by Jane (October 1973) Parts
1 2
3 4
5 6
Part V
The women
of Jane, the abortion service, performed their first complete dilation
and curettage quite unexpectedly, on a delightful young patient who
was scheduled for an induced miscarriage, but turned out to be only
13 weeks pregnant.
The D&C
was uncomplicated, the patient was cooperative, and the reactions
of the four counselors present ranged from awe to ecstasy over the
act and its implications.
As soon
as the new “abortionist” pulled out the speculum and said,
“There, all done,” the room turned into bedlam.
One counselor
jumped around and yelled: “We can do it ourselves! From now on,
we can do it ourselves!”
A second
counselor cleaned up the patient and explained to her that she had
been done by D&C and wouldn’t have to go through a miscarriage,
then added offhandedly that she was the first D&C to be done from
start to finish by a woman from the service.
The patient
started giggling and said, “No kidding? It’s all over? I’m
really your first?”
The fourth
counselor heard the noise and came in to find people laughing and
chatting. The scene looked to her like a party.
But she and the counselor who had performed the abortion couldn’t
join wholeheartedly in the celebration. Both old-timers in the service,
their enthusiasm was tempered by the view that abortion was only the
best of two tragic choices.
More important,
they knew that this new achievement would mean more drastic changes
in the activities and policies of the service, which was already
going through changes so fast that the organizers were under unrelenting
heavy pressure.
Even though
we had been inducing and midwifing miscarriages for more than six
months, we had avoided thinking of ourselves as actual abortionists.
Inducing a miscarriage was simple, and the miscarriage itself was
a matter of nature taking over. We counseled, comforted and watched
for complications-we considered ourselves midwives rather than abortionists.
And in
our year of work with “Dr.” C, who was now the only abortionist
we dealt with, we considered ourselves counselors and medical assistants.
True, we were developing the skills to do abortions, but “Dr.”
C always took primary responsibility for the medical end.
However,
doing a D&C on our own put us in the unquestionable category of
abortionist. Armed with this new competence, we had no excuse for
not using it . . . if the need was there.
The need
was growing daily. Jane was getting upwards of 100 calls a week now,
and more than one-third of these women were poor.
They were desperate for abortions, and had neither the money nor
the connections to have it done through medical channels. Many of
these women would choose catheters, quinine or coathangers rather
than another baby.
Under
our existing setup with “Dr.” C, there was no way to continue
to provide abortions for the volume of women who could not pay. Our
current price was $350, most of which went to “Dr.” C and
his nurse. Each Friday and Saturday, he did from 15 to 20 abortions—two
or three each day for free.
But as
more and more nonpaying patients came through the service, we had
increasing conflicts with “Dr.” C over money. He demanded
that his total take for the weekend be above a certain amount, regardless
of volume. When it fell below that amount, he became angry, sometimes
hostile.
We maintained
that we would not turn women away for lack of money, but he countered
that most women could come up with more money if they were pressed
harder.
After
each major clash with “Dr.” C the service would devote most
of its next meeting to: MONEY.
“Our
abortionist is upset about his finances,” someone would tell
the group, launching a discussion of how to present the matter of
money to a woman, how to help her find money if she had none, how
to distinguish between the woes of the poor college student from Winnetka
who had empty pockets but rich friends, and the crisis of the black
woman from 47th and Cottage, who had absolutely no one to turn to.
Taking
a firm line on money required a sensitive balance, especially for
new counselors. If we stressed money too hard or too soon, we sometimes
scared away the most desperate of women—to what or whom we never
knew.
And it
caused moral conflicts for all of us. After all, we joined the service
to help women, not increase their hardship. Getting an abortion was
a tough enough ordeal without additional crippling financial worries.
It is
rhetoric to say that we felt continuing moral outrage over the sexist
society which kept abortions illegal and black market prices high.
Of course we did, when we had extra energy to indulge in moral outrage.
In the
meantime, we were working in that system. The practical fact was
that the bills had to be pald, and as long as we were working with “Dr.”
C or any other abortionist, the biggest bill would be his fees.
Sooner
or later during these recurring discussions of money, a new counselor
would ask: “Why should we be squeezing out some poor woman's
last nickel, when our abortionist is collecting more than $7,000 each
weekend?” Our only response was that we had no choice—we
needed him, just as he needed us.
So finally,
when the news broke that women in the service had done a D&C by
themselves, and had done many others in the presence of “Dr.”
C, sentiment was unanimous: we had to set up to do them ourselves.
We were
at this time working on Fridays and Saturdays assisting “Dr.”
C, and also independently inducing about six miscarriages each Thursday.
Jane began
steadily to add short-term D&Cs to our Thursday workload. Within
a month, we were doing a total of 12 abortions each Thursday, with
no problems, as well as working with “Dr.” C.
By the
end of two months, the counselor who had performed the first D&C
felt quite competent at the procedure . . . or at least as competent
as any of us ever were to feel, taking another woman’s life into
our hands.
The process
of training other counselors to be abortionists began almost immediately
and continued for the life of the service. Each abortion became a
training session, with patient, abortionist, assistant or trainee
all participating.
The tone
was markedly different than learning with “Dr.” C, where
there was a high degree of pressure and anxiety, and often of secretiveness—all
of us tried to act blasé so the patient would not think she
was being used as a guinea pig.
But now
learning became part of the political component of the abortion for
everyone involved. We would explain to the patient the need for having
other women learn, and ask her cooperation.
If she agreed—and many patients agreed enthusiastically—then
the trainee could slowly and carefully begin to learn the feel of
the instruments.
Now we
could say freely, as a trainee abortionist took curette in hand: “Pull
the curette toward you all the way around. Never push. Now scrape
harder, until you hear the rasping sound—that means the uterus
wall is clean.”
And to
the patient: “Can you hear the sound when we scrape on top? Does
it feel any different? Does it hurt?”
We learned
to use pain as an indication of the status of the abortion. Scraping
a clean uterus wail with the curette produced a cramping sensation,
while scraping a wall covered with soft placenta usually produced
no sensation.
A conscious,
lucid patient, we became convinced, contributed to the success of
the abortion. We felt that we owed our remarkably successful medical
record over the years in large part to patient participation. Total
anesthesia, still used for D&C's in many hospitals, adds danger
and expense and prevents the valuable commentary of the patient.
For example,
we might feel a strange ridge or pocket on the inside of the uterus
with the curette. After questioning a number of patients with the
same condition, we learned that this occurred with women who had
once had a certain brand of intrauterine device for birth control.
Unless these pockets were scraped thoroughly, they became pockets
of infection.
Tiny clots
of dark blood sometimes appeared in an otherwise normal D&C.
We learned
by questioning the patient that these were caused by oral doses quinine,
which the woman had taken to self-abort. After many similar cases,
when we saw the clots we would ask: “Did you take quinine?”
And she usually responded, “Yes, How did you know?”
Although
the pure mechanics of doing an abortion are simple—dilation,
removal of solid material with a forceps, scraping with a curette—it
seemed to require an almost intuitive sense as well.
Working
in an unseen area, an abortionist must depend on touch via an instrument,
on sound and on visual observation of what is removed. We couldn’t
look at the uterus wall to tell if it was clean.
Two other qualities were essential to a competent abortionist:
ability to relate to the working team—patient, assistant and trainee—and
experience, lots of it.
As more
of us became potential abortionists, we were faced with a new political
dilemma: the status that went with being “the abortionist.”
For a
number of reasons, a few of the counselors were more adept than others
at performing a D&C. They combined physical coordination with
the ability to mentally visualize the inside of the uterus.
Most important,
they were able to concentrate, to put moral and emotional conflicts
aside while the abortion was being performed. They could relate to
the team, but put top energy into the physical job at hand.
The best
abortionists did not necessarily make better counselors, better coordinators
or better political leaders. The abortionist was just another link
in a chain where a weakness at any point could cause tragedy.
And yet,
the authority and status that the abortionist commanded while the
medical procedure was being performed carried over into other areas
of the service.
In fact,
several counselors with the most remarkable of other talents felt
extreme disappointment and embarrassment at not being able to perform
an abortion well.
Perhaps
it was because the medical mystique had been ingrained into us, perhaps
because a certain few strong personalities had both the opportunity
and the aptitude to learn to do a D&C, perhaps because our two
years of having to cater to male abortionists made us think of any
abortionist as “the boss.”
We tried
at our weekly meetings to deal with the problems of elitism in the
service. We always felt the need to set aside more time for personal
and collective gripes. But such discussions usually took second place
to more immediate work.
Rap groups
were very popular in the women’s movement at the time. Most of
us resisted having the service become a rap group at the expense of
efficiency and patient welfare.
We lost
and gained in the process. Many issues that should have been discussed
at length, especially with new counselors, were slighted. But we
also discovered that a collective group built on work and action
develops its own type of mutual personal support.
So, forsaking
sensitivity sessions, the service sought operational ways of equalizing
the status of abortionist, assistant, counselor and patient.
For one
thing, we used the term “paramedic” whenever possible to
refer to anyone in direct medical contact with the patient, whether
abortionist, assistant or trainee.
For another,
every counselor, after serving an apprenticeship counseling with
experienced counselors, was given the opportunity to work at the
apartment where the abortions were being done. She was encouraged
to perform simple paramedic functions—giving shots, inserting a speculum and taking
pap smears.
We also
switched jobs during the abortion to break down impressions of individual
status. At the beginning, one counselor would hold the patients hand
and talk to her, while another inserted speculum, took a pap smear
and injected Novocain. Then the counselors changed places, and the
one who was talking to the patient and getting to know her completed
the abortion.
Not only
did this system diffuse status, but later, when several of us had
to face a judge after a major arrest, it diffused responsibility.
Former patients who had been subpoenaed could not point to a single
woman and say, “That's the abortionist.”
And for
the patient, the experience of dealing with several women in a paramedic
capacity both broke down the medical mystique of any particular job
and heightened her respect for women in general, herself included.
Observing
abortions firsthand, many counselors understood the process better,
felt less mystery and drama in regard to it, and could counsel better
as a result.
Other
counselors held full-time jobs and could not participate during the
day. Some felt uncomfortable watching the medical procedures, but
still felt competent to explain the process to women they counseled,
it became clear that medical know-how was not, the primary criterion
for being a good counselor.
The service
refused on political grounds to offer a bargain price for abortions
done by us, while those done by “Dr.” C still cost top dollar.
We didn’t want to enhance the sexist impression that some abortions
were “worth more” simply because they were done by a man.
On the
other hand, we wanted to take advantage of our own cheap labor and
make abortions available to poor women at a lower cost.
The challenge was not just to take care of low-money cases, but
to set up a system in which no woman would get special treatment
because of her financial status.
We decided
not to offer any choices as to abortionist, and not to mention that
one cost less than another. Instead, each woman was counseled that
she would be done either by a man or a woman, both of whom had substantial
experience doing abortions, and was charged according to her ability
to pay.
Then we
left it to Jane to schedule more low-money cases for Thursday than
for the weekends, but also to make sure that there were at least
two paying and two nonpaying patients on each day, no matter who
was the abortionist.
Money
was collected from each woman by the driver, before she arrived at
the abortion place. The paramedics who did the abortions, whether
us or “Dr.” C, never knew how much any woman paid.
The system met the collective immediate needs—the volume of paying
cases was high enough to keep “Dr.” C relatively satisfied,
and we had a means for taking care of real financial hardship cases.
The other
changes that resulted from our being independent abortionists,
at least part-time, were more sweeping:
- Internally,
for better or worse, we had a sudden abundance of money for running
the service.
- Operationally,
we had to find sources for drugs and supplies—how does a lay
person obtain a dilator and a set of
curettes—or 1,000 ergotrate tablets... or 500 syringes?
- Legally,
we had to face the fact that we would be considered full-fledged
abortionists in the eyes of the law. We could no longer hide behind
the label of “counselor,” and we no longer could expect
“Dr.” C to act as a buffer, with his know-how and his
ready cash for dealing with a bust.
- Personally,
we had to cope with a range of problems, including anxiety and guilt,
strains on family and friendships, and social disapproval.
- And morally,
we had to be ready to accept the full consequences of our activities,
even if they resulted in illness, personal tragedy or death.
Dealing
with death was a daily moral issue for some counselors, while for
others the issue arose only once-when a woman who came through the
service died.
