'After Tiller': Ignoring Threats, Doctors Do Third-Trimester Abortions

Jan. 21, 2013— -- Spend 10 minutes on the phone with Dr. Susan Robinson, an obstetrician-gynecologist who specializes in providing women with third-trimester abortions, and the name Aron Ralston will invariably come up. He's the mountain climber who was trapped in a canyon in Utah after a boulder crushed his right hand. He was pinned down by the boulder for five days (the film "127 Hours" is based on his story) until he realized the only way he could get free would be to cut off his hand.

It's a graphic, horrific image, but Robinson says it's the best analogy she can think of to describe women who are pregnant in their third trimester and "have thought about it deeply, consulted their conscience, wrestled with the ethics, and decided the best thing for themselves and their families is to have an abortion."

"People think you choose an abortion like you choose red or green shoes, or a flavor of ice cream," Robinson told ABC News. "But in fact, they [the women I see] need an abortion the way Aron Ralston needed to cut his hand off."

Robinson is one of four doctors featured in the documentary "After Tiller," which screened at the Sundance Film Festival this past weekend. "A #Sundance first: security guards checking bags and wanding people before abortion documentary 'After Tiller,'" tweeted Sean Means, movie critic for The Salt Lake Tribune.

The film takes its name from Dr. George Tiller, a third-trimester abortion provider in Wichita, Kan., who was assassinated in May 2009 while attending church. Robinson worked with Tiller, as did Shelley Sella, who worked as a midwife before becoming a doctor and abortion provider, and is also featured in the film. The two now operate out of a clinic in Albuquerque.

"We learned at his knee," said Robinson, speaking of Tiller. "Kindness, courtesy, justice, love and respect are the hallmarks of a good doctor-patient relationship. People tell me every single day, 'Dr. Robinson, you've given me my life back.' For these women it is life or death. Many women try to self-abort. The less available it is, the poor will have the hardest time."

A Red-Hot Issue

If abortion is a hot-button political issue, then third-trimester abortion is red-hot, and such words as "kindness" and "respect" are not two that leap to mind for many people. The arrest two years ago of Philadelphia doctor Kermit Gosnell, who was accused of killing a woman with a lethal dose of Demerol, put a gruesome face on doctors performing third-trimester abortions. Police, searching his office, found what prosecutors called "a house of horrors," where illegal abortions were performed, bags and bottles of aborted fetuses scattered throughout the building, a place where fetuses were delivered live and then killed with scissors.

But even many supporters of abortion rights draw a line at third-trimester abortions. A 2011 Gallup poll showed that making abortion illegal in the last trimester got strong support from both pro-choice (79 percent) and pro-life advocates (94 percent). Laws passed in 41 states prohibit abortions, except to protect the woman's life, after a certain point in the pregnancy, usually fetal viability (about 24 weeks). In the U.S., 88 percent of abortions are done in the first 12 weeks, according to the Guttmacher Institute; fewer than 1 percent are in the third trimester.

"No Hope"

Dr. Lauren Streicher, an assistant clinical professor of obstetrics and gynecology at Northwestern University's medical school, does not provide third-trimester abortions but said, "In my career, there have been times when I've had to tell women this desperately-desired pregnancy has not gone well. These are babies that have congenital abnormalities that are incompatible with life -- no hope, no brain, no kidneys, something that is not surgically fixable."

In an academic, urban center, Streicher says she can refer her patients to doctors at a family planning clinic who do provide third-trimester abortions, but are not as public as the four doctors in "After Tiller," whose patients often find them via the Internet and who need financial help from organizations such as the National Abortion Federation.

Women whose fetuses have terrible abnormalities, Robinson said, "are a lot easier for people to understand. The husband and wife want to spare their baby whatever suffering that baby would have."

"Then there's the group of women who didn't know they were pregnant," she said. "They were told they were not pregnant for one reason or another and they are just as desperate. 'I already have three children, my husband just lost his job and I can barely put food on the table. If I add a new baby to this family, we'll all go under.'"

"After Tiller" follows the four doctors past the anti-abortion protesters who regularly stand outside their clinics. It shows Drs. Robinson and Sella in Albuquerque; Dr. Warren Hern in Boulder, Colo.; and it shows Germantown, Md., where LeRoy Carhart recently set up a practice. The camera never shows the faces of the patients, but instead shows hands fidgeting in laps, boxes of tissues being consumed, voices quaking, lots of crying.

"The Face of Late Abortion"

Martha Shane and Lana Wilson, both 29, are the filmmakers. "After Dr. Tiller's assassination in 2009, I remember watching the news coverage," said Wilson. "He'd been going to this church for over 20 years, and here the No. 1 villain of the pro-life movement is a deeply religious Christian. He'd been shot before. Who would want to do a job where most of the country maligns them? Are there other people who do this work? Will anyone want to keep doing this work? What's it like to work every day under these conditions?"

Robinson and Sella were initially reluctant to participate. "Dr. Tiller did not give interviews," said Robinson. "Period. End of story. His reason for not doing that was, he'd say, 'It's not about me, it's about the patient.'"

So Robinson said no at first to Shane and Wilson. But the two women came to visit, and Robinson said they were "very charming, very persistent." Others at the clinic suggested they open it to the filmmakers. "'Patients are stigmatized, doctors are stigmatized,'" they told her. Robinson decided, "I want to be a face that is not that gruesome guy from Philadelphia, Gosnell, those ghastly botched abortions. He's the face of late abortion. I look like someone's grandmother. It's a little harder to make me into a bloody butcher."

Running Out of Providers

At 66, Robinson thinks about retiring but says she can't possibly, because who would do her work? "I've been doing OB/GYN for 30 years. I did a residency in OB and a fellowship in perinatology, high-risk obstetrics." But abortion provider David Gunn was shot and killed in Pensacola, Fla., in 1993. "I thought, Oh, my God, all the doctors are going to head for the hills." Then anti-abortion activist John Salvi walked into two abortion clinics in Brookline, Mass., and killed two receptionists. After that, Robinson began to perform abortions full-time.

Those who perform third-trimester abortions are, says Dr. Jennifer Austin, an OB/GYN in Oakland, Calif., "a rapidly shrinking population. When you become a doctor, you're starting to settle down, get married, have children, you start to worry about the safety of your children and family. I'm less concerned about abortion's being outlawed than about running out of providers."

Security, for the filmmakers, was a concern; while they did take the camera into the doctors' home, they did not, say, follow a doctor to a place he or she went with regularity and at a certain time -- no Saturday morning trips to the grocery store, for instance.

"Totally Different Worlds"

And then there was the question of "figuring out how to treat the protesters," said Wilson. "We didn't want to do this black-and-white political [film]. They're always present in the doctors' lives, lurking in the air as a potential threat." As the doctors and patients walk past the protestors, the camera goes past them. The doctors don't stop to talk, so the camera doesn't stop. A city council meeting features community members who do not want the doctors in their midst, for business reasons and for personal reasons.

"Outside versus inside the clinic, it feels like totally different worlds," said Shane.

Inside of course are the doctors and patients, and the filmmakers were hoping to present not only the former's story but the latter's. "There's a lack of accurate information out there about why women seek third-trimester abortions," said Shane. "It's important to have their stories out there."

"The patients who did agree to participate can't really believe they're in this situation," said Wilson. "They so understood people who wouldn't understand why you'd need [this procedure]."

The filmmakers tried to blend into the lives of the clinic. "Patients agreeing to film with us would say, 'Is this for a school project?'" said Wilson. "We look very young and unintimidating. Often women who are there are alone, without a partner or family member, and they wanted friends around them to go through it with."