Dr. Luu Ireland is an assistant professor of Obstetrics and Gynecology at the University of Massachusetts. She joined the UMass faculty in 2015 completing Fellowship training in Family Planning. She has been recognized as an advocate for her patients through her work on the state and local level as well as her strong support of resident education. She is a family planning specialist, providing complex contraception and abortion services here in Massachusetts, and a leader in the effort for increased access to reproductive healthcare services.
-A SEED IS PLANTED-
Dr. Luu Ireland is many things – a physician, an educator, an advocate – but the beginnings of any accomplished physician is unique. Her story is that of a girl raised in a bicultural, biracial household and the challenges she faced in her pursuit of knowledge.
“I grew up in a very conservative immigrant household. My mom is from Mexico, my dad is from Vietnam. Reproductive health, sex and anything regarding reproductive function was very taboo in my family and it was not something that was discussed. I grew up believing everything my parents told me. My parents told me that pregnancy was achieved when a man kissed a woman and a man dropped an egg in the belly of the woman. And I believed it with all my heart.”
“The first time I realized that I had knowledge gaps in this area was when I was in third grade. I went over to my best friend’s (at the time) house, and somehow we started talking about how babies were made – and she knew the anatomically correct way that babies are made – and we got into an argument about who was right. The way that many children try to resolve arguments, I said, “How about we both just be right?” And she said, “No, you are wrong. That’s not how babies are made. A penis goes into the vagina, and that’s how babies are made!” And I remember marching home and confronting my mom…and after I explained to her what Laura had said, my mom said “You know, mija – she’s right.” And I remember feeling so disappointed and so betrayed… and it was the first time that I can remember someone lying to me about how my body works. It certainly wasn’t the last time. I think that childhood experience planted a seed in terms of me wanting to maximize my knowledge about reproductive health and making sure that other people around me did too.”
-DIVERSE VALUES & ACCEPTANCE-
In a time when abortion is still a very divisive topic, Dr. Luu Ireland shares her experience with how her family has found a way to allow her to continue loving the work that she does, even if there is a misalignment of values. Because, ultimately, we can all choose love.
“Growing up in a biracial, or bicultural, home means that you never feel like you are really part of one culture. I never grew up feeling like I 100% identified with being Latina or I 100% identified with being Vietnamese. My experience was always diluted depending on which part of the family I spent time with. Because English was not the first language of either of my parents, they only spoke English to each other, so I never learned my native languages. I learned Spanish in college, but I’m not a native speaker, and language is such a big part of culture that it really impacted my ability to identify as fully as I wanted to with the cultures to which I belong. Because of that, there were many culture clashes that I had with my family from early on with many different issues. While the idea of abortion is probably a more loaded topic than some of the other things that we disagree with, it’s not the only thing that we disagree on. We have come to a place of radical acceptance – they don’t agree with it, but now we don’t talk about it, because we choose to focus on what makes our relationship work and not on what makes it not work.”
-THE IMPORTANCE OF KNOWLEDGE-
We (physicians) all learn in our pre-med college classes, and then again during our medical school years, Erikson’s stages of development. In this theory, there are themes of conflict and resolution which pervade an individual’s life, at certain developmental ages of that life. According to Erikson’s theory, through those conflicts and resolutions, all of us (as humans) attain a certain virtue at each stage. Dr. Luu Ireland’s narrative is rich in detail of her conflicts and resolutions, and how that has shaped her perception of the world – how she interacts with that world – and how she chooses to make a difference in that world.
“Growing up, navigating the world of adolescence and romantic relationships and sexual activity, I realized so many of me and my friends had so little knowledge about how to prevent STDs, how to prevent pregnancy, what to do when you get pregnant…and around the same time, one of my cousins had an unintended pregnancy. Again, these feelings of us not knowing enough about how our bodies work came to that surface. I just wanted to be part of the solution, and not part of the problem.”
“I was always a science kid, I was a science nerd. I loved my anatomy class. I knew I was going to go into medicine. I used to always operate on my Rainbow Brite dolls. Moving forward, I knew I wanted to go into medicine and I knew I wanted to combine my love of science with a commitment to serve as an educator on reproductive and sexual health. At the time, I had really wanted to work with adolescent populations because I had felt so unknowledgeable at that time in my life.”
Physicians train for years…many of our prime years are spent in the library studying, and then later, studying in the hospital by taking care of patients. But why do we do all of this? Is it just for the pursuit of knowledge? Or perhaps the pursuit of a stable job and financial security? If you asked most physicians, the theme would be similar and it’s as simple as just wanting to be there, to alleviate suffering and to help with the healing process.
“As I was going through grad school, I applied to med school and got accepted to UCLA medical school. I was actually very torn between family medicine and OB/GYN. Ultimately, I decided on OB/GYN. It’s part of my social justice evolution that I came to know that the issue with people not knowing much about their reproductive and sexual health also extended into difficulty accessing reproductive health services including abortion…and abortion became something that I was really interested in being able to provide in my future career. When I went to OB/GYN residency, I had the mindset that, of course, I was going to be an obstetrician. And I was going to get all the training in providing abortion care. I was going to be able to provide comprehensive reproductive healthcare. ”
“As I was going through residency, (I realized that) although we had abortion training, it was very limited. We were doing mostly first trimester procedures and the women that I felt needed the most help often really struggled to find it. For example, women with very wanted pregnancies, such as one who came in at 17 weeks PPROM’ed - their OB/GYN would just refer them to the family planning specialist. Or the 20 weeker who on her anatomic ultrasound had a fatal anatomic heart anomaly – they were going to be referred out because their provider didn’t know what to do with them. And I just felt like that was so heartbreaking. I didn’t want to be the kind of doctor who, when their patient was going through one of the most painful experiences in their life, was going to send them to someone else. I wanted to be there for them when things got really hard. So that was the first moment where I felt like I needed training beyond my OB/GYN residency to provide the abortion services my patients may need. Because I wanted to be the doctor that, if that was going to happen to my patient, I wanted to be able to walk her through that experience and get her on the other side.”
-A STORY OF SENSELESS LOSS-
Stories define a lot of why we do the things that we do. Dr. Luu Ireland shares a story that she has carried with her. A story that reminds her of why she continues to do work that is often physically, mentally and emotionally taxing.
“During my third year in residency, I did an elective rotation in Kenya and I was really excited about going there and being able to do vaginal breeches and vaginal twins – I thought it was going to be a really exciting obstetrical experience because the other thing that I really love is obstetrics and delivering babies. I just think that it is such a privilege to be there at such an emotionally charged moment at the very beginning of somebody’s life. But when I went to Kenya, I would say that 75% of what I ended up doing was post-abortion care.”
“In Kenya, abortion is illegal. It is completely inaccessible. On paper, it is to save the life of a woman but that is very hard to prove. And when it is so rare, no one knows exactly how to do it. So there was a lot of unsafe abortion and there was a lot of self-managed abortions. Patients would come in with incomplete abortions, septic abortions, hemorrhaging with pelvic infections. I was really blown away that this was really happening in the 2000s in the world. There was one particular patient that tipped me over into doing family planning fellowship. She was a 24yo college student who was brought in by her aunt after delivering a 24-week stillbirth at home (she had 6 months of amenorrhea, which is typically how patients present so she would be in approximately the 20 weeks). She had not delivered the placenta, had been bleeding, was starting to fade in and out of consciousness. When we saw her, we knew that we needed to get her to the OR right away. We got her to the OR, we did a D&C, delivered the placenta, but as we were doing the D&C, her uterus was so necrotic that chunks of her myometrium were just coming out. We converted to laparotomy, did a hysterectomy, and it was a miracle that we were actually able to get blood products because that was so hard to do in Kenya…we got her two units of blood and miraculously, she survived the surgery. I was super excited to check in on her during rounds the next day when I came back to the hospital and I came to find out that she had passed away overnight. She had flash pulmonary edema from all the fluids she had gotten during resuscitation and the one ventilator that existed at that hospital was being used by another patient. And I was gutted by this experience. Not only because we had worked so hard to save her but it was so senseless. This was a 24-year-old woman who was going to college and was going to make a life for herself in a very resource poor country, and it just seemed like such a senseless loss. And it made me realize how important it is to have legal abortion access…and that’s the thing that tipped me over into doing family planning fellowship.”
-FIRST A LEARNER, THEN AN EDUCATOR-
“I went to family planning fellowship after that and I knew that what I wanted to do wasn’t going to stop at me providing abortions. I really wanted to educate other people how to do abortions. I felt like that was how I was going to maximize my impact and maximize access for women seeking this service. So I knew that when I graduated from fellowship that I wanted to work in an academic center. I knew that I wanted to work in a place that didn’t have a family planning fellowship because it was really important to me that generalist OB/GYN’s learn to do abortions as part of their ability to provide comprehensive reproductive healthcare. And so this was the first job I took out of fellowship and I absolutely love it. I’m very, very happy here. I get the privilege of delivering babies – the privilege of doing a lot of complicated contraception – and the privilege of being able to provide abortion services to people who need them.”
-STRESS OF UNPLANNED PREGNANCY IN THE TIME OF COVID-
Dr. Luu Ireland continued to provide reproductive healthcare services at Planned Parenthood as well as at the University of Massachusetts during the COVID19 pandemic. She has been able to witness how the Pandemic impacted the patients she vowed to serve.
“Living and practicing in Massachusetts – we live in the ideal of circumstances. Our DPH at the start of COVID said that abortion was going to be an essential service. Our hospital has really prioritized patients coming in for LARC. We’ve really started to pick up on immediate postpartum LARC – we’re doing telemedicine for all the other birth control counseling that we do that will result in birth control by prescription. But even in the best of circumstances, COVID has definitely presented barriers. When it comes to contraceptive access, a lot of patients don’t realize that we are seeing patients for birth control and will go without it. A lot of patients are afraid to come into a healthcare setting because of the risk of transmission of COVID. As happens with any natural disaster and people staying at home more, the rates of unintended pregnancies are starting to go up. COVID also presents an additional barrier in that so many people are out of work right now and financial pressures on families is higher than it ever has been. I have patients who are not sure how they are going to pay their rent. Patients who are struggling to put food on the table. The stress of an unplanned pregnancy is higher than ever given that families are struggling to make ends meet in a way that they never have before. And so, while there was an initial lull in people seeking abortion services at the beginning of COVID – I think because people didn’t want to interface with the healthcare system – we’re really starting to see an increase now in central Massachusetts. My days at Planned Parenthood have been very long and there’s been a lot of stress from my patients, and there’s a lot of discussion on how COVID is playing into their decisions to end a pregnancy.”
-COVID WAS NOT FAIR-
Physicians like to keep count of things – as Atul Gawande noted so eloquently in his book Better, “Regardless of what one ultimately does in medicine – or outside medicine, for that matter – one should be a scientist in the world…If you count something you find interesting, you will learn something interesting.” We were learning through counting on the labor and delivery floor that COVID was not color-blind.
“COVID has really magnified racial and ethnic disparities. The kinds of patients we are seeing in the hospital with COVID, at least in the OB/GYN world, are by-and-large people of color and people who don’t speak English. And they’re coming in with much more severe disease than our white counter-parts, who are our much more educated and financially-stable counterparts. It is important to realize that being able to “stay-at-home” is a privilege that many of our patients simply cannot afford. ”
Lưu Ireland, MD, MPH
Assistant Professor of Obstetrics & Gynecology
Family Planning Specialist
University of Massachusetts