6 - Post-Roe America: The Next Generation
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What is the Dobbs decision and why does it matter for medical education?
Before we jump into today's episode, I wanted to tell you about a podcast that I love and that I think can help us understand this moment in abortion care. Hosted by Dahlia Lithwick, Slate's Amicus Podcast is all about the Supreme Court and the law, but you don't have to be a constitutional lawyer to listen to it. And actually, last week I had the pleasure of talking with Dahlia as a guest on the show. Here's Dahlia.
Thanks, Allie. On Amicus, we have this basic guiding principle that knowledge is power, and that even, or perhaps especially, an opaque and lofty institution like the US Supreme Court could do with more people understanding where its decisions come from and what those decisions can mean for the rest of us, the American public. Because as this Six to three supermajority conservative court has shown those decisions reach into every single corner of our lives and they reach ever further into the lives of healthcare workers. So find us on Saturdays wherever you listen to your podcasts. It's Amicus, that's A M I C U S from the Latin, your friend with me, Dolly Lithwick, looking Forward to talking to you.
At the Nocturnist, we are careful to ensure that all stories comply with healthcare privacy laws. Details may have been changed to ensure patient confidentiality. All views expressed are those of the person speaking and not their employer.
Welcome back to the Nocturinists, Postro America. I'm Doctor Ellie Bloch. This week we're looking at a very specific corner of the abortion world. It's an issue we've heard about over and over again as one of the most important impacts of the Dobbs decision. But it's also been one of the least covered. So today we're diving into medical training and education. Training to be an abortion provider has never been like training for any other medical specialty. It's rarely covered in med school, and only certain residency programs even offer abortion training at all. When I was in residency, even in an unrestricted state with a strong abortion care program, I still did an elective in Mexico City, simply to get the practice I felt I needed to be trained to competence.
And this is common for many abortion providers, to travel out of state or even out of the country to get this basic skill set. The Dobbs decision has only further limited training opportunities. And when we're talking about medical education, we're also talking about the type of care an entire generation of clinicians will be able to provide. So to start today's episode, we asked one of my mentors to give us a crash course on what you need to know if you're learning how to do an abortion.
So okay, the vagina is a dark canal. At the end of the dark canal there's like the cervix that's a little Donut and it's a donut that is very t tightly closed. That donut it's made by a muscle and it it has a a canal, right, that's going from there up into the uterus where the fetus is.
She wanted to stay anonymous, so we'll call her Julie. As someone who has spent years teaching others this procedure, Julie really impressed upon us the importance of hands on practice.
And in order to get into the uterus to empty it, you gotta be able to find your way through that twisty canal. And you can't see it. It's a total feel thing. You gotta feel you gotta know like how much pressure to put. Am I putting enough pressure? Am I putting too much pressure? Because you can create a false passageway. You can like force a really sharp instrument to go into the muscle.
How does hands‑on abortion training differ from other medical procedures?
We call it a gritty feeling that you have when you're making a false passage and you you need to know that and back off and try something different and get into that uterus in the right way. And then of course the other risk with any time you're putting something into the uterus is that you go through the uterus. So you go into the uterus and then out the back into the abdominal cavity. And so that's making a what we call a perforation, a hole in the uterus, then then that can cause damage to the bowels and And You know, perforations can cause hysterectomies and
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Chapters
8 chapters
1
What is the Dobbs decision and why does it matter for medical education?
0:00–3:51
2
How does hands‑on abortion training differ from other medical procedures?
3:51–8:06
3
What challenges do educators face teaching abortion care after Dobbs?
8:06–12:31
4
How are trainees like Meredith adapting their curricula in restrictive states?
12:31–16:26
5
Why is it crucial for future doctors like Anastasia to secure abortion training now?
16:26–19:23
6
How does Bria’s experience illustrate the geographic divide in abortion education?
19:23–22:41
7
What are the national statistics on residency abortion training gaps post‑Dobbs?
22:41–25:20
8
How can listeners get involved in supporting the next generation of abortion providers?
25:20–28:36