(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?

To Abortioneers: Help Out About A Girl!

Dear Abortioneers Out There:

I have a confession. I'm having a mini - tiny even - crisis. OK. "Crisis" is a bit dramatic; but I could totally use your help. The dilemma: I can hardly relate to clients who worry about god and if this god is going to forgive them for their abortion(s). Why is this a mini crisis? Well, because:

a) where I live, some of our abortion clients seem to be concerned about this (at least on some level), and
b) because I'm meant to have a counseling session with someone tomorrow to further discuss her spirituality and her abortion decision-making decision.

I hardly feel qualified. I used to be religious. Perhaps even zealous. I've probably even blogged about it before. I was super conservative....a long, long time ago; but that religiousness has now been out of my life for as many years as it had been in it. So I find myself at this...strange place....where I can sort of/kind of remember when I worried what god would think of me, but mostly, I just can't.

Not remembering and grasping onto this I'm-concerned-about-what-god-would-want-me-to-do thing isn't helping me at work right now. When I was a bit religious (occasionally going to church) and still holding down my abortioneer job, I loved it when women mentioned god during counseling sessions. I could relate. I could talk about god and spirituality easily. I wasn't in the slightest offended by the idea of a god or by religion itself (whereas now, religion offends me). So it seems like some twisted act of fate (or perhaps god has a sense of humor? Ha!) that I'm meant to talk to a bright, capable, young woman tomorrow who holds in her hands her very future, and the only thing stifling her is something I think is imaginary: god. I don't understand. I just want to say to said bright, capable young woman, "You know. I hate to break it to ya, but there is no god. Or if there is a god, this god is sooooo not going to care about if you have an abortion or not. If there's a god, it might be a teensy bit more caught up with more important matters like, um, global warming, civil wars across the world, genocides. That sort of thing." Yet, I can't bring myself to say that (at least not to her), because....well, she believes in some god who is going to care if she has an abortion or not.

I'll be frank (or - um - even more frank). I'm not really sure what to do. I keep re-reading literature from RCRC (Religious Coalition for Reproductive Choice) and other documents, but it's not really helping me get back to understanding this spiritual concern she has. I want to give her some words of wisdom, of comfort. I want to be able to say something she can relate to, that helps her heart feel at ease: whatever decision she makes. Yet the reality is, it doesn't - I don't think - really matter what I tell her because it truly only matters what she thinks/believes. Problem is: I just can't relate.

I suppose I need to get over myself a bit. Not expect that I have to have words of wisdom. But I still am supposed to say SOMETHING to her, RIGHT? If she comes to our counseling appointment talking about god and her spirituality and reconciling that with her abortion decision (which is exactly what she told me she needs help doing!), I really don't know what I'm going to say. (BTW - I am trying to find clergy or something willing to talk to her!)

So, sisters in abortionland, maybe you can help me out. Do any of you relate to what I'm talking about? I know there are abortioneers out there who are religious/spiritual. What kind of wisdom do you give to women? Do you have some advice for me? I appreciate it. Thanks!

Much love,
About a Girl.

My New Love: Options Counseling

I have a new found love: options counseling. Who knew? I mean, I've done options counseling for years; but in my experience, it's not that common many women ask for it. Usually, women who call the clinic already know they want an abortion. They've had a few days (weeks, months) to think about it. They're certain. Or they wouldn't call to begin with. (Most of the time.)

Occasionally, however, a woman calls and says she is unsure of her decision and wants to talk to someone. Even so, almost every single person I've spoken to only considered two options: abortion or motherhood. Not adoption. I've never thought it was odd women didn't include adoption in their options; and I assumed for those that adoption was a serious consideration, they'd just call the local Open Adoption agency (like this one) or maybe their church. Not the abortion clinic.

I've recently provided options counseling to two women only considering abortion or adoption. Believe it or not, in my many years as an abortioneer, I had never ever ever talked to a woman who considered adoption (unless she was over the gestational limit for an elective abortion and adoption or giving birth became her only options. But that's different.)! How I've gone so long talking to zero women about adoption (because they've all been like, "Um. Nope! Can't do adoption. No way!") might be strange.

I have no clue what I'd do without Anne Baker's "Abortion and Options Counseling" (here or here) and The Pregnancy Options Workbook. I have to say, though, I have loved.loved.loved.loved this new experience in options counseling where adoption has entered the equation. I feel stretched. I'm learning more. And it's fascinating! Maybe because it's new to me. Regardless, these two women have taught me a lot and I find myself thinking of them regularly. They've reminded why I love - even adore - this work so much. They've reminded me to stop. To pause. In options counseling, you need to get to know the women better. To listen to their hearts, their dreams, their deepest desires. I get an opportunity to do a really good job. To excel at my work. To listen.Listen.Listen. To ask hard questions that maybe others can't ask. To feel honored to be the person to listen. To make a connection with more depth and even get to spend more time with them.

When a woman is right on the cusp between two completely different lives, two completely worlds, it's astonishing. Awesome. Really quite amazing to witness. In all seriousness, when these options counseling sessions take place, I hear in my mind Robert Frost's "The Road Not Taken,"
Two roads diverged in a wood, and I—
I took the one less traveled by,
And that has made all the difference.

Frost knew what he was talking about. It's hard to make decisions, to make choices. I think these women are quite incredible and brave. And I truly feel honored to listen to them. Grateful, even. And...on that note, dear Abortioneers...if you haven't yet heard, here's some super duper fab news: The Backline (Options Counseling talkline) is re-opening starting THURSDAY! Check it out here. Congrats, Backline!

In You We Trust

In a world where no one has enough money and survival feels like a burden, financial counseling is monotonous, hardening, and repetitive. As we know, often getting an abortion means coming up with money that most people don’t have. It means selling belongings that you might need, not paying bills, getting evicted, selling food stamps, lying, and borrowing money with no means of paying back. Most women have to piece together money that simply does not exist.

I spend a vast amount of my time running through a long list of ideas about how to exhaust resources that aren’t exactly available. Most times women have to compromise their pride, independence, and sometimes honesty in order to raise money. Every so often, a women needs more than money. Another part of my job is to offer options counseling: I help women think through all of their options regarding the pregnancy.

When someone faces an unintended pregnancy she has three basic options; carry the pregnancy to term and parent a child, carry to term and give that child to someone else to raise, or have an abortion. Most of the women who reach me already know they want an abortion and they just need help figuring out the how. But sometimes I am in the position of helping a patient think through this major decision.

For me, helping women figure out what they want to do is one of the most important aspects of my job. When a woman is unsure about what to do with her pregnancy, first I remind her that no one else can make this choice for her -- not her mom, not her boyfriend, not the staff at an anti-choice pregnancy crisis center, and not me. I let her know that I can help her try and sort out her own thoughts and give her accurate information, but ultimately she needs to figure out what she thinks is right for her life and body. I always tell patients who are teetering on their decision not to have an abortion if they are not sure it’s what they want. I tell them to find out how far into the pregnancy they are and hope time is on their side.

Most women I have spoken to never consider adoption as a real option. When I counsel women they typically weigh two options, parenting or ending the pregnancy. Adoption is not an option for everyone. Most often putting a brown or black child up for adoption means foster care, which may or may not ensure a stable home. On the other hand white women who bear healthy white children are able to set up private adoptions, have medical expenses paid and sometimes other expenses, and choose an open adoption if they want. We live in a society where race defines one’s life options. White people more often have resources and the ability to adopt children, and the demand for white adoptees is much higher than the supply. As transracial adoption becomes more popular this trend could change; however, the mental and emotional health of transracial adoptees is also a very complex issue. In addition to race as a factor, adoption or foster care means that after spending nine months carrying a fetus in her body a woman will not know if that child is safe, cared for, and happy. Most women I talk to immediately shoot down any suggestion of adoption.

When a woman wants help making her decision and for her the options are parenthood or abortion, I ask her if she has a support network, what her goals are, where she sees herself in five years, and how a child might add to her life or hinder her from accomplishing her goals. Most recently, an 18 year old asked me, “I mean is a child really like a burden?” I wanted to say, “um, YES!” However, in the interest of being objective I said, well a child does not have to be a burden, but raising a child means putting someone else’s needs before your own, and that’s a challenge, so if someone is not ready to take on that challenge raising a child may feel burdensome.

The most common emotion after an abortion is relief, particularly when a woman goes into the procedure feeling sure this is what is right for her life and body. When I provide options counseling for women, I want them to know that I trust their ability to make the right choice. I want them to know that whichever choice they make is OK. Options counseling is refreshing when most of my conversations are about nickels and dimes. These conversations with patients remind me why I believe in this work and why pro-choice is synonymous with pro- woman, pro-empowerment, and pro-family.