Doctors shun life-saving abortion

As 32-year-old Daniela found out, access to the procedure at a public hospital can be impossible The government is planning to make the law covering terminations even tougher

Daniela, pictured this week in her Madrid apartment.
Daniela, pictured this week in her Madrid apartment.Cristóbal Manuel

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.

More than a minor delay


For five weeks, a 17-year-old from a town in Valencia province went knocking from door to door before she was allowed to have an abortion. Her first request in late December, when she was five weeks pregnant, was turned down on the grounds that she needed to come with one of her parents.

"Not true. The current legislation says that if the minor [a 16- or a 17-year-old] is at risk of family pressure to keep the baby, as was her case, the doctor can go ahead with the operation without parental consent," says Marcela Jabbaz, a sociologist and member of the Federation of Progressive Women in the Valencia Region, who assisted the young woman in her quest. "She was sure that her mother would not approve and that, as punishment, she would send her back to Ecuador [she has dual nationality]."

The sociologist went with her on her second visit to the local health center. Again, they ran into hurdles. "We would rather she came with her parents. Sometimes they are scared to tell them about it, but it's not so bad in the end," the doctor told them. "And other times, they get a beating," retorts Jabbaz as she remembers the physician's words.

Using the terms of the law, they managed to overcome all the obstacles in their way and obtained permission to go to a private clinic that has an agreement with the public health system. "It is curious that they do not offer to do it at a public hospital," says the sociologist.

But there was one more hoop to jump through. The law says that the doctor may request a report from a psychologist or social worker. And the doctor did. "We knocked on all the doors, but neither the local social services nor the health center nor private professionals would do it. In the end, we just happened to try the school counselor, and we got lucky." Five weeks after that first request, at 10 weeks pregnant, the young woman got her abortion.

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