Third-trimester abortion doctor wants to build compassion with book
Dr. Shelley Sella, the first woman in the nation to openly offer third-trimester abortions, took out a pen and began to journal as she traveled on a plane to her first day of work at a Kansas clinic.
Nearly 20 years later, she had 22 notebooks filled with medical notes and, mainly, patients’ stories.
Sella, who retired in 2021, turned the notebooks into a book, which she describes as “not a political diatribe” but a compelling look at the reasons women end up seeking abortions in the last three months of pregnancy. In “Beyond Limits: Stories of Third-Trimester Abortion Care,” Sella writes about real patients, but as “composites” — their stories are true, but each character’s journey to the clinic is a compilation of a few patients’ stories.
“My goal is to help people gain a better understanding of this segment of abortion care, and through understanding, gain compassion, and through compassion, really understand that this is a decision that the pregnant person makes themselves based on the reality of their lives,” she said.
When Sella, an obstetrician and gynecologist, began focusing her practice exclusively on abortion care in 2000, there were only two other doctors in the nation who performed abortions in later pregnancy. Those were Dr. Warren Hern of Boulder, who retired in April, and Dr. George Tiller, who was murdered in 2009 in Kansas by an antiabortion extremist.
Sella worked in Wichita with Tiller until his assasination, then joined Dr. Susan Robinson in 2010 to set up a third-trimester abortion practice in Albuquerque, New Mexico, where Sella worked until she retired.
On a recent visit to Colorado to promote her book, Sella talked with The Sun about the future of third-trimester abortion care, what compelled her to keep working after the murder of her colleague, and what makes her think her book could create compassion. This interview transcript was edited for clarity and length.
SUN: It seems like a heavy book. How will you persuade people to read it?
SELLA: It actually isn’t. And many people who’ve already read it have told me that they were expecting that, and it surprisingly wasn’t. It’s emotional, and people have also told me that they’ve cried, but they ultimately don’t find the stories or the book heavy. People relate to stories. People relate to other people. It’s not a heavily political book. It’s actually a rather quick read. It’s compelling because people’s lives are compelling, and I think once they start reading, they’re quite drawn in because of people’s lives and stories.
SUN: What kinds of stories are in the book?
SELLA: The structure of the book is that I formed six composites of patients, so they’re composites of true patients that I saw, and I explain what their situations are, their life circumstances that brought them to the clinic. I take them through a week at the clinic because it’s a multiday process.
There are so many stereotypes about who gets third-trimester abortions, and also misunderstanding of the process itself.
It’s the patients who have discovered at some point in the pregnancy that the baby has a condition that would either not survive at birth, or would have major problems after birth, and those are the ones we often hear about. But then I also have three patients who have what I call maternal indications. They are there either because continuing the pregnancy and giving birth would gravely affect their health, or because of difficult life circumstances. And those are the stories we don’t hear about. That was very deliberate on my part. I want for us to have compassion and understanding for them both, equally.
SUN: Describe one of the patient stories that fits into that category of difficult life circumstances.
SELLA: The name of the patient is Laura and she was in a domestic violence situation. She was trapped in her home. She already had several children. She realized that she was pregnant very early on in the first trimester, and she knew that her life was dangerous, and it was also dangerous for her children. She wanted an abortion, but she couldn’t access funds because her husband controlled funds. Luckily, she had a relative who helped her and she managed to escape. Then there were several barriers to her access to care. First she went to a clinic, and they accepted only cash, but she didn’t have any cash, so she was sent home. Then she had to wait until she could escape again. The next time she went to a clinic, there was a 24-hour waiting period, so she went back home. She went to another clinic, and at that point, she was too far along in that state (Texas) to get an abortion, so she went back home. And then finally, she did learn of the clinic in Albuquerque, and finally she was able to leave her home.
I met her before Roe was overturned, so abortion was legal at that point, as was telehealth, but there were so many barriers to telehealth in Texas. In Texas, you had to be in person.
I also talk about a teenager who finds herself pregnant and is afraid to tell her parents because they have said, “If you come home pregnant, we never want to see you again.” I talk about someone who came from an immigrant, religious family and felt that she just couldn’t tell her parents that she was pregnant, and she too found out that she was pregnant early on in pregnancy. She had to go in front of a judge to get a judicial bypass, and she actually got it, but by the time she could leave her home and get an abortion, she was too far along for the state where she lived (in the Midwest).
SUN: Colorado is one of the few states in the nation that does not limit when during a pregnancy abortion is allowed, and as other states have enacted bans and restrictions, Colorado clinics have seen a huge increase in the number of patients traveling here for abortion care. Dr. Hern was known nationwide as one of the few doctors providing abortions in the third trimester. His clinic closed with his retirement, but staff he worked with at Boulder Abortion Clinic are planning to open a new practice.
Is there a shortage of third-trimester abortion care in the country?
SELLA: In fact, there are more clinics than ever that are offering third-trimester abortion care. There are clinics that have extended their gestational limit as well, so there is not a shortage of third-trimester abortion providers.
When I first started, there were two clinics in the entire country that offered this care. (Boulder and Wichita, Kansas). (Now, there are also clinics offering third-term abortions in Washington, D.C.; Albuquerque, New Mexico; and Chicago.)
The reason that these clinics are opening, or that clinics are extending their gestational limits, is really a direct result of Roe being overturned. More and more people are needing to travel to access abortion care, which only leads to delays, which leads to needing later abortion care. Before Roe was overturned, 1 in 10 patients traveled. Now it’s 1 in 5.
SUN: Did you think about a career change after Dr. Tiller was murdered?
SELLA: I didn’t think that. I think what was scary was the very, very beginning when he had been killed and the killer had escaped and he hadn’t been caught yet. Where is he? What is he going to do next? Who is he going to attack next? But he was actually rather quickly apprehended.
But after that, I just felt that this is important work.
His death was a huge blow. He was my mentor. He was my colleague. He was a very good friend. But I felt very committed to continuing the work. And Dr. Susan Robinson, one of my colleagues in Kansas, we decided to look for work together, and luckily, there was a provider in New Mexico who had been a friend of Dr. Tiller’s and wanted to expand his practice to third-trimester abortions after Dr. Tiller’s death. At that point, after Dr. Tiller was killed, there was only Warren Hern.
SUN: You use the term third-trimester abortion, not late-term abortion. Explain why this language has changed.
SELLA: “Late-term” is very imprecise, to say the least. In Alabama, viability is at conception, and for some people, “late-term” is 10 weeks. It’s medically very imprecise. The one that I see used mostly is abortion care later in pregnancy, which is also imprecise. “Late-term” abortion got vilified; it became this kind of inflammatory expression.