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.

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).