The story of the time I was a dick

Why does she keep shouting ABORTION at me? 

Yesterday our guest blogger Amy mentioned that phone calls about abortion care often sound like this:

"Um...I wanted to know how much it costs?" and "Hi...I'm looking for some information about...abortion?" (spoken as a question, with the word "abortion" issued in a whisper)

And that her responses sometimes sounded like this:

"I would be happy to answer any questions you have about ABORTION! What type of ABORTION do you think you might be interested in having?"

I can totally relate. Who hasn't had this kind of call? It was one of the first patterns I noticed about callers when I started working on the phone lines.

Maybe Amy was more mature or less self-centered than me when she started her clinic work. But for my part, there was a real evolution in how I understood such callers. Initially, I felt frustrated to pick up the phone at my work and hear that the person on the other end of the line couldn't bring themselves to speak about my work. I experienced it as stigmatizing of ME, like they were attempting to distance themselves from my work even as they were asking me to tell them about it.

Sometimes they would ask with words like "terminations" or "D&C" instead of "abortion" -- maybe those words sounded more genteel or more like medicalese.

I'm ashamed to say that, early on, if someone called and said, "Hi, I need to know how much it costs," I would reply, "For what kind of services?" Even though it soon became clear that, if someone was calling about, say, a Pap smear, they simply said "Hi, I need to know how much a Pap smear costs." For a brief period of time, I believed that it was more important for the caller to say the word abortion than to feel comfortable asking about it.

At least that phase ended rather quickly. When a woman called and I heard echoes as she asked me questions, I mentioned her voice was sounding funny, as though she was in a bathroom or something -- and she said yes, she was at work and this was the only private place she could duck into. Duh, me.

Whether because they're not sure they've called the right place, they can't believe they're in this situation, or they can't risk being overheard by a coworker or family member, callers can't always discuss abortion openly and explicitly over the phone.

There will be time for that at their appointment, if they make one, when they meet with the counselor or health educator to express any questions or concerns about their health, the procedure itself, their experiences leading up to the appointment and how they will fare afterward. Usually patients can bring a loved one or support person into the counseling/education session, but a portion is also dedicated to one-on-one time with the staff person, in case the patient has something that might not be easy or safe to express in front of their companion. These sessions can be conducted as part of an abortion appointment, or prior to deciding whether or not to have an abortion. It's dramatically different from a phone call that might by necessity be taking place in public.

So now I know better. I learned to respond to "I need to know how much you charge" with something like, "Sure, I can talk to you about our different fees, but we provide many kinds of care here. Were you asking about a Pap smear, or...an abortion, or...?" If they are asking about an abortion, they normally stop me there and say "Yes, that's it." Easy peasy. It's okay for me to do the talking, if that's what the caller is looking for.

Not that every caller is in this situation! It runs the gamut: on one end is this (or even, as Amy writes, the ones who never call), and on the other end is someone calling to set up their appointment while also ordering dinner for five from the drive-through. But that's a story for another post.

Guest post: Caring for the Ones Who Never Call

I'm incredibly pleased to introduce a guest writer today. Amy Littlefield is a former abortion counselor and founder of The Provider Project: Stories From the Abortion-Providing Community, an excellent and groundbreaking endeavor that really strikes a chord with our own blog's founding mission.

Stay tuned to the Provider Project, where Amy's piece is cross-posted, and you might see an Abortioneers post there soon!

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Amy Littlefield

Caring for the Ones Who Never Call

It can be a scary prospect to call up an abortion clinic and make an appointment for what has become one of our society's most stigmatized -- and yet one of its most common -- medical procedures.

Which is probably why some patients don't immediately admit that's why they're calling.

As a former phone counselor at a clinic, I used to hear a lot of: "Um...I wanted to know how much it costs?" and "Hi...I'm looking for some information about...abortion?"

(This last one was spoken as a question, with the word "abortion" issued in a whisper, like a big, bad, ugly secret.)

I sometimes tried to use the word as much as possible when I answered those tentative calls.

"I would be happy to answer any questions you have about ABORTION! What type of ABORTION do you think you might be interested in having?"

Often, these patients weren’t simply calling for information; they knew they wanted an abortion, but they were scared and confused about what the process might entail.

I sometimes felt like women called just to test us out. Maybe they had always believed abortion was murder and they wanted to know whether we would tell them what they were doing was wrong or try to make them feel guilty. Maybe they were wondering whether the women who worked in the Big, Bad Baby-Killing Center were human beings like them. Many were scared they wouldn't be able to have children in the future, or that we would do something violent and terrible to remove their unwanted pregnancies.

They were certain we would judge them, just as others in their life had judged them. They were wondering whether they could trust us with their stories.

They ached to justify themselves.

"Look, I have to do this, I have a nine-month-old at home."

"I'm homeless and I already have two kids."

"I've never believed in abortion, but I just can't have a baby right now."

I was sometimes amazed at how relieved women were to tell their stories. To a stranger. Over the phone. And to have that stranger accept their stories Without judgment. Without telling them what was right and what was wrong. So listening became part of the process of making an appointment. When I finished booking the appointment and asked if they had any other questions, I could sometimes hear the relief in their voices.

Given how terrifying that first step can be for many patients, I often wondered how many women wanted to call, but never did.

The abortion rate has been declining among almost all groups of women across the country (although a recent study [pdf] showed that the global abortion rate has stalled after a period of decline). Many in the abortion-providing community believe this decline is a result of rising stigma, not of improved access to birth control or sex education (since, by and large, those things are not improving). Nor is it happening because women's economic situations have magically improved, since the abortion rate is still rising among poor women (which proves, by the way, that you can't advocate for reproductive justice without combating capitalist exploitation of the poor).

Brigit Ordway, a veteran counselor whom I interviewed as part of an audio project compiling voices from the abortion-providing community told me she thinks women face more stigma now than they did back in the decade or so after it was legalized.

She said:

"That's the biggest difference now -- women aren't telling each other about this. We all did and we got support, for the most part. Now, probably most women would get support from their friends and family, but they’re assuming that they won't. They're assuming that everybody is not pro-choice and that they're going to be judged and maybe even worse, you know, maybe somebody's going to come throw something at them. So women are silent about it now. They don't get the support of each other or society, because they don't talk about it, I think. It's a huge difference. It's all now secret and shameful for people."

So abortion counseling, for me, whether it was done on the phone or in person, became largely about trying to lift the burden of guilt that women thought they were obligated to feel for having an abortion. It was about helping them realize that they were still good, still loving, still worthy of respect. They drove past protesters and graphic posters of chopped-up babies to get into the clinic, but once they were inside, they were treated with respect.

Every so often we would get a call from a woman who wanted to come to the clinic, but couldn't bring herself to enter the doors after she saw the protesters' signs. Those women reminded me how limited my understanding of abortion is. I saw women who were beating themselves up emotionally for having an abortion they felt was necessary. But I never saw the women who were too scared to come in, too scared to even call.

One abortion provider whom I interviewed has found a way to help those women.

Dr. Deborah Oyer, who owns a clinic in Seattle, Washington, created a series of videos describing the process of an abortion at her clinic. In a soothing and straightforward voice, she describes the steps a patient goes through, from the moment she enters the door until she leaves. This is the kind of education I tried to do with patients over the phone -- but she has found a way to do it without requiring women to take that scary first step. Instead, wrapped in the Internet's comfy blanket of anonymity, they can learn that abortion is not as scary as they might have imagined.

The videos provide basic education about abortion and birth control that counteract common and harmful myths. They also show women that -- contrary to popular mythology -- the doctor who will be performing their abortion is a friendly and approachable woman, not a crazy, rabid devil-monster with horns (Oyer told me she often sees women relax visibly after she enters the room, since she is so un-monsterlike). She has one video that consists entirely of her introducing herself. That video, uploaded two years ago, has 550 views on YouTube.

The video about surgical abortion has 58,816.

The one on medication abortion has 27,668.

Clearly, people need this information.

I'm grateful to Deborah Oyer for putting her voice and face out there, despite the risks that it could mean for her in a world where abortion providers are targeted with hate speech and harassment, and even sometimes with bullets. I'm grateful that there is accurate information out there about abortion for everyone -- of every gender -- who wonders how it is done. But I’m especially grateful that there is education for the patients whom I never got to talk to -- for the ones who never call.

Listen to Deborah Oyer discussing the videos at The Provider Project, www.theproviderproject.org.

Blinded with science

When I was very little, I decided I would never be a doctor because kids disliked doctors, and I didn't want to be disliked. In middle school, I eschewed the sciences because they gave me anxiety attacks. As a high schooler, I declared that I would never work any place that had stirrups (I disliked both horses and what little I knew of gynecology, so it worked out). And in college, I avoided the math and science buildings like an anti-choicer avoids logic and reason. When I started working at the clinic, it was because of the opportunity to advocate for women and reproductive justice, and for those causes, I could overlook the stirrups.

I was never the number one candidate for the really clinic-y part of clinic work. For a while, I focused on counseling, administrative work, advocacy, and interpreting, and I left the medical side to the professionals. But the more time I spent at the clinic, the more I found myself jumping at the chance to observe procedures and asking clinicians about the hows and whys. For fun, I learned how to prick my own finger and test my own hematocrit. I taught myself medical abbreviations and Googled hypothetical drug interactions in my free time. I became fascinated by the way a chromosomal shift can wreak havoc and also, how a body knows how to restore itself.

I also became the amateur gynecological resource for friends, and I offered my party trick of suggesting the best contraceptive for your life in under five minutes. And I never felt like more of a true science nerd than when I saw Iron and Wine in concert and kept seeing "Fe and Wine" in my head. Except maybe for when my brain automatically transliterated "salt" to "NaCl." Formerly an avowed humanities major, I'm now a walking periodic table.

So thanks, pro-choice movement, for having the unexpected side effect (ha--see what I did there?) of turning me on to science and medicine. Maybe if my high school chemistry teacher had explained molecular structures in terms of pharmacology instead of hexagons on a paper, I would be holding a B.S. degree right now. (If not an M.D.)

(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?

Abortion in My Dreams

Last night I dreamt I was walking through the halls of a University. I’m not sure I even went there. I overheard three girls behind me talking about “some pill” that could induce an abortion. They called it some dream name I don’t quite remember. One of the girls in the group disagreed and thought it was just a myth. I whipped around to face this group of strangers and said, “Actually, it’s true.” They all looked at me like, what does she know? So, I continued to talk.

I continued to impart every ounce of knowledge I could spew out before they would no longer listen. I told them how no matter what you end up deciding to do with an unplanned pregnancy, it is a difficult situation to be in for every woman. The same girl who disagreed with the idea of a medical abortion, then told me, “it would never happen to me. I would never be in that situation.” I proceeded to list off the endless ways; she absolutely could be “that girl.” The girl who thinks, this could never happen to me. I’m not like them. I wanted to help her see and feel and empathize with all the women who may have thought it would also never happen to them, to be pregnant with an unwanted pregnancy.

Now the dream gets a little fuzzy...

Last thing I remember is screaming out through my tears, pleading almost, for them to understand how inaccessible an abortion is for many women. How expensive it can be. How health insurance does not always cover abortion. How Medicaid often does not cover abortion. As they walked through the heavy locking doors to their gymnasium, they all looked back at me. I could see in their eyes, a touch of pity, for trying desperately to reach through to them; a touch of sympathy, for my unyielding passion about abortion acceptance and accessibility; and just maybe, a touch of understanding.

When I awoke, I still felt the desperate urge to relay how important it is to keep abortion available and affordable, free from stigma, violence and shame. I wanted those girls to feel as dedicated to the struggle for abortion’s acceptance into the medical field, as a simple, safe procedure that should be afforded to any woman who chooses to terminate an unwanted pregnancy.

I used to dream a lot about abortion. When you are working in the field (at a clinic, a fund, a non-profit organization, as a counselor, a provider, etc.) abortion permeates every atom of your being. At least, it did for me.

After 5-6 years of working “in the field,” I have become distanced from this way of life. As if I have been pushed into the periphery. I chose to study sexuality and reproductive health in graduate school, in hopes that I would have a wider forum to talk about abortion. This is rarely the case. It is no longer part of my everyday language. Days can go by where I don’t even say the word-Abortion. This is a big shift for me, from saying it around 100 times a days-to patients, their friends and families, clinics, provider, MY friends and family.

My dream reminded me, that although I feel separated sometimes from the everyday discussion of abortion, I am just as passionate, energized and determined to fight for abortion acceptance in all realms of life. I continue to educate people whenever I can about the intersecting social/political/economical issues that abortion effects. I will continue to join like-minded people in discussions, fundraisers, blogs, and marches to keep abortion at the forefront.

I believe no matter where my life takes me; I will never be far away from the abortion world. And that makes me feel good.