abortion

Abortion Doula Diaries: On miscarriages

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Two of the three women at the clinic last week who were having “abortions,” were actually having D&C’s (the medical name for the procedure used during most first trimester abortions) to deal with incomplete miscarriages.

Both were wanted pregnancies, and both had been experiencing vaginal bleeding for a number of weeks. Both basically had their pregnancies terminated via natural causes, aka a miscarriage. Miscarriages are very common, and physicians estimate that between 10-15% of pregnancies end in miscarriage during the first 8 weeks. Some women may never know they are pregnant, but simply have a late period that could actually be a miscarriage.

Some miscarriages complete on their own, requiring no medical intervention. But some miscarriages might not complete fully (aka the contents of the uterus may remain) and necessitate medical intervention. The medical procedure for a miscarriage is basically the same as for a first trimester abortion.

A good percentage of the women I’ve supported in my abortion doula work aren’t actually choosing to terminate pregnancies–they are having medical procedures to treat their already-in-process miscarriages. These women are often ignored by the abortion debates which assume anyone getting what we call an “abortion” procedure is actually choosing to terminate.

Often the women who are having miscarriages in some ways need more support than those choosing to terminate. Like one woman I worked with last week, the pregnancy was very much wanted, and she was very sad to have lost it. While a woman choosing to terminate might feel relief once the procedure is over, a woman with a miscarriage might instead feel the immense sadness that comes from the reality that she is no longer pregnant.

A question remains about what would happen to these women if abortion were outlawed, or made inaccessible. Even if there were miscarriage exceptions in the law, it’s very possible that due to the burden to “prove” a miscarriage, plus the risk involved in providing the procedure, these women would be unable to get the procedure they need.

We saw the beginnings of this impact in Nebraska, where a woman was forced to carry a pregnancy to term despite the fact that they knew the child would die upon being born. For women who don’t want to go through the waiting and delivery with an unviable pregnancy, this is tantamount to torture.

In the case of early miscarriages that don’t complete on their own, we’re talking putting the mother’s life at risk–particularly if the limitations on abortion mean that doctors aren’t even learning to do these procedures.

I’ve talked before about the impacts of anti-abortion legislation on women who want to parent, and every time I work with someone at the clinic who is having an “abortion” to resolve an incomplete miscarriage, I’m reminded of this fact.

Abortion Doula Diaries: Que bueno que estas aqui

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Every shift I work at the hospital leaves me with many reflections on the experience of supporting women through abortions, the things I learn about their lives in the short time we spend together, the twisted way politics interferes with what happens there.

Every woman responds differently to the experience, brings a different level of energy, nervousness, calm.

This afternoon I’m thinking about one of the two women I supported this morning. She reminded me a lot of one of the first women I worked with. Both were emotional during the procedure, and when we talked afterwards, they explained how isolated and alone they felt. Both were Spanish-speaking immigrant women, both lived in close vicinity to extended family. Both talked about their partners, how unsupported and alone they felt as women–how they weren’t treated well. Me siento tan solita (I feel so alone) she told me this morning.

Often in the Latino community, we get stereotyped for being very family centered. Big families where everyone lives really close by, is very involved in each others lives. Often this is juxtaposed with the more American or Anglo family style–fewer kids, more distance between everyone, less involvement. Obviously these are generalizations, stereotypes, but I have felt the impact of American family culture in my own family–as a kid I remember spending much more time with cousins and Uncles and Aunts, grandparents, all of us together in summers and Christmas’s. Now as we’ve grown, this first generation of truly American children, we’ve scattered across the country, hundreds of miles from one another.

Sometimes I wonder what it would be like to be closer to everyone, to feel the warmth and stress and love of my blood relatives. Sometimes I wonder if we wouldn’t be better off, staying close, being more involved.

But then I’m reminded that it’s not always so simple, that it’s not always so black and white. Then I meet women like those I’ve met at the clinic, and I remember that family doesn’t always equal companionship. That sometimes, family relationships can be damaging, unhealthy, harmful. Both of these women hinted at abuse, neglect, mistreatment from their own family. This is how you come to feel so alone amongst many people.

The more I do this work, the more I think that most of my value as a doula in these moments is simply being a kind stranger who listens. I never feel like I’m doing very much, usually just making conversation, reassuring, holding hands and caressing shoulders. I’m a smiling face at the bedside without any other tasks than to just be present.

Today one of the women looked up at me during the procedure and smiled: Que bueno que estas aqui (How good that you are here). I responded: Mi placer (My pleasure). And it really is my pleasure, my delight that such a simple act might have an impact. Might make someone feel less alone and more resilient.

Before we parted ways she said to me Este trabajo que tu haces es muy lindo (This work that you do is very lovely).

If my doula trainer doesn’t talk about abortion, does that mean they are anti-choice?

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So I get a lot of questions from readers via email (and try to answer all of them, albeit not always quickly) and I figure other readers out there might have similar questions. I’m going to try and post my answers when I think others might be interested.

This question came from a reproductive rights activist in Puerto Rico who was interested in doing a doula training with a local organization but decided against it in part because they didn’t mention abortion or abortion care.

My response:

I hear you about the lack of discussion of abortion and doula care for pregnancy termination–but you have to remember that extending doula care to abortion is still a really new concept. While I wish all doula groups and trainings would talk about it, pretty much none of them do, so I wouldn’t assume that means they are anti-choice.

Some choose to focus on birth so they can limit the scope and really adequately train folks (there is so much to cover!) and some do it so they can bring together women across the political spectrum.

The key here is that the skills you learn are applicable and transferable to care across the spectrum of pregnancy. If you did want to get something started in PR, the Doula Project in NYC provides curriculum and training about abortion doula care to groups around the country.

So all that to say don’t write them off too soon, and know that there are probably people with varying ideologies about abortion inside the organization. The skills of doula care are still really important, and you can take those and expand on your expertise as you will.

I also added the doula group she told me about to the Doula Trainings page.

Why midwives would make great abortion providers

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It’s the National Day of Appreciation for Abortion Providers. I think we can all understand in this current climate how difficult a job that is to hold. Not many other doctors have legislators meddling in their medical practice, determining what they can do, what they can say, who they can serve. Not to mention the extremists who want to murder providers, and target them with violence.

We all know that we need more providers. There aren’t enough people willing to do this work, and there is a lot of need. We often hear the statistic that 86% of all counties in the US have no abortion provider. I want a world where folks don’t have to go to a special clinic, or a special provider, for abortion care. I want a world where abortion care isn’t segregated from the rest of medical care that a person needs. Where family practice doctors perform procedures (this used to be much more common).

You know who would make great abortion providers?

Midwives.

Talk about full-spectrum care. Midwives already provide care across the spectrum of a woman’s reproductive life–from well-woman care, to pap smears and yearly exams, to prenatal care and childbirth. Abortion would be a logical addition to their scope of practice.

Unfortunately the politics of abortion in this country, and the politics of the medical establishment mean that this is a far-fetched goal. Anti-choice advocates would surely fight any attempt to broaden who is allowed to perform an abortion and doctors (or at least the professional associations that represent their interests) would surely fight any thing that would mean they lose their monopoly on a medical service.

The UK considered a move to allow nurses and midwives to perform the service in 2007, but to my knowledge it didn’t go anywhere.

Historically, midwives were the abortion providers. Before our more advanced medical procedures were invented, midwives were the ones who counseled women on what herbs to use, what other techniques they might have for regulating their menstruation and their fertility. Before women’s health was even considered as part of medical practice, midwives were there providing compassionate care to women and their reproductive lives.

I want midwives to take this back.

A person can dream right?

UPDATE:

Thanks to J at Ipas for pointing out their work training midwives internationally in abortion care:

In many areas around the globe, such as South Africa and Ethiopia, midwives are authorized to perform uterine evacuation or medication abortion. In fact, a national training program in South Africa for midwives has helped to reduce the number of abortion-related deaths.

“Every year, more than 67,000 women die from complications from unsafe abortion — largely because they don’t have access to safe reproductive health care. Midwives, who often live in the communities where women are, can play a key role in providing critical reproductive health services to women if they are trained and empowered,” says Ramatu Daroda, senior training and services advisor for Ipas and trained midwife.

Since 2001, Ipas has trained more than 10,000 midwives in abortion and postabortion care. Ipas strongly believes that midwives are an integral part of reproductive health service delivery; and supports midwifery training and incentives, so that midwives can continue to improve maternal health.

Awesome.

Proof that anti-abortion laws hurt ALL pregnant women

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We’re only just starting to see the impacts of new extreme anti-abortion legislation that has been passed around the country.

As I argue in this post, these laws also restrict the choices of women who want to parent. I’m going to try to keep an eye on the stories that highlight these connections because I think it busts open the myth that anti-choice activists are only focused on restricting abortion. They’re actually focused on restricting women’s autonomy in a myriad of ways related to pregnancy.

From Nebraska State Paper:

Nebraska’s new abortion law forced Danielle Deaver to live through ten excruciating days, waiting to give birth to a baby that she and her doctors knew would die minutes later, fighting for breath that would not come.

And that’s what happened. The one-pound, ten-ounce girl, Elizabeth, was born December 8th. Deaver and husband Robb watched, held and comforted the baby as it gasped for air, hoping she was not suffering. She died 15 minutes later.

The sponsor of the controversial Nebraska statute, Sen. Mike Flood of Norfolk, told the Des Moines Register that the law worked as it was intended in the Deavers’ case.

“Even in these situations where the baby has a terminal condition or there’s not much chance of surviving outside of the womb, my point has been and remains that is still a life,” Flood said in an interview with the Iowa newspaper.

The law, the only one of its kind in America, prohibits abortions after the 20th week. It is based on the disputed argument that a fetus may feel pain at that stage. It took effect last October.

These situations, while rare, do happen. Not all women, when faced with a fetus that is known not to be viable, would choose to terminate early. Some would want to carry the fetus to term, and spend that time in whatever way they choose.

The point is: she should have a choice. No one should be forced to carry an unviable fetus to term. No one should have lawmakers interfering with a medical decision that should be kept between the family and the medical providers.

“Our hands were tied,” Danielle Deaver of Grand Island told The Register in a story published Sunday.  “The outcome of my pregnancy, that choice was made by God. I feel like how to handle the end of my pregnancy, that choice should have been mine, and it wasn’t because of a law.”

Also, what kind of BS argument is that about fetal pain? For one thing, the research behind the idea of fetal pain is super sketchy. And for another, what about the suffering of this newborn as it died?

I’ll keep saying it over and over: anti-abortion laws don’t just hurt women who want to terminate their pregnancies. They also hurt women who want to parent.

h/t Mary M.

Behind the Billboards

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Photo of billboard with a young black child's face and the words "black children are an endangered species"

My latest article for Colorlines went up today, an in-depth look into the black anti-choice movement behind the recent billboard campaigns. The subtitle reads:

On more than 170 billboards nationwide, a campaign is exploiting America’s racist medical history to foster the belief that abortion is black genocide.

The research for this piece was intense–it required a lot of time spent on anti-choice websites, reading their rhetoric and language. It also required wrapping my mind around 100 plus years of history of eugenics and discriminatory policies on behalf of the US government toward women of color, low-income women and disabled women’s reproduction.

It also included the opportunity to interview Dorothy Roberts, an amazing activist and researcher and expert in this arena. If you haven’t read her seminal work, Killing the Black Body, drop everything and go find a copy. Seriously. Her work lays out so extensively how the battle for reproductive rights in this country has been racialized from the start–a fact that our movement often neglects.

This book should be required reading for all doulas and birth workers. The history of the treatment and manipulation of women of color’s reproduction by the medical community, the government and the social system is so hugely important and so often neglected by our movements. As doulas, it’s our obligation to understand this background and use that understanding to provide sensitive and compassionate care to the folks we work with.

From my article:

Women’s reproduction has long been at the mercy of state control, particularly for women of color. For black women, this history dates back to slavery. As Dorothy Roberts outlined in her seminal 1998 book, “Killing the Black Body,” women held in bondage had no control over their fertility whatsoever, and they were relied upon and manipulated in order to produce the next generation of labor. Even after emancipation, eugenics and paternalistic ideas about who was fit to reproduce influenced government policy in the U.S. These policies overwhelmingly impacted the lives and health of women of color, as well as low-income women, women with disabilities and others deemed “unfit.” There is a deep history of forced sterilization across communities of color—some of which actually did result in the near elimination of certain Native American tribes.

These practices are not ancient history, and many incarnations still exist today: primarily through economic and social welfare programs that limit women’s access to certain forms of contraception or place caps on how many children they can have when receiving welfare. For example, undocumented women I worked with in Pennsylvania were able to get coverage for sterilization as part of their emergency medical coverage during pregnancy, but could not receive coverage for other forms of birth control since their Medicaid ran out shortly after giving birth. Women’s reproduction—but more specifically, the reproduction of women of color and low-income women—remains a practice in which the government is invested and deeply entwined.

I’ll leave you with one of Robert’s quotes from the piece:

“They are essentially blaming black women for their reproductive decisions and then the solution is to restrict and regulate black women’s decisions about their bodies,” Roberts says of the burgeoning black anti-abortion movement. “Ironically, they have that in common with eugenicists.”

Read the whole thing here.

Why birth activists should care about anti-abortion laws

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The reproductive rights community has been in an uproar about recent attempts at restricting abortion nationally. It seems to be priority number one for the GOP nationally–despite the fact that these types of laws are symbolic nods to the Christian Right at best, and horrific violations of pregnant women’s bodily autonomy at worst.

All of the typical players are up in arms at the new legislative attempts, which are covered pretty extensively here.

But I realize that folks who read this blog may think that the reason I care about this legislation is because I work with women having abortions. What we often don’t talk about is how legislation that attempts to restrict abortion by emphasizing the “rights” of the fetus (or, as Lynn Paltrow want us to call it, fetal separatism) have big impacts on the rights of pregnant women who actually carry their pregnancies to term.

That’s right: anti-choice laws don’t just impact women seeking abortions, they impact birthing women as well.

How so?

Here is a post I wrote for Feministing about the proposed South Dakota law that would possibly allow for the murder of abortion providers (which has now been shelved):

From Mother Jones:

A law under consideration in South Dakota would expand the definition of “justifiable homicide” to include killings that are intended to prevent harm to a fetus—a move that could make it legal to kill doctors who perform abortions. The Republican-backed legislation, House Bill 1171, has passed out of committee on a nine-to-three party-line vote, and is expected to face a floor vote in the state’s GOP-dominated House of Representatives soon.

It’s clear this bill likely has the goal of inciting violence–murder–of abortion providers. But I think this logic can actually be taken a step further, to include the murder of a pregnant woman herself.

Often one connection between anti-choice legislation that isn’t talked about is how it affects the rights of pregnant women who do want to parent. I’m talking about the rights of pregnant women to decide what kind of medical treatment they will seek–and not necessarily abortion.

There is an incredible battle going on around the country about the rights of pregnant women to refuse certain types of medical care (as the rest of us are legally entitled to do). In numerous cases, women have been forced against their will to have c-sections or other medical procedures in the name of the protecting the fetus.

This proposed legislation takes that logic to it’s extreme–not only is it okay to super-cede the autonomy and rights of pregnant women in the name of the fetus–you could actually justifiably murder her in pursuit of this as well. In addition, of course, to doctors performing perfectly legal and constitutionally protected abortions.

Can we agree to stop calling them pro-life now?

The laws that interfere with a woman’s ability to make decisions about terminating her pregnancy also interfere with a woman’s ability to make decisions about what medical care to seek for her birth.

These laws allow providers and lawmakers to force women into c-sections they don’t want, force them into mandatory bed rest, all sorts of other interventions, in the name of protecting the fetus.

This isn’t hypothetical folks. It’s happening around the country.

As birth activists, we know that often the medical claims behind these kinds of decisions to force women into c-sections are bogus. They’re based on shaky science and a medicine that disregards the desires of a pregnant women.

It’s not just pro-choice advocates who need lawmakers out of our wombs. It’s parenting moms too, who want to be trusted to make the medical decisions that are best for them–without fear of state or court intervention.

These battles cannot be seen as distinct. If women aren’t trusted and allowed to make decisions about their medical care for abortions, they won’t be trusted to make decisions about their medical care for pregnancy and birth either.

This is why we need movements where we work together, across issues and across communities. We’re fighting the same fights, with common enemies and common goals.

Let’s work together.

Anti-Abortion Bills Surging Through Capitol Hill—and States, Too

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Protestor holding sign that reads "Boehner defund Planned Parenthood"
via Colorlines

After spending yesterday morning supporting a woman during her abortion, I spent the afternoon editing this piece for Colorlines:

It shouldn’t be a surprise to anyone that the House GOP leadership has come out strong with an anti-abortion agenda only weeks into the 112th Congress. A November meeting foreshadowed the fate of reproductive rights under the House’s new leadership: Randall Terry, an anti-abortion extremist whose work incites violence and has been called “domestic terrorism,” met with soon-to-be Speaker John Boehner’s chief of staff. In the anti-abortion world, it doesn’t get more extreme than Randall Terry.

What’s striking, and drawing less attention, is that the invigorated attack on women’s health on Capitol Hill is just the beginning. The November elections also swept in a wave of anti-choice state governments, where the fight against reproductive rights has become increasingly defined by race baiting meant to divide the pro-choice community.

I felt the contradiction and distance between the experience of women actually having abortions and the hate, lies and rhetoric of the anti-choice movement. One thing is frighteningly clear: these anti-choice folks don’t care about women. In fact, they want to punish women, make their lives more difficult, keep them from maintaining personal and bodily autonomy.

The experiences of actual women don’t even factor into these debates–they are replaced by moral showboating, empty rhetoric and misinformation.

If it wasn’t for the policies of New York State, which goes against national trends and provides access to abortion for all women, regardless of ability to pay, I wouldn’t be able to do my work as an abortion doula. Most of the women I work with at the public hospital are uninsured, most are women of color. Many are immigrants. The Hyde Amendment says they shouldn’t be able to get the procedures they want and need.

Thank you New York State for valuing the lives and choices of these women.

The sad reality is many states (including our federal House of Representatives) is going in the opposite direction.

Read more about that in my Colorlines article.

Abortion doula diaries: Do all women feel sadness?

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I worked at the hospital this morning as an abortion doula. There was only one patient today.

After my first post about being an abortion doula, I’ve been thinking a lot about the responses I received. Some where the to-be-expected anti-choice comments about how what I do, or what I call myself, is a contradiction. Some were simply well-meaning comments about how needed this work is, or how great I am for being with women during such a difficult time.

Abortion gets so much attention as a political issue in this society that it often totally obscures people’s actual experience.

Today was a reminder of how those assumptions are often totally incorrect.

As I mentioned in my first post, it’s not uncommon for the procedure to be emotional for women. But it’s not always for the reason that one might think. People assume that abortions are about sadness.

Not for everyone.

For example, the woman I supported today was most nervous about the pain she might feel during the procedure. We talked about it beforehand, I tried to reassure her. Once the procedure had started, she began to cry, and proceeded to cry through until the end.

She held my hand tightly, I caressed her shoulder and tried to say reassuring things (you’re doing great, don’t forget to breathe) throughout. For most people, the procedure only takes 10-15 minutes.

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My first day as an abortion doula

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I arrive at the hospital around 9am, head up to the right floor, showing my volunteer ID badge to the security guard as I head toward the elevators.

I round the corner and enter the floor, delicately labeled Women’s Choices where the procedures will take place. I walk into the makeshift office/empty procedure room where the Residents/Doctors who will be performing the procedures sit debriefing the morning’s cases. I’m greeted by the Doula Project coordinator/Counselor at the hospital, and she debriefs with me about the folks on tap for the morning. While everyone is in for a first trimester abortion, the stories are different. Some are elective procedures, some are wanted pregnancies with medical issues–ectopic, fetal demise, etc.

I walk into the waiting room where the women are already wearing hospital gowns and socks, sitting nervously, quietly, waiting their turn. They are asked to arrive really early–7am–with the hope that it means most will be there by 9. I offer blankets, sometimes speaking in English and Spanish, sometimes using hand motions to communicate with patients who speak another language.

Everyone has been fasting since the night before, adding to the discomfort, tinging the air with acridity from hungry breaths. I sit, introduce myself to the patients, make polite conversation. Everyone responds differently, some want to talk, some want to sit quietly. Mostly I listen, try to remain attuned to the signals they send about whether they want company or silence.

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