To Have an IUD or Not to Have an IUD (And then, which type?)

Desembarazarme’s recent post about IUDs here got me thinking. IUDs definitely are more popular. Not so much the ParaGard, but Mirena is. Women are often asking for it and providers are generally – in my experience – urging women to use it. I hope, too, that as long-term birth control methods become more available, that our community doesn’t swing their biases towards one method over another (but , this does seem to happen). The thing is, no method is the savior of all birth control for all women. We’re individual, unique people and different methods fit our needs: including abortion as birth control.

I’ve talked about my very own personal choice to not use hormonal birth control for over 15 years. With my current partner, we combine natural family planning with withdrawal and Plan B to control pregnancy. It’s worked for us. I’ve only become pregnant when I’ve wanted to. Despite this, I’ve actually been considering an IUD for years. When I recently discussed this with my Gynecologist and explained to him my reasons for considering the IUD, he told me that Mirena “is the birth control of choice for female OB/GYNs…even for themselves…so that tells you something,” and admitted that he’d recommend it over the ParaGard (which contains no hormones, but generally causes heavier, longer periods and cramps).

The doctor at my clinic loves the IUD, too, and inserts them immediately following an abortion for many of our clients. Many of our clients soon have them removed, though, because there is “nuisance” bleeding for a few months with the Mirena (which has a small level of progesterone) and then no period at all. (Some of us like to have our period to feel more certain we’re not pregnant, even though you can have bleeding and still be pregnant.) Personally, I’m still a bit on the fence about it and since it does cost so much money, I find it hard to just “play” with the method and see if it will work for me, only discover it doesn’t, after forking out over $500.

What do you guys think?

P.S. If you want the recipe for the IUD cookies (they are super cool!), then check out this blog here.

On chives and choice

I was happy when my friend's son learned to talk. Not because he was able to communicate, "I am hungry and I would like to see my mama now please" (or something to that effect) instead of screeeeeeeaming, although that certainly was a perk. But because I was able to say, "Thomas*, can I pick you up?" and he could say, "No!"

One of the many, many reasons I'm not a fan of babies is because to me, it's weird that you would walk up to this tiny human and grab its fingers and pinch its cheeks. I would no sooner do that to my cousin than I would to my landlord. And if I did, for some strange reason, have the inclination to do that to my landlord, I could say, "Rupert*, may I pinch your cheeks?" (And I'm positive he would say, "No. Also, evicted!")

What I'm saying is that choice comes naturally to me. We talk about the rhetoric of choice versus life and justice versus choice, (and I don't disagree that the "life" argument is bullshit and that reproductive justice > simple choice) but at my own core, I'm pro-choice even when abortion isn't involved.

I teach a fitness class on the side (sometimes, I sneak in abortion humor. You can take the instructor out of the clinic, but you can't take the clinic out of the instructor!), and I intellectually know that my job is to direct and correct. But it takes effort to do that because my inclination is to say, "Huh. That's an interesting take on the exercise, but if it doesn't hurt your hip and if you're not knocking out your neighbor, then go ahead with those roundhouse kicks as the rest of us stretch."

For that matter, when my cat steps in my dinner plate (I live alone), I do remove her, but I have to explain to her why I'm lifting her from my potatoes and how I do respect her right to dip her toes in the chives. She made the choice to encroach, I made the choice to overrule her, but I still need to explain and offer informed consent.

And mashed potatoes or unwanted pregnancies, I am so very much all about choice.

* Of course, all names have been changed to protect the innocent.

A woman is a living, growing human being

In our sidebar we link to blogs of people who have had an abortion and want to write about their experience. Here's a new (to me) one: My Journey Through Abortion. The post I'm linking begins like this: "I think I am going to talk about what I have learned."

This is a wonderful, fascinating topic. How the abortion was good for me. Not just, How it sucked less than the alternative; not just, How it didn't really suck any more than getting wisdom teeth out sucks and I'm damn glad that both services exist in safe legal settings. Yes, those are interesting too. But those are already part of the public rhetoric about abortion, and the one that people who've never experienced abortion feel most comfortable joining in. It's wonderful and fascinating when a woman who's had an abortion feels able to say out loud that she is a better person after her abortion -- not in spite of it or in opposition to it or in penance for it, but thanks to it.

She is better after her abortion than she was before it. How remarkable! This exists completely outside the discourse where, no matter what else you believe, abortion must be a loss, and a taking-away -- where mathematically, and thus objectively, and thus morally, she is less than when she was pregnant. (You < You+embryo. More is more. Very baroque.) But women know this isn't true, especially when we are at our healthiest: being "good" doesn't mean saying Yes to every request; it doesn't mean taking on more than you can just-because; it does mean being true to yourself.

In the documentary "The Coat Hanger Project," interviewee Jeannie Ludlow says something remarkable that people don't discuss enough. I'll have to paraphrase: In her experience as a clinic counselor, she says, abortion can be a good thing for women; it allows some women to grow in ways that they otherwise would not have had the chance to grow. This doesn't mean, though, that no women feel wistful about their pregnancy, or that no women think of their embryo or fetus. Of course some of them don't; and some of them do but also feel joyous about returning to non-pregnancy, some of them do but also think of themselves or of their born or future children.

A friend told me about her recent experience with abortion and how it is changing her life already -- from a series of crises and dangerous disregard for self, to a new stream of moments where you face the same old decisions and this time you choose life: your life.

~

I'm willing to bet that some of our patients, if they had a blog or a diary, would express something similar to this blogger's words:

"I have learned that I am not really good at pulling the trigger on moving forward. It is like I am sitting in my car, flat tire, spare in the trunk. And I am too damn lazy to get out, open the trunk, get the jack out, and get to work. It is not because the view from the car is spectacular or because there are good tunes on the radio. It is because I am scared to move forward. I am too focused on the fact that I have a flat tire, and I have forgotten that I can FIX THE FLAT."

Especially when talk turns to second-trimester abortion, so many people seem to imagine women as two-dimensional things. If anyone ever asks you "why did she wait so long?" -- remind them of three things:
1) Health care is expensive, abortion isn't covered, and most people aren't rich.
2) Sometimes biology is sneaky and pregnancy isn't discovered quickly.
3) Women are people: sometimes they're unsure what to do, or they freeze, or panic, or they take time to weigh an important decision. Just like you.

Surviving partner violence isn't as simple as they make it sound

We were working with a patient living through extreme domestic violence. There was some concern that she might also be experiencing verbal abuse during the appointment itself. The security guard was asked to stay alert to the situation. Under their breath, the nurses were venting fantasies of retributive violence against the perpetrator. The counseling session was long -- such sessions invariably include attempts to verify that the patient is making as free a choice as she possibly can, discussions about involving the police, explanation of what resources exist that could support a patient (and any children) in getting away from the perpetrator.

All too often, the counseling sessions also include a heartbreaking resignation by both parties that today is not the day that things will change. We've talked (and rambled) about partner violence before, and there are lots of informative reference materials online, so I know you know about the insanely cruel catch-22 of trying to escape violence and stay safe and not go homeless or hungry. A lot of times, no counselor (including one at a DV crisis center or a specialized police unit) is in a position to "convince" someone to leave their abuser. In these times, no matter how much you've tried it will probably feel like you haven't done enough to help.

And sometimes a patient is terribly unhappy with the idea of having an abortion, but never wanted to become pregnant in the first place and had little or no choice in it. I think about this every time I hear people oppose legal abortion on the basis that "most" women are "coerced" into choosing abortion. This twists a lot of situations into one word, when actually "I don't want to but feel I have to" can mean so many different things -- including "I don't want to, but my experience tells me I'll be in greater danger if I don't, and promises of support from the system won't make a difference." Whether the abuser wants her to have an abortion or doesn't want her to have an abortion is ultimately immaterial to whether we, the abortioneers she seeks out, act on the woman's own decision to have or not have an abortion. (Certain people seem to think that if a woman weighs the situation and decides to have an abortion, and this is also what her abuser wants to happen, then we should cut off her reproductive rights to spite his face. No, the punishment for violent partners isn't an unwanted baby! It's jail time.)

It's really draining to hear outsiders say things like "So your solution is that we should have legal abortion instead of fix the system to support women?" Duh, no. Why are such people always assuming you can EITHER support addressing systemic problems OR support assisting someone who has an immediate problem and faces limited possible approaches? Total false dichotomy. I favor doing both of the above, because both are needed! How is that difficult to grasp?

The patient wasn't happy about having an abortion, but she was firm in her decision. She wasn't happy with her abuser, but not confident that she and her kids would be able to survive if she left him, either. Despite our staff's efforts, this was not the day that she could decide to find a safer life.

If you know someone is abusing children, in many cases reporting is mandated and there are channels for it and the kids get "taken away" (sometimes out of the frying pan and into the fire, sadly) and they may gain state protection in the form of an undisclosed placement location or something like that. If you know someone is abusing an adult, that isn't usually the case. She cried in the recovery room and everyone was worried and angry but we had to discharge her into the care of the person who was hurting her, because she's an adult and that's what she told us to do. It sucked. 

Close your eyes and imagine something for me

welcome to your new home

What if you moved to another country and had no family there, and your first language was one that very few people in your new home had even heard of, and you spoke very little of theirs? You might be relieved and happy to find someone who shared your mother tongue and your host country's language, someone who could help you navigate this new place as well as be a friend who understood where you came from.

You might start dating this person, move in with him, end up relying on him in most aspects of your life. He might be a lot older than you, take advantage of your dependence, control your access to food or transportation or a phone, and refuse to use birth control. 

What if you got pregnant? What if you got pregnant and had always looked forward to having children and this person who had final say in your life was not a fan of the idea? And what if you couldn't get your own job or lease or even typical social services -- shelter, healthcare, food for an infant -- because your immigration status wasn't clear? What would you do? 

You might decide that, as much as you'd rather have a child, the only feasible course of action is to seek an abortion, just like he is telling you. You might have to rely on him to translate during the counseling session, and there's really no point trying to say how you really feel, because he already knows it, and he won't translate it to the counselor, and anyway what you'd rather do doesn't change what you must do. 

After the abortion you might try to spill your guts, in spurts, and using a combination of elementary vocabulary and charades, to the various staff in the recovery room. Unfortunately, if you talked to me, I might have a really hard time understanding the full extent of your situation, and try to comfort you with tissues and talk about the hope of having a child when you're in better circumstances -- not realizing that the road to better circumstances isn't visible from here. (It's a lot harder for me to write about this failure to listen well than to read J's story of a failure in his early days as an aid worker: why?) But I'd notice that you kept saying you didn't feel strong enough to get dressed and be discharged yet, even though your vital signs were normal three times in a row. 

If you talked to my more perceptive colleague, she might try to ask you if you had "somewhere else to go" -- but you don't know anyone or anyplace other than this man. She might call in a counselor and make a bunch of phone calls to informal assistance resources, trying in vain to find someone who spoke the right language. The three of you might make a plan to have you come back in a few days for "a check-up" and hope that this guy at least respects medical orders and will give you another ride to the clinic. 

All of this, to our regret, would happen after the abortion that you wished you didn't have to have, because while antis are lately fixated on stopping "coerced" abortions, they are apparently completely clueless about the forces and circumstances that actually make women have abortions they wish they didn't have to have. When language barriers don't prevent women and girls from telling us what's in their heart, when immigration laws don't leave the most vulnerable with nowhere to turn, when men don't take the opportunity to take advantage, when families don't make their daughters believe that can't possibly come home pregnant, (you fill in the blank): that's when women will only have the abortions they want. 

the women

I have delivered a baby and performed a 9-week abortion. Although both procedures were very different, they were equally powerful.

In the delivery, it was the woman’s fourth baby. A girl this time, after three boys. She was thrilled and wept at the sound of her crying daughter. I cried a little bit as well. This pregnancy was so wanted and so desired. Plus, being the first person to touch a baby and deliver her/him into this world is incredible in itself.

In the 9-week abortion, it was the woman’s third pregnancy. This pregnancy was unplanned and unwanted. She had two children at home and was not financially ready to bring another child into the world at this time. Plus, she was with a new partner and was not ready to have a child with him. It was a hard decision, but in the end, the right one for her. During the procedure, she talked about her children and cried a little bit. When it was over, she looked so relieved and thanked me.

I have been so fortunate to have affected both of these women’s lives in unique and different ways. Both were such beautiful experiences that I will never forget.

Delivering a baby only reaffirmed to me that motherhood should be a choice. Women should not be forced into that position or punished by it. Motherhood is beautiful but it is hard and not always at the best time or with the right person.

Performing an abortion made me further appreciate that abortion is a hard, thoughtful and challenging decision. It is personal and sacred. And nobody should interfere with that decision. It also made me realize how easy it is to perform a first trimester abortion. The procedure itself was over in 7 minutes-and performed entirely by me-a medical student. And with over 90% of abortions in this category, it’s aggravating to think anti-choicers and politicians out there are putting so many blockades in front of women, almost forcing them into a second trimester procedure (more expensive and slightly riskier).

Thank you to all the abortioneers out there for continuing to fight for women’s choices. Having participated in both a birth and an abortion, my pro-choice beliefs have been reaffirmed.