Anatomy of an unsafe abortion

Dr. Jen Gunter, who is an OB/GYN and a pain medicine physician, writes a harrowing account of receiving a patient who has undergone an unsafe abortion, and is bleeding to death:

On the gurney lay a young woman the color of white marble. The red pool between her legs, ominously free of clots, offered a silent explanation.

“She arrived a few minutes ago. Not even a note.” My resident was breathless with anger, adrenaline, and panic.

I had an idea who she went to. The same one the others did. The same one many more would visit. A doctor, but considering what I had seen he could’t have any formal gynecology training. The only thing he offered that the well-trained provers didn’t was a cut-rate price. If you don’t know to ask, well, a doctor is a doctor. That’s assuming you are empowered enough to have such a discussion. I was also pretty sure his office didn’t offer interpreters.

I needed equipment not available in an emergency room. I looked at the emergency room attending. “Call the OR and tell them we need a room. Now.” And then I turned to my resident. I was going to tell him to physically make sure a room, any room, was ready when we arrived, but he had already sprinted towards the stairs. He knew.

Read the entire account here: Anatomy of an unsafe abortion.

Required reading in this year of presidential elections in America, in which so many candidates would have us return to the dark era in which abortion was illegal. Outlawing abortion doesn't end abortion, it just makes scenes like this more common.

And here's a follow-up post worth reading, by Dr. Gunter.

(thanks, @Scanman / image: Shutterstock)


  1. This was always one of the most deeply disturbing stories my parents would recall from medical school, when they were working the ER in south Philly before Roe v Wade. “Every night” they’d say, a woman would come in just like that, and bleed out in the OR.

    (Sorry I bring my parents’ medical background up a lot; I’d bring up my own more if we were discussing datacenter nitty-gritty.)

    1. It’s ok. My parents don’t have a medical background. But two of my moms friends died in HS. Both girls were said to have “killed themselves” out of shame because they were in trouble. But really, they both died from botched abortions. People used unsafe abortion to try to argue that abortion should be illegal because it’s inherently unsafe though. This isn’t true, of course, any more than any medical procedure is inherently unsafe. But it’s worth mentioning that people do try to make that argument.

    2. “Every night” they’d say, a woman would come in just like that, and bleed out in the OR.
      I got a similar set if words from my mom who used to work as an ER nurse/tech (something of that sort) in the days before Roe.

  2. But Rick Santorum swore to me that outlawing abortions would prevent this and I completely trust his judgment on such a matter, seeing as how he possesses a medical degree and has years of experience working in the medical field.


    1.  I thought woman were just supposed to shut up and have our babies?  It is what god wants, right?

  3. An illegal clinic in my neighborhood was doing liposuction.  If people will have fat sucked out of them illegally, why not pregnancies?

    (And by the way, this guy sexually abused his female patients, smoked cigars while doing the operations, and in one case went to a patient’s home to flush the fat down her toilet.)

  4. Of course, only poor women will die, middle class women go to Canada, Puerto  Rico or Mexico, rich women go to Sweden.

      1. Actually, Puerto Rico “belongs to but is not part of” the United States. Unless you’re just referring to it’s location in the Americas.

    1. yup. equity of risk was among my first thoughts on reading this. the wives, daughters, and girlfriends in families with some means still get to have their abortions and go on with their lives.

  5. It is always interesting to see purportedly lassaiz-faire propoents decry the obvious outcomes of lassaiz-faire policies (ie. black/grey market surgery on the cheap). Or in other words: the american “political” system in a nutshell.

    1.  Uh, “laissez-faire” policies would imply that abortions should be legal if people are willing to pay for them.  In this particular case, the problem is that conservatives are not endorsing “laissez-faire”.  (Literally, “let you do” — legal restrictions on abortion are about as far from “laissez-faire” philosophy as you can get.)

      1. Is that not what I said? Abortions will happen whether or not they are legally or morally sanctioned. My point is that those who are “anti-“big”-government” or against regulation in all forms usually tend to fall down when those dogmatic beliefs encounter the real world: where no amount of moralizing or heralding of “the free market” is going to stop abortions. The moral grandstanding elides the ideological inconsistency and counter-productive results…unless one truly hates women and their bodies, in which case: the position is simply dishonest in not explicitly speaking of the need, over and above that for a “free market”, to perpetuate patriarchy.

  6. What annoys me the most about the pro-lifers is how little they actually care about the lives they’re supposedly trying to save. None of them would care any more about this woman’s [hypothetical] child than they do about the woman herself, and you can see quite clearly that at best, they would prefer never to have to interact with her.

    1. They will care up until the point when the child is educated and rejects superstition.

      In the meantime they will go after the education system for trying to teach evidence based thinking.

    2. Ahh, but you see, the issue is really not the baby but to punish the wicked (women) who cannot keep their legs crossed. And the natural consequence is of course an unwanted baby! If we have legal abortions then women can have s… e… x… without punishment, and we cannot have that, can we. Oh, and we need of course to make contraception illegal, too. When we have an unhappy mom with an unwanted baby the case is closed, so no need to think anymore about that.

      Why they don’t need to punish wicked men who cannot keep their pants zipped up I haven’t quite figured out yet.

      1. In Abrahamic religions, men are perfect, unsullied angels until one of those damned, evil, boner-causing temptresses flashes a tad too much ankle or wrist.  At that point she was just asking for it, amiright?

    3. Pro-lifers concerns range from conception to birth.  After that, everyone is on their own.
      My response to pro-lifers: “Oh, and how many children have you adopted?”
      If their answer is none, my reply is, “You are not part of the solution- you’re part of the problem.”  
      Not much conversation after that.

      1.  I had that very conversation the other day. Her explanation was that she “couldn’t afford to adopt”.

        1. Of course not; she can’t very well be expected to get a job when she’s so busy protesting.

  7. I want a unicorn chaser.

    Actually, I just want the horn.  I want to take that horn and stuff it up the a$$ of each and every one of the bastards, and pin them to the wall with it while they read this aloud to each other.

    If the anti-choice faction was really about preventing abortions, they would do the logical thing and pour every dollar they possibly could into comprehensive sex education, contraceptives, and reproductive health.  Their real agenda is to return women to their “rightful” role in society as second-class citizens under the control of men, and eliminating sexual freedoms.  The misogyny and sex-negativity of the anti-choice movement boggles my mind.

    1. Yes, yes!!! So much this!

      The anti-choice movement is not about the baby, it’s about the woman and the woman having “free” sex. Otherwise the answer would be sex education. In my country we have sex education from the lower grades, and teenage pregnancy is more or less unheard of. I should really dig up (sorry) the abortion rates here vs. the US, but I would bet they are much lower here, too.

      A baby is not a punishment, and a teenage girl should not have to be “punished” for having sex.

    2.  This kind of demonization of pro-lifers is absurd.

      Prolifers believe abortion is immoral because they see it as equivalent to murdering children. They may have other issues with society, such as promiscuity etc… but these are secondary. Virtually no one opposes abortion for such reasons.

      The fact that the choice abortion/children falls on women is a biological coincidence, not a some right-wing plot. It is not misogynistic to be opposed to it, even though the issue mainly affects women. In fact about half of prolifers are women, and it seems unlikely that many or even most of such people are misogynists.

      Prolifers also care about children and life through all stages. Just because many prolifers do not support socialist economic policies does not contradict this. They are separate issues. Well, you may disagree, but at least you should accept that this is how they are seen, not unreasonably, by the people who hold those views.

      1. I think there’s a false dichotomy in our midst. I’ve always maintained that there’s no way they could ALL be doing it because women (especially those who can’t afford kids or contraceptives or abortions) are “too free” but there’s no way that NONE (or even a miniscule porton) of them could have that reasoning, explicitly or otherwise. And I think the latter is a lot more prevalent among the pro-life politicians (the male portion of which being notably larger than any counterparts) and maybe less among the voters.

      2. Everything you just said is a lie.

        It is either a lie you tell yourself so that you can sleep at night, or it’s a lie you willingly tell because you have no shame.

        But a lie, it is.

      3. Demonization of pro-choice is equally absurd, friend. Not implying that’s your position, just pointing it out.

        A world where nobody can have an abortion, but children living in poverty and abuse doesn’t mean anything to you because of your economic beliefs? You are kidding me.

        In the real world, there is no separation of issues. Only in your head.

      4. *sighs* women can be misogynistic. See:  Ann Coulter. Also the fact that pregnancy happens inside a woman is not “beside the point” or “just too bad for her” but rather ignoring this major medical fact is hugely… dare I say it… misogynistic. Not to mention ignorant of biology. Until they figure out a way to take a fertilized egg out of a woman and keep it alive the ONLY thing that matters is the body and life of the person that is happening to. It’s not a small thing. It’s the whole thing.

      5. “Prolifers also care about children and life through all stages. Just because many prolifers do not support socialist economic policies does not contradict this.”

      6. If it is just about preventing the need for abortions, why is it that not a single national or influential anti-abortion group supports access to contraceptives or anything but abstinence-only sex education?

        If their goals or driving motives were simply to stop abortions, there are many effective actions they could support that would greatly reduce the demand. These actions are not taken. In fact, they are lobbied against.

        Anti-abortion is about punishment and control.

      7. Citation needed. I follow AMerican politics and invariably the more pro life a politician is, the more he or she support the death penalty. So don’t try to sell us bullshit.

        I will eat humble pie and apologize to you when you show me data that pro lifers are more opposed to death penalty than the general population. Otherwise, I’ll call on your lies.

      8. “biological coincidence”?  “not misogynistic”?  “the issue mainly affects women”?  wtf?  You’re a biological coincidence.  The reason so many prolifers are women is because they’re brainwashed by religious propaganda.  Religion makes people stupid.  It’s sad that instead of supporting fellow women, they stand against them.  You can believe what you want, but that does not give you the right to tell someone else what to believe or what’s best for her.  It’s ok to offer suggestions or all options available, but not to enforce ones you think are right.

      9. George, why aren’t anti-choice activists working for comprehensive sex education for everyone?  Why aren’t they advocating for universal access to contraception?  

        If not having abortions is at the top of your priority list, why not go back to the source and try to eliminate unwanted pregnancies?

  8. And this is one of the reasons I think we should keep abortions legal. If people want to reduce the number  of abortions they need to look at education and solving societies ills.

  9. What is wrong with America these days? We would look up to you as our great example, but it seems you turn swiftly back to the Middle Ages (which you never had by the way). Why is this happening? 

  10. good grief, I had to stop reading…  I have a very weak stomach!

    While I hold that a lot of the procedures that are currently legal shouldn’t be, if it’s a legal procedure then doctors who screw up regularly should be fined and imprisoned!

    1. Seconded. I wish the guys would post on “women’s issues” more often. Are they explicitly left to Xeni? Or do the guys just not see such stories as post-worthy? Or, do they just not see them in the first place? Or?

      1.  I agree that it is an excellent post.  However, I don’t view this story as a “woman’s issue” — obviously, yes, abortions are done to women, but the possible loss of this woman’s life because of social and political constraints that limit her access to a professionally trained specialist operating with appropriate medical safeguards (ie in a hospital) is an issue that ALL of society should address. 

        Although I am a woman, I am not horrified because that could be me.  Unlike that woman I am well educated, have lots of family and social support should I decide to have an abortion, and live in a place where I have decent access to affordable care (Canada).  I am horrified because her brush with death, and many other women’s loss of life, is horrific and needless.  I am horrified as a human being, and I imagine that many men are equally horrified.  Access to reproductive care (including abortion) is a HUMAN issue. 

      2.  Dunno, Cory thanked Xeni for a heads up on a very Cory story that he posted yesterday, so I think the BB bloggers may have bailiwicks and respect each other’s specialties and interests.  Xeni seems to do most of the more political stuff whether or not it’s specifically women’s issues (and I’m with Kludgegrrl that this might be better thought of as a public health and/or civil rights issue than a “women’s issue”).

  11. This “coat hanger” myth has been debunked long ago.  90% of illegal abortions were done by DOCTORS.  

    And there were only 39 deaths in 1972 from illegal abortions in the ENTIRE COUNTRY.  Not 5,000 or 10,00 as has been claimed.

      1. One source (although it does not entirely support ikonag’s proposition):

        “For 1972, the last full year before Roe, the federal Centers for Disease Control reported that 39 women died due to illegal abortion. (The death total for all abortions, including legal ones, was 88.) That figure is low, thanks to underreporting, but in any case the number of deaths had been dropping sharply for the previous few years. A statistic perhaps more typical of the pre-Roe era was reported in a 1969 Scientific American article cowritten by Christopher Tietze, a senior fellow with the Population Council: ‘The National Center for Health Statistics listed 235 deaths from abortion in 1965. Total mortality from illegal abortions was undoubtedly larger than that figure, but in all likelihood it was under 1,000.'”

    1. I doubt you can prove false Xeni’s succinct summary–

      Outlawing abortion doesn’t end abortion, it just makes scenes like this more common. 

      (Though I might have added “much” before “more” there.)

      And btw, ONLY 39 deaths? Even if that number is that low, you’re saying that’s okay with you?!

      1.  All medical procedures carry risk.  It is not possible to reduce the risk to zero.  You don’t stop doing the procedures just because there is a nonzero risk however.  I’m sure there are people who die from appendectomies every year too, doesn’t mean we shouldn’t do them. 

    2. Ummm… you do know that one of the major things that people did back then was not call deaths from illegal abortions deaths from abortions. In fact, one major act of defiance occurred when doctors started labeling such deaths as abortion related deaths and not “fevers” or “suicides”

    3.  You even read the article?  The writer assumed the abortion was performed by a doctor — with no gynecological training.  But then, you strike me as the sort that hires a proctologist for brain surgery.

    4. Not sure where you’re getting your numbers, so I can’t really address them, but please do keep in mind that death following an illegal abortion would be recorded as something else entirely.  Septicemia, perhaps.

      Getting an accurate count of anything that is the effect of doing something illegal is incredibly difficult, and more so when there’s a strong social stigma against it.

  12. I heard Sarah Weddington speak at a conference several years back and she said that this was essentially what carried Roe v Wade. The numbers of reported causes of things like this were climbing year on year as better national health statistics were becoming available and people quickly realized that what-ever their moralizing might say, it was nothing compared to the real terror of this happening in every corner of America to daughters, sisters, nieces, wives and mothers. She it was the most unnerving thought when she considered the “moral right’s” ability to possibly overturn the case.

  13. To me, this is all a package with murder being the number one cause of death among pregnant women, on top of the much increased level of non-fatal domestic violence. She gets it from all sides: pressure to have (unprotected) sex, ignorance of how to avoid pregnancy and how to get proper prenatal care, pressure to have an abortion, legal obstacles to abortion, fear of leaving, fear of staying, danger of having an abortion, danger of staying pregnant. Even women who intend to have the baby and raise it on their own are in danger. More privileged women have advantages, but they are not exempt.

    I think we need to include the problem of raising better men in this discussion. A decent support system should ideally start with a decent man taking that side of pressures and dangers off the woman. (I don’t know how much this is a problem with female partners, but I’d bet that women with female partners have proportionally many fewer unplanned pregnancies than women who go with men.)

    1. Heh, yes, people in lesbian relationships are less likely to get pregnant by accident, if they do it’s often the result of rape – and there’s a reasonable chance their partners will support their decisions.

      It’s not as rosy a picture for teens though – lgbt youth are actually more likely to become pregnant (or impregnate someone else) than straight youth.  Counterintuitive, I know, but a lot of them are closeted and having sex to prove they’re straight…  they’re more likely to have risky sex.  They’re also more at risk for STIs.  Oh, and there’s always the fun thing where some people rape lesbians as an attempt to make them straight.

      But yeah, barring really unpleasant things, most of the time same-sex couples don’t have to worry about unplanned pregnancies.  I was just joking about this last night – if my girlfriend and I get pregnant, everyone will know we did it on purpose.  :)

  14. Pointing out that anti-choicers care more about punish women for having unauthorized sex than they do lowering the abortion rate isn’t “demonizing” the anti-choice movement. It’s a theory that better explains the behavior of anti-choicers (obsessing about contraception as well as abortion, supporting abstinence-only programs, opposing real sex education, opposing social problems that support women and children) than the theory “they really think embryos are people” do. In addition to the damning evidence of their lack of interest in policies that actually lower the abortion rate, have you ever asked an anti-choicer what they think the penalty for “murdering” an “unborn baby” should be? After all, murder is a pretty serious crime. You’d think they’d be able to provide at least a ballpark estimate: 4-6 years? Maybe 10 or 20? But they never can. They haven’t even thought about what they want. They oppose abortion, but they can’t even conceptualize of what would be necessary to turn it into something that’s actually illegal. Sometimes you get people saying that the doctors, not the women, should be punished, which is even more evidence of the misogyny at the heart of the matter, since it reveals that they think of women as child-like, mentally incompetent beings who can’t be held responsible for their own actions.

  15. Margaret Sanger, describing her experience as a social worker in the 1910s, in _An Autobiography_ (1938):

    “Pregnancy was a chronic condition among the women of this class. Suggestions as to what to do for a girl who was “in trouble” or a married woman who was “caught” passed from mouth to mouth–herb teas, turpentine, steaming, rolling downstairs,inserting slippery elm, knitting needles, shoe­hooks… The doomed women implored me to reveal the “secret” rich people had, offering to pay me extra to tell them; many really believed I was holding back information for money. They asked everybody and tried anything, but nothing did them any good. On Saturday nights I have seen groups of from fifty to one hundred with their shawls over their heads waiting outside the office of a five­dollar abortionist. These were not merely “unfortunate conditions among the poor” such as we read about. I knew the women personally. They were living, breathing, human beings, with hopes, fears, and aspirations like my own, yet their weary, misshapen bodies, “always ailing, never failing, ” were destined to be thrown on the scrap heap before they were thirty-five…. No matter what it might cost, I was finished with palliatives and superficial cures; I was resolved to seek out the root of evil, to do something to change the destiny of mothers whose miseries were vast as the sky.”

    The conditions that led to Planned Parenthood have not changed. Women have always needed and wanted to control their fertility and to make choices about reproduction. Impoverished, vulnerable women must have those choices too. This is should not be a political issue. It should be a medical issue.

  16. You guys simply don’t understand.   The religious right cares about life … Christian life.   To them … and I am not exaggerating … they consider these women dead already because they are baby killers and unsaved.   There is no hypocrisy about it at all in their minds … you are either God fearing Christian or you are damned — a dead person walking.   That includes people of other faiths as well.

    This election year, some of the candidates aren’t even bothering to hide their contempt for unsaved sinners like you and me, and these young victims of “doctors”.   They might as well die in a back alley as far as Santorum et al are concerned.

    1. Agreed.

      We should make no mistake, the republicans have made it very clear they will attack a woman’s right to choose if they are given more control even in cases of rape or when the woman’s life is in danger.

      It’s bizarre how much “compassion” some conservatives muster for a zygote, but at the same time show so little care for people as soon as they leave the womb.

      If they really cared for fetuses and the women that carry them, they’d support a single payer system for health care… but they don’t even bother to educate themselves on the system and instead parrot corporatist talking points like evil idiots.

      Oh, that’s right… instead of proper health care, the downtrodden can get humiliating charity from churches that don’t meet their needs so they can putter along until they die while the Jeebus people think they are God’s gift to the fucking world.

      So much suffering is caused by satanic conservative leaders and the dupes that follow them.  Sick.  Sick.  Sick.

    2.  For sure, some people think that way. Others can be atheist and still be against abortion as an ethics issue. As a reminder, one need not believe in a god to be “good” or ethical.

        1.  It’s an expensive medical procedure that tends to (understandably) be a negative emotional experience. Most abortions are a signal that we fucked up somewhere in society, generally in terms of educating young men and women on contraception.

          Abortions aren’t unethical, but they are bad, in the same sense as any other medical issue that should never have gotten to the point of surgery.

          1. Several things wrong with your points here.

            One, not all abortions are surgery. Plenty of early abortions are nonsurgical.

            An abortion isn’t any worse than getting a cavity filled. Sure, you’d rather not need a filling, but it’s best to get one if you need one.

            Framing it as a negative emotional experience is damaging because it puts pressure on women who don’t find it upsetting. It encourages secrecy instead of openness, which damages families. 

            Abortions aren’t bad. People are better off when they have access to abortions.

            Also, sometimes contraception fails, and that doesn’t mean we fucked up somewhere as a society. Most women who have abortions already have children. (source: Guttmacher)

          2. Oh, hi Amphigorey.

            One, not all abortions are surgery. Plenty of early abortions are nonsurgical.
            I’m aware.

            Also, sometimes contraception fails…
            I appreciate your candor, alhough I was already aware of this one, too.

            Abortions aren’t bad. People are better off when they have access to abortions.
            Yes! This is why I never even came close to any other conclusion.

            An abortion isn’t any worse than getting a cavity filled. (…) Framing it as a negative emotional experience is damaging because it puts pressure on women who don’t find it upsetting.

            I don’t need to frame it as anything. Is an abortion also just as bad as getting an icky boo-boo on your finger?

        2.  The ethics are pretty simple:  is it ethical to kill people for any reason? If not, when is a fetus a person? Are there exceptions? etc etc etc. There are 1001 different answers. If it were clear cut, it wouldn’t be the hot issue it is. I am sure we will have similar issues with our brain-dead harvest clones in the future.

      1. This is a religious issue, in any practical terms. Let’s not try to swing the narrative around too much.

        1.  Is it? I don’t think – and I may be mistaken – god forbids abortions in the bible. Hell he sent angels to slay first borns.

          So the root of the christains pro-life view is one of ethics. Life begins somewhere between conception and birth. Ask 1000 people and you will probably get 1000 different answers as to when that is, exactly. They err to the earliest possible point. Everyone else will have a line in the sand somewhere else – and that is where the ethics questions lie.

  17. A few years ago, The Economist had an interesting article on the effect that taking Roe  v Wade off the table would have on US politics; they pointed out that in states where it’s essentially impossible to get an abortion now, little would change – ditto for most states in which it’s comparatively simple.  The argument was that it would be removed as a national wedge issue – the right wing would have a lot less to complain about nationally, and they could go back to arguing that they shouldn’t pay taxes.  Obviously abortion should be safe and legal everywhere – and I’ve worked with some physicians who have similar stories from ‘back in the day,’ only in theirs, the rich girls could always find ‘a good doctor’ to solve their ‘medical problem’ – but it’s an interesting notion to wonder whether something other than Roe v Wade is all we should be worrying about.

    1.  I disagree that overturning Roe v. Wade would reduce the power of abortion as a wedge issue. Instead, it would ramp it up. Once Roe v. Wade was gone, conservatives would push a federal law to make abortion completely illegal in all states.

  18. I’m politically pro-choice, but personally, I would not want to have an abortion except under some extreme circumstances.

    My reason for being pro-choice is simply this: Making abortion illegal does not stop it from happening, at least not entirely. But while it is legal, it at least has regulations that will be followed by the majority of providers. The doctors who provide abortions are held to a set of standards: ethically, procedurally, and educationally. There is a minimum standard of sanitation set for the location where the procedure is performed. When it is illegal, a woman who seeks an abortion does not necessarily have these protections, and certainly little recourse if those standards are not met. (Certainly without admitting her own criminal behavior in the process). Instead, it recreates a grey/black market where the quality of the procedure will be in question for those who cannot afford to go elsewhere to obtain it legally.

    One of my great-aunts had an illegal abortion back in the 1930’s. She was 16 and unmarried. The resulting infection left her sterile for life. It could certainly be argued that she still could have gotten that same infection had the procedure been performed legally in a hospital – but if I were a betting woman, I’d say that odds are, her care would have been better in a hospital.

    Long story short: However distasteful it may be to an individual person morally, at least by remaining a *legal* option, there are some sort of legal and ethical standards in place regarding the practice.

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