by Jane (September 1973)
Parts 1
2 3
4 5 6
Part IV
For the
first year and a half of the service, we steadily learned more about
abortions and specific medical techniques, the use of drugs and instruments,
and we performed minor paramedic procedures.
We became
more competent as counselors and organizers, and we recruited many
new counselors as the number of patients and scope of activity grew.
Fees for a D&C dropped form $500 to $350, with the number of free
abortions growing as volume increased.
But we
still relied on our male abortionist (“Dr.” C) to do the
more than 30 D&C’s a week. We in the meantime, concentrated
on expanding our service, while we were continually developing the
skill and the confidence to do D&Cs ourselves.
Our biggest
headaches came from the two or three cases a week when a woman turned
out to be more pregnant than expected and we suddenly had to deal
with an induced miscarriage instead of a simple D&C.
Even with
written notes from a doctor and pelvic exams beforehand, it was impossible
always to predict the length of pregnancy. Some women menstruated
for the first several months of their pregnancy.
Suddenly,
the woman had to make major changes in plans under extreme stress.
She had to deal with a process that would take days instead of minutes
and involve more pain, more risk and often more money.
Suddenly,
there was no way to keep the abortion a secret from an intolerant
parent or boyfriend, husband or employer. Women on welfare stood
to lose their payments if the caseworker found out they had an abortion.
Women had to find baby sitters and arrange time off work—often
this meant loss of job or income.
The counselor
would have to be on call around the clock till the woman safely miscarried.
She would have to arrange a place for the woman to stay while she
was in labor; or if the woman had no one-else to turn, the counselor
would have to fill in as babysitter, housekeeper and midwife till
the ordeal was over.
Sometimes
she would receive a frantic call from a woman in labor and rush to
the woman’s house regardless of the hour of day or night, only
to be confronted by angry husband or parents whose only response to
the crisis was to yell recriminations or threaten to call the police,
while the daughter or wife was in heavy labor in the bedroom.
Fear of
arrest or lawsuit was only a minor consideration at times like these—
the counselor’s first concern was to take care of the woman.
The lack
of mutual support and trust between parents and daughter was sometimes
astounding. Now, when their child needed help and understanding more
than any time in her life, many parents chose to vent accumulated
hostilities.
But for
many young girls, the crisis reestablished long-lost communication
with their parents. To their surprise, parents were beside them,
comforting and helping.
Counselors
encouraged minors to tell their parents once the miscarriage had
been induced. Usually the parents found out anyway, and often they
turned out to be more supportive than the girl suspected. But ultimately,
we relied on the young woman’s judgment of how to handle the
family scene.
For short-term
D&Cs, however, we never pushed women to tell parents or relatives
beforehand. They were welcome to bring a relative or friend to the
counseling session, but never forced to, regardless of their age.
Too often, especially for young Catholic girls, telling their parents
meant they would be sent to a home, forced to carry a baby to full
term against their will and then forced to give it up for adoption.
Many older women who came through the service had been scarred
into permanent bitterness by such an experience when they were younger.
Understandably,
the temptation was great to do borderline pregnancies (13 to 16 weeks)
by D&C rather than by induced miscarriage.
It saved
the patient days of waiting, hours of pain and extra cost. It saved
the counselor the extra worry and arrangements. And it spared the
service potential unpleasant encounters with hospitals and police.
Equally
important, it made us all feel good. Women who were dreading a miscarriage
were overjoyed when they learned they were being done direct, and
would not have to go through labor.
(And unspoken,
but in the back of some minds: “Thank God! No 16-week fetus to
wrap up and throw in the nearest city trash can.”)
When the
woman was expecting to get a short-term D&C, but turned out to
be a borderline, the temptation to do the abortion direct was even
greater. Then there were the special cases—the woman who was
16-weeks pregnant, but whose husband had a vasectomy a year ago.
Or the
woman sent to us by a local gynecologist—she had a cancerous
kidney removed just months before, but had been refused a therapeutic
D&C by the hospital board. Her doctor felt that going through
with the pregnancy would kill her.
Her D&C
was a rough experience, but three weeks later she gained ten pounds
and was well. Her physician told us she would probably be dead now,
but for us.
Other
abortionists in the city and in clinics in Washington, D.C. and later
in New York said flatly that a D&C couldn’t be done past
12 weeks. But in central Europe they were being done routinely up
to 16 weeks.
We knew
it could be done. In the four years of the service, we did more than
a thousand successful direct abortions on women 13 or more weeks
pregnant.
Doing
a 15- or 16-week D&C was no picnic. A D&C at eight weeks takes
five minutes and the dangers are minimal. But at 15 weeks, it takes
from 20 to 45 minutes. If it’s an unexpected borderline, then
all other women who are waiting to be done that day are all delayed
at least 45 minutes.
It’s
an exhausting experience for all concerned- Even the most cooperative
women get tired of lying so long in one position with instruments
being pushed in and out of their bodies. It’s often painful.
But the bravery and commitment of most of these women gave us encouragement
and support.
For the
abortionist, the pure physical strain is remarkable. Pulling large
pieces of fetal material through a resisting cervix takes a lot of
strength. Huge blisters on hands are an occupational by-product—
one can frequently identify an abortionist by placement of calluses
caused by the instruments.
The psychic
drain is also enormous— trying to concentrate on the physical
procedures, while the assistant is tending to the woman’s emotional
needs.
The room
is charged with tension. Time pressure is constant. In a 15-week
abortion, the possibility of hemorrhage is greater. If heavy bleeding
starts during the abortion, the only way to stop it is to get the
uterus clean . . . fast. So if bleeding starts, the work is accelerated,
not stopped.
Fortunately,
we never had a situation during a borderline where heavy bleeding
could not be stopped.
Jane usually
scheduled two or three borderlines in a day of 20 or so abortions.
But some days, unexpected borderlines seemed to come one after another.
Sometimes a woman who was scheduled for an induced miscarriage would
plead to be done direct, because the effects on her life situation
of a long-term miscarriage would be so tragic. The decision was often
hard to make.
There
were days when our judgment faltered. When, because of pure exhaustion,
we induced a woman who could have been done direct. Or worse, those
few occasions when we took on a longer case than could be done direct,
and would up with an incomplete borderline D&C.
The best
thing that can happen with an incomplete abortion at 15 weeks is
that the woman will pass the remaining material without problem in
a minor labor. The dangers are that the retained material will cause
an infection, or worse, that a broken fetal bone will puncture the
uterus during a heavy contraction.
So we
almost always insisted that incomplete D&Cs be taken to the hospital
where the procedure could be completed under more controlled conditions.
It’s one- thing to explain to the emergency room personnel that
a woman is going through a spontaneous miscarriage—quite another
to have to account for only half of a retained fetus.
Some hospitals
were more accepting of such situations than others—Cook County
encountered so many attempted abortions that they took them in stride.
But we
had to warn all women who went to the hospital with an induced miscarriage
or an incomplete D&C to resist surgery unless they got a consulting
opinion from a private doctor.
If a woman
was Black or Spanish or on welfare, and had several previous pregnancies,
the hospital would sometime attempt to give her a complete hysterectomy—obtaining
her permission while she was in heavy labor and unable to make a clear
decision, or insisting to her that the radical operation was necessary
to save her life.
Several
women who came through the service subsequently had hysterectomies
because of incomplete abortions or problem miscarriages. All but
two of these we considered medically unjustified, and had strong
medical opinions supporting our view. Some medical facilities, we
learned, justified the operation on the basis of the woman’s repeated
“immoral behavior.” Blacks recognized it as “genocide.”
One prominent
Chicago gynecologist confided to us that he had punctured nine or
ten uteruses in the operating room that he knew of. "It’s
inevitable,” he said “When it happens, I just watch the
woman very carefully for infection or inflammation. Usually the
uterus heals without problem.”
Of course,
for women who chose to come to our women paramedics for an induced
miscarriage with the Leunbach paste, rather than through “Dr.”
C, there was never any question of a borderline D&C. They were
all counseled and prepared for a long-term miscarriage. We set aside
Thursday morning as “woman’s day” for inducing long-terms.
We induced
and midwifed our first nine miscarriages without incident . . . then
we ran out of the paste.
When we
confided the problem to “Dr.” C, he said that he would rather
not deal with long-term miscarriages anyway. Then he casually mentioned
that he had a gallon or two of the paste in a friend’s house,
and we were welcome to it.
So we
rented another midwife apartment and made plans to stay in the business
of induced miscarriages, at least for the time being.
The limited
revenues we received from the long-terms were a great boost for the
morale and the efficiency of the service. For the first time, we
could pay our phone bills and expenses without asking for an allowance
from “Dr.” C.
We had
midwifed about a hundred miscarriages safely during the first 18
months of the service, and we were becoming quite confident about
our judgment and ability. Then a single incident shook the foundations
of our confidence and forced our hands medically.
It had
been a long Saturday—21 D&Cs and three induced miscarriages.
“Dr.” C and two counselors decided to stay for half an
hour at the work place and have a bottle of wine, a rare occurrence,
for usually everyone was in a big hurry to get out.
Then the
phone rang. It was Carolyn. An unanticipated long-term from the day
before. She was in labor and couldn’t find her counselor (the
counselor was, in fact, attending another long-term at the time).
We were glad we were there when she called, but also wearily regretful
we hadn’t left five minutes earlier. We corked up the bottle
and brought Carolyn back to a counselor’s house
Carolyn
was a delightful young woman. We sat around and rapped for several
hours until her labor pains got so heavy she had to lie down. “Dr.”
C, out of amused curiosity, decided to stick around to observe the
action that night.
Carolyn
had a hard but relatively short labor. After three hours, in a heavy
contraction and a tiny spurt of blood, she passed a 15 week fetus.
She was exhausted, but otherwise felt fine.
We made
her comfortable in bed until she began contractions to pass the placenta.
She wasn’t bleeding at all. One of us disposed of the fetus—an
onerous task for those of us who had conflicts about abortion and
the status of fetal life.
Ten minutes
later, the counselor with Carolyn noticed a narrow trickle of blood
down the sheet. Pulling aside the cover she saw that Carolyn was
lying in a pool of blood.
She called
the other counselor. One hurried for ice trays to place over the
uterus, while the other gave Carolyn a shot of ergotrate to control
bleeding and then massaged her uterus. She was contracting steadily,
but not heavily, and she was still not passing the placenta—just blood.
We tried
to tug gently on the cord and to pull out the placenta by hand, but
small pieces broke off and the bleeding continued. Blood soaked up
the bed, saturated towels and ran all over the floor. Blood was everywhere.
When we
first called “Dr.” C for help, he chuckled and said, “Come
on, girls. You know that it always looks like more blood than there
really is. Give her another shot of ergotrate.”
Less than
a minute later we called him again. He strolled calmly Into the room
. . .and paled.
Two seconds
later, his color was back and he was giving orders calmly and smoothly, "Hey, you're a mess.Let's get you cleaned up a little.”
And to
us: “Get the instruments ready. Don’t take the time to sterilize
them.”
While
we put new sheets on the bed, he carried Carolyn to the bathtub—a
heavy stream of blood marring their path—hosed her down, and
carried her back to the clean bed. By this time the instruments were
sitting next to the bed. About two minutes had passed . . . and at
least a pint of blood.
He said, “Okay, now we have to put the speculum in again. It won’t
hurt much.”
Carolyn
was so weak, she didn’t care about pain. She did what she was
told, knowing there was nothing she could do for herself.
“Dr.”
C looked in with the headlamp, reached in with the forceps, then sat
back and said to us: “Come here and take a look.”
Blood
was still pouring as heavy as ever, and we didn’t think this
was the time for a lesson, but he wouldn’t go ahead till we came
to look. He slowly began pulling away pieces of bloody tissue that
filled her vagina, and soon we saw that the cervix was being held
wide open by the same bloody mass, which was pouring blood like a
sponge with water pouring through it.
“The
placenta is stuck in the cervix,” he explained. The contractions
are too weak to pass it.”
He grasped
the mass with a large forceps, and in one slow tug pulled out the
entire placenta. The cervix virtually snapped shut behind it, and
the bleeding slowed to mere spotting.
Carolyn
was ashen but alive, and she whispered to us, “I’m okay.”
“All right, let’s get this place cleaned up. Keep her warm
and get her some orange juice to drink,” Dr. C. ordered—
smuggly we thought. But then we saw that his hands were shaking.
Some accidental
or intuitive or holy combination of circumstances came together that
night to save that woman’s life (and to save the service, as
well). Chance, we realized, plays a big part, even in matters of life
and death. A year later, when we were better equipped to accept it,
an equally coincidental set of circumstances was to combine to cause
tragedy.
We had
formed the service to do good, not harm. We knew and often discussed
the fact that we weren’t perfect, we made mistakes.
We had to learn from both bad and good experiences trying constantly
to reduce the elements of chance, to find the right combinations.
But in matters of life and death, sickness and health, we always
found it hard to shrug and say, “Well, we learned from that mistake.”
Medical
schools prepare their students to deal with their mistakes. We had
no protective training or legal shroud. We had only the support of
each other and the belief that, on balance, our cause was good and
our service was essential.
At this
point, the women who worked as assistants were still limited to the
eight or so who had gained the trust and approval of “Dr.”
C.
They had become familiar with the tools and techniques for a D&C,
although they had not attempted one themselves. They had been observing
abortions for about 10 months and were proficient at giving shots,
inserting a speculum, administering injections of novacaine around
the cervix and taking pap smears to determine infection and cancer.
But when
it came time to dilate and use a forceps or curette, the counselor/
assistant stepped aside and “Dr.” C took over.
As we
assumed more and more assistant duties, and were now setting up working
places and taking over safety precautions—-formerly his concerns— “Dr.” C grew more bored. His energy now went into increasing
pressure for speed and efficiency.
Instead
of working in one-bedroom apartments, he insisted that we find apartments
with two bedrooms, so that a patient could be prepped and cleaned
up in one room, while the actual abortion was being done on another
patient in the other room.
“Dr.”
C had been commuting into town to work. on Fridays and Saturdays ever
since the Mafia had driven him out for refusing to pay protection.
The number of patients that we could handle each of those days jumped
from about 12 to 20 with the addition of the extra room, still not
keeping pace with Jane’s increasing volume of calls. The four
or five long-terms that we induced on Thursday mornings relieved the
work load only slightly.
We all
felt the pressure to find a way to handle the increasing volume of
abortions, more and more of which were “hard” cases—the
very young, the very poor, the very far pregnant.
“Dr.”
C was appreciating the money he was getting from the volume of abortions,
but he was also feeling the pressure and responsibility of the workload,
especially since he had a family and a life to maintain in another
place. While he indicated no immediate plans to step out, he warned
us repeatedly that he would not be available forever.
It was
clear that if we were to handle our increasing volume, we would either
have to hire another abortionist or learn to do them ourselves. We
were reluctant to repeat our unpleasant experience with the Northside
abortion ring.
Clearly,
learning to do a D&C ourselves, from start to finish, was the
final essential step in having a service that could be controlled
and run by women.
It was
never clear at any given time whether “Dr.” C was motivated
to teach us to be relieved of responsibility, because of a surge of
commitment to a political idea he felt was sound, because he didn’t
want us to hire another abortionist, or because of that restless energy
and impatience that made him constantly uncomfortable with the status
quo.
One thing
was clear—the pressure to teach and the pressure to learn created
great conflicts—both within us and between us. For if we learned
to do abortions, we would certainly use our knowledge. And that would
inevitably cut into his job and his status.
Sometimes “Dr.” C seemed driven in his desire to teach .. as though
he had to do it quickly, while he had a rush of commitment. And when
those rushes came, those of us with the desire and the aptitude would
have to be on hand to learn.
Sometimes
he would turn to the assistant, curette in hand, and say, “Here,
you scrape around and check to see if it’s clean.” When,
we took curette gingerly in hand, he would order, “Harder.
Harder. Hold it this way. Pull toward you. You can’t be afraid
to use your muscles, and you can’t be so afraid to cause
pain that you don’t do the job right.”
Sometimes,
if a patient was bleeding slightly more than normal, but not dangerously,
he would hand the assistant a forceps and say, “There must be
a piece of placenta still in there. Get it out, will you?” And
then he would step back, making it clear that he would do nothing
about the situation until the assistant had at least tried.
We were
all on a rush. Paranoia and tension among us was high. Certain women
who had the favor of “Dr.” C were being pushed to learn,
while others felt left out. “Dr.” C often expressed subtle
fear and, resentment over the encroachment on his trade secrets and
his domain of authority, and yet he constantly pushed to teach just
as we constantly pushed to learn.
And so
we learned—in bits and pieces— grabbing the opportunity,
even while we had doubts about our moral rights to place our inexperienced
hands on another sister’s body.
But for
the first few months, “Dr.” C was always in the background,
apparently nonchalant and confident of us, but always ready to step
in if the need arose.
And so,
we were armed with tools and knowledge for doing a D&C months
before we were to attempt one on our own. We lacked the expertise
that goes with repeated experience, and the daring to do it without
that experience.
When it
finally happened, it was an accident. Four counselors were working
at the apartment one Thursday, breaking water bags and inserting
Leunbach paste for long-term miscarriages. The fourth and last patient
for the day was a 19-year-old black woman, about 14 weeks pregnant
fully counseled and prepared for a labor and miscarriage.
We were
all glad this was the last patient—four in one day was a lot
of responsibility and severe emotional drain. We were not fully sure
of ourselves yet, even for this simple procedure. We dilated the patient
and reached in with a forceps to break the membrane. Two other counselors
were talking to the patient and watching.
There
was the usual gush of water slightly pink with blood—and in the
teeth of the forceps the arm of a 14-week fetus.
The counselor
who was doing the abortion looked silently at the forceps and its
contents for a full ten seconds. The other counselors were silent...
watching.
Finally
the woman asked, “Is anything wrong.”
“Not
at all,” the counselor replied. “In fact, I think we’ll
do you direct and get the whole thing over with today.”
Suddenly
the room was charged with energy again. One counselor began talking
animatedly to the woman, explaining a D&C, while the other stood
ready to help. The patient remained calm and confident.
“Okay—this
is one of those times when there is no choice but to... so go.
. . .
Remember... be cool... we’ve seen it done a thousand times..
. reach in again with the forceps. .. gently explore the wall of the
uterus ... feel for loose material . . . twist ever so gently to make
sure it’s loose . . . pull slowly through the cervix.
...Another
arm and hand...a big piece of placenta . . a leg . . . an endless
length of tiny intestine . . . a large bone that comes with a stronger
tug—a shoulder . . .
. . .
The woman winces as a hip bone is pulled through the cervix . . .
the other leg . . . the ribs . . . a two inch length of backbone.
. . .
Now with each tug, there’s a small gush of blood. Only the head
is left. Forget that for now and get the placenta off the wall so
the bleeding will stop— switch to a curette and scrape the placenta
down towards the opening.
Now .
. . back to the forceps—in and out, in and out—pulling the
loose placenta out. The bleeding stops almost entirely.
Now feel
with the forceps, find the head, crush it and pull. Harder. The patient
moans softly as a piece of skull is pulled out, then the next piece,
and finally the last piece.
“Okay.
Once more around with the curette to make sure the walls are clean
and it’s all over.” Already the uterus is starting to contract
and become firm, and the final curetting is complete.
Unscrew
the speculum and slowly pull it out.
“There. All done.”
Twenty
minutes had passed. And an eternity.
Suddenly
the room is in bedlam. One counselor is jumping around and yelling, “We can do it ourselves! From now on, we can do it ourselves!”
(Continued) On to Part V
