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!
--Bon
It is difficult sometimes to be a counselor. I know because I was one. In a culture where everything is expected quickly, rarely do people have time to "check in" emotionally, as you say. Sure, these women "go through the motions and talk," but it isn't until they sit down with a counselor that they open up, ask questions, and receive the information they need to be comfortable with their decisions-- either to terminate their pregnancies or carry them to term.
We, as counselors, just want people to make the best decisions-- decisions they can live with long after the choice has been made. We cannot and do not want to make these decisions for them.
You're right, Bon. Every situation is unique. I just wish there wasn't so much anti-choice disinformation out there trying to influence (dare I say make?) a woman's decision about regarding her private medical procedure.
Posted by: Kelly Gorski | Friday, January 19, 2007 at 11:22 AM
Hi Bon :)
It must be an interesting place to work, with people from all walks of life with the exact same problem, what do you say to a client who is having second thoughts?
Posted by: Jaisee | Thursday, January 18, 2007 at 03:10 AM
I just found your blog and am grateful to see it. I am a counselor at a Planned Parenthood and it is nice to be able to go to a site where people share similar experiences from the provider side. I've never seen such a thing so far. I really wish people who aren't supportive of the idea of this blog would just go away. There is room for debate in the world, but sometimes people of like mind just want to gather to share ideas. I don't think we should have to argue and defend every statement we make when the reason this blog seems to exist is to share. There are other places where debate is great and necessary and appropriate. I don't consider this to be one.
Posted by: H | Wednesday, January 10, 2007 at 04:22 PM
Please forgive me for using your comment box to speak with you, but I could find no way to send you a more private e-mail. You may feel free to delete this comment if you see fit.
Reading through your blog has been very interesting to me. I want to be completely honest with you, in that I am a post-abortive pro-life activist, who works to raise awareness about post-abortion trauma and the importance of counseling, as well as helping women who are facing crisis pregnancies to make a healthy and informed decision for themselves and their children. You (both) have compassion and care for the women who receive your services - your frankness is very educational to me, and both are heartening to see in a field where you and I both know many doctors are hardened and do not care properly for their patients.
I wanted to ask you what your opinion of organizations that provide non-judgemental post-abortion counseling. (If you would like a list of organizations that I as a post-abortive woman give my support to, please let me know) You must see that abortion is a very difficult decision, one rarely (and hopefully never) taken lightly by many women who are faced with very trying life circumstances. Do you believe post-abortion counseling and emotional/spiritual support is important? If so, do you believe that abortion can be healed without recognizing the mother's loss of her child, in addition to the trauma to the individual of the procedure itself?
I greatly appreciate your time. Thank you for reading, and you can e-mail me anytime. I will continue to follow your dialogue - thank you for sharing.
Posted by: Andrea S. | Monday, January 08, 2007 at 07:58 AM
This is a real need for better abortion care on the part of providers. Here are some women's experiences of being shuffled through clinics with little to no counseling, false information, and very little care.
http://passboards.org/showthread.php?t=142391
http://passboards.org/showthread.php?t=146445
Posted by: Anon | Thursday, January 04, 2007 at 01:19 PM
Hey Bon!
Thanks for being as direct as possible about some of the procedures involved in abortion. I hope you had a good Christmas and that 2007 is as rewarding and thought provoking as 2006.
Posted by: Julie | Tuesday, January 02, 2007 at 08:18 PM
I think it is wonderful that the two of you offer counseling and are caring enough to check in with the women you see need that extra help. I, myself went through an abortion and felt like i was on an assembly line. the experience was horrible and could have been prevented had i been lucky enough to come into contact with someone as caring and perceptive as the two of you seem. Keep up the exceptional work!
my blogspot, where i regularly write not only about the experience itself, but how i am dealing with it to this day, is http://aftersophie.blogspot.com/
Posted by: aftersophie123 | Tuesday, January 02, 2007 at 11:07 AM