Beyond Limits: Stories of Third Trimester Abortion Care by Shelley Sella, MD. Published 2025.
Do I have any idea how this book got on my radar? Nope, none.
But I am not surprised I had it to read. I believe I was perusing the new and notable section of the library. You know, the section where they put all the recently returned and the new and shiny books? Yeah, there.
I am very interested in feminine medical care, especially in these fraught times. Especially when females are under attack by those who should care for us in the governments. Yes, plural. State governments are as complicit as the federal.
But this cannot have escaped Dispatch readers’ attention. Nor the side I am on.
The woman’s.
Always.
This was a quick read. That is not saying it was an easy read. It was definitely not an easy read.
However, I believe it to be an important one.
In these stories, families cared for regardless of their feeling on abortion. That is, until they need one.
In this book, the author is careful to tell all the stories but focuses on the maternal indication, meaning that to be denied an abortion would have substantial negative effects on their life, or the fetal indication, meaning that there is something deathly wrong with the baby. One woman is anti-abortion until she needs one. Another is anti-abortion but understands that this is in the child’s best interest. Unsurprisingly, the second family have the support of their pastor and that of their community.
Dr. Sella points out when the mother has religious beliefs that conflict with abortion, pain, distress, and anxiety are heightened. And she takes steps to lessen all of these. She gives each couple a book about others who have to make the decision of peace for their baby, wanted as they are, loved as they are. It is “A Time to Decide, a Time to Heal: For Parents Making Difficult Decisions about the Babies They Love”. This book is written by Molly A, Minnick, MSW, Kathleen J. Delp, ACSW, and Mary C. Ciotti, MD.
For me this is take away from the entire book. Yes, the baby is dying, but not because of anything the mother did, and not because they aren’t loved and it sucks but the parents will get through this and by undergoing a late 2nd and 3rd trimester abortion, they are giving babies peace and not a life of struggle and pain and death. Or the mother faces certain hardships or death to carry the baby to term.
This doctor and clinic take steps to decrease the mother’s anxiety, with lowered lights, soothing music, and medication as needed to keep the patient less anxious and to decrease the pain. A counselor is also present. This is about supporting the mother who has chosen a better end for their wanted baby. Every person is there for support of the mother.
This book is part history lesson about the abortion care in the U.S. From the 1970s, all the way through the current Dobbs decision. Dr. Sella takes us along on her personal journey and history. Interspersed with the real time four days it takes to complete a third trimester abortion. These chapters focus on four mothers who are at the clinic in search of care.
The author was adamant that she not go to medical school, that she could provide care and counseling away from the bedside. But the doctors were still in charge and she realized that she wanted to support at bedside and give her patients back the power.
She gives the patients scripts to use when talking about why they are no longer pregnant. “The baby was sick and we went for testing. The baby didn’t make it. It’s hard for me to talk about right now.
What struck me as especially compassionate was the discussion she led with the families of what would happen after the now still birthed baby. All of it to make sure the families were as supported as they wanted.
Pictures, both medical of anomalies and commemorative are taken after the stillbirth. These pictures are always taken and kept in the chart, even if the woman says they aren’t wanted. That way they can give them to the family if they change their mind.
Taking pictures of a deceased infant has come a long way in the 25 years I’ve been a nurse. Now there can be photo shoots, and keeping the body in the room on a cold cot for as long as necessary. I have had many conversations with women, patients and friends alike, who have told me they would have like a picture. Or a remembrance of some kind so that others know that this baby was here, and was loved, and died. Because they haven’t forgotten.
Footprints and handprints can be taken. She counsels the families that if the pregnancy is ended closer to term, there will be a birth certificate and a death certificate. The mothers will have the option to view the baby the next day, after they’ve rested and recovered a little. But there is no pressure to do so. Of the four mothers the book is about, only one does so.
In the beginning and through the process, she counsels the families in a group, so that they have support and can feel comfortable sharing their stories.
She leads them through the expected question of will the baby feel any pain. She explains that is why the heart is stopped, through medication, before the delivery can take place. If there is no heartbeat, there can be no pain. Fetal pain is a subject that I have heard a lot about, probably because of the anti-abortion insistence that there is pain for a fetus during an abortion. There is no studies backing that up.
Through the entire book, the author is open to ongoing changes in American law and what these challenges mean to abortion care. And the unceasing anti-abortion backlash, up to an including the release of her personal home address leading to protests in her neighborhood.
Up to and including the murder of her mentor at the hands of an anti-abortion zealot. Inside of his personal church, where he was an usher. What these zealots fail to comprehend is that these are human beings they are calling murderers, and pigs, and more, This is a human being that they killed to satisfy their hate. As if by killing the head of the serpent they would kill the clinic and the need for this level of abortion care.
I think the best way to end was with what one of the fathers said when it was over and they were preparing to leave “Quite frankly, my religion has let me down.”
There are reasons listed in the book as to why these four women are seeking third trimester abortion care. Their babies are ill or the procedure is done to support the mother or the procedure is done to protect the life of the mother and she can now undergo additional cancer care. Dr. Sella ends each procedure four day period with a final meeting with the families.
There are several reasons to have a third trimester abortion. Some are fetal abnormalities incompatible with life. Some are maternal cancers or heart problems. Some are dealt blows by life such as rape or abuse. The reasons are the woman’s alone.
I am a firm believer that personal stories can change mountains and make the explaining of third term abortion need impactful. The personal stories and names, changed though I am sure they are, humanize the patients and give voice to the circumstances that led them to make the decisions they do.
This was one of the best medical non-fiction books that I’ve read. I will be recommending it to all the OB and Labor and Delivery nurses I know.
Dispatches from the Evening Shift 