What's your Story?

Please enjoy this one last wise blog by our guest guru, deliverance:

“How can you feel so much for another person, a complete stranger?”

Recently this question was posed in my Abnormal Psychology class. It resonated with me because it seems to articulate one of the most significant obstacles in the

complex world of abortion, which is that we see each other as separate.

"She is different," the woman says, who is 6 weeks and was in the waiting room with another woman who is "showing." "How can she do that to a baby?"

"They aren't like me. I am 40 and done having children. I've never planned on coming here," she explains, as if all other patients have visions of their reprodutive futures.

"I am different than them. I care," she tells me, angered by patients in the waiting room who have the nerve to laugh in an abortion clinic.

Nobody plans to have an abortion at 22 weeks, or at 40 years old. The way people deal with having to make tough decisions is not uniform; some laugh, others cry, and a few might not even acknowledge the difficulty of making such decisions until years later.

When I began training for my job, I also wondered what it would be like to talk about intimate details of a "stranger's" life. When I found myself invested in the most essential part of my job, though--making sure patients are listened and attended to--all such reservations disappeared.

I suppose what I'm saying can be put into two words: Trust women.

Sympathize, imagine, discuss, do what you have to do--but I am as you are.

There are differences among us, such as class, race, and most importantly in this case, gender, but we all want to feel like we are creating happy and fulfilling lives for ourselves and those we love.

If we are supplying someone else's ability to live, and decide we cannot continue to do such, know that it isn't easy--but it's also not your place to judge. At the risk of sounding preachy, let go of that which you cannot control (and how sad it is that control over women's bodies has become sanctioned by law).

If I had to identify the single most important thing abortion care has taught me in the precious 13 months I have been benfitting from it, it is that we should never judge others, for we never know another person's story, unless we ask.

Image: One Heart, One World

Getting to Know You

Hello readers. I wanted to introduce myself -- I'm vegan vagina, and I'm new to the Abortioneers, but not to abortioneering.

I am currently working toward a Masters in Public Health degree, so I mainly take classes and work part-time, meaning that there is little time for me to get connected with fellow abortioneers (besides this great blog!). About a month after I moved here I contacted an organization that I had read about years prior and always admired. This organization is sort of like the abortion underground railroad. The group is made up of volunteers who offer their homes and time to women who come to our large city for multiple day abortions and a) can't afford a hotel, and/or b) do not have anyone to go with them to their appointments.

I had an interview with one of the directors and within a few months I was cleared to start hosting. I host on average every other month, usually for one night. My responsibilities are to meet the woman at the clinic at the end of her first day and bring her to my home (and also bring her back to the clinic the next morning). I provide things like dinner, a bed, reassurance, birth control advice, heating pad, snuggles from my dog, and really whatever the woman requests.

That's me in a nutshell--stay tuned for upcoming thrilling tales of my life as a host and general all-around abortioneer. And yes, fear not, I will relate abortion to vegansim.

Do you have that pill?

The abortion pill has been available the entire 6 years I have worked in abortion provision, in fact its been available for 10 years today! It seems to have become more prevelant over the past few years as the technology has aged. Personally, I don't think I would make the choice to take the pill if I needed an abortion, I like to get anything uncomfortable over with as quickly as possible. When women ask about the pill as though it might be as simple as taking ibuprofin for a headache I try to explain to them they will go through essentially what is a miscarriage at home.

I have friends who have taken the pill who have had very intense experiences and others who say its no harder than a heavy period. After taking mifeprex patients generally take cytotec or misoprostol orally or vaginally and then expel the pregnancy tissue. Patients should expect to experience intense cramping and heavy blood clots. Its an abortion that takes place in the privacy of one's home and for women in challenging or abusive relationships they are able to tell their partner or family it was a miscarriage if needed. The pill or combination of pills used to induce an abortion in the first 9 weeks of pregnancy have revolutionized access to early pregnancy termination in the United States and abroad.

Most recently, clinics in Iowa have began to revolutionize distribution of the pill through telemedicine. Women across the United States don't have access to local providers and this might be one answer to helping women access safe care early on in their pregnancy. I'm pretty amazed by this technology and I hope it can spread to other areas, particuarly rural areas. Women need access to safe abortion and if telemedicine is part of the answer to that necessity I'm all about it.

May you relish your free time at your retirement home in heaven

Today The Abortioneers would like to dedicate your attention to Dr. William Harrison--a deeply passionate and exceptionally skilled obstetrician who dedicated his life to serving women and families of the Midwest. It is with heavy hearts and tinging uteri that we contemplate the passing of Dr. Harrison and the closing of an Arkansas clinic where patients received the full spectrum of reproductive care.

As an active member of the ever-small (and decidedly dwindling?) abortion-care community, Dr. Harrison was never short on powerful and compassionate insight. You can read about his experiences as an abortion warrior at Fayetteville Women's Clinic website. Notably, in Why I Provide Abortions, Dr. Harrison describes an encounter as a third-year medical student with a 40-plus-year-old woman, a poverty-stricken mother of several children, in 1967, who upon discovering another pregnancy, poignantly lamented: "Oh God, doctor, I was hoping it was cancer."

Beyond our loss of one of our fiercest and most vocal first-generation-post-Roe doctors and the CLOSING OF ONE OF FRIGHTENINGLY-FEW COMPREHENSIVE CARE CENTERS IN THE US, The Abortioneers can't help but to re-recite this ever-impending statistic: The United States and Canada face a dangerous shortage of trained abortion providers. In 2000, 87% of the counties in the United States had no provider. The “graying” of current providers (57% of whom are over the age of 50), violence that targets physicians, and restrictive legislation threaten to drive these numbers even lower. In addition, medical schools are simply not addressing the topic; most physicians are graduating with little more than circumstantial knowledge of abortion.

We are comforted by Dr. Harrison's prevailing faith and inspired by a legacy he conscientiously ensured almost to the very day that he died.

(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?

Deception

A fantastical post by Mr. Banana Grabber this past Sunday reminded me of an experience I had a couple years ago. After joining Abortion Land and having had my eyes opened to the horror of CPCs, I started looking out for them everywhere. Under tables, behind bookcases. I had to make sure patients had the correct names, addresses, phone numbers of clinics to ensure that they didn't accidentally wander into a CPC wondering why they have no trained health care personnel on staff. So it was pretty obvious when the signs depicting a distraught young black woman and the thoughts floating around in her head ("...my baby...") started showing up in city buses that they were up to no good. So like any curious/concerned/asshole person, I gave them a ring.

The conversation went a little like this:

Me: Hi, I think I'm pregnant.
Them: We offer free pregnancy tests if you come to one of our centers.
Me: What kind of pregnancy test? I don't like needles.
Them: No it's a urine test.
Me: Is it accurate?
Them: Sure, it's [some commercial brand] that is 99.9% accurate, like in the commercials.
Me: Do you have a doctor on staff?
Them: No
Me: What kind of people work there?
Them: We're social workers.
Me: But what if I want some medical information? I want to make sure I'm healthy.
Them: Well, you can come into our center and we can give you some information.
Me: I work, and I don't have a car. I don't know if I can get there. Can you tell me some info over the phone?
Them: We don't give out information over the phone, you'll have to come into our center. (emphasis added)

I think I even got an address for one in the 'burbs where "se habla Español", but of course I didn't go. I did try not to sound to hip to what they were really about. I figured I'd ask questions that any average Joanna would ask about a pregnancy center, using cues from actual phone convos I'd had with patients. I don't remember now if I blocked my number or not; they undoubtedly have caller ID, but luckily I never received a call back.

So, let's go through the red flags that most folks would just gloss over:

1. No doctor - or nurse, or physician's assistant, or nurse's assistant, or dental hygienist - was employed. They are not licensed to practice health care or give medical opinions (at least credible ones)
2. No clinically significant pregnancy test is administered, meaning they have no diagnostic/laboratory capacity. They buy stick tests from the drugstore that you could easily administer yourself.
3. Ambiguous clinic name. I don't remember what it was when I called, and it didn't say on the bus signs, but I remember being confused by the name. It was very unclear what kind of enterprise this was.
4. Insisting that I come to the center! They would not talk to me about anything over the phone. They wouldn't refer me to any external resources (not even external anti resources, which I found surprising). They wanted me to come in so they could hold me hostage and force feed me propaganda.

For lack of time to live a double life I dropped my investigation. I didn't think I had the gumption to actually go there and snoop around wearing a wire, but maybe I should one of these days. Of course, to get the kind of info I'd need for an exposé I'd have to get real specific and make it clear that I was onto them. For example:

"Please cite the research that you use to determine that 50% of women die within one year after having abortions."
"Please describe the physiological mechanism by which abortion causes cancer of any kind."
"Please explain why you have no health care professionals present to substantiate these health risks."
"Is this center affiliated with any religious institutions? If so, why?" (After all, there must be some atheist antis out there!)

And so on. But how to carry this out without blowing my cover? I guess it's a lost cause. But what a scoop! At the very least, some CPCs are being *sorta* honest about what they can do for you. Take the banner above, from a CPC in Michigan. They admit on their website that they do not perform abortion services, and gives a fair assessment of Plan B (at least!). Haven't gone through the entire site, but why is that so hard for CPCs to do? Why can't they just say, up front, WE DO NOT PROVIDE ABORTIONS. It might be bizarre for us to request that McDonald's disclaim that they don't provide abortion services, but not so for a pregnancy center! What a bunch of whiners.

Anywho. Pregnant ladies, if you're out there, please beware!

Plight of Feminist Abortion Providers

OK. I think I'm bracing myself to piss off a lot of people with this post. So here it goes...

Am I the only one out there that thinks some of our feminist clinics have changed? Maybe lost of some their feminist qualities? Lost some of those things that make them different from the regular, kinda corporate-like abortion clinics? Despite good intentions, I think they have. Sometimes I feel a bit angry about this, but then I knock myself upside the head and think, “Of course they have. Times have changed.”

Over the years, they’ve had to adapt. Clinics have had flex to external pressures of physicians, state and national law, and medical standards; not to mention meeting the ever-changing expectations of clients and the local community. As independent abortion clinics have adhered and adjusted to these changes, they've lost some of their roots: what makes them who they are. What makes them different.

Why are feminist-based abortion clinics special? They typically were established, owned, and operated by women whose ideals spat in the face of the status quo. They had dreams of women working passionately, cooperatively towards a common goal: demystifying abortion. Breaking the “standard expectations” of women to their very bones; allowing a space for women to feel free, to make their own choices, apart from judgment. A sacred place for women have a voice. A place to rediscover, remember who they are.

Why has this changed? Because administrators are so focused on administrative type things (budgets, appeasing all they need to appease, putting out fires, lobbying, etc.), it becomes difficult to focus on feminist things like: making sure staff earn a sustainable living (see Deliverance's post last week); ensuring that power of hierarchy doesn’t become a poison to morale; and remembering…instilling institutional (gasp!) memory and culture within staff and management, lest they (the organization) forgets who THEY are. Their roots.

There are other reasons they’ve changed, too. Let’s face it: there’s a decrease in abortion. Little clinics are struggling to stay open – just like Sparky touched on the other day. I mean, if not as many people need abortions, you’ve either got to diversify the services you offer (expand them?) or you’re going to simply struggle to provide abortions.

We talk a lot about stupid, restricting new laws that are being conceived and born every day. They’re annoying. So are restrictions by the department of health (like Sparky mentioned last week). But there’s another reason things have changed for feminist clinics. Another reason they’re busy and finding it hard to do feminist things: competition. Okay. Come on. Admit it. Clinics have competitors. Yes. Yes. I know. I spoke the unspoken. (Gasp!) I mean, HELLO. Running a business doesn’t make you less altruistic. And, honestly, it doesn’t take a rocket scientist to figure out that small women-owned and operated, independent businesses, find it hard to stand tall against corporate-like competitors.

It’s super important that access to abortion is increased. We already know nearly all counties in the USA don’t have abortion providers. That is wrong and it sucks. But there’s another side to all of this. Clinics are closing down. Not because of obnoxious, annoying protesters and harassing laws. Not because the department of health is making things difficult (well, except in this instance!). You’re all clever. So I’ll just ask you this: were any of the clinics that closed down recently Planned Parenthoods? Not that I know of. (I could be wrong.) They were all little clinics. And I'm sorry to admit this, but even the pro-lifers wrote an article about this back in February. (And no, I'm not going to provide the link here, because I don't want to give traffic to their site. Yes. I'm being a bit totalitarian about it.)

Who is out there talking about this? Even the clinics shutting down and the feminists don't seem to be making enough noise. Some organizations are out there waving the flag that hospitals should provide more abortion services. Okay. Great. But again, the more hospitals are out there doing abortions, the more corporate institutions are out there expanding their abortion services, the fewer independent providers there will be. It’s just kind of a fact. The way I see it: too many big fish in a small bowl fighting for a service on the decline.

So. Things have changed. Feminist clinics are too busy fighting to keep their doors open because financially, in straight-up business terms, it’s tough. The tides are turning.

I ask this: what happens to the women?

Crisis Pregnancy Centers

Recently, there was a pretty alarming article in the news about crisis pregnancy centers and their advertising techniques. For eons now, CPCs have spread lies and misinformation, so this is not a new development by any means, but the tidbits I found in this piece really pissed me off.

A young woman in North Texas went to what she thought was an unbiased options counseling center, called the Arlington Crisis Pregnancy Center. Unfortunately, she was gravely mistaken.

She was shown a 20-minute video of "fetuses, complications and horrible things."
Then a counselor told her that 50 percent of women who have an abortion get breast cancer and 30 percent die within a year of the procedure.
She left with one final thought from her counselor. "God wouldn't forgive me if I murdered my baby.”

50% of women who have an abortion get breast cancer? Not according to the World Health Organization, the U.S. National Cancer Institute, the American Cancer Society, the American College of Obstetricians and Gynecologists, or the American Medical Association.

30% of women DIE within a year of the procedure? Talk about fear mongering! So, just to take a quick minute to think about this, if there were 45 million (legal) abortions from 1973 – 2005, I guess then 13.5 million died because of it. Or, more then everyone in the entire state of Illinois.



Glory To God On High, For He Knows Abortion Will Make You Die, Maybe Of Cancer

I am just baffled at the total shithead nature of CPCs. Why in God’s name (pun intended) would you lie to these women? Scare them? Terrify them?

This young woman, unsurprisingly, chose not to return to this terrible place for more medical work.

When Sarah didn't return for a sonogram, the counselor tried to contact her at home. But instead of talking to Sarah, the counselor talked to her boyfriend's mother, who was visiting.
"She was told I was pregnant and considering an abortion and that she needed to stop me in order to save me," Sarah said.

AGAIN. SERIOUSLY? The best part about this is that a real abortion clinic would NEVER do this. Further, if one did, that would be a HIPAA violation. However, since CPCs are not "real" clinics, and thus do not fall under the same rules and laws, they can pretty much do whatever they want. Seems fair, huh?

CPCs routinely have confusing signs saying they offer “options” counseling (abortion definitely not among them), contraception, etc.

To wit:

As for accusations that the centers are deceptive, Joe Young (vice president of operations for Heartbeat International) said they're truthful about the services they provide. When they advertise that they provide family planning, they do. It's just in a natural way, not involving pills or contraceptives, he said.

DKSFJ:SLEKNT:SBL JF:KLSDJF:SLDKFJSETH#*$%YW(#$*%Y{

REALLY? The double standard around abortion services is really frustrating. Can you imagine if this happened in a different setting?

SIGN: CANCER CLINIC – WE OFFER CANCER TREATMENT
Hello! Welcome! We offer lots of cancer treatment services! ……Oh – you wanted traditional, medically accepted forms of treatment? Chemotherapy and the like? Oh no, sorry. We offer the natural method. Praying. By the way, if you get chemotherapy, you will rot in Hell and gnash your teeth for an eternity. And if you don’t return for your follow-up visit I am going to call your phone repeatedly and tell members of your family you have cancer.

So... how do we fix this?

I'm not sure what the best solution is here. How do we regulate places that make themselves appear to be medical facilities, but are not? There can't really be a law about lying. Certainly that is awful and disingenuous, but that is impossible to regulate. I think some sort of patient confidentiality needs to be put into place. It is unfair to try to convince women you are a medical facility and thus abide by those laws, when in actuality you do not and have no intention of respecting that woman's privacy.

Further, I think it is perfectly reasonable to require CPCs to have signs out front stating they do not provide abortion services or contraception, if they do not. Similarly, abortion clinics advertise on their signs they offer abortions. The fact that CPCs are against having to put this information out in front of their facility proves my point. They want to lie to women; create the illusion of being a real abortion clinic. If the fact they do NOT offer abortion is apparent, that stops women from coming in who have no interest in their services. AKA their target population. God forbid we stop putting women through unncessary stress and harrassment.

:-/

Burn-out

Thank you to deliverance for joining us again as guest blogger today!

*******************************

I was talking with a co-worker yesterday about our work in abortion care. "We should all work part-time here, and then part-time somewhere else, like…an ice cream shop!"

What a great idea, I thought.

Burnout has gotten me down and it is harder than ever to self-motivate. A sanctuary-type environment where I used to continually stumble upon joyful moments, has become a normal office building with boring tasks.

It's not the absence of all joy or gratification, but those moments have become few *and* far between.

Part of it is repetition--the same stories ("I feel like I am killing."), the same obstacles (poverty), and less patient interaction in my current position.

It's also about money. Recently I called a few clinics to get an idea of how much others charge for abortions. There was a clinic a few states away charging over $600.00 for first trimester abortions. Considering how challenging it is for patients at our clinic to pay for procedures, I can't imagine how difficult it is to come up with twice as much money. Then again, women in that state probably don't have any other option.

According to the National Abortion Federation, women cannot access abortion in 88% of counties in the U.S., and that percentage rises to 97% for women in rural areas (http://www.prochoice.org/about_abortion/facts/access_abortion.html). It doesn't take a genius to figure out why we need people who have a ton of passion and motivation to work in abortion care--this right is, and has been, on the brink of extinction.

I have met and waved goodbye to numerous abortioneers who have flung their entire selves into abortion care, but when it comes down to it (and I really do hate to say it), what we make isn't sustainable. If you want to have a family, go back to school, travel to get away from such stressful work, while also meeting rent, buying groceries, and paying off student loans (a Bachelor's degree is required for many positions at clinics)--good luck.

There is an effort on many of our parts to not only be happy, but to thrive with less--we don't need most of the shit we buy anyway--but fair pay is surely a feminist issue, one which many clinics want to avoid discussing. "Everyone needs a raise," is a reply I've gotten quite often, but I don't think that's so true when looking at wages for administrators and doctors.

Despite all of this, there are still some abortioneers who stick around. They have worked at clinics in the same position for 7 or 8 years, and although many clinics don't have much room for advancement, they hang on because our work can be that important and fulfilling. Some go to medical school to become providers. Others study midwifery, so they can deliver babies as well as provide abortions, in the few states where midwives are able to do such comprehensive care. A few play the game of working their way up to an administrative position.

When I realized I wouldn't be one of those people, I started to make plans to "move on," as people call it (even though I will take this work everywhere with me). I feel guilty for knowing I will one day leave, and resentful for what could've been.

For those of you who stay for the duration of your working life, thank you for being the backbones of our movement. Your amount of commitment and dedication is astounding to me.

We Will Keep Our Clinics Open!

In the last year (+) several abortion clinics around the country have closed for a myriad of reasons. We often mention that a vast majority of abortion doctors are "aging out" and fewer medical students currently coming out of school are motivated to provide abortions. Several clinics have also closed after inspections by the Department of Health and Human Services or similar state agencies (DHH, DHS). Abortion provision is challenging and comes up against many blockades on many levels. 

In Fayetteville, Arkansas, the Fayetteville Women's Center closed its doors because the doctor is facing health problems. Several other doctors have become ill, died, or simply reached the age, or well beyond the age, of retirement. Dr. Eugene Glick and Dr. Tiller are two doctors who come to mind who have passed away. Of course, Dr. Tiller did not die of old age or a disease, he was murdered by anti-abortion radicals.

Several clinics have closed after DHH inspections. This is challenging because when a clinic is shut down or its license is suspended, the fairness of DHH is always in question. A few months in Montgomery, Alabama, the Beacon Women's Center had its licence suspended after a DHH inspection. More recently in Shreveport, Louisiana, the Hope Medical Group for Women was shut down after a DHH inspection. Based on a recent law signed by the Louisiana governor, any abortion clinic with any defiency at all must suspend operation immediately and the appeals process to reopen can take months -- here is an article from RH Reality Check to help give a little perspective. According to that article, the owner of Hope Medical Group is going to challenge this law in court. In the northeast, at least two doctors have had to close their doors because of problems found by DHH.

When clinics are closed because DHH finds problems, it is challenging. If DHH came into abortion clinics and advised staff on how to run better medical facilities, that would be great. For example, at my clinic we are constantly striving to improve our patient care and services. The problem is that in reality, very often  DHH inspectors walk into abortion clinics with the intent of finding something wrong. When I read a news story about a clinic being ordered to close, there is no way to know if the problems cited are problems that actually warranted (medically or otherwise) shutting the clinic down. In states like Alabama or Louisiana where the social environment is conservative, it's very possible that both the DHH inspector and the person who wrote the news article are anti-choice. Really, I guess that is possible in Anywhere, USA.

Where I work we spend day after day stressing over what DHH might try to make into an issue. We know we run a clinic that offers safe medical care. Yet instead of focusing on improving our overall patient care and services, we must worry over which piece of our policies and procedures DHH might decide to pick apart if an anti-choice inspector shows up one day.

Abortion care is under seige in this country. Roe v. Wade may never even be overturned, but folks who are in power and against abortion continue to attempt everything they can to make it as difficult as possible to seek abortion care. My boss, who has worked in abortion provision since Roe v. Wade, often mentions that liberals are not as organized as we once were. Women who are of reproductive age today were not alive or not of reproductive age during pre-Roe years. Sometimes I wonder how many hoops women will have to jump through to get a simple medical procedure before folks are ready to get back out and yell, "We will keep our clinics open, enough is enough!"

Keeping my feet on the ground

("...and I don't go to sleep to dream")

Thinking about money again.

In my non-abortioneer job, we've been working hard to finish a proposal for a bunch of money that would enable organizations in low-resource settings to prevent death and disabilities due to unsafe abortion. (If you're curious about this, the immediate strategies are [a] averting unwanted pregnancies, [b] improving the quality of abortion care, and [c] training health providers in how to treat women presenting with complications from unsafe abortions.)

So yeah, big grant proposal means late hours in the office trying to figure out what the donors want to hear and how we can use their money for the things we specialize in, writing the perfect proposal that will win their hearts, and trying to negotiate the budget section and which partner organizations will get what-size chunk for how much work. Sometimes in the midst of all the math, I wonder how all that hypothetical money went so fast.

I also marvel at the higher rungs of the wider not-for-profit world -- from CARE to the American Cancer Society -- where salaries seem comparatively luxurious and the projects move comparatively slowly and the schedules seem like they're mostly meetings and luncheons or something. Sometimes it seems like the institutions all around me are wordlessly shuttling me in that direction, too.

It's what I was afraid of the first time I left my job in a clinic and thought I might try policy or advocacy -- that there'd be less interacting with the people I'm trying to be there for, more isolation at a desk hoping that my abstractions might do something useful like increase contraceptive access a little or reduce wait times for post-abortion care a little.

At the same time as your goals are getting more abstracted, you're also trying to "advance your career" so you can have more responsibility, help formulate goals, or make a unique contribution... And to be very honest, sometimes it's too easy to think of earning power as shorthand for getting somewhere, and that can make you accept others' values as your own, forget what you came here to accomplish, or in some other way lose perspective.

I'm not saying I'm sure my own perspective is perfect, only that on the other hand it's quite simple to keep on track when I am working with clients directly. It reminds me what matters right now, keeps me humble about all that I still need to learn, and gives me a healthy outsider's view of the weird process of trying to find a place for myself in the inevitable hierarchy.


In my imagination the thing I really fear looks like me sitting at a desk pushing paper -- stressing about donor-pleasing language, navigating five different colors of "track changes" in a document, going to an endless string of meetings to plan work that will always be postponed for more meetings -- not seeing any concrete results that make people's lives easier, and managing to make money off it. And that's another reason I love being an abortioneer and don't want to trade for an "easier," "better," or "more important" job: to me those other jobs seem like none of the above.

Now...how will I pay off my grad school loans? (The question that makes the world go round, right?)

Some E-Cards

Lean on Me

I was fortunate enough to have several friends come to me recently to tell me their abortion stories. I had only mentioned my work in passing and they approached me separately to confide in me. Their abortions weren't particularly recent, but they were still hurting. Some women hurt, some don't, and neither response is wrong. (And for the love of Mike, some fillings hurt, but that's no reason to outlaw them, so can it, antis.) My friends were and are glad they had a choice, they don't regret their decisions, but they were living quietly with their grief. I jumped into counselor mode in the middle of the coffee shop and I listened, offered resources, and suggested healing and coping techniques. And we hugged and I gave them instructions to call or email me whenever they needed an ear.

After I counsel women at work, I give hugs or a pat on the back or a few pamphlets or a souvenir flowchart we developed together that details a plan for healing. And I write my phone number at the clinic on the handouts with my name next to it, and I give the clients the same instructions to call me whenever they need to. Only a handful of women have taken me up on it, and I love hearing from them because even if they're sad, they usually are calling to also say thank you or tell me about the good things going on in their lives, or because they're open to talking. The rest, I think about and send a wish into the universe for their well-being. I don't forget them. And the thing that struck me the most when my friends came to me was the hope that they had a counselor who listened to them and walked with them through their abortion experiences. And I worried that they didn't.

A couple of weeks ago on PostSecret there was a postcard that said something to to the effect of, "To the nurse who held my hand last year as I lost my baby and told me eventually I would be OK: I am. Thank you." I wish I had saved the image, but it came and went like the postcards do every week. I loved that card, though. (And maybe it was about a sick infant or a miscarriage, but the beauty of the site is that it's open to interpretation.) It was like getting to hear the happy ending of every client I've ever wondered about. And I like being a part of the beginning, middle, and end for my friends.


Update - Thanks to a couple of lovely readers who let us know where to find that PostSecret submission! Here it is:

When Pro-Choice gets Personal

I recently visited my hometown and stopped by an old friend's home. She was excited to see me, and for me to meet her new niece. This particular friend has at least one older sister who already has children, so I figured it was one of her daughters. I came in the house, scooped up a precious little lady in pink polka dots (after my own heart!) and giggled and squeed. My friend's younger sister, who is several years younger than I am, introduced me to her boyfriend, from whose grasp I had blindly stolen the baby. I looked back and forth at the two of them and realized: the baby was hers!

Nobody had explicitly mentioned that the baby belonged to the youngest of the brood. I guess I had just assumed that she was too young to have children. I managed a "Congratulations!", though my mind was racing and I was in shock. But to look at the little family huddled up in the living room - Mom, Dad, Auntie - you could surmise that this was a perfectly healthy and happy bunch. As for the baby, she was really something. I couldn't keep my hands off her. What a doll! I played with her, sang to her, watched as Dad, still in his work uniform, changed her diaper and scolded Mom for swinging her too hard ("She could fly right into the wall!"). It was wonderful.

Since becoming an Abortioneer, I've become even more pro-choice than I'd ever thought possible. Because I not only celebrate the right to choose abortion, but also the right to bear children. I had always considered unwed motherhood something distant, completely outside of my scope of being. My middle-class, pill-popping environment had made it so. And for a split second, when I realized that this young woman was a mother, I felt as though something had gone wrong. I wanted to say "You could have called me! I would have known what to do!" But that thought was gone sooner than it came. My friend, and anyone who friends me on Facebook, knows where I stand on the issue, and is aware that I have information and "connections". This was a smart woman. If she had wanted help I'm sure she could have found it. But she was a mommy, and she had a daddy and a big warm family there for her. And her little Christmas miracle made them all smile and laugh, and why would I spoil that? My services, so to speak, were not needed here. All the wanted from me was to enjoy the opportunity to kiss a cheek, tickle a belly, and celebrate a special little person with old friends. And I'm so glad I did.

HOWEVER! To all the women out there with different situations, or the same situation but different feelings, you can still call on The Abortioneers. We'll support you through it all.

Too Far

It kinda sucks when someone is too far to be seen at the clinic and you have to turn them away. Of course, lots of effort goes into ensuring she can see another provider; but sometimes that means the patient has to wait several days or travel a long distance (possibly even out of state) to be seen. Work schedules get rearranged – again. Childcare rearranged – again. Driver’s schedule rearranged – again. Extra costs ensue: additional abortion fees; gas/train/bus/plane money; hotel fees; costs of missing work (both financially and also potentially risking termination for attendance issues); emotional costs of making all these changes in plans and waiting and hoping she won’t be too far – again.

Thankfully , there are lots of advocates and funds out there who will help clients obtain abortions under these stressful and disappointing situations. We Abortioneers are so grateful to funds like NAF, NNAF, EMA, WRRAP, TEA Fund, and CAIR who help women still have access to abortions.

Labor Day

For those of us in the medical world, labor is synonymous with child birth. Why? Because if you have ever been in a delivery room, you know that pushing a baby out of you is a HELL of a lot of work!

I personally have never done this sort of labor myself, but I can only imagine the energy it requires.

However, the labor doesn’t stop in the delivery room. Raising a child is, by far, the hardest job in the world. It takes time, patience, money, and unconditional love. And for some women, they are not quite ready for this type of job-they are not financially stable, they are with the wrong partner, they are not emotionally ready, they are taking care of their children.* For whatever reason, it’s not the right time for them to begin this type of labor.

Choosing to terminate a pregnancy is difficult, as is raising a child. We must learn as a society to trust women and their choices. Women know what is right for them and their lives, and it will be our job as physicians and members of the community to support a woman in whatever she decides to do with her body.

On this Labor Day, I honor the women who dedicate their lives to their children and who make difficult decisions as to whether to be a mother. I remember all the women who died unnecessarily during delivery and who died from botched, unsafe abortions.

Today, let's not forget the power of choice and how it can affect all women, everywhere!


*Most women who choose abortion are mothers already.

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. 

Service

Thank you to deliverance, who joins us for another guest-blogging stint this Thursday morning!
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"Serving, like healing, is mutual. There is no debt. I am as served as the person I am serving. When I help I have a feeling of satisfaction. When I serve I have a feeling of gratitude."
-Dr. Rachel Remen


Abortion work is draining.

Most service professions are, but the stubbornly looming abortion debate is inescapable.

Every once in awhile, unknowingly, my patients provide some much needed fresh air.

Last week I was assigned the role of Patient Support. This job includes assisting doctors in procedure rooms, ensuring equipment is clean, but most importantly, making sure patients have someone to help them through an abortion procedure.

Unlike many outpatient surgeries, abortion comes with a myriad of emotions. It is different than a typical surgery, because there are intangible parts of a person which need attention and care.

Many women walk in the door having absorbed persistent rhetoric meant to make a common medical procedure much harder than it should be—"Abortion is murder," "'Mommy,' I love you," "You are heartless."

Having the opportunity to make an abortion experience comfortable and safe for a woman reminds me of why I am in abortion care.

A patient affected me last week by gushing, "Thank you, you are so kind. Thank you for being there for me." Another held my hand until her procedure was finished. Another told me that our clinic was lucky to have me, and offered a complimentary pass to her yoga studio.

Abortion work may be draining, but patients are endlessly gracious.

They serve me just as much as I serve them.

Note to Self: DON'T MOVE TO MISSOURI

Or as a friend of mine would say, Missour-uh.

I'm not an angry person, but laws like this make me seethe, and I'm not talking about the strip clubs. ""The life of each human being begins at conception," according to Senate Bill 793" -- this is the name of the bill! I had no idea that becoming a state senator made you a qualified medical professional, allowing you to make such a statement. This bill mandates that abortion clinics give pamphlets to women stating this (religious agenda) and detailing fetal development, among other gems.

Due to the awesome foresight of the Missouri legislature, women will not only have to wait 24 hours to "think about" their abortion. Because they haven't thought long enough. Now they will also have to be given misleading information that, let's face it, is meant to make them feel guilty.

The Courthouse News Service had one of my favorite quotes. "State Sen. Jim Lembke, R-Lemay, told the St. Louis Post-Dispatch that this 'information' 'is not a religious statement; it's a scientific statement.'" Oh, it's a scientific statement is it? Ok, Sen. Jim Lembke, show me this scientific data that supports your claim. Sen. Lembke's bio on the Missouri State Senate website says nothing of any medical or scientific background, so I'm curious to know where he is getting this information.

Why do we let politicians control our lives?