Gabrielle Goodrick’s day at Camelback Family Planning in Arizona begins early, immersed in legal documents. As nurses and doctors prepare for a busy day, the 59-year-old family medicine physician and clinic owner faces a critical decision regarding a patient whose pregnancy faces serious complications.
Since the Supreme Court’s overturning of Roe v. Wade in June 2022, Arizona has enforced a 15-week abortion ban, with limited exceptions for medical emergencies. Arizona voters are set to vote on a ballot measure in November to potentially establish the right to abortion up to fetal viability in the state constitution. However, this offers no immediate solution for a 32-year-old patient currently in Goodrick’s waiting room at Camelback Family Planning.
This patient, initially overjoyed about her pregnancy after seven years, experienced a devastating premature rupture of membranes at 17 weeks. With no amniotic fluid, the pregnancy is no longer viable, and the risk of infection is imminent.
In the clinic’s break room at Camelback Family Planning, Goodrick reviews legal documents, including letters exchanged between state representatives and Arizona’s attorney general regarding the definition of a “medical emergency.” She discusses the patient’s case with her nursing staff, while her colleague, obstetrician-gynecologist Barbara Zipkin, and her dog Scooter listen attentively. Scooter, a maltese-yorkie mix, is a regular presence, offering comfort to patients.
Charge nurse Michele Cunningham and a receptionist at Camelback Family Planning clinic consult about patient scheduling, reflecting the clinic’s commitment to efficient and compassionate care.
“No one will do it,” Goodrick states, referring to performing an abortion after 15 weeks in situations like this. While some post-15-week abortions have occurred in Arizona due to severe infections, Goodrick is reluctant to wait for the patient to deteriorate to that point.
The patient’s healthcare network declined to terminate the pregnancy, leading her and her husband to consider a clinic in Las Vegas. However, the six-hour journey to Nevada presents a significant obstacle. Furthermore, this Nevada clinic, like many offering later-term abortions in the US, primarily performs dilation and evacuation (D&E). D&E involves cervical dilation, often using laminaria, followed by uterine evacuation using suction or instruments. This procedure typically does not allow for the fetus to be delivered intact, a crucial aspect for this patient who wishes to hold and grieve her baby.
Camelback Family Planning stands out as one of the few US clinics offering induction abortion as an alternative. Similar to medication abortion in the first trimester using mifepristone and misoprostol, induction abortion utilizes the same medications in later trimesters. Due to the fetus’s larger size, misoprostol induces labor-like contractions. While typically performed in a hospital setting, Camelback Family Planning manages pain with painkillers and conscious sedation. This method allows patients to deliver and hold the fetus, providing a crucial step in the grieving process, including taking footprints as mementos.
An Arizona abortion consent form, highlighting the state’s mandatory waiting periods and counseling requirements that patients at Camelback Family Planning must navigate before receiving care.
Despite potential legal risks, particularly in Arizona’s restrictive abortion environment, Goodrick feels compelled to act. She notes the frustration that more physicians aren’t proactively challenging abortion restrictions, a sentiment echoed by many doctors facing similar dilemmas nationwide as stories of denied emergency abortions increase.
Zipkin firmly agrees, stating, “I’m not afraid. Let’s do it,” reinforcing Camelback Family Planning’s commitment to patient care even in the face of legal uncertainty.
Post-Roe, an increasing number of patients across the US are seeking abortion care later in pregnancy due to mounting restrictions delaying access. Many patients find D&E, the most common second-trimester abortion procedure, undesirable for personal reasons, such as the wish to hold the fetus or avoid laminaria-induced cervical dilation.
While abortion pills are FDA-approved for pregnancies up to 10 weeks, their “off-label” use for later-term abortions remains legal. Common in second and third-trimester care in Northern Europe and endorsed by the World Health Organization up to 24 weeks and beyond, medication abortion offers a less invasive alternative.
Goodrick and her colleagues at Camelback Family Planning advocate for broader physician education on later-term abortion pill usage. They believe this could significantly expand abortion access by enabling more physicians with labor and delivery expertise, not just surgical specialists skilled in D&E, to provide this essential care. Despite opposition from conservative groups attempting to discredit abortion pills as “unsafe,” Goodrick views them as a potential equalizer in abortion care provision.
Dr. Athena Zimon at Camelback Family Planning, ensuring the success of a medication abortion procedure, demonstrating the clinic’s meticulous patient follow-up and care.
To further this cause, they published a study sharing their experience with hundreds of induction abortions performed at Camelback Family Planning between 18 and 24 weeks before Roe v. Wade was overturned. They also actively train medical students, fostering the next generation of abortion care providers.
Operating under Arizona’s 15-week ban has presented challenges for Camelback Family Planning, but not insurmountable ones. For patients beyond 15 weeks, Camelback Family Planning directs them to a Southern California clinic to initiate mifepristone, halting the pregnancy’s progression. Upon returning to Arizona, Goodrick’s team administers misoprostol to induce contractions. They operate within a legal loophole, treating what is technically considered a stillbirth, allowing patients to avoid costly surgical procedures and out-of-state travel expenses.
The patient seeking care in mid-September marks a significant milestone: the first patient Camelback Family Planning will treat entirely within Arizona since the 15-week ban took effect in 2022.
“When she found out that we could see her, she started crying,” Goodrick recalls. “She was so upset still about the hospital not helping her. She was just overwhelmingly relieved.”
A lone protester stands outside Camelback Family Planning, a common scene highlighting the ongoing debates and challenges surrounding abortion access and the clinic’s role in providing care amidst opposition.
Goodrick acknowledges the “scary” environment for doctors pushing back against abortion restrictions, understanding hospital risk aversion. However, she firmly believes, “I think it’s up to the medical field to say [to the state], ‘You don’t know what you’re talking about.'”
Goodrick’s path to abortion care was not initially planned. Early in her career, she recognized a critical need. She recalls the news surrounding Henry Morgentaler, a Holocaust survivor and Canadian physician who became a pioneer in advocating for and providing abortion services, ultimately leading to nationwide legalization in Canada in 1988. Inspired by this, Goodrick enrolled in medical school.
At the University of Vermont, Goodrick was drawn to women’s health but opted for family medicine over surgical OB-GYN, seeking a holistic approach. In 1990, anti-abortion protests targeted clinics in Burlington, prompting her to co-found a pro-choice medical student alliance.
A staff member at Camelback Family Planning retrieves mifepristone pills, essential for medication abortions and reflecting the clinic’s commitment to offering comprehensive reproductive healthcare options.
“I didn’t really think of abortions like, ‘This is what I’m going to do,'” she says. However, during her residency at Phoenix Baptist hospital in 1993, a rotation at Planned Parenthood sparked her interest. She later opened a family practice, incorporating abortion services, though not as her primary focus initially.
This shifted after the FDA approval of mifepristone in 2000. Goodrick became a regional pioneer in offering the abortion pill, attracting patients from across the country. Even with Roe v. Wade in place, second-trimester abortion providers were scarce, and the murder of Dr. George Tiller, a prominent provider, in 2009 underscored the risks and challenges. As Goodrick honed her D&E skills, she worried about the long-term sustainability of this specialized surgical care.
In 2018, at an international conference, Goodrick learned about Sweden’s standard practice of using abortion pills, not surgery, for second-trimester abortions. Professor Kristina Gemzell Danielsson, a key figure in developing the WHO’s second-trimester medication abortion protocol, explained that geographical factors and patient accessibility favored medication abortion in Sweden. Today, it’s widely available across Swedish OB-GYN clinics, often administered by midwives.
Goodrick consults with a young patient at Camelback Family Planning during a mandatory consent meeting, emphasizing the clinic’s patient-centered approach and commitment to informed decision-making.
Upon returning to Arizona, Goodrick proposed integrating medication abortion for second-trimester care at Camelback Family Planning. Initially hesitant, her colleagues, including Zipkin, eventually embraced the approach. While D&E has been the US standard since the 1970s, and early studies suggested fewer complications compared to induction, current research indicates comparable safety. Induction abortion eliminates the risk of uterine perforation associated with surgical D&E and avoids the discomfort of pre-procedure laminaria insertion.
Goodrick and her team, including Dr. Atsuko Koyama and Dr. Zimon, collaborate at Camelback Family Planning, showcasing the clinic’s team-based approach to innovative reproductive healthcare practices.
While D&E training remains crucial for managing incomplete medication abortions, Goodrick believes expanding medication abortion access can empower more providers, particularly in areas with limited OB-GYN access, to offer vital abortion care.
Where will abortion be on the ballot in the 2024 US election? Read more
The morning after meeting the 20-week pregnant patient, Goodrick arrives at Camelback Family Planning to find the usual half-dozen protesters. Clinic escorts, including a 66-year-old volunteer in a rainbow vest and witch hat, cheerfully greet patients, shielding them from the protesters. The escort shares her own experience of receiving a second-trimester D&E in 1999 after a fetal anomaly diagnosis, emphasizing that such care might be inaccessible in today’s Arizona.
Inside, the 32-year-old patient rests. Zipkin has administered misoprostol and pain medication. By lunchtime, delivery is imminent. “Doctor!” a nurse calls. Moments later, Goodrick joins Zipkin.
Dr. Koyama’s dog, Sushi, provides emotional support to a patient at Camelback Family Planning, illustrating the clinic’s holistic approach to patient well-being and compassionate care.
Less than an hour later, both doctors are back in the break room. The patient is recovering, and her husband is joining her to say goodbye to their baby. “She did great,” Zipkin affirms.
Goodrick has consulted with the Arizona attorney general, who confirmed the case qualifies as a medical emergency. However, concerns linger about potential scrutiny from the Arizona Department of Health and a conservative county attorney.
Goodrick hopes the upcoming November vote on abortion rights will alleviate such anxieties. “Obviously what happens federally is very important, but every state needs their own ballot initiative,” she emphasizes.
In these moments, Goodrick reflects on the legacy of pioneers like Dr. Tiller. “A lot of us still think of him. ‘What would he do now? How would he act? How would he be calm and sure of himself?'” she says.
This is why she told the attorney general, “In the future, if you hear of these cases and they can’t get done in the hospital, tell us. We’ll see them,” underscoring Camelback Family Planning’s unwavering commitment to providing essential abortion care, even in the most challenging circumstances.
