesia, but also want the Manual Vacuum Aspiration procedure. At our state of the art facility we are able to provide local, twilight and or general anesthesia for aspiration procedure upon your request. 

Abortion is the ONLY use for Manual Vacuum Aspiration procedures.

False – although Manual Vacuum Aspiration has made abortion services accessible this technology is also used for other important medical procedures when the conditions require it. MVP technology is used for menstrual regulation, treatment of incomplete miscarriages, Endometrial Biopsies and as a back up procedure for failed use of the Abortion Pill (PDF Page 8) .

Aspiration Facts

The Aspiration Procedure (MVA) helps provide high quality abortion services in areas without access to electricity or traditional western medical services.

True – While abortion is legal in many countries access to abortion services is highly restricted due to lack of resources such as electricity, hospital settings and limited funds (Page 16). It is a safer, more effective, form of treatment than Dilation and Curettage (D&C) previously the only abortion technique available under these conditions.

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The Aspiration Procedure (MVA) has increased access to safe abortion world wide.

True –The portability and simplicity of the MVA procedure allows it to be performed in remote locations. This has allowed safe, sanitary abortions to be provided in “community based” healthcare settings. (Page 8)  Dilation and Curettage requires a different level of skill and support meaning that usually only doctors and hospitals could safely provide these services in under developed nations.

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In countries where abortion access is extremely limited, the Aspiration Procedure has eliminated the need for costly and difficult travel.

True – In counties such as China, Viet Nam and Bangladesh Manual Vacuum Aspiration has been used for decades (Page 10). The light, portable equipment which does not require electricity and makes it ideal for medical providers to take to remote areas to provide abortion services where it was once legal but not accessible.

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The Aspiration Procedure (MVA) is a safe and effective backup to Medical Abortion.

True: When women choose the Abortion Pill as an option to terminate a early pregnancy it is usually because they want to avoid a surgical procedure with anesthesia. Unfortunately, the Abortion Pill is not perfect. In about 5 % of cases women do not completely pass the pregnancy tissue during the induced miscarriage. In these cases The Aspiration procedure (MVA) is a safe fall back option to compete the abortion process.(Page 11)  It can use minimal anesthesia and allow women a less stressful alternative to Electrical Vacuum Aspiration (EVA).

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The Aspiration Procedure has allowed mobile medical teams to provide relief for rape victims in war torn countries.

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True: As pointed out by The United Nations Higher Commission on Refugees, refugee women are extremely vulnerable when it comes to sexual health. Often the victims of rape and often with a total lack of access to birth control even in non coercive relationship refugee women are at high risk for unintended pregnancies. In cases like the 1999 flee of refugees from Kosovo to Albanian refugee camps the portable and effective use of Manual Vacuum Aspiration (MVA) allowed women in these difficult circumstances to receive abortion services (Page 13) . Replacing the more complex and painful Dilation and Curettage procedure greatly reduced chances of complications and minimized further trauma to already victimized women.

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