Friday, January 09, 2009

Holding the secret

Sheree came to the clinic alone and had noted on her chart that she had told no one about her pregnancy or her abortion. I'm always curious about women's reasons for keeping information private from their loved ones and asked her how she was handling the day. Sheree worked in insurance and had managed chronic pain all her life from a riding accident as a child. "I can't tell anyone, but not for the reasons you would think," she said, matter-of-factly.

"Here's what happened: My dad is dying, or at least he's probably dying. We all got together for an early holiday this fall because we weren't sure if he'd still be around. My dad and I were on the same pain medicine for a while, before things got worse for him. When I went home, I had forgotten mine. My mom remembered that we had the same prescription and said, 'I'll just go get some of your dad's old ones.' She handed me the pills, I took enough to make up my usual dose and then, several hours later, I was still in pain. When I looked in the cupboard for some more, I realized that she had grabbed the wrong bottle and given me the wrong medication--they looked exactly the same, those pills. I didn't think it was such a big deal until my period didn't come a few weeks later."

Sheree looked up the medication she had mistakenly taken and realized it posed a significant danger to fetuses. She called the drug manufacturer, who referred her to a physician and researched like crazy. Taking those pills may have caused serious birth defects if taken early in the pregnancy. "So now what do I do? If I tell my parents, they'll be crushed at what's happened. They'll feel like it's their fault. I can't put that guilt on them. This was a mistake, plain and simple. It would kill them--KILL THEM to know, especially with my dad being sick. If I tell my fiance, he'll be furious at them for the mistake. It would ruin their relationship--they're always a little testy with each other. If I continue the pregnancy and the baby us sick, everyone will want to know how it could have happened."

To tell this story would strain or destroy all the family relationships around her. "I need them right now, for when my dad passes. I need everyone getting along. This sucks--there's no other word for it. But I just need to keep it to myself right now." There were other events in the life of her family that Sheree needed to prepare for, both difficult and joyous--her dad's impending death, her upcoming wedding to her fiance. "I'll be okay," she promised, "this is just something I need to do for myself and my family, to keep us all intact right now." We made a plan for her to contact a neutral friend in another state if she was struggling--that felt private and secure enough for her--and she promised to call me if she was having a difficult time. "I really am feeling okay about this. Maybe someday I'll tell--just not today."

-Nell

Thursday, January 01, 2009

Goodness

There must be something about New Year's that inspires me to write after such a long time! We started this blog on New Year's if I remember correctly.

A colleague of mine, Charlotte Taft, gave a workshop last  year called "Working From Goodness" through the Abortion Care Network. It really spoke to my positive take on life, so I was remembering this approach talking to a 41 year old mother of two teens this past week. She was very teary but had compelling reasons for seeking an abortion: she had some serious health problems that a pregnancy would complicate. Someone else would say, "I  have no choice..." but she did consider continuing the pregnancy for a long time. But no matter how she looked at it, an abortion seemed to be the right and best choice for her and her family.

I met up with her because she could not stop crying when she got to the procedure room and the nurse felt that she could use some help. (I like that all staff are clear that we don't want to do an abortion on someone who is out of control crying.)

As is often the case, Claire (not her real name) didn't exactly know what was so hard, or at least she couldn't articulate it. So, I asked a few questions and it seemed as though she just felt bad, guilty, and in disbelief that she would ever be in a situation like this, and specifically choosing an abortion. I said, as I often do, "I see a good person, in a bad situation, doing the best she can." She agreed but she was not to be comforted by a simple platitude, as true as it was.
 And she WAS a good woman-- she could have been your Sunday School teacher, or the PTA mom that stayed on long after he kids graduated. And I am sure she never did imagine walking into an abortion clinic. The more we talked about her life though, the more I could help her see that this was a very complex decision involving lots of different parts of her life, and that she could have a lot of contradictory feelings about it. For instance, it was clear she was sad about this loss, angry that she got pregnant, and also angry that she had this chronic disease. I gave her the analogy of a ball of different strands of thread that she needed to tease apart.

Finally, she said, "There's one more thread that's at work here-- my daughter--she is 18 but having a very hard time and she needs my attention. She's a good kid at heart, she just got into with some not-so-OK kids."  We talked about that a moment and then I said, "You know how you have believed in her goodness and held that belief for her?" She nodded vigorously. "Well, that's what I want to do for you. You really are doing the best  you can."

There was a new peace within her after we finished. I held her hand during the procedure and although she squeezed my hand tightly, and yes, when it was done, she quietly wept,  she knew that she was good person choosing the best she could for her life.

--Bon

Wednesday, December 31, 2008

Book Recommendation

999 A friend tipped me off to this great book for tweens and teens called Respect: A Girl's Guide to Getting Respect and Dealing When Your Line is Crossed. I'm always on the lookout for books for our patient waiting room and this one really caught my eye. It doesn't just cover relationship negotiation skills, but encourages girls to develop a better sense of themselves and their talents, to fight impulses to be perfect, treat themselves with kindness and forgiveness, to speak up and move into action when they see things in the world they want to change. This book seems like a great antidote to the attitudes Courtney Martin wrote about in her book: Perfect Girls, Starving Daughters: The Frightening New Normalcy of Hating Your Body. (Which I think may also be published under the title: Perfect Girls, Starving Daughters: How the Quest for Perfection is Harming Young Women.)

I got a little bit misty-eyed thinking about how valuable a 10 or 13 year-old me would have appreciated this book.

-Nell

Tuesday, December 30, 2008

Birth Control Budgeting

I had not paid that much attention to the gift certificates that some Planned Parenthoods in the Midwest made available this holiday season. There was such a furor over them, so many silly accusations ("they can only be used for abortions!"), so much angry anti-abortion chatter. I tuned out the news stories about them. Today, though, when I met with Rachel, it struck me what a practical and responsible thing they might actually be.

In her last year in college, Rachel was working two part time jobs to make ends meet. Applying to graduate school had eaten up a good chunk of her usual monthly budget--traveling for an in-person interview, a $40 application fee to this school, a $50 one to that one. Soon she needed to pay this month's credit card and next month's rent. She looked for somewhere to cut back. One of the expenses she cut out were her pills. "They're almost $60 a month. I just figured that I'd skip a few weeks until I had more money and it would probably be okay. I could start back up with my next paycheck." She and her boyfriend used either condoms and withdrawal through the first weeks of the month. She started her pills about two and a half weeks later, starting halfway through the pack. "I assumed that because I had been on them for so long, it would just be okay and that I couldn't possibly get pregnant so soon after stopping them."

When her period didn't come, she knew immediately that something was wrong. She and her boyfriend were certain that they did not want to start a family yet. They were each preparing to graduate college and move to separate states.

What if Rachel had a gift certificate or a pharmacy gift-card tucked away in the back of her wallet exactly for an unexpected birth control budget-crunch?  A friend of mine's parents had always stuck condoms in his stocking when he was a teen--a teasing reminder to be prepared and responsible in his sexuality. A gift certificate that could be used to get an extra month of pills when your bank account runs dry is a really responsible gift, the more I think about it.

-Nell

Sunday, December 21, 2008

No Title, No Answers

Every day since I saw her, I have been thinking of LaTisha.  She is as young a patient as I've ever seen, just twelve.  LaTisha came in with her mom and grandmother.  I had told them at the time the appointment was made that in our state, we are mandated reporters, meaning that we have to notify Child Protection Services in her county of her pregnancy, which we did.  I think the purpose of the law is to be sure that a pregnant twelve year old is not a victim of a sexual predator and that there is no evidence of parental neglect. 

In this case, LaTisha's boyfriend is the same age, they had been "playing house" when the pregnancy occurred. She wasn't even sure what had happened or how a woman becomes pregnant but neither had she been forced or tricked. Nor was there evidence of parental neglect.  She comes from a very close, very religious family.  It was rare that she was ever alone nor was she permitted to be in the company of boys.  But unintended pregnancies still occur even in the best of families.

Given her tender age, it took a long time for LaTisha to even figure out she might be pregnant.  The other women in the household noticed the changes in her body and ran a pregnancy test. Of course it was positive.  As far as they knew, no one in their family had ever had an abortion, but the more they thought about it, the more they realized that LaTisha was still a child, too young to even take care of herself.  Her mom and grandmother work full time to support the family and greatgrandma is not well enough to work or to care for an infant.  So one of them would have to quit working if the pregnancy were to continue.  Then a visit to a gynecologist led them to understand the risks of this little girl carrying a pregnancy to term.  The doctor labeled her high risk..

The more the family thought and prayed, the more they felt that God was leading them to abortion.  However, by the time they convinced greatgrandma that this was best for their beloved daughter, LaTisha was almost 23 weeks pregnant.  They were all in shock when the ultrasound revealed a pregnancy of that gestational age because they had been thinking that she was about 16 weeks.  Mom started to cry that she feared something terrible could happen if her daughter had a baby when her little body was not ready for it, but grandma said that she did not think her mom, greatgrandma, would ever agree to an abortion at nearly 6 months.  And no one in our part of the state performs abortions that far along.

If an abortion were to be performed, it would have to be out-of-state.  A call to a referral reminded us that with LaTisha's age, tiny body and gestational development, her procedure would have to be done over four days!  It would be three days of dialators, then the abortion on the fourth day.  Little LaTisha started to cry and said, "I just want to play basketball.  I don't want a baby."  Grandma was crying, saying, "I want my baby (meaning her granddaughter) to have another chance.  A baby should not have a baby!"

I spent all morning with them, exploring all options.  But they were all in shock, needed to talk to greatgrandma, the family matriarch, before they could decide anything.  I gave them all of the contact information and reminded them that they had only one week to complete this abortion, after which time LaTisha would have to continue the pregnancy. 

I called their house two days later to see how they all were doing, but got no answer.  I may never know what they decided to do.  The complexity of the situation was so clear, but answers were not.  I could see reasons for her to continue the pregnancy and reasons for her to seek an abortion.  But only after returning home and praying together would a decision be made.  The mom, grandma and greatgrandma all wanted to do the right thing for their little girl. They want her to be safe, they want her to have a chance to have her childhood, they want a sign from God which direction to take.  I have no idea what that might be.

Lu

After today, only more light.

It's nearly midnight, on the shortest, darkest day of the year. I'm thinking about one of my patients and hoping that she's doing well. The holidays always seem to amplify the stress in patients' lives, especially with this year's economy. I've talked to so many women this month who've recounted trying to pay out-of-control heating bills, learning that holiday bonuses aren't coming, spending long hours in Toys for Tots lines to get presents for their children. Wendy took all of this in stride and talked about caring for her family and practicing her faith with such clear devotion and joy. She had loaded prayers and meditations onto her headset and listened to them while she waited.

"I have three special needs children and my husband just got back from Afghanistan. When he got back, I had really hoped that things would go back to normal, but he really needs help, more help than I can give him. I can't have him around the children like this. They are a blessing, but they don't understand his behavior, his coming and going all the time and when he gets angry..."

"When I learned that I was pregnant, I didn't know why God was putting this on my plate. Wasn't there enough? I had always said that I was pro-life and I really seriously wanted to know what would make someone feel so desperate that they would not want to have a baby. Now, I'm in that place and I know. I get it. I can't believe how judgmental I was. I really couldn't wrap my head around why someone would feel that it was okay to have an abortion until I had to go through it myself and realized that it's not just about promoting one unborn life. As a woman, I have to be responsible for all these lives--my children, my husband, my own. I thought, at first, because I wanted to have an abortion, that maybe I wasn't the woman I thought I was. But I am. I am a good person who is compassionate and this has made me more compassionate."

"I first made my appointment a few weeks ago, but I wasn't ready yet. I had to grieve--my life is not what I thought it would be. I had to say goodbye to this baby and explain to it my reasons. What I've seen, since I've walked in the door here, I could have never imagined. I have seen total strangers holding each others hands, saying to one another that it's going to be okay. I'm in the presence of all these women, all of us in places we never thought that we would be, all supporting each other. That's a really amazing gift, you know? Your staff here, I see you as the boatmen, carrying all of us safely from this shore to the next. It's almost the New Year. 2009 is going to be a different year for me."

I wish all the women we see the clarity and resolution that Wendy was able to find. Happy holidays to all our readers. Peace and be well.

-Nell

Wednesday, December 17, 2008

Tragedy of Abortion Rhetoric

The Tragedy Of Abortion Rhetoric by Fran Varian

Submitted by Bee on Mon, 10/20/2008 - 7:26am.

I came to abortion work in a rather circuitous way. It was not expected after seven years of strict Catholic schooling and twenty-one Thanksgivings full of staunchly conservative, pro-life family debates. By the time I arrived in Seattle in 1998, a newly graduated college-educated feminist, I had left all of the conservative Catholicism behind me, but I still did not anticipate that abortion work would become my passion.

I was living in a house with three other newly graduated feminists and we were all looking for work at the same time. My housemate learned of an open position in a local abortion clinic and after much thought decided it wasn’t the work for her. The interview fell to me by default.

One moment I was a “I’m pro-choice but I don’t think I would ever have an abortion,” feminist, and the next I was counseling women who were terminating their pregnancies. My clinic was special. It was one of the three free-standing facilities in the country at the time that routinely performed abortions well into the twenty-fourth week of pregnancy. Yes, we performed the much talked about, often loathed (even in liberal circles) late-term abortion.

Talking about abortion makes people uncomfortable. Even if you theoretically believe in a woman’s right to chose whether or not she will continue a pregnancy, you probably don’t want to know the details of how that pregnancy will be ended. And, chances are if you’re one of the millions upon millions of women who have had an abortion (or two or three) you still don’t want to know all of the details.

I know all of the details. I’ve seen thousands of abortions. And, watching the last Presidential debate on Wednesday night I was reminded yet again that we will have no real freedom over the domain of our own bodies until we untangle the rhetorical nonsense both sides of the debate throw up rather than discuss the real issues.

Partial-birth abortion is an ugly misnomer which obscures the difficulties surrounding the decision to terminate a pregnancy past 12-14 weeks. It implies a horrific and gruesome scenario in which a woman labors to deliver a viable baby who is somehow then executed. This is not only untrue, it’s illegal and unethical and you would be hard pressed to find an ob-gyn or abortionist in this country who would do it.

Do late term abortions often end perfectly viable pregnancies? Of course they do. Early abortions end viable pregnancies too, as do miscarriages. But when I hear Senator Obama talk about the “tragedy” of abortion, much to the agreement of Senator McCain, my skin crawls. We all agree, say the politicians, that the best solution to this problem is to have fewer abortions, period.

I don’t agree with them. I think the only solution is for all of us to become very serious about creating a world where the children who already exist have a decent chance at growing up healthy and in control of their own destiny.

A year ago I wrote a piece for Hip Mama about a twelve year-old boy from Maryland named Deamonte Driver who died because his family couldn’t find a dentist willing to accept Medicaid to extract his abscessed tooth.

As you read this there are approximately 83,000 children in the foster care system in the state of California alone.

In my very short life I have worked with children whose parents locked them in closets for days. I have pulled a young girl out of a crack house where she sat patiently waiting for her mother to get high in the back room. I have counseled hundreds upon hundreds of children and young women who were pregnant because their fathers, brothers, ministers, uncles, boyfriends, some stranger, or a group of strangers raped them.

It is said of Hemmingway that he preferred simple, unadorned language because after witnessing the horrors of war words like “horror” had no meaning anymore.

I am very certain that neither candidate for President is qualified to speak about the tragedy of abortion. Neither one of them.

Many of the women I had the honor of talking to before they had their abortion told me they would prefer not to terminate their pregnancies but they simply could not afford to bring a child into this world. They wanted their pregnancy, they loved their pregnancy, but they could not in good conscience ask their child to suffer the same poverty they were suffering.

Women who terminate in their second trimester often do so because they are uninsured or their employer-sponsored insurance plans exclude contraceptive and abortion benefits. They can’t raise the money for a first trimester abortion, which often means they have to desperately scurry to borrow money for more expensive second-trimester procedures.

Some women simply have no idea they are pregnant until they are well into their second trimester. We receive ridiculously mixed messages about our sexuality. We are taught that it is our responsibility to be attractive and sexy, then we fight legislation to teach sex education in the public schools. How many adult women do you know at this very moment who can’t give you an accurate, concise explanation of how her own reproductive system works?

Many women don’t receive crucial genetic testing results until their second trimester. I vividly remember holding the hand of a lovely biologist who learned at 18 weeks that her fetus would not survive the rest of her pregnancy. She was given the “choice” of terminating at that point or waiting to deliver her dead baby several weeks later.

Determining the morality of a stranger’s actions is pretty easy when you don’t know the facts. And when it comes to abortion we never want to know the facts. The facts make us squeamish. The facts point us to the truth that while we profess to hold “life” in the highest esteem we do precious little as a culture to ensure the most basic quality of life for our most vulnerable.

I don’t dislike people who are opposed to abortion. Abortion is a very personal decision which, in my vast experience, is best left to the woman who has to harbor that pregnancy and spend the rest of her life dealing with it’s consequences. While many abortion opponents speak of the physical dangers women face when aborting, the truth is that having a first trimester abortion in this country is significantly safer for a woman than carrying that pregnancy to term. And of course, once you decide to carry that pregnancy you have to find a way to pay for it. My very good friend just gave birth to perfect, gorgeous, and much wanted twin baby girls. The hospital bill for her delivery alone was $80,000.

People who want to get pregnant and people who want to be parents face these obstacles, often joyfully. And I support them wholeheartedly. Forcing a woman who does not want to be pregnant or parent to continue her pregnancy amounts to nothing more than another, government sanctioned, act of violence against her and against her fetus.

I dislike rhetoric and sound bites about abortion offered up by people who don’t know what they’re talking about, and that includes every single politician I’ve ever heard speak on the subject.

Deamonte Driver’s death is an American tragedy.

The crashing, tumbling, increasingly corrupt health care system which benefits the CEO’s of insurance companies and their lobbyists at the expense of the rest of us is an American tragedy.

The fact that a blonde, blue-eyed baby is exponentially more likely to be adopted than a six year-old child of color is an American tragedy. The fact that children with disabilities of any age or ethnicity are lost in the system is an American tragedy.

We need to change the public agenda. We need to talk about quality of life for all of our children.

Abortion is a decision that women from every socio-economic group and every kind of religious and moral background has to face at some point in her life. It is a reality that we do not like to think about. It is a birth control method we don’t speak of in polite conversation. There is evidence of women aborting from the dawn of time and it isn’t likely to go away any time soon, because as long as women fear for their ability to feed their children and keep them safe they will question bringing them into the world.

If our politicians are serious about lowering the number of abortions in this country it would be in their best interest to stop wasting money bombing other women’s children around the world. If we truly wish to cultivate a culture of life in this country we need to put our money where our rhetoric is. We need a viable universal health care plan from Senators McCain and Obama. We need financial assistance for single mothers and struggling families instead of Wall Street millionaires. We need to recognize the beauty of all kinds of family structures and stop preventing perfectly loving people from adopting and fostering children because they are single, gay, or otherwise non-nuclear.

I have watched the abortions you don’t want to think about. I have also watched beautiful, brilliant living children subjected to unspeakable horrors that I wish I didn’t have to think about. I’ve seen politicians and ministers and good respectable people question the morality of women who have chosen abortion over failing a child they would have loved dearly.

I haven’t seen any politician reaching out to Deamonte Driver’s mother and apologizing to her for her son’s death. I don’t see them dedicating substantial amounts of money toward the future well-being of the children already in existence. I don’t see us take accountability for the fact that as a nation we fail our children and their families, not to mention the children of the world and their families every single day.

That makes me squeamish. That is immoral. That is a tragedy.

Frances Varian is a writer and a performance artist who lives in Durham, North Carolina with her partner and an assortment of poorly behaved animals. Her work has been published in: Without A Net: The Female Experience of Growing Up Working Class, It's So You:35 Women Write About Personal Expression Through Fashion and Style, Lodestar Quarterly, and HipMama.com.

She has featured at the Seattle Poetry Festival, The Bumbershoot Arts Festival, The San Francisco Queer Arts Festivals and many dive bars and cafes up and down the West Coast.

She is currently working on healing from late stage Lyme Disease and raising awareness about the disease and the need for health care reform in the United States. For more information about Lyme Disease and Fran please visit: www.helphealfran.org

Monday, December 15, 2008

Interview with Judy Norsigian

I'll try to post some more stories over the next few days, but I wanted to highlight this great interview with Judy Norsigian on the History of Childbirth in the US. Norsigian has been a lifelong women's health activist and was one of the authors of Our Bodies, Ourselves.

You can listen the interview from Chicago Public Radio here.

-Nell

Thursday, December 11, 2008

We're back posting again...

I want to apologize to all our readers for the extended absence. The autumn got away from us. Organizing around the election (and the excitement afterward) managed to eat up all of October and November and the next thing I knew it was the holidays. Lu and I each had to hire and train some new staff who we're soooo excited about. The process of finding the right people to work in our clinics takes a lot of time and energy, as does the process of training new staff so that they're ready to handle whatever our patients might need.

I have been really touched to see how our blog inspired other women to blog about their abortion experiences--all the nitty, gritty details of them. Several women have mentioned in the comments section of our blog how they wished that there were more real-life stories about what it's like to have an abortion. Here are two more blogs written by women documenting thier abortion experiences step-by-step: Un-Expecting, Pro-Choice Abortion Blog. (Just like I'd mentioned with the 'what to expect when you're aborting' blog, it's hard to vouch for authenticity online, but these women have put up some appreciated, very rarely heard perspectives.)

Blogs like these have been criticized as taking an abortion experience too lightly, but they remind me of the way that girlfriends share and gripe together over all the less-pleasant details of pregnancy. I really appreciated this post, by the Un-Expecting author. It reminded me of something a patient said to me last week. "I didn't mind the vomiting and the flatulence and the breaking out and the having-to-pee-all-the-time when my daughters were born. I actually kind of looked forward to them," she said. "But all those symptoms now--when they're not a sign of 'the blessed event?' I just think they're kind of gross..." I asked her what was getting her through all this if she felt so crummy. Her answer? A sense of humor.

Finally, I just want to send some warm thoughts out to the Un-expecting author, who is preparing for her appointment on Monday. Best of luck, I hope that you get the love and care you deserve.

-Nell

Thursday, December 04, 2008

"Sometimes it just comes together"

The other day a fellow counselor was telling me about a counseling session with a couple whose planned pregnancy was ended after receiving the news that their baby had a fatal abnormality.  The couple was very grateful for the support at our clinic, and in particular, the way the counselor was able to help them sort out individually just what kind of help was needed for each to accept the loss, and to allow each to figure out how he/she needed to grieve.  I asked this counselor to write up as guest blogger her experience with the couple.  What follows is her description of the very subtle process of good counseling, of just letting it flow to its natural end. 

Lu


Sometimes, it seems, a counseling session just "comes together".
You're talking with someone and there doesn't seem to be a definite
direction that the conversation is heading, but, all the while,
through the give and take, it comes exactly to the place that it needs
to be.  A relationship is established and you feel comfortable risking
saying something and then it turns out to be the exact right thing.  I
was fortunate enough to participate in a session like that not too
long ago.
The couple had learned that there was a fetal anomaly with a planned
pregnancy and that made the difficult decision to terminate.  They lived
far away and were unable to find a provider that they felt comfortable
with in their state.  They were appalled when they came face to face
with the reality of how limited the resources for abortion can be, even
when medically necessary. They had family in the city where I work and
so they felt able to come here.
They were in their early 40's, and very articulate which definitely
made my job easier.  I'll call them Jane and Joe.  After speaking with
Jane, she suggested that Joe was having some difficulties and it might
be helpful for me to talk to him privately. It was with him that the
"magic" happened.
As I said, he was articulate.  He spoke about several other abortion
experiences he had been involved in and how he'd felt.  Ultimately, he
began talking about whether or not he wanted to view the tissue after
the abortion was completed. He seemed torn about it- like he felt he
"should" but not sure that he wanted to. I said "Kind of like going to
someone's funeral that you think you "should" go to." For him, that
was the exact right thing for me to say.  For me, it felt like I had
almost just stumbled upon it. He decided that viewing the tissue was
the right thing for him to do and he did so.  I think that was a very
helpful part of the whole experience for him and I was glad to have
assisted him.


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