Ask an Abortion Provider
Hello! I am a person who is training to become an abortion provider. As you can imagine, it is really fucking weird to be one of me, especially lately! I think maybe you have some questions?
1st question: Why?
I can pretty safely assume you have not socially encountered one of us before. No, not because I think you’re not cool enough! Let me explain. I went into healthcare in general because of a bunch of shitty gynecologists growing up who told me, for instance, that “when you” (me) “have sex with so many people” (I, like, halved the real number) “so young” (18) that “none of them care about you” (me). I figured the most direct way to ensure that there wasn’t a total asshole at the bottom of the table was to do it myself.
But why abortion, then? State-of-abortion fact storm forecasted for this paragraph. How many providers do you think there are in this country? Like, total. 30,000? 10,000? Nope, fewer than 2,000. Here’s a quote I read today: “Now only 2 percent of ob-gyns perform half of all abortions. Many are approaching retirement. Others are weary of stigma, threats and violence. The number of providers has declined by 37 percent since 1982.” Fewer providers in practice mean fewer people to train from. And other factors — like how only 12% of ob/gyn residency programs require training in abortion — also contribute to our dwindling numbers. So, this time, it was seeing that the most direct way to ensure that anyone — anyone!! — was at the bottom of the table was to do it myself.
There was also a personal reason. On the way to providing abortions (president!) I became a person who has had one (also a member!). In December 2006, at age 20, some wayward jizz from a guy who was still a virgin put me up the stick. That’s right — CONTACT PREGNANT — the statistic, 1 in 1000? Whatever. Let’s just say I took one for the team. Hearing those sighs of relief, first 999 of you reading this! Everyone else: you are at risk. The whole thing went well with no complications and a lot of support from the people around me. The only hitch in the procedure was when I told the doctor about my long-range dream to become a gynecologist and how I had wanted to volunteer there and now, ha-ha, I was a patient. She listened with all of her heart minus the part that governs word choice and then told me that she was proud of my aspiration. What oh. Aspiration like goal! My goal. Of becoming a provider. Not aspiration like an abortion! An aspiration abortion. The kind I was getting.
I was able to move on quickly. The dude forgave me for my method of breaking it to him, which was asking “So, do you want to see what a positive pregnancy test looks like?” and stuck with me. We got engaged this past November. I finished college, got into a grad program to become a nurse practitioner, and four years to the very day of my own abortion I assisted for the first time on another person’s. I have no regrets, and although I’ll never know what could have been PSYCH I do know what could have been! The dude and I would have broken up and I would have not finished college let alone grad school, and I would have been a fucking disaster of a mother, because even now the best I can promise to a child is to be convincing enough that they can’t tell I secretly wish they were an adult instead.
I speak of my abortion as a positive experience, not to secure the “most awesome abortion” prize (hello judges…?) but to save a seat for the possibility that this doesn’t have to be the worst thing that ever happened to you in your whole life. I don’t want it to in any way represent anyone else’s experience or make them feel disavowed of their own. So let me say: this is my personal experience with abortion! It was positive in every respect. It made me want to help other people also have as positive an experience as possible, so I went into the business. If you think that’s a bullshit line, or it makes you uncomfortable to think about abortion as something that could possibly be positive for a person, think of why you’re a person who doesn’t want someone to do the best that they can under the circumstances they’re in.
2nd question: What’s it like?
Abortion training in this country is basically done by “apprenticeship” — if you’re an MD/DO, you’re supposed to learn in residency, but as we saw that doesn’t happen so often, so there are organizations like Medical Students for Choice to connect people to training or fellowships like the Ryan that you can take on in your own time. As a nurse practitioner (or a PA, or a midwife) what we’re allowed to do depends on where and when we’re practicing. We can provide medication abortion (mifepristone and misoprostol) in 15+ states but surgical abortion in far fewer, even though the actual procedure is exactly the same as other ones (like completing a failed miscarriage) that are solidly within our scope of practice almost everywhere. This is basically because the world is a vampire, sent to jail. The actual hands-on training is straightforward, because first-trimester surgical abortion is a very technically simple procedure. Completing 100 to 300 procedures is considered achieving competency, and the reason it takes that many procedures is because complications (like infection) happen so infrequently that it takes that many to see even a single one.
When I started I knew intellectually that half the country wished I hadn’t gone to work that day and a smaller percentage probably wished I hadn’t even woken up, but pro-life was never part of my life until I actually took on the job. The idea of “sin” had eroded out of my parents’ Catholicism so that the only part they passed on was the punishment style (“I want to let you know that if you have sex you can get a yeast infection in your eyes and you would deserve it”). I am lucky to be training in a liberal Northeastern state: the biggest impact of “antis” on my training is that I have to bring my lunch every day because it’s not really a good idea to go outside more than you have to. The protesters only figured out that I was a clinician-in-training and not a nightmarishly fertile young woman by my 3rd or 4th visit, and when they called me “babykiller” I was like “No way, I’m still working on ultrasound technique!” A couple weeks later I finally got my shit together to look directly at them and I saw that they were (a) a scraggly group of five or so and (b) all old white dudes, historically the least likely demographic to spiritually or morally lead me. Relief!
I had spent most of my life thinking that “following politics” was like being the sports fan who makes sure to watch every game her team plays and always wears the jersey on gameday. Yeah, I want us to win too, duh, but you know, does it really matter if I’m sitting there? I’ll check it out if they get to the playoffs or whatever. But now that the news is me I understand the value of a stupid tie with team colors. I saw that South Dakota bill and I cried. I wanted to call up my friends and say, “Hello! So, at least a couple people in South Dakota want to make it so that it kind of wouldn’t be illegal to kill an abortion provider. Like, me, your friend who does abortions. I’m an abortion provider and I’m your friend. So it would become legal for someone to kill me, your abortion-providing friend. So please, please, please help me do something about this.”
Up until recently I’d come out of any closet I found myself in — queer, non-monogamous, I fucking love Tool still, whatever — not that I live to hear the drink-choking sound, but because, to me, coming out was just one of the ways I could pay back the privileges that had been arbitrarily bestowed upon me (educated! white-appearing! “normal!”). My responsibility to normalize as much as I could. But training as an abortion provider is the first thing in my life that I hold back on spilling about. At the core of it, there’s a huge gap between saying “I had one” and saying “I do them.” I don’t want to alienate people. And nothing else I’ve ever done or been has felt like a direct invitation to a motivated someone out there to kill me and get away with it.
3rd question: What about the patients? Like, who are they?
I can confidently say that not a single one of my patients wants to be there. If we somehow removed the emotional content and just looked at everything else, abortion is an experience that is at least a little physically painful, and expensive both financially and in time investment. The process of obtaining one is full of bullshit even under the best of circumstances. Please see hilarious Onion articles “I’m Totally Psyched About this Abortion!” and “New Law Requires Women to Name Baby, Paint Nursery Before Getting Abortion.”
Nobody wants a fucking abortion or at any point in their lives thought, “Oh, who cares, I’ll just take care of it.” Not even the woman on her tenth who said to me when I came in the room, “Hm, I haven’t seen you before! You must be new.” I am going to tell you that having 10 abortions is extremely rare, but I am also going to tell you without even starting another sentence that it doesn’t matter how rare it is because there should be no hierarchy of abortion. On demand, without apology? Great, I’m glad we all agree. It all breaks down to this: no one is immune to mistakes, whether it’s a mistake of their own making or (more likely) an end effect of the system, especially our fucked-up broken medical system I hate representing. (Sorry, system! Had to say it.) If you think I am making too many excuses for my patients, I will let you know that I am often one of the first people to make excuses for them in their lives and am happy to do so for no fee whatsoever. I would juggle speculums if they asked. I have not yet been asked to do this.
Additionally, the women who come to terminate their pregnancies at my clinic and in general are disproportionately poor. Is this because poor people are disproportionately stupid and can’t use a condom or don’t believe it works or whatever? Nope! It’s because poor people are disproportionately fucked by the system. I could tell you things that would make you SO MAD but I won’t. OK fine, I will, just one thing.
If a patient who has just gotten an abortion wants an IUD — the most effective form of birth control, little chance for user error, good for five or 10 years depending on which kind you get — they have to come back for it, not because there’s any clinical reason to wait, but because Medicaid doesn’t cover two procedures in one day. Most of the time the way this ends up breaking down is they come back for their follow-up appointment, then again for a pap smear/pelvic exam to “clear” them for the IUD, then one more time for the insertion. All to make sure it gets covered. And also please don’t get pregnant at any point in that month-long process where you don’t have your preferred method of contraception because then the process repeats. Man, are they ever stupid not to pay for it themselves with the five hundred dollars they allotted that year specifically for that purpose! I wonder what else they’re dumb at.
But “the remorseful patient” is the only patient whom your nice-but-then-surprisingly-conservative aunt is going to be like, “Well, I mean, I don’t believe in it, but if she was really sorry. And if she was married and it was crazy how it happened.” If you need help recruiting your aunt and others who are not quite on board with us no-hierarchy-of-abortion people yet, try my favorite fact for this situation: 65% of women who get abortions in this country are already moms! Smile, there’s a 65% chance your mother chose abortion because she wanted to make sure she could take care of her already-existing children, i.e., you. If that doesn’t work, take the “trend” angle and say how more evidence is showing that contraceptive sabotage is part of domestic violence. And just as no one is immune to contraception just straight up not working, no one is immune to those probably-apocryphal “I Didn’t Know I Was Pregnant” stories, so encourage their recounting and then bring it on home. Should these women be forced to have a baby, too? I’ll be seeing both of you at the potluck next week!
4th question: What is the craziest thing you’ve encountered?
Every day I have gone into the clinic I cannot help but feel I’m working with the heavy shit — high drama. Not just the threat of violence and the content of the work but the fact that the news has a way of showing up in your waiting room pretty much daily. I shall call this place that is so dense with significance “Nightmare Town.” Which includes pro-life patients! Yes! They too get abortions! I will tell you the story of the one who was my patient.
I was with the doctor I train with doing the initial steps of an intake — an ultrasound to date the pregnancy and a full history.The patient says to the doctor, “I should not be here today. I agree with the people out there.” Gestures out window to street. The people at the bus stop???? “The people who are protesting. I think what you are doing is wrong. I think you should be killed.” Oh. Whoaaaa!
Dr. S does a clinical version of “Werewolf-ing Yourself” which consists of extensively documenting this woman’s ambivalence in the chart, alerting the counseling staff to a patient who would require a lot of support and quickly peacing out of the room before she voiced any of the many justifiable but possibly hurtful words that could come in response to someone looking you in the eye and telling you that you should die for what you do. The only thing that she did say before closing the door was to me, and it was “Your turn!” This is because my secret healthcare superpower is invulnerability to other people’s cognitive dissonance, no matter how profound.
So I told my patient what I truly believe, which is: “I’m so sorry that you feel that way because feeling that way has got to make this an even harder decision than it already is. I imagine it must really feel awful to think that you have to do something that goes against your own beliefs.” (Secret inspiration: my own feelings about the situation!) “I know there is no way you’re going to go home feeling you did the absolute right thing no matter what happens today. We are not going to do any procedure until you are absolutely certain that this is what you want. I do not want you to have an abortion. The only that I want you to do is the thing that is most right for you, whether it’s continuing this pregnancy and becoming a parent, or adoption, or abortion.” Then we brought her with her boyfriend to the counselor who talked with them for hours about the spectrum of resources available for not just abortion but adoption and parenting. At my clinic, we joke that we turn away more patients than the protestors do. And although she did end up terminating the pregnancy, the procedure went well, there were no complications, and she told the staff we had been the “most supportive!” I personally thanked her and told her it was an honor to be there for her and still get teary when I think about it. Ice burn, Lila Rose!
Another visit to Nightmare Town. One week, on a Monday, I read about the Burris Amendment, which was an amendment to the defense bill that would have let soldiers have abortions in military facilities overseas. I read “Current law bans abortions in most cases at military facilities, even if women pay themselves, meaning they must go outside to private hospitals and clinics — an impossibility for many of the estimated 100,000 American servicewomen in foreign countries, particularly in Iraq and Afghanistan.” It was struck down. Couple days later one of our patients was a soldier from Afghanistan. Hey, I was just reading about you guys.
No contraception around (she was stationed pretty far out) meant that she got pregnant. “Regulations require that a woman be flown home within two weeks of the time she finds out she’s pregnant, a particular stigma for unmarried women that ends any future career advancement.” Ends any future career advancement. For my patient, that meant that she had to figure out how to make it back to the states on her own. Even if she had chosen to “go straight,” it wouldn’tve been much better: “Servicewomen who make the decision to have an abortion must first seek approval from their commanding officer to take leave from their military duty and return to the United States or a country where abortion is legal.” (Guttmacher.) Ask your boss if you can please take off a while for your abortion. And no matter what, she had to pay for it all herself. So even though she knew she was pregnant almost immediately, it took eight weeks to make arrangements, travel plans and raise all the money. That means by the time she walked in our door, she was beginning her second trimester, which is a way more expensive and invasive procedure. She also had to spend eight more weeks than she had to miserably pregnant. In Afghanistan.
Her procedure went well with no complications (notice trend) and before she left, Dr. S took her hand and said, “Thank you for saving us out there.” She responded, “Hey, thanks for saving me over here today.” As I watched them the thought that someone somewhere had to be scripting this appeared and then immediately burst. Here’s the policy that you can get pissed about, and now here’s the person you were pissed for. I see a lot of people get frustrated and huffy about stuff, and you can, but then you have to promise to actually do something about it. I have the privilege to be reminded that this is someone’s life, not the New York Times Most Emailed Article. And it is an honor to be reminded. It makes me work harder. Being an abortion provider has meant that I drive home from work knowing I did something, actually everything in my power, to support people who needed it. It’s a privilege and it’s fucking awesome.
Dolores P. is most of the way through training as a nurse practitioner. She has probably seen at least 1,000 vaginas. She’s also into reading, driving very fast, and penpals: firstname.lastname@example.org.
Photo via the Wellcome Library.