Thursday, September 23, 2010

(Un)Comfortably Numb

Sometimes when I'm counseling, clients will use the session not only as an opportunity for their questions and fears about surgery, recovery, and choice, but as an opportunity to try to get information about those mysterious other women filling the waiting room. "How far can you do this to?" they ask cryptically, grammatically ambiguously. "How could someone do that?" they continue, pitting their own 6 week abortion against another possibly 23 week abortion. And then I explain choice and circumstances and sometimes they get it, sometimes, they don't. Recently, as I described to the client what to expect, anesthesia-wise, she blurted, "Why would someone want to be awake for this?! That just sounds awful. Knock me out, please."

My opinion doesn't matter, but in the interest of full disclosure and biases, if I were to have an abortion, I'd go with general anesthesia, no contest. Sure, I'd like to know exactly what's going on, partially so that I would better be able to inform clients. But I know myself, and I would be way too tense, way too uncomfortable for my own good, for the doctor's good, for anyone's good, just because that's how I am at any medical appointment. A first-trimester (6-12 weeks) abortion takes five minutes, tops. With general anesthesia, the patient is monitored by a nurse-anesthetist the whole time -- all of ten minutes. The anesthesia travels into the body through an IV in the arm -- no masks, no machines doing the breathing for you. Yes, the medications include Propofol, the notorious Michael Jackson drug, but it's not something the client takes home with her, and if there's anything slightly sketchy in her medical history, we have a long discussion about the risks and benefits of general anesthesia. But generally (no pun intended), a clinic's anesthesia is less intense than what's used for wisdom tooth removals. Clients love it because they don't feel nor remember anything, and they wake up relatively quickly. They hate it because they give up some control, they can't eat or drink anything, they need to have a driver, and because anesthesia is scary. Most of the clients at my clinic choose to be asleep.

Being awake, on the other hand, involves BEING AWAKE. Some clinics offer sedation or narcotics, but my clinic is not one of those. And some clinics offer ONLY local anesthesia -- my clinic is not one of those, either, but it illustrates just how manageable being awake can be. It isn't for everyone. But again, it's a five minute procedure, and because there's no cutting ("surgery" is a misnomer), only minimal dilation of the cervix, being awake is do-able. And in that case, the doctor administers a local anesthetic like Lidocaine via injection into the cervix. The sensitive cervix is numbed, but numbing the entire uterus just isn't possible, and the uterus is going to cramp during an abortion -- it's just the nature of the muscle. Woman have described the cramping as stronger than menstrual cramps, but not as intense as childbirth. And based on my hand-holding experience, those evaluations seem to be pretty accurate. Some women carry on conversations with a few winces, and others nearly break my hand as they scream. Some of the clients choose to be awake because they value being present in their abortion experience. It gives them some power. Others opt for a few minutes of discomfort over the nausea they historically experienced post-general anesthesia. And some just don't see the whole procedure as that big of a deal -- why be asleep for a simple, safe gynecological procedure? Other women would rather be out of it, but with no one to accompany them to the clinic, local is the only choice. And some women opt to be awake just because it's less expensive, which breaks my heart. And speaking of heartbreak, let's not even get into the mothers of teens who insist that their daughters need to be awake so that they can be punished for getting pregnant.

I'm intrigued by this aspect of abortion -- a choice within a choice, as it were. And as a fellow Abortioneer pointed out, the choice of being asleep versus awake varies widely from clinic to clinic, city to city. Readers, what are your experiences with clients' preferences? Have you, yourself, made that particular decision? Does your clinic offer anesthesia experiences other than what I described above?

And stay tuned -- in the coming weeks, we'll also explore things like abortion by pill and why some women love it, some women hate it, some providers heart it, some eschew it. And we take requests: What abortion mysteries or intricacies would you like to know more about?


  1. I have had two abortions. Both local and general. The first one, I was seventeen, driving across state lines to have an abortion in a state that didn't have parental consent. I had to have local for that one. I don't remember if I had the option of general or not. I had never had a gynecological exam, so I was very, very tense. Add to that the fact that I had gone to a CPC and was scared out of my mind that I was going to die by having an abortion. Seriously, I thought I was going to die, but I still knew I didn't want to carry the pregnancy to term. After the abortion, the doctor came to see me in the recovery room to tell me I had done a good job, and apologized for the CPC. I get teary when I think about how kind he was to me. He didn't need to do that, and I am so grateful for him, for how he treated me. I felt like a person, not just a number. And that makes me angry when I think about how anti-choicers make abortionists into these butchers who have no feelings for their patients. Because, he did. I knew he cared. Probably he wouldn't remember me today, but still...I remember him.

    The second abortion eight years later, I had the option of general and I took it. I am so glad I did. The situation around the second abortion was so different. I was severely sick with anorexia, taking OTC diet pills. We were on BC, but it failed. I was scared I had caused harm by taking the pills. So I knew I couldn't go through with the pregnancy. Even though I had a very positive experience with my first abortion, I still...well I was still nervous. I remember coming out of the anesthesia and being all giddy that it was over, that it wasn't as bad as I had thought it would be. If I had to do it again, I would take general again.

  2. Awesome post, thanks D! I would also like to know if any abortioneers work at clinics where "general anesthesia" DOES mean a breathing machine, or inhaled gas, or some other option that is not IV-administered as described here. Is there anyplace that uses nitrous oxide instead of full sedation? And if your clinic offers "twilight sedation," what does it consist of there?

    I'd imagine that the possibilities are even more complex in hospital settings. And perhaps more narrow (local or bust?) in a private doctor's office.

  3. After having two abortions, at two different clinics, and working in two different abortion clinics, in two different states, I would opt for local with sedation, if the clinic offers that.

    With both my abortions, I had general anesthesia. With the first I was very upset, which may have been why I woke up to the taste of vomit in my mouth. The nurses and doctor were very professional, but very rough - I wanted a few minutes to calm myself down, was told we don't have time for that," an IV was stuck in my arm, and I woke up in the recovery area.

    The second (at a different clinic) was MUCH more pleasant. I knew exactly what was going to happen, the nurses and doctor were MUCH nicer, and I woke up feeling loopy but fine.

    At the first abortion clinic I worked at (in fact, the same clinic I had my second abortion at), there was the choice of general, local, or local with sedation (I don't recall the medication used for sedation). Patients chose them for their own reasons, except when circumstances prevented (the gestational age of the fetus, certain medical conditions, etc.). There wasn't a lot of differences in the emotional experiences of the women who had general or local - some woke up crying, some woke up smiling, some cried during the whole procedure, some didn't even flinch.

    At the abortion clinic I worked at recently, the only options were local or local with "sedation". The medication used was Ativan (lorazepam, an anti-anxiety medication). Most women had good experiences with it, some said it made no difference, others actually fell asleep during the procedure. The side effects seem to be much gentler than with general anesthesia

  4. Excellent post -- really demystifies abortion care. Yay!

    When I worked at a clinic, we offered local anesthesia. The experience varied from woman to woman -- many couldn't feel anything at all, some felt everything as if there was no anesthesia, and many were somewhere in between. I think most women would choose general if they could, but many a) couldn't afford it or b) didn't have someone to pick them up afterwards (a clinic requirement). Some women chose local because they wanted a faster recovery time.

    Many choices within a choice.

  5. I work at two clinics, one provides local and "twilight" anesthesia and the other has local, "twilight" (aka: IV sedation) and general anesthesia. At the first clinic, the patient receives ibuprofen for the local procedure - that's it. The second clinic provides ibuprofen and xanax. Some women come out of procedure saying it was easier than expected, others report it as the most painful experience ever. It seems based upon an individual's pain tolerance. However, almost every patient reports the procedure as being faster and less traumatic then she had expected.

    As for the twilight sedation, it is a mixture of two medications provided in the vein through an IV - our patients are awake, but the cramping is minimized. Of course, GA involves us sedating the patient completely.

    Many of our patients who opt for the local procedure do so because it is cheaper. Others because they have children to care for at home and need to be alert and oriented (not groggy) to care for them upon returning home. And others, sadly, don't have support and need to be able to drive themselves home.


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