'There is no limit on when we can carry out abortions'
Caitriona Palmer talks to Dr Susan Robinson, a friend and colleague of the murdered Dr George Tiller, who carries on his controversial work of providing late-term abortions
Dr Susan Robinson
The call came one Sunday morning in late May 2009 when Susan Robinson was relaxing at home. On the line was Shelley Sella, Robinson's friend and colleague. Sella was crying, Robinson remembers, barely unable to get any words out.
"I have really bad news. George has been shot," Sella said, informing Robinson that their mentor and employer, controversial late abortion provider, Dr George Tiller, had just been shot dead at point blank range in the head at his church.
"It was a horrible moment," Robinson (67) says. "He knew he could get shot. He was very hard to get at, except at church. At work he had a guard. At home he lived in a gated community. But he wasn't guarded in any way at church."
This Saturday in Dublin, Sella will speak at the premiere of After Tiller, a documentary about her former boss that will be shown at the Irish Film Institute.
Tiller's death at the hands of anti-abortion militant Scott Roeder was life shattering for Robinson and Sella. The week after his death, Tiller's family closed the abortion clinic in Wichita, Kansas where Robinson and Sella worked. Determined to carry on his legacy, the women packed up and moved their practice to New Mexico, one of the few remaining states that places no limits on the gestational age of a fetus that can be aborted.
Now, as one of only four doctors in the United States willing to perform abortions after 30 weeks openly, Robinson has assumed the dangerous mantle that Tiller once held: a medical doctor working on the moral and legal fringes, despised by many of her medical peers and a target of right-wing media vitriol.
As Ireland comes to terms with the new abortion law that allows limited terminations to protect the life of the mother, abortion law in the United States is under its greatest assault since the Roe V Wade ruling in 1973.
Anti-abortion activists label Robinson a "baby killer", a physician pariah willing to terminate the lives of fetuses in the third trimester of pregnancy, most of whom would survive should they be born alive.
But Robinson's supporters and colleagues see it differently, arguing that she is a humanitarian helping out the most marginalised and vulnerable of women. Many others who come to Robinson are carrying fetuses destined to be too ill or disabled to live productive lives outside of the womb.
"I listen to the woman and her story and I am easily moved by the desperation of the person who is sitting there in front of me," Robinson told the Irish Independent from her home. "What's on my mind is what will happen to this woman if I help her versus if I don't help her."
"This does not feel like a position of unmitigated power. This feels like a position of wishing like hell that you could help these terribly desperate, needy people."
Robinson's controversial medical work takes place in downtown Albuquerque. Every morning on their way into the clinic, Robinson's staff must run the gauntlet of noisy anti-abortion protesters.
"Some are very restrained and just pray or say the rosary," says Robinson. "Others scream with a bull horn at the patients as they get out of their car."
Inside Robinson's clinic sit women in various stages of pregnancy, all of whom are there to terminate their pregnancies.
"They come in all ages, they come in all shapes and sizes, they come in all sorts of ethnicities, they come speaking all sorts of languages," says Robinson. "Some are married. Some are unmarried. Some are having their first abortion, some are having their second or third. You can't categorise them.
"The only thing that every single patient has in common is that none of them planned to be there," she says.
In New Mexico there are no legal limits on abortion and so the grey zone of when to terminate rests solely with the doctor alone.
"So there is nothing legal to stop me from doing any abortion that I think is appropriate," Robinson says. "Of course, that is a mixed bag, for me."
For pregnancies above 30 weeks Robinson relies on an ultrasound to check the age of the fetus but admits that this notoriously inaccurate method, combined with the often hazy conception dates provided by the women, can produce a window of error of plus or minus three weeks.
"Let's say the woman is at 31 weeks," Robinson says, "well, given the inaccuracy of the ultrasound she could perfectly be 34 weeks. How would I feel if that happened?"
And it has happened.
Robinson still recalls the shock she felt when she terminated the pregnancy of a fetus she thought was approximately 32 weeks. But when she saw the aborted body she realised that it was more like 37 weeks. She was devastated. "It was quite a moment," she remembers.
For those women who call Robinson's clinic to inquire about abortion, trained counsellors are on hand to discuss all options with them, including adoption. For those who decide to go ahead, there are two options depending on the age of the fetus.
For pregnancies 18 weeks and above – long before a fetus is believed to feel any pain – Robinson injects the fetus with Digoxin, a drug which induces cardiac arrest and, in her words, "euthanises the fetus". The fetus is then removed from the womb with instruments in a procedure called a dilation and extraction (D&E).
For pregnancies over 25 weeks – comprising just 1pc of abortions – the euthanised fetus must be born vaginally in an induced abortion that can take up to three days. The women are not given epidurals. The costs of the terminations vary but can be as much as several thousand dollars, she says.
For those patients unable to pay the high cost of their abortions, the owner of her clinic, Dr Curtis Boyd, will help by cutting medical costs and sometimes even paying for food, transportation and housing.
Condemning women who come to her in the later stages of pregnancy is all too easy, says Robinson, without taking into account the often overwhelming litany of economic and social woes that often prevent them from seeking help earlier.
'We have a lot of patients whose other children are in care or have been taken away from them for some reason or other," she says. "They can't get birth control and they can't qualify for funding because they haven't done the mountains of paperwork that it takes.
"It makes me a little cynical about all these people who are screaming and yelling about how terrible all these abortions are," she says.
"Well okay then, if they think they're so terrible let's provide universal free birth control and you'll see the rate drop. And then for the people who decide to keep the pregnancy. . . let's see really good support for them like daycare availability, health insurance, food stamps.
"They're all for the pre-born but once you're born you're on your own," she says.
Since George Tiller's violent death Robinson has become more safety conscious. Both the FBI and domestic terrorism officials have visited her home. She won't discuss the specifics of these visits but says she's taken "precautions" on their advice. But she remains sanguine about the dangers: "I'm 67," she says. "I've won the game of life."
She scoffs when asked whether the new law in Ireland will potentially open the flood gates to later term abortions, noting that the new law is "so restricted" that it would take an Irish doctor "who had a lot of personal courage to fly in the face of public opinion and disapproval and go ahead and do what the patient really needed."
Her work, she says, is about continuing the legacy of her mentor, George Tiller, who she says, "was firmly convinced that he was saving lives, women's lives. And I am firmly convinced that we are too."
But saving lives can sometimes be bittersweet.
"I spend a lot of time wishing that I could make the world a place where it weren't so necessary for so many people to end up needing abortions at all," she says, "let alone late abortions."
Dr Susan Robinson is featured in the documentary 'After Tiller' at the IFI in Dublin on Saturday at 4pm, part of the IFI Stranger Than Fiction Documentary film Festival. For more information, see www.ifi.ie.