Thursday, January 7, 2010


This winter, it will snow. And if the snow and ice are bad enough and if the city is unprepared enough, the clinic will close. I worry about the women who are close to the gestational limit, who would get a call from us letting them know their last chance didn't work out due to precipitation. And I worry about the women who would say, "Well, then, I guess God just wanted me to keep this baby." They say that a lot. If they're short on money or if their ride falls through or if our doctor has to leave because of an emergency elsewhere, it's God's will, and suddenly, this unexpected, unwanted pregnancy is OK.

I'm fascinated by these cases and by the whims that govern them. Just moments before one of us sits down with the woman to have the difficult conversation that there's no more time to wait for the money to be transferred, the woman was fervently insisting that this pregnancy couldn't come at a worse time, under worse circumstances. And then, when we voice the cutoff, God's will (sometimes, fate, for the more abstractly spiritual clients) changes. Is that what the woman really always wanted? Was she so desperate to be passive in her decision that she was willing to wait to run out of options? Is that why she was so very reluctant to borrow money or to pawn things to pay for her abortion? If she does give birth, will she be OK? Will her future children be OK? And if we had managed to waive just enough of the fee or if the doctor was able to stay for just one more patient (her), the most chilling question is, would she blame the clinic? Our worst nightmare is having a client perceive that we, of all people, coerced her into an abortion. We don't, we haven't, we wouldn't. Just like I would never completely doubt the woman's sudden bend toward God's will. If that's in her heart one bit, it's right for her. Women, know what is in your heart


  1. I wonder if you will accept a comment from someone who does not share your principles and perspectives on abortion.

    I have experienced an unplanned pregnancy. (I was, however, pro-life before I got pregnant.)

    You wrote:
    “And then, when we voice the cutoff, God's will (sometimes, fate, for the more abstractly spiritual clients) changes. Is that what the woman really always wanted?”

    I don’t know about wanting an abortion, because I never have, but I do know that when I was pregnant your sentences above would have made no sense to me: I didn’t want to be pregnant and unwed, I didn’t want to be pregnant and in the job I was in (I would very likely have lost my job), I didn’t want to be pregnant by the man I was pregnant by – I didn’t really want any of it. If I wanted something, I wanted never to have gotten myself into that situation.

    If there had been some way to simply undo, rewind and never be pregnant in the first place, I would have taken it in a heartbeat.

    I can’t speak certainly for anyone else, but if I had to guess, I would guess that some women who find themselves pregnant in unfortunate circumstances equally wish that the situation simply never happened and would happily accept a “do-over.”

    Perhaps this is where the apparent whimsicality in the women you encounter comes from. Abortion is not a re-wind, it’s not a do-over, it won’t simply make the pregnancy never have occurred. Absolutely nothing can do that. But maybe in desperate circumstances abortion seems close enough, or perhaps those of us who find ourselves in that situation want to believe it’s close enough. And maybe some women who have been there end up realizing it isn’t.

    I ended up miscarrying my unplanned child. I found I didn’t want that either.

  2. As a magical thinker myself, I understand this coping mechanism well. Though, the real world has certainly changed my spin on *god*.

  3. I often contemplate this reliance phenomenon when doing paperwork for women who are early in pregnancy and more likely to experience a missed abortion, as in: what if...

    I'll never forget the patient I advocated for who had a child as a result of a missed abortion. She was a blessed woman indeed. However, I couldn't shake the feeling that her child may have been deprived of key nutrients and exposed to trauma too early in the development and life cycle, as in: What if our faith in religious doctrine, cultural norms, and/or magical phenomena overrides our primal human instincts to survive and/or thrive...

  4. Anonymous, I appreciate your civility and your willingness to share and to talk about something that rings very true to me--You very succinctly captured what a lot of our patients do go through. And some of them identify as pro-life.

    I'm sorry for your loss of that pregnancy.

  5. Elisabeth, I've dealt with that same paperwork and counseled patients after missed ABs, but I've not yet had one decide to continue the pregnancy regardless. It certainly is interesting, and there is A LOT at play.

  6. D.O.W., I do the same thing, but usually or "smaller" things. Otherwise, I'm too much of a control freak, I think.

  7. I absolutely do that too -- leave up to circumstance the decisions I don't want to make myself. It's a tendency I now try to moderate in myself when I catch it, largely because of all the times a client has said that maybe x or y obstacle was as sign from God, or she was making an appointment because her mom was making her, or she was canceling it because her boyfriend was making her, etc -- and all the conversations we then had about that. Whether she was allowing herself to be buffeted toward an abortion or toward carrying to term, I'd always try to make the point that if she didn't make the decision for herself, she could easily end up regretting either outcome, blaming herself and/or feeling depressed. It sort of became my number-one tripwire in counseling.

    Wow, sorry for babbling! Clearly I still feel strongly about this one...

  8. OK, I've been thinking about this more since you wrote it. Maybe I'll blog about it later, but here's what's going around in my head so far: we try so hard to encourage a woman's own needs and wants to come through in her decisionmaking, and in all that we've posted here, the reasons for that have gone without saying. It seems to me like there are a lot of reasons for it, and perhaps some of them are inherent to abortion, but probably most of them can be sorted into two categories: those inherent to all kinds of surgeries and other medical services/products (e.g. pharmacists don't sell drugs that aren't needed, and need is decided by a patient and her doctor and expressed in the form of a prescription), and those mediated by social values around pregnancy (e.g. would we worry so much about a patient's emotional prognosis, so to speak, if we could trust that she alone was in control of what pregnancy and its termination means to her?).

    OK well... my thoughts are getting away from me now, but if you have some counter-thoughts let me know!


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