We started this blog two years ago, I think. I know I thought we would give it a year. We are still here, albeit less often than we might like.
I just got through reading the comments section which is livelier than our posts most times. Glad we can spark conversation, although every time I read the comments I realize that the level of discourse on abortion is pretty uninformed. One writer asks that we explain the procedure more.
OK. The cervix is the opening of the uterus and is itself a strong circular muscle. Its mission in life is to be shut until it needs to be open. The younger a woman is, and if she has never given birth vaginally, the harder it is to open that cervix. It also softens at 7-8 weeks from the first day of the last period (LMP). And it needs to open more the farther along a pregnancy is. After the first trimester the doctor may use a slower method to keep the cervix safe. This usually means laminaria, which in natural form, are literally sea weed sticks that expand when wet. Lately a lot of providers are using a medication to soften the cervix even in early pregnancies because it makes it easier and SAFER to dilate the cervix.
There is never a case where an instrument like a forceps is used to dilate the cervix. Dilators--or increasingly larger rods-- are used. The vast majority of abortions are done in the first trimester so you are looking at something about the width of a regular pen.
Keep in mind that describing ALL medical procedures is difficult. I remember getting a root canal and a lovely technician taking a lot of time to explain it all and show me the instruments with which the doctor would "ream out" the nerve in my tooth. I nearly threw up.
The other topic that seems to be generating a lot of comment is about "credentialing" of counselors. This is also a lively debate among providers. There are several problems with this discussion. One is the definition of "counseling" of which there is no real agreement, especially single encounter, pre-procedure counseling. A bigger debate is about what outcomes are attributable to counseling. The other issue is what does a "credential" mean? There are MSW's, certified counselors, marriage and family therapists, psychologists, and psychiatrists, all are recognized more in some states than others. Nurses can do therapy in some states.
What we are doing comes more under the category of "check-in" (certainly not therapy or counseling) and that may bring up more in some cases than in others. I would say that about 90% of the women I see don't need "counseling" at all, but may appreciate the chance to "check-in" emotionally."How are you doing? Who's supporting you? Any concerns? How do you think you will be emotionally afterwards?" Some women, those 10% usually, are brought to our offices by very complicated situations, difficult decisions, life in transition, abuse, and all the rest you can imagine. While we cannot SOLVE their problems, clearly, we also cannot pretend that we don't notice them, and inquire how they are coping with these stressors.
This is what sets Lou and I apart from many of our colleagues, some of whom do not even offer "counseling" per se. We feel that after listening to tens of thousands of women that we are willing to risk a little beyond the medical model, and ask questions that get to the heart of things. It seems to us that pregnancy, much less ending pregnancy, is so incredibly complex and rich with layers of meaning, that it deserves some real conversation, unlike my root canal. Lou is credentialed at the Master's Level; I am not, although I do have supervision and have steeped myself in counseling texts. On the other hand, both of us really function as administrators, not counselors.
What all of us--or all quality providers-- have in common is wanting to provide the best, safest services according to what we see. For some that means a quick appointment, for others it means great pain management, and for us, it means giving people a chance to check in about how they are doing with what can be a difficult decision under complicated circumstances in a society that condemns or silences women who choose abortion. Bottom line, you as consumers--of gyn exams or birth control or any medical service--need to decide what you need and choose the provider that works for you. Or, speak up about what you need to the provider you have. (But that's a whole 'nother discussion...)
Happy New Year!