Dreamland

Maybe this happens to every abortioneer. I know a few other abortioneers have shared their dreams about pregnancy and abortion. I had a dream I was 20 weeks and 6 days pregnant. I had no idea I was pregnant until for some random reason I got an ultrasound and I was told I was in the second trimester of a pregnancy.

I was astounded. I'm gay and I have not slept with a man in over 5 years. In my dream I could not comprehend how I ended up pregnant without sleeping with a man. It seemed obvious my very masculine female bodied partner was who impregnated me. It was some form of immaculate conception except in my dream it seemed less immaculate.

I considered abortion, my partner was like, "this is amazing, its my baby of coarse you aren't going to get rid of it." There I was knowing I did not plan this pregnancy and I have always been very clear that any pregnancy will be very planned especially given that accidents are so highly unlikely given my sexuality. In my dream I started searching for a pregnancy test, just like the ones we use at work. I finally found one and only when I saw the positive second line did I believe the ultrasound.

I felt really ambivalent about keeping the pregnancy because I did not plan it and it did not feel like it was the right time. However, I also felt really unsure about having and abortion. Ultimately I very ambivalently decided I would keep the pregnancy. Then I got lost in an unfamiliar city, alone, still trying to figure out how the hell I got pregnant.

I woke up thinking about pregnancy, parenthood, abortion, and babies. I feel really blessed that planning pregnancy is pretty much a must because I'm gay. I fear that when I'm ready it might be hard, or my ovaries will have expired. However, I feel really blessed that I will not face an accident that results in an unplanned pregnancy. In my dream every one around me was like, "this is amazing!" and all I could think was that I did not plan to get pregnant right now!

When faced with something so unintended I felt really unsure of what to do. I know one thing, it was really important to know I had the ability to choose how to handle the very unexpected circumstance.

Guest post: Telling my patients "No"

Happy Friday! Please warmly welcome Candid Cannula, a fellow abortioneer who's graciously joined us for a guest post this morning. I loved reading about her counseling dilemma -- one that we all grapple with, I think -- and hope you will too.

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“I hope this is the right thing to do,” my patient – let’s call her Nicole – said right off the bat, instantly setting off warning bells. I asked her to elaborate, and her next sentence did nothing to alleviate my concerns: “Well, I’m basically being forced to do this.”

Those two sentences told me all I thought I needed to know, and I was sure that Nicole was not going to be seen today. But I pressed further, asking her all the standard questions to get a better picture of her situation. How had she felt when she first found out she was pregnant? Who had she told? Who was forcing her to be there, and in what way? Had she talked to anyone who was supportive? Had she considered continuing the pregnancy? How did she think she would feel after an abortion?

My role as an abortion counselor has two distinct parts: providing informed consent for abortion procedures, risks, aftercare instructions and contraceptive options; and discussing patients’ decisions to terminate their pregnancies, ensuring that they are confident it is the right choice for them and that they are not being coerced. I have the awe-inspiring right to turn patients away if I feel the latter criteria are unfulfilled, and it is that right that I struggle with when faced with patients like Nicole.

Her story came out in bits and pieces as we continued to talk: like so many of my patients, she had always considered herself to be against abortion and never imagined that she would wind up across from me in this counseling room. She did not think she would cope well after the procedure and she was struggling with whether it was the “right” thing for her to do. At twenty-one, she was a few years removed from legal childhood yet still dependent on her parents, and she said that they were the ones making her terminate the pregnancy. “My parents will kick me out if I have a baby,” she told me. “I’ll be homeless. I won’t have anywhere to go.”

What would you do if your parents were supportive of you either way?

“Honestly,” she said wearily, “I wouldn’t be sitting here right now.”

Nicole was not going to have a procedure that day. I was sure of it. But when I brought up the idea of her leaving, her tune changed.

“No,” she said urgently. “I have to do this.”

You told me you’re being forced. You told me you don’t want to have an abortion. We can’t see you when you’ve told me those things.

“I’m being forced, but I have to do this. I don’t WANT to do this, but I HAVE to. You don’t understand! It’s my decision too. I came here for an abortion, and I have to have an abortion.”

Nicole, what you’ve told me worries me. We find that women cope best after an abortion when they’ve been able to come to terms with it as their decision. Take some more time. The procedure, the cost won’t change between now and next week. Come back next week if you decide this is the right thing for you. We’ll still be here.

“NO!” she exclaimed. “I planned for this today. I can’t come back next week. Nothing’s going to change! You don’t understand, I don’t HAVE a choice. Yeah, I’m going to feel awful afterwards, and yeah, I’ll probably regret it in a way, but it’ll be worse otherwise – I have to have an abortion today!”

I spent a very long time with Nicole gathering the pieces of her story, asking the same questions, asking different questions, offering her resources to be able to continue the pregnancy, alternately trying to convince her to reschedule her appointment and feeling terribly conflicted about whether that was the right thing to do. I had little doubt that she would end up having an abortion, but maybe she could be in a better place with more time to own the decision. Or maybe another week would only create additional obstacles and difficulty, needlessly complicating her life further.

Where does the patient’s constitutional right to choose an abortion intersect with the counselor’s responsibility to screen and refuse service due to perceived ambivalence or coercion? What do ambivalence and coercion mean for women who lack the emotional or financial support to continue a pregnancy they may otherwise have welcomed? I came to feel that Nicole’s claim of being forced to be there was her way of coping with needing an abortion so that she didn’t lose her family and her home. She may have made a different decision if her family supported her either way, but the reality was that they didn’t, and she wanted to keep them in her life more than she wanted to continue the pregnancy. Many women are “forced” to have an abortion by various life circumstances; does it matter whether those circumstances are other people or faceless considerations like financial constraints, age, or health problems?

I’ve turned abortion patients away who have returned a week or two later, grateful for the extra time to think about the decision and better equipped to cope afterwards. I know that sometimes, it truly is better to wait when ambivalence is detected; patients can’t change their mind after the procedure. But I struggle with exercising my right to turn patients away when they protest. How do I know which patients will truly benefit from it? Doesn’t the patient ultimately know what’s best for her? Why should it be my right to deny a patient the service she insists on accessing?

Nicole had her procedure that day. Like many of my patients, I imagine no pregnancy outcome would have been positive for her. Many patients will never feel 100% confident or at peace with the decision to have an abortion. But no one would have subjected her to an assessment of ambivalence or coercion in order to continue the pregnancy, and that’s one thing that makes abortioneering such a uniquely challenging kind of work. In the counseling room, it’s often a delicate balancing act: trusting the patient to know what’s best for her, and stepping in when I judge that she is simply not ready to take the step that day.

A woman is a living, growing human being

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

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

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

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

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

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

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

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