Sunday, October 31, 2010

The Least Balanced Among Them

Sparky wrote a post about the Rachel Maddow documentary "The Assassination of Dr. Tiller."

I watched it, and thought it was very good. I was expecting to get extremely emotional watching it, but I did not. Seeing Dr. Sella get choked up was very moving, the patient stories, obviously -- but for the most part, I kept it together way better than I was anticipating.

For me, the best point the documentary made was expressed by one of Dr. Tiller's staffers. Essentially, she was saying that anti leaders, like Troy Newman or Randall Terry, are culpable to some degree for the behavior of people like Scott Roeder. She said, and I am paraphrasing here, that they use language of violence, murder, and hatred to incite people. Then, when the least balanced among them acts out as a result of that, they stand back as if they are not accountable and had nothing to do with it. Not unlike how when a football player does something wrong to a player on the opposite team, and then afterwards, when a flag is thrown and he gets caught, he stands there with his hands up as if that somehow proves he didn't do it.

Did I do that?

It is very important for the mainstream media and population in this country to understand this concept. Not just for abortion rights, but a variety of extremely important topics. For example, Fox News saying Obama is a Muslim over and over and over and over and over and over and then acting like it is an interesting news piece / revelation when most of the viewers of Fox News think Obama is Muslim. Similarly, when Bill O'Reilly calls Dr. Tiller "Tiller the Killer" on Fox News 30+ times, it's no wonder then viewers of the program start to view Tiller as not a person but a mass murderer.

The problem lies in where exactly the line of culpability starts and ends. Obviously, it's very complicated and difficult to ascertain. It is mostly shades of gray, and that is why they can get away with it.

I think, generally, the rhetoric of hatred that is so pervasive in this country seriously needs to subside. Hate breeds hate. I have no problem engaging with anti-choicers about the issue and talking about it. Note the word "talking." Talking implies two or more people are participating in a dialogue. I am more than happy to do that. If nothing else, it will help me understand where he or she is coming from better. I have a really hard time doing this, though, when the person is incredibly fired up, saying things that are blatant lies, and seem totally okay with the murder of my colleague. The least balanced among them - those who harass, shame, stalk, humiliate, murder - they are ruining it for everyone.

It would be nice if anti-choice folks were more willing to regulate the behavior of the extreme among them. Their leaders, Randall Terrycoughcough, seem more than happy to embrace their behavior.

Thursday, October 28, 2010


This past week I have unfortunately been spending most of my time with a loved one at the hospital. This person is extremely important in my life and he suffered an accident, which required surgery and subsequent rehabilitation before he can go home. I have always felt relatively comfortable in hospitals seeing as I grew up with parents who worked in one and I have spent most of my post-college career in various public health roles. Spending this week in the hospital as a “visitor” has given me new perspective on healthcare and how so many people go through procedures alone. The first day we were in the emergency room surrounded by patients in serious condition who were all alone. A man near us who had serious head trauma stated that he did not want to bother his family. When we went to see my loved one in recovery the nurse seemed shocked that there were so many of us to visit the same person. I have always taken it for granted that when I have health issues my family and friends will physically rush to be by my side.

When I worked at an abortion clinic we offered clients the choice to have local anesthesia, and many women chose this because they did not have anyone who could accompany them to their appointment. The law required that anyone receiving general anesthesia must have a “driver” to take them home and for many women there were too many barriers to finding someone to fill this role. Some women seemed happy to have local because they simply did not want to tell anyone about their abortion. Some women struggled with the fact that none of their friends or family were willing or able to be with them. Some women were planning on having general and had a driver with them at the beginning of the clinic day but for various reasons their driver refused to wait the long hours and left them there with no other option but to be awake for the procedure.

The organization I volunteer with works with women who are required to have a “driver” since their two-day procedures necessitate anesthesia. The main piece of our organization is providing them housing between the two days, but we also serve as the legal person who picks them up from the clinic after their first day (and sometimes second day). Since 2006 about 40% of the women we host are alone when they come to our city for an abortion. Over the past year I have started to view myself as more than just a host, rather I am there to help them feel less alone in what can be a very overwhelming, exhausting, and emotional experience. Many of these women have never traveled to a big city, and I serve as a semblance of support for them. I am the non-judgmental friend who is there to listen, to hug, or just to sit in silence with. I try to schedule my shifts so that I am free the morning of their procedure in case they want me to stay at the clinic so they are not alone. I am not required to do this, but I want them to know I am there for them in case they need anything or for some reason there is a problem.

As I mentioned above, some women want to go through the abortion experience alone, because an abortion is after all a simple medical procedure. However, for those women who travel hundreds of miles to a foreign city and have to stay in a stranger’s home, I try to provide as much support and comfort as I can. I always ask women what they want or need from me because no two women are alike in their experience. I try to help them feel less alone, not just physically but emotionally. I always check in with them by phone the night after and then a few days later to let them know I will remain there for them. Abortion provision is certainly a broken system, but I like to think there are many others like me out there helping women to feel a little less alone.

Wednesday, October 27, 2010

Staying Motivated

We know doing direct service abortion work can take its toll. After reading our dear Desembarazame's recent post, Trust, I got to thinking: what can we do to keep ourselves motivated? We've talked about how to not burn out, how to take care of ourselves; but what can we do to stay on fire, to keep "burning-in" day in and day out?

I loved what Desembarazame said about wearing her "Trust Women" button (and believing in it to her bones) and about dancing around in the building. I can imagine her - as I'm sure you can, too - bringing a lot of happiness and light to her clinic. I totally wish I worked with her!!! (She would completely rock as a co-worker, wouldn't she?!) I relate to how despite believing so much in what we do, it can be exhausting. Especially in times of change. Especially when co-workers are all up in eachother's business. Especially when I'm annoyed with some decision that someone has made.

Some motivation tips:
1) Share client stories with co-workers (even when they're being - err - a bit challenging. I'm talking about your co-workers, not the clients!).
2) Try to have direct contact with clients, make a connection (remember why you're doing what you're doing).
3) Pick people's brains that have done the work longer than you: ask them for stories from "back in the day." (They'll probably love a skip down memory lane.)
4) Read the Abortioneers Blog!! (Cheeky, I know!)
5) Or...STOP reading about abortiony stuff and abortionland! Take a break! (But not from our blog. OK? Please? Oh, well, alright. If you need a break, it's okay. We won't judge.) :)
*5) Take a long weekend off. No, not just from our blog...from your job, too! Yes, I'm serious! Play hooky! You have our permission! (Uhm...just don't tell your boss!)

In all seriousness, sometimes we need more than a weekend hiatus. Sometimes we need a few months. Or a year. Or longer. It's okay. Honestly. It is.

What kind of things help all of you not just avoid burn-out, but get you to BURN IN (per Jack Kerouac, per Daughter of Wands), to stay motivated?

*PS: We don't endorse lying to your employers. But we know everyone plays a little hooky-hooky sometimes. Just don't call in on a super busy day, like, when people are on vacation or you have clinic!!!!! Be a good co-worker and play sick responsibly!

*PPS: No, don't show this to your HR Manager. And no, we don't offer sick notes: fresh out!

Tuesday, October 26, 2010

Thanks, Rachel Maddow

you are the shit

If you haven't already heard of or watched it, last night Rachel Maddow's show did a special episode on Dr. Tiller's murder. I was unable to watch it because of my lack of cable, but I definitely plan to locate it on the wonderful interwebs.

Here is a brief clip of Maddow interviewing Dr. Elizabeth Newhall. Maddow and Newhall discuss the "WANTED" ads created by anti-choice radicals that target abortion doctors and threaten their lives. I would like to thank Rachel Maddow for broaching a subject that most mainstream media just won't. Abortion providers are endangered. When I am in the clinic, particuarly if I'm alone, I am always very vigilant about making sure doors are locked and I check security cameras countless times a day. It's mad what we, abortion providers, have to do just to do our jobs and help others carry out their choices as they see fit.

Please share if you were able to watch Rachel Maddow's show last night -- what did you think of it? -- or if you know a good way to watch the whole thing online...

Thanks to our com mentors the link above will bring you to the whole episode or you can read commentary for multiple ways of viewing the episode!

Monday, October 25, 2010

A surprisingly delicate subject*

Lately I've been spending more shifts in the surgical suite, where I check on patients' wellbeing after their abortions, sterilize instruments, or play some role in the procedure itself. Often that means serving as a "patient advocate" (attending to a woman's emotional and physical experience of the procedure, similar to the role of abortion doulas) or as an interpreter. But I'm also spending more shifts assisting the doctor providing the abortion, and that means seeing lots of vaginas.

Vulvas, to be more exact, of which the vagina is really only a small part. And here's one thing I keep incidentally noticing when I'm on this side of the sheet and stirrups: many women's vulvas are shaved! Not merely trimmed, but all the way de-pubed (whether bald or stubbly).

I don't want to be overly crass. And I'm certainly not judging -- over the years I've gone through many "hairstyles" myself. It's just that I started wondering why it's so common. I came up with a couple of possibilities:

1) That's just a lot of people's preferred habit, and the appointment day is just a day like any other.

2) You've heard that before a surgery, you're supposed to shave the area to be operated on. You figure that might be true of a "surgical" abortion even though you've been told there's no cutting involved. (You can't automatically know that a sterile speculum will be used to hold your vagina open, so that the sterile dilators and cannula don't touch your vulva on their way to your uterus, which is much more sensitive to germs than your vagina or vulva.)

3) A stranger is going to see your vulva, and that makes you anxious about being hairy. So you shave before going for pap smears, and this gyno visit is no different in that respect. You've seen "Knocked Up," and that woman's vulva -- in the middle of giving birth -- was, well, strikingly bald. Actually, how did she pull that off with her theatrically giant belly in the way? If Katherine Heigl's body double (vagina double?) had to be shaved for a delivery scene, it must mean real-life women ought to be trimmed to that aesthetic at a moment's notice, because what if you have to go to the doctor? A shaved vulva is basically the new clean-pair-of-underpants, amirite?

In contemplating these, I found myself really hoping that #3 is not at play, because I'd hate for an appointment that's likely staffed with strangers and already stressful to generate that unnecessary layer of extra anxiety. Note to potential patients: Don't worry! No one here will have a problem with your hair. At least at your abortion, of all places, of all times, I hope you can rest easy with your vulva the way it is.

Unfortunately, I also found myself thinking that my least favorite hypothesis seems like the most plausible.

And with that, we conclude the shoddiest descriptive study ever.

*The hesitation I felt when writing this post did take me by surprise. I blog about abortion, for chrissake! What could be a more delicate subject than that? But take an important personal decision, mix in the "violation of privacy" feeling that many of us get from any brush with the old stirrups and duck-lips, and then bring up pubic hair, which at a minimum probably calls up most people's anxious memories of being twelve years old and wondering if you've got too much, too little, too bushy, too wiry, omfg...And suddenly adult-you can't figure out if this feels weird because you're violating HIPAA (you're not), because you're talking about something dirty (you're not), or because you're acknowledging you saw people's vulvas (well, duh). (Otherwise you'd be doing abortions blindfolded, right?) (PPS, a nurse friend recently told me that standard nursing textbooks instruct to "note hair distribution" during a vaginal exam!)

Anyway -- I promise I wasn't staring; I promise I didn't take mental note of how much you, as an individual patient, grow/trim; and I promise that whatever you personally do with your personal hair is no biggie to me. We'll offer you safe, friendly care no matter what's underneath the sheet. Even if for some reason you've got it
painstakingly waxed into an Italian status symbol.

Thursday, October 21, 2010


I'm not an optimist by nature, but by God, I force myself to be one. There's enough negativity in and around abortion care; no one needs me to be a grumpy, jaded provider. I dance at work and joke with clients and hype up my co-workers and proclaim my love for the clinic from the rooftops. And sometimes, it's the most exhausting part of the work I do.

I wear a "Trust Women" button like the one worn by Dr. Tiller. I believe it with all my heart and it's the reason I go to work every day, ignoring the protesters, ignoring my lower back pain and sciatica after 12+ hour days. I've sacrificed relationships and friends and sleep and food and health and leisure time and luxuries and vacations for this job. I do it because I trust and love every woman who enters my clinic, and I value the work I do. And I know that the clients appreciate all of us providers. But they don't always trust us.

Women constantly ask us if our clinic is clean, if real doctors perform the abortion, if they'll be infertile, if they'll get breast cancer. They call afterward and accuse us of "leaving something inside of me," they blame their stubbed toe on something we did, they call us money-hungry whores because we can't secure enough funding for them. And it hurts so much and it makes me so angry to constantly be the enemy, no matter what. Providers aren't perfect, but we're good and selfless people and we deserve trust and respect.

I'm sorry I can't be your regularly scheduled, sunny Desembarazarme, but I'm human and I struggle, and I trust you to be here for me.

Wednesday, October 20, 2010

Nice save

Ahh, I just love the smell of lunacy early in the morning.

The time is upon us: "40 Days for Life" is well under way across the U.S. and other countries. I took a moment to peruse the website and found some real gems. Here is my favorite, from a collection of what appears to be soundbites from 40 Days participants:

"Learning that the 'free ultrasound' coupon worked, convincing women to get ultrasounds – and saving lives "

I'm so glad that your scheme "worked", and it doesn't sound the least bit conniving or devious. What a farce; tempting women with coupons? How about you offer her some free childcare for that baby she's about to have that she can't support? Which is not to mention that ultrasounds are also provided in ab clinic, but that's a different can of worms.

In the corner of the website there is this ticker:

September 22 – October 31
Day 29 – 346 babies saved

More like 346 women harassed, accused, guilt-tripped. Oh wait, it's more like a billion women. Those 346 are just the ones who actually stopped to listen to you, who either didn't want to have abortions in the first place or who didn't know where to turn for real information and advice and fell victim to your lies and injustice.

In a list of ways for antis to "get involved", the lovely folks at 40 Days recommend the following:

"And please consider fasting. Some people are unable to fast from food for health reasons; that's understandable. Fasting simply involves renouncing an activity that can put a barrier between you and God. It could be television, the internet, chocolate, coffee, etc. You really can do without it. Take the time you usually spend in those activities and give it back to God."

Yes, please starve yourselves. Not only will it do nothing to end abortion, but it will hopefully reduce your anti vigor and I can enjoy a peaceful walk to work. Maybe you can "fast" from being lazy idiots and go help people in need. Clean up one of the filthy, drug-paraphernalia-ridden parks that unplanned children are playing in/being kidnapped and raped in. Or are you too afraid to know how some people really live once they drive away from that clinic? Maybe. All that matters to you is that you have your chance to scream at people during your free Saturdays and head back to cushy homes where you don't have to worry about others' problems. Helping your fellow man, indeed.

Do us all a favor; if you really want to make lots of happy children why don't you start making this world a better place for them. Better homes for our children mean better communities for everybody, including yourselves you anti pricks.

Tuesday, October 19, 2010

About Face

The sisters opened the clinic named after their dead mother three years after the Supreme Court acknowledged a woman’s right to privacy not her body. For the first two decades, patients kept thanking anyone who would listen for sparing their husbands and children, their cervixes and uteruses, for saving their lives. A bulletin board of flowery thank yous used to hang in the clinic entrance. The entrance was firebombed in 1993. The half-burnt bulletin board is propped behind the refrigerator in the staff kitchen. The last thank-you note was posted in 1988 when the eldest sister still doled-out stain glass hearts to each patient in the recovery room. The clinic was once tall sanctuaries and windows overlooking a river, and the body positive art in every corner was emulating. Beamed ceilings were enclosed with brick walls and curvaceous everything else. A patient who remembered her first abortion in a basement off an alleyway with cold, rough hands in the same stark and struggling neighborhood was enamored by the sense that she was not only safe, she is celebrated. Her uterus is a muscle. Her body is a temple. After the fire, the sisters moved, not because of the stench, but because the city built a baseball stadium in its place. Right field was once the abortion clinic where patients were grateful. The second abortion clinic was hard to buy. Landlords taunted by anti-abortion zealots cancelled paperwork. The sisters had to measure the widths between the walls, the distance to the nearest hospital—St. Mark’s. The sisters store the tissue in the basement, and the middle sister is the only one to integrate their clearance, to mop borderless square feet in the dark and not dream of babies floating down hallways without any light. The patients were living in-truth, and protestors were retired soldiers from extremist churches still hiding twenty-miles out of town in the cornfields. Even priests were feeling grateful for the retreat from networking with rogue ob-gynecologists on behalf of pregnant confessors with seven children and drunk husbands. The youngest sister used to stand outside the entrance and wave away depraved men in high-water khakis and yellow butterfly collared shirts with a rain stick. Sometimes the patient and the sister would hold each other and weep for a few moments once past the locked and taunted doors before they ever blew-up. Inside, the patients immediately felt home. The clinic is still in the same neighborhood, but it is a freestanding, neighbor-less building and there is a private parking lot. The parking lot is fenced like a fortress. The protestors have mellowed but insidiously expanded to pray their thing outside alleyways, in the pews every Sunday, on Capitol Hill. They are each about three steps away from the property, less than three steps away from snapping and murdering a doctor, one unintended pregnancy away from having an abortion. The abortion patient thinks the hatred must have a point, that lines in the eyes of the father have been crossed. The patient is pissed to be here. The youngest sister begins to smoke nonchalantly to guard the surgical entrance to the clinic as the clinic awaits the doctor. She watches anti-abortion rhetoric undulate into the enclosed lot to suck on patients’ eardrums before they enter the clinic. She watches protestors become patients. The middle sister wipes the body art with cleaning oils, arranges the screens between the beds in the recovery room to let the ch’i fill the room where everyone bleeds. She whispers wishes into dream catchers that hang over every padded lounge chair. Someday soon the gratitude will come home. The eldest sister champions spaying and neutering cats and dogs. She installed a kitty-course along the ceilings of her quaint, deteriorating mansion. She lets the evergreen bushes grow. No one leaves one-hundred-thousand earthworms on her doorstep for it.

Sunday, October 17, 2010


Mirena IUD

I have an IUD. I am pretty much in love with it. Over the years, I had heard all sorts of things about them, but the biggest thing was that IUDs were mainly for married women who were done having children. AKA, not me. It also seemed like kind of a pain (pun intended) to get it inserted, cost alot of money, etc etc etc.

Well, first off, pretty much anyone can get an IUD. You don't have to be married, or "done" having babies. It turns out, IUDs are recommended for post-having babies women because giving birth stretches out your uterus, which makes the IUD insertion generally less painful and less likely to be expelled. However, that doesn't mean you can't get one if you haven't given birth.

Since I was no longer happy using oral contraceptive pills, I decided to take the plunge and get a Mirena in June. The ENTIRE thing was covered by my insurance so I figured worst-case, if I hated it, I could get it removed after three months and then go back on the Pill. I was pleasantly surprised to find the insertion wasn't terribly uncomfortable. I had cramping and spotting afterwards for a few weeks on and off. Then it was over and everything has been going swimmingly since.

I bring this up not only because I think the IUD is an underutilized form of birth control, but also because post-abortion and post-partum IUD insertion is becoming a growing trend here in the US. Since the cervix is already dilated and you already have your feet in the stirrups, it's a pretty convenient time to get your birth control taken care of for the next couple years. In addition to the convenience, there is also evidence to suggest this is a particularly useful form of birth control for low-income populations because it lasts for so long and does not require a lot of maintenance (versus having to go to the pharmacy every month to pick up pills, pay for the pills every month, etc). Plus, getting an IUD inserted at the time of an abortion is helpful because it saves the woman an additional trip to the doctor.

A very low percentage of U.S. women in general use the IUD, and even smaller amount of low-income women use it. Studies have suggested about 1% of low-income young women use it as a method of birth control. Informed counseling, I think, can change this, and there are programs out there which offer IUDs for free/low-cost to qualifying patients. For clinic-working abortioneers out there, if your clinic doesn't offer IUD insertion, or have discounts for low income women, it might be worth checking your state laws, programs, etc... maybe something is out there.

Thursday, October 14, 2010


In a recent chat with fellow Abortioneers, the question arose of whether it is possible to work in Abortion Land without being a feminist. About a Girl recently expressed her discontent at the diminishing sense of feminism in our clinics, superseded by a for-profit model that shifts the focus from the woman to the service-payment exchange. I can't really begrudge that; you provide a service that people want, one that will never diminish in demand, and you've got a pretty steady stream of income. It's good business sense, not personal. Then again, it's not a dental office. It's an abortion clinic. Women go there to make some of the most important decisions of their lives. Shouldn't the clinics give a damn?

I suppose, by default, if you are providing a service that advances women, you hold some feminist ideals. Even if you are just a health care tycoon by day, the fact that you enter into the line of abortion fire confirms your feminist leanings. I would agree with that. But if I were to ask the manager of a large clinic chain if he were a feminist, what would he respond? Might he identify as a not-feminist, yet still commit to his position and intend to provide quality services? I would agree with that also.

I think there are two separate ideas at play: feminism and Feminism. You can be feminist, and believe in "the radical notion that women are people", or you can be a Feminist and officially align yourself with a cause that holds certain and specific ideals. And while this distinction may seem slight or nitpicky, I consider it important in distinguishing the who from the what, the estar from the ser.

Example: I have Depression. I am a Depressed person. This is a label that I wear, because having a clinically-diagnosed, chronic mental illness that necessitates treatment with drugs and/or therapy is a part of my being. It is a part of who I am, and not just a condition or a state. I rally 100% behind the Depression cause, because it is a struggle I will likely battle throughout my lifetime. On the other hand, some people are depressed. They feel sad from time to time, but not for unusually long periods of time. They may seek drug or psychotherapy, but those avenues are not essential to alleviating the condition. Depression is not an part of their being, but it is something about which they have some feelings, however strong, and experiences that do affect how they react and respond to life circumstances.

Wax philosophical, much?

The point is, I think that people are generally able to relate to feminist causes. People can stand behind women obtaining education, women receiving equal pay, and women having the same opportunities as men without too much debate. I believe in all of the above, and then some, but I can't say I stand 100% behind all Feminist ideals. Frankly, I feel there are too many different schools of thought, too many "waves" to keep track of, in order to arrive at a cohesive and concise definition of a Feminist movement. And so, I appreciate that folks can support and even enable a woman's right to choose without having to declare a commitment to Feminism per se. Maybe it's because they don't like labels. Maybe because they consider capital-F-Feminism to be a movement in a more stringent sense that they don't feel comfortable aligning with. Or maybe because, sometimes, you don't really need to give a special name to what it is that you do. Because you must. And no matter what you call it, you are in it for the women.

(That said, I absolutely adore About a Girl and love her post!)

Wednesday, October 13, 2010

Laughter is the Best Medicine

Is it just me, or do Abortioneers have a wickedly amazing sense of humor?

Humor as a coping mechanism cannot be underrated. Our work is incredibly stressful, let alone isolating. We spend time with women who can be in crisis mode, and we, by default, take the brunt of their stress. In the very least, we carry their stories in our hearts, taking on a bit of their lives with us (even if we try not to). Stories can weigh on our shoulders, but we can’t exactly go home and unload to the non-abortiony people in our lives. They wouldn’t get it anyway. And we can’t violate patients’ privacy. So, the people we really rely on our are truest allies: our co-workers.

Enter humor. My co-workers are hilarious and can make fun of the most “dark” of situations. Like protesters and violence that ensues: “Hey, Kara! If you don’t come back from escorting that client, can I have your penis pen? No?! Shit! What about your original Tiller Attitude is Everything button?” They make fun of each other with quick wit. There are things you’d only hear abortion workers wittingly joke about: aspirators; forceps; stuck condoms; flavored lubricant; sex; vaginas; cervixes and uteri. We laugh about tampons and periods. About blood. The humor lets us speak the unspeakable. Express fears of violence and discuss the visceral aspects of abortion (like the smell of blood + the autoclave = “clinic”).

So give us some humor love. What are some of the super funny things you’ve recently heard your co-workers talk about? Let it out. Have a good laugh.

Monday, October 11, 2010

Love and Rage

I often transport patients after their abortion. After the doctor has completed the abortion, I help the woman off the procedure table and into recovery while a medical assistant disinfects the procedure room. The clinic I work in does not offer general anesthesia and we sedate very few patients. So typically I am transporting patients who were fully conscious  during their abortion.

Some patients get up and want to walk out of the room with little help from me, others grab my hand like they have known me forever, some women cry, others grimace in pain, and some chit chat with me. I always tell them whatever pain they are feeling will decrease dramatically during recovery and afterwards. I walk them into recovery and help them get situated while the nurse begins to take their post-operative vital signs.

I often tell women the best way to tell how you will feel after your abortion is how you feel going into the procedure. When women cry buckets of tears in recovery I feel sad for them. I feel sad they are in whatever predictament life has wedged them into. Some women are silent, they stare at the floor or close their eyes. I want to tell women: Don't feel shame, don't feel sad, it's OK! So often, I believe that sadness is about the larger circumstances of their life that may have caused them to choose abortion. Whenever I see a woman go through these kind of emotions I try to ensure she gets information for post-abortion counseling.

When a woman goes through with the procedure because she feels like she has no other option, I'm saddened because I want women to have the ability and resources to make their own choice. I don't want women to have abortions because they feel like there is no other choice that could work. I see patients who are sad after their abortion just as often as I see patients who are elated they aren't pregnant anymore.

When a patient thanks me and tells me how comfortable she felt in the clinic I'm overjoyed, I know we are offering quality care. When a woman returns for her follow-up and looks like a new person, or like the weight of the world has been taken off her shoulders, I'm overjoyed. When a woman walks to recovery with relief written across her face I feel fulfilled and I know that we have provided her with a needed service.

Recently, I heard a male partner in the waiting room say, "No one who is here, wants to be here." And it's true, no one want to face an unintended pregnancy. The nature of the work I do fills me with love and rage. I'm enraged when people protest the clinic and when the state passes laws that make my job harder. I'm enraged when partners, parents, and friends are not emotionally supportive of the women they escort into the clinic, I'm enraged when a woman tells me she doesn't believe in abortion but her circumstance is different.

I am filled with love for each woman who walks through the clinic no matter what choice she makes. I hope for every woman she has someone in her life who can treat her with love and compassion after her abortion. The fact is a lot of women are alone, and a lot are accompanied by a minimally-supportive partner or friend. I wish I could make a pamphlet for support people who bring women to the clinic. I think it would go something like this...

Post-Abortion Support:

  1) Rub her feet, her back, anywhere she wants massaged
  2) Buy her favorite food
  3) Rent her favorite movie
  4) Clean up the house for her
  5) Cook her dinner, and breakfast the next day
  6) Listen
  7) Leave her alone if that's what she wants
  8) Pick up her prescription
  9) Take care of the kids or the dog or whatever else might need taking care of
10) Most importantly, trust her and listen when she tells you what she needs

Thursday, October 7, 2010

Beyond the First Trimester

Pictured: Misoprostol tablets

Correct me if I'm wrong, but I feel like most people who know what's up know the gist of a first trimester abortion procedure. The cervix is minimally dilated, the doctor inserts a small plastic tube through the cervix and into the uterus, the tube is connected to the aspirator, which creates gentle suction to remove the pregnancy tissue, it takes five minutes, all is well, some cramping and bleeding are normal as the uterus return to a non-pregnant state. Everyone get that?

But the second trimester abortion is more shrouded in secrecy, maybe because it's less socially acceptable or because fewer clinics offer it or because it's less common (most abortions take place in the first trimester). I'm not going to get into why women do have second trimester abortions because it doesn't matter. Jezebel offered a pretty comprehensive explanation a few months ago about the ins and outs of the second tri procedure, so I wanted to offer an overview of the process and technicalities. Again, this is based on my own experiences and my clinic's protocols. Your mileage may vary.

A second trimester abortion is known as a D&E, or a dilation and evacuation procedure, and it takes place over the course of two to three days--that's the dilation process. The evacuation part is only about 10 to 15 minutes. There's still no cutting involved--everything is removed through the cervix, and it's still a minimally-invasive and safe procedure. But since the fetus is more developed, the cervix needs to dilate more to accommodate the instruments and the removal.

There are a few options for opening the cervix, including the use of Misoprostol, a medication that softens and opens the cervix or a clinician inserts small, sterile seaweed sticks called laminaria into the cervix. Sometimes, the client takes an anti-anxiety medication beforehand, and some clinicians use local anesthetic on the cervix before inserting dilators. The insertion is quick and the woman can't feel the laminaria once it's in place. It remains snug in the cervix overnight and it absorbs moisture which gently dilates the cervix to the appropriate amount. A dilating cervix causes cramping, but it's manageable, especially with pain medication and heating pads.

If the woman is measuring later in the second trimester, the doctor might also inject Digoxin, a common heart medication, through her abdomen and into the uterus in order to stop the fetal heart. This usually happens on the first day of the procedure, after the laminaria is inserted. Because the cervix is opening overnight, there's a small risk for miscarriage, so this injection is a preventative and humane measure.

The client usually spends the night near the clinic. Clinics are not equipped with overnight facilities, so the client stays in a hotel or with a friend or with someone like Vegan Vagina. And women leave with lengthy instructions and lists of phone numbers in case of emergency. If all goes well, the client returns to the clinic early in the morning for the procedure, itself. It's performed under general anesthesia or with some type of sedation. The doctor removes the laminaria if it was in place and then removes the fetus using suction and instruments similar to those that are used for a first trimester abortion. the process still doesn't cause any problems with fertility, health, etc. (I cannot say that enough.) It's normal to have more cramping and bleeding than after first trimester procedures because the uterus kind of has further to go back to normal, and the woman is more likely to have increased breast tenderness. But it's safe, it's do-able, and most importantly, it's completely necessary for the freedom and well-being of women. And because we, as providers, spend a few days with women going through the D&E process, women and their families who have entrusted us with their freedom and well-being, it's also special for us. Thank you, women.

Wednesday, October 6, 2010

26 by 26

As I enter my final weeks of marathon training, the number 26 is constantly looming overhead. Yet when I hear the number 26, my very first, knee-jerk thought is still of abortion. For most people I train with, hearing "26" would immediately conjure up the miles of sweat, pain, and tears that will constitute their marathon. But for me, even after two and a half years of being a runner and training for this marathon goal, 26 still reminds me of the last moment a woman can legally obtain an abortion in Georgia. Why? I lived in Georgia for ten years and was extremely active in pro-choice activism and also worked for two years at an abortion clinic. Our clinic had doctors trained and licensed to provide abortions up until 26 weeks, and we probably saw on average one woman per week who was 26 weeks into her pregnancy.

Training for a marathon is a painfully solo endeavor. Every step that a runner takes is deliberate and intentional. I can make the decision to stop at any moment and it won't affect anyone else. Even when I am running with teammates or friends I have to rely on my own determination to get through a run and to not quit early. In an ideal world pregnancy would also be intentional and chosen freely, but this is often not the case.

The first race I ever trained for was a half-marathon that I completed through Team in Training, a fundraising team for leukemia and lymphoma. Every week at our team runs, we were reminded of why we were fundraising and training, and that our participation would fund treatment for cancer patients and research that would lead to a cure. We met cancer survivors and children currently going through treatment--constant reminders of the parallels between our journey to a race and their journey to a cure. My difficulties were not physical but mental, and I had to constantly talk myself into continuing, convince myself that I could finish. There were many times where I reminded myself that what I was going through was very minor compared to the challenges confronted by people living with cancer. This might seem a bit dramatic, but for some reason it worked. It kept things in perspective for me and made the pain and misery go away. I felt selfish for complaining about running: if that was my biggest complaint then I should consider myself lucky. I started changing my attitude and found myself coming to appreciate what my body could take on. I won't say that my first half-marathon was easy--it certainly was not. For the last five miles I was pretty unhappy and just wanted it to be over.

A combination of factors has led me to enjoy this marathon training much more than last time. I have been a runner for 2.5 years now, so I had a much better base to start from. I also decided to listen to the entire library of Dan Savage's "Savage Love" podcast, which provides humorous sex and dating advice—that definitely makes the time fly by. Most importantly, my outlook has changed. I have seen so many runners get injured and I myself have had bouts of injuries through the years. I appreciate running for what it is in my life right now and never take it for granted. I thank my body for transforming into an experienced runner and responding well to the process of training.

I no longer think about cancer when I run--I think about abortion. A few weeks into my training, the whole connection between 26-week abortion limits in Georgia and 26 miles of running just hit me like a truck. These two things that are both so instrumental in shaping who I am have this undeniable link and I realize I am the woman who I am today because of abortion and running. Abortion has changed my views on the entire world. It brought things onto my radar I never knew about and it allowed me to appreciate my body and the control I have over it and how it is not something to take for granted. Once I could be thankful for that, I was finally able to take on running and marathon training and have it be a meaningful and whole experience. Ever since noticing this pair of twenty-sixes, I have used my runs to think about the challenges we all face in life and how insurmountable they appear. It is rare that people, especially women, can tackle these huge challenges. Too many barriers exist for women who are trying to seek an abortion. The women who are able to terminate a pregnancy at 26 weeks are some of the most determined, resourceful, and dedicated women I have ever seen. Most women who seek abortions are less than ten weeks pregnant, however there are a tiny percentage who choose to terminate later in the second trimester. Their stories and reasons are varied, but they are never decisions made lightly. I I think about what women go through to obtain an abortion and it makes my marathon training seem trite. And to be honest, although I haven't struggled too much this go-round, I know that come October 9th there will be times I want to quit. I know myself pretty well and I can't imagine that I will give up, but that option will be there constantly dangling in front of me.

Women seeking abortions often give up. Not for lack of trying. They simply can't get the money together, can't get time off of work, can't find an adult to serve as their driver, can't find childcare, their insurance denies them coverage at the last minute, or they are a minor and can't get a parent's permission. There are dozens of other reasons. These women end up with an unwanted child. There are just too many things going against them. For these women it is not about attitude or determination, rather it is institutional barriers preventing them from controlling their own bodies. When I think about all the women who can not obtain an abortion due to cost, or timing or the inability to find childcare for their existing children it is really utterly depressing. And then I think about how blessed I am to have such control over my own body. I feel blessed and then I feel shitty right after. I have the luxury of training for a marathon and not worrying about having an unwanted child.

Tuesday, October 5, 2010

The Uterus Is Not a Haunted House

Please pardon my absence. I was fine-tuning my wand. No burning-out here. Just burning-in.*

The abortion clinic waiting room reminds me of the DMV in Los Angeles, only decked-out with woman art. I hope I’m next. Next, to kill my baby, not to drive around mom and dad’s Jeep Cherokee.

(You do understand that embryos and fetuses are not actually babies, but this story is not about getting your facts straight.)

Mom is there. One honeybee hovers in our corner. Mom and I are settled on a somewhat soiled couch. In many ways, the clinic looks like it is archiving the 70’s. In many ways, it is.

Mom reminds me that bees are our ancestors come to say, hello. I do not want the honeybee to follow me to my room for surgery. Even if the honeybee is my grandmother. I do not want her there.

(You do understand that the bee dies in this story, but this story is not about the bees dying.)

When mom’s father died, I was twelve years old. We drove across New York and Pennsylvania to attend the funeral. On the way back East, I found blood in my underwear at a rest stop but waited to tell mom until we were home. When I told her, I felt embarrassed, but she acted elated even though her dad was dead.

(You do understand that dads die, but this story is not about dads dying.)

I started using pads, but I was distracted by menstruating on a wad of laminated cotton during class. However, no matter the tampon, I’d bleed.

The ultrasound technician was the first to discover I have two vaginas at my initial appointment for the abortion—one cervix and one uterus, but two vaginas. No wonder the tampons, I blurted.

(You do understand that some women have two vaginas, two cervixes, two uteruses, but this story is not about biology.)

The ultrasound technician assured me I could do with them what I wanted, that having two vaginas would not harm me. You have two pockets, spaces, canals, two places to bond with and explore, two avenues. She is a hippy. She wore a scarf around her head. I went home and looked in a mirror.

Early on, the Man-Involved liked to spend time on me. I thought he knew my body better than I did. Now, he gets hard immediately, and slips himself right into me. We have sex for roughly ten-minutes, and then he’s done, and I am sort-of wet and bubbling. He lies to the side to catch his breath, and I feel cold.

(You do understand by, Early on, I mean, the first week, but this story isn’t about dumb-fucking.)

In the mirror, having two vaginas looks like having the number eight instead of a zero. The sign of infinity. I will not tell the Man-Involved about the abortion or the vaginas.

I choose to go to sleep for my abortion. I wake with a feeling of elation that I am not pregnant. The hippy technician is rubbing my back where my uterus beats. I think back to my rape before I met the Man-Involved and wonder, which vagina? I hope I had the abortion there too. One still untaken. Everything unexplored. I am only sixteen.

(You do understand that every two minutes someone is sexually assaulted in the United States, but this story is not about how men can stop rape. Or is it?)

When it is time to leave the clinic, mom leaves me on a bench in the sun to retrieve the car. I enjoy the heat but am nauseous maybe or exhausted really. A honeybee lands on my can of ginger ale then buzzes across the small parking lot to sting an abortion protestor’s dog—a yellow lab. The protestor is holding an image of an enlarged fetus that appears to be smiling. The protestor is a man. He looks from his whimpering dog to me.

Before getting in my mom’s car, I snatch the dying bee from the sidewalk. It is still pulsating. My uterus tugs. I put the bee in my sweatshirt pouch. I wonder how long the protestor spends on women. He breeds his dog. Her nipples sag like leaking snow cones.

He says god will forgive me if I repent. I tell him I have two vaginas. He says he’ll pray for me.

(Oh, please. You do understand that abortion IS a prayer.)

* Concept of burning-in directly inspired by the words of poet, Jack Kerouac: The only people for me are the mad ones, the ones who are mad to live, mad to talk, mad to be saved, desirous of everything at the same time, the ones who never yawn or say a commonplace thing, but burn, burn, burn, like fabulous yellow roman candles exploding like spiders across the stars and in the middle you see the blue centerlight pop and everybody goes "Awww!”

Monday, October 4, 2010

Abortion Doulas

This past week, I had the extraordinary opportunity to witness an abortion doula at work.

We were performing a 12 week termination on a woman who had a fetal demise. The woman was teary before the procedure and definitely nervous. The abortion doula sat with her while she received her counseling, while her IV was placed, and while she waited for the procedure room to become available.

As the patient entered the room and sat on the table, the doula was with her the entire time. The doula stroked her hair out of her face, held her hand and talked to her about anything and everything. While we were performing the procedure, the two women talked about the patient’s children, the weather, and popular tv shows. Before the patient knew it, the procedure was over.

I have always been a supporter of doulas-whether for child bearing or termination-but to watch the abortion doula in action was amazing. She was so supportive of the woman. She was her advocate and her friend throughout the whole procedure. The doula completely changed how that woman will remember her experience.

Doulas should be an integral part of the pro-choice movement. They are patient advocates and their supporters. Years later, the patient will most likely not remember me or the attending, but she will certainly remember her doula.

You can read more about abortion doulas here