Colleagues called me ‘the terminator’: medical professionals speak of their experiences of providing abortion

Medical professionals working in the abortion service have given a unique insight into their concerns in new research, describing how they encountered “ill-feeling” from colleagues and suffered “moments of doubt”.

The research, by academics in UCD’s schools of nursing and perinatal health, is a small-scale study based on interviews with 13 providers of abortion services, including GPs, midwives, obstetricians and nurses.

Despite teething troubles at the start of the service, none of those interviewed had considered leaving abortion care and all were proud of their work.

All had faced isolated experiences with anti-abortion sentiment. Common examples included being “cornered” and “intimidated” by family and friends who questioned their support for the service, or local community members “gossiping” about their involvement, or writing to complain about it.

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Two GPs said they had experienced a “definite silence” from staff; an obstetrician described being referred to as “the terminator” by colleagues; and the nurses and a midwife recalled colleagues expressing “judgment”, “nastiness” and “ill-feeling” about their involvement with abortion services.

“The isolated nature [of these experiences] made them easy to tolerate,” the study notes, while providers also learned to limit or withhold information about their work.

Abortion was introduced in 2019 and is currently available in 12 out of 19 maternity units and from one in 10 GPs. A recent Government-commissioned review called for abortion provision to be further liberalised.

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In the study, providers believed the majority of those who did not support abortion during the referendum had accepted the results and “moved on”. Fears about repercussions had proven “unfounded”.

However, five providers said they had experienced protests at their workplace, though these had “little impact” due to poor organisation and small numbers.

Within the service, high levels of conscientious objection created issues with implementation. In hospital, nurses and midwives said that as a result they “automatically became the person who provided” care. One midwife said she had to cancel planned days off to be available and another said they had to ask women to return home on multiple occasions because doctors refused to prescribe medication.

Some said the service was being provided in an unsuitable part of their hospital. “The nurses and midwives also said that continuing high levels of conscientious objection along with low staffing levels meant they often provide care in addition to their general workload, usually without remuneration.”

While some initially held concerns about the introduction of liberalised abortion care, all believed restrictive abortion laws had a negative impact on the physical and mental health of women in Ireland.

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Most of those interviewed described moments when they questioned if abortion care was morally justified. Some expressed concern about abortion being used as a method of contraception, according to the study, published in Sexual and Reproductive Health Matters journal.

Handling foetal remains, especially when required multiple times a week, was referred to as the most difficult part of abortion care. One midwife recalled an experience where a patient returned to the hospital with her baby after deciding not to proceed with abortion.

All of those interviewed reflected positively on their work. “They also believed that implementation has been successful in delivering a safe, robust, and largely accessible service in general practice, though noted greater challenges in Irish hospitals. Personally, many experienced moments of doubt in their work, though all remained committed to the provision of care, believing abortion to be an important and necessary service.”