Saturday, January 31, 2009

There is no answer

In the last twenty four hours I have felt a decided shift in my emotions. I feel like I have returned to normal life, as though I have been away. I find myself reflecting on my abortion in those rare moments of quiet and solitude, but abortion is no longer the overriding thought on my mind.

In those moments today, I have ruminated about how I made my decision. I knew that in order to feel sure that I was making the right decision I needed to consider the very difficult ethical conundrums raised by abortion. I suppose that says it all. I do not see abortion in absolute terms but rather in terms of unanswerable dilemmas.

My body has created life twice. It is impossible for me to deny that with time, good luck, and no accidents of biology, the fetus grows into a baby, who is born, and then develops into a person. In the days before my abortion, I force myself to wonder if this fetus would become a person who looks like my other children, who bear a striking resemblance to one another. I contemplate whether it is a male or female. I think about my two children’s distinct personalities and about what kind of person this fetus might have become.

Those thoughts are difficult to have, but for me they were important. My answers reflect my fundamental views of personhood. I do not think of the fetus as the “unborn” but rather in terms of “potential life.” Miscarriage occurs in one out of four pregnancies. Sadly I know of too many cases, even well after the supposed mark of fetal viability (24 weeks) that ended in badly. I myself endured pre-term labor at 24 weeks with my first pregnancy which ended happily, while many other women on the maternal-fetal ward had far sadder outcomes. I mourn with friends who have terminated pregnancies for medical reasons, or endured a stillbirth due to medical complications during delivery. The process of creating life is sadly fraught with many moments that can go terribly wrong.

I believe that each unique combination of an egg and a sperm creates a different potential life and that personality is the result of a complex interaction of biology and environment that occurs over a lifetime. I do not believe that a specific fetus was destined to be a specific person and that if that fetus is aborted or miscarried that the world is missing the next “Beethoven, finder of the cure for cancer, or fill in the blank” any more than I think that the miscarried or aborted fetus might have become “Hitler, Charles Manson, or another potential blight upon the world.”

It turns out that the answers to my hard questions really were not the important part of my process. It was the asking that proved most valuable. Avoiding the hard thoughts, the conflicts with moral, ethical, religious, or philosophical beliefs seems to me the surest way to make the wrong individual choice about abortion. To me however that is the best answer anyone is going to get, their individual answer because really there is no answer.

Why I will continue to write

Many years ago, in an undergraduate women’s studies class I read Kristen Luker’s now classic Abortion and the Politics of Motherhood. Those were the hot days of the abortion wars, yet Luker’s careful nuanced analysis not of the rhetoric or of the leadership, but of the beliefs and attitudes of activists on both sides of the struggle made perfect sense to me. Luker showed that abortion is not about reproduction so much as it is about how individuals view the organization of society, the relationships between women and men, the function of religion in society, and the other beliefs that comprise what we often call a world view. Ruth Rosen, another fabulous scholar whose writings I have long admired, makes a similar point about contraception in her recent article about the exclusion of family planning funding from the economic stimulus package. It all comes down to how you define women’s primary function. Are women people just like men, or are they meant foremost to be mothers?

I have ruminated on how my blog must read to the “other side.” I do not think anything I say will change anyone’s mind, mostly because I still believe that beliefs about abortion are largely dictated by two fundamentally clashing views of the world. What I do hope is that by giving voice to one woman’s experience of abortion I can move beyond pithy slogans or religious injunctions to show the feelings and thoughts that accompany abortion. Because that is what abortion really is, a medical procedure that individual women understand in unique ways, filtered through life experiences, religious beliefs, philosophical underpinnings and all the other myriad factors that make up the way people make sense of the world. Banal generalizations and sweeping statements serve only to fan the flames of dissent.

So I have decided to continue to chronicle my abortion process. The professor in me cannot bear to let this teaching moment pass. I also think that the unfolding experience abortion is something few women have shared. There are many fine sites on which women can share their stories, but the longer process is invisible.

I already know that I am going to gradually break the silence and anonymity I have sought. As long as I hide, I will feel a sense of shame. I anticipate also that there may be moments, perhaps the monthly anniversaries, perhaps my first period, who knows, that revive the memories of my abortion.

The comment function is turned on. You cannot post anonymously. I reserve the right to eliminate any posts I find offensive. Start your own blog if you disagree :)

Day 2

I wake up full of dread, but in no pain. I focus on getting my children ready for the day and packing my bag.

I am anxious about the pain to come and I am feeling angry and resentful with my husband. We are both on edge and snap at each other. I lock myself in the bathroom to cry silently so my son will not hear me.

On the drive to the clinic, I decide I have to talk to my husband about the day before. I tell him how hard it was to absorb the intense experience. I tell how hard it was to know the exact moment my pregnancy ended and how difficult it was to go through that alone. I tell him that I am scared to go through the dilation by myself.

He is angry and scared as well. He is mad that he can’t help me, mad that he feels torn between my needs and taking care of our children.

As we drive over I realize that I am having contractions. They are not too painful, but they are frequent. I am not surprised given my medical history.

When we arrive at the clinic, there are two people waving brochures at us as we drive into the parking lot. It takes a minute for me to realize that they are anti-abortion protesters. My husband is angry and wants to confront them. They are two old people just standing there. They do not yell anything at us or try to harass us, so I tell him to calm down.

I walk in the clinic and see the head of counseling. She knows why I am there and asks if I want to come in the back to lie down where it is more comfortable. I know this means I will have to leave my husband, but since we have already decided there is little point in him waiting all day, I decide to do it now. Still I tear up as I hug him goodbye.

As I walk into the back, the counselor asks how I am feeling. I tell her I am contracting. I am brought into a room with those weird medical recliners that are ironically what they often provide for new fathers. The crying woman from the previous day is already there. She is already crying. We talk a little bit about how we are hungry. I say that I cannot believe we have to be back here without our support people and she agrees. The young woman from the day before comes in. She is obviously in pain and is completely silent. A nurse comes in and asks them some questions, but she cannot find my chart. I soon find out why. The head of counseling comes to get me. At first I do not understand. I ask if it is time for the cytotec. She explains that the doctor has decided to take me straight to the OR since I am contracting. I am relieved. I quickly text my husband. I am glad that I have pretyped the message that the surgery is about to start since I have no time before they take my bag away.

I am taken into a dressing room and given a gown, booties and a cap to put on. I am jumped to the head of the queue. I walk into the OR and see my doctor. He tells me this is the top OR staff and tells them I am a professor and advocate for the cause. While they prep me the OR nurse tells me about life before Roe and what she saw. This is why she works at the clinic a day a week. The scrub nurse tells me about the protesters when I ask about them. She says that while the clinic has escorts for the weekends, the protesters are usually these old people who are quite civil. We talk about how lucky they are not to have the awful situations that exist elsewhere.

The anesthesiologist gives me an injection and the next thing I know I am in recovery and it is 10 o’clock. I am in pain, cramping. The nurses are kind and bring me a heating pad. I call my husband to tell him I am out of surgery. Recovery is a huge room with women continually being wheeled in and walking out. The nurses offer me pain meds once they have checked my blood pressure and taken out my IV.

I walk back over to the first room where I am given a drink and some crackers. The crying woman is gone, but the young girl is still there. Obviously she is still dilating and in pain. I get dressed and wait for my husband. Women come and go and I just sort of zone out, dozing. . My husband needed to pick up my son so it takes him about an hour and fifteen minutes to get back.

In the car I take the pain pill I packed. I feel strange, relieved, exhausted, and drained. We stop for some food since I have not been able to eat. We talk a little. We had a friend to take my son for the afternoon in anticipation of a much later discharge, and we decide that since he has been looking forward to it, we will stick with that plan.

My husband and I stay in our bed all afternoon as per my recovery instructions to take it easy. He watches the new Batman movie on TV while I intermittently sleep, play on the computer and finish listening to my audiobook. I am not in any pain. By the time my children are home I feel well enough to get up and make them dinner. I give my daughter her bath. The only difficult part is the restriction to not lift anything that weighs more than ten pounds, but my husband lifts her out of the bath and into her crib later that night.

It is all oddly anticlimactic.

pain update day four

I had no pain yesterday and stopped taking the pain meds completely.

I had very little bleeding yesterday. There was a little more this morning and a few clots, but still lighter than a period.

thought of this morning

if I was more pregnant than I thought, then I do not think I got pregnant the one time we did not use birth control. Should that matter to me? Since one of the things I have been beating myself up about is that I was not "responsible" it kind of does.

Apparently I am not alone in this situation.
Fifty-four percent of women who have abortions had used a contraceptive method (usually the condom or the pill) during the month they became pregnant. Among those women, 76% of pill users and 49% of condom users report having used their method inconsistently, while 13% of pill users and 14% of condom users report correct use.

Want to know how reliable your birth control is in practice (scroll down to 7 for a chart on ideal v actual failure rates)

Friday, January 30, 2009

abortion wars, a middle ground?

Is it just my personal experience, or is abortion everywhere in the news right now?

Fascinating piece on pro-life advocates who are taking a new tactic, attempting to reduce the number of abortions, rather than over turn the legal right to get one.

However, lest you think things are approaching a sane and sensible debate, the issue is becoming hotter on the international stage.

I am going to be fine

Tthat was my first thought this morning.

I have always been a person who dreams vividly. During difficult experiences my dreams often reflect my anxieties. I wondered if I would have dreams about my abortion, or being pregnant, or having a baby, but I have not.

I realized that it is simply going to take time for me to process this very intense experience that occurred in a relatively short amount of time.

I read a really interesting interview with Jennifer Baumgardner, feminist activist and creator of the "I had an abortion" campaign about how women continually reassess their experiences of abortion at different stages of their lives. That seems right to me based on my experience of miscarriage. At each subsequent pregnancy and then birth, the miscarriage carried different weight for me.

Other than some awful gas pains late last night, I feel fine. I have almost no bleeding at all and no pain. I will take an pill with me to school in case I start to cramp again, but as of right now I feel perfectly normal. The most difficult part is the weight lifting limitation since my two year old still likes to be picked up.

Thursday, January 29, 2009


Just got off the phone with my sister. It helped so much to talk to someone who has also experienced an abortion.

I wish every woman had someone close the her with whom she could share her feelings about her abortion, but the reality is that some women have no one.

A wonderful service exists however to serves women who have abortions, and their partners, friends and family. Exhale respects the cultural, social and religious beliefs of all our callers. All calls are confidential.

Call Exhale to talk freely about your experience with abortion.

1-866-4 EXHALE (1-866-439–4253)

Monday – Friday:
5 p.m. – 10 p.m. Pacific
Saturday – Sunday:
12 p.m. – 10 p.m. Pacific

pain update morning of day 2

none. Been about 6-7 hours since I took a pain pill but I have no cramping or pain at all.

The Hardest Part

The counselor at a clinic is always the sort of job I hope my students will get and indeed this woman was a women’s studies minor. She is wonderful, training an intern, so I dutifully answer all the questions. She then walks me through what will happen next. She tells me that tomorrow I will be giving cytotec, ironically the drug in both the abortion pill as well as the drug used to induce labor in pregnant women. She warns me that it can be quite painful, cause nausea or the shakes. The worst part is that in a clinic setting, you cannot take a support person back with you, so I will be alone during this experience, which can take up to four hours.

I am aware that the two day procedure involves the slow, gradual dilation of the cervix to about 2 cm and that before I leave today sea sponges will be placed in my cervix to begin dilation. However, What she tells me next is sort of surprising. She tells me that the shot of digoxin to stop the fetal heart will happen today. While I knew this would happen, I thought it occurred in the OR immediately prior to the abortion. I admit to being somewhat startled. My husband has returned home to pick up our children since the appointments have run so late. There will be no one there to hold my hand at the moment this pregnancy ends. It is a sobering thought, to know the exact moment, but perhaps that is how it should be.

The insertion of the laminaria is painful. No point in elaborating, but painful is accurate. Immediately menstrual type cramps begin. I am barely aware of the quick shot through to the amniotic sac. I am grateful for the distraction, but also happy that before the sonographer and the physician came into the room, I had taken a moment to say goodbye to this pregnancy that I had know for only 12 days. I thought I might share here exactly what I said, but I think I will keep that private for myself.

After that I return to the waiting room for my husband to return. I am now in constant pain. It is not awful, like bad period cramps, but definitely not comfortable.

The ride home feels long and I am grateful that our car has heated seats. I take a pain pill as soon as I get in the car. I am relieved that I had the foresight to put one in the car from an older prescription.

When I get home, I use the techniques they teach you for early labor. I turn on the heating pad and head for a shower. I let the hot water hit the small of my back for a long while. I then curl up in bed with the heating pad. It takes about six hours for the cramping to stop. About four hours in, I take another pain pill.

In the meantime, my husband cares for my children. After they are in bed he goes out to meet students, pick up my antibiotics, and get dinner for himself. I stay awake until almost midnight, drinking as much water as I can, and to take one last pain pill.

Miraculously I manage to sleep on and off throughout the night. I am not plagued by nightmares, but I am definitely restless.

Day 1 The Waiting Room

When I arrive I cannot believe how crowded it is; young women mostly, many African American. Some wait with friends, others with boyfriends, a few with their mothers, which heartens me. I am closer to the age of most of the mothers and I am insanely grateful that it is me undergoing this procedure, not my daughter.

I am taken into the back for an ultrasound. It becomes clear how exceptional my case is when the physician is called in to look at the images. He is a wonderful man, calm, competent and clearly an advocate of a woman’s right to choose. I like him immensely and we have a great conversation about what an eye opener this experience has been to me as a professor, a life long feminist and pro-choice activist. He treats me with dignity and as if I have the intelligence to make my own decisions.

My gestational dates are further than I thought. I suppose what I took for a period one month must not have been. I’m still confused as to when I conceived since I bled every month until the last, but I suppose it does not really matter. Although I had not wanted any concrete details, I am not upset when I learn the exact date. I am more worried that because of my complicated medical history the doctor decides I must have a two day procedure. I know this means pre-dilation of the cervix today.

I then begin the long queue. I see a nurse who checks my vitals, pricks my finger to check for blood type and anemia. I see a financial counselor where I learn that had my insurance not covered the procedure, it would have cost around $1800. I wonder where some of these young women are getting the money.

I then somehow get lost in the shift from the one day to the two day schedule, so I spend three hours in the waiting room. During that time I have ample opportunity to observe the other patients. Most of the women look serious, but calm. A few are crying, or closing their eyes. One woman in particular catches my eye. She is visibly pregnant, accompanied not only by her husband but her parents. She cries silently the entire time. She so obviously does not want to be terminating this pregnancy that I can only conclude that it must be for medical reasons. I wonder what she is doing at this clinic rather than in a hospital. One of the ironies of my situation is had I undergone genetic testing and decided to “terminate for medical reasons” as they say in medical lingo, my physician would have performed the procedure in the hospital. Because I “elected” to terminate my pregnancy, she would not.

After waiting quite a while and speaking first to the nurse, then to the receptionist, they realize I am still waiting. I see the nurse who reviews my medical history. I thank her, as I do every staff member I meet that day, for doing the work that they do. I tell them that I understand how lucky I am to have access to such a place staffed by people committed to women. Like many of the staff, she tells me her reasons for working at the clinic. She is a committed pro-choice activist, who believes in her work. We review my history and she is thorough and calm, explains that I will need to take antibiotics starting tonight and that she will also give me a prescription for pain medication. She advises me to hydrate today to make it easier tomorrow when I will not be able to eat or drink. She laughs as I leave and tells me that she needs more patients like me.

I’m back into the waiting room, which is almost empty. By now I have identified the other patients who are also undergoing the two day procedure today. The crying woman and a young African American woman, also visibly pregnant, who has waited with her mother for most of the day. I hear her mother asking the nurse how much the prescriptions will cost. I hear the nurse tell her that the antibiotic is most important and then the pain pills. I wish that I had my wallet so I could slip her the money. This process is grueling enough without financial worries weighing too and I hate to think of the young woman in pain tonight. I hear the nurse explain to her that the ibuprofen rx is really just the equivalent of 4 OTC ibuprofen and that she can buy whatever brand is cheapest.

Next the counselor

home again

I was quite dreading the painful part of today, but because I started having contractions I got to jump the queue and have everything done in the OR under anesthesia just in case anything went wrong

Mostly just feeling relieved that it is over.
I'm zonked out of percocet, not that they give you anything more than Tylenol with codeine but I had some l left over

pain update day 1

cramping stopped around 10PM last night and I got some sleep.

Just anxious about today. Want things over.

will post soon, so much to write about

Wednesday, January 28, 2009

change of plans

turns out I need a two day procedure

spent 8 hours mostly waiting a clinic today

will blog more later

unforseen complication

due to snow/ice my son's school is CLOSED today. We decide to drop my daughter at the sitter, have my son and husband drop me off (with hubby running into the clinic to sign the form for anesthesia) and then he will come back home, by which time our son's babysitter will hopefully be here.

At this point, I don't care if I have to do the whole procedure alone, I'm not postponing.

I try to call the clinic to make sure they are open, but there is no answer yet.

Tuesday, January 27, 2009

Random Ironies

About a week before I found out I was pregnant, my son stated campaigning for a sibling. He has since stopped.

His sister picked up with a counter slogan incessantly repeating “mommy I want you. I need you” as if to emphasize that she was not getting enough attention.

I continued to use condoms diligently long after I got pregnant. It really was the ONE time we didn't and we should have been safe. How ironic if it turns out that my 40 year old body is in peri-menopause, as I thought, and is just randomly shooting off eggs?

I learned that my physician would not perform my abortion the day after the anniversary of Roe v Wade, the day on which President Obama rescinded the global gag rule. I know how I will commemorate my abortion, through pro-choice activism every January 22.


The law in my state which provides exemptions for provider conscience in cases of abortion explicitly “does not apply to non-profit, non-sectarian hospitals open to the public,” you know like the "my tax dollars, STATE FUNDED FREAKING medical school hospital" where my physician is employed?

Money, Money Money

I am incredibly lucky in that I am well insured. I just got a call from the clinic telling me that I am covered 100%, no co-pay, no deductible. My husband, the primary insured, needs to call to confirm my benefits (I think the annual thing that tells them I have no other insurance of my own), but once I have the name and reference number, we should be golden.

This clearly is not the case for most women.

According to the Guttmacher Institute, in 2005, the last year for which they have compiled statistics, the cost of a non-hospital abortion with local anesthesia at 10 weeks’ gestation ranged from $90 to $1,800; the average amount paid was $413.

In 17 states, pregnant women qualify for medicaid and can receive public funds for abortion for any reason. Sounds good, but scarily, 13 of those states do so only because they are compelled to by court order. Other states provide funding for abortion only in specific instances.

On the flip side, restricting insurance coverage for abortion is a roundabout way to circumvent legalized abortion. Could it happen to you?

Thing to Pack for your abortion

1. comfy clothing including granny underwear
2. warm socks – medical settings are always cold and you will be in a ridiculously flimsy gown
3. a sweater or blanket – ditto above
4. lip balm – medical facilities are always dry sterile places
5. hand lotion – ditto above
6. something to entertain yourself with (books, MP3 player etc) – you will be waiting a lot, for your turn, to dilate, to be deemed “recovered,” to be picked up
7. fully charged cell phone – to call your escort or other support folks
8. in the car have a snack, as you will be starved from not eating all day. I’m taking yogurt and a granola bar, and pain killers in case the anesthesia is wearing off. I’ll also be popping a prophylactic Gas X pill.

If you’ve ever given birth, the above list will look quite familiar as it is pretty much the “mommy” part of the “going to the hospital to give birth” packing list.

Pre-abortion instructions and Preparation

Things I am told by the clinic
• Do not take any medications containing aspirin for 4 days prior
• The day prior, do not drink or eat anything after midnight
• The day prior, do not do any illegal drugs, including marijuana
• The day of do not wear any of the following, make up, nail polish, jewelry, or contact lenses
• Do not bring anything of value or any children with you to the clinic
• Do bring your insurance card, a current pay stub for the insuree, and a person to sign for the responsibility of picking you up after you receive general anesthesia.
• Plan to be at the clinic for 5-7 hours

Things I do to prepare
• Buy new yoga pants
• Color my hair
• shave my legs
• touch up my toe nail polish
• I want to get a manicure, but the place is closed due to snow, so I file my own nails
• Eat whatever the hell I want since I will not get to eat for most of tomorrow. I give myself a stomach ache eating brownies for breakfast.
• For good measure, I buy some new underwear, socks, and a cute a-line sweater dress to wear Friday to work with tights, boots and beads. No reason to look frumpy and it will hopefully hide the stupid pads I will have to wear.

Things I stock up on
• Gas x (having had 3 prior uterine surgeries I know the gas pains are terrible after)
• yogurt (because you get pumped full of antibiotics which kills the good bacteria in your body)
• Naproxen (my OTC pain killer of choice), although I am also relieved to see that I have some Rx analgesics still in the medicine cabinet,
• Pads of all sorts since I assume you bleed a lot. You do after birth and a miscarriage.

An open letter to my Doctor

Dear Doctor

First I want to thank you for the things you did to assist me in securing my second trimester elective abortion. You kindly arranged for an immediate ultrasound and made the circumstances clear so I would not have to explain once again that I planned to terminate the pregnancy. Most importantly, you secured a competent and capable physician to perform the procedure.

However, I need to tell you that I was uncomfortable with the fact that you allowed your ethical problems with my decision to be so apparent. The credo of the physician is to “first do no harm,” and I felt harmed by your attitude.

You said “well I have good news and bad news. The good news is that you are not 24 weeks yet. The bad news is that you are probably 17-18 week and I do not normally do abortions that far. I know one guy who might agree to do it, but I do not know given your medical history if he will. If it has to be performed in a hospital setting then it is back on me.”

Perhaps next time, and yes there will be a next time because I am not the only woman to choose to terminate a second trimester pregnancy, you might say the following:

"Good news! You are not 24 weeks, so abortion is still your legal option. I am going to arrange for an ultrasound so that we will have exact gestational dating, since manual examination and LMP are only estimates [in fact I was closer to 15 weeks]. The best place for you to get your abortion is at X clinic which handles a high volume of elective second trimester abortions. Let me make a few calls and come right back."

Since the doctor who does support a woman’s full legal right to choose was willing to perform my abortion on an outpatient basis I could have been spared the above. Instead, on the 30 minute drive to the ultrasound appointment I got to worry that
1. I was actually 17-18 weeks along in my pregnancy, or maybe even further, which means a far more complicated medical procedure.
2. I would be put in the position of having my abortion performed by a physician who did not believe it was ethical.

I recognize your right to draw ethical lines in the sand. What I do not recognize is your right to share your ethical lines with me. Right now, in this country, at this time, I have the legal right to an abortion up to 24 weeks. As long as the procedure is safe, that is all that should matter to you as my physician.

Again, I do thank you for the care that you do give. I am happy to know that you do perform elective second trimester abortions at earlier gestation dates since there are fewer providers willing to perform any abortions in the second trimester. I also appreciate that it seemed that you would perform the procedure if you were the only physician possible. However, I do no think that I will remain your patient any longer. From the moment I made my intentions clear I felt like everyone in your office wanted only to be rid of me as quickly as possible.


cry #3

just started crying as I told my husband how pissed and grumpy I am today.

I just feel stupid, stupid, stupid for
... not using birth control that one time
... for not realizing I was pregnant sooner
... for not getting my blood work done the day after my internist appointment
... for letting the ob/gyn receptionist make me wait a week for an appointment after I found out I was pregnant

Only good thing is that my husband reassured me that the ultrasound report was only comforting (I told him I did not want to know any specific information) so reading through the lines I would say it matched my gestational dates by LMP.

I just want this over

I'm tired of seeing spots every time I stand up. I have to break my cardio workout into fourths because I get breathless.

My husband just came in and said he intercepted the ultrasound report in the mail yesterday and opened it. I am pissed. He opened it. Stupid paternalistic gesture although I suppose it is his fetus too. I had a plan in place already. While I do not even see why I need the ultrasound report as I will have an ultrasound guided abortion due to previous c-sections, I planned to take it unopened in case the clinic asked for it. I tell him to take the damn thing with him to work and bring it tomorrow. I do not want any more information than that I feel in my body. I do not want to walk by it all day sitting on the front hall desk.

I am grumpy, edgy, anxious and would like to just zone out for the entire day, but no I have to go to Target to print out pictures for my son to use in a class project this week, finish prepping my work for the week in case I do not feel well on Thursday. I plan to teach Friday.

Next up, what to bring to your abortion (hint, a lot of the stuff you take to give birth)

Birth, it is everywhere….

I am so tired these days that I fall asleep by 9PM, usually with the TV still on, and wake up some time in the middle of the night.

Two nights ago I awoke to a TLC special about that Duggar family woman giving birth to her 18th child, followed by a special wedding edition of the show featuring their oldest son, who promised, along with his new bride, to let God decide the number and timing of their children. More power to them. The kids in these huge family seem well mannered and happy, albeit living a worldview that is completely foreign to me.

This morning I awoke to Anderson Cooper reporting on the birth of octuplets at 31 weeks. While the doctors are largely celebratory in their press conference, Anderson reports that of the last set of octuplets, one died shortly after birth.

Neither incident effects me in the least. These are women exercising an extreme choice that I would not pursue, but I would not try to stop them.

Monday, January 26, 2009

Nice to know someone is thinking about women like me.

Very cool article that defends the right to a second trimester abortion up to the point of viability.

FAQs in response to hypothetical comments

1. How could you possible not know that you were pregnant, and so very pregnant at that?
• I had a simultaneous illness that “masked” many of the symptoms
• I gained virtually no weight and continued to fit in regular clothes
• I still experienced period like bleeding
• Every pregnancy is different. In my first I had almost no nausea, my second an average amount of nausea and my third so much nausea that I required medications. This pregnancy my major “symptoms” (in retrospect) were heartburn and vertigo.

2. But you are so “far” in your pregnancy!
• First, I believe that life begins at birth. Lines in the sand are just that, shifting philosophical boundaries that I think each person has the right to determine for herself based on religion, biology, philosophy, whatever. Being “closer” or “further” for me is relative. More than half way and I would have considered continuing the pregnancy. I have absolutely no justification for my line. It is just mine.
• While some 1970s feminist fantasized about an “artificial” womb that could replace the uterus, so far as I know, even if I hit the magical marker of fetal viability at 24 weeks (which does not take into account the low survival/high complication rate for premature fetuses) I would not be able to find a doctor to deliver me at 24 weeks. The American College of Obstetrics and Gynecology explicitly precludes inducing birth prior to 37 weeks without medical justification.

3. I’m pretty sure you are going to hell, eternal damnation, fill in the blank torture, but I will pray for you.
• Thanks for your concern. Please flip to the concordance in your Bible. See “judge not” and “casting stones.”
• Perhaps instead of harassing women about their choices, you should
a) spend your time rocking crack babies at the local hospital
b) become a licensed foster parent and/or start adopting unwanted children
c) contemplate sterilization so you do not spread your views to the next generation.

4. Aren’t you worried about being plagued by a lifetime of regret/remorse/guilt?
• No. In addition to teaching the abortion debate for decades, I have been through abortions with friends and students. Relief is the predominant emotion these women felt. I have no doubt that women who are pressured into abortion or who hold religious/moral beliefs that are in conflict with the idea of abortion may experience regret/remorse/guilt. However, assuming that a causal relationship exists between having an abortion and the production of regret/remorse/guilt is weak logic.
• Ironically, I now realize that I began the process of making this decision for myself during prenatal testing in prior pregnancies. There is no point in undergoing prenatal screening unless you know what you will do with that knowledge. I thought through my ethics in a much more concrete fashion during those pregnancies.
• I suppose the benefit of being forty years old and in this unenviable situation is that I am aware that even the worst times in life are survivable. I am certain that this abortion will not rank as the most difficult decision of my life. I know its hard to believe if you are 20 and reading this, but sadly it is true. Life can suck really badly at times.

ahhh memories

During my college years, the right to an abortion was under severe attack. Operation Rescue tried to shut down clinics and pro-choice supporters would attempt to stop them. In the build up to Webster, there were many marches and rallies. These were some of my favorite pro-choice buttons. You can still get them here.

And so I ....

...gave these nice people a donation, Medical Students for Choice. I wonder if in a strange way the very legalization of abortion has contributed to the decline in physicians who learn the procedure. Physicians were at the forefront of the movement to make abortion safe and legal for women because they saw the direct outcome of illegal abortion, dead women.

... am taking my checkbook with me to make a donation to the freestanding clinic that is willing to provide me with the right to control my own body, when the medical school affiliated hospital will not. Want to ensure you will have a clinic of your own in case you need it? Check out this list of competent clinics.

...give a huge shout out to NARAL, which defends, at least on a theoretical legal basis, the right of all women to continue to enjoy the right to choose.

maybe this is why ...

Eighty-seven percent of all U.S. counties lacked an abortion provider in 2005; 35% of women live in those counties.

then again, maybe not ...

When women have abortions (in weeks from the last menstrual period)
Eighty-nine percent of abortions occur in the first 12 weeks of pregnancy, 2004.

So maybe I am not the only one ....

Six in 10 U.S. women having abortions are already mothers.

Sunday, January 25, 2009

To share or not share

People I have told
My husband
My sister
My oldest friend
My best friend
My geographically closest friend
One colleague at work

People I have not told
My parents (although my husband told his parents!)
The members of my online mothers groups with whom I post daily
Friends who live close by

Why I told

My geographically closest friend was the first person I told. I found out while driving home from work. While stopped at a gas station, I picked up my voice mail. I had a message from my internist. Not my internist’s office, but my internist himself. He said “I got your test results back, are you sitting down? You are pregnant.” My legs literally began to shake. I don’t think I could have driven the rest of the commute home, and my friend lives about 5 minutes away. She is also helping with the childcare logistics on the day of my abortion. Sadly her husband has inoperable brain cancer and he has an MRI scheduled for that day. I know that wait for those MRIs is a huge emotional drain for her, so I am trying not to rely on her for emotional support.

My sister has had two elective abortions. I helped her through the first one when she was just out of college. She tells me that I will get through this and not be haunted by my decision. She calls to check in on me and offers to fly back for the abortion, but I know taking off time in the middle of the week mid-school year is almost impossible for her.

My best friend, who is also a physician, had an abortion for a very different reason. Her second pregnancy pre-natal testing revealed trisomy 18 and she made the agonizing decision to terminate. I tried to offer support, but had recently moved across the country so was only there somewhat for her. She is mostly concerned with the medical aspects of an abortion at this stage of gestation and tries to talk me through it. She has two children of her own, so long emotional conversations coast to coast are not really possible.

I reach my oldest friend while she is on the ski slopes. She knows how conflicted I am as a mother and is 100% behind my decision. She is perhaps the person with whom I am most honest about the negative aspects of motherhood, mostly because she has no children of her own and plans none. Still she has not experienced abortion and other than telling me she supports me, there is little she can offer.

My colleague at work is perhaps the person I am closest to there, which is odd since she is a woman my mother’s age. I am fully aware that she is pro-choice and since I need her to take my Friday classes so I can go to the ob/gyn, I decide to tell her the truth. Everyone at work gets the slightly euphemistic “I had some abnormal test results that require follow up and possibly an outpatient procedure.” I work at a religiously affiliated institution and besides it is not really anyone’s business.

Although I have lived in my geographic location for four years, I do not have many close friends here. I have at least two women friends who I sense would rally to me, but I feel uncomfortable sharing with them since it seems like information that belongs to a deeper level of friendship. Maybe sharing this crisis would take us to that level, but I do not have the energy for drama, so I do not risk telling.

Why I did not tell

Although I have come to peace with my parents as people who did the best they could raising me, and I think they are largely pro-choice, this is not a level of information I would ever care to share with them. They know nothing about my miscarriage either. My mother has a tendency to get overly emotionally involved and I do not need her feelings to think about in addition to my own. That my husband told his parents still baffles me. I know his mother had an abortion, and he says that they are supportive of our decision, but I find it ironic that I speak with my parents almost daily and did not tell them, while he seldom calls his parents, yet as far as I know they are the only people he has told. He has a close friend who is a single adoptive mother who would love to be pregnant herself, so she is not a good person to lean on. He has his own therapist and I trust him to get the support he needs.

Perhaps the strangest thing for me is not telling my online mothers group. This online group formed during the pregnancy of my first son and we have been posting together for over four years. I am on our discussion board numerous times a day. However, I know that the issue of abortion is a divisive one. We have both pro-choice and pro-life members. I also know that there are members who would happily switch places with me now since they desire more children and that there are women battling various levels of infertility. I have simply stopped posting of late. When members email me privately to find out why I have not been on the board, I offer a vague non-answer. I am sure several of the members will figure out the situation from my response, and I know that at least two of the people who emailed me are pro-choice, but it just does not seem fair to burden them with the knowledge when other members of the group are unaware.

The emotional aspects

I scheduled an appointment with a therapist as soon as I found out about this unwanted pregnancy. I spent most of the week between finding out and my first ob/gyn appointment trying not to think about it. I felt like I was in suspension, just waiting.

Fortunately, or not depending on your perspective, the week unfolds as if the universe itself wants to make the point that I cannot handle another child.

First my daughter gets the stomach flu, vomits in the middle of the night and spends the rest of the night tossing and turning in my bed. She has not slept through the night since. It is like having a 2 year old newborn as she awakens at least once an hour all night. The next day, a holiday, we take both children to the pediatrician. They both have sinus infections. This is day four in a row of my son being at home since we kept him out of school on Friday since he seemed to be getting sick. We all have cabin fever but it is too cold outside to go anywhere.

My daughter does not react well to the antibiotics and is super clingy and needy and wants only to be velcroed to my body. Turns out she caught the flu from her daycare provider who is unable to take her for three days while the flu works its way through her family. We juggle teaching schedules to accommodate having her with us 24/7. I come down with the flu. I can barely lift my head from the pillow, but it is my husband's first day of classes so he must teach. Somehow I manage to keep her from killing herself while I doze on the sofa. My husband next gets the flu, so off she goes to school with me. I line up students to watch her, but she is not appreciative and starts crying half way through each class period. I teach four classes holding her for the second half of instruction. I'm completely drained by the end of each day, physically by the demands of holding her and emotionally from the trials of juggling multiples roles simultaneously.

Meanwhile, my husband has our long awaited appointment with my son's principal and school psychologist. Based on classroom evaluations, they believe he has a "classic" sensory disorder and have requested a full special education evaluation at the district level. While this finding merely confirms what we have suspected, it also means that we are in for a long road of therapy. The school is happy with the changes we implemented over the winter break and they encourage us to continue to work at home with him while they work with him the classroom. I am exhausted already at the thought of how we will manage this work in addition to everything else that we already do on a daily basis. I am also dreading the emotional energy it will take to deal with him without getting angry. Since he seeks rather than avoids sensory stimulation he often seems ill behaved. I am teaching him yoga and other ways to channel his need for stimulation, but it is very hard at times to deal with a child literally bouncing off the furniture and walls, say when you are in the midst of cooking dinner at a hot stove.

Meanwhile, I have pretty much stopped eating. My longstanding eating disorder has been triggered by this uncontrollable bodily experience. In the week after I learn I am pregnant I lose 3 pounds and weigh at or less than what I must have weighed when I got pregnant (I though I put on a few pounds from holiday treats). I find this unfathomable as by this point in my prior two pregnancies I was wearing maternity clothes. I am no longer hungry. It is as if my body does not want to nourish this fetus, although I know that in actuality it will be my body that suffers since fetal nutritional demands are met first.

I have odd fears. I mostly fear perceiving fetal movement. I notice that when I take a Tylenol PM to help me sleep, I feel nothing below my belly button. I have starting taking 25 mg Benadryl tablets around the clock to ensure I will feel nothing. I know in a sense I'm being silly and I'm not going to feel the discernible hand or foot that you feel late in pregnancy, but still it is my fear. Strangely enough, I find myself paying great attention to my appearance. It is as if I am saying “see I do not even look pregnant. See how I still fit in my cute outfits."

My poor husband is a kind supportive guy who keeps asking what he can do to help me. I feel awful that all I want is for him to leave me alone. I want to cocoon myself until Wednesday. I cannot allow myself to be emotional at all because I must hold it together for my children. I have cried exactly twice, once when talking to my sister, who has experienced abortion, and once in the waiting room for the ultrasound. I am a pragmatist. I deal, but do not expect me to feel. I know that makes it hard on my husband who copes with things differently, but I need to take care of me. I feel guilty about that, about putting my needs first. I feel like a hamster on a wheel, a snake eating its tail. I must take care of me so I can take care of my children, which means not taking care of my husband or really taking care of me right now. So be it.

The Medical Professionals

Because I have taught about the issue of abortion for years, I was well aware that the number of physicians who perform the procedure is small. However, I was not prepared for my own encounter with the medical establishment.

When I first called my ob/gyn office, the receptionist could not seem to wrap her mind around the fact that I was calling to schedule an appointment about an abortion. She repeatedly referred to my appointment as the "first prenatal visit." It played like a scene from a bad abortion documentary, but I managed to shrug off my annoyance.

Just about the only good news I got in relationship to this unwanted pregnancy was that the first physician with an opening in my ob/gyn practice was my favorite doctor. When I went in, along with my husband, we were straightforward about the situation. I am fairly stoic and did not get emotional when discussing the issue with her.

On manual examination of my uterus, she guestimated my gestation to be 17-18 weeks. Frankly, since I was able to provide her with a date for my last period that put me closer to 15 weeks, I found that rather irresponsible, especially considering that since I have a malformed uterus, my body does not carry pregnancies normally. It was also very clear that she was very uncomfortable with the idea of elective termination at that gestation. At one point, and perhaps this was my imagination, it almost seemed as though she choked back a cry. Now I must say in her defense, that she is apparently the only physician on staff of a major medical school hospital in a state with some of the most liberal abortion laws that does perform elective second trimester abortions. I commend her for that. I also recognize that physicians have the right to their own ethical lines in the sand. Still her reaction really threw me for a loop.

She told me that she knew of one doctor who did perform elective second trimester abortions and that she would call him immediately. She feared that because of my previous c-sections and uterine anomaly, he would not want to perform the procedure outside of a hospital in which case, as she put it "it would be back on her." That sobered us up quite a bit as she left to make the calls. Did my reproductive choices really come down to one or two people? She also called to get me in for an ultrasound immediately so that there would be accurate gestational dates. To her credit, she explained to that office the reason for the ultrasound so I was spared any congratulatory messages upon arrival. That staff was also very professional. Just as we were going back for the ultrasound, the ob/gyn office called to say that my physician had reached the other abortion provider and that he had agreed to do the procedure. That was a huge relief. I was very unhappy about putting my physician in a position that made her feel unethical and did not want that to deal with on top of my own emotions.

On the drive to the ultrasound, my husband and I discussed our decision again. I asked if her estimation of gestation made any difference to him. We also discussed at what stage in the second trimester we would consider continuing the pregnancy. We both agreed that 20 weeks was our cutting off point. When we arrived at the ultrasound, there was a woman with a newborn that was crying. The sound pushed me over the edge and I began to sob. Again, I felt like I was in a bad abortion documentary. It recalled for me also my awful post-miscarriage visit to the ob/gyn where I also broke down when faced with a newborn baby, although for very different reasons. I put on my MP3 player during the u/s and closed my eyes. I had asked my husband to find out the gestation, but the ultrasound tech insisted she could not tell us. A half an hour after we returned home, I got a call from that very office telling me that I was meant to have a copy of the record to take to my abortion appointment. How ironic.

Still as we drove home, and I began to process the experience, I realized that I was happy with the estimated gestation based on my last monthly period. I wanted as little information as possible. I still believe that life begins not at conception, but at birth, and my decision was not swayed by someone else's ethical line in the sand. I had my own.

If anything, I am even more grateful that I live in a time when abortion is still legal and that I am in a geographical location where I have easy access to a competent provider. I try to imagine having no options save for a back alley abortion or giving birth to an unwanted child. In trying to work out the childcare logistics for the day of my abortion, I cannot imagine having to travel to another state. It also reminds me of a slogan from the '80s "never again, never go back." In recent years, I have slacked off on my pro-choice activism. It is still a voting litmus test for me, but this experience has renewed my commitment to make sure that all women have the right to "my body, my life, my right to decide."

The Ying and Yang

In 2003, before the birth of my first child, I experienced an early miscarriage. In some odd way, that first and what will now be my last pregnancy feel related to me.

In the first case, that pregnancy was also "unplanned." After much debate about having children, my partner and I were not "not trying" but also "not actively trying" if that makes sense. Labor Day weekend (how appropriate) 2002, I took a home pregnancy test. We were both delighted and happily anticipated that child. We were both completely devastated when I miscarried. I have to say that next to getting divorced, that miscarriage was probably the most difficult personal time of my life.

When I think about how I might feel after the abortion, I also find it useful to think about my miscarriage. What was so upsetting to me was the lack of control I felt. I wanted to be pregnant and I was not. I feel now like at least I have control over what will happen to my body.

While I felt sadness for a long time after my miscarriage, many of my feelings related to fear that I would never have a child. I am not one who commemorates the anniversary of that pregnancy (although I do still remember the EDD), as other women do. I do not think of that fetus as an "unborn" child watching over me from heaven. I do not find myself looking at my oldest child and thinking he could have an older sibling. In fact, other than times when miscarriages come up, when friends have experienced them for example, I really do not think about my first pregnancy any more.

I sort of think that will be how this pregnancy will be incorporated into my life. I have consciously chosen not to look at the EDD, do not know my exact gestation by ultrasoud and want to know no details. I do not think that I will spend time in the future wondering about the person this fetus might have become. I do not imagine that I will look at my youngest and think that she could have been the middle child. I hope that I will be able to draw on the experience to help other women in the future, since that is what I do in my life.

My husband chose to watch the ultrasound screen during the dating ulstrasound. I could not do that. I have my bodily sensations to make this real. Because I had a problematic first pregnancy I had ultrasounds every two weeks. I know exactly what this gestation entails. At this point in my prior pregnancies, I knew the sex of the fetus and had selected names. I responded to that fetus as a potential person. From the moment I learned of this pregnancy I have felt nothing but unhappiness, not one spark of "what if" or "if only" has crossed my mind. All I have hoped for is a miscarriage so that I would be spared this difficult experience.

In a strange way, I feel like I had no control over losing a pregnancy that I wanted and I now have control over a pregnancy I do not want. They are the ying and the yang of my reproductive experiences.

But I am already a mother...

Indeed, rather than tipping my decision towards continuing this unwanted pregnancy, the fact that I am already a mother is pushing me in the opposite direction. I know exactly what raising a child entails and I do not feel like I can raise a third child.

In part, my feelings stem from a longstanding conflict I have felt between my role as an individual and my role as a mother. Perhaps it is because I was relatively older when I came to motherhood (36 and 38) that I have had a hard time reconciling the two. I spent 18 years as an adult, responsible only for myself. During that time I pursued a career that I love that I feel makes a valuable contribution to society. There is not a week that goes by that I do not feel the conflict between my work and my children. I feel guilty that I do not want to spend more time with my children. The media bombards us with stories of women who wish they could stay at home full time. I can think of nothing worse. I have to say, I am very fortunate. My husband and I both have flexible schedules so we are able to use only part time care and did not start until the children were each almost two. I still spend two days a week "at home" although during that time both children are in part time care so that I can do some work. Still, the guilt remains.

In part, my feelings stem from the children I have to mother. My four year old son has recently been diagnosed with a sensory disorder. I just managed to wrap my mind around the fact that other than teaching, he was going to need all my time and energy to help him learn to cope with this disorder. He is incredibly smart and has figured out lots of techniques himself, but we are doing a great deal of work at home with him to also reinforce positive methods for deal with sensations that bother him. That leaves my darling little two year old to assert herself. In addition to the normal "terrible twos" she is determined not to be ignored! I have a great deal of guilt about the amount of attention she gets since her brother needs so much already. However, I must also confess that not a week goes by that I am not incredibly frustrated or angry with my children. They are demanding and needy and damn it, sometimes I do not feel like being their mother. I admit to yelling at them more than I want or handling them too roughly at times.

When I try to picture fitting a new baby in to this situation, it becomes clear that it is impossible. If I do not feel like a good enough mother for the children that I have, how can I be a mother to yet another? I feel that the people who would suffer most if I continued this pregnancy would be the children themselves.

What I've been thinking so far

While I have always been pro-choice, I cannot say that the decision to terminate this unwanted pregnancy came lightly. I have thought through just about every option.

Right now I want to write about why I have not chosen adoption. My thoughts are haphazard right now, mostly because my thinking usually occurs with one or two small children in the background.

1. During my college years there was a terrible adoption case that garnered a huge amount of attention. A highly respected lawyer faked an adoption and kept the baby for himself and his wife. He was abusive to both and eventually beat the child to death at which time the case became a matter of huge public debate. The notion that I could hand my child over to someone else to raise is impossible for me to accept.

2. But what about an open adoption so that I would be able to monitor the raising of said child? I have a friend who chose an open adoption when she became pregnant as a teenager. She still sees that child regularly and has a good relationship with her and her adoptive parents. However, I feel that it would be very difficult to have a relationship with a child, who would be a full sibling to my children, without explaining why I gave the child up. The core reason I am choosing to abort is that I do not want another child. I cannot fathom telling that to a child, yet I cannot imagine concocting some sort of lie to explain my decision.

3. But what about a closed adoption. They do still exist! Umm well sort of. Adoption law is increasingly shifting, as it should IMHO, to giving greater rights to adoptees. I see no guarantee that at some point in the future, I might get a phone call or a knock on a door from the child I gave up. that puts me back to choice #2.

4. From a medical point of view, I am at the beginning of my second trimester and have had no prenatal care. While sick in the fall I took just about every OTC medication you can think of. I am fearful about the potential fetal impact. From the standpoint of my health, I do not have easy pregnancies due to a congenital uterine abnormality. I spent 12 weeks on bedrest during my first pregnancy and both my children were born slightly premature via c-section. To continue this pregnancy would mean many more months in which I would be physically incapacitated and would require that I undergo a fourth uterine surgery. During my last c-section the obstetrician repeatedly remarked that she was happy this pregnancy would be my last since my uterus has a great deal of scar tissue and was paper thin by the end of my pregnancy.

Next up, considering things from the standpoint of me as a mother

My Story

I went in for my physical two weeks ago and since my periods have been erratic of late, my doctor ran a blood panel for peri-menopause. Big surprise I am pregnant and actually quite pregnant, about 15 weeks.

Were I in an a more academic frame of mind, I might note how context actually creates somatic experiences. The sensations I have, everything below my shoulders and above my knees, now seems like confirmation of my pregnancy. I am sure I had these same bodily sensations the day before, but attributed them to different causes.

In particular, I recently had whooping cough. Exhaustion, sore abdominal muscles, an upset stomach from broad spectrum antibiotics all seemed to explain the way I felt. Had my primary care doc not insisted on running an hCG test along with other hormones I do not know when I would have realized that I was pregnant.

I am the mother to a four year old son and a two year old daughter. I considered my family complete. I went on the pill at 16 so that I'd never have to deal with an unwanted pregnancy, but after the birth of my second child, the pill made me nauseous. My husband planned to get a vasectomy. Exclusively breastfeeding provided good birth control until my daughter was sixteen months old. And yes, like so many of my students have told me, it was the ONE time we didn't use a condom that I got pregnant.

I have always been pro-choice. I participated in the pro-choice movement while in college. As a professor, I have taught the issue many times. While experiencing an unwanted pregnancy has caused to me to relate to the issue differently, it has not challenged my core view, voiced by Margaret Sanger, that every child should be a wanted child.

My abortion is scheduled for three days from now.

Blogging My Abortion

I was pretty shocked when I discovered only three other abortion blogs. Ironically, I learned about my unwanted pregnancy the day after the anniversary of Roe V Wade, so blogging abortion had received a lot of media attention. Still the abortion blogs I did find chronicled the experiences of women in the early stages of pregnancy. What I craved most were the words of a woman like me, in her second trimester undergoing an elective abortion.

As a professor, I see most everything in life as a "teachable moment." While I probably will not share this information with my students (I am un-tenured at a religiously affiliated institution), I hope other readers will learn something from the chronicle of my experience. Oddly enough I hope not only that women facing "the choice" will find it helpful, but that people who wonder "how someone can choose abortion" will also benefit from following my process. THIS IS HOW. READ AND LEARN.