Extract Canada’s standard of obstetric care is excellent, and although some improvements can be made, they can be carried out within the existing system. That is the main finding from a major CMA study on obstetric care, the first of its kind in Canada, which has been sent to association members with this issue of CMAJ. . . . There is no reason for Canada to introduce a midwifery system since there is neither a calculable need nor a significant demand, the CMA has concluded.
Extract Cook and Howe (Can Med Assoc J 1984; 131: 539) state that “a possible tragedy was avoided” by recommending an abortion to a pregnant woman with schizophrenia. What constitutes a tragedy may be considered from different perspectives, and I would like to suggest an alternative view. It can be considered a tragedy that many well-intentioned health professionals believe that suppressing a life is an appropriate way of preventing human suffering. . . that many childless couples have to wait years to adopt while thousands of potentially adoptable children . . . are prevented from being born . . .
Extract Your correspondents Dr. Coffey and Drs. Cohen, Rapson and Watters (ibid, page 213) all refer to our review, published over 4 years ago,1 of the consequences of induced abortion to children born subsequently. Much progress has since been made in Europe in preventing these consequences . . .
The main conclusions of our 1972 review have, indeed, been confirmed in many subsequent studies and more recent reviews. It may reasonably be inferred from the Bristol study and from other European studies that between 20 and 25% of women who have had an induced abortion need a cerclage operation to be able to carry a subsequent pregnancy to term. The percentage may well be lower in Canada if a higher percentage of abortions are undertaken earlier in pregnancy. . .
It is important for any woman who hopes to have a child subsequent to an induced abortion to accept that she will then be in a high-risk category and must report a subsequent pregnancy early, and that she will need specialist obstetric care. . . .
Cohen and her colleagues describe us as “two crusaders for compulsory pregnancy”. This is untruthful abuse. Your correspondence columns might better be used to discuss the many steps that might be taken in Canada to reduce the unfortunate consequences of induced abortion, including the careful counselling of women and the wider use of the cerclage operation early enough in a subsequent pregnancy.
Authors’ Summary A questionnaire was submitted to the mothers of 200 consecutively delivered infants; 15% of mothers were unmarried. The results showed a high prevalence of unwanted pregnancy, most accounted for by well educated, married women having their first or second baby, and despite access to contraceptive agents. Most of the married women and over 50% of the unmarried who had not wanted to become pregnant wanted the baby after its birth.
Extract The use of an oral anticoagulant in an attempt to induce abortion has not previously been reported. . . Her knowledge of its effects stemmed from two episodes of heavy vaginal bleeding which had been ascribed to the drug. It is felt that in this way she sought to rid herself of a pregnancy which she believed would disrupt her life. In common with almost all patients who knowingly ingest anticoagulants illicitly, she persistently denied self-medication. With adequate psychiatric and social service assistance the underlying problems were resolved and the pregnancy was concluded successfully with the birth of a live infant…
Extract I am afraid, therefore, that the potential trainee with a conscientious objection to abortion must face the fact that even if he is fortunate enough to obtain trainee posts in units where his conscience can be respected, he will still have to face the fact at the end of his training, that if he does not obtain a post in a large teaching unit, he is likely to have to face the choice of either leaving the specialty or the country.
Extract . . . man’s right to live and work according to the dictates of conscience is an asset precious to him and medicine itself. Because of their religious conviction two senior members of this division of obstetrics and gynaecology do not perform abortions. . . If when they leave . . . they can be replaced by men or women of equal calibre Oxford will be fortunate. The integrity, experience, skill, and potential of applicants for these posts will be more important than their willingness to terminate pregnancy.
Extract I would be grateful if readers would let me know if reports we hear about British hospital practice are factual or not. We are told that candidates for obstetrical and gynaecological posts are first asked if they will co-operate in the abortion programme of that hospital, and their selection depends on the answer to this question.. .
Extract I think we must all be a little tired of the diatribes from some members of the medical profession in the press and on television against the Abortion Act. There are quite a number who find it is satisfactory. . . We see these patients at clinics, and we take them into National Health Service hospitals, either maternity units or gynaecological units, and whenever possible do the operation personally… I am a little amazed at the howls of protest that it is interfering with the ordinary work of units and outpatient clinics. . . .I have not, as yet, found that it is making my waiting-list longer or interfering with the intake of patients into the maternity units.
Extract Already we are finding that the impact of the Abortion Act is making great demands on hospital beds and operating time, and we agree wholeheartedly with Mr. Lewis’s statement to the effect that the whole character of the gynaecologist’s outpatient work has altered because of the numerous requests for termination at almost every session.
