A personal abortion narrative

I received an email yesterday from a fellow blogger (I'm not sure if she wants to be named or not, so I'll just call her B. for now) with a disturbing story forwarded from a close friend who had a harrowing abortion experience. Everyone reading this should know that I'm pro-choice and that this is in no way an anti-abortion narrative. However, just like any other medical procedure, abortions need to be handled in a respectful and caring manner, and the below experience seems very far from appropriate, thoughtful or attentive. While I personally have always had good feelings when it comes to Planned Parenthood--and I certainly support and appreciate their mission and goals for women's health--I think it's exceptionally important to showcase problems with the system when they arise. Just because I respect an organization doesn't mean they do everything perfectly or that there isn't room for significant improvement.

As an introduction to her friend's account, B. writes:

I am forwarding this story on behalf of my friend. I am trying to get the word out to as many people as possible, and encourage women that have had similar experiences to share them. She recently had an abortion at a Planned Parenthood clinic and the experience was so awful that she feels that it did more harm to her psyche than just the abortion itself would have. She said to me: "I'm seriously fucked up in the head now because of the experience. And I honestly believe it's not because I had an abortion but because I was apart of what went on that day. It was horrible. I was the ONLY woman there crying. There were women in the waiting room laughing, having a grand ol' time like it was nothing. I know people cope with situations differently, but this was crazy."

Here is the story she wrote. I don't know if you guys can post part or all of it, but I just want to share it, and she has given me permission to do so. I also want to encourage anyone that has had similar experiences to write to PP, to do anything they can to spread the word and hope to have this rectified. This is an organization that claims to care about woman, and no woman should have to experience what my friend went through.

Her friend's story, in full, is below the cut:

"I recently had an abortion at the Falls Church, VA Planned Parenthood. Having an abortion is delicate process, starting with the decision to terminate the pregnancy. Planned Parenthood has made that process the absolute WORST it could've been and I'd like to share my experience with you. Starting with the initial appointment I made at the D.C. Planned Parenthood for November 22nd. That appointment was scheduled for 11:30. When we showed up, there were a minimum of 20 protestors outside throwing rosary beads at me and trying to shove a bible in my face. After going through that, I was turned away (as was the couple in line before us) by the security guard behind the desk due to, "We ain't takin' no mo appointments today. You gotta reschedule." There was no apology offered and to be honest, she was very rude. When I called to reschedule the receptionist explained to me that they always over-book the appointments because a lot of people usually don't show up. Apparently that day everyone showed up and the building was at maximum capacity. No one called to inform me that I wouldn't be able to be seen. The time and gas money spent driving, the money spent on parking, and the harassment from protestors could've been avoided with a simple phone call.

"I decided that I'd rather have the procedure done at a different PP because I didn't want to have the same thing happen to me again. When I called the Falls Church, VA Planned Parenthood I explained to the receptionist what happened at the D.C. office and asked if that could happen there. She was appalled at what happened and asked if I would tell my story to one of the head people, to which I agreed. I went ahead and made the appointment at the Falls Church office. Later that day I received a phone call from a very nice lady who offered me a sincere apology and said that shouldn't have happened and she would get to the bottom of it.

"On Friday, December 5, 2008 my boyfriend and I arrived at the Falls Church office at approximately 8:30 a.m. I wasn't greeted with a smile, only a cold voice asking for my identification. I showed the receptionist my i.d. and she handed me paperwork. She then wrote a #4 next to my name on her list. After I filled out the papers, I was told to have a seat and I would be called back (for what, I didn't know) in a few minutes. A few minutes later the receptionist called my name and told me that it would be $425. We paid her then sat back down. After waiting just a little bit, I was called back and my boyfriend attempted to come back with me. The nurse quickly told him that he wasn't allowed back so he stayed in the waiting room. I was taken into a room and told to remove my clothes from the waist down, cover up with the provided paper blanket and have a seat on the table. I asked the lady what was going to happen and she informed me that I was going to have an ultrasound to see how far along I am. I'm not sure why my boyfriend wasn't able to be in the room for this because if I were keeping the baby, he would be able to be in the room for an ultrasound. The lady came back in the room, grabbed a long probe, covered it with lubricating gel, and said only, "Spread your legs." I was a little surprised because I was assuming that it was going to be an abdominal ultrasound, not a vaginal. Maybe I shouldn't have assumed, but it wasn't explained to me by any of the PP employees, so I didn't know. She then probed around and said, "Ten weeks and 2 days." That kind of surprised me because based on my calculations I wasn't that far along. I asked her to explain to me how she calculated that date. Her explanation was exactly how I calculated it, which didn't add up to 10 weeks. When I told her that, her only explanation was that "it's very confusing." She then told me to get dressed and go back in the waiting room, offering nothing to clean the gel from my vagina.

"Again I'm in the waiting room when I get called back again. This time my boyfriend was able to come back with me because it was for counseling. The counselor was very pleasant and informative and didn't mind answering any questions that either of us had. This part was the ONLY good experience I had at PP. After the session was over, she told us to go back into the waiting room.

"I was in the waiting room for less than a minute when I got called back again; this time to have my blood pressure taken and to have my blood drawn. Again, my boyfriend was not allowed to come back with me. The nurse asked me what my blood type was and I told her B positive. She said, "Well we still have to draw your blood to check if your Rh is negative." She did the bp check and drew my blood, never saying a word, then told me to go back into the waiting room.

"After waiting for a while again, a lady opened the door and called 4 names, including mine, to come back. It was now 10:00 a.m. and my boyfriend wasn't able to come back, again. She had us all sit in chairs while she called one of us at a time to talk about if we wanted Xanax, give us OTC pain meds, and ask us about our preference of birth control. I was able to hear the conversations she was having with the other 3 ladies (numbers 1-3), because as I said earlier, I was #4. One lady chose the nuva ring, one didn't want anything, and the other wanted pills. Is it a HIPAA violation that I know each of their names and what method of birth control they're on due to the fact that I could hear the conversations? The lady then informed me that the doctor doesn't arrive until noon so we could either wait on the 2nd floor or we could leave but we had to be back by 11:30 a.m. When I asked why I had to be there so early if the doctor didn't arrive until noon, she said, "Because we've got 35 women to process."

"After waiting for another two hours on the 2nd floor, the same 4 women were called to go upstairs. We all went upstairs, waited a few minutes, then we were all called to go back to finally have the procedure done. Again, my boyfriend was not able to come back with me. They put the first 2 women in exam rooms not far from where the other woman and I were sitting. The doctor walked into the first room, I could hear the woman yell in pain, and the faint sound of the machine. A few minutes later he walked out the first exam room, dropped the chart off with the nurse, and then walked into the second exam room. The first woman the doctor performed the procedure on came out of the room and sat down at one of the chairs that were lined up next to each other. They then called the woman who was waiting with me to go back. The doctor walked out of the second room, handed the chart to the nurse, and then went into the next room. The second woman came out after having her procedure and was sat next to the other woman in the row of chairs.

"The whole time this is happening, I am sitting there crying my eyes out. Of course there were many reasons for that. One being that it was a VERY difficult decision for me and my boyfriend and another being that I felt like this was a factory. The doctor was turnin' and burnin' 'em like we were products on an assembly line moving down a conveyor belt in batches of four. Several PP employees walked by me while I was crying and ignored me like I didn't even exist. Finally a nurse walked over with a box of tissues and told me that she's sorry I had to hear one of the women scream. She said that not everyone's experience is like that. Then it was my turn.

"I was called back into the room and told to remove my clothing from the waist down and cover up. Still crying, the nurse asked me if I wanted to change my mind, I told her no. She left the room and I removed my clothes. While I was sitting there waiting and crying profusely, I could hear people outside having a conversation and laughing. The doctor and nurse came in. The doctor saw me crying and said, "Oh ees Ok, ees OK." I asked them both why my boyfriend couldn't be in the room with me because he really wanted to be in the room and not let me go through it alone. I explained that if I were keeping the baby he could be in the room when I delivered it, and I didn't understand why he couldn't be there to support me. This was a decision that we BOTH made; yet I have to go through the procedure by myself. I wasn't given any explanation as to why he couldn't be there. The doctor did what he had to do and quickly left the room, as he did with all the other women. I was handed my clothes and told to go to the "recovery area".

"I felt so horrible, so insignificant that I didn't want to be there any longer. I refused to sit with the 3 other women who were sitting in the chairs because I didn't want to feel any more impersonal than I already had. The nurse tried to convince me to stay, but I declined. She made me sign a release form stating that I refused the medical advice to stay. I allowed her to take my blood pressure, she gave me my bag, and I left.

"The entire process took an unnecessary 5 hours, most of which was spent waiting. The people treat you like you're just another number on the list getting an abortion and not a PERSON with FEELINGS. I was not exaggerating when I said that it felt like an assembly line. Calling 4 women back in a row is completely inappropriate. That takes away from it being a PERSONAL decision and a PERSONAL experience. I should NEVER have been close enough to hear that woman yelling in pain during her procedure. Having the doctor arrive at noon to turn and burn 'em is the most unprofessional, impersonal experience I've EVER had in a doctor's office. And yes, any way you look at it, turn and burn is EXACTLY what he was doing. Had that doctor gotten there at 9:00 a.m. he could've spent the QUALITY time he should have with each woman, one at a time. Each woman should have her own recovery time, not in a room with a row of chairs, sitting next to another woman who has just gone through the same thing. And most importantly, if a woman is there with her significant other, mother, sister, best friend, or anyone who's there to support her, that person should most definitely be able to be in the room with her to support her every single step of the way. I understand that ultimately it's the woman's body and her choice, but a lot of times it's a joint decision made by both the man and woman in a loving relationship. As I mentioned before, if the couple chose to have the baby, the man could be there for every process. Yet to terminate the pregnancy, the only support he can offer is from the waiting room? Ridiculous. It's terrible that Planned Parenthood, being one of the biggest advocates for women, treat the men that love those women like they're insignificant in a situation like abortion.

"I have several friends who have had abortions at other independent clinics and their process was absolutely personal and professional. They paid the same, if not less than I did and their experience was much, much better than mine. They were treated like people with feelings, they had personal attention, and their doctor didn't just come in, do the job, then scurry out to go to the next room.

"Had I known that I was going to be treated the way I was at Planned Parenthood, I never would've gone. But the damage is done and I will forever have to remember the terribly devastating experience that I went through in addition to the natural feelings that women have after having an abortion. Hopefully whomever is reading this letter can see exactly how traumatic the process at Planned Parenthood is and will do something to change it so other women won't have to experience the same. If not, at least I've said my part and that's all that I can do."

World Aids Day

Today is World AIDS Day, a day dedicated to raising awareness, encouraging testing, and fighting the global specter of the HIV/AIDS epidemic.

About an hour ago, President-Elect Obama's released online his taped address to the Saddleback Civil Forum on Global Health (transcript available at The Washington Post's website). I honestly thought the speech could have been a little more convincing, more dynamic, but then again it was just a short, taped video address so what could he really say?

While trying to find a more, er, passionate response to World Aids Day, I came across this video, sponsored by Johnson and Johnson, about the organization Mothers2Mothers, which offers "social, emotional and psychological support" to pregnant African women who are HIV-positive. I know very little about the organization so far, but you can check out the video below:


I don't think this falls into the category of consumer-driven AIDS awareness hype, even though M2M is prominently sponsored by a major company. And, on the surface at least, I like the idea of what amounts to a counseling/mentoring/consciousness raising organization dedicated to bringing women together for mutual support, advice and consolation.

(Updated to add: Bil at The Bilerco Project has a great selection of World Aids Day videos from around the world.)

The Not-So-Subtle Misogyny of the Cesarean Section

Until recently, I was absolutely stumped as to what I wanted to write about for my first post at Fourth Wave. Many topics (including and not including Sarah Palin) occurred to me but none seemed exactly right. Last week, sitting in my little office behind medical records in our Family Medicine Center, I finally realized exactly what I wanted to talk about: Cesarean sections as a form of oppression of women.

For those of you who don't know, I am a lesbian with no children and no plans to have children who works as a Medical Support Assistant for the Maternal and Child Health Program at a University clinic. I had no medical experience when I began work here and my experience with children was limited to babysitting, to time spent with numerous younger cousins, and to extended time with my niece and nephew, who live only ten miles from me. Over the last two years, I have absorbed a vast amount of knowledge on pregnancy, childbirth, and breastfeeding and I'm now considering adding a lactation consultant specialty to my nursing degree when I finish.

One of the things our clinic is known for is our support of TOLAC/VBAC. For those of you not fluent in "medicalese", TOLAC is a Trial of Labor After Cesarean and a VBAC is a Vaginal Birth After Cesarean. Women who have had one or more Cesarean sections are free to request a TOLAC as part of their childbirth process here and the goal is to have a successful VBAC. What is so unbelievable to me is that we are just one of a few clinics/medical centers/obstetrics providers in our state that supports this labor/birth option. Most other clinics/medical centers/obstetrics providers in our state tell women who have had previous c-sections that their ONLY labor/birth option is a repeat c-section. Ninety percent of women in the US who have had a previous c-section are having repeat c-sections with their successive pregnancies because of a lack of medical support for a completely natural birth option. Why the lack of support?

The reasons why medical providers are unwilling to support a natural birth option after a previous surgical intervention are woven inextricably with the reasons why the c-section rate in this country surpasses necessity and belief. Currently, approximately 1 in 3 US births end in Cesarean section while the World Health Organization maintains that only 10 - 15% of births should do so. We are subjecting twice the recommended number of women and children to surgical interventions during childbirth without good evidence for our actions. And by "we", I mean the health care industry. Contrary to popular belief (made popular by sensationalist media outlets), there are not droves of women ordering non-medically indicated Cesareans for cosmetic/personal/scheduling reasons.

So if there are no droves of women requesting Cesareans for Convenience and only 10 - 15% of births are statistically likely to require medically-indicated surgical intervention, where are all these other Cesareans coming from?

Natural Vaginal Birth Takes Too Long

First and foremost, the health care industry and insurance companies believe natural birth takes too long. Patients these days are being shuffled out of hospitals earlier and earlier after major illnesses/surgeries due to a combination of overcrowded conditions and insurance companies' resistance to compensating hospitals for longer stays. Therefore patients that have longer labors often receive medical intervention to "speed things up", including pharmacological inductions and AROM (Artificial Rupture of Membranes). The problem with these interventions is that many times a woman's body simply isn't ready to give birth yet, often leading to Cesarean sections due to fetal distress.

Also, many insurance companies offer a "global fee" for childbirth that does not take into account the length of the labor, so many providers are paid the same whether a woman's natural labor takes 30 minutes (precipitous) or 30 hours (prolonged). Some providers, therefore, are more likely to suggest induction or AROM for longer labor periods for simple financial reasons that only benefit themselves.

Pregnancy and Birth as a Medical Condition rather than a Natural Process

Added to this travesty is the disturbing trend of national medical associations, such as ACOG (American College of Obstetricians and Gynecologists), toward the criminalization of non-hospital births. Birth Centers are closing all over the country due to a reluctance of major medical centers to support them and midwives and homebirths are being attacked on legal fronts, threatening the entire natural birth concept.

The truth of this matter is that 90% of the time, birth is a natural event that requires little medical intervention. It certainly does not require a hospital or else many of our grandparents and some of our parents would not have been born. The Western transition toward hospital births began in the 1920s in Germany and became very popular in the US during the 1950s (that decade is another entire study in anti-feminist behavior in and of itself). Since then, birth has been regarded by the US health care industry as an illness rather than as a natural function of a woman's body and they have devised numerous "interventions" that they claim are for the safety of the mother and the child. Some of these interventions are medically indicated but some have no evidence to support them. Some, like continuous fetal monitoring, have recently been linked to the increase in Cesarean sections.

Only about 30% of the world's children are born in hospitals or health care centers and yet we are seeing a population boom in almost all regions of the world. Women have been giving birth to healthy, hearty children without the benefit of routine medical care for thousands of years.

Don't get me wrong; I am not advocating that birth should be without medical care or monitoring. Certainly maternal and fetal outcomes, especially in developing countries, can be improved drastically by medical presence. What I am advocating is a discontinuation of the (mostly Western medicine) mindset that pregnancy is something to be "fixed".

The Concept of "Routine" Surgery

As anyone who has ever had abdominal surgery will tell you, there is nothing "routine" about it. Depending on the complexity of the surgery and the location/size of the incision, it can take years to recuperate from abdominal surgery. The short-term complications are the same for any major surgery: increased risk of infection, of blood clots, of chronic pain, of being readmitted to the hospital for failure to thrive or other poor functioning. There is also an increased risk of hysterectomy and of surgical injury. The long-term is much more complicated. Chronic pain, inability to lift weights over 10lbs, lack of stamina, infertility, weight gain, long-term absences from work, adhesions, gastrointestinal difficulties including intestinal blockages, future ectopic pregnancies, complications with future pregnancies--all these are possible with Cesarean sections but are rarely discussed with the patient. And what about babies born by Cesarean? They are more prone to respiratory illnesses and asthma, they are susceptible to surgical injury themselves, they are more likely to experience difficulty breastfeeding, and they miss out on that first skin-to-skin contact with their mother in the first hour of life that is so necessary to the hormonal health of both mother and child. Cesarean sections are hardly "routine" surgeries but most hospitals, insurance companies, and even patients treat them as such.

Why do they do so? One of the reasons are the inordinate numbers of "reality" television shows on channels like the Discovery Channel that portray birth as something that a) always happens in a hospital and b) always requires significant medical intervention. We call it "birth as a rescue operation" around here and we are disgusted. The shows focus on the most at-risk patients with the most severe complications and present these births as the norm, scaring women into believing that their babies might die if their births aren't micromanaged by medical personnel. Another reason is our Western ability to accept non-medically-indicated surgery in general. Statistically speaking, how many people in, say, Laos get cosmetic surgery? Compare that with US figures and you'll see a part of the problem.

With these three factors (and I'm sure there are others), it is not hard to interpret the non-medically-indicated Cesarean section as a misogynistic dismissal of a woman's innate abilities. So what are the remedies? How can we lower our out-of-control Cesarean rates in this country?

Support Midwives, Birth Centers, and Homebirths

The birth center that is affiliated with our clinic is the last free-standing birth center in our state. They facilitate approximately 450 births a year and their Cesarean rate hovers at about 5%. Homebirths attended by qualified midwives also enjoy extremely low rates of Cesarean section, especially homebirths for low-risk women. There are no electronic fetal monitors at homebirths and midwives are more likely to allow the pregnant woman's body to direct the birth process, intervening only when medically crucial.

There is absolutely nothing behind the desire to criminalize homebirth other than greed, plain and simple. Hospital births cost money, Cesarean sections cost more. Doctors and insurance companies profit from expensive medical procedures and they do so at the expense of women and children. Period.

Study after study has proven that homebirths attended by qualified providers are safer and cheaper than hospital births and yet ACOG and the AMA push to criminalize the practice?

Even if you never plan to have a child, please support the right of women to choose midwives and homebirths for their deliveries.

Choose Family Medicine Providers

Statistically speaking, more women are choosing to specialize in Family Medicine and women providers are more likely to approach medicine in a collaborative give-and-take way. Family Medicine providers who also provide obstetric care are more likely to support alternative birth processes.

For example, at our Family Medicine Clinic we offer three types of prenatal care to our pregnant patients: traditional care, where the woman sees an individual provider for a 20 minute appointment at regular intervals; group prenatal care, where a group of 4 to 8 women at roughly the same gestational age see a provider and a group facilitator for 90 minutes of care at regular intervals, including group discussion and special talks; and focused prenatal care, where a woman who is low risk and/or who has had multiple low risk pregnancies/births with excellent outcomes can choose to see a provider fewer times over the course of her pregnancy.

What are the benefits, specifically in regards to the Cesarean section? Well, our hospital's overall rate of Cesarean births is approximately 30%, right with the national trend. Our Family Medicine Center's rate is currently 18% and we are actively trying to lower it. We are conscious of the WHO recommendations and are trying very hard to meet them through extensive training in labor support and other practical means of allowing a woman's body to direct the birthing process.

Trust Your Body

A woman's body has all the tools it needs to give birth. Period. Except for the statistically few women who require substantial medical intervention, the other people present during births are really only there to cheer a woman on, to occasionally "catch" a baby, and to clean up afterwards.

Do not buy into the crap that pregnancy and birth is "too hard" or "too scary." Do not watch those ridiculous medical shows on Discovery that present birth as a dangerous condition that requires medical intervention. Do not let any provider make decisions for your and your baby without your input.

Do educate yourself about the birth process. Do consider all your birth options keeping foremost in your mind what you hope for and want out of the experience. Do shop around for a provider that can give you the support you need to give birth in the way you have chosen.

Women are strong. Birth is natural. Anyone who tells you otherwise is lying to you.