'Life-affirming' care and the hardest of cases
A Pillar interview
As different states continue to try to shake out the “new normal” after the Supreme Court decision in Dobbs, doctors, lawyers, and legislators are all wrestling with questions about language, intention, and what it means to protect the life of a mother.
Dr. John Bruchalski has practiced obstetrics and gynecology since 1987 and has spent the last three decades asking himself these same questions.
Bruchalski began his career practicing the full range of “reproductive medicine,” including abortions. But he experienced a profound conversion of heart following a live birth during a late-term abortion procedure, and resolved to practice a different kind of medicine, founding in 1994 the Tepeyac OB/GYN practice in Northern Virginia that supports fertility counseling, natural family planning, and support for families that have received an adverse prenatal diagnosis for their child.
He spoke to Charlie Camosy about “life-affirming” medicine, treating both the mother and her child as patients, and how he, as a doctor, sees some of the hardest of hard cases which have become flashpoints in the post-Dobbs debate.
You have an incredible personal story.
How does one go from being an OB/GYN who performed abortions to giving talks at pro-life conferences?
Meaningful relationships, science, and grace.
Only by the mercy of Christ and my parents' persistent rosary intercession for their son (Polish through and through) do I believe I came back to Christ and quit abortions.
From college to the middle of my OB/GYN residency, I was seduced by the new opium of the liberated: elective abortion on demand. I went along with the popular ideas of the time: that contraception, IVF, and abortion would liberate women from the chains of their fertility–those chains being the physical, emotional, and financial burden of childbearing. Modern gynecology residency programs embody these ideas, and I went along with them during my training. I performed elective abortions, many for medical reasons — spina bifida, hydropcephalus, chromosomal abnormalities.
During this time, a few important things happened. I was drawn to the medical testimony of famous geneticist Jerome Lejegune, who testified in a court case that IVF embryos were human based on the fact they contain all the genetic makeup of humans.
I began to think more about when life began and how a fertilized egg is one of us, part of the human family. I also befriended pro-life colleagues volunteers at a pregnancy center. But I was living a double life. I was volunteering at a crisis pregnancy center in the evening and performing elective abortions at the hospital when patients presented with this desire.
That period in my life was bookended by two vivid, spiritual experiences. I heard an audible voice while visiting Tepeyac Hill in Mexico City ask, “Why are you hurting me?” – which I promptly blew off.
Then one day in the hospital, I was trying to save one patient’s unborn baby in one room and terminate another pregnancy in the next — which is a cognitive dissonance many OB/GYNS face when they are treating two similar cases so vastly differently based on the wantedness of the unborn baby. A NICU doctor called me out for treating the unwanted babies as tumors. That caught my attention, and the coffee and conversation we shared afterward was quite influential in my heart softening.
The closing bookend occurred later on Podbrdo hill in Medjugorje, when I received a message from Christ and his Mother during prayer: “Medicine is an act of mercy. Be an excellent physician. Serve the least daily. Follow the teachings on doctrine and morals of my Son’s Church regarding your profession. My Son will renew you and medicine.”
Us Polish kids need to have things explained in clear and simple language, words and gestures, I reckon.
I knew I was loved, forgiven, freed, and that I would practice medicine in a totally different way from that moment forward. I would never perform an abortion ever again. I would practice excellent, life-affirming medicine and care for both of my patients.
Can you tell us more about founding a fully pro-life OB/GYN practice?
After I completed my residency, I joined a wonderful pro-life practice in Maryland, but they could not see the poor due to economic realities, and the approaches of reproductive health were varied.
So in 1994, my wife Carolyn and I set out to start our own life-affirming practice. We started by seeing patients at our home. She acted as nurse, manager, and right hand of Tepeyac Family Center, which was located centrally in the Arlington diocese. My friend Bob Laird became my manager. Together we begged for alms. There was no business plan. It was “life at the improv”.
A standard, for-profit model gave way in the early 2000s to a not-for-profit model. My accountants always said in order to keep our doors open, we couldn’t see the uninsured or underinsured patients from the regional pregnancy centers and we had to decrease the time of visits to become more efficient. But I didn’t agree to that and by the grace of God we’ve survived.
I made every mistake in the book and we are still here after 28 years. Now others joined and sacrificed one and all to see the insured and the underserved and those from the local pregnancy centers. We use the various methods of fertility awareness and have a perinatal hospice. We see all the basic diseases in our specialty and do our best to treat the disease always and consider an integrated, holistic approach to the language of the feminine body.
Post-Dobbs, our opponents are predictably focused, not on the overwhelming majority of the hundreds-of-thousands of killings of prenatal children, but on the hard cases which are comparatively quite rare.
We will talk about those, but first let's talk about what abortion is actually about in the United States.
Based on your own experience, what factors are driving most women to have abortions? And how can Catholics live out our calling to be Christ in response?
I believe fear is driving most women to have elective abortions, particularly fear of suffering. The big lie is that elective abortion is healthcare. Elective abortion is a bandaid on real, serious issues with social and psychological complexities.
Elective abortions in this country are about having “no choice”. I am now almost 62 years old, and been on both sides of the atrocity we call abortion on demand for feminine empowerment. Tens of thousands of women I knew and spoke with in all facets of my life have commonly said, “I have/had no choice.” No money. No support. I can’t keep it, I can’t adopt, so I must abort it most commonly heard. These are the fear-based reasons we chose abortion as patients and drive the conversation to elective abortion as providers.
“There is no such thing as neutral advice,” I hear often. Doctors can really ignite the fear of women facing an unwanted pregnancy or a life-limiting prenatal diagnosis by offering elective abortion as the “merciful and medical” solution.
We counter this reproductive health narrative with accompaniment. Rather than robbing our patients of an opportunity for courage, or underestimating their capacity to face suffering, we need to speak the medical truth and encourage them.
We must tell the truth that elective abortions are never medically necessary and they don’t undo trauma or eliminate suffering. Leaning in together, “compassion” with our gaze and hands and intellect, to treat both patients, and getting through the suffering together…that is our response.
As Catholics living our calling to serve the least of our sisters and brothers, as serving Jesus, Dobbs does not change our work, but intensifies it. We ought to meet the evil of abortion with love and compassion — listening and walking with the woman who God has allowed to cross our path. You have to know your communities and regions pregnancy resource centers. Let her know there’s non-judgemental help from people who genuinely understand her situation and they can get through this suffering. Women are resilient without the violence of elective abortion as a means for seeking fulfillment.
OK, can you help pro-life Catholics think through some of the hard cases that will say grow in importance as the fights over abortion policy racket up in the coming weeks and months?
Let's start with the heartbreaking story of the ten-year-old in Ohio was apparently raped and became pregnant by her mother's live-in boyfriend.
How should we think and speak about such a horror show?
When rape is part of the horror show presented to doctors, abortion appears the “humane” thing to offer from their vantage point. It’s the “merciful” thing to do. “How human are you, doctor?” is the unspoken question between this example.
Most feel that how someone was conceived (in rape) gives us the license to end the life of who was conceived. Especially if the girl who is now a mother is so young, the reality of the pregnancy is beyond comprehension.
The experience of the brutality of the violence has already damaged the heart and psyche and soul and body image of that young woman. Turning her against her unborn child in an elective abortion will not fix that and has a significant chance to compound the trauma. Trauma piles up.
Another aspect of these cases that should be concerning is that elective abortion is one way to cover up a crime. How many doctors have become an accessory in covering up the crime and have left the rape unreported?
Now, how do you listen and care about such a horror show? We must speak with compassion and reframe our vantage as if your child was in this same situation that is so really, really, bitter and hard? We should embrace the agonizing pain and emptiness felt by the victim and her family. How we respond to injustice done to us is what elevates us from the slop and injustices of life.
We must also internalize the reality that His “good news” never provides easy answers, but with our full, all-in, accompaniment and knowing the resources that make up for what we lack — think of the Colossians 1:24 paradox — obstacles can become opportunities. Grace does the hard work. Trusting in Him is the challenge, and we are Christ’s hands and gaze to that family in that agonizing moment.
I'm deeply concerned that intentionally-created confusion and misinformation about the relationship of pro-life laws to saving the life of the mother will produce a situation in the US similar to what happened in Ireland.
Almost all U.S. pro-life laws will be at risk, in my view, if we cannot give an account of how we will save the life of the mother when she is threatened by her pregnancy. Indeed, these stories seem to be at the heart of what drove the surprising defeat of pro-lifers in Kansas this past week.
Maybe with reference to one or two examples, how should pro-lifers be thinking and speaking about both prenatal justice and the duty of physicians to save the life of the mother?
There is a lot of confusion and fear over what doctors can and should do when the mother’s life is compromised, or is thought to be compromised, in a post-Dobbs world. Yet, we have been treating these conditions without elective abortion before Roe, during Roe and now after Roe, successfully and competently.
Many doctors are having to shift their thinking because all they’ve known is Roe. Elective abortion has been the default backup for so long. I understand that.
But the broader message I want to send to women is that, as a doctor who practices life-affirming medicine, I never choose the baby over her. I will also never kill her baby because her baby is my patient as well.
Mom and baby are on the same team, the same family. As a doctor, I never pit the mother against her baby. The life-affirming approach is to get both mother and baby as far along in the pregnancy as possible if it is safe. What’s good for the mother is often good for the baby. If the mother’s life is in danger, the baby is in danger too. We use our Intensive Care units, we use our technology to monitor physiology and look for the move toward more severe illness if that occurs.
Here’s a specific example. A patient’s amniotic sac (the water around the baby) breaks prematurely at 14 weeks gestation (few ounces in weight for the fetus). Mom has a fever of 100.5 and an elevated white blood cell count. But she is not cramping, meaning she is not in labor. Mom is beginning to develop chorioamnionitis (infection of the placental membranes. This is supported by fever and elevated WBCs.
The life-affirming approach is to treat the infection beginning to percolate, not directly kill the baby. The unborn child is not the disease here, the brewing infection is. We must do an early delivery — empty the womb with cytotec and pitocin in order to attack the infection, similar to draining an abscess. We would regret that by principle of double effect the unborn baby dies because it is not far enough along to be viable outside the womb.
These are the cases that many pro-abortionists call an abortion because the baby dies, or they are fear mongering that pro-life doctors would just let the mother die. But this is not an elective abortion because ending the life of the unborn child was never the direct intention in treating the infection and saving the life of the mother.
Most diseases in mothers develop to a life-threatening status after the child is viable and can go to the NICU. Before viability, you care for the mom, treat her disease, stabilize her vitals. Once the disease progresses with infection of the womb, hemorrhage, you deliver the child never intending to kill that fetus as the problem but the underlying disease that is following its natural progression.
We try to treat both patients because that provides the best outcomes for both and we try to get them as far along as possible. We always treat the patients with thoroughness. That is what the consults of the specialties and the ICU units are for. That is what the technology is for, to try to get both as far along as possible. Once you have a handle on the disease process and that process is evolving towards “life threatening” status, you only deliver the child when you have a handle on the disease and the severity and the physiology that the pregnancy is burdening the mom with.
It is important for doctors to speak honestly to the patients. There must be trust between us and our patients. I am forthcoming about the benefits and risks to my patients. What is needed is sound medical treatment that provides the patient with information and competency and compassion that can mitigate the fear. We also stress that she and her child are not at fault in the situation where we deliver the child early.
We must treat the disease causing the problem and that may include the delivery of her precious child.
It is worth noting that Catholic hospitals, despite never doing elective abortions and serving disproportionately vulnerable communities, have the same or better maternal health outcomes as secular hospitals who do elective abortions.
But I've heard that this is misleading because some Catholic hospitals refer hard cases to other hospitals. You're the expert here: what's the real story?
That’s a complicated question that needs more of an answer than maybe we have space and time for here. Most of the doctors in the community work at both places. Also, so many Catholic hospital systems have blurred the lines of their ERDs [Ethical and Religious Directives] through mergers with secular entities to increase their bottom line. This is not an easy question.
The real answer is the Catholic approach of life affirming medicine can hold its “medical” own vis a vis secular institutions.
When you provide the best of modern medicine to sick individuals, that maximizes their chance to do well. When you provide exceptional medical care for sick mothers, they and their unborn children do very well.
Over the last five decades the understanding of the pathophysiology of gestational diabetes, pregnancy induced hypertension, lupus, pulmonary hypertension, cardiac electrical or valvular disease, breast cancer, etc. has improved significantly.
During the same time period, the technology has also increased in sensitivity and sophistication alongside the understanding of the natural history of the diseases threading mom. This has led to better outcomes in the face of the short sighted, bandaid approach that holds that moms do better when they are recommended “therapeutical” abortion so early in the disease course.
So many of the women I aborted wished they would have waited one more day or week or month. The dogma that elective abortion is safer for women than childbirth is part of the great lie we have bought for decades.
We now treat these diseases by killing the unborn child causing those diseases. We must relearn how to hate the disease yet love both of our patients in OBGYN practice.
Overlaying this approach, medicine today, five decades after Roe, has become so risk averse at the hospital and personal level, many times for economic reimbursement reasons in an attempt to minimize the intrinsic risks involved in healthcare.
My residency provided this case. “Blue Betty” walked down the corridor at the Catholic OB clinic. Because they “ignorantly and criminally” did not perform therapeutic abortions at that hospital, we transferred her to the secular medical center, despite the ICU physicians at the Catholic hospital wanting to treat her disease.
We aborted by dilation and evacuation (D&E), and with the hemorrhage and fluid shifts, Betty died in the process, because we did not thoroughly manage her medical disease before we planned our treatment. We rushed to elective abortion and they both died. It is so sad when we propose killing the unborn child in order to try to prevent any suffering at all.
How should pro-life legislation be written, do you think, to ensure that physicians feel totally safe to act to save the life of the mother?
This is out of my league. Words matter. Elective abortion needs to be defined clearly. Get the best legal minds in a room with American Association of Prolife Obstetrician Gynecologists, and high risk maternal fetal medicine specialists, to define elective abortion clearly. That would cover the 90+% of abortions that are done. They could then approach a definition of what constitutes “life of the mother.” Miscarriage management and ectopic management are not elective abortions because the intent is different and the target of the treatment is the disease and not the child.
It is hard to use old legal arguments written during Roe for a Dobbs America, but it must be done. Protecting our conscience-based, scientifically sound, medical treatment that does not involve elective abortions is paramount in fighting the discrimination coming from licensing boards in the states to coerce or punish us into providing or referring for elective abortions.
Most of these doctors who have said they’ve had to consult their lawyers before treating patients with potentially life-threatening cases have only ever practiced under Roe. That is understandable. We can begin that conversation because of Dobbs and that is a blessing and a moment that we cannot waste.