May 27, 2025 • 44 mins
There are many reasons why someone may require a third-trimester abortion, including both fetal implications and maternal implications (such as health diagnoses and difficult life circumstances). Dr. Shelley Sella, retired OB-GYN, first woman to openly provide third-trimester abortion care in the U.S., and author of Beyond Limits: Stories of Third-Trimester Abortion Care, sits down to share her expertise, discuss the multitude of reasons why someone seeks a third-trimester abortion, and touch on the personal stories shared in the book.
Dr. Sella became involved in the women’s health movement in college, which eventually sent her to medical school to begin her journey studying to be an OB-GYN. Dr. Sella was mentored by Dr. George Tiller, who provided late term abortions and who was assassinated in Kansas in 2009. Beyond Limits follows Dr. Sella during a week at the abortion clinic, sharing stories of patients requiring third-trimester abortions for a myriad of reasons.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Jennie (00:03):
Welcome to rePROs Fight Back, a podcast on all things
related to sexual andreproductive health, rights, and
justice. [music intro]Hi rePROs.
How's everybody doing?
I'm your host, Jennie Wetter,and my pronouns are she/her.
So y'all, I hope you had awonderful holiday weekend and
got to enjoy some good weatherwhere you are I am recording
(00:24):
this on Friday before theweekend so I'm hoping for nice
weather all weekend.
It's been like really rainy andgloomy and kind of gross here
so I haven't been able to enjoybeing outside or having my
windows open very much so I'mvery much looking forward to a
nice weekend where I can youknow go for some walks and spend
(00:45):
some time outside and have mywindows open I know the kitties
will be very excited for me tohave the windows open.
They have clearly been pouting,not being able to sit in the
windows.
So, hopefully it will be verynice this weekend.
Other than that, I don't reallyhave any big plans.
I'm really just kind of lookingforward to some downtime, maybe
(01:06):
do some fun reading.
I don't know.
We'll see.
Maybe even baking.
I don't know.
I'm hoping to maybe get somerhubarb and maybe do...
My mom used to always make arhubarb upside down cake that I
loved.
So, I'm hoping to find somerhubarb so I can make that this
weekend and that'll just bethinking of home and will make
(01:27):
me very, very happy.
So, that is my plan for theholiday weekend.
But yeah, not a whole lot.
But there has been a lot goingon that we do need to talk
about.
The house...
passed a funding bill thaty'all is bad.
It's bad.
They're calling it their "big,beautiful budget bill," which,
okay...
(01:47):
but it is bad.
It's bad.
It would really gut Medicaid,kicking millions of people off
of their insurance.
It also really slashes the SNAPprogram, which is food stamps.
Again, kicking a lot of peopleoff of those services.
Again, millions and millions ofpeople.
(02:08):
It is just all of this to fundtax cuts for the most wealthy.
We're going to cut programshelping those the most in need.
And that is just disgusting.
That is just disgusting.
There is no other word for it.
It is just disgusting that weare hurting people who need help
to give more money to thepeople who don't need it.
(02:30):
And those weren't the onlythings.
There are so many terriblethings in that bill.
It would also "defund" PlannedParenthood, which we've talked
about before.
It's not like there's this lineitem that says, here, all this
money is going to PlannedParenthood.
It means that people onMedicaid who go to Planned
Parenthood for their healthcare,often their only healthcare
(02:50):
they access, will no longer beable to do so.
So, it means that patients whoare going there for their family
planning services who are onMedicaid cannot do that.
It's going to have devastatingimpacts.
I'm going to have somebody onin the next week or so to talk
about that and what that willmean for people accessing
(03:11):
healthcare, what it would meanfor Planned Parenthood.
We'll dig more into that later.
And then I think the otherreally important thing we need
to flag in this bill is thatthey added a provision that
would prevent trans people fromaccessing gender-affirming care
through Medicaid.
And by that, it's not justyoung people, which is what we
have seen a lot of the attackson access to gender-affirming
(03:35):
care be about was young people.
This is anyone.
Anybody on Medicaid would notbe able to access
gender-affirming care usingtheir Medicaid coverage.
Again, that would be absolutelydevastating.
The important thing to notewith all of the things I just
talked about (03:49):
that was the bill that passed the House.
It has not passed the Senateyet.
It is not in place.
It is not law.
There is still time to pushback and let your senators know
that you do not support thesecuts.
Honestly, also let your Housemembers know because I'm sure
the Senate is not going to passthe exact same version of the
bill that the House did.
There will be some negotiationthat is going to have to go back
(04:12):
and forth.
So make sure that you areletting your representatives
know that you do not supportthese cuts to Medicaid, to SNAP,
to access to gender affirmingcare, to cutting funding for
Planned Parenthood, all thethings.
And there are so many more youcould talk to them about.
This is a really bad bill.
So, make your voice heard.
It's really important right nowat this moment to speak out.
(04:34):
So, yeah.
Lots happening.
Let's see.
I guess it's been a while, solet's maybe do a little quick
housekeeping.
One, did you know that rePROsFight Back has a newsletter?
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(06:24):
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(06:47):
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Like I said, I always love tohear from y'all so feel free to
reach out to us anytime.
Okay with all of that, let'sturn to this week's interview.
I'm so excited to have ontoday, Dr.
Sella.
She was an abortion provider.
She provided abortions later inpregnancy, and she wrote this
really great book, BeyondLimits, Stories of Third
(07:40):
Trimester Abortion Care, thaty'all, I cannot recommend it
enough.
I really enjoyed reading it.
I learned so much, not justabout how she provides abortion
later in pregnancy, but having adeeper understanding of her
patients and what they have gonethrough.
I think so often the stories wehear about abortion later in
(08:00):
pregnancy are so focused onthose who get a late fetal
diagnosis that we don't oftenhear all of the other stories.
And this book was a reallygreat opportunity to understand
the full range of people whoneed to access that care and
what is happening in theirlives.
It just really puts personalfaces behind all of the stories.
And I just found it increasedmy empathy so much.
(08:22):
I had already felt for all ofthese people who were in these
situations and I alreadysupported abortion later in
pregnancy but this just, like,even more so now and there were
tears there was just like somuch so much pulling on my
heartstrings hearing thesestories and thinking through
what all of these people hadbeen through that just it was a
(08:43):
lot just to hear all of thehurdles they had to go to access
this care.
So with that, let's go to myinterview with Dr.
Sella.
Hi, Dr.
Sella.
Thank you so much forbeing here.
Dr. Shelley Sella (08:56):
Thank you for having me.
Jennie (08:57):
I'm so excited to talk to you today.
But before we dig in, would youlike to take a second and
introduce yourself?
Dr. Shelley Sella (09:04):
Sure.
I'm Dr. Shelley Sella.
I'm a retired OBGYN, and I'mthe first woman to openly
provide third trimester abortioncare.
In the United States, that is.
Jennie (09:17):
I'm so excited to have you on.
I just finished reading yourbook that is coming out next
month, and it's called BeyondLimits, Stories of
Third-Trimester Abortion Care,and I just, I absolutely loved
it.
It was so moving, and...
we'll talk through multipleparts of the book, but I just
(09:37):
wanted to thank you for writingit because it really did make an
impact.
And I think it will be a reallypowerful tool.
Dr. Shelley Sella (09:44):
Well, thank you for saying that.
And that's really the intent ofthe book, really, is to help
change people's hearts and mindsabout third trimester abortion
care, which, as you know, is themost stigmatized and
misunderstood aspect of abortioncare.
So, to hear you say that isactually very, very gratifying,
(10:07):
and I hope that other people whoread it have the same
experience.
My intent was not to write anovertly political book.
It was really to talk about thepatients that I saw, to talk
about my particular journey toproviding that care.
And with the hope that byfocusing on stories on people,
(10:28):
that it would have an impact, itwould have a different kind of
impact, it would affect, itwould impact people's hearts,
and then help move them.
Jennie (10:35):
So, one of the things I really loved about the book is
you telling your story.
And we do an annual episodeevery year where we have people
tell their origin stories on howthey either got their job or
like how they got into thisfield.
Would you like to share yoursexual and reproductive health
origin story here?
Dr. Shelley Sella (10:53):
Well, I'll give you the abridged version.
And for the more complete andcomplicated version, you have to
read my book.
But I became interested in thewomen's health movement in
college.
And I went to the University ofWisconsin, Madison, and we just
talked about how you went theretoo, but it was a different
(11:13):
time.
Jennie (11:14):
Yeah, and one thing I think I forgot to mention, I
think my mom might have beenthere at that same time.
Dr. Shelley Sella (11:18):
Oh, wow.
Maybe we were friends.
So that was, at that time,there really was a burgeoning
women's health movement and awomen's movement.
And at the time, and right now,it may seem odd to even be
talking about a women's healthmovement when we now are so much
more expansive in ourunderstanding.
(11:40):
But then at that point, thatwas how people were referred.
And so that interest led me toan internship at the Los Angeles
Feminist Women's Health Center.
And they were really at thevanguard of the women's
movement.
And just to stop for a momentand to explain what I'm talking
(12:00):
about when I say the women'shealth movement, it was really a
response to this very malepatriarchal model of health
care.
It was about giving power backto women, giving power back to
patients, educating them, havingthem control their bodies and
also control the experience inthe doctor's office.
So, it was a really kind of aground, from the ground up
(12:24):
movement rather than a top-downmovement.
So for example, at the LosAngeles Feminist Women's Health
Center, the doctors were there,but had a minimal role.
They were essentiallytechnicians.
And actually, when I got to theclinic is when I realized they
were providing abortions.
I didn't even know that.
(12:44):
But the doctor was the one whoprovided the abortion.
The patient, the lay healthworkers, as everyone was called,
did everything else.
They did the lab test.
They ran groups.
And so, rather than anindividual experience between a
health care provider and thepatient, it was a group of women
(13:08):
sitting together with the layhealth worker.
So, for example, pregnancytests were done in a group.
Results were discussed in agroup.
And then if someone decided tohave an abortion there was a lay
health worker who was acounselor with that patient and
actually i'm using the wordpatient but we were told not to
(13:31):
use the word patient we were...
because it was a peerrelationship.
We weren't better than theperson we were caring for.
So we used "women." And that'sa shift, I think.
And so, the doctor was the onewho performed the abortion.
And that's it.
That's all they did.
The health workers dideverything else.
(13:55):
So that was kind of the modelthat was in my head.
Group experiences, usinghealthcare or healthcare as a
way to empower people.
Providing healthcare in adifferent way.
And so from that experience, Iactually decided to become a
doctor, which is funny becausethere was such a bias in that
(14:17):
movement against doctors.
Like, why would you want to bea doctor?
But...
I wanted to be able to not justoffer the emotional care, the
educational care.
I wanted to offer the technicalpart of it.
I wanted the whole thing or tolearn everything.
And so I did go to medicalschool with the intention to
(14:37):
provide abortions.
And that's a whole other longstory.
But I would describe it as ajourney.
But that was the beginning.
Really, the foundation was atthe Los Angeles Feminist Women's
Health Center.
Jennie (14:53):
I really loved how you interspersed your story with the
week that you had thesepatients.
It was just brilliantly done.
And I loved seeing how you tookall of these past experiences
you had with these differentparts of care you encountered to
find the way you ended upproviding care and you could
(15:16):
feel the patient-centeredness ofit.
And it was just reallywonderful to see how it all came
together to provide thisservice and you could feel the
way that it was helping peoplewho came to see you for the
abortions later in pregnancy.
Dr. Shelley Sella (15:32):
Yeah, I mean, when you're saying that, I'm
thinking one of the reallyimportant experiences I had
subsequently was the two years Iworked with home birth midwives
in Santa Cruz, California.
And that also was this model ofcare, which is called the
midwifery model of care, thatagain, centers the woman and her
experience and empowers her,honors the process, honors the
(15:59):
birthing process, honors her andher family.
And that was key to how Isubsequently provided abortion
care.
I mean, that was the thingabout third trimester abortions,
because it's a longer process.
It's not a quick, in-clinic,first trimester abortion or
(16:19):
medication abortion.
It occurs over several days.
So it gives the provider timeto understand what's going on,
to spend time with the patientand their family, and to develop
trust between provider andpatient.
The process of a thirdtrimester abortion where I
(16:40):
worked was the inductiondelivery of a stillborn.
So it was a delivery.
So it was using the samephilosophy, the same orientation
that I had learned from workingwith midwives and translating
that or transferring it toabortion care.
Jennie (16:59):
Yeah, I really appreciated that.
And I really appreciate the wayyou brought in the group
dynamic, because I think from alot of the stories you hear, how
so often people talk about howthey have felt alone and didn't
feel like they could talk topeople or were dealing with it
on their own.
And it was really wonderful tosee the way, again, when you all
(17:21):
read this book, you'll see thateach chapter is like a day
talking about this likemulti-day process and following
six people.
And it was really wonderful tosee the thought.
I could feel it built into allthe steps where you had the two
groups, you had the maternalindications and the fetal
(17:42):
indications, and then each hadtheir own support system of
group counseling.
And I could just feel thethoughtfulness that went through
all of it as to why there werethe separate groups and the ways
that these people weresupporting each other to know
that they weren't alone in thisprocess.
Dr. Shelley Sella (18:00):
Yeah, and I think the group process was very
important and key to the carethat we offer.
And I would like to say thatthat was started by Dr.
George Tiller.
So that was the physician whowas my mentor, and then we
worked together in Wichita,Kansas, until he was
assassinated in church.
So he was one of the firstpeople to provide third
(18:23):
trimester abortion care in theUnited States, and it was his
idea to have the groups.
And so when I came to theclinic to visit the first time
and I saw the groups, it's like,ah, I've seen this before, and
it works.
It's actually very helpful.
And then After he wasassassinated, a doctor in
Albuquerque, New Mexico, CurtisBoyd, invited one of my
(18:46):
colleagues, Dr.
Susan Robinson and I, to starta third trimester abortion
practice at his already existingpractice.
That clinic was really knownfor its excellent counseling
that they offered patients inthe first and second trimester.
But it was one-on-onecounseling.
So what we did when we came,we...
(19:08):
combined the two so thatpatients would still have that
really good one-on-onecounseling, and they would also
have the groups.
And I think patients reallyappreciated it.
You know, there would be timeswhere people would say at the
beginning, oh, I don't likegroups, I don't want to talk.
Jennie (19:25):
I could totally see myself being that person.
Dr. Shelley Sella (19:29):
And then they would, and I would say, you
know, just even just sitting ina room with other people might
be helpful.
Jennie (19:37):
Yeah.
Dr. Shelley Sella (19:38):
And invariably, that person would
start talking once they were inthe group, because you're in a
group with people who completelyunderstand what you're going
through.
And it's a support group.
Part of the purpose of thegroup was to transmit
information, but the majority ofthe time spent was people
talking to each other.
And they formed connections,like...
(20:00):
in the book, I talk about onegroup afterwards, they all went
out to dinner.
That wasn't that uncommon.
And then sometimes people wouldstay in touch for years,
offering support, and throughgood and bad.
I know of one couple where theyheard, oh, so-and-so had a
baby, they were doing well,so-and-so went back to school.
(20:21):
I mean, different situationsthat people stayed connected to
each other.
So it's powerful.
I think the groups were verypowerful.
Jennie (20:28):
I also really appreciate it.
I mean, this was a general weekthat you picked that you told
the stories for, but it was, Ithink, really important to the
book to see all of theindividual stories so that
people get a betterunderstanding because I think
there's so much myths anddisinformation about why people
get abortion later in pregnancyand a lot of judgment and stigma
(20:53):
around it.
And I think this book did areally great job of dispelling
that and showing who thesepeople who were accessing care
were and why they were makingthose choices
Dr. Shelley Sella (21:03):
Yeah, I think that's certainly an important
part of the book.
The stories are, the patientsare composites.
Each patient representspatients that I saw.
So they're composites of truepatients.
But I did, I was deliberateabout deciding what kind of
patients I would talk about.
(21:24):
And I was also deliberate abouthaving three, you mentioned
fetal indications and threematernal indications.
Let me explain that a littlebit.
Fetal indications are patientswho come because their baby, and
that is the word that they use,has a condition that's been
diagnosed at some point in thepregnancy.
(21:44):
It could be a condition thatwas picked up early in the
pregnancy and then they keepfollowing it and it gets worse
and worse, more serious.
Or it could be something that'spicked up very late in
pregnancy.
Those are the stories we oftenhear about.
Like, if the media is going totalk about one kind of patient
(22:05):
in the third trimester, they'regoing to talk about them.
And I think there's thatdecision made, like, these are
the most deserving, perhaps, ofcompassion, that maybe these
will pull at our heartstringsand maybe we will change our
mind about third trimesterabortion.
And I think their situation iscompelling and deserves
(22:27):
compassion.
And equally-
Jennie (22:29):
Yeah, I mean, like I said, I told you, I think,
before we started recording thatI cried multiple times reading
this book, but I found thefetal, I mean, the maternal
indication stories often just asheartbreaking for all of the
situations that all of them werein to be in that place.
Dr. Shelley Sella (22:48):
Exactly, yeah.
So, the maternal indicationspatients that I saw were ones
who had difficult lifecircumstances, and anything you
can imagine can happen.
I talked about one person whowas a victim of domestic
violence, one person with adiagnosis of cancer who couldn't
get treatment while she waspregnant, but whose symptoms
(23:12):
were hidden by the cancerrecurrence.
And I talked about a teenager,which I thought was very
important to talk about, becauseteenagers are stigmatized even
more than anyone else.
And so, I wanted people toreally understand what was going
on for a teenager.
And I believe that the maternalindication patients are as
(23:34):
deserving of our compassion asthe fetal indication patients.
Jennie (23:39):
Absolutely.
I thought all of the storieswere told in just such a
compassionate way.
I could just feel yourcompassion for your work and for
all of the patients justbleeding through on the page.
Like it was just, just so wellwritten.
Dr. Shelley Sella (23:57):
I got a lot of help.
I'll start with my wife, Julie,who was the first editor.
And, you know, this is thefirst book I've ever written,
and I really had no idea what Iwas doing.
And I also had no idea how longit would take.
I thought when I wrote thefirst draft, I thought, oh,
(24:17):
okay, I'm done.
Jennie (24:19):
Yeah. [chuckles]
Dr. Shelley Sella (24:20):
Little did I know.
It's really quite a process.
Jennie (24:23):
As somebody who is a big reader, anybody who can write a
book is magic to me.
Like I just, so I, yeah, I findthe whole thing just magical.
So it was, like I said, it wasa really wonderful book.
Dr. Shelley Sella (24:40):
Thank you.
Jennie (24:40):
So what is one thing or two, you may have a couple, that
you wish people knew aboutabortion later in pregnancy?
Dr. Shelley Sella (24:48):
What I want people to know is that, and I
want to reframe it a little bit,not what I wish people knew
about third trimester abortion,but what people knew about the
people who get third trimesterabortions, who need third
trimester abortions.
And their situations aresimilar.
(25:10):
to those seeking first andsecond trimester abortions, but
they are a lot more desperate,meaning they know that if they
are turned away or if they can'tobtain a third trimester
abortion, if they're turned awayat this clinic, that's it.
They are going to be forced tohave a child.
(25:31):
I think it's more and more anissue these days because of all
the restrictions and bans.
Restrictions and bans lead tolater abortion.
So we're seeing increasingnumbers of people who are
traveling out of state.
At this point, it's one infive.
(25:52):
Before Roe was overturned, itwas one in ten, which is also
way too many.
But it's one in five women areleaving their state to access an
abortion, and that's leading tomore and more delays.
But that's not the only reasonwhy people seek third trimester
abortions.
And even if abortion wasaccessible, free, legal in all
(26:17):
states, there would always be aneed for third trimester
abortions.
And that's something else Iwish people would know.
Jennie (26:24):
That's such an important point.
Dr. Shelley Sella (26:25):
Yeah, because...
We just don't know.
We cannot predict what willhappen.
Someone with a highly desiredpregnancy cannot predict that
the baby may develop a conditionor be born or have one that may
worsen with time.
We can't predict that birthcontrol fails.
(26:46):
We can't predict that someonehas cancer and their symptoms
are hidden.
We can't predict... there's somuch... that life circumstances
change that maybe you thoughtyou could manage a third child,
but you just lost your job andyour rent just went up and you
(27:08):
can barely feed the kids thatyou already have.
Life is complicated.
I guess that's what I want tosay, what I want people to
acknowledge, because we knowthis, but people to acknowledge
that life is complicated, and itdoesn't fit into gestational
limits that the state hasdecided that that's how we
(27:29):
should decide who can have anabortion or not.
Jennie (27:32):
Yeah, I was just thinking that, like, there is no
way the state can legislate forthe complexity of people's
lives in gestational bans where,you know, hear them talk about
exceptions and stuff.
And if there's anything we haveseen.
I mean, always, butparticularly since the loss of
Roe, is how exceptions are notclear and do not work.
(27:56):
That you have people who aremiscarrying who still can't get
care because there is still afetal heartbeat and they are
waiting until the person is sickenough before they can provide
the care that that personclearly needs and will get.
But you just can't legislatethe complexity of the reality of
(28:16):
a pregnancy in a person's life.
Dr. Shelley Sella (28:18):
Yeah, and I agree.
Exceptions are absurd.
And as I write in the book, Ireally don't believe in a
hierarchy of desperation.
And there's always, not always,sometimes when there are
exceptions, there will beexceptions for rape and incest.
And then I think, wait, arethose the worst things that can
(28:40):
happen to someone?
Yes, they are bad, and thereare a lot of other bad things
that can happen to people thatmake that person decide that the
pregnancy is not viable forthem.
And so I do talk about thisnotion of viability, which is
not what was codified in Roe,a fetus who can survive
(29:01):
pregnancy outside the womb withor without support, it's the
pregnant person themselvesdeciding that the pregnancy is
not viable and taking intoaccount all the complexity of
their lives and coming to adecision.
The decision comes from themand not from the government.
Jennie (29:19):
Yeah, I mean, who knows your life and what you can do
and handle better than you?
Dr. Shelley Sella (29:23):
Exactly, exactly.
Jennie (29:25):
Like I said, I really did enjoy this book and...
I really appreciated getting tounderstand the process better.
I think I had a general idea.
I've worked in this field for along time.
I knew generally how thirdtrimester abortions worked, but
(29:46):
it was really illuminating tosit through all of the chapters
where you had, like, here's whathappened Tuesday morning,
here's what happened Tuesdayafternoon, and really seeing how
the process worked and gettinga better understanding of that,
but also how the patients weresupported throughout it.
I think that was just reallywell written.
Dr. Shelley Sella (30:08):
Thank you.
Well, that was very deliberateon my part.
When I thought about writing abook, I thought I wanted for
people to understand thepatients, why they come to the
clinic, why they have a thirdtrimester abortion, and I also
wanted people to understand thecare.
And the care is emotional, andwe talked about the groups, but
(30:31):
there's also a physicalcomponent to it.
And when I think about howabortion care in general, but
especially in the thirdtrimester, is...
misunderstood and stigmatizedand vilified, part of it is that
people don't have a conceptionof what actually happened.
And so I really, I thought, Ireally want to describe the
(30:53):
process.
Because when you understandthat, and again, it's an
induction delivery of astillborn, then maybe it will
help reduce the stigma and thefear and the lack of
understanding and the lack ofcompassion.
You know, if you have somecrazy idea of how it happens,
then you have less compassionfor the person who is coming to
(31:18):
the clinic.
So yes, that was a verydeliberate part to really break
it down for people.
Jennie (31:24):
I really always appreciate the attempts to knock
down the stigma.
You know, we talked about bothgoing to school in Madison.
When I was there, there wasoften this family that came to
Library Mall that had like, youknow, the big gory signs that
were there, you know, streetpreaching.
I feel like it was like everyMonday or something, I don't
(31:47):
remember.
And then I would always seethem and
also I work on Capitol Hill, there used to be a truck that drove around with similar things on it, so you can see the ways they really do try to stigmatize and vilify the service, but also the provider. And so, I really did think the thoughtful way you talked about it and made it clear what the process is through all of the conversations with your patients, was really well thought-out.
(32:20):
Yeah, I'm just thinking about thosephotos and thinking that
despite those gory photos,people still have abortions.
You know, it's not like itprevents people from needing an
abortion and having an abortion,but it just augments the
stigma.
And I guess that's the point ofthat, really.
(32:44):
Third trimester abortions aredifferent.
It's a different process.
And I do want to say differentclinics have different
techniques.
I describe what it was likewhere I practiced.
But it's different in the firsttrimester and the second.
It's a different process thanthe first and second trimester.
I'm always a big fan of seeingstigma be chipped away at.
(33:05):
I've talked about it on thepodcast before, but I went to
Catholic school K through eight.
So definitely, I think I waslucky compared to a lot of other
people.
Like I didn't, my school wasnot one of the ones that was
like really preaching andpushing on that.
But it was definitely like, youknow, It was Catholic school
sex ed, if you could call itthat.
(33:27):
So, you know, all the shame andstigma baked in.
But I also was very lucky tohave my mom who, like I said,
Catholic school.
So a friend asked me if Iwanted to go protest at the
Planned Parenthood in Madison.
Well, wanted to go save babieswith her and her family that
weekend and going home andtalking to my mom and being
like, oh my God, I'm going to gosave babies.
(33:49):
And her sitting me down andjust having a really
age-appropriate conversation ofthinking through people's lives
and just really kind of doingthat person-centered, have you
thought about if this person isin this situation or what about
this or what about that?
And then did the...
I think very smart of (34:09):
if you still want to go, you can go,
like make your own decisions.
And obviously, I did not go.
But she really did that work,whether she knew it or not, of
like breaking down the stigma oflike putting yourself in that
place and thinking through allof the situations in people's
lives and understanding why aperson would make those
(34:32):
decisions, which I just thoughtwas so important.
Dr. Shelley Sella (34:35):
Yeah, your mother sounds amazing.
Kudos to her.
I mean, really, that'swonderful.
I mean, what she wasdemonstrating to you was
empathy.
see why they're making thedecisions that they do.
(34:55):
And really, empathy has nolimits.
So, I really appreciate yourmother.
I do want to talk aboutreligion just for a moment,
because there is also thisbelief, oh, you know, a Catholic
person would never have anabortion.
But, you know, that's just nottrue.
And I saw people from allreligions, all, and all
(35:17):
political persuasions, all ofthem.
And it didn't matter.
You know, when you are facedwith a difficult situation, you
have to make a decision.
You'll make the decision that'sthe best for you and your
family.
And you're not going to think,oh, you know, my church believes
so and so, you know, is againstabortion, so I won't have an
abortion.
(35:37):
But the problem is, though, andI do talk about that in the
book-
Jennie (35:42):
Yeah, those two stories were really profound.
Do you want to talk about itreal quick?
Dr. Shelley Sella (35:47):
Yeah, I talk about two couples who came in
because of a fetal condition,that they felt that the best
thing that they could do toprevent their baby from
suffering was to have anabortion.
And one couple was veryreligious, Catholic, and the
others were kind of evangelicalChristians.
And it was really interesting,the contrast between the two.
(36:10):
One, the Catholic couple feltvery isolated and isolated.
Shame.
They felt that their religionwas not able to support them.
And that was hard.
It was very hard for them.
They felt very isolated.
And the other couple was theopposite.
They were equally religiousChristian, but their pastor
(36:34):
supported them and theircongregation supported them.
And they offered them literalsupport by giving them money to
be able to travel to the clinic.
And what was great, though, wasthe group.
Because in the group, thosecouples could meet each other
and talk to each other and getsupport.
But that kind of shows how itcan be that you don't have to
(36:58):
abandon your religious beliefsto have an abortion, but
religion can be a source ofsupport.
And it also could be a sourceof censure and lack of support,
condemnation.
And that just makes it harderfor the person who is seeking an
abortion.
Jennie (37:17):
Yeah, those two stories really hit me hard thinking
through.
I mean, it just made it so muchharder for that couple who
didn't have the support thatthey were really struggling with
the decision and just thinkingthrough, you know...
was Catholic and the guilt andshame that is really just baked
in and takes a long time to getrid of.
(37:40):
I'm sure I have not gotten ridof all of it, but even with the
work I do, there's still a lotof that that got baked in early
that is hard to shake.
I really resonated with thosetwo stories and seeing the
difference in how those twocouples were dealing with all of
it.
Dr. Shelley Sella (37:58):
Yeah, and how difficult.
I mean, I think the situationwas inherently difficult for
both couples.
They both, you know, acceptedthis pregnancy, were expecting
the pregnancy to go a certainway, and it didn't.
But for one couple, there wasthe support of their community.
That's what their religious...
(38:19):
their church was.
It was part of their community,and they had the support of the
community, and the other didnot.
Jennie (38:26):
Okay.
So, I always like to wrap upour conversations thinking about
the audience and what can theaudience do.
So, how can they support thirdtrimester abortions or what can
they do that would be helpfulright now?
Dr. Shelley Sella (38:45):
I think reading the book will be very
helpful because it will give youa different perspective.
For those who are confusedabout the issue or for those who
feel uneasy, I think this bookwill help.
And for those who...
already support all trimesterabortion, I think you'll enjoy
(39:05):
the book.
But I think third trimesterabortion care needs to come out
of the closet.
And I think it's starting to,really.
This is the beginning.
And so I think the more peopletalk about it, the more people
acknowledge that it is part ofabortion care, the better.
So even just starting theseconversations, I think, is very
(39:27):
helpful.
And then when issues come up,when ballot initiatives, for
example, come up, thinkingbeyond viability limits, beyond
gestational limits, beyond bans,I talk about that at the end of
the book, where Roe is over.
The age of Roe is over.
(39:48):
And so we have an opportunityto create something different.
better.
And I think that's whereeducation and better
understanding comes in so thatwe don't need to go backwards
and say, oh, yeah, let's restoreRoe because Roe was so
problematic.
Let's move beyond that.
Let's move beyond gestationallimits.
(40:09):
Let's think of viability asjust what we were talking about.
Viability is the personthemselves deciding that the
pregnancy is viable or not.
This is an opportunity.
But we can have thatopportunity when we understand
the issue.
That's my hope.
Jennie (40:27):
Yeah, and I see this tool as a great resource for
people who may support abortionat any time, but don't have the
language or the comfort with itto be able to speak about it
when they hear other peopletalking about it.
I think this book would bereally helpful for those people
to be able to talk about itbetter.
(40:47):
I feel like I am betterequipped with a deeper
understanding, and I've beendoing this work for a long time,
and I think one thing I justthought of as we were talking
that we didn't really mention isgestational bans are in place
in so many states and therearen't that many providers of
(41:08):
third trimester abortion.
So, we talked about why it's soimportant to have access, but
that there is very little accessand people have traveled great
distances to get it, whichpushes it further out of reach
because It's more expensive ifthey have to travel a long way,
all of those things.
So, maybe we just want to talkabout that really quick.
Dr. Shelley Sella (41:28):
Yeah, I mean, I think just what we were
saying, the need has increased.
There are more providers of alltrimester.
By all trimester, I meanclinics that provide first,
second, and third trimesterabortions.
So when I first started, therewere two providers that offered
this care.
(41:48):
And then I started, there werethree, and then Dr.
Robinson.
I mean, gradually, there were afew more.
But now it's really changed.
There are more clinicsoffering all trimester care.
There are more young providerscoming into the field who are
very interested in providingthis care.
And they are.
The problem is all the bansthat are in so many states.
(42:11):
I mean, the lack of access.
But in terms of third trimesterabortion care, there are
providers who are doing that.
It's different than it was even10, 15 years ago.
And I think that's great.
I think that means that peoplewho are coming out of training
have a different view ofabortion.
They're seeing it in anexpansive way, not in a
(42:33):
restrictive way.
So, I think that's a wonderfulthing.
Jennie (42:36):
That's so wonderful to hear.
A little bit of l ight.
Yes!
Dr. Shelley Sella (42:40):
Yeah, a little bit of light.
Jennie (42:42):
Well, Dr.
Sella, thank you so much forbeing here.
I very much enjoyed talking toyou.
I really enjoyed your book, andI hope my audience will check
it out.
I've already been talking aboutit with people, so I already
know we have a few people whoare going to be going out and
buying it.
Dr. Shelley Sella (42:55):
Great.
Well, thank you so much.
And I do want to mention,actually, on my website,
ShellySella.com.
It has a list of events andwhere I'll be because I am going
on a book tour.
And I may be in your city.
So, I hope to see you all.
Jennie (43:11):
Yes, I'm going to make my best effort to come see you
when you're here.
Dr. Shelley Sella (43:14):
Wonderful.
And that's June 28th in DC.
Jennie (43:18):
Yes.
Dr. Shelley Sella (43:18):
Okay.
Thank you so much.
Jennie (43:20):
Okay, y'all, I really, like I said, I cannot recommend
Dr.
Sella's book enough.
It is Beyond Limits, Stories ofThird Trimester Abortion Care.
It's so good.
I highly, highly recommend it.
I hope you enjoyed myconversation with Dr.
Sella and that you're enjoyingthis series on abortion later in
pregnancy.
And I will see everybody nextweek. [music outro]
If you have any questions, comments, or topics you would like us to cover, always feel free to shoot me an email. You can reach me at jennie@reprosfightback.com or you can find us on social media. We're at @RePROsFightBack on Facebook and Twitter or @reprosfb on Instagram. If you love our podcast and wanna make sure more people find it, take the time to rate and review us on your favorite podcast platform. Or if you wanna make sure to support the podcast, you can also donate on our website at reprosfightback.com. Thanks all!
Welcome to rePROs Fight Back, a podcast on all things
related to sexual andreproductive health, rights, and
justice. [music intro]Hi rePROs.
How's everybody doing?
I'm your host, Jennie Wetter,and my pronouns are she/her.
So y'all, I hope you had awonderful holiday weekend and
got to enjoy some good weatherwhere you are I am recording
(00:24):
this on Friday before theweekend so I'm hoping for nice
weather all weekend.
It's been like really rainy andgloomy and kind of gross here
so I haven't been able to enjoybeing outside or having my
windows open very much so I'mvery much looking forward to a
nice weekend where I can youknow go for some walks and spend
(00:45):
some time outside and have mywindows open I know the kitties
will be very excited for me tohave the windows open.
They have clearly been pouting,not being able to sit in the
windows.
So, hopefully it will be verynice this weekend.
Other than that, I don't reallyhave any big plans.
I'm really just kind of lookingforward to some downtime, maybe
(01:06):
do some fun reading.
I don't know.
We'll see.
Maybe even baking.
I don't know.
I'm hoping to maybe get somerhubarb and maybe do...
My mom used to always make arhubarb upside down cake that I
loved.
So, I'm hoping to find somerhubarb so I can make that this
weekend and that'll just bethinking of home and will make
(01:27):
me very, very happy.
So, that is my plan for theholiday weekend.
But yeah, not a whole lot.
But there has been a lot goingon that we do need to talk
about.
The house...
passed a funding bill thaty'all is bad.
It's bad.
They're calling it their "big,beautiful budget bill," which,
okay...
(01:47):
but it is bad.
It's bad.
It would really gut Medicaid,kicking millions of people off
of their insurance.
It also really slashes the SNAPprogram, which is food stamps.
Again, kicking a lot of peopleoff of those services.
Again, millions and millions ofpeople.
(02:08):
It is just all of this to fundtax cuts for the most wealthy.
We're going to cut programshelping those the most in need.
And that is just disgusting.
That is just disgusting.
There is no other word for it.
It is just disgusting that weare hurting people who need help
to give more money to thepeople who don't need it.
(02:30):
And those weren't the onlythings.
There are so many terriblethings in that bill.
It would also "defund" PlannedParenthood, which we've talked
about before.
It's not like there's this lineitem that says, here, all this
money is going to PlannedParenthood.
It means that people onMedicaid who go to Planned
Parenthood for their healthcare,often their only healthcare
(02:50):
they access, will no longer beable to do so.
So, it means that patients whoare going there for their family
planning services who are onMedicaid cannot do that.
It's going to have devastatingimpacts.
I'm going to have somebody onin the next week or so to talk
about that and what that willmean for people accessing
(03:11):
healthcare, what it would meanfor Planned Parenthood.
We'll dig more into that later.
And then I think the otherreally important thing we need
to flag in this bill is thatthey added a provision that
would prevent trans people fromaccessing gender-affirming care
through Medicaid.
And by that, it's not justyoung people, which is what we
have seen a lot of the attackson access to gender-affirming
(03:35):
care be about was young people.
This is anyone.
Anybody on Medicaid would notbe able to access
gender-affirming care usingtheir Medicaid coverage.
Again, that would be absolutelydevastating.
The important thing to notewith all of the things I just
talked about (03:49):
that was the bill that passed the House.
It has not passed the Senateyet.
It is not in place.
It is not law.
There is still time to pushback and let your senators know
that you do not support thesecuts.
Honestly, also let your Housemembers know because I'm sure
the Senate is not going to passthe exact same version of the
bill that the House did.
There will be some negotiationthat is going to have to go back
(04:12):
and forth.
So make sure that you areletting your representatives
know that you do not supportthese cuts to Medicaid, to SNAP,
to access to gender affirmingcare, to cutting funding for
Planned Parenthood, all thethings.
And there are so many more youcould talk to them about.
This is a really bad bill.
So, make your voice heard.
It's really important right nowat this moment to speak out.
(04:34):
So, yeah.
Lots happening.
Let's see.
I guess it's been a while, solet's maybe do a little quick
housekeeping.
One, did you know that rePROsFight Back has a newsletter?
So if you go to our website,you can sign up for our
newsletter to make sure that youget an email in your inbox
(04:55):
whenever a new episode comesout or if we have an event— like
recently we just had a webinartalking about the report card,
you would have made sure you gotan invitation to that— or if we
have a new report that comesout so we would make sure you
got that in your inbox rightaway.
So, make sure to sign up forthe newsletter if you enjoy us.
(05:41):
Also, if you haven't already, make sure you subscribe to the podcast or follow or whatever the action that your favorite podcast platform requires. That way you will never miss an episode. And if you really love the podcast, it's also really helpful if you can rate and review us. This is how other people know that people are listening and know that it's a good podcast. So, if you like us, it would be great if you can take two seconds and give us five stars or write areview letting us know what you
think.
Or if you want to let me knowwhat you think and or if you
have topics you want us to coveror comments on something we've
covered, I always love to hearfrom y'all so if you want to
shoot me an email atjennie@reprosfightback.com or
you can reach out to us onsocial we're at @rePROs Fight
(06:03):
Back on most of the platformsexcept for Instagram where we
are @reprosfb and if you wantto find me on either Twitter or
Bluesky, I'm @Jennie In DC andI'm always happy to hear from
y'all so if you love the podcastI would love to hear that.
And then lastly, ourhouse-keeping usual, if you
(06:24):
really love the podcast and wantto support us you can donate
and we also have a giveaway soif you donate $25 to us you get
these amazing stickers thatLiberal Jane designed for us and
a postcard that she alsodesigned and if you donate $50,
you get all of the stickers andthe postcard plus this really
cute bag we had designed thatsays, "abortion is a human right
(06:47):
not a dirty word." I love thatbag so much and I love the
stickers— they're on all mythings— so if you want to get
yours make sure that you donateto support rePROs Fight Back and
then also just like stay tuned: we are busy, busy, busy working (06:57):
undefined
to set up a merch store so youwill be able to buy some of the
things on T-shirts or mugs or Idon't know we're still working
on it so if you have some youwould like us to put our designs
on let us know and maybe we'lladd it to the merch store so
feel free to reach out to us onsocial or reach out to me.
(07:19):
Like I said, I always love tohear from y'all so feel free to
reach out to us anytime.
Okay with all of that, let'sturn to this week's interview.
I'm so excited to have ontoday, Dr.
Sella.
She was an abortion provider.
She provided abortions later inpregnancy, and she wrote this
really great book, BeyondLimits, Stories of Third
(07:40):
Trimester Abortion Care, thaty'all, I cannot recommend it
enough.
I really enjoyed reading it.
I learned so much, not justabout how she provides abortion
later in pregnancy, but having adeeper understanding of her
patients and what they have gonethrough.
I think so often the stories wehear about abortion later in
(08:00):
pregnancy are so focused onthose who get a late fetal
diagnosis that we don't oftenhear all of the other stories.
And this book was a reallygreat opportunity to understand
the full range of people whoneed to access that care and
what is happening in theirlives.
It just really puts personalfaces behind all of the stories.
And I just found it increasedmy empathy so much.
(08:22):
I had already felt for all ofthese people who were in these
situations and I alreadysupported abortion later in
pregnancy but this just, like,even more so now and there were
tears there was just like somuch so much pulling on my
heartstrings hearing thesestories and thinking through
what all of these people hadbeen through that just it was a
(08:43):
lot just to hear all of thehurdles they had to go to access
this care.
So with that, let's go to myinterview with Dr.
Sella.
Hi, Dr.
Sella.
Thank you so much forbeing here.
Dr. Shelley Sella (08:56):
Thank you for having me.
Jennie (08:57):
I'm so excited to talk to you today.
But before we dig in, would youlike to take a second and
introduce yourself?
Dr. Shelley Sella (09:04):
Sure.
I'm Dr. Shelley Sella.
I'm a retired OBGYN, and I'mthe first woman to openly
provide third trimester abortioncare.
In the United States, that is.
Jennie (09:17):
I'm so excited to have you on.
I just finished reading yourbook that is coming out next
month, and it's called BeyondLimits, Stories of
Third-Trimester Abortion Care,and I just, I absolutely loved
it.
It was so moving, and...
we'll talk through multipleparts of the book, but I just
(09:37):
wanted to thank you for writingit because it really did make an
impact.
And I think it will be a reallypowerful tool.
Dr. Shelley Sella (09:44):
Well, thank you for saying that.
And that's really the intent ofthe book, really, is to help
change people's hearts and mindsabout third trimester abortion
care, which, as you know, is themost stigmatized and
misunderstood aspect of abortioncare.
So, to hear you say that isactually very, very gratifying,
(10:07):
and I hope that other people whoread it have the same
experience.
My intent was not to write anovertly political book.
It was really to talk about thepatients that I saw, to talk
about my particular journey toproviding that care.
And with the hope that byfocusing on stories on people,
(10:28):
that it would have an impact, itwould have a different kind of
impact, it would affect, itwould impact people's hearts,
and then help move them.
Jennie (10:35):
So, one of the things I really loved about the book is
you telling your story.
And we do an annual episodeevery year where we have people
tell their origin stories on howthey either got their job or
like how they got into thisfield.
Would you like to share yoursexual and reproductive health
origin story here?
Dr. Shelley Sella (10:53):
Well, I'll give you the abridged version.
And for the more complete andcomplicated version, you have to
read my book.
But I became interested in thewomen's health movement in
college.
And I went to the University ofWisconsin, Madison, and we just
talked about how you went theretoo, but it was a different
(11:13):
time.
Jennie (11:14):
Yeah, and one thing I think I forgot to mention, I
think my mom might have beenthere at that same time.
Dr. Shelley Sella (11:18):
Oh, wow.
Maybe we were friends.
So that was, at that time,there really was a burgeoning
women's health movement and awomen's movement.
And at the time, and right now,it may seem odd to even be
talking about a women's healthmovement when we now are so much
more expansive in ourunderstanding.
(11:40):
But then at that point, thatwas how people were referred.
And so that interest led me toan internship at the Los Angeles
Feminist Women's Health Center.
And they were really at thevanguard of the women's
movement.
And just to stop for a momentand to explain what I'm talking
(12:00):
about when I say the women'shealth movement, it was really a
response to this very malepatriarchal model of health
care.
It was about giving power backto women, giving power back to
patients, educating them, havingthem control their bodies and
also control the experience inthe doctor's office.
So, it was a really kind of aground, from the ground up
(12:24):
movement rather than a top-downmovement.
So for example, at the LosAngeles Feminist Women's Health
Center, the doctors were there,but had a minimal role.
They were essentiallytechnicians.
And actually, when I got to theclinic is when I realized they
were providing abortions.
I didn't even know that.
(12:44):
But the doctor was the one whoprovided the abortion.
The patient, the lay healthworkers, as everyone was called,
did everything else.
They did the lab test.
They ran groups.
And so, rather than anindividual experience between a
health care provider and thepatient, it was a group of women
(13:08):
sitting together with the layhealth worker.
So, for example, pregnancytests were done in a group.
Results were discussed in agroup.
And then if someone decided tohave an abortion there was a lay
health worker who was acounselor with that patient and
actually i'm using the wordpatient but we were told not to
(13:31):
use the word patient we were...
because it was a peerrelationship.
We weren't better than theperson we were caring for.
So we used "women." And that'sa shift, I think.
And so, the doctor was the onewho performed the abortion.
And that's it.
That's all they did.
The health workers dideverything else.
(13:55):
So that was kind of the modelthat was in my head.
Group experiences, usinghealthcare or healthcare as a
way to empower people.
Providing healthcare in adifferent way.
And so from that experience, Iactually decided to become a
doctor, which is funny becausethere was such a bias in that
(14:17):
movement against doctors.
Like, why would you want to bea doctor?
But...
I wanted to be able to not justoffer the emotional care, the
educational care.
I wanted to offer the technicalpart of it.
I wanted the whole thing or tolearn everything.
And so I did go to medicalschool with the intention to
(14:37):
provide abortions.
And that's a whole other longstory.
But I would describe it as ajourney.
But that was the beginning.
Really, the foundation was atthe Los Angeles Feminist Women's
Health Center.
Jennie (14:53):
I really loved how you interspersed your story with the
week that you had thesepatients.
It was just brilliantly done.
And I loved seeing how you tookall of these past experiences
you had with these differentparts of care you encountered to
find the way you ended upproviding care and you could
(15:16):
feel the patient-centeredness ofit.
And it was just reallywonderful to see how it all came
together to provide thisservice and you could feel the
way that it was helping peoplewho came to see you for the
abortions later in pregnancy.
Dr. Shelley Sella (15:32):
Yeah, I mean, when you're saying that, I'm
thinking one of the reallyimportant experiences I had
subsequently was the two years Iworked with home birth midwives
in Santa Cruz, California.
And that also was this model ofcare, which is called the
midwifery model of care, thatagain, centers the woman and her
experience and empowers her,honors the process, honors the
(15:59):
birthing process, honors her andher family.
And that was key to how Isubsequently provided abortion
care.
I mean, that was the thingabout third trimester abortions,
because it's a longer process.
It's not a quick, in-clinic,first trimester abortion or
(16:19):
medication abortion.
It occurs over several days.
So it gives the provider timeto understand what's going on,
to spend time with the patientand their family, and to develop
trust between provider andpatient.
The process of a thirdtrimester abortion where I
(16:40):
worked was the inductiondelivery of a stillborn.
So it was a delivery.
So it was using the samephilosophy, the same orientation
that I had learned from workingwith midwives and translating
that or transferring it toabortion care.
Jennie (16:59):
Yeah, I really appreciated that.
And I really appreciate the wayyou brought in the group
dynamic, because I think from alot of the stories you hear, how
so often people talk about howthey have felt alone and didn't
feel like they could talk topeople or were dealing with it
on their own.
And it was really wonderful tosee the way, again, when you all
(17:21):
read this book, you'll see thateach chapter is like a day
talking about this likemulti-day process and following
six people.
And it was really wonderful tosee the thought.
I could feel it built into allthe steps where you had the two
groups, you had the maternalindications and the fetal
(17:42):
indications, and then each hadtheir own support system of
group counseling.
And I could just feel thethoughtfulness that went through
all of it as to why there werethe separate groups and the ways
that these people weresupporting each other to know
that they weren't alone in thisprocess.
Dr. Shelley Sella (18:00):
Yeah, and I think the group process was very
important and key to the carethat we offer.
And I would like to say thatthat was started by Dr.
George Tiller.
So that was the physician whowas my mentor, and then we
worked together in Wichita,Kansas, until he was
assassinated in church.
So he was one of the firstpeople to provide third
(18:23):
trimester abortion care in theUnited States, and it was his
idea to have the groups.
And so when I came to theclinic to visit the first time
and I saw the groups, it's like,ah, I've seen this before, and
it works.
It's actually very helpful.
And then After he wasassassinated, a doctor in
Albuquerque, New Mexico, CurtisBoyd, invited one of my
(18:46):
colleagues, Dr.
Susan Robinson and I, to starta third trimester abortion
practice at his already existingpractice.
That clinic was really knownfor its excellent counseling
that they offered patients inthe first and second trimester.
But it was one-on-onecounseling.
So what we did when we came,we...
(19:08):
combined the two so thatpatients would still have that
really good one-on-onecounseling, and they would also
have the groups.
And I think patients reallyappreciated it.
You know, there would be timeswhere people would say at the
beginning, oh, I don't likegroups, I don't want to talk.
Jennie (19:25):
I could totally see myself being that person.
Dr. Shelley Sella (19:29):
And then they would, and I would say, you
know, just even just sitting ina room with other people might
be helpful.
Jennie (19:37):
Yeah.
Dr. Shelley Sella (19:38):
And invariably, that person would
start talking once they were inthe group, because you're in a
group with people who completelyunderstand what you're going
through.
And it's a support group.
Part of the purpose of thegroup was to transmit
information, but the majority ofthe time spent was people
talking to each other.
And they formed connections,like...
(20:00):
in the book, I talk about onegroup afterwards, they all went
out to dinner.
That wasn't that uncommon.
And then sometimes people wouldstay in touch for years,
offering support, and throughgood and bad.
I know of one couple where theyheard, oh, so-and-so had a
baby, they were doing well,so-and-so went back to school.
(20:21):
I mean, different situationsthat people stayed connected to
each other.
So it's powerful.
I think the groups were verypowerful.
Jennie (20:28):
I also really appreciate it.
I mean, this was a general weekthat you picked that you told
the stories for, but it was, Ithink, really important to the
book to see all of theindividual stories so that
people get a betterunderstanding because I think
there's so much myths anddisinformation about why people
get abortion later in pregnancyand a lot of judgment and stigma
(20:53):
around it.
And I think this book did areally great job of dispelling
that and showing who thesepeople who were accessing care
were and why they were makingthose choices
Dr. Shelley Sella (21:03):
Yeah, I think that's certainly an important
part of the book.
The stories are, the patientsare composites.
Each patient representspatients that I saw.
So they're composites of truepatients.
But I did, I was deliberateabout deciding what kind of
patients I would talk about.
(21:24):
And I was also deliberate abouthaving three, you mentioned
fetal indications and threematernal indications.
Let me explain that a littlebit.
Fetal indications are patientswho come because their baby, and
that is the word that they use,has a condition that's been
diagnosed at some point in thepregnancy.
(21:44):
It could be a condition thatwas picked up early in the
pregnancy and then they keepfollowing it and it gets worse
and worse, more serious.
Or it could be something that'spicked up very late in
pregnancy.
Those are the stories we oftenhear about.
Like, if the media is going totalk about one kind of patient
(22:05):
in the third trimester, they'regoing to talk about them.
And I think there's thatdecision made, like, these are
the most deserving, perhaps, ofcompassion, that maybe these
will pull at our heartstringsand maybe we will change our
mind about third trimesterabortion.
And I think their situation iscompelling and deserves
(22:27):
compassion.
And equally-
Jennie (22:29):
Yeah, I mean, like I said, I told you, I think,
before we started recording thatI cried multiple times reading
this book, but I found thefetal, I mean, the maternal
indication stories often just asheartbreaking for all of the
situations that all of them werein to be in that place.
Dr. Shelley Sella (22:48):
Exactly, yeah.
So, the maternal indicationspatients that I saw were ones
who had difficult lifecircumstances, and anything you
can imagine can happen.
I talked about one person whowas a victim of domestic
violence, one person with adiagnosis of cancer who couldn't
get treatment while she waspregnant, but whose symptoms
(23:12):
were hidden by the cancerrecurrence.
And I talked about a teenager,which I thought was very
important to talk about, becauseteenagers are stigmatized even
more than anyone else.
And so, I wanted people toreally understand what was going
on for a teenager.
And I believe that the maternalindication patients are as
(23:34):
deserving of our compassion asthe fetal indication patients.
Jennie (23:39):
Absolutely.
I thought all of the storieswere told in just such a
compassionate way.
I could just feel yourcompassion for your work and for
all of the patients justbleeding through on the page.
Like it was just, just so wellwritten.
Dr. Shelley Sella (23:57):
I got a lot of help.
I'll start with my wife, Julie,who was the first editor.
And, you know, this is thefirst book I've ever written,
and I really had no idea what Iwas doing.
And I also had no idea how longit would take.
I thought when I wrote thefirst draft, I thought, oh,
(24:17):
okay, I'm done.
Jennie (24:19):
Yeah. [chuckles]
Dr. Shelley Sella (24:20):
Little did I know.
It's really quite a process.
Jennie (24:23):
As somebody who is a big reader, anybody who can write a
book is magic to me.
Like I just, so I, yeah, I findthe whole thing just magical.
So it was, like I said, it wasa really wonderful book.
Dr. Shelley Sella (24:40):
Thank you.
Jennie (24:40):
So what is one thing or two, you may have a couple, that
you wish people knew aboutabortion later in pregnancy?
Dr. Shelley Sella (24:48):
What I want people to know is that, and I
want to reframe it a little bit,not what I wish people knew
about third trimester abortion,but what people knew about the
people who get third trimesterabortions, who need third
trimester abortions.
And their situations aresimilar.
(25:10):
to those seeking first andsecond trimester abortions, but
they are a lot more desperate,meaning they know that if they
are turned away or if they can'tobtain a third trimester
abortion, if they're turned awayat this clinic, that's it.
They are going to be forced tohave a child.
(25:31):
I think it's more and more anissue these days because of all
the restrictions and bans.
Restrictions and bans lead tolater abortion.
So we're seeing increasingnumbers of people who are
traveling out of state.
At this point, it's one infive.
(25:52):
Before Roe was overturned, itwas one in ten, which is also
way too many.
But it's one in five women areleaving their state to access an
abortion, and that's leading tomore and more delays.
But that's not the only reasonwhy people seek third trimester
abortions.
And even if abortion wasaccessible, free, legal in all
(26:17):
states, there would always be aneed for third trimester
abortions.
And that's something else Iwish people would know.
Jennie (26:24):
That's such an important point.
Dr. Shelley Sella (26:25):
Yeah, because...
We just don't know.
We cannot predict what willhappen.
Someone with a highly desiredpregnancy cannot predict that
the baby may develop a conditionor be born or have one that may
worsen with time.
We can't predict that birthcontrol fails.
(26:46):
We can't predict that someonehas cancer and their symptoms
are hidden.
We can't predict... there's somuch... that life circumstances
change that maybe you thoughtyou could manage a third child,
but you just lost your job andyour rent just went up and you
(27:08):
can barely feed the kids thatyou already have.
Life is complicated.
I guess that's what I want tosay, what I want people to
acknowledge, because we knowthis, but people to acknowledge
that life is complicated, and itdoesn't fit into gestational
limits that the state hasdecided that that's how we
(27:29):
should decide who can have anabortion or not.
Jennie (27:32):
Yeah, I was just thinking that, like, there is no
way the state can legislate forthe complexity of people's
lives in gestational bans where,you know, hear them talk about
exceptions and stuff.
And if there's anything we haveseen.
I mean, always, butparticularly since the loss of
Roe, is how exceptions are notclear and do not work.
(27:56):
That you have people who aremiscarrying who still can't get
care because there is still afetal heartbeat and they are
waiting until the person is sickenough before they can provide
the care that that personclearly needs and will get.
But you just can't legislatethe complexity of the reality of
(28:16):
a pregnancy in a person's life.
Dr. Shelley Sella (28:18):
Yeah, and I agree.
Exceptions are absurd.
And as I write in the book, Ireally don't believe in a
hierarchy of desperation.
And there's always, not always,sometimes when there are
exceptions, there will beexceptions for rape and incest.
And then I think, wait, arethose the worst things that can
(28:40):
happen to someone?
Yes, they are bad, and thereare a lot of other bad things
that can happen to people thatmake that person decide that the
pregnancy is not viable forthem.
And so I do talk about thisnotion of viability, which is
not what was codified in Roe,a fetus who can survive
(29:01):
pregnancy outside the womb withor without support, it's the
pregnant person themselvesdeciding that the pregnancy is
not viable and taking intoaccount all the complexity of
their lives and coming to adecision.
The decision comes from themand not from the government.
Jennie (29:19):
Yeah, I mean, who knows your life and what you can do
and handle better than you?
Dr. Shelley Sella (29:23):
Exactly, exactly.
Jennie (29:25):
Like I said, I really did enjoy this book and...
I really appreciated getting tounderstand the process better.
I think I had a general idea.
I've worked in this field for along time.
I knew generally how thirdtrimester abortions worked, but
(29:46):
it was really illuminating tosit through all of the chapters
where you had, like, here's whathappened Tuesday morning,
here's what happened Tuesdayafternoon, and really seeing how
the process worked and gettinga better understanding of that,
but also how the patients weresupported throughout it.
I think that was just reallywell written.
Dr. Shelley Sella (30:08):
Thank you.
Well, that was very deliberateon my part.
When I thought about writing abook, I thought I wanted for
people to understand thepatients, why they come to the
clinic, why they have a thirdtrimester abortion, and I also
wanted people to understand thecare.
And the care is emotional, andwe talked about the groups, but
(30:31):
there's also a physicalcomponent to it.
And when I think about howabortion care in general, but
especially in the thirdtrimester, is...
misunderstood and stigmatizedand vilified, part of it is that
people don't have a conceptionof what actually happened.
And so I really, I thought, Ireally want to describe the
(30:53):
process.
Because when you understandthat, and again, it's an
induction delivery of astillborn, then maybe it will
help reduce the stigma and thefear and the lack of
understanding and the lack ofcompassion.
You know, if you have somecrazy idea of how it happens,
then you have less compassionfor the person who is coming to
(31:18):
the clinic.
So yes, that was a verydeliberate part to really break
it down for people.
Jennie (31:24):
I really always appreciate the attempts to knock
down the stigma.
You know, we talked about bothgoing to school in Madison.
When I was there, there wasoften this family that came to
Library Mall that had like, youknow, the big gory signs that
were there, you know, streetpreaching.
I feel like it was like everyMonday or something, I don't
(31:47):
remember.
And then I would always seethem and
also I work on Capitol Hill, there used to be a truck that drove around with similar things on it, so you can see the ways they really do try to stigmatize and vilify the service, but also the provider. And so, I really did think the thoughtful way you talked about it and made it clear what the process is through all of the conversations with your patients, was really well thought-out.
(32:20):
Yeah, I'm just thinking about thosephotos and thinking that
despite those gory photos,people still have abortions.
You know, it's not like itprevents people from needing an
abortion and having an abortion,but it just augments the
stigma.
And I guess that's the point ofthat, really.
(32:44):
Third trimester abortions aredifferent.
It's a different process.
And I do want to say differentclinics have different
techniques.
I describe what it was likewhere I practiced.
But it's different in the firsttrimester and the second.
It's a different process thanthe first and second trimester.
I'm always a big fan of seeingstigma be chipped away at.
(33:05):
I've talked about it on thepodcast before, but I went to
Catholic school K through eight.
So definitely, I think I waslucky compared to a lot of other
people.
Like I didn't, my school wasnot one of the ones that was
like really preaching andpushing on that.
But it was definitely like, youknow, It was Catholic school
sex ed, if you could call itthat.
(33:27):
So, you know, all the shame andstigma baked in.
But I also was very lucky tohave my mom who, like I said,
Catholic school.
So a friend asked me if Iwanted to go protest at the
Planned Parenthood in Madison.
Well, wanted to go save babieswith her and her family that
weekend and going home andtalking to my mom and being
like, oh my God, I'm going to gosave babies.
(33:49):
And her sitting me down andjust having a really
age-appropriate conversation ofthinking through people's lives
and just really kind of doingthat person-centered, have you
thought about if this person isin this situation or what about
this or what about that?
And then did the...
I think very smart of (34:09):
if you still want to go, you can go,
like make your own decisions.
And obviously, I did not go.
But she really did that work,whether she knew it or not, of
like breaking down the stigma oflike putting yourself in that
place and thinking through allof the situations in people's
lives and understanding why aperson would make those
(34:32):
decisions, which I just thoughtwas so important.
Dr. Shelley Sella (34:35):
Yeah, your mother sounds amazing.
Kudos to her.
I mean, really, that'swonderful.
I mean, what she wasdemonstrating to you was
empathy.
see why they're making thedecisions that they do.
(34:55):
And really, empathy has nolimits.
So, I really appreciate yourmother.
I do want to talk aboutreligion just for a moment,
because there is also thisbelief, oh, you know, a Catholic
person would never have anabortion.
But, you know, that's just nottrue.
And I saw people from allreligions, all, and all
(35:17):
political persuasions, all ofthem.
And it didn't matter.
You know, when you are facedwith a difficult situation, you
have to make a decision.
You'll make the decision that'sthe best for you and your
family.
And you're not going to think,oh, you know, my church believes
so and so, you know, is againstabortion, so I won't have an
abortion.
(35:37):
But the problem is, though, andI do talk about that in the
book-
Jennie (35:42):
Yeah, those two stories were really profound.
Do you want to talk about itreal quick?
Dr. Shelley Sella (35:47):
Yeah, I talk about two couples who came in
because of a fetal condition,that they felt that the best
thing that they could do toprevent their baby from
suffering was to have anabortion.
And one couple was veryreligious, Catholic, and the
others were kind of evangelicalChristians.
And it was really interesting,the contrast between the two.
(36:10):
One, the Catholic couple feltvery isolated and isolated.
Shame.
They felt that their religionwas not able to support them.
And that was hard.
It was very hard for them.
They felt very isolated.
And the other couple was theopposite.
They were equally religiousChristian, but their pastor
(36:34):
supported them and theircongregation supported them.
And they offered them literalsupport by giving them money to
be able to travel to the clinic.
And what was great, though, wasthe group.
Because in the group, thosecouples could meet each other
and talk to each other and getsupport.
But that kind of shows how itcan be that you don't have to
(36:58):
abandon your religious beliefsto have an abortion, but
religion can be a source ofsupport.
And it also could be a sourceof censure and lack of support,
condemnation.
And that just makes it harderfor the person who is seeking an
abortion.
Jennie (37:17):
Yeah, those two stories really hit me hard thinking
through.
I mean, it just made it so muchharder for that couple who
didn't have the support thatthey were really struggling with
the decision and just thinkingthrough, you know...
was Catholic and the guilt andshame that is really just baked
in and takes a long time to getrid of.
(37:40):
I'm sure I have not gotten ridof all of it, but even with the
work I do, there's still a lotof that that got baked in early
that is hard to shake.
I really resonated with thosetwo stories and seeing the
difference in how those twocouples were dealing with all of
it.
Dr. Shelley Sella (37:58):
Yeah, and how difficult.
I mean, I think the situationwas inherently difficult for
both couples.
They both, you know, acceptedthis pregnancy, were expecting
the pregnancy to go a certainway, and it didn't.
But for one couple, there wasthe support of their community.
That's what their religious...
(38:19):
their church was.
It was part of their community,and they had the support of the
community, and the other didnot.
Jennie (38:26):
Okay.
So, I always like to wrap upour conversations thinking about
the audience and what can theaudience do.
So, how can they support thirdtrimester abortions or what can
they do that would be helpfulright now?
Dr. Shelley Sella (38:45):
I think reading the book will be very
helpful because it will give youa different perspective.
For those who are confusedabout the issue or for those who
feel uneasy, I think this bookwill help.
And for those who...
already support all trimesterabortion, I think you'll enjoy
(39:05):
the book.
But I think third trimesterabortion care needs to come out
of the closet.
And I think it's starting to,really.
This is the beginning.
And so I think the more peopletalk about it, the more people
acknowledge that it is part ofabortion care, the better.
So even just starting theseconversations, I think, is very
(39:27):
helpful.
And then when issues come up,when ballot initiatives, for
example, come up, thinkingbeyond viability limits, beyond
gestational limits, beyond bans,I talk about that at the end of
the book, where Roe is over.
The age of Roe is over.
(39:48):
And so we have an opportunityto create something different.
better.
And I think that's whereeducation and better
understanding comes in so thatwe don't need to go backwards
and say, oh, yeah, let's restoreRoe because Roe was so
problematic.
Let's move beyond that.
Let's move beyond gestationallimits.
(40:09):
Let's think of viability asjust what we were talking about.
Viability is the personthemselves deciding that the
pregnancy is viable or not.
This is an opportunity.
But we can have thatopportunity when we understand
the issue.
That's my hope.
Jennie (40:27):
Yeah, and I see this tool as a great resource for
people who may support abortionat any time, but don't have the
language or the comfort with itto be able to speak about it
when they hear other peopletalking about it.
I think this book would bereally helpful for those people
to be able to talk about itbetter.
(40:47):
I feel like I am betterequipped with a deeper
understanding, and I've beendoing this work for a long time,
and I think one thing I justthought of as we were talking
that we didn't really mention isgestational bans are in place
in so many states and therearen't that many providers of
(41:08):
third trimester abortion.
So, we talked about why it's soimportant to have access, but
that there is very little accessand people have traveled great
distances to get it, whichpushes it further out of reach
because It's more expensive ifthey have to travel a long way,
all of those things.
So, maybe we just want to talkabout that really quick.
Dr. Shelley Sella (41:28):
Yeah, I mean, I think just what we were
saying, the need has increased.
There are more providers of alltrimester.
By all trimester, I meanclinics that provide first,
second, and third trimesterabortions.
So when I first started, therewere two providers that offered
this care.
(41:48):
And then I started, there werethree, and then Dr.
Robinson.
I mean, gradually, there were afew more.
But now it's really changed.
There are more clinicsoffering all trimester care.
There are more young providerscoming into the field who are
very interested in providingthis care.
And they are.
The problem is all the bansthat are in so many states.
(42:11):
I mean, the lack of access.
But in terms of third trimesterabortion care, there are
providers who are doing that.
It's different than it was even10, 15 years ago.
And I think that's great.
I think that means that peoplewho are coming out of training
have a different view ofabortion.
They're seeing it in anexpansive way, not in a
(42:33):
restrictive way.
So, I think that's a wonderfulthing.
Jennie (42:36):
That's so wonderful to hear.
A little bit of l ight.
Yes!
Dr. Shelley Sella (42:40):
Yeah, a little bit of light.
Jennie (42:42):
Well, Dr.
Sella, thank you so much forbeing here.
I very much enjoyed talking toyou.
I really enjoyed your book, andI hope my audience will check
it out.
I've already been talking aboutit with people, so I already
know we have a few people whoare going to be going out and
buying it.
Dr. Shelley Sella (42:55):
Great.
Well, thank you so much.
And I do want to mention,actually, on my website,
ShellySella.com.
It has a list of events andwhere I'll be because I am going
on a book tour.
And I may be in your city.
So, I hope to see you all.
Jennie (43:11):
Yes, I'm going to make my best effort to come see you
when you're here.
Dr. Shelley Sella (43:14):
Wonderful.
And that's June 28th in DC.
Jennie (43:18):
Yes.
Dr. Shelley Sella (43:18):
Okay.
Thank you so much.
Jennie (43:20):
Okay, y'all, I really, like I said, I cannot recommend
Dr.
Sella's book enough.
It is Beyond Limits, Stories ofThird Trimester Abortion Care.
It's so good.
I highly, highly recommend it.
I hope you enjoyed myconversation with Dr.
Sella and that you're enjoyingthis series on abortion later in
pregnancy.
And I will see everybody nextweek. [music outro]
If you have any questions, comments, or topics you would like us to cover, always feel free to shoot me an email. You can reach me at jennie@reprosfightback.com or you can find us on social media. We're at @RePROsFightBack on Facebook and Twitter or @reprosfb on Instagram. If you love our podcast and wanna make sure more people find it, take the time to rate and review us on your favorite podcast platform. Or if you wanna make sure to support the podcast, you can also donate on our website at reprosfightback.com. Thanks all!
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On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!