Barely Legal

In Minnesota, finding an abortion doctor gets harder all the time

When Dr. Greta Mueller* moved to the Twin Cities a few years ago, she assumed that abortions would be among the myriad services she would provide. A talented OB-GYN trained on the East Coast, Mueller is adept at the relatively uncomplicated suction curettage procedure used for most first-trimester abortions as well as the more difficult dilation and evacuation (D&E) method used to terminate many second-trimester pregnancies. "It was an expected part of our training," she says over coffee at a Minneapolis café. "To not learn how to do them was an effort [that only] a handful of people [made]."

Not long after Mueller set up practice at a local clinic, a patient's baby was diagnosed with spina bifida--a birth defect in which the neural tube fails to close during fetal development, leaving a portion of the spinal cord disconnected or outside of the body. Mueller explained to the patient that she had a choice: She could go to a medical center that repairs spina bifida in utero, terminate the pregnancy, or wait until the baby was born and deal with the complications then. When the woman decided to terminate, Mueller promised to perform the abortion herself.

Mueller first tried to arrange for the procedure at a Twin Cities hospital, which had the necessary surgical equipment (the patient was 17 weeks pregnant), but was told that she would first have to convince the hospital's "abortion committee." (According to Tim Stanley, executive director of NARAL Pro-Choice Minnesota, Regions Hospital in St. Paul is the only facility in the state to readily provide abortions. The other 136 Minnesota hospitals require that a physician negotiate a screening committee. Depending on committee members' beliefs and fears, policies vary widely.) "I had no idea that I would have to get permission [for a legal procedure]," Mueller recalls.

Pamela Valfer

Before she even contacted the committee, Mueller learned that the hospital only granted permission for abortions of, in the language of the OB world, "lethal anomalies," which fetuses with spina bifida are not. Mueller sent her patient to a perinatologist to confirm the diagnosis. A counselor who worked alongside the perinatologist suggested to the now-distraught pregnant woman that she have an induction-type termination where she would prematurely deliver the baby. The patient agreed and Mueller tried to find a cooperative hospital. When none would grant her permission, Mueller called the counselor and demanded to know why she'd offered up a procedure that was next to impossible to arrange. The counselor suggested that the patient go to Kansas.

Recounting the story, Mueller's jaw drops. "I was furious," she says. Finally, she referred the patient to Meadowbrook Women's Clinic, one of seven remaining abortion clinics in Minnesota, for a D & E. "I felt terrible for this patient, because I told her I could take care of her and then I had to hand her off to a stranger," says Mueller. "That was my rude awakening to Minnesota."

 

The April 25 march on Washington notwithstanding, the pro-life movement has been monumentally successful in scaring pro-choice health care providers across the country, increasingly few of whom are willing to risk their careers and personal safety over a procedure that comprises only a tiny fraction of any OB-GYN's practice. This state of affairs is the result of a piecemeal, below the radar, and little understood campaign by pro-lifers to limit a woman's practical options for abortion. Their tactics combine legislative battles for ever more restrictive legislation with ceaseless grassroots intimidation: loud, menacing protests at abortion clinics, the leafleting of medical schools--including the University of Minnesota's--and the active support of pro-life doctors who advance their beliefs in medical settings, including patient consultations.

The sense of fear is so palpable that the majority of doctors who provide abortions--even two or three per year--and agreed speak for this story insisted that their names and other identifying characteristics be changed and that the names of the clinics and hospitals where they work be omitted. When discussing the rare fetal anomalies that these doctors had terminated, it was not uncommon for them to ask that the details be kept out of the story for fear that they would somehow be linked to the cases and tracked down.

In Minnesota, the legislative successes of Minnesota Citizens Concerned for Life (MCCL) have been spearheaded by State Senator Michelle Fischbach, a Republican from Paynesville who is married to Scott Fischbach, MCCL's current director. NARAL's Tim Stanley further points out that 70 percent of state representatives and 60 percent of state senators are antichoice and vote accordingly. Largely due to the work of Fischbach and her supporters, Minnesota has fallen from a 1996 NARAL ranking of "B+" to a current grade of "D" and a 28th-place ranking in a state-by-state survey of abortion rights. (But that "D" practically makes Minnesota the model student of the upper Midwest: Wisconsin, North Dakota, South Dakota, and Michigan all get "F"s from NARAL--Iowa received a "C-".)

Not only does Minnesota have one of the most restrictive abortion laws in the country pertaining to minors--both legal guardians have to be notified; if the parents don't support the termination, the minor must appear before a judge--but only a physician can legally provide an abortion, even a miscarriage induced by the so-called abortion pill, RU-486. While a handful of states, including Connecticut and New York, allow nurse practitioners and nurse midwives to dispense it with relative ease, Minnesota law requires that a doctor personally put the pill in the patient's hand and watch her swallow it. And, in fact, after RU-486 became legal in 2000, according to Stanley, most local hospitals and clinics declined to provide the pill at all, for fear of being targeted by antichoice activists.

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