by Jane (August 1973) Parts 1
2 3 4
5 6
Part III
The
knowledge gap between older and newer counselors was a continuing
internal problem, one that was hard to bridge in such a high pressure
and emotionally contradictory underground organization. There were
so many things that could not be spelled out to newcomers for security
reasons and so many other things that could be learned only by experience.
At any rate one day a newer counselor became convinced for her
own reasons that Dr. C was not a doctor.
She raised the question angrily at the next meeting of the service
and added that she didn’t want to work with the service if it
didn’t use legitimate medical people.
Several other counselors echoed her concerns. They felt they had
been misled by “elitists” in the service who had full knowledge
they didn’t and as a result new counselors passed on misinformation
to the women they counseled.
The “elitists” said that they actually did not know the
answer. But they agreed to talk with Dr. C. and report back at the
next meeting.
Doctor C was totally opposed to our breaking the news that he was
not an M.D.
He said it would destroy the confidence of the counselors in him
and jeopardize his job. Patients who believed in the infallibility
of doctors would have less confidence and more problems if they knew
the truth. Also if some disillusioned counselor or patient turned
him in, the police would be harsher on a paramedic, and he felt be
would no longer be treated by counselors or patients with the respect
he deserved.
But one old-time counselor was as insistent about telling the truth
as Dr. C was about maintaining the myth. And although the repercussions
of their clash echoed for years. the political consequences of her
unbending position were momentous.
At the next meeting we laid out the a facts—our abortionist was
not a doctor and the nurse was not a real nurse. They were lay people
who had extensive training and experience doing abortions.
We told the new counselors how we had searched among available
abortionists and felt that their person was the best available.
Two counselors quit our the spot.
But most of the 20 counselors were fascinated rather than shocked.
They spent hours that night exploring the doctor mystique and the
concept of paramedics.
They compared feedback from the women they had counseled and became
more convinced more than ever that the service was providing an essential
alternative — and was providing it with more humanity, efficiency
and competence than was available anywhere else.
In addition we were now providing abortions for women who simply
couldn’t
afford to obtain them elsewhere. The basic price was down to $400
plus an increasing number of free and low-cost abortions.
While money was a constant source of conflict between the service
and the abortionists, the increased volume of cases and our assumption
of many of the risks and responsibilities made the weekly payment
satisfactory to them.
The service decided to drop the word “doctor” from counseling
sessions and instead to stress to the women that they would be done
by a competent paramedic who had been specially trained to do abortions.
To our surprise found that most of the women we counseled were
not the slightest bit disturbed. Their prevailing concerns were “Can
he do the job?” and “Do you counselors trust him?”
They had been burdened long enough with their unwanted pregnancy,
and had been unable to find help through the legitimate medical profession.
They just wanted to turn the responsibility over to someone they
could trust.
Once
we had discovered and dealt with the matter of paramedic abortionist
it was a short step the question “If he can do it then why
not me?”
But by the time we integrated the concept of the paramedic intellectually
and politically, we had already had significant paramedic experience
of a different type in our dealing with long-term pregnancies.
The search for a way to handle long-term pregnancies led us into
totally unforeseen activities into new political perspectives and
into more trouble. frustration and pure exhaustion than any other
problem.
At some magical mark in her pregnancy—ranging anywhere from eight
weeks to fourteen weeks depending upon the place and the abortionist—
a woman suddenly lost all options except the choice whether to raise
the baby herself or give it up adoption.
Her chances of obtaining an abortion— either legally or illegally—were
almost nil, and when one could be obtained it was financially prohibitive
for most women ..upwards of $800. The problem was complicated by the
increased pain, risk and time commitment of an induced miscarriage
and the decreased chances for sympathetic port-abortion medical care.
To complete the woman’s trauma there was an implicit attitude
of contempt and distaste for her. “How could she be dumb enough
to wait this long?” and “If she’s waited this long,
she might as well go ahead and have the baby,” were the prevailing
attitudes.
In fact many of these women had already been through weeks of red
tape to wind up at a dead end. Others waited weeks crucial weeks
while getting a series of shots to “bring down a period” from
their private doctors or one of several local gynecologists who profited
from the business.
Others wasted weeks trying to get the money but were short on money,
but still long on pregnancy. Women in their forties who thought they
were “going through the a change” when they missed several
periods in a row suddenly learned they were four months pregnant.
And then there were the young girls who totally denied the condition
in the hope that if they ignored it, it would go away. Finally a
friend or relative noticed their enlarged abdomens and make them
face up to the problem.
The
reasons were many, and by the time many of these women reached Jane,
their situations were desperate. The first thing Jane did was to
rush all women who were 11 to 13 weeks pregnant to the front of the
line, postponing money problems and setting up emergency counseling
sessions, so that these women could still obtain a D&C if possible.
For the increasing number of unmistakable long terms-14 weeks and
more—we had to find a method and a system for taking care of
them.
Even
today, after more than four years experience with various methods
for inducing long-term miscarriages we still find it hard to evaluate
which methods are best. Each seems to have its advantages and its
complications.
Some
are more practical in an illegal setting there others. Perhaps we
should unanimously condemn the catheter as a method for inducing
a miscarriage, but then it sure beats a rusty coathanger.
Our first experience with a long-term was a 19-year-old who drove
down from Minneapolis about six weeks after the service opened. She
was six months pregnant and Catholic, and she insisted that her father
would have a heart attack if he found out she was pregnant.
The abortionist met with us and explained in detail the method
he used to induce a miscarriage: break the water bag, extract all
the water, and wait for labor to begin. In addition, he used antibiotics
to fight infection, oxtoxins (pitosin) to induce the labor, and ergotrate
to control bleeding.
The labor would be the same as for having a baby, beginning with
mild cramps and progressing to heavy rhythmic contractions. Then,
in a heavy contraction. the woman would pass the fetus. After a short
while, the contractions would begin again, and she would pass the
placenta.
She would have to be attended constantly during labor, and then
watched carefully after she miscarried. The fetus would have to be
disposed of.
In the next day or so she would receive a D&C to make sure her
uterus was clean because retained placenta was a major cause of complication.
The cost for the induced miscarriage and the follow-up D&C were
usually $1,000, but since this was the first care, he would do it
for only $600.
“It’s nothing to worry about,” he assured us. “Women
go through it alone all the time. Miscarriages are common. The most
important thing is to keep the women calm and in self-control.”
But we were staggered by the medical implications and the responsibility,
and we felt (rightfully) that he was oversimplifying.
We met with the woman, explained the entire procedure and emphasized
our uncertainty.
She reluctantly decided to have the baby, and returned home to
tell her parents. Her father had the predicted heart attack and she
had the baby and gave it up for adoption.
The only positive note the whole story was that her sister became
active in abortion counseling end set up a service modeled after
ours in Minneapolis
Clearly the way to deal with long-term pregnancies was not to avoid
them.
The
next longterm pregnancy was an 18-year-old Puerto Rican woman, four
and one-half months pregnant and determined to have an abortion.
We made arrangements for her to stay at a counselor’s house during
labor, and to be in constant telephone contact with the abortionist
in case of an emergency.
She was induced in the morning—with no problems.
That night our abortionist left town under threat by the Mafia
for refusing to pay protection.
Two days later, the woman was in heavy labor, and as her pains
got heavier, her temperature fluctuated between 99 and 102. The counselor
had no one to call for advice, and finally in desperation called
her own gynecologist and lied to him that her friend seemed to be
having a miscarriage.
He arranged to meet them at the hospital, where things went as
smoothly as a prepared script. The gynecologist examined her, said
a few words to emergency admissions, and had her sent up to gynecology.
They gave her some antibiotics and some pitocin, and she miscarried
without problem in two hours.
The next day, the counselor caught hell from her gynecologist,
who had learned about the abortion from the patient.
This was typical of the response that we got from most doctors
when we asked them for help with induced miscarriages. Although providing
post-abortion help was not illegal, they felt that admitting such
cases to the hospital was a nuisance and jeopardized their reputations.
With a few significant exceptions they not only refused to help
but condemned others who tried to fill the medical void. Abortion
was illegal. If women were using quinine and coathangers on themselves
in desperation that was a situation most gynecologists choose to
ignore.
Hospital emergency rooms were no better. If they suspected an
abortion. they often called the police before they even examined
the woman in labor. Sometimes they would admit a woman and then withhold
drugs from her unless she talked. Sometimes they flatly refused to
admit her, even though she was in heavy labor.
After several such experiences, the service decided that more than
ever it wanted to take care of long-term pregnancies, and that it
would simply have to figure out ways to manage without help from
the medical profession.
That decision initiated a year during which we expanded
our activities with “Dr.” C and simultaneously set up a system
that induced, midwifed and arranged post-abortion care for more than
200 long-term women.
Our first breakthrough came when Jane received a call from a “doctor”
in Detroit who was soliciting abortion business.
He told Jane he would do D&C's up to 12 weeks- in his Detroit
clinic for $400 “but long-terms would cost $250 just to be induced,
and $600 if the miscarriage took place in the clinic.”
The abortionist (whom we came to call Nathan Detroit) described
a method for inducing an abortion called “Leunbach” that be
said was widely used in Scandinavian countries. A sterile oxytoxin
paste was introduced into the uterus through a hollow cannula, which
is inserted barely through the cervix.
The
paste or jelly he said, separates the placenta from the wall of the
uterus and caused a miscarriage. He said the method was painless
and required no dilation or drugs at the time of insertion the paste.
Labor would follow within 4 hours. The method could be used to introduce
miscarriage at any time in the pregnancy.
A
bonus feature was that this method looked like a normal miscarriage.
A woman went to the hospital in labor there would be no way to tell
she had been artificially induced.
He
invited Jane to visit his clinic in get first-hand information. She
accepted for the next week. In the meantime, the counselor who volunteered
to make the visit spent several days in the library trying to research
Leunbach paste.
It was mentioned in a number of medical publications, but about
as briefly as Nathan’s description of it. We found this to be true
whenever we researched methods of abortion. In a country when abortions
are illegal, there are no text hooks on how to do them.
The counselor was duly impressed with the clinic, which was set
up in the upstairs of a big old Detroit house. She observed one D&C
and one Leunbach paste insertion. It really was painless. She also
talked with one post-miscarriage patient who was awaiting a follow-up
D&C. The patient described the labor a “just like having
a baby”.
Nathan said that the follow-up D&C was done in the clinic as an
added precaution, it was unnecessary most cases. In fact, he said,
even a lay person could tell if the miscarriage was complete by looking
at the miscarriage placenta and observing whether it was intact or
there were pieces missing.
He
knew of the volume of calls Jane was receiving, and was apparently
anxious to get a piece of them, for he volunteered to come to Chicago
the next week to help us out. If we arranged the places he would
put the paste in as many long-term women as we could set up in one
day and would charge us only $1000 for the day But from that time
on he added, the charge would be the regular $200 each.
He arrived at the airport the next week with all of this equipment
in one tiny briefcase. Six women, ranging from 10 to 18 weeks pregnant
had been counseled, had paid Jane $175 each, and were awaiting to
be induced, four at their own homes, two at a counselors house, where
they would stay during labor.
If the day hadn’t been so exhausting it would have been comical.
Every one was in a third floor apartment and Nathan was terribly out
of condition. He insisted that the kitchen table was the only place
to start the abortion and in each case took on the ludicrous atmosphere
of the kitchen it took place in. A small flashlight provided illumination.
Nathan took for granted that the counselor with him was experienced
in medical matters (she had in fact seen her first abortion at his
clinic the week before), and he barked orders at her all day. But
the cases were started without problem, and he left that evening
with $1000 in his pocket.
The same night we got a call from one of the patients who was having
labor pains. She had several children and a previous miscarriage
and said she and her sister could handle the whole thing by themselves.
The anxious counselor kept in close phone contact with the woman
and by 3 am, she had passed both the fetus and the placenta and was
in bed asleep.
Two of the women decided to go to the hospital when their labor
pains began. They were both coached to stick to their story, no matter
what the hospital said: that they were pregnant and suddenly that
day they had begun having cramps and bleeding.
One other woman miscarried at home after a ten hour labor. and
two others miscarried at a counselor’s home, with several extremely
apprehensive counselors present.
It is impossible to describe to someone who hasn’t experienced
or been present during a labor the trauma a woman goes through. The
pains gradually get bad, then they get worse, then they get totally
unbearable, and then they get still worse before the baby/fetus is
delivered.
Although both miscarriages were normal, the counselors (one of
whom had no children) were astonished at the strength and intensity
of the labor pains, and with the gush of blood that came with the
passage of the fetus. They were also amazed at the total relief from
pain both women felt as soon as the fetus was passed.
In both cases the women were remarkably strong during labor. Shortly
after the miscarriage, the placenta was passed and the bleeding stopped
almost entirely.
After witnessing the pain of an induced miscarriage, one counselor
experienced in the use of LaMaze (natural childbirth techniques)
taught the basis of those techniques to all counselors who attended
longterm miscarriages. The effect of even brief counseling in LaMaze
upon women in labor were amazing. Armed with the technique, they
could deal with even the most severe labor pains without drugs.
Seeing her first fetus was a totally shocking entry into reality
for every counselor who attended a long term miscarriage. A 16 week
fetus is a fully formed human being with fingernails and sex organs.
Few counselors could maintain such emotional distance that they
did not spend sleepless nights wondering about life and death, about
freedom of choice,about killing, about the end justifying the means.
But seeing the relief of the women—young, old, rich, poor —
after the miscarriage was the overriding experience. These women had
been carrying an unwanted body in their own bodies for months, trying
to get rid of it in that time, and suddenly they were free. They had
a new lease on life.
But in the case of the women who had miscarried outside the hospital,
the new lease was short. Within several days, they each had severe
cramps and intermittent bleeding.
Each had to go to the hospital, where the problem was diagnosed
as a retained placenta and treated with a cleanup D&C. The hospital
charges for the D&C plus drugs and extras ranged from $250 to
$450, taking the total cost of the abortion well out of the bargain
range we had hoped for.
When we complained to Nathan, he insisted that the incomplete cases
were coincidences, but he offered us an alternative plan for saving
money. We could buy tubes of Leunbach paste from him for $50 each,
he would throw in a cannula and we could administer the paste ourselves.That
way, even if the woman had to pay for a cleanup D&C, the total
cost would be under $350.
The suggestion astounded us- we are simply not yet bold enough
to perform a major medical procedure ourselves. But we bought a dozen
tubes of the paste and stored them in the refrigerator as directed.
(Editor's Note: The paragraph that goes here was indecipherable in
the copy we have, but involves how the service could use “Dr.”
C)
We
were saved from the immediate dilemma of whether to insert the paste
ourselves when were approached by a group of Northside abortionists
who agreed to insert the paste (their own) and do a followup D&C
in their Northside office for $400. They would also help care for
women in labor if we provided a place. As part of the bargain, we
would have to throw in a few short-terms each week for the same price.
This group of abortionists came recommended by several local MD’s,
but in a system that turned on payoffs and kickbacks, references were
meaningless.
In desperation for a way to take care of longterms, we decided
to give them a try. Two short-term patients volunteered, and their
reports were tolerable, if not enthusiastic. They said that only
men were present during the abortion, and that their manner was cold
and secretive, but the place was clean and the medical results were
satisfactory.
We decided to use them for longterm miscarriages, and to keep the
number of short-term cases we sent them to the absolute minimum.
In anticipation of the induced miscarriages, a counselor volunteered
her large apartment for the women in labor. She and another counselor
(who had joined the service after a horrendous experience with a
catheter induced abortion) also volunteered to study midwife techniques
and to sit with women in labor.
The anticipated expansion also meant that we had to drop our 16
hour answering service for a system that could receive messages any
hour of the day or night.
We mentioned the problem to "Dr." C one morning and mere
hours later, a fancy tape arrived at Jane’s home, complete with
a portable beeper that enabled her to pick up tape messages from any
phone. The new system greatly increased Jane’s flexibility and
unquestionably built up credits for “Dr.” C
The Northside abortionists were to distinguish themselves during
the next few months we worked with them by sending away women who
were a little short of funds, by being awed and incompetent in the
presence of women in labor, and by somehow dodging most cleanup D&C’s,
so that cases with retained placentas ended up in the hospital anyway.
We soon learned that they were one of the biggest abortion outfits
in the city and that they paid protection to the Mafia, and that
they were unscrupulous in their pursuit of money.
Apparently their protection was not sufficient, for two months
after our first contact with them, they were arrested with two of
our patients in their apartment, making front page headlines in all
four dailies.
Ultimately they got off the bust by paying the police and the court
about $30,000. Before the settlement, the states attorney called
and questioned Jane several times...without success. After the settlement
we heard from him no more.
The Northside group was soon back in business, but we refused to
have any further dealings with them.
On the
whole, our generally negative experience with them proved valuable.
In the face of their incompetence, several counselors became very
competent in attending women in labor. We attended about 18 miscarriages
in this period, and sometimes had as many as 4 patients in the apartment
at one time in various stages between induction and followup D&C.
We learned to speed up sluggish labor with special exercises (old
wive’s remedies that really worked), we learned to ease the pain
of harsh labors with Lamaze breathing and sympathetic care, we learned
to control post miscarriage bleeding with shots of ergotrate, icepacks
and gentle massage of the abdomen.
We also learned when a situation was beyond our competence, and
we had to take a woman to the hospital. Fortunately, for the first
few months, these situations were limited to excessively long labors,
to cases where the placenta did not pass and to cases of mild but
continual bleeding.
Facing hospital staffs in such situations continued to be a frightening,
humiliating and often legally threatening experience — but unavoidable.
Most importantly, our experience with the Northside Group convinced
us that if these incompetent, inhumane men could clear $400 for simply
administering the paste, we could also do it...for our cost alone.
So that fall, one full year after the service began, we finally
took speculum, flashlight and cannula in hand and induced our first
abortion.
Our
hands shook so bad that we could not even put the speculum in straight,
and we emptied the first tube of Leunbach paste ($50 worth) onto
the floor. But our two young volunteer patients were good humored
and encouraging, and the job was finally done.
And it was so simple! So damn simple, after avoiding it all these
months. Just slip the tip of the cannula through the opening of the
cervix and gently squeeze the paste in. No pain, no blood, no problems.
And a happy, friendly, less costly experience for the women.
The two women went to a counselor’s apartment where they were
closely attended. We somehow expected special problems because we
had overstepped our bounds by performing a medical procedure.
But both miscarried within three days. One required no cleanup
D&C
and the other relieved a D&C from "Dr." C. Total cost:
$400 for both, which they split.
We were excited, of course. Putting in Leunbach paste through a
cannula was hardly a complicated medical procedure, but it was still
an abortion...and we did it ourselves.
Armed with our new techniques, we began to take on more long-terms
and to intensify our training and organization for midwiving women
in labor.
After
the Northside bust, we had to abandon the midwife apartment, which
was being watched by the police. Instead the counselors who chose
to counsel for long-term miscarriages arranged a place for each of
their patients. Sometimes it was their own or another counselors
apartment, sometimes the home of the patient.
To each long-term was offered the following alternatives: to be
induced by a woman from the service by Leunbach paste or to have
their water bag broken by “Dr.” C, to go through labor at a counselor’s
house or at their own home under the care of a counselor or to go
directly to the hospital when their labor began; and finally, to go
to the hospital for a cleanup D&C or to come back through the
service and have it done by “Dr.” C.
About three women a week chose to be induced by us for a charge
of $50 plus the $250 by “Dr.” C. or a hospital D&C. An
equal number chose to be induced by “Dr.” C. who now agreed
to break the water bag and later do a followup D&C for the regular
short-term charge of $400.....if we took responsibility for the labor
and miscarriage.
Of these five or six anticipated long-terms at least two each week
had insurance or a welfare green card and chose to go the hospital
for the miscarriage...sticking to the well-rehearsed story that it
was spontaneous.
The
other women were our responsibility. and each made details plans
with her counselor about what to do and where to go when the labor
pains began.
About
two women a week went through the service for a D&C, but turned
out to be more than 14 weeks pregnant.
These women had not been counseled for an induced miscarriage.
and they often had to make a last minute decision whether to go ahead
with the abortion. Worse, sometimes only after the abortion was started
did we discover that the woman was too far along to be done by D&C.
On
to Part IV
