Doctors shun life-saving abortion

La Paz Hospital, one of the largest public health centers in Madrid, refused to perform an abortion on Daniela, a 32-year-old woman who had lost all her amniotic fluid when she was 20 weeks pregnant. In these conditions, a fetus no longer has a chance to live, according to all the specialists consulted by this newspaper, and the mother is at risk of serious infection.

Even though she met all the requirements set out in the current abortion law - which the Popular Party government plans to toughen up on - the Madrid hospital refused to terminate her pregnancy. Eventually, Daniela, who was on intravenous antibiotics to prevent infections, was discharged from La Paz so she could go to a private center for her abortion, after the regional government confirmed her right to one.

A spokeswoman at La Paz said that all the doctors there are conscientious objectors - whose rights are enshrined in the current Spanish law on abortion - and that in 2010 the gynecology department in full decided not to carry out any abortions, ever.

Daniela, a physiotherapist, tells her story serenely, speaking with a mild Brazilian accent.

"We really wanted this child, we'd been undergoing fertility treatments for two years," she says, sitting in her uptown Madrid apartment in the company of her husband Miguel, a university lecturer.

They are hypocrites; they washed their hands of the whole business"

Daniela remembers the dates quite clearly. "At 13 weeks I bled, but was told it was normal. On December 27, when I was 16 weeks pregnant, I woke up soaked in blood."

The tests began in earnest then, but despite all the indications that the amniotic membranes might have ruptured, doctors at La Paz ruled out this possibility. On New Year's Eve she was admitted to the hospital and put on antibiotics as a precautionary measure.

On January 7 she was sent home with a severe oligoamnios diagnosis, meaning she had a very small amount of amniotic fluid. She is convinced that her sac was already ruptured by then.

"They told us the fetus had a very slim chance, but we decided to wait because we really wanted this child," says Miguel.

On January 23, at 20 weeks, Daniela went back to the emergency room after losing fluid once again. This time, the diagnosis was unequivocal: "premature rupture of membranes in pre-term gestation."

Without amniotic fluid, the womb presses down on the fetus, whose lungs cannot develop properly and who is, therefore, at risk of deformities, explains Juan Fernández, head of obstetrics at Severo Ochoa in Madrid, one of the few public hospitals to perform abortions. If the membranes break at an advanced stage, there are survival options, but before the 20th week "the natural result is that the fetus will die. It is non-viable, and there is a risk of infection for the mother."

Javier Pérez-Pedregosa, a prenatal diagnosis specialist at the private clinic Sanitas in La Moraleja, agrees.

"With such an early membrane rupture, the lack of amniotic fluid inevitably causes lung hypoplasia, a very serious condition that prevents the lungs from developing. There is also a serious risk of deformities in the joints because of the lack of mobility. Such a fetus has no chance of survival," he says. "It may be born, but it will die."

That is when Daniela and Miguel say that their ordeal really began. "They told us that the child's lungs would not develop, and that there was a risk of infection for Daniela. Their scenario was terrible, but they offered no solution. We had a week to decide because the legal deadline was coming up," says Miguel.

Convinced that they had no choice, they asked to terminate the pregnancy. "But they told us that they didn't do that there, that if the fetus had no heartbeat they would take it out of my body, but otherwise they would do nothing," says Daniela.

In these cases, patients are ordinarily referred to a private clinic. But Daniela was told that if she wanted to terminate her pregnancy, she would have to ask for a discharge and deal with everything herself. "To me this was not a voluntary option, but a therapeutic one. There was no solution. It hurts me that they wrote down that I am the one who asked to terminate the pregnancy."

This was a Friday. Miguel and Daniela decided to leave. She was given oral antibiotics, and the couple went to the only agency in the entire Madrid region with the power to have her referred to the private clinic Dator, which specializes in abortions.

"It is hypocritical for them to tell you that the fetus is non-viable but then have them wash their hands of the whole business," says Miguel.

The couple say they wanted to tell their story so people will know what getting an abortion in Madrid is like, and to demand that the public health system guarantee women's right to it "at least in the cases of therapeutic terminations due to non-viable fetuses."

In 2012, there were 20,134 abortions in the Madrid region, of which only 27 (0.13 percent) were carried out at public hospitals, according to the Health Ministry. At the national level, there were 112,390 pregnancy terminations, of which 6.5 percent took place in public health centers. A few years ago this figure barely reached three percent.