Medical Tourism

I have hosted women from small towns within my own state, women from nearby states, and even a woman from Canada. They come to my large metropolitan city because they are past the legal limit in their state, or there just simply is not a provider trained or willing to perform abortions in the second trimester where they live. For example, the woman from Canada was within the legal limits, but there was not a provider, so her public health insurance PAID for the entire cost of her procedure in OUR country!

I always ask the women if they have been to New York City before. Some of them live only a few hours away and I sort of assumed they had been to NYC on a field trip, family trip, or getaway. However, as far as I can remember, every woman I have hosted said she had never been to NYC until the present trip.

We usually leave the clinic in a cab, which for many of them is the first time in a cab. The cab drivers here are fast and tend to weave a bit, which is not the best environment for an often-queasy woman going through a 2-day abortion. One woman was mesmerized by the TV screen built into the cab that had a map displaying showed our location. The women all stare out the window and ask every block what landmarks we are passing and if we will see famous buildings or people…usually people they know from reality TV or celebrity gossip magazines.

I have had a few women assume they will feel fine the afternoon after their procedure and they tell me they will go shopping, eat at a famous restaurant, or try to get cheap tickets to a Broadway show. I try not to break their hearts, but I am honest that they probably will want to stay off their feet and get some rest. They insist they will be fine and I usually keep my mouth shut.

I think about my first time visiting NYC when I was a small child. We ascended the Statue of Liberty, ate in Chinatown, climbed rocks in Central Park, and saw “Cats” the musical. My memories are so positive, and filled with love from my immediate and extended family. I can’t imagine what it would be like to have my first NYC memories consist of hours in a waiting room, sleeping at a stranger’s apartment, and lying in stirrups with unfamiliar medical staff. It pains me to think about how these women experience NYC for the first (and possibly only) time. I don’t think this is how they ever imagined a trip to the Big Apple.

I hope they find their way back to NYC again, in a different circumstance, at a different time. I would love for them to see this city on their own terms and not in a post-anesthesia haze. NYC is symbolic to so many people for so many reasons, and I like to think that the city plays a role in shaping women’s lives. They come here to take charge of their lives and they return home to Rochester, Albany, or even Ontario, as new people (or renewed people).

Alicia Keys sings it best:

Concrete jungle where dreams are made of,
There's nothing you can’t do,
Now you're in New York!!!
These streets will make you feel brand new,
the lights will inspire you,
Let's hear it for New York, New York, New York

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.

(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?