Tuesday night homework: please help Georgia!

Can't you see my crazy eyes? Don't make me a law! 

Friends, readers, countrypersons: lend me your eyeballs! I have an important piece of evening reading for you, followed by a super-quick writing assignment. Scroll down if you want to skip my navel-gazing and discover your mission.

[COMMENCE NAVEL-GAZING]

Lately I've been feeling like I can't even keep up with the onslaught of legislation designed to prevent would-be abortion patients from getting the care they need and to make their providers give up, board up the clinic and retire or something.

Not tryna brag, but in previous years I was pretty damn knowledgeable about the status of abortion legislation, regulation and jurisprudence at the federal level and in most states. If you asked me about a state-level bill I could usually tell you what its language really meant or what stage in the legislative process it had reached so far or what its practical implications might be.

This year, though? This year, if you told me "I saw on facebook that Hawaii is going to require married women to get a permission slip signed by their mother and their boss and then wait 7 to 10 business days before having an abortion," well idunno, maybe they are! Who am I to say, "No way, no way would lawmakers ever try to do something so awful and insane"? Recent evidence points to the contrary!

Honestly, it was difficult just now to dream up an example that's plainly absurd, because real-life happenings have been so goddamn absurd. But when a bill becomes law, whether or not it is too crazy to exist doesn't matter -- because suddenly it does exist, period. Suddenly you can't get the care you need. Suddenly your doctor has to decide between following her duty to care for her patients' needs, or obeying a law she knows is unjust.

That moment when the laughably absurd bill becomes the terrifyingly absurd reality has happened to me before, most starkly in 2006 when the Supreme Court decided Gonzales v. Carhart. The ruling allowed Congress's so-called Partial Birth Abortion Ban Act to take effect, via an unprecedentedly patronizing position on the part of Justice Kennedy that the government has an interest in protecting "mothers" (any pregnant person) from making decisions they might "come to regret." On the day of that ruling, I was at work, speaking with a woman whose baby was dying in utero; she asked if it was possible to remove the fetus relatively intact so she and her husband could hold it and "say goodbye." I found myself telling that woman, and others like her later, that we could not attempt to honor her request because Congress had just outlawed it. Your representative called; he says to tell you tough titties, crybaby.

[END NAVEL-GAZING]

Those terrible moments will happen again and again unless we refuse to feel helpless and instead move to take action. Your assignment is to foment urgent last-minute opposition to Georgia HB 954, yet another insane proposal to outlaw certain abortions. Georgia has seen and defeated similar bills in past years; but this one has gotten quite far in the legislative process -- meaning it's in grave danger of passing.

I once lived in Georgia. I still feel a strong connection to it, and I really hate that it feels like the rest of the country considers Georgia a lost cause when it comes to rights and liberties, or thinks such legislation won't make that much of a difference for that many women. They're wrong. Many people don't know this, but Georgia has several providers who currently care for patients with later pregnancies and patients with severe or complicated health conditions. Without appropriate providers in Georgia, these patients would have to travel clear across the country or receive care in less well-equipped facilities.

There are three days left to the legislative session, and that's when the crazy backdoor shit goes down. If you have any connection to Georgia, please contact the state representative in your area and ask them to OPPOSE HB 954; if you have no connection to Georgia, please spread the word to others ASAP.

Here's the update (and news item clarification) that I received today from the organizers on the ground with Planned Parenthood Southeast:

Today, the Atlanta Journal Constitution covered the bill in an irresponsible piece of reporting and on the front page no less. Contrary to the story, last night the bill was not stripped and was not killed for the session. The bill is not based on sound science and seeks to intrude on the doctor-patient relationship of women facing some of the most difficult medical circumstances. 

Among other things, here's what's still wrong with HB 954:

• The bill is still unconstitutional. It still has only a narrow health exception and includes no exception for the mental health of the mother.
• The bill still requires the physician to use the method most likely to save the life of the unborn child even if that method causes health risks to the mother.
• The bill still includes no exception for rape or incest.

We know all too well that it isn't over until it's over when it comes to the General Assembly. Session ends on March 29, and we need to keep up the pressure to ensure that private medical decisions are left to a woman and her doctor.


Lawmakers need to look at how similar bills have impacted women in other state and understand that Georgia women deserve better. This bill is an example of the level of government intrusion that takes place in women's health care and we need to let our legislators know that we've had enough. Contact your senator now. Tell them you've had enough of their lack of concern for victims of rape or incest, their intrusion into how doctors practice medicine and their intrusion into women's lives.

UPDATE: Good news, but don't exhale yet! The bill appears to have died after revision by the Senate...because Republican House members refused to accept the addition of an exception for women with "medically futile" pregnancies (i.e. dead or dying fetuses). In other words, House members remain committed to a no-exceptions ban -- and there are 48 hours left in the session for them to try to revive one. A few years ago, this was more than enough time for them to pass a last-minute mandatory-ultrasound law right under everyone's noses. PLEASE stay on top of this until the session is officially over.

Dear Beatrix (as inspired by Kill Bill)

Back-story: The following letter is written to a real friend of mine who I met in Atlanta three years ago. In 2008, I received a phone call that a woman was en route from five states away and was desperate to find anyone to be her “driver”, aka she needed someone to pick her up from and take her back to the clinic for her 2-day abortion procedure. This was the last week that she could legally obtain an abortion. Little did I know when I agreed to this that she would help me as much as I helped her, and we would form a unique relationship that endures today.

Dear Beatrix*,

I just finished reading Linda Lovelace’s autobiography, “Ordeal”. Linda was the star of the infamous Deep Throat, which was considered scandalous for its time and featured the plotline of a woman who had a clitoris in her throat so giving head provided her with immense pleasure (as if, ugh). I have never actually watched Deep Throat, and after reading Linda’s autobiography I certainly never will. Linda details how she was forced to do the film by her abusive husband and raped repeatedly during the filming and forced to “service” many of the people involved with the production. Linda spent four years with this husband who essentially kidnapped her and forced her to be prostituted for his benefit (financial and psychological). She details in her book many examples of verbal, mental, physical, and financial abuse she suffered while trapped with this man. Abuse is the only way to describe what happened to her while with his man. Nothing else.

When I think about women I know in abusive relationships so many people come to mind. Some have varying degrees that they endure and it is often really hard for me as an outsider to make a judgment or to know exactly how bad things are. With physical abuse there are bruises and cuts and burns and attempts to cover up with makeup and scarves. With verbal and emotional abuse it can be so hidden yet so intensely damaging. I think about you and I think about me, because with both of us, at the point in our lives when we met, we both so desperately needed to leave people who were emotionally and verbally abusive. I still struggle to type the words, and even still doubt them. I have no physical scars or markers, only my memory and my confidence in how I experienced things.

I don’t remember when you started to open up to me about your abusive boyfriend, the person who you had gotten pregnant with. Was it at the clinic the first afternoon we met? Was it that night as we shared dinner over two steaming bowls of Pho? Was it months later over email, where you shared with me your emotions around your abortion? In the many emails we exchanged after we met, the topic of your abusive boyfriend came up. You knew that as long as you were with him you should not and could not bring a child into the situation. You knew that you needed to leave him before you could be the best mother you wanted to be. You knew that you had to prioritize yourself and grow strong enough to leave him before you could add a child to the mix. Having a child would have tied you to him forever. So you had the abortion, and he made you feel bad about it, which was just more evidence of his manipulation and emotional abuse.

I never equated my situation with yours. I was never faced with the added pressure of an unplanned pregnancy that would complicate my messed up and unhealthy relationship. Yet, the words you spoke about how he treated you felt like my own. I did not tell many people about the depths of what I was going through, just like you did not tell anyone about your own abuse and about the abortion. I was in major denial, and was living in a fantasy world where I hoped things would change. However, every time I heard from you and found myself giving you advice, I knew I had to stop being hypocritical and heed my own words.

Three years later and where are the two of us? I moved away from the city where memories of the emotional scars still haunt me. You left him and are making your way on your own. It is hard to tell over email how someone is really doing, but I trust your words. We reunited this summer when I traveled to your city and, while it was only the 2nd time we were together, I saw a light shining in you that was clearly absent that weekend back in Atlanta. I have seen so much strength in you over the years, first with the decision to have the abortion and then to leave him and finally to make solid steps to move on with your life. It took me living in a new place to truly rid myself of the damage I incurred. I think we both have grown immensely in these years and know what we deserve for the future. And if I ever forget you better remind me.

So to you I say thanks, and I’m always here for you.

Love, Vegan Vagina**

*not her real name
**not my real name

All Quiet on the Western Front

I haven’t hosted any abortion clients in months. It feels eerily quiet. Why isn’t there a demand for abortion hosting? Are women able to afford hotels suddenly? Are women terminating their pregnancies earlier and do not need to travel to my city for 2nd tri procedures? Or, are women not even raising enough funds for an abortion and never make it here? I have no idea. All I can do is wonder.

What happens when volunteers aren’t needed? When we don’t get to flex our hosting muscles as frequently as we hoped or planned? How do we retain interest and stay motivated?

How many of us have showed up at a volunteer gig only to be under-utilized or ignored? I wish there was a way to know why the phone has not rung in months, or why my pullout couch goes unused. Where are all the women in need? Am I any less of a volunteer if I am not actually hosting?

Maybe you should ask, "Why did we make her wait so long?"

I'd wanted to write a good solid post expanding on my last one -- about why some women "wait so long" to have an abortion -- and connecting the dots to social justice. It is Martin Luther King day, after all, and while we ought to be carrying his goals of racial and economic justice in our minds every day, it always helps to describe the links aloud. But: I've been getting sick this weekend and today I woke up with puffy eyes and that underwater feeling in my head and it's making me feel dizzy. I'm going to limit this to my research summaries, because you're smart and insightful enough to connect the dots yourself, and because I can't see my keyboard very well. 

*

In 2008 researchers at ANSIRH published an unusual study of delay in obtaining abortion care [PDF]. For purposes of analysis, they divided the process into three stages -- between the first missed period and the first pregnancy test; between the first pregnancy test and the first call to an abortion provider; and between that first call and actually having the abortion -- and then identified the circumstances that were closely associated with longer time for each stage. The factors associated with delay varied based on stage. In the first stage, significant delay before the pregnancy test occurred for women who were obese, weren't sure of the date of their last period, were assessed as being in denial about pregnancy or "afraid of an abortion," abused drugs or alcohol, or had had a second-trimester abortion in the past. (A lot of these seem logical, don't they?) 

However, these were not significantly associated with delay in the second stage; rather, women had a longer stage 2 if they had had trouble obtaining MediCal (California's health insurance for low-income residents, which includes coverage for in-state abortion care), and if they had "had difficulty with their decision to terminate this pregnancy." In the third stage, delay in having the abortion itself was associated with (again) having had a second-trimester abortion in the past; having been initially referred to some other clinic than the study site; having an unsupportive partner; and having had difficulty coming up with the money to pay for an abortion. 

So logistical barriers emerge in stage 2 and 3, and especially economic ones. Social/emotional barriers are still present, but different from in stage 1. (Understandably you might delay your call to the clinic if you're having a hard time deciding what to do with your pregnancy; you might try to reconcile a reticent partner to your decision before you head to the appointment -- or your partner might be actively trying to prevent you from getting there!) 

(Additional interesting findings from the last stage: what shortened the time between calling a clinic and having an abortion? (1) Nausea and vomiting [heh, shocker]; (2) having had “difficulty deciding” to seek an abortion. That is, if a woman struggled with her decision, she was likely to have a longer time than other women between taking a pregnancy test and calling a clinic, and a shorter time than other women between calling a clinic and having an abortion.) 

*

From several of the same California researchers, a 2006 multivariate logistic regression study: "Delays in suspecting and testing for pregnancy cumulatively caused 58% of second-trimester patients to miss the opportunity to have a first-trimester abortion. Women presenting in the second trimester experienced significantly more delaying factors, with logistical delays occurring significantly more frequently for these women (63.3% versus 30.4%). Factors associated with second-trimester abortion were delay in obtaining state insurance, difficulty locating a provider, initial referral elsewhere, and uncertainty about last menstrual period." Interestingly, second-trimester abortion was associated with both having had a prior second-trimester abortion and never having had an abortion before. 

*

In 2006 the Guttmacher Institute published a study on timing and reasons for delay [PDF] as well. They broke the process into more steps, and measured median time for each. 

-From the last menstrual period to suspecting pregnancy: 33 days (which makes sense if you imagine the average 28-day cycle then add about a week for your first missed period); it was a week longer for minors than for adults (which also makes sense if you consider how irregular most young people's cycles are)

-From suspecting pregnancy to confirming pregnancy (pregnancy test or sonogram): 4 days

-From confirming the pregnancy to deciding to have an abortion: zero days

-From deciding to have an abortion to first attempting to obtain abortion services (calling to make an appointment): 2 days

-From first attempting to obtain abortion services to obtaining the abortion: 7 days

...So that's 48 days right there (and that's just adding up medians, meaning half of women have a longer delay in each of these steps), yet I think somehow a lot of people hear "seven weeks" and think that's a really long time to "wait." I saw an actual published writer write that abortions should only be legal up til six weeks because "forty-two days is plenty of time to decide to have an abortion." Reality to actual published writer, please come in. 

58% of women reported that they would have rather had the abortion sooner, and these women were asked about the reasons for the delay they experienced (women could give multiple reasons). Most commonly, these respondents said: 

-It took a long time to find out about the pregnancy: 36%

-It took a long time to decide to have an abortion: 39%

It took a long time to make arrangements: 59%. Poor women were about twice as likely to be delayed by difficulties in making arrangement. (This includes money, referrals, appointments, transportation, judicial bypass for minors, legally required waiting periods, etc.) 

Patients mentioned a lot of other reasons, including:

-As partial response to Frances Kissling's question, 0.2% stated they found out late about a fetal anomaly (but this isn't broken up by trimester or week; I still think the later abortion patients she was asking about would give this response more often). 

-Only 2% said they "didn't think it was important to have it earlier." (Granted, this doesn't include possible similar answers from the 41% of women who didn't say they'd have rather had the abortion earlier, but I imagine a lot of those 41% had theirs quite early. I wish I could see a full data set on this.) 

I highly recommend reading the rest of this article because it has a section on qualitative findings from in-depth interviews that I just couldn't do justice here. Among other things, it shares the words of women who "knew right away" that they were decided on seeking an abortion, and of  women who found it a "hard decision" and took longer to feel firm in their choice.** 

*

What about demographic characteristics? Poor women with no insurance coverage for abortion, black women, and young women are likely to have later abortions than other women. However, being poor and lacking insurance coverage disproportionately co-occur with being black and being young. In some studies, each of these effects persists even after controlling for the others; in other studies, they confound one another and only the poverty/insurance effect remains significant. 

I think you can guess what I was going to say about all that. To make a long story short: justice in healthcare access must include attention to reproductive matters. If you care about making a more just society, please express support for public funding for contraception and abortion; donate to your local abortion fund; work to reduce stigma against both abortion and pregnancy; combat racist, ageist and classist stereotypes of appropriate motherhood; and learn about domestic violence and sexual assault prevention. 

**If you want to read more about abortion decision-making, here are some articles to try [unfortunately a few only give the abstract for free]: 

2010: Kjelsvik M. Pregnant and ambivalent. First-time pregnant women’s experience of the decision-making process related to completing or terminating pregnancy – a phenomenological study. 

2005: Finer LB et al. Reasons US women have abortions: quantitative and qualitative perspectives.

1985: Faria G, Barrett E, Goodman LM. Women and abortion: attitudes, social networks, decision-making.

1984: Friedlander ML, Kaul TJ, Stimel CA. Abortion: predicting the complexity of the decision-making process. 

(And if anyone can find the following in English, let me know:) 

1999: Tornbom M et al. Decision-making about unwanted pregnancy.

1990: Ytterstad TS, Tollan A. The decision process in induced abortion. 

Another FAQ: "Why did she wait so long?"

Yes, it's a frequently-asked question, and I kinda hate it. Like she "waited" around until her schedule cleared up or something. If a woman finally makes it to an appointment at 18 weeks, it's safe to assume she wasn't "waiting," she was being delayed. 

This came up for me yet again last month when Frances Kissling, who formerly led Catholics for Choice, controversially questioned whether we really know anything at all about why some women have later procedures.* To make a long story short, Kissling said we don't know how many abortions are done because of fetal anomaly,** said that "there is no evidence regarding shame over sexual abuse leading to pregnancy denial, indecision etc as a major factor," and asked "Do we really think women who do not have the money for a first trimester abortion find the larger amount needed for a later procedure in any significant numbers?"

Apparently, even people (like Kissling) who have experience providing abortion care and emergency abortion funding for second-trimester patients may feel this way. But that baffles me, honestly. Because I have those experiences too, and I've spent so many days/weeks/months, yes months, working with the same women who are still trying to obtain treatment for the same pregnancy, and heard all of the trials and tribulations along the way. How could someone who's done this still feel they "don't know" why women "wait until" the second trimester, while I feel I know it all too well?

Here is your frequently-given answer:

Women DO suffer, sometimes terribly, from shame and denial -- young women especially. They don't tell their parents, who might beat them, throw them out of the house, or simply 'be disappointed' about either consensual sex or rape (outrageous but not uncommon) or the pregnancy itself; imagine how much more complicated and traumatic when abuse by a trusted relative or family friend is involved. Will they even believe her? How can she bring herself to speak up?

Then there's the surprising number of women who simply don't realize for a few months that they're pregnant: they have urgent things on their mind, like keeping their children clothed and fed, where outgrowing their shoes can be an unaffordable problem, and maybe to scrounge up some shoe-money they'll forgo lunches at work, so feeling tired and slightly sick all the time is nothing new; you get the picture. Or they keep getting their "period" (actually implantation bleeding, 1/3 of women have it through the first trimester) or are in some other way among the "lucky" women who barely have any symptoms.

And yes, HELL yes, women do spend months getting the money together. In my area, most of the quality providers charge around $500 for a first-trimester abortion; some places are able to discount $100-150 with proof of Medicaid. This is low compared to most out-of-pocket medical costs, and has barely kept up with inflation since 1973, but of course if you're on Medicaid you probably don't have $350 in your pocket. Sure it doesn't "make sense" to try to get $2700 instead of $350, as Kissling says, but the logical conclusion of that view is If they can't get the $350 right away, why are they bothering at all? Yet we know women are much more determined to decide their pregnancy outcomes than that. Plus, when I work on funding, a lot of the second-trimester patients I talk to got their price information when they first called a clinic in the first trimester, and had a terrible shock when they called back several weeks later and the price was higher.

Then, if they are lucky enough to find out about emergency funds, which many clinics don't even know about (!), they will still be disappointed to learn that the fund can't always pay everything they are missing. "Can you pawn your TV, get a predatory payday loan or a loan for your car title, can you borrow ten dollars from everyone you know, can you find five houses to clean after work this week?" (It sucks to talk about these options -- even more so if they've already been checked off.) They painstakingly set that money aside. Then, maybe, a drug-addicted relative steals it from them. (Yes, really.) They're back at square one. Or they have to help their family move before the eviction date and the delay takes them from week 12 to week 13, and they've moved to another neighborhood/town and have to find a new clinic with a new price, or a ride to the old clinic. And so on.

The funny thing is that when I mentioned all of this in a comment on Kissling's article, I felt shy and embarrassed, because someone with her experience has surely heard it all before! But why do the detailed memories come back to me so readily whenever this subject comes up, and not to her? These stories and examples are not statistical evidence (which might be what she was calling for without naming it as such), but they are not nearly rare, either. I've heard them for years -- sometimes alldayeveryday -- but never lost my trust in women and girls' good-faith efforts to TCB as efficiently as they were able, or implied that their own words about "why" the delay (not that I was owed an explanation at all) were not reliable enough.

The entire post I just wrote is only a small handful of common examples, in a health care context where abortion is mostly privately provided and privately paid for. There's no one Major Reason (or 3 or 5) explaining the course of all women's pregnancies up til their appointments. To sum it up in different words: the British Pregnancy Advisory Service reviewed a full month's worth of requests for abortion past 22 weeks in the UK. The article where I read about this, A Moral Defence of Late Abortion, is fantastic in itself, but if you want to get to the details of the audit, scroll down. There you go: your frequently-given answer, woman by woman.

Prolixly yours,
Placenta Sandwich

PS: I don't hold it personally against Kissling. I still like other things she's written. Like this article, for example, that I think everyone supporting abortion rights ought to take to heart this new year - Twelve Things You Can Do To Help Increase Abortion Access.***


*The main point of Kissling's article was to address the calls for "honesty" from pro- and anti-choice camps alike; she stated she isn't comfortable with some pro-choice advocates' rhetoric, like typical characterizations of "reasons" for the 10% of abortions that occur beyond the first trimester. By way of example, she quoted Catherine Epstein writing that major reasons for the vaguely-defined "late abortion" include fetal anomaly, shame or denial following sexual abuse, and the struggle to get enough money for the abortion. 
**What we know about abortions sought because of fetal anomaly is that they represent less than 1% of ALL abortions, but probably much more of what are vaguely referred to as "late abortions" (I'll try to find exact percentages, but the reporting is not uniform across states). Between Epstein's and Kissling's articles, the distinction between "second trimester" abortions (after 12 weeks) and "late abortions" (after 20 or 21 or 22 weeks, depending who you ask, when fetal anomalies are more often detected) became blurred in the arguments. 
***Even though, as the National Network of Abortion Funds pointed out, many clinics and doctors DO already forgo payment to provide urgently-needed abortions. I had to go and be argumentative, didn't I? 

Everything you wanted to know about abortion hosting but were too afraid to ask

I know that sometimes us abortioneers take for granted that we understand the ins and outs of all things abortion and we leave our readers confused or seeking information. In past blogs we have written about the basics of 1st trimester procedures, 2nd trimester procedures, medical abortions, etc. I wanted to take the opportunity to go over some commonly asked questions about abortion hosting. Listed below are the questions I get most often, but feel free to ask about anything I forgot in the comments section.

How do women get connected with volunteer hosts?

Women usually do not get linked up with our service until their first day at the clinic (the women we host are almost always having 2-day second trimester procedures). When they arrive at the clinic they often find out that the cost of their procedure is more than they anticipated and they no longer have hotel money. Every now and then women know in advance that they will need hosting but it is usually the day of that everything transpires. The clinic staff will screen the woman to make sure she is a good fit for volunteer hosting and then the clinic staff will contact our volunteer hosting service to let us know there is a woman who needs to be hosted that night.

How do women get to your apartment?

I always go to the clinic to meet the women at the end of their first day. The law requires that women have someone pick them up from the clinic after being administered anesthesia. In addition, many women are not familiar with my city and would have a hard time navigating to find my apartment. When I go to the clinic to meet them the clinic staff always introduces us and the women are eager to get out of the clinic and head to a relaxing home and eat some food. I always offer to get a cab for the women, even though I rarely take cabs myself. Luckily I do not live too far from the clinics we work with so the cab ride is not super expensive. I know this is an added cost for myself but I try to put myself in their shoes and I think it would be hard to take mass transit during rush hour after all the anesthesia and long day at the clinic.

Do you cook meals for them?

Every woman I have hosted has either wanted to order takeout or has brought some food with her. After midnight they need to be NPO (no food or drink in their system) so breakfast is not an issue. In regards to the meals, I always offer to pay and the women usually appreciate and accept the offer. The money for the meals (and cabs) comes out of my own pocket and for me I see it as similar to a monthly donation that I give to improve abortion access.

Has anyone ever started passing the pregnancy or bled on your bed?

No! I have heard 1 or 2 stories about this but it has never happened to me. I knew when I signed up for this gig that it is a possibility, but it is one I am willing to accept.

Aren’t you worried that strangers will steal from you????

It definitely crosses my mind, just like it would cross my mind if I left my car door unlocked over night. Any person is at risk for being mugged or having property stolen from them at any time anywhere. I like to have faith in people and not assume the immediate worst. If I lived my life expecting the worst out of people that would be pretty shitty of me, right? Most of the women I have hosted (and their guests) have been extremely appreciative and truly thankful for my hospitality.

How do you feel about hosting the male partners?

We are given the option as hosts to pass on hosting a woman if she comes with a male guest (but don’t worry we will find a host who is open to hosting male partners). Many of us have tiny apartments and often these are studios with little privacy. In my first few months I said I was not going to host any women who had men with them, mainly because I will still getting used to hosting and was not 100% comfortable with an unknown male in my home. The clinics do a good job of screening for women who might be in an unsafe situation where the male partner could be abusive or could create a dangerous situation. If one partner wants the abortion and the other does not, this can lead to intimate partner violence (I think all of us who work in abortioneering have seen this in one form or another). It would not be safe for a volunteer host to have a couple in their home who might get violent due to the circumstances around their abortion. About six months ago I got a call to host a woman and her boyfriend and as I have mentioned before, they were the best guests I have had so far (my Beefaroni guests!).

What do you and the women (and their guests) do all night?

We talk a lot. We talk about their lives and my life and their abortion or not their abortion. We talk about future birth control methods, we talk about their gay brother, we talk about their career dreams of being a nurse, we talk about how they want to lose weight after the abortion, and we talk about celebrity gossip. We talk about my veganism and we talk about their children. We talk about the next day and what they can expect from the procedure and the weeks after. We watch the few TV stations that come in through my antenna; American Idol is a favorite. We watch my Netflix DVDs of Glee and we even once watched “Boys Don’t Cry”. Women go on walks in the park near my apartment and they go on my porch to smoke or they spend the entire night on their cell phone. Or they pass out right after dinner. Every woman has different needs and wants different things from me, and I do my best to provide.

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.