In Conversation with Dr. Shelley Sella

Third-trimester abortion is one of the most taboo topics in abortion care. Dr. Shelley Sella is one of the few doctors in the country whose career has been devoted to providing it. Her new book, Beyond Limits: Stories of Third-Trimester Abortion Care, blew me away: She rejects much of the common language rules around abortion (the political mandate to say “fetus” rather than “baby,” the definition of viability) and tells patient stories interwoven with her own. 

I first saw Dr. Sella in After Tiller, a 2013 documentary about the only four doctors openly performing third-trimester abortions in the U.S. at the time. She had worked with George Tiller, the famous abortion doctor who was murdered in church in 2009, forming a lineage carried on by a few brave practitioners today. Dr. Sella’s own feminist work began in the lesbian feminist scene at the University of Wisconsin–Madison, where she helped run a volunteer ride service for students traveling at night. She later worked at the L.A. Women’s Health Center, which was throwing off male doctors’ control over reproductive care and introducing treatment done in group settings to lessen the stigma and isolation of reproductive medicine. She would continue group counseling when she merged with Tiller’s practice later; the book contains moving scenes of patients finding connection with each other in Dr. Sella’s warm, feminist, and anti-bureaucratic clinic.

I spoke with Dr. Sella about her book below. You can catch her on the road across the country. —Sarah Leonard

SARAH LEONARD A lot of law and opinion around abortion is grounded in the term “viability,” which you redefine in this book.

SHELLEY SELLA Abortion is legal up to viability in a lot of states, and then people are criminalized. The Roe decision defined viability as survival outside the womb with or without support. Back then, that point was about 28 weeks. Now, it’s about 22, 23 weeks, although about 40 percent don’t live. So that’s one problem with the viability framework. But the other is that it doesn’t deal with the pregnant person. It’s just about the fetus. There’s no connection. 

What I’m proposing is that instead of using this arbitrary ever-changing term, “viability,” we let the pregnant person determine whether the pregnancy is viable or not. That’s why people have abortions. They have decided that the pregnancy is not viable for them. They’re taking many things into consideration and the gestational age of the fetus is just one of them — right? Can I care for this child? What will the child’s life be like? Do I have adequate resources? How will my health be affected by having a child? How will my other children, if I have them, be affected? It is a completely holistic view. But that’s not how it’s viewed typically in judicial decisions or in the legislature. They forget the person who’s carrying the pregnancy. 

SL I interviewed the journalist Amanda Hess for this newsletter about her book on all the tech that has developed around pregnancy, like pregnancy tracking apps. She was struck by the imagery in these apps; like when you open it, there’s a picture of a fetus floating in space.

SS It’s literally disembodied. But it’s in the body! And that’s so important to consider.

SL I wonder if you could talk about the range of emotional responses you encounter in this work and the differences between third-trimester abortions due to fetal versus maternal indications. 

SS Everyone is different, but I could say in general that cases with fetal indications (where an anomaly has been picked up that shows the baby will not be healthy) involve a lot of grief about the loss of a wanted baby. Often, these are people who have received good prenatal care but faced a complication and have to travel out of state. Sometimes their provider will tell them directly, here are places where you can go, I’m sorry, I can’t care for you. Sometimes the provider doesn’t give them options, and they have to look on the internet for a place to go. That kind of the stigma — the restrictions, the bans that force you to leave your state — is amplified by the loss and grief of people who wanted the baby. 

SL And maternal?

SS For maternal indications, there’s a huge range of emotions because there are so many different situations. If someone didn’t realize they were pregnant until late in the pregnancy, there’s shock. They may have to leave their state without telling anyone and hiding the pregnancy the whole time. There’s often a sense of relief. Finally, someone can take care of me. I’ve gone from clinic to clinic and each time I get there, I’m too late. Actually, I was just thinking about this young woman whose mother took her to an abortion clinic and the tech said sorry, you’re too late. Good luck buying baby clothes. So coming to our clinic is a huge sense of relief. 

The longer I’ve done this work, though, the more commonality I see. Fetal indication patients have tender feelings toward their baby, but maternal indication patients do too. They want their child to have a good life. They want to be healthy. They don’t feel that they can continue the pregnancy in a way that will work out. Often, the maternal indication patients are vilified and stigmatized even more. I wish people would see them with compassion and empathy.

SL I was struck by some of your stories about younger patients who have essentially been in denial that they’re pregnant. I think people often believe that’s ridiculous or impossible, but I find it very easy to imagine. We’re all in denial about all kinds of things all the time — our psychology as human beings is wild, and if this is something that could be a catastrophe for your life, you might really not want to believe it. 

SS Absolutely. I’m gaining weight. I haven’t worked out, or I’m eating a lot of junk food, or I’m really under a lot of stress. And then that makes sense to you until it doesn’t. The patients that I saw were somehow able to break through that denial and decide: This is not something I can handle. I need help.

SL In these answers, you often say “baby” whereas many advocates for reproductive rights prefer “fetus.” In our forthcoming issue there’s a big essay about abortion in American literature and the failures of political language to capture the range of emotional experiences that people can have. I wonder if this is part of that.

SS I use the word baby deliberately because that is the word that people use, especially in a wanted pregnancy. But I guess I also reject that whole dichotomy. I took care of a lot of patients at six weeks who considered it a baby. That didn’t mean they didn’t want an abortion.

I have to say, I don’t like the word fetus. It sounds so medical, and maybe that’s what you’re talking about — people want it to be kind of detached. But I don’t know why we have to be detached from this. If someone considers this a baby, then it’s a baby. I totally accept how people view their pregnancy. 

That’s what I’m talking about with viability. They decide that the pregnancy is nonviable — whether they call it a fetus or a baby is irrelevant. And I think it does kind of a disservice to just say, oh, this is a fetus, just a clump of cells. It’s not just tissue. It is how that person experiences it. It doesn’t mean that I can’t do the work or that the person doesn’t want an abortion.

The anti-abortion side won the language battle. They’re calling it a baby. And so we think “baby” and we have tender feelings. I’m not going to have tender feelings toward a fetus or the person carrying the fetus. “Baby” just brings up so much. In the clinic, we had notebooks and people would write things to their child and they would say, I’m sorry, I had to make this decision, but I needed to, it was the best thing for my family. And I’m paraphrasing now, but at least you’ll be in heaven with grandma. And I read that more than once — there’s solace in that. There’s grief and solace.

SL You survived the peak of Project Rescue’s violence and the murder of your colleague Dr. Tiller. Right-wing violence is on the rise again in general, and I wonder if you have any advice for people practicing now, or just for lefty people trying to cope with this violence.

SS We used to think about the risk to providers and now it’s to the patients, to someone who helps the patient get an abortion. It’s just been ramped up; it’s the criminalization of everyone. I was at the National Abortion Federation conference and someone talked about anticipatory compliance. My instinct is don’t give up, keep going, keep talking. Don’t shut up. Don’t anticipate that something’s going to happen and pull back like the universities, like the law firms. It’s important for us to be out there.