|
Getting your Trinity Audio player ready...
|
As some states adopt abortion bans in the wake of the U.S. Supreme Court's decision to overturn Roe v. Wade, Stanford University Medicine is increasing access to a program teaching abortion care and complex family planning for visiting medical students and resident doctors.
Dr. Erica P. Cahill is the assistant program director for Stanford University Medicine's Complex Family Planning fellowship program, which includes abortion care training. Courtesy Dr. Erica P. Cahill.
The Complex Family Planning training program aims to expand training in a field that was already lacking adequate available services, said Dr. Erica Cahill, Stanford University Medicine assistant program director for the fellowship. Complex family planning includes birth control options; unintended and abnormal pregnancies; contraception for women with complex medical issues; difficult IUD/Implant insertion and removal; and abortion care.
"At all levels, we're trying to increase our ability to have more learners from restrictive states," Cahill said.
Depending on the year, up to 12 students train in a four-week rotation. Stanford medical students have priority, and visiting students are admitted if there's no Stanford student interested in an opening, she said. The program is receiving much attraction from out-of-state students, but that's been the case for a long time, Cahill said.
Governmental restrictions on abortion aren't the only reasons students are attending, she said.
"We've had students come even from not restrictive states that just have a program that's run by a religious hospital, or something where they're not able to get abortion training … but I would say more commonly, it is from restrictive states," she said. "We've been increasingly getting, in the past year, more people reaching out to us from programs in Texas, for sure."
Not having enough trained medical personnel in abortion and complex family planning is "a huge threat to the health of pregnant people and women's health, and it has been for a long time," Cahill said.
"The training scope of abortion care was already really limited and restricted, so I would say we're continuing our expansion," she said. "Even though it feels like a huge new influx, this has already been a huge problem in the field of obstetrics and gynecology and other fields, too. These are critical skills that are common and this is not like a rare occurrence. Caring for people with complications in early pregnancy is something that happens every day in OB-GYN, and so not having the skills or tools or knowledge is terrible for a provider and it's not because people don't want it for the most part. It's because they're not able to access that training," she said.
The decision to have a baby — or not — is complicated, weighing on many factors in one's life, she said. There are also many complications out of the control of what the person wants that lead to an abortion being necessary during pregnancy, she said.
"There's a lot of challenges in interpretation of these rules about whether or not we can provide standard of care treatment for miscarriage; standard of care treatment for ectopic pregnancy; standard of care treatment for molar pregnancy — like all of these things that are perhaps on a spectrum of care of first-trimester pregnancy care — that all are linked in medicine. You can't piece them out from each other," she said.
Cahill also sees a flip side to the Supreme Court's abortion decision that offers a glimmer of hope.
"What we're seeing is this huge commitment from other specialties," she said. "At Stanford, our emergency medicine colleagues, our family medicine colleagues, our pediatricians, our anesthesiologists are all thinking more about how they can help support abortion care and pregnancy-related care in different ways.
"And I think we're seeing that across the country, as people are not going to be able to receive standard of care for miscarriage, abortion or pregnancy complications by their OB-GYN due to these terrible restrictions. They're going to get that care in the emergency room; they're going to have to come to the emergency room. And so our emergency medicine colleagues are adapting quickly and trying to learn quickly how to adapt to being able to still keep people safe when they're seeing complications that would ordinarily be avoided by routine standard of OB-GYN care."
Cahill said that's the sort of interesting place where medicine is headed due to abortion regulations.
"We have emergency medicine residents reaching out to us; we have family medicine residents reaching out to us, and general surgery," she said. "So I think that's a little bit of hope in this time of darkness; that there are so many people who — it hasn't been in their realm because it's been able to be in the realm of obstetrics and gynecology and reproductive health — and now, everyone is like, 'But how could I, in my role, help also? How could I be the most prepared? How can I have the most knowledge and skills to provide the best care to patients?' And I think we're seeing that around the country. So that's really exciting. "
Cahill said it's important to note that abortion is safe and legal in California, and there also are many places where people are accessing nonsurgical medication abortion by pill.
"We were really lucky that the American Board of American College of OB-GYN and the ACGME (Accreditation Council for Graduate Medical Education), which is our group that makes this sort of standards of training, have been really supportive and agile in adapting to all they can to support continued training to provide the best care," she said.
