Monday, September 22, 2014

An Early Beneficiary of New York's Liberalized Abortion Law

"Amanda" is one of the women Life Dynamics identifies on their "Blackmun Wall" as having been killed by a safe and legal abortion. Amanda was 19 years old when she traveled from Indiana to New York for a legal abortion in 1970. She was 12 weeks pregnant.

The doctor performed the abortion on September 3. He was unable to remove any of the fetus or placenta. For some reason, he did not suspect a problem. He discharged Amanda and she returned home.

Upon her return home, she suffered from pain, nausea, and vomiting, so she sought care from a physician in her community. She was admitted to the hospital with a perforated uterus.

Her doctor performed a lapartotomy, and found that the fetus was still inside Amanda's perforated uterus. The abortion was completed and the hole in her uterus was repaired.

After the surgery, she had a series of complications beginning with difficulty breathing. On September 10, doctors performed a hysterectomy. She continued to be treated in the hospital, but despite all their efforts she died on September 22.

I believe that Dr. Paul Jarrett was one of the doctors who tried to save her life. His full story is here.

A few months into my residency, I came face to face with the issue of abortion for the first time. An 18-year-old Indiana University coed came into Coleman Hospital with lower abdominal pain. She related to me that she had been to New York City earlier that day to have a legal abortion performed at a clinic there. She had gotten on a plane at 8am at Indianapolis International Airport and flown to New York. She was taken to a legitimate clinic by a cab driver. She had believed she was two and a half months pregnant, but after the doctor had unsuccessfully attempted to abort the pregnancy, he told her she wasn't really pregnant after all and sent her home. She returned to Indiana on the 4pm flight as planned.

When she returned home in terrible pain, she realized she was in trouble and for the first time, told her mother what had happened to her. Her mother contacted her own gynecologist, who in turn referred the patient to Coleman Hospital to be evaluated by the resident on call--me.

Even though I was still wet behind the ears, I know that this pale, frightened little girl was still 10 weeks pregnant and her blood count was only half of what it should be. The private, attending doctor came in and took the patient to surgery immediately that night, where he repaired the hole that had been torn in the back of her uterus, which had caused her massive internal hemorrhage.

Over the course of the next few days, infection set in which did not respond to antibiotics, and we made the painful decision to perform a hysterectomy. Tragically, the shock from the infection severely damaged her lungs and her course was steadily downhill. As I helplessly watched, she slipped into unconsciousness and a few days later she died.
As you can see from the graph below, abortion deaths were falling dramatically before legalization. This steep fall had been in place for decades. To argue that legalization lowered abortion mortality simply isn't supported by the data.

Saturday, September 20, 2014

Doctor implicated in 1930

On September 9, 1930, 20-year-old telephone operator Matilda (or Mathilde) C. Kleinschmidt underwent a criminal abortion, believed to have been performed in the office of Dr. J. Murney Nicholson. When she took ill, her boyfriend told her that he would call in another doctor to care for her. Matilda insisted, "Another doctor won[']t look at me. He won[']t take the case." Matilda died on September 21. On September 22, Nicholson was held by the coroner for murder. John C. Ross was held as an accessory. Nicholson was indicted for felony murder in Matilda's death. Matilda's abortion was typical of illegal abortions in that it was performed by a physician.

Thursday, September 18, 2014

Reflections on the "Abortion Doula"

The Cut has shared a piece that I find both fascinating and revolting: A woman named Alex Ronan reminisces about "My Year as an Abortion Doula."

The title itself is enough to offend. The linking of abortion with the very concept of a doula is grotesque. A doula is the woman's coach, comforter, and companion as she gives birth, welcoming a child that she would give her life to protect. Abortion is the antithesis of birth. It is the rejecting of a child whose life is being taken at the mother's behest for reasons of her own. It is impossible to imagine two events more diametrically opposed, be it physically, emotionally, socially, morally, or spiritually.

Ronan acknowledges the gulf fleetingly as she notes, "Some birth doulas were reluctant to consider the needs of women terminating pregnancies as at all similar to their patients carrying them to term." This entire concept, it seems, is one that Ronan is not comfortable exploring. That one sentence says all she is willing to say.

Ronan touches a bit less fleetingly on mainstream abortion's reaction to the idea of "abortion doulas." 
[M]any pro-choice doulas, doctors, and nonprofits were unwilling to acknowledge how difficult and painful many women find abortion. To some on the left, drawing any more attention to the messiness of the procedure and the decisions surrounding it would mean potentially undermining the work of the political movement.
This disconnect between the politics of the movement and the realty of the practice is something Ronan likewise elects not to explore.

She begins her tale with the story of a woman she calls "Dee," the very first woman she guided through what was intended to be a routine second-trimester abortion. Slender seaweed sticks called laminaria were being inserted into Dee's cervix, where they were to wick up moisture and expand, dilating the cervix to facilitate removing the fetus as its life is ended.

Somehow, during this process, Dee began to bleed alarmingly. She was rushed to what I presume was a surgical room to have the abortion completed immediately.
The resident begins to perform the procedure as the attending barks commands. “Pull,” she says, “harder.” The body does not want to let go. The resident will not stop. It strikes me as strangely similar to birth, only the opposite word and a different outcome. Pull. Pull. Pull. What’s called the products of conception bucket is mostly filled with bloody gunk. I make out a doll-size arm, fist curled. It feels like I shouldn’t look, but I can’t turn away. 
Pulling the fetus out in pieces was a pointless ordeal for everybody; Dee continues to hemorrhage and is saved only by a hysterectomy, which of course would have gotten the fetus out of her body, albeit not out of her womb, and would have achieved an equally lethal outcome for the child.

Ronan is, predictably, shaken. "In the hallway," she says, "I stumble a bit, groping at the wall, slide down until I’m seated. A janitor comes by and points out the nearest bathroom, which I walk to slowly. I lock the door, splash water on my face, and sit on the toilet."

She does not, however, elaborate on why she is so strongly affected. The reader is presumed to know. Witnessing open abdominal surgery when one had been expecting only an innocuous-looking laminaria insertion would certainly rattle one. All the blood, the urgency, and the moment when one life was ended as another hung in the balance, would leave even a seasoned professional flustered. Knowing that a woman of childbearing age has just lost her uterus, likewise, could be very disturbing, particularly if the woman had intended to have children later, when the circumstances were more auspicious.Ronan tells us nothing of that. Nor does she reflect on the sight of the tiny arm and the certain knowledge that the rest of the mangled remains of what had, moments before, been a living human being were also in that gory bucket. Like the reaction of most doulas to "abortion doulas" and the abortion advocacy vs. abortion reality disconnect, this is something that Ronan shies away from.

What Ronan does explore a bit more, though still tenously, is the context in which women are resorting to abortion. She describes a training session with other new "abortion doulas."
An 11-year-old in for an abortion who asks for birth control when she’s alone with the doctor. Her mother works nights; she’d been left with a friend who has a twentysomething son. She calls him her boyfriend; he will go to jail. A woman who says she’d like to do another ultrasound to see if it’s definitely a girl, because she’ll only keep it if it isn’t. A drug addict covered in track marks with two kids in the foster-care system who refuses birth control.

“What do you assume?” Mitchell asked of each case. “How can you be supportive?” We talked about what would be hard for us to overcome, things we might say or do and how we might feel. I felt embarrassed by my assumptions, and the limits of my compassion. I judged these women on the worthiness of their reasons (“Would she really only keep a boy?” I wondered) and found myself questioning why those who come in for late-term abortions had waited so long to decide. Later, I learned from Mahoney that all the examples were real cases that had come from her first six months working as an abortion doula.
The lesson, intentionally or not, achieves many goals. It steels the neophytes to whatever tragic or outrageous situations they might encounter. It teaches them to respond to these tragedies or outrages by suppressing their own moral judgment and substituting a political judgment that abortion, as a right, trumps all else. Regardless of how repugnant one might find sex selection abortions, abortions as a primary method of birth control, or any other distressing situation, all of that must be put aside. The only thing that matters is getting the patient through the abortion as smoothly as possible. Everything else must be put aside.

No questions are to be asked about the sexual abuse of an 11-year-old girl by the grown son of her babysitter. How does one decide that it is unacceptably "judgmental" to even ask oneself if this situation should be allowed to continue? Any normal human being would want to rescue the girl, to contact the police or child protective services or a rape crisis hotline. It takes special training to learn that "being supportive" means never asking tough questions, either of the patient or of oneself. One must look only at the patient, and only in this moment. One must avert one's eyes from the abuser as well as from the fetus.

Ronan tells more about the patients and their reactions to the abortions. Some cry and shake. One cheekily chatted up the abortion staff and offered them discounts at her jewelry store. Ronan finds the distressed ones much easier to work with, though she stresses that she is not judging the matter-of-fact ones. She says that "Pain breaks down barriers" and makes it easier to do her hand-holding and hair-stroking. She doesn't touch on any incongruity between the banality of abortion as a routine medical procedure and the tiny arm in the bucket. To do so, after all, would be to judge, which seems to be the only sin recognized in an abortion practice. They've been taught, after all, to see no sin in a grown man impregnating an 11-year-old girl.

Ronan's story continues on a predictable path, gliding over the surface of abortion practice, never asking any hard questions of herself or the reader. "Kindness," she says, " is more important than truth." I find myself wondering if the real kindness is to the patient, who must force often force herself into tunnel vision just to get through an abortion she doesn't want but sees no way to avoid, or if the kindness is to the "abortion doula" herself, who wants to keep uncomfortable truths at bay. It's best to just focus on distractions, on superficiality, of just getting through the present. Never mind what's on the other side. Never mind the tiny, bloody fist and the tiny person it was once attached to. 

Ronan's closing paragraph is telling:
I have, by this point, seen lots of women and lots of fetuses, and the sight of the second doesn’t change my feelings about the first. The mourning for what could have been is countered by an appreciation for what is — a woman’s life, allowed to proceed as she wants it to. When it is over, I say, “You did great. You were so brave,” and I tell them they’re done now, because sometimes they don’t know. “It’s all finished,” I say.
It's finished for Ronan. She accepts the mangled little bodies as the price that is paid for "a woman's life, allowed to proceed as she wants it to." As if that 11-year-old girl is a woman whose life, after she leaves the facility, will proceed as she wants it to. For her, for all but the most flippant women, it's not over. It's never over.

"Most first-trimester abortions," Ronan tells us, "are vacuum aspiration. The machine sounds like a sucking through a straw when you’re at the bottom of the glass. The vacuuming is sometimes painful, but I think patients find the sound harder to bear. LiteFM stations play in the background. Most first-trimester abortions take fewer than four songs. Sitting in bars with my friends on summer nights, I hear the same songs and wonder after the women."

But evidently not enough. Not enough to ever question whether or not what they did that day even helped her at all.

Sunday, September 14, 2014

The Wendy Davis Abortion

I've delayed writing about Wendy Davis' truly heart-rending story about how, after receiving a devastating prenatal diagnosis, was presented by doctors with two options: let her unborn daughter suffer a wretched existence and early death, or ease the anguish of waiting for the inevitable tragedy via a late-term abortion.

It's difficult to write about this tragedy in a way that respects Wendy Davis' grief while still asserting that what she went through does not justify the decision to abort her little girl.

When a family is told that their unborn child will soon die, there is never going to be a happy resolution. Hopes and dreams are destroyed and replaced by anguish. What is bewildering is how anybody could actually believe that the death of a child will somehow hurt less if the child's death is hastened by an abortion.
Doctors are by nature people who are driven to take action against suffering. But whose suffering is lessened when a woman aborts after a prenatal diagnosis like the one the Davis family received? It does not seem that Wendy Davis suffered any less:
An indescribable blackness followed. It was a deep, dark despair and grief, a heavy wave that crushed me, that made me wonder if I would ever surface. It would take me the better part of a year to ultimately make my way up and out of it. And when I finally did come through it, I emerged a different person. Changed. Forever changed.
The suffering is reduced not for the family, but for the doctor, who, after the abortion, no longer needs to go through the ordeal of prenatal visits that can only bring bad news: that the inevitable has happened and the baby has died. If the woman aborts, the doctor's suffering is certainly lessened. But it is the patient who pays the price.

As I said before, when the baby has a condition so serious that she might not survive until birth, and surely will not live long afterward, there is no happy ending. But that does not mean that there can only be the anguish of a treasured life cut cruelly short. Parents who have access to perinatal hospice report finding joy in the tragedy -- the joy of treasuring every single moment of their child's short life.

Perinatal hospice is not nearly as easy for the physician as an abortion referral. The patient and her family are provided with ongoing support in every way: medical, emotional, spiritual, and practical. This is far more time-intensive and resource-intensive than an abortion referral.

Unlike an abortion, perinatal hospice recognizes and respects that grief and anguish are inevitable, regardless of how soon or late the pregnancy and the child's life end. The woman will be a grieving mother for the rest of her life. Abortion can not in any way change that. The woman is allowed to walk through that grief without relinquishing the child a moment sooner. It spares the woman from the needless additional agony of signing her child's death warrant in the form of an abortion consent form, and of helplessly enduring a procedure that kills her child in the one place she should be safest, in her mother's womb. The regret can be devastating, as "Janice" told Troy Newman:
I will never however forget the day I was given the digoxin shot through my stomach into the heart of my baby. It took me 45 minutes to calm down enough so that Dr. Tiller and one of his nurses could come in to do this. I was hysterical because after this there was no turning back. By telling them I was ready for them to come in and do it, I was telling them that it was ok to kill my daughter. They sedated me and then did it. 


I am no longer grateful for Dr. Tiller “helping me.” He didn’t help me at all. I wish now I would [have] had the courage to deliver my little girl and let her get even just one breath of air before she passed, to let her see my face just once before she passed. I will never have that chance now and I will always have to live with the decision I made and the nightmares of what happened to me in Kansas.
Remarkably, perinatal hospice also offers something that the parents never could have expected when that world-shattering diagnosis comes. It offers them a chance to find joy even in the grief. The woman is still supported in nurturing her baby, keeping her safe in the womb. And she and her family may have the opportunity to meet the child, to build memories of having held and treasured a living child who was afforded the opportunity to know a mother's caresses and kisses, her scent, the feel of her skin against her own.

The greatest tragedy of these situations is that so few women are given this support. Too few are even told that even if perintal hospice isn't available in their area, there is still support from other parents who have faced the same ordeal, the same choice, and found their joy.

Many abortion supporters argue that it should still be the woman's choice about how she deals with the dreadful news that her unborn baby is dying. But how much is it a real choice, when doctors and other medical professionals are urging an abortion, are assuring her that it will be for the best, and are pressing her to make a decision quickly, while she's still reeling from such a blow? It's difficult to believe that given the choice between not having even a moment of joy and possibly having the chance to meet and cherish her baby any woman would say she'd rather have only anguish and no joy whatsoever, thank you very much. And given how much pressure is often put on the woman, how much of a choice is the woman really making at all? Read Renee's story.
We were only told that he would be very sick and would have a difficult life. The doctors kept reminding us that it wasn’t too late to terminate the pregnancy. One doctor even called me on the telephone and told me he’d like for me to reconsider my decision not to terminate. He said my son may always have to live in a children’s hospital and his life may be miserable and full of pain. He said that if I don’t terminate the pregnancy, I may feel guilty later on because I could have spared my son such a miserable life.
Abortion supporters will argue that it's condescending and cruel to insist that the woman go through with the pregnancy when all the pregnancy is bringing is continued heartbreak. But again, the heartbreak is inevitable. The choice isn't between heartbreak and peace. It's between having only dark memories and having some joyful memories as well. You can read Jessica's story about her stillborn daughter, or Tam's story about her daughter's four days of being lavished with love. Or Sarah's story about the few precious moments she had with her baby girl:
I have loved Beatrix since the day I was born, it seems like. I was made for loving my beautiful baby girl. My arms were made to hold her until she breathed her last. My lips to cover her face with kisses. I wonder if she knew I was the one who had carried her all that time, safe in her quiet place? I would like to think she did- that when I kissed her and whispered in her ear, so many times, that I loved her, she recognized my voice, and felt loved.
Abortion also closes off the real, if tiny, possibility that the doctors are wrong. How much greater will the woman's anguish be if after the abortion she learns that she'd signed away the life of a child who had a much brighter prognosis, or who was not in any way ailing at all?

Listen to actress Lynn Ferguson, sister of late-night host Craig Ferguson, talk about the pressure brought upon her to abort a child who in the end was born perfectly healthy: Before Fergus.

It's understandable that, given the trauma she's been through, Wendy Davis would cling to the idea that abortion was the only compassionate option available to women like her. No doubt it will be painful to confront the fact that she could have had the chance for precious time with her child. But her own personal tragedy must not let us lose sight of what we owe to other women like her, and their unborn children. Every woman deserves the utmost support in loving her baby, and every baby deserves the chance to every moment of life.