abortionclinicdays

One week, Two girls

The Houston Chronicle revisited a story this week about two pregnant fourteen year old girls in Texas who each secretly delivered in a bathroom stall. One young woman was at an airport and delivered a stillborn fetus shortly after landing at the terminal. No one in her family knew that she was pregnant and the authorities declared that it was a pregnancy incompatible with life. A second high school freshman, also secretly pregnant, gave birth to a 35 or 36 week baby who drown or was smothered and died in that stall. There will be criminal charges brought against her. Two fourteen year olds. One week in Texas.

As an abortion counselor, this is one of the scariest things I imagine when I send a woman home. Will she be one of those girls who...? Maybe she is too far along for us to see her and she goes home with a page of local resources; maybe she is not entirely resolved yet that an abortion is the right decision for her and it's not time to make a decision yet. Sometimes when I try to reconnect with women after an options counseling to see how they are faring, I find that they have given me incorrect phone numbers, or given me the contact information of a friend or boyfriend and have to sweetly ask “can you have her give Nell a call,” without explaining why I'm calling.

This news story reminded me of a woman who we spent many months working with at the clinic, with no resolution. She first called when she first found out she was pregnant. Based on her periods, we guessed that she was about 8 weeks in pregnancy. A teenager, she lived a few hours away. She made an appointment, which she did not show for. As the weeks went by, she would schedule again and again.

I had spoken to her many times. She was trying to arrange everything secretly. She did not have a car and her boyfriend had no license. Could she ask a friend for a ride, I suggested . “No, I don't want anyone to know about this.” What would happen if she talked to her mother about this? “She's be really disappointed in me.” Would she hurt you or kick you out of the house? Would she want you to continue the pregnancy? “No, we just never talk about these things and it would be...weird.” She reiterated time and time again that she did not want to be pregnant, but she just could not bring herself to talk to ask anyone for help.

She was a good kid. She had never let anyone in her family down. She was really, really scared.

I told her about the website MomDadImPregnant.com, which is designed for teens who have to have that conversation with their parents. She pulled it up while we were on the phone together. “Okay...” she mumbled while reading, “okay...” Then the line went dead. I called her back.  “Sorry,” she said, “my mom walked by.”

At this point, nearly everyone at the clinic had tried to brainstorm with her to help her make it to her appointment. We were so used to talking with each other about how we could try to help her, we had a code name for her when we would see each other outside of work. Usually we never have to be discussing and case managing specific patients, but in this case, everyone had taken a turn trying to help her get a bus ticket, find a willing driver from our lists of volunteers or tried after hours to reach her by phone. So no one would guess what or who we were talking about, we called her Matt Damon. (It was the least likely name we could think of and the easiest one to remember.) As she neared number of weeks in pregnancy our clinic sets for a cutoff, I decided that we needed to have a really serious talk. “Matt, either way you need some medical care,” I told her over the phone. “If you're going to continue this pregnancy, we need to make sure that everything's healthy. If you don't want to, we've got about a week left, based on when your last periods were. If you're going to have an abortion, if you're going to parent, either way, I think it's time tell someone what's going on. You need a little help.”

Finally, after a cab trip that cost nearly $200, she came to the clinic by herself for a consult appointment.  We did a sonogram and we had exactly 48 hours to pull everything together before she was over the cutoff. “I know that I should tell someone,” she said and trailed off...

We made plans for her to come back for an appointment. “Here's what we can do, Matt,” I told her, “We can get an emergency grant to cover most of the cost of the surgery. We can waive much of the rest. What we need from you to do is talk to someone at home about this. You're going to need a ride and it doesn't sound like you've got another $200 for a cab ride, right?” She nodded. “Whatever you choose, you know that you need some medical care, to either see us and not be pregnant or start some prenatal care, right?” She nodded. I sent her home with a copy of The Pregnancy Options Handbook, just in case was was more ambivalent than she was letting on.

Two days later, her appointment time came and went. Hours went by. I pulled her chart from the other day and called the number listed on it. The line was not in service. By now, Matt is too far to have an abortion in most areas of the country. I truly do hope that she's okay, that she won't be one of those girls who...

Nell

Some Women

There have been a few women lately whose stories have stuck with me, so I wanted to share them here.

Lindsey (as always not her real name) is 37, has some serious medical conditions, and, as she put it, "just missed having kids" because she was taking care of elderly parents, in business, busy. She and her husband of 25 or so years were still in love and met with me on an off day so that we would have time to talk about what was troubling her. She talked about her life for about an hour and how upset she was that she was pregnant. There was nothing that I heard that was encouraging about having a child; she was happy with her life mostly, but she was also doing some spiritual work and wanted to be sure having a child wasn't "supposed to be" her new path. That is such a  hard thing for so many: figuring out what meaning life has for us. She scheduled for the following week and I genuinely thought that she was fairly resolved. When she and her husband returned, I talked to them for over an hour again, and still she was not completely "there." But, as  her husband pointed out, she had not taken one step toward having the baby either (prenatal vitamins etc.) She didn't say anything different, but just couldn't go forward. I encouraged them to leave, to take a walk, anything to break the deadlock. What seemed like hours later, I was holding her hand during the abortion and she finally said, in a very small voice, "Am I bad person?"  "Can I have an abortion and still be a good person?" is a question that lurks in many women's minds.

Melanie was a difficult patient for  me, which was good, if you see what I mean. Her voice tone was, well, whiny, and it really seemed that she was not taking responsibility for her decision. Her partner was, like Lindsey's, kind and patient and devoted and he was clear that this was the wrong time for them to be pregnant. They were both quite deeply religious. I listened to her carefully and very directly told her that she  did not sound resolved at all, and that if she went through with the abortion, she could regret her decision and jeopardize her own emotional stability as well as her relationship. (She kept saying, "Well, maybe I should just get it over with." I sent her off with the Pregnancy Options Workbook, and with a new workbook called "A Guide to Emotional and Spiritual Resolution After an Abortion," which I felt she would need sooner or later.

When she came back the following week I couldn't believe it was the same person. First of all, her voice was in a normal register and she just looked "centered." She had filled out her workbook and was brimming with an energy she did not have before. She was still anxious about the procedure and she too gripped my hand tightly during the abortion. She too was having problems with the idea of having an abortion and still being a good person. When she asked "what do you do with it?" I suggested that she could enclose a  note, and both the remains and the note would get incinerated and 'return to the universe'. Her partner went outside and brought back a rose and we included that too. I let her smell the rose, which was so fragrant, and I hope that is her memory of her abortion instead of all the negative thoughts she had about herself the first time I talked to her.

Finally, LaShonda got to me because she was sobbing. She too was religious and struggling with what was "right." She had 4 kids and 3 of them were the result of marital rape. She had been abused so severely that she lost the use of a limb. We are talking about Sybil kind of abuse here, the kind that you read about and can't quite get your mind around. And she  needed to talk about it. And I listened intently, trying not to hear the horror of it, but to that thread of strength and hope that somehow kept her going to get out of those situations. She nearly died so many times, and no one helped her but her young child who was also abused in a very sick way. The irony for her was that she was with a wonderful caring man now--why  keep the rapist's child and not the one created out of love? But she also knew that she was spent physically and every other way and it was time for her to heal herself and her children. As with Lindsay and Melanie, she gripped me fiercely during the abortion, and said, "I never told anyone these things before." She will stay with me for a very long while.

A fellow counselor from another clinic told me that she often writes a patient's name on a little piece of paper and puts it in her pocket. She often finds it in the laundry or mixed up with her shopping list, but it is her way of getting  some closure on emotionally significant sessions.

Dear readers, thank you for being my ritual for closure tonight.

--Bon

response to "Choosing Us"

I thank Nell for bringing Alison's post to our attention.  Alison's experience is, in fact, shared by many many women who choose abortion.  I know, because I talk to those women every day.  I also know that more and more women (and their partners) are choosing to create their own personal goodbye ceremonies.  I loved Alison and Walter's!  They each wrote their letter to the pregnancy before putting the petals of the flower into the water.  There can be both sadness and choice without guilt.  Women and men can choose what is best for them at this point in their lives.  Many couples so respect and honor life that they do not treat it lightly.  All do not believe that an unintended pregnancy need be continued if this is not the best time to give the child the kind of life s/he deserves.  I commend Alison for sharing her story with us and I encourage other women to do the same.  The anti choice voices have been much too loud for way too long.  Now is the time for women to tell their own stories, their own truths.  Yes, abortion can be sad, but it can at the same time be joyous.  When a woman realizes that she does not have the maturity, resources, time or wisdom to properly honor the life within her, abortion can be the choice of goodness.

On an unrelated topic,  I was struck that the clinic Alison described had a "No Men Beyond This Point" sign posted!!  I encourage women and men to search out a clinic that encourages men to participate, lets them in the procedure, or in counseling, or in the ultrasound.  It helps to strengthen the relationship, helps the couple to go through the procedure together, helps both of them to move through the grieving process together, producing a better outcome for all. 

Please do tell us your stories!  We want to hear from those of you who know that you made the best choice possible at that time.

Lu

Fetal Personhood: Where birth choices and abortion choices meet

There is a very interesting post on RH Reality Check today that reviews the American Medical Association's recent decision to push for legislation criminalizing home birth.

Here is the text of the AMA's Resolution 205 on Home Birth.

How do beliefs and legislation like this gain support? Amie Newman suggests that as soon as a fetus gains legal protections which trump a pregnant woman's right to self-determination, a birthing mother loses all her power to make critical decisions about how and where her baby should be born.

Can you have it both ways? If I am not intelligent, critical or responsible enough to consider when it is the correct time to bring new life into the world through my body, how can I be trusted to know the best, most appropriate way to birth my baby into the world? Who should be trusted? Who gets to decide?

Let's revisit a question that was posed for anti-abortion protesters in a widely circulated video and essay.

Illegal home birth--how much time should she do?

Nell

"Choosing Us" by Alison Piepmier

I've been meaning to add a link to this story by Alison Piepmeier for quite a while. Even though close to 40% of American women will have an abortion during their childbearing years, it's one of the few things that we don't talk about freely. Is there anything else happens to 40% of us that we don't talk about?

We talk about sex and finances and relationships/partnerships and illness and parenting and all messy details of our lives. Why not about this?

I think this is a beautiful, brave essay. What would the world look like if we could all tell our stories so freely?

Nell

Choosing Us

The Grandma

Sometimes the waiting rooms at our clinic can be pretty quiet places. Sometimes no one talks to each other, frustrated from a long drive or worried about getting home in time to get their kids off the bus. Other times, though, it's almost magical. Connections can form between patients and their families that are really healing.

A few weeks ago, one of the patients brought her grandmother along as her support. They'd had long morning, many hours of driving already. Initially, the grandmother looked uncomfortable, but she warmed up as other women started filling in the empty chairs. Patients chatted about where they were from, what they'd expected the clinic would be like, about the lives that had brought them there.

Finally, grandma chimed in. “Let me tell you what it was like when I first got married. Back then, you couldn't even get one.” She started telling stories about her years as a young wife, with very little idea about how reproduction worked and about her friends and what they'd tried to do when they found out they were pregnant for the fifth or seventh or ninth time. “That's nothing,” said another patient, “my grandmother had twelve children. Twelve!” Slowly, the stories started coming out, about grandmothers, mothers, daughters, dreams for family, dreams for themselves. Grandma opened the floodgates, opened her arms, grandma started the storytelling.

Being the counselor, I knew everyone's stories already. One woman had just finally taken out a restraining order against her husband after years of abuse. Another had a daughter with a full scholarship to a prestigious university in the fall. Having sacrificed everything for her daughter, she was dumbfounded to learn she was pregnant at 41. A third was a college student far from home, wishing her family could be there with her that day. It was her comment that made me pause. “My grandma's real religious, I don't think I could ever tell her about this. I wish you were my grandma. I can talk to you, I think you'd understand.”

Nell

Is it normal?

Fetal development is something I find fascinating, particularly the moral and ethical decision-making that results from our increased knowledge of fetal development and available prenatal testing. Working at the abortion clinic, these issues are frequently part of our conversations with women. While increased prenatal testing or research on how medications, drugs or alcohol affect a developing pregnancy give us a better idea about how to assess risk, it's still just information, just numbers. It doesn't shed that much light on those deeper questions of parenthood, mothering and when, if ever, is an abortion is the correct decision to make your own life.

Most women I meet with have pregnancies that happened unexpectedly and are reviewing their behavior to consider what they would have done differently, if only they'd known. Some women come with particular genetic counseling or diagnosis information, are trying to reconcile behaviors they know were not healthy for a developing pregnancy, like heavy drinking or the use of a particular medications.

“I've been on Paxil for three years and I didn't know I was pregnant. I read online that it causes birth defects.”

“I had a urinary tract infection and I didn't know my birth control pills wouldn't work with the antibiotic I was on. Then I turned 21 and I've pretty much been partying ever since. I had no idea I was pregnant.”

“The emergency room gave me an X-ray before the pregnancy test came back positive. They said it was an honest mistake, but that x-rays cause birth defects. Can you tell if it's normal?”

These discussions are rich ones. Often these women want to know for sure—is there something wrong with this pregnancy? I will give them my honest answer—in most cases, I don't know. In most cases, there's not really a way to know now at 5 or 10 weeks if this pregnancy is absolutely healthy due to, for instance, drinking or drug use. More sophisticated diagnostic tests are not available until later in the pregnancy, after which an abortion becomes much more difficult to obtain due to the limited number of skilled practitioners who provide second trimester abortions.

Continuing to limit the availability of second trimester abortions means that women who wait to get more advanced prenatal testing results will have fewer and fewer options, should they wait for amniocentesis testing or high definition diagnostic ultrasounds. My partner frowned which I mentioned this. “So they go through all this song-and-dance about informed consent for an abortion, but the information that could really be the most meaningful, like could this be a healthy baby, can only come after you're not allowed to have an abortion anymore?”

We can't tell at an early gestation if the medication you took actually will have an impact on this pregnancy, or if your antidepressants will affect the development. I can't tell you if you will have a child with a learning disability or with ADHD. I can't tell you at 7 weeks gestation when the pregnancy is the size of a blueberry or large grain of rice, if this will be a baby born with the bipolar disorder that your father, your sister and you struggle with. No one can.

Instead, I can talk to them about relative risk, what the realistic likelihood of an impaired outcome might be. I can refer them to genetic counseling, if that's appropriate. I can help them imagine a life becoming a parent to a child with special needs, but I can't answer that question of “is it normal?” or worse yet, “is this abortion the right thing to do?” What is normal? What does that actually mean to you? I will talk about the most recent research about of fetal alcohol syndrome or neonatal abstinence syndrome. I'll remind patients (and everyone else who uses the phrase, in fact) that there really is no such thing as a “crack baby.”

“This is about your family and you as a mother,” I'll tell her. “Only you know what you can handle and how you want to raise your family. You know in your heart the mother that you are capable of being and you know better than anyone else what level of risk you are comfortable taking on.” Often, what this woman is asking is “when is it a responsible time to bring life into the world?” and “am I a monster if, after searching my heart, I realize that I can not do that right now?” These are issues of faith, of practical support, of finances, family and, finally, the profound question of what we owe to the children we bring into the world. Do women have a responsibility to bring each and every pregnancy they have into the world? Do they have a responsibility to bring only healthy babies into the world? Only babies with the option of a self-sufficient life? Only babies who will have a high IQ? Only those who can hold down a steady job and support you in your old age?

Is it healthy? Is it normal? What a question. In most cases, I can't say if a fetus is “normal” and I know that this isn't what many couples want to hear. They may want to hear that an abortion is absolutely the right thing to do. It would be easier for them if this is what I said. Aren't I one of the experts in this area, after all? But I can't and I don't. That is for them to answer.

One woman I met with a few months ago had spent years caring for her brother, who had a profound cognitive disability. She had been a moderate drinker for the first few weeks, before she found out she was pregnant. While we discussed that the actual rate of risk for cognitive and behavioral difficulties associated with drinking, she replied that “Even a little bit of risk is too much for me right now. My parents are sick and my brother requires constant care. I love my brother, but I can't take even the littlest chance that I'd have another family member who would need that kind of care.”

Another woman I met with earlier this year was reliant on medications to control her seizures. Tearfully, she explained that she had always thought abortion was wrong, but that her doctor was quickly dismissive. He told her there was “no way she'd have a normal pregnancy.” When I asked more specific questions about what this meant, she realized that she really didn't know. She left our office after a sonogram and counseling session, deciding that she needed more information about the medications she was on. When she came back a week later for her abortion, she was much more at peace, with a fuller understanding of what it would be like to be off her medications and how the pills may impact the pregnancy she had at that time. I asked her how this information impacted her decision. “I'm not just trusting the doctor, “she said, “I'm trusting myself.”

-Nell