Tell it slant

Emily Dickinson advised, "Tell all the truth, but tell it slant." Tim O'Brien wrote an entire book that might be part fact, part fiction, part ambiguity, but none of it a lie. In my recent quest to speak my truth and speak it from my heart, I realized I was speaking my truth with hyperbole, sarcasm, and humor, but not with my heart.

When I write here, I employ humor to make things easier to me to say and for you to read. I meld my real life with a fake life so that you will know what I am without knowing who I am. I am unequivocally a pro-choice crusader, but my favorite color may or may not be purple.

When I tell client stories, I am well aware that they are not my stories to tell. HIPAA binds me to change details and nuances, and my own ethos binds me to relay the gist without relaying the experience that I may or may not interpret properly anyway.

The stories that clients tell us, anyway, are half truths. I may find out about the abusive boyfriend, and my co-worker may find out about the childhood molestation, and neither of us find out about the past abortion. "I'm fine" can mean both yes and no and maybe. "I'm killing my baby" can be internalized rhetoric or personal conviction or uncertainty about both or neither.

And when I tell clients that they will be OK, I can't guarantee that; I can only hope. When I call them from the waiting room Price is Right-style ("Jane McAbortionpants, come on doooown!"), the silliness covers my annoyance with a long day and my discomfort with clients' discomfort. And then I go home and say that my day was "good" because sometimes that's easier than reliving heartache and frustrations.

Thank you, readers, for hearing our abortion reality, however embellished, or minimized or raw. This is my heart.

On chives and choice

I was happy when my friend's son learned to talk. Not because he was able to communicate, "I am hungry and I would like to see my mama now please" (or something to that effect) instead of screeeeeeeaming, although that certainly was a perk. But because I was able to say, "Thomas*, can I pick you up?" and he could say, "No!"

One of the many, many reasons I'm not a fan of babies is because to me, it's weird that you would walk up to this tiny human and grab its fingers and pinch its cheeks. I would no sooner do that to my cousin than I would to my landlord. And if I did, for some strange reason, have the inclination to do that to my landlord, I could say, "Rupert*, may I pinch your cheeks?" (And I'm positive he would say, "No. Also, evicted!")

What I'm saying is that choice comes naturally to me. We talk about the rhetoric of choice versus life and justice versus choice, (and I don't disagree that the "life" argument is bullshit and that reproductive justice > simple choice) but at my own core, I'm pro-choice even when abortion isn't involved.

I teach a fitness class on the side (sometimes, I sneak in abortion humor. You can take the instructor out of the clinic, but you can't take the clinic out of the instructor!), and I intellectually know that my job is to direct and correct. But it takes effort to do that because my inclination is to say, "Huh. That's an interesting take on the exercise, but if it doesn't hurt your hip and if you're not knocking out your neighbor, then go ahead with those roundhouse kicks as the rest of us stretch."

For that matter, when my cat steps in my dinner plate (I live alone), I do remove her, but I have to explain to her why I'm lifting her from my potatoes and how I do respect her right to dip her toes in the chives. She made the choice to encroach, I made the choice to overrule her, but I still need to explain and offer informed consent.

And mashed potatoes or unwanted pregnancies, I am so very much all about choice.

* Of course, all names have been changed to protect the innocent.

"Stop the hate"

PETA activists throw paint. Anti-choice protesters throw weird little plastic fetuses. Gay-rights advocates throw...glitter bombs.

I really tried to resist the urge to add my commentary that if Newt is all about "liv[ing] in a free country," it's interesting that he's not in favor of the freedom to love and marry nor the freedom of choice. But ANYWAY.

One of my mentors told me about this video last night as we also talked about fear. Antis fear strong women and autonomy and a complex right to choice and reproductive justice that they don't fully understand. Abortioneers don't fear antis as much as we fear the loss of our rights and our beliefs and options.

I don't think that much about bombs when I go to work, but recently, I made a dark joke to a loved one and she responded, "Oh my God, I never considered that danger for you. Be careful!" It's simultaneously encouraging and horrifying that I can joke about something like that, and it's sobering to be reminded that it's a reality.

Last night, my mentor mused, "You should just throw a glitter bomb at the protesters," and I like her style. Shouldn't we all subvert what bombs are and how fear is expressed, keep it light as we deal with the heavy, and "feel the rainbow"?

"Man in the clinic!"

Abortioneering is a fairly female-dominated field, and when I hear the classic "But what about the menz?!" whining about consent from the "father" or when I see a male partner trying to force a woman into or out of an abortion, I'm completely OK with not involving that sex in the Abortioneering process. But in the real world, I do work with a couple of men who are 100% feminists, champions of women, in favor of abortion access on demand, and who give no credence to the idea that men should have any say in what a woman does with her own body. It seems to come naturally to them and I've never heard any complaints from them, but I have to wonder about what elements of the job get to them because they aren't immune. And they're still a part of the world where patriarchy rules and men don't talk about feelings, especially about feelings of working in an abortion clinic where there are vaginas. And that's got to be difficult. I love my Abortioneer brethren like I do my sistren, and I want them to feel supported and appreciated.

So, I'm curious, Abortioneers: Are any of you of the male persuasion? Do you work with a token male or two? What have your experiences been?

Making a statement

Sometimes, I consider whether I would love my job as much as I do if it weren't so controversial, if the mere act of going in to work weren't so badass, if the answer to "What do you do?" weren't guaranteed to make a statement. I can't pretend that loving my job isn't partially a political act. I adore advocating for women, fighting the evil forces of the anti-choicers, and the way I feel when a client expresses her appreciation, and those things wouldn't affect me quite the same way if not for how (inexplicably) volatile choice is.

Don't get it twisted; I'm not in any way thanking the antis for making me excited to go to work. Well, unless that angers them...in that case, I will admit that on a day when I didn't sleep enough and I'm walking through puddles and my hair is looking weird, seeing the protesters outside my clinic inspires me to work harder and longer and better.

But that's the dramatic side, the one that gives me activist cred at fundraisers and boosts my ego. The quieter side is the one that truly sustains me and sustains choice and providers and clinics. If I woke up tomorrow in my dream world of abortion on demand and coffee flowing from my faucet and kittens all over my apartment, I would still leave my cat- and caffeine-filled apartment and go and proudly facilitate abortions and choice and justice. Because it would be the same amazing clients, dedicated staff, and a very much needed service. I believe in choice because of what it is fundamentally, not because of what it's been made into politically. Even if abortion were treated as casually as our society treats a Pap smear, if it bored people at cocktail parties, I would still honor and revere it, and THAT is badass.

I'm quite disappointed at the lack of stock images of women of color. I tried.

Blinded with science

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

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

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

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

Walking Contradiction: Confessions of an Abortioneer

Recently, I've caught myself looking at my pro-choice friends (which should be ALL of my friends because I aim to have no anti-choicers in my life) and thinking, "Sure, she SAYS she's pro-choice, but when is she gonna put her money where her mouth is?!" (Or put her pen and paper where her mouth is, or put her mouth where her private views are, or put her volunteer hours where her mouth is or whatever convoluted metaphor describes it best.) Never mind the fact that just last week, I was saying, "I don't care how you do or don't show your views; just support choice!"

And even worse, I've caught myself looking at some of my other pro-choice friends and thinking, "Sure, she volunteered as an escort once, but that doesn't mean she can run her mouth all the time about what it's like to fight to abortion access on a daily basis! I'm the only one who knows that!" And then, read the above paragraph, rinse, repeat, and shake your head at me.

I didn't even realize that I was doing this until recently. I shake my head at me. And friends and family who read this, no, I'm not talking about you. And the thing is that even if I were, the point of this post is my unique experience as an abortioneer and my strange, strange biases. I don't have answers and I'm not proud of this confession, but when I put it out there, it loses some of its power over me. And sometimes, I need to show my unpretty side of abortioneering.

Full disclosure?

As a rule, I don't keep my status as an abortioneer a secret. I mean, my identity as an Abortioneer blogger is a secret, but as someone in the abortion field, I am out and proud. I've never had an abortion so I can't talk freely about that to erase the stigma, but I sure can talk about my job as a way to show that people who are pro-choice (or super-duper pro-choice) aren't the devil incarnate. The only times I can recall not disclosing my line of work were when the person I was talking to was wearing an "It's a child, not a choice T-shirt" (in that case, I ran away) or when I was at a party and starving and wanted to focus on my chips and dip rather than talk about the job where I'd been all day. I mean, I have my limits.

So, I've introduced myself to a group by saying, "I'm [Desembarazarme], I like to run, I paint in my spare time, and I work at an abortion clinic." I've told the woman in line at the grocery store, "I work at [abortion clinic name]. What do you do?" It's seamless and matter-of-act because that's how it is for me.

But during one of my standard introductions recently, I had the thought that my attitude might not be serving everyone. It occurred to me that the woman sitting next to me at the dinner party might be pro-choice, but she might be processing her own recent abortion. The older woman in the vintage NOW shirt might seem to me like an ally, but she might be an ally because her friend died in a pre-Roe abortion, and no matter how gleefully pro-choice I am, she might not need that reminder of abortion right here, right now. And even though I can be fairly certain that the college-aged super-liberal guy who's a barista at my neighborhood coffee shop isn't pregnant, that doesn't mean that his girlfriend isn't and that he isn't faced with a tough decision himself, and he's just at work in order to escape it for a minute.

My realizations made me worry that my very presence and my willingness to talk, talk, talk about abortion might backfire. They might make the wrong people consider the wrong things when I'm not meeting them where they are. In my haste to say, "Look at what pro-choice can be!", I forget what else pro-choice can be. It can be sad and personal and delicate. And I never want to serve as a reminder of that. I want to be a resource and shoulder to cry on and an empowering friend, but I don't want to be the face of what people deal with in their own time.

And I don't have answers to this unique situation I'm in. I want to be who I am, but not at the expense of those who are trying to be who they are in a more gray area. I've looked at life from both sides now.

You've got mail

Dear Patients,

Maybe I met you years ago or days ago, and maybe I'll meet you tomorrow or years in the future. I hope I made or will make a positive impact on you, but your abortion experience really wasn't or isn't or won't be about me. And that's one of the things I want to say to you. Your abortion is YOURS--your story to tell, your experience to shape. You have no obligation to justify your decision to anyone. You have a right to be informed, even when it means asking uncomfortable questions like, "What happens to the fetus afterward?" You don't need to be sad if you're not, nor do you have to be happy just because you exercised bodily autonomy. We might talk about how we'd like you to be grateful and advocate for others, but my wish is that you will make the choice for you and you will honor yourself and your choice in the best way for YOU. You have every right to be scared, and you also have every right to the safest and most caring healthcare, which is what we want to give you. You are strong enough to do this, whether "this" is having an abortion or not having one. You are allowed to dwell in as many gray areas as you'd like. We, as staff, might bristle when you ask things like, "Are your instruments clean?" but you have a right to wonder and to ask and to use your voice in whatever way you can or want. You do have a voice, but your abortion doesn't have to be a political act, either. You can be selfless or selfish or both at once. You can yell at me or hug me, and I will find some part of you, large or small, to care for. Your privacy is protected and so is your dignity, and we wish for the clinic to be a safe space for you. You might have just one abortion or just fourteen, and there is not a thing wrong with either one. There is nothing wrong with YOU.

Again, this isn't about me. But I want you to know that I don't forget you, and I am so very honored to be a part of your choice, process, justice, and life.

All the best,
Desembarazarme

What coffee and abortion have in common

I don't quite understand the obsession with Planned Parenthod. I LOVE Planned Parenthood. I have friends who have been staff and patients of Planned Parenthood, I have a Planned Parenthood T-shirt, I refer clients to Planned Parenthood, and I would gladly submit my resume to Planned Parenthood. The thing about Planned Parenthood is that it has, at least among people I know, become the generic name for "abortion clinic." Dear friends of mine love and support the work that I do, and they even put out calls for support of abortion. But those calls for support always seem to say, "Make a donation to Planned Parenthood!" "If I won the lottery, the first place I'd give to is Planned Parenthood." They know where I work, and it happens to be an independent abortion clinic. An independent clinic that doesn't receive government funding and that always welcomes donation and support, especially in this economy. And I know of plenty of other similar clinics that have had to close because of a lack of funds.

What I'm saying is that if your BFF worked at Independent Coffee Beanery, would you really suggest that Starbucks needed the money more? That's actually not the best analogy because Planned Parenthood isn't a corporate behemoth, and I respect Planned Parenthood and I do want them to benefit from donations...but sometimes, I want my little clinic that could to benefit from some cash money here and there. (I might be jealous of Planned Parenthood, but I'm also human and I heart my clinic.)

So if you're a little flush or if your rich pro-choice aunt wants to contribute to the cause, maybe think about checking FAN or Abortion Clinics Online for contact info of lesser-known but super-important clinics in your area that might need a little help, especially in this political and economic climate (Also, think about patronizing your independent coffee shop.)

Nurturing Choice

I've heard the argument for parental notification/consent laws that reasons, "Why shouldn't the parent be involved in the daughter's life and decisions and choices?" It sounds so innocuous and Norman Rockwellian when it's stated like that, but we Abortioneers all know that sometimes it's more like, "This girl is going to be beaten into next week and into the foster care system and into teenage parenthood if lawmakers require consent/notification."

But laws and barriers to reproductive justice aside, I wanted to give a shout out to the parents of all abortion patients (not just minors) who are so involved and so loving. I've always known that if I had an abortion, my mom would be my first choice as a driver/support person. Even when I was in a long-term relationship, I would have chosen her. Above anyone else, I would want her comfort and humor and company. And I have absolutely no doubt that even if it meant taking a day off from work and driving a few hours to my city, she would be there for me.

My friend had an abortion a few years ago, and she came to my clinic with her mom in tow. She, too, had a partner, and she was well above 18, but her mom was her first choice. I could tell her mom was glad to be at her side, but it wasn't easy for her. I knew from past conversations that my friend's mom was pro-choice, and she had even had an abortion and a D&C (for miscarriage management) herself, but that day was hard for her. Although I was friends with the mom, too, I didn't delve into it, but I can only assume that her tears were from memories of her experiences or from the fierce desire to protect her daughter. But whatever baggage she carried, she was at her daughter's side, trying not to cry and trying to make the day about her adult child.

I also remember fathers of clients who were or were not required to accompany their daughters to the clinic, but who were obviously distraught. They weren't distraught because their daughters were killing their grandchildren (anti-choice rhetoric, right there), but because their daughters were faced with their first major adult decisions or because it was the first time their adult daughters had come to them for help or support. They didn't have to say what was running through their minds, but it was evident from the way they softly asked me, "How is she doing?" or implored, "Take good care of her." More than one burly man had tears in his eyes.

I've also seen a mother who accompanied her very young daughter to the clinic and whose boyfriend was responsible for the pregnancy, unbeknownst (until now) to the mother. In another case, the mother's son had brokered the rape of her daughter, also unbeknownst to the mom. Both mothers were clearly heartbroken over the complexities of the situations, as well as the implications of blame that they shouldered. In each of those cases, I made it a point to take the mothers aside and hug them and whisper simply, "You're a good mom."

Thank you, endlessly, to all of the good parents who support their daughters who chose abortion or who chose parenthood or who chose adoption. And thank you to all the parents who chose abortion, parenting, or adoption in order to give better lives to their daughters and sons.

Some details of each of these stories have been changed in order to protect client privacy.

What I hear you saying is...

Part of the pre-abortion process at my clinic is counseling. Clients talk with a counselor one-on-one to review their medical histories, discuss the details of the procedure, ask questions about the aftercare instructions, and work thorough any lingering doubts or concerns they have. Some clients latch onto this idea and want to use it as an in-depth therapy session for things that really should be handled by a professional, while other clients roll their eyes at the idea and assume that counseling is yet another law with which the clinic must comply, a law created with the assumption that women don’t understand what an abortion is or that every human was once a fetus.

But the majority of the clients welcome the opportunity to talk with someone whose job it is to listen and to be pro-choice. I value it because it gives clinic staff a chance to develop a rapport with a client. (Not to mention the chance to debunk myths about having to slice someone stem to stern to perform an abortion.)

I actually took the counseling portion of the program for granted until I learned that some very compassionate, professional clinics don’t offer counseling to their clients. It could be a trick to save time (clients always complain about how long the process takes) or minimize cost (we ARE in a recession), and it could simply be what has worked and continues to work for individual clinics.

So, readers, I’m curious: If you’re an Abortioneer, does your clinic offer counseling? If you’re a friend of the Abortioneers, would you opt for counseling, given the choice? And if you’ve been a patient, did you have a counseling session? What have your experiences been?

Common anti-choice bumper stickers and my responses to them

Because it's too cold to write anything of substance.

"Abortion stops a beating heart
Well, yes. Generally, that's the idea.

"Smile! Your mom chose life!"
I'll smile because she was able to CHOOSE, and if she had chosen otherwise, I wouldn't hold it against her at all, not to mention, I wouldn't have known the difference.

"Take my hand, not my life." (Accompanied by a photo of a fetal hand)
I'm not sure that's possible.

"It's a child, not a choice."
It's a fetus AND a choice!

"Choose life"
Wham! is back?!

"Abortion hurts women."
Wrong. YOU hurt women, douchebag.

"Adoption, not abortion"
You offering?

"Don't abort me!"
I won't, stock image kid, age 2.

"Pretend I'm a tree and save me!"
I don't want a tree growing in my uterus, either.

"I'm pro-life. Ask me why."
I'd imagine it's because you're a self-righteous, misguided misogynist asshole.

I think I need to stop now because I'm sick of Googling slogans to jog my memory.

What's love got to do with it?

"Sex is painful, but I'm fine."
"He said he'd pull out, but I guess he didn't."
"I don't think I've ever orgasmed."
"I don't really enjoy sex, but I just get through it because that's part of being a woman."
"I told him I was pretty sure I was ovulating, but he didn't listen."
"I have to put the medication IN my vagina?! Which hole is that?"
"He doesn't think it's important to use birth control."

I don't think that a lot of abortion clients are having particularly good sex. At all. I've heard all of the above statements from women I've counseled and my co-workers and I have had meetings about expanding birth control discussions to include questions about sexual side effects since so many women seen hesitant to bring those up if they even recognize them in the first place.

Our clients aren't dumb, and I'm not blaming them for the lack of sexual empowerment I've seen from working at the clinic. But they live in a society that values male sexual satisfaction to the extent that Viagra is lauded as a discovery tantamount to the Polio vaccine (vaccine/autism debate notwithstanding). They live in a society that only refers to vaginas as "down there," and limits related dialog to freshness, which brings right back to the obsession with male sexuality. We all know the axiom that if men could get pregnant, abortion would be a sacrament," and I bet you that if a man experienced pain during sex, a full-scale, multimillion dollar investigation wold be launched.

And that male-centric sexual society is the one that values the cuuuute little baybee fetus and refuses to even acknowledge the enormous amount of women's rights involved in the need for choice and the need for abortion. And sex is about communication and bonding and mutual pleasure (usually about these things. I know it's not 1956.), so if the sex complaints above are any indication, of course the couple is in no position to bring a baby into the relationship. And I'm so glad there's a choice available, but that choice sure doesn't exist in a vacuum. (No pun intended.)

We are one thankful rafter of abortioneers

Here at the Abortioneers we wanted to share with all of our great readers what each one of us is thankful for this year (and also what we have been thanked for). Sit back and relax in your Thanksgiving food coma and see what we are thankful for in our lives.

Revolutionary Vagina:

Sometimes we go through life taking for granted the amazing gifts we have. I certainly do my fair share of that. Whatever many of us think of Thanksgiving and its origins, it is a holiday that causes us to take a moment and reflect upon those great gifts in our life. I am thankful for my family. I have the most amazing, supportive family, and I am so appreciative of all they have taught me. I am thankful for great friends. I am thankful for a fabulous roommie, and her cute little dog who brings me joy every day. And while it may drive me nuts sometimes, I am thankful for a job that fulfills me and pays my bills.

Anti-Anti:

border terriers
hawaiian pizza
karaoke
natty boh
in-flight movies
reese's peanut butter cups
st. ives apricot scrub
and her two sisters whose birthdays come exactly one week before and after TG, making it a nonstop party til xmas

About A Girl:

Thankful for:
1) legal abortion
2) amazing doctors who give a shit
3) incredible co-workers who are compassionate
4) a boss who remembers what our work is about: the women
5) to work for an organization I'm proud of
6) IPAS
7) Medical Abortion
8) Providers who do abortions later in gestation
9) Abortion funding
10) The women!

Things I've been told "thank you" for lately:
1) For helping to find abortion funding
2) for being non-jugmental
3) for giving information

Placenta Sandwich:

It's nice to get thanks from patients, but for various reasons, I don't really expect it: they have much bigger things on their minds; they are stressed out; their abortion is a right, not a privilege; and they don't owe me anything for doing my job. In a way I think we abortioneers take on the responsibility for gratitude. When a volunteer fund agrees to allocate their scarce resources to my patient's care, I thank the funding volunteer profusely; and when our clinic agrees to discount the price of care for a woman in need, her case manager thanks our clinic manager. When our doctor leaves the clinic, I say "thank you, Dr. X," and when I leave the clinic, my supervisor says "thank you, placenta sandwich" -- we're all thanking each other for showing up and being part of the team, even if we've had a rough day. And when people ask how to avoid burnout at work, I think of all the coworkers I'm thankful for and say, "It helps if you get lucky and work with awesome people."

Thank you, abortioneers, for being the funnest, funniest, coolest, cleverest, biggest-hearted, best colleagues of all time. You're dedicated to our work, you're good-humored in tough times, and you're so good at supporting women in their various situations that I am always startled when I go out into the real world and remember that not everyone is like you.

Sparky:

I am always thankful for the work I do. Each time a patient is thankful, I feel thankful she was able to get the care she needed. Last week, in a pinch where the native Spanish speaker I work with was tied up, I was thankful to be able to talk to 2 Spanish-speaking patients with some fluency. Then, I was thankful when another patient, an older woman with several children, hugged me as she left the clinic after her procedure. I am thankful every time a woman expresses gratitutude, relief, or self-assurance.

Desembarazarme:

I'm thankful for passionate staff, caring and competent doctors, endless research, all of our clients, the right to choose, the myriad of birth control options, and the part I get to play in so many women's lives.

Mr. Banana Grabber:

I am thankful for abortion providers. I am thankful we live in a society that decided in 1973 women should have the control over their bodies. I am thankful I have resources available to me which enable me to make sure I do not get pregnant. I am thankful that if I did get pregnant, I could choose to have an abortion. I am thankful that I have that option available in a safe setting. I am thankful for those who support me and my work. I am thankful that, unlike many of my patients, I know where my next meal is coming from and where I am going to sleep tonight. I am thankful I have never in my life had to worry about that. I am thankful my parents love and support me. I am thankful I have a partner who respects me and honors me. Finally, I am thankful for my fellow Abortioneers for their work, love, and support.

Vegan Vagina:

I am thankful for my health, family, friends, my best-in-the-world-EVER dog, embracing veganism, being comfortable in my own skin, opening my home to women in need, living a life that challenges me to grow, anything made out of fleece, clean air, and rollerblading.


Finally, we want to all thank our READERS. That is you! Anyone reading this right now---thank you thank you thank you. Without you we would not have anyone to share our stories, opinions, efforts, successes, failures, and everything else we love to talk about regarding abortion. We love having such smart, passionate, and engaged readers and it is such a joy to have this as a place for the abortioneer community to gather.

HAPPY THANKSGIVING

Love, all of the Abortioneers (and Harley the turkey who I adopted this holiday!)

It's an Abortioneer's World...Kinda

I work at an abortion clinic and I have a pregnant friend and a pregnant acquaintance. For what it's worth, one pregnancy was planned, one wasn't, and both are welcome. I can't wait to meet their babies, and I tell them that. I even call a 9-week fetus a baby in the case of the shopkeeper I chat with. It's all about the intention, and even though I can completely visualize what her 9-weeker looks like thanks to my pathology experience, and it sure doesn't look like a baby, I respect that her outcome will be, barring any complications (knock on wood), a full-term baby.

See how I knocked on wood there? After clinic work, which includes D&Cs for miscarriage management and terminations due to fetal anomalies, I can't think of a pregnancy without thinking of what could go wrong. I also can't ask about the gestational age (I do ask the pregnant ladies in my life, "How far along are you? because I know it would be odd to inquire about gestation like I do at the clinic. We try to avoid "How far along are you?" because it implies that a pregnancy will be carried to term.) without envisioning the development I've seen in pathology. I can't visualize the third trimester development because I've never seen that, but I really do feel so fortunate to have gotten such an intimate glimpse of human biology and development. (And no, I don't say to my friend, "Oh! Your baby is about the size of a mango! Have you had an anmiocentesis? Because now is when something might go wrong.")

Working at the clinic isn't just about abortions. I've met the babies of clients who have decided not to terminate and who brought the baby to see us. We also provide care for infertility and we cheer when someone gets pregnant. Several co-workers of mine have been pregnant and bring their kids to work to see all of their aunties. I once told a toddler, "I remember seeing you on your mama's ultrasound around 19 weeks!" Remember the Jennifer Baumgardner book, Abortion and Life? That's my life. Abortion and pregnancy and life and me, and they're all beautiful.

Stock photo because that's just all-round safer.

Trust

I'm not an optimist by nature, but by God, I force myself to be one. There's enough negativity in and around abortion care; no one needs me to be a grumpy, jaded provider. I dance at work and joke with clients and hype up my co-workers and proclaim my love for the clinic from the rooftops. And sometimes, it's the most exhausting part of the work I do.

I wear a "Trust Women" button like the one worn by Dr. Tiller. I believe it with all my heart and it's the reason I go to work every day, ignoring the protesters, ignoring my lower back pain and sciatica after 12+ hour days. I've sacrificed relationships and friends and sleep and food and health and leisure time and luxuries and vacations for this job. I do it because I trust and love every woman who enters my clinic, and I value the work I do. And I know that the clients appreciate all of us providers. But they don't always trust us.

Women constantly ask us if our clinic is clean, if real doctors perform the abortion, if they'll be infertile, if they'll get breast cancer. They call afterward and accuse us of "leaving something inside of me," they blame their stubbed toe on something we did, they call us money-hungry whores because we can't secure enough funding for them. And it hurts so much and it makes me so angry to constantly be the enemy, no matter what. Providers aren't perfect, but we're good and selfless people and we deserve trust and respect.

I'm sorry I can't be your regularly scheduled, sunny Desembarazarme, but I'm human and I struggle, and I trust you to be here for me.

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.

(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?

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: