Conversations with Jody: An OB-GYN talks life post-Roe and why Santa Cruz could soon see more late-term abortions

Dr. Laetitia Oderman is one of two doctors in Santa Cruz County who perform second-trimester abortions.
Dr. Laetitia Oderman is a Palo Alto Medical Foundation OB-GYN and one of two doctors in Santa Cruz County who perform second-trimester abortions.

Laetitia Oderman is one of two Santa Cruz doctors who provide second-trimester abortions. In this first “Conversations with Jody,” feature, she talks to Community Voices editor Jody K. Biehl about the end of Roe and what bans on abortions in dozens of states will mean for California, Santa Cruz and for her personally.

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Laetitia Oderman has never spoken publicly about her work.

Jody K. Biehl Conversations

She is an OB-GYN physician at Palo Alto Medical Foundation (PAMF) and one of the two doctors in Santa Cruz County who perform second-trimester abortions.

I spoke to her on June 25, one day after the Supreme Court’s 5-4 decision to reverse Roe v. Wade. States across the nation (I counted 31) are enacting legislation to limit abortion in various ways, and I figured Laetitia would be able to give me — and you — an inside, informed look at what the reversal and the changing state laws will mean for her, for the patients she treats in Santa Cruz and for others across the country who might be coming to California to seek help.

When Roe fell, eight states immediately banned abortions. Five others will have bans in place within the next few weeks. More than half our country will soon see tighter restrictions, particularly on second-trimester abortions.

California will be a big outlier.

We, along with 19 other states and Washington, D.C., are enacting legislation that will likely protect abortion rights. There is talk of becoming an abortion “sanctuary” state.

In this interview — the first of a new Community Voices series of “Conversations” — Laetitia talks about the terrible predicaments her patients face. And she helps explain why they, and soon, perhaps many more, might seek second-trimester abortions.

She talks about why it’s sometimes hard to get an abortion in Santa Cruz County, the conversations about Roe she has had with her two school-age children, and the personal toll the work takes. And she cites a groundbreaking UC San Francisco study that compares the lives of women who have had abortions to those who were denied care.

You notice I refer to Laetitia by her first name. That’s part of the informal nature of this new feature. I’ll be meeting people in person — usually over coffee or some beverage of their choice — and I’ll try to capture the mood and feel of our conversation.

For instance, Laetitia is petite, warm, and energetic. She is dressed in sports clothes. She has long, dark hair she keeps trying to wrangle into a baseball cap. As we talk, I see how passionately she worries about her patients and the hurdles they face.

We met at 11th Hour Coffee on the Westside. When I arrived, she was talking animatedly to a woman with a toddler. A patient, she tells me, as she and the woman hug goodbye.

We find a table and talk for 90 minutes, making her late to meet her family and friends. She drinks a latte, and neither of us notices that her avocado toast never shows up.

She’s a real Californian — except she was born in France and lived there until she was 8. She fell in love with Santa Cruz while an undergraduate at UCSC, During those years, she worked at Planned Parenthood’s Santa Cruz office. She went to medical school at UC Davis and did her residency at UCSF, where she met her mentor, Jennifer Hastings, a family practice doctor at Dominican Hospital.

UCSF’s hospital had (and still has) a progressive OB-GYN residency with a family planning fellowship on site. “The social justice piece is embedded really deeply into the curriculum,” Laetitia said. “It has one of the only abortion clinics in California that goes out to 23 weeks and six days.”

That training — and her love for Santa Cruz — shaped her course.

Today, Laetitia offers comprehensive women’s health services at PAMF. That includes advice on contraception — including implanting IUDs and Nexplanon (implanted in the arm), preconception counseling, gynecologic surgery, prenatal care, births and, when needed, abortions.

She sees people at their most ecstatic and most anguished. Births. Fear of pregnancy. Infertility. Miscarriages. Abortions.

She sees dozens of patients a day, and every day, someone on her team of seven doctors will perform an abortion. Her team also includes six midwives, but they don’t do surgical abortions.

Not yet. She thinks that’s coming, particularly as the demand for abortions climbs in “sanctuary” states like California.

Currently, most abortions — over 90%, she says — in Santa Cruz County and across the country occur in the first trimester, usually at under nine weeks. That could change soon as women have to wait longer and sometimes travel to other states to get care, she says.

Some abortions — usually the women with the hardest stories — are already occurring later, up to 23 weeks into a pregnancy.

She understands it’s “gory” and hard to think of ending a pregnancy that late, when a fetus is more formed, but what people miss, she says, and what is missing from our national dialogue, are “the conversations happening in the exam rooms,” the disenfranchisement these women face and the hurdles that prevent them from getting care. Few have any doubts about their choice, she says.

“They are 100% clear, this is what they want and need,” she said.

Laetitia shares what she can here, without violating patient confidentiality.

When we met, she was late to join friends, her husband, a social studies teacher, and their kids at the Westside farmers market.

But she made time — a lot of time — to talk to me, to us.

I edited this interview for clarity.

Dr. Laetitia Oderman is one of two doctors in Santa Cruz County who performs second-trimester abortions.

Jody: We are here on a Saturday, the day after the Supreme Court overturned Roe v. Wade. You are a busy doctor and have a family that doesn’t see you nearly enough. Yet you are having coffee with me. Why did you feel that we needed to talk today?

Laetitia: Well, I needed something productive to do with this deep sadness that I have, that I feel for women, mostly poor women and women of color, who I think will be impacted the greatest by this decision. And just to sit around and not feel I’m making an impact was unthinkable. I want to help give them a voice.

Jody: Tell me about some of the women you treat, the ones you want to give a voice.

Laetitia: Every story is different, but often they are women who in general didn’t know they were pregnant initially and then had barriers to access health care, whether it be financial or other. Maybe they didn’t have insurance. They may be immigrants.

I had a patient not long ago who was a new immigrant from Mexico. She didn’t know she was pregnant. She fell jumping over the border wall, shattered her ankle and found out she was pregnant when she went to the ER for her ankle. She didn’t know she was pregnant because she hadn’t had voluntary sex. She had been probably drugged and raped while coming across the border.

And so yeah, this is a rather extreme example of the fact that women who are seeking second-trimester abortions are generally not what people might think. It’s not that they didn’t take birth control or that they are putting it off or flip-flopping on their decisions. They may have had birth control failure. They may have had difficulty accessing health care due to finances and work/childcare issues. They may be in an abusive relationship. It’s mostly that they’re in these horrifically challenging situations.

Jody: In some cases, women are ill and are choosing between their own lives and the lives of their babies, right?

Laetitia: Yes. Those are almost the easier cases. It’s easy to pull people’s heartstrings when I talk about my patient with newly diagnosed breast cancer. The cancer is hormone receptor-positive, and if she doesn’t terminate the pregnancy, she’s risking her life and the life her existing child would have without her. I have lots of those stories.

And stories of women who really want their babies, but whose water breaks before 23 weeks, which risks them becoming septic or dying of a bad blood bacterial infection if they don’t terminate the pregnancy. There’s really almost zero chance of survival for the fetus. And so again, in some cases, we’re talking about a life-saving abortion.

There are, of course, other cases of women who really want their babies, but the baby has a severe genetic and/or anatomic abnormality. It can take until 22-23 weeks to confirm this kind of diagnosis. Some of these are severe enough not to be compatible with life.

It’s really easy for people to get behind that or abortion in the case of rape or incest. And I really want people to take away from this the importance of really protecting the privacy of the conversations that happen behind closed doors between a woman and her physician. I want to emphasize that women seeking second-trimester abortions, which is my major concern, are often the most disenfranchised and need our support and care the most, even in California. And so how do we really, even in our most progressive states, how do we fight to keep second-trimester abortion legal?

We women are going to have to be resourceful again. I say again, with sadness, I never thought I would see this in my lifetime. This is just to go backwards. Backwards in human rights, which is really what this is. It’s a woman’s rights we are talking about.

Jody: There are arguments about when to cut off abortions, often counting in weeks. How do you look at those debates?

Laetitia: Gestational age — the number of weeks — you know, is it 15 weeks, 14 weeks, 13 weeks, that’s so arbitrary. Especially because we’re a country where we don’t have universal health care. It’s not easy to access care. It’s expensive, and it’s logistically challenging. And we don’t support the children once they’re born and you know, we don’t provide a good safety net, like many other countries do.

The most important thing is the double whammy of no universal health care and putting these arbitrary limits on women. Who can say when a woman is going to figure it all out and get to a health provider?

Jody: How easy is it to access abortion care in our county?

Laetitia: It’s actually quite hard. Even just the process of getting in to see a medical professional is daunting and challenging, and then they might go to one provider who says, “Oh, it looks like you’re too far along for me, you’ll need to go somewhere else.”

But then how do they even find out where that somewhere else is? It’s not like there’s a public directory of abortion providers in our community, for safety reasons. So yeah, second-trimester abortions are a small number compared to the rest of the care I do. But they’re always the women who need our care the most.

And it’s the question of what happens if care is denied. For me, it’s both a question of pushing women to have children they don’t want, but also what happens to those children? Statistically, what we’ve seen is that those kids don’t fare well. And in fact, there are higher incarceration rates, higher mental health issues and higher poverty in many cases. Women who are already in precarious financial situations are then forced to have babies. Having that baby often puts them below the poverty line.

Jody: Do studies show this?

Laetitia: Yeah, I was actually just pulling up this maternity study, which is the Turnaway Study by the Bixby Center for Global Reproductive Health at UCSF. It was published in the last few years [starting in 2013 and as a book in 2020].

We had always assumed — and those of us who provide abortion care always knew — that women in horribly difficult situations who get turned away for abortions end up in dire circumstances just based on our circumstantial understanding of their lives. But this was the first study to really quantify that. It’s the first study to rigorously compare the effects on women who received abortions with the effects on women who sought abortions, but were denied them.

It involved 1,000 women from 30 facilities across 21 states, and they conducted interviews over five years and compared the trajectories of women who received abortions for unwanted pregnancies to those who were turned away because they were past the facilities’ gestational age limit.

And so what they found was that abortion does not harm women. It does not increase their risk of having suicidal thoughts or developing PTSD, depression, anxiety, low self-esteem or lower life satisfaction. And over 95% of women said abortion was the right choice for them in retrospect, they were more likely to have a positive outlook on their future and aspirational life plans within a year.

And most women gave multiple reasons for seeking abortion, including all the things we talked about. Finances, timing issues with a partner, need to focus on their own children, need for education.

So here’s the crux here: Women denied an abortion had almost four times greater odds of household income below the federal poverty level and three times greater odds of being unemployed.

And at the five-year mark, [the women denied abortions] had an increased likelihood of not having enough money to pay for basic medical, basic family necessities like food, housing, transportation. Also, if they were denied an abortion, they were more likely to stay in contact with violent partners, putting them and their children at greater risk than if they had received the abortion.

I want to emphasize that women seeking second-trimester abortions, which is my major concern, are often the most disenfranchised and need our support and care the most, even in California.

Jody: So the impact is not just on the mother, but also on other children she might have?

Laetitia: Yes. exactly. Existing children of women denied abortions were more than three times more likely to live in households below the federal poverty level. And they were less likely to achieve developmental milestones than the existing children of women who received abortions.

So it’s huge, huge, huge, huge. And I, again, I worry the most about women, poor women, women of color, who historically have not had access to abortion.

When it was illegal, these sort of back-alley abortions that we knew about in the ‘60s before Roe, were happening. And again, now, late-term abortions are needed for poor people because of delayed access to health care. They are more likely to seek abortion care in the second trimester when many states — even progressive states — will probably outlaw abortion. Just from a lack of understanding, really.

Jody: Why do you say lack of understanding?

Laetitia: Well, I think most people have this misconception about health care. Those of us who are wealthy enough to have health care and easy access to medical care, we find that if we’re pregnant, we get a pregnancy test, we go to the doctor, we get an ultrasound. We know. I think we assume that that’s how easy it is to access health care for others.

And that’s just not the case. Even in our own community. I see women who are 14-15 weeks pregnant. It literally took them six weeks just to get to me. They were 100% sure of their decision, they just could not get to the right care faster.

Jody: Is that because they couldn’t get an appointment or is it because they didn’t know how to get to you?

Laetitia: Yeah, often, they didn’t know they were pregnant. You know, not everyone has regular periods. And so you might be six, eight weeks before you find out you’re pregnant. And then they had to go get a pregnancy test to confirm. Then they didn’t have health insurance. So then they have to navigate like, how do you apply for MediCal if you are pregnant? Do you Google that?

And then what? Do you go to the county building? Maybe there’s a huge line or maybe you’re working that day or you don’t have child care or you wait in line for two hours, but you can’t wait in line for the third hour.

Then you have to fill out all the paperwork, which includes proof of income, and then you have to make an appointment and maybe that appointment isn’t for one or two more weeks because of the impact of COVID-19 on staffing in medical clinics locally or because of backup. And then, by the time it’s your turn, you’re too far along for that clinic to service you and maybe they don’t know where to refer you.

You can quickly see how a week turns into two weeks turns into three weeks, etc. And that’s in California, in progressive Santa Cruz County. So I can’t imagine what the hurdles will be like for women elsewhere. It’s heartbreaking.

Jody: And, in Texas and possibly elsewhere, there are laws that ban abortions after six weeks, but that also includes measures to allow residents to sue clinics, doctors, nurses and even people who drive people to get the procedure for up to $10,000.

Laetitia: It’s beyond my wildest imagination to criminalize the process of helping someone and to turn doctors into criminals. It’s just … it’s all something I never thought I’d see in my lifetime. I always knew that women — I’m 46 — women of my generation, we had maybe an earshot of what it was like pre-Roe. But doctors in my generation have never seen women turning septic from illegal abortions. And now I think that’s a very real possibility.

Jody: And how do you think this is going to affect us here in Santa Cruz, where both the city and the county passed resolutions supporting women’s rights to abortion, and in California, where we have clear abortion-rights protections in place? Are we going to see a large influx of people coming in? Are you expecting to see a lot of people from states where abortions are outlawed?

Laetitia: I assume there will be an influx and we’ll need to step up and be prepared for that. Again, I worry the most about women who won’t be able to travel. You can just imagine, again, the logistics of finding out where to go in another state you’re not familiar with. You can’t just easily access this kind of health care. Again, there are no public directories for this kind of care.

So these are women who are in their free time cold-calling and trying to figure out where to go. Many of them have multiple children already. And then they have to figure out the cost of travel and a hotel in a city where they’re not a resident or maybe don’t have family to stay with and no one to watch their kids. Plus, even if you have insurance, then you’re accessing care that’s both outside your state and that’s not considered emergency care. And so they’re paying out of pocket.

The hurdles are huge. We’re really talking about rich women traveling. So I think there will be an influx, yes. But unfortunately, I don’t think it will be enough to make a dent in the need for care because poor women are not going to be able to jump many of those hurdles.

It’s beyond my wildest imagination to criminalize the process of helping someone you know and to turn doctors into criminals. It’s just … it’s all something I never thought I’d see in my lifetime.

Jody: And again, the consequences will be national, in poverty levels, education levels, domestic violence, incarceration rates …

Laetitia: Yeah, so much. Including children’s developmental milestones. The ripple effects of this are hard to fathom. It’s… it’s too much to think about. It’s … it’s heartbreaking.

Jody: And what about you as a parent of two kids in elementary school? How do you talk about this with your kids?

Laetitia: Yeah, I mean, my kids are pretty politically savvy, just because their dad’s a social studies teacher and I’m a reproductive justice health care worker. So they hear a lot. My younger child had a really just kind of matter-of-fact response and said, “The government shouldn’t be able to control what we do with our bodies.”

She wasn’t spoon-fed that. It was just her natural response. She said it with this dumbfounded look. It’s sad to think about how geographically my kids may be limited and where they choose to live. And yet, they’re lucky. They have health care and — I just keep going back to this — my kids themselves will not be impacted. I hope this is fuel for them to be leaders in the charge and the fight for human rights. Because I think, you know, I’m certainly not an expert in constitutional law by any means, but to read Justice [Clarence] Thomas’ concurring opinion overturning Roe, they’re coming for birth control and LGBTQ rights next.

Jody: Do you see yourself — or other doctors and health care providers from California and other pro-abortion states — perhaps in the near future traveling to other states or to the outskirts of other states to make health care accessible to women who need it?

Laetitia: I hope so. I hope there will be doctors like me who dig deep to fill that need, but there’s security and safety concerns about doing that and potential legal implications and licensing issues.

I know in Poland there was a boat that floated in international waters providing abortion medicine. So yeah, I think we’re gonna have to be creative about solutions to keep women safe. What that looks like, it’s hard to know yet. I’m certain there’s lots of people much smarter than me who are scrambling to figure out how to keep women safe across the country. And I hope I can get involved in whatever capacity.

Jody: They are already there on social media. There are women using code words to let each other know they are ready to help each other travel for abortions.

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Laetitia: Wow. Yeah, well, we women are going to have to be resourceful again. I say again, with sadness, I never thought I would see this in my lifetime. This is just to go backwards. Backwards in human rights, which is really what this is. It’s a woman’s rights we are talking about.

Jody: Are you concerned about talking publicly about what you do? Do you worry about safety?

Laetitia: Yeah. In fact, for many years, I didn’t talk about it, didn’t out myself, if you will, just because I was concerned about my own family’s safety and the potential safety repercussions. But I just feel this duty to speak up now. I mean, I definitely had conversations with my family about what it could mean for them. And my husband was like, of course, you have to do it … he’s definitely a feminist. And my kids were like, of course, you have to do it, but I do worry.

Let us not forget that, the day before the Dobbs decision (which reversed Roe), the Supreme Court declared that private citizens can legally conceal and carry hand guns in public places, pretty much anywhere. I knew George Tiller, an abortion provider who was murdered while attending church services [in Wichita, Kansas in 2009].

The threat to our safety is real. And we are here, just trying to help women.

Jody: What would you say to someone who firmly believes this is a human life? This is our nation’s big debate — the issue that has pulled our country apart for decades. It’s hard to argue against belief, but what would you as a doctor say?

Laetitia: This really gets into the ethics of abortion and when does human life begin. What is the value of an unborn human life? I would say it’s a beating of cells to a certain point that it isn’t a heart until it’s fully formed. That is my physio-anatomic response, my “doctor sort-of-science response.”

But again, we’re comparing the value of unborn, unformed life to that of a fully formed, full human. It’s the difference between potential life and life. The living woman who has connections and relationships. She has sisters and parents, brothers and kids and aunts, a partner, and friends. She may have other kids. To me, the answer is clear. I value the life of the woman.

I would say that, at a minimum, I hope we can find collective agreement that abortion is harm reduction. Right?

History has proven that women will seek abortion, regardless of whether it is legal or not. They will go to great lengths to end pregnancies they are not prepared to continue. And so, do we want to keep it safe or not? And I would say we have to, we have to keep it safe.

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