The Truth About Third-Trimester Abortion Care

In recent weeks, lawmakers in several states have introduced legislation to further restrict or criminalize abortion later in pregnancy. Some claim these measures are about protecting life. But I know the reality. For 20 years, I was the first woman doctor in the United States to openly provide abortions in the third trimester of pregnancy. My patients' stories—of trauma, desperation, and resilience—tell a very different story from the political rhetoric, which often demonizes the procedure, vilifies doctors, and shames those who seek care.

Though this procedure makes up a relatively small segment of abortion care (by some estimates, around 1%), it is the key to understanding all abortion care. When we listen to those in the most desperate circumstances, we begin to understand everyone who seeks an abortion—and the urgent need for safe, legal, and accessible care in every trimester.

I began this work in Wichita, Kan. under the mentorship of the late Dr. George Tiller. After his assassination in 2009 by an anti-abortion extremist, I continued the work in Albuquerque, New Mexico until I stepped away from clinical practice in 2021. In those years, I cared for patients who had nowhere else to turn. They needed care, often after exhausting every other option.

Some received a devastating diagnosis late in pregnancy—a condition that meant their baby would not survive long after birth or would endure profound suffering. Some were lethal, like Potter’s syndrome, where the baby’s kidneys never develop. Others, like lissencephaly, a severe brain condition, were non-lethal, but were marked by a short life of intractable seizures.

But patients whose babies have fetal indications are not the only patients who seek third-trimester abortions. I have also cared for victims of domestic violence who were trapped in their homes and couldn’t escape to seek an abortion until their abuser was jailed. I’ve cared for patients who were raped and were so traumatized that they could not confront the possibility of pregnancy. I have performed abortions when birth control, even the most effective kinds, failed. Because they were on birth control, they could not believe that their bodily changes were pregnancy-related until they finally discovered that they were pregnant and in the third trimester.

I have assisted mothers who were initially planning to continue the pregnancy but lost their jobs and could barely afford to care for the children they already had. I have also cared for many teenagers and even younger girls who were too afraid to tell anyone that they were pregnant and who hid behind baggy clothes until they could no longer keep their pregnancy a secret. And in recent years, I saw more and more patients who did seek abortions earlier in pregnancy, but the barriers of different state regulations prevented them from obtaining one until they managed to make their way to my door. These barriers included gestational limits, waiting periods, cost, transportation, and increased demand due to clinics around the country being forced to close.

What these barriers failed to do, however, was to dissuade women from ending their pregnancy.

These obstacles didn’t stop people from seeking abortions—they only delayed care and deepened hardship. And the consequences of those delays were not theoretical. The landmark Turnaway study found that people denied abortions face increased rates of poverty, physical complications, and long-term health issues.

Read More: What Trump Has Done on Reproductive Health Care In His First 100 Days

My patients didn’t need a study to tell them that. They lived it. One told me that continuing her pregnancy would have been a death sentence and that an abortion would be lifesaving. Many of them initially held strong anti-abortion views while simultaneously believing that having an abortion was essential to prevent suffering for themselves and their families. Many also expressed deep concern for their future child. If they were to give birth, they all wanted their child to live a good life, with adequate food, shelter, and opportunities. They knew, to their deepest core, that the circumstances of their particular pregnancy would make that impossible.

We are told to be “reasonable” about abortion and accept limits—15 weeks, 20 weeks, 24 But the truth is, they do not reflect the unpredictable realities of pregnancy, or the complexity of human lives. Every time we accept a limit, we inch closer to a world where no abortion is safe, legal, or accessible.

It creates the slippery slope to the total bans we are seeing in increasing numbers of states—when, in fact, we must wholeheartedly support the growing number of abortion seekers who are driven to seek a third-trimester abortion. They are as deserving as anyone else of compassionate and competent care.

A father once told me that, in light of his baby’s condition, he considered it immoral to continue the pregnancy. A young rape victim’s mother once said to me, “You don’t know the story until you are the story.”

When these stories are truly heard, judgment fades. Understanding and compassion take their place.