University of Pittsburgh

SCHOOL OF MEDICINE
Department of Obstetrics, Gynecology and Reproductive Sciences

April 7, 2016

Dear Representative,

Im writing to express my strong opposition to HB 1948. As a board-certified

obstetrician/gynecologist who provides the full range of gynecology care, and as Director of
Family Planning at Magee-Womens Hospital of UPMC, I urge you to vote against this bill which
would limit access to safe, legal abortion and would come between a woman and her doctor.

While only 2% of all abortions take place after the 20th week of pregnancy1, access to this care
is vital for the health and wellbeing of all Pennsylvania women and families. This bill inserts
politicians squarely between doctors and our patients, forcing physicians to abandon our own
ethics and good practice and provide lesser care, face criminal penalties, or deny women the
care they need. That is why mainstream medical organizations like the American Congress of
Obstetricians and Gynecologists oppose these specific bills, stating the predominant approach
to abortion after 13 weeks, commonly referred to as dilation and evacuation, is evidence-based
and medically preferred because it results in the fewest complications for women compared to
alternative procedures.1

As a physician in one of the few Pennsylvania hospitals to provide abortion care, Magee-
Womens Hospital of UPMC, I have seen that there are many complex and personal reasons
why my patients seek abortion later in pregnancy. One of my patients, Jessica*, was 18 weeks
pregnant when she had a routine ultrasound in pregnancy that did not fully show the heart or
head. She was referred to a high-risk obstetrician, and by the time she had her follow-up
ultrasound at 22 weeks, she found out that her baby was in severe heart failure with multiple
abnormalities. She was devastated by the news. Since she lived in a state that had a ban on
abortion at 22 weeks, she had to travel to Pittsburgh to receive the safest method of abortion in

1
Foster,DGandKimport,K.WhoSeeksAbortionsAfter20Weeks?PerspectivesonSexualandReproductive
HealthDecember2013.
2
AmericanCongressofObstetriciansandGynecologists,ACOGStatementRegardingAbortionProcedureBans,
October15,2015.Availableathttp://www.acog.org/AboutACOG/NewsRoom/Statements/2015/ACOG
StatementRegardingAbortionProcedureBans.

*Nameshavebeenchangedtoprotectprivacy.

MAGEE-WOMENS HOSPITAL, 300 HALKET STREET, PITTSBURGH, PA 15213-3180

(412) 641-1403 FAX (412) 641-1133
the second trimester in order to do what she felt was the most compassionate thing for her
dying baby.

My patient, Amanda, had a routine anatomy ultrasound in the second trimester. She and her
husband found out unexpectedly that their baby had a severe lethal skeletal abnormality where
bones fracture easily and frequently. There were already signs of multiple fractures by
ultrasound, and the pressure of the ultrasound itself was clearly showing damage to the bones.
If their baby survived to delivery, it would experience multiple fractures from the delivery process
itself, before passing away. They felt that the most compassionate option was to terminate the
pregnancy in the second trimester. This ban would have prohibited me from being able to take
care of this woman and her family.

My patient, Sarah, was 16 years old and the victim of incest by her stepfather. She did not
realize that she was pregnant, and by the time she presented to me for care, she was 14 weeks
pregnant. Being able to have an abortion allowed her to move on with her life while her
stepfather was being prosecuted for incest.

My patient, Meredith, who underwent an abortion at 21 weeks for multiple severe fetal
anomalies, wrote a letter several years after her abortion to thank me for the care that I
provided. With her permission, Id like to quote portions of her letter, because her words provide
an example of what women go through when they make this decision, and how important it is to
have the choice to undergo an abortion:

Tomorrow is 3 years since my 20 week ultrasound revealed that I was carrying a very
sick baby who would most likely not survive pregnancy or birth. I have spent the last 3
years thinking of my life in 2 parts before and after the ultrasound. I look back at that
time as a horrible nightmare. However, you and your staff and everyone I encountered
treated me with such dignity and kindness. I can never thank you enough for your help at
such a terrible time and also for your skilled hands performing the D&E.

I am writing this letter to thank you for so many things. When I decided to terminate the
pregnancy, there were no doctors in the ob/gyn practice I belonged to that were willing to
do the procedure at 20+ weeks. I was also so frightened that I would not be able to go
 on to have another child. But, thanks to your skilled hands, I went on to become
pregnant with the happiest, sweetest child I know.

So many people today demonize women who terminate pregnancies and those who
perform the procedures. And growing up in a devout Catholic family, I never would have
thought that I would choose that path. Life doesnt always turn out the way we plan, and
again I am thankful for your help.

In asking permission from Meredith to quote her letter in order to oppose HB 1948, she told me:

I would be so happy to have my words used. I had my ultrasound on day one of the 20th
week, and I remember feeling pressure to have my D&E scheduled before 22 weeks,
before it was too late to go that route. 20 weeks does not give women much time for
other tests and results that would allow them to decide if the procedure is right for them.
Every time I read a news story about new, more difficult restrictions being placed on
abortion, I worry about women who will not be able to make a choice, as difficult as it
can be, that is best for them.

HB 1948 would prevent me from caring for women like Jessica, Amanda, and Sarah. It would
prevent me from helping women like Meredith, who made the choice that was best for her and
her family with the time that she needed to make her decision. She would not have had this
option if this bill had been in effect when she was diagnosed with the severe fetal anomaly.

When a woman experiences a complicated life situation, she needs care from the medical
professionals she trusts. My patients trust me to provide them with the safest, high quality care.
This bill would harm women by forcing me to go against my professional medical judgment and
training and preventing me from providing the best care that I can to my patients.

Every pregnant woman faces unique circumstances, challenges, and potential medical issues.
Physicians must be able to provide their patients with the best and highest quality medical care
possible based on their experience, training and expertise. Lawmakers are not medical experts
and this is not an area where lawmakers should be intruding. Please vote against HB 1948 to
protect the sanctity of the doctor/patient relationship and the women and families of
Pennsylvania.

Sincerely,

Beatrice Chen, MD, MPH

Assistant Professor
Director of Family Planning, Magee-Womens Hospital of UPMC
Department of Obstetrics, Gynecology, and Reproductive Sciences
University of Pittsburgh