It's the great moral divide of our age. Here one doctor explains why she's so passionate about persuading her patients NOT to have abortions. Arms folded protectively around her chest, the thirty-something in her smart business suit was tearful but adamant.
"I can't have this baby," she said, hands twisting nervously in her lap. "I just can't. I'm not ready for it. It would ruin my career, and my relationship. I just can't cope." Across from her, Dr Tammie Downes leaned forward and gently posed the questions she had asked so many other women in the same position.
"What would have to change to make you see things differently? What would help you to see this baby as good news and not bad news?"
They are simple questions, but for the distressed patient they were to make a life-changing difference. Prompted to think about what she was actually frightened of, she broke down in tears and confessed to a fear of losing the successful career and lifestyle she had worked so hard to build.
It was a cathartic moment, and one that led her to a profound reassessment.
"As soon as the words were uttered," says Dr Downes, "she found herself thinking 'does my job really matter more than my unborn baby? Can't I find a way of having both?'."
Instead of the abortion she had been so determined to have, the young woman gave birth seven months later to a baby boy.
"I saw her shortly after she gave birth and she was delighted. She adores her little boy. Her relationship with the father did not survive, but she has coped. And she still has her job," says Dr Downes.
It is a scene that has, one way or another, been played out countless times in Dr Downes's homely West Country surgery.
Those who sit in the patient's chair are all different – some are young women, unprepared for motherhood, others are career women apparently unwilling to be mothers, while some are mothers already and believe their family to be complete as it is.
Nonetheless, with her guidance, many of those who have come to see Dr Downes determined to have a termination have been persuaded to think differently. And none of them, it seems, has regretted it.
"There have been a lot of very unsure mothers-to-be in my surgery, but as soon as the baby is born they have lost all that uncertainty," she says.
Not everyone will, of course, feel comfortable with Dr Downes's firm declarations…
For 36-year-old Dr Downes, there has never been any room for doubt.
A cheerful and modest woman, her deeply-held belief that all human life is precious has only
been strengthened during her 12 years as a doctor, seven of them as a GP.
Married for the last six years to a vicar, Greg, she has yet to have children of her own, although she admits she would dearly love them.
"My husband and I would love to have kids but so far nothing's happened," she says. "We'll see what happens next. We haven't ruled out adoption eventually."
It would, of course, be easy to dismiss Dr Downes as a…one-woman crusader for the Pro-Life lobby.
Instead, she insists that whatever her personal beliefs, she feels her duty as a doctor is to help navigate women through the fraught moral and emotional maze of an unwanted pregnancy.
"People talk about being pro-choice as being pro-abortion, but I like to think I am pro an informed choice, which many women don't always make.
"When your life is in turmoil, which inevitably it is when you have a pregnancy you feel is unwanted, then it is the worst possible time to be making a decision," she says.
"What I hope to do is create a situation where women can look back and understand the framework within which they made their decision."
It sounds obvious, after all, isn't that what a doctor is there for? But Dr Downes believes it is often not the case. She feels that abortion on demand has come to be seen as an easy option for both patients and doctors.
"You just do it and then the baby's gone and you get on with your life – and some GPs don't necessarily do much to disabuse women of that notion. But the fact is it's not like taking an antibiotic. There are enormous emotional and practical implications whatever you do and that is what I try to help women understand," she says.
Over the years, she believes, thanks to her prompting, around one in three women she has treated have been able to change their mind.
This does, of course, leave many others who press ahead with their terminations, and as their GP, Dr Downes often bears witness to the sometimes unexpected emotional aftermath.
She remembers one patient, an 18-year-old hairdresser with an unreliable boyfriend, who came in determined to terminate her unborn child.
"She said: 'I don't want this.' She was adamant, as I recall. I talked to her, asked her again what would have to change for her to feel differently. She said she had hoped to be older when she had her first baby, and for her relationship to be more stable."
Unable to shake off her fears, the girl went ahead with her abortion, but her story has a surprising twist. Only five months later, she came back and revealed she was pregnant once more. This time, however, she wanted to keep her baby.
"She told me the decision to have an abortion was the worst one she had ever made and she was desperate to make amends," Dr Downes recalls.
"Her circumstances had not changed at all – she was still only 18, her relationship was still in its very early days – but this time it didn't matter. It was hard not to feel that at some subconscious level she had got pregnant to redeem what she had done."
It is not the first time she has witnessed the fallout of such raw regret, a regret that remains a powerful force whether a woman is 18 or 38, and one which has increasingly bolstered her resolve that her views on this subject are right.
Dr Downes recalls one divorced woman in her 30s – who already had a child – who then underwent an abortion, insistent that she could not cope with another baby. The woman had embarked on a new relationship and was utterly distraught to find herself pregnant.
"She was very emotional and kept saying 'I can't go through with it. It's not fair on the child I already have and my relationship is too new'." They had a lengthy discussion about her fears, but again it was not enough to dissuade the patient from her chosen course.
"I saw her quite a few times after that, sometimes just passing by the surgery, and every time I saw her she seemed to be crying," Dr Downes says.
"A few months later she came in again. She was pregnant and she said there was no way she would consider terminating it because of what she'd been through last time. Her boyfriend left her, but she never looked back. She had a beautiful baby girl to whom she is now devoted."
There are other stories, too, of the babies who might never have been born were it not for Dr Downes's intervention.
Like the child of an engaged thirty-something who, unsure of her true feelings for her fiance, had reluctantly decided to have an abortion, a decision that conflicted with her Christian faith.
"I don't ever force the issue of religion, but when she revealed she was a Christian I told her to read Psalm 139 in the Bible. It is a beautiful psalm which talks about the sanctity of life," Dr Downes recalls.
"It was to prove a turning point – the young lady decided to have the baby after all. She is now married, with a baby daughter, and is happy and content. She wrote me a beautiful letter saying the psalm had helped her to focus her mind."
Then there was the Asian family, a couple who already had three children under five and were shocked to find another on the way. "They were sure they couldn't cope. They kept saying their family was 'complete'.
"Again, I asked them to think about things in a different way. What is a complete family? Doesn't every child complete a family? I asked them to spend some time just talking together.
"They came back a week later and said they were going to keep the child. They are now exhausted but happy. They have told me they couldn't believe they ever thought about not having her."
Sometimes, Dr Downes says, her role is simply a case of getting people to think about their decision in a slightly different way.
"There are huge implications to having children of course, and that is what people who have initially made the decision to have an abortion tend to focus on. But there are also implications to having an abortion, too, which you will also live with for the rest of your life.
"Quite often the deeply held sense of guilt and grief never leave you, however your life unfolds."
She recalls a lady she met while working in the gynaecology department of a hospital.
"The woman was in her 50s and about to have a hysterectomy. The doctor asked her to recall her gynaecological history and she broke down into sobs, revealing that she had had an abortion when she was 16.
"This lady had gone on to have a family, but the memory of it was still raw," she says.
Today, some GPs are so opposed to abortion that they put up posters in their surgery declaring that they will not undertake consultations with women seeking abortion.
Dr Downes professes herself baffled by this.
While she will not sign an abortion form herself – instead equipping her patients with the information they need to go to a local abortion clinic – she actively wants to encourage those seeking a termination into her surgery so that she can discuss their choices with them.
"The point is that whatever my own personal feelings, I want to help these women. Why would I want to put a barrier up?"
Some women, of course, will regard Dr Downes as more than a little sanctimonious, perhaps even feeling that she is abusing her position in some way. But she insists her private beliefs and professional conduct have never been in conflict.
And as a 'conscientious objector' herself, she has been heartened to learn of the growing number of GPs who see abortion provision as a contravention of their Hippocratic duty to protect and save life.
"Initially, I felt surprised because my general perception of the world is that people are losing their moral compass somewhat, that convenience is the watchword we live by these days," she says.
"But at the same time I think doctors are starting to confront the fact that there is a conflict in the work we do.
"There we are, desperately trying to save the life of a premature baby born at 21-weeks-old in one hospital theatre, and then down the corridor there are women coming in to abort babies at up to 24 weeks. How can anyone say this makes sense?"
The problem is that there is no straightforward solution to the complex and emotive issue of unwanted pregnancy…But her voice is one of many calling for a reduction in the age limit at which abortion is legal.
"The idea that you can still terminate life at 24 weeks seems ridiculous to
me when you have research showing that babies can feel pain at 16 weeks.
There has to be a new debate about this at least."
It is a debate that will continue to rage both in public life and in the
privacy of GPs' consulting rooms across the country.
In the meantime Dr Downes will continue her work, asking the simple
questions that in some
cases can literally mean the difference between life
A version of this interview appears in this week's First magazine.
[7May07, Daily Mail, K. Knight; "Pro-Life E-News" #714, [email protected], 15May2007]