Playing around with some fun design ideas for radical nursing bumper stickers…inspired by a Facebook comment earlier that ACNM has a Midwives for Life group, but no Midwives for Choice group. I’m not a graphic designer…but I love the idea of bumper stickers, pins, shirts, bags, etc. Anyone with design skills want to help make this a reality?
Today I was asked by a patient whether I found this work hard. By “this work,” she was referring to the fact that I work as a nurse in an abortion clinic. She’s not the first patient that’s asked this question since I started working in the clinic this past September. I still struggle sometimes with how to answer. I’ve been writing and re-writing this post in my head for the past four months, trying to sort through the various emotions I’ve been processing as I settled into this new job.
For background: I mostly work in the recovery room, caring for people as they wake up from general anesthesia after their abortion. I’d say most of our patients are coming in between 6 and 16 weeks for their procedures…but not infrequently, we also care for patients coming in later in their pregnancies, up to 23 weeks. Many of these cases are for fetal anomalies. I also care for patients after local procedures—that is, for patients who opted to not use general anesthesia. Most of these patients are earlier gestation—between 6 and 10 weeks.
So…to answer the question:
In many ways, no, I don’t find it hard at all. In terms of the nursing care itself, it’s not super complicated. My patients are, for the most part, healthy people coming in for a normal out-patient procedure. While some folks have reactions to anesthesia, most people wake up fairly quickly…a bit groggy and often forgetful, but the point is, they wake up, often within 15 minutes of first falling asleep. This is not ICU or trauma or emergency nursing. I monitor their breathing and other vital signs, check for bleeding, assess their ability to safely get home. When they’re awake, I go over pain management and how to take their antibiotics and talk them through what to expect physically over the next few weeks.…most days, I get into a good rhythm and there are few, if any complications.
In other ways, yes, it’s a challenge. I struggle with how to balance the needs of the clinic flow with my own ethics and priorities as a nurse. I want to spend time with my patients, to offer space for them to share their stories and feel heard. I want them to not feel rushed in the recovery process…I want them to feel like they can take an hour, or more, if they need it, gathering the strength they need to walk out of the clinic and back to the rest of their lives. The reality is, I don’t have much time with my patients—maybe a half hour or 40 minutes for general anesthesia patients, 20 minutes for locals. Sometimes that’s enough, but sometimes, it’s not. I feel good knowing that I refer every patient to great organizations like Backline…but I became a nurse to be able to connect with the whole person in front of me, not just offer referrals and take blood pressures.
Is it hard? Is it heavy?
The days in which I care for women who are terminating a deeply desired pregnancy due to a fetal anomaly, yes, it feels hard. What could I possibly do for or say to a woman ending a pregnancy due to a fetal anomaly after rounds and rounds of IVF that might ease her pain?
The days in which I care for a patient who would be thrilled to parent another child but can’t afford the expense, yes, it’s heartbreaking. There are so many systemic issues of inequity at play in the lives of the patients who come to us…to see these same systemic issues play out over and over again feels frustrating.
When I care for someone who for their entire life never thought they’d have an abortion, but whose nausea and vomiting are so horrifically awful that they can’t stand another day of pregnancy…yes, those days feel heavy.
However, contrary to what some people might imagine an abortion clinic to feel like…I find myself laughing and smiling quite a bit at work. My patients are funny…and often draw on their sense of humor to help them through what can be a difficult and uncomfortable experience. We joke about weird family members, lame boyfriends, the crazy protesters outside, how cold the OR is, what they’re going to eat first when they get home, what ridonkulus TV show on Netflix they’re going to curl up and watch. We talk about the mundane as much as the profound, finding moments of warmth and connection in between the fog of anesthesia and the sinking in that this pregnancy—desired or not—is over. For every patient I see with tears of sadness and loss, there are also women who cry and laugh at the same time, sighing an incredible sigh of relief as they smile and reply “Thank God!” when I tell them they’re no longer pregnant.
The heaviness I might feel on any given day is often mitigated by the support of my co-workers, who are wonderful. But here is a truth, one that I don’t share with my patients: while it’s not always heavy work, being an abortion nurse is lonely work.
It’s not something you can generally talk about at a dinner party, or at that family reunion, or on the bus to the person who sits next to you and asks what you do when they notice your scrubs…at least not easily, for most of us. Not many people want to hear about the challenges of being a nurse in an abortion clinic. Add to that the fact that there’s no American Association of Abortion Nurses out there. There’s no network—either within other nursing organizations, or in a professional group designed just for us—for those of us doing this work around the country to come together and share our experiences. I know that there are abortion nurses in private clinics large and small, in hospitals, and in Planned Parenthoods across the country doing the same thing I am…and yet, because no professional nursing organization exists specifically for us, we are scattered like stars across the galaxy…able to glimpse each other from light years away, but generally unable to connect.
This past year has been notable for an increase in public storytelling around experiences of abortion. But that publicity is relegated mostly to those who had abortions, or, sometimes, those who provide the actual abortion. For the nurses, nursing assistants, and medical assistants who also provide much-needed and vital care, our experiences are still largely missing from this conversation. The only organizations that come close are Clinicians for Choice, geared for advanced practice clinicians who perform abortion care (which, as a nurse, I am not), or Nursing Students for Choice (which does fantastic work, but is still more geared towards students).
“Abortion providers are, by and large ostracized from the medical world just as much as abortion has become isolated from the rest of women’s reproductive health care, and this is where abortion and providers are vulnerable…This book left me with a feeling that cannot be squashed. That we are in this together. That we must rebuild a community of all those working in reproductive health and abortion care, not just for our own sakes, but to make this whole community safer and stronger.”
Now that I’m feeling more settled in my role, I find myself wanting to reach out to other nurses doing this work. I know, realistically, that many will make the decision to remain anonymous, heeding very real threats to their safety. I understand and respect that decision. But if you are a nurse willing to reach out, to connect, to share your story, and to potentially find yourself connected other fellow abortion nurses…well…I extend a warm and hearty invitation for you to be in touch. Let’s help take care of each other as we follow our calling to this vital work. The people we serve need us to take care of each other as much as they need us to take care of them.
Growing up, January 22 was not a day I thought of as any different from other days in January. However, as I learned more about the history of reproductive health politics in the United States, this day has transformed into both a celebration and a yearly opportunity to reaffirm my vision of the kind of health care provider I want to be.
Today, on the 41st anniversary of the Roe v. Wade case that legalized abortion in the US, I’m thinking about all the recent hype around the Korean “Baby Boxes.” In theory, they provide a way for “desperate young mothers” who “can’t” parent their infants to “safely” and anonymously give away their children. I’m thinking about what the sanctioning of anonymous abandonment means for the very fabric of Korean society. What does it mean for the human rights and dignity of Korean children, who are suddenly cut off from their families, their birth story, their medical history, and if adopted, their cultural lineage?
As a Korean-American adoptee, I think every day about my birth mother, who became pregnant with me against her will. I wonder how much of her pregnancy, the continuation of her pregnancy, and the process of my adoption felt like a “choice” to her. What options were truly available to her? What would she have done if she had had access to the kind of contraception and family planning care that I believe is a human right? How might her life–and mine–have been different if single-parenting in Korea were a real choice, not a guaranteed sentence to a life-time of stigma and shame?
It should go without saying that I am grateful for my life. Yet at the same time I am deeply troubled by the fact that given what I know of Korean history and politics, it is highly unlikely that my birth mother felt any kind of true agency or empowerment in her decision-making around her pregnancy.
Today I stand with the many unwed Korean mothers, Korean adoptees, activists and leaders in Korea who are voicing their concerns with the Baby Boxes and working to offer real support for all parents, not just those that fit the mold of “appropriate” parents.
I stand with those who refuse to pit abortion and adoption against each other as moral opposites. Adoption is not a more “noble” decision than abortion, nor is abortion immoral. They are simply two of the possible three outcomes of a pregnancy.
I stand with all the leaders in the adult adoptee community who are advocating for more ethical practices in the domestic and international adoption industry.
I stand with the courageous health care providers–the nurses, nurse-practitioners, nurse-midwives, physician’s assistants and physicians who provide compassionate, supportive abortion care every day. I aspire to be among them in the future.
I stand with all the people of the world who have experienced a pregnancy–intended or not–who have felt judged, stigmatized, or ashamed for the way they feel about their pregnancy.
As a Korean-American adoptee, future nurse-midwife, and reproductive justice advocate, I affirm my commitment to be a leader in the realm of full-spectrum reproductive health care. There is so much at stake. We need all of us to create the kind of world that supports all families, regardless of who they are, how much money they have, or what others think of them.
No, this isn’t a post about Star Trek (although, I may have watched it from time to time with my dad).
It’s actually a post (finally) about my amazing weekend in Minneapolis for the first annual Nursing Students for Choice Activist Summit. It came at a great time–I really needed a reminder of why I’m subjecting myself to the stress that is otherwise known as an accelerated nursing program.
It’s so that I can become a full-spectrum nurse-midwife who provides comprehensive reproductive health care.
There’s something so powerful in being in a room full of your people. Do you know what I mean? It’s that feeling of walking in, and recognizing yourself in the people that surround you: We are all here because we are dedicating our lives professionally and personally to ensure that everyone has access to quality health care, including abortion. We’re here because we believe that nurses are leaders in this work.
I’ve been at other conferences related to reproductive health and justice, but always as the younger, not-yet professional. At those conferences I see where I would like to be in ten years. I see the communities that can be built when we network across the country to collaborate together. But that’s not quite the space I’m in yet. I’m hungry to connect with others who share my experience, who are in that messy phase of becoming the kind of health care provider they want to be.
What made this weekend so rich was that it was geared specifically to where I am in my professional development as a nursing/nurse-midwifery student. The workshops spoke to the particular challenges that nursing students face in getting the education and clinical training opportunities they need to become competent providers. We learned strategies from each other about how to advocate for more reproductive health material in both undergrad and grad nursing curriculum. We practiced our decision-assessment and counseling skills. I also really appreciated the chance get hands-on and practice both an MVA and an IUD insertion.
But beyond the specific skills and strategies is something even more valuable to me. What I carried home with me and continue to draw upon is the sense of community we cultivated. There is a new generation of nurses rising up. We’re eager for change. We see ourselves as leaders in the expansion of full-spectrum reproductive health care. It’s incredibly exciting to be a part of the culture change within the world of nursing that will lead to more nurses being involved in abortion care and family planning. Who says we need to wait until we’re RN’s, or CNM’s, or NP’s to start advocating for change? Not us! I look forward to staying connected with the new friends and colleagues I’ve met and continue to support each other in our work.
(Hats off the entire NSfC team that made this gathering happen–you folks are amazing and wonderful and made this first summit an awesome experience!)
I had the opportunity to view this documentary for the second time tonight…it’s an incredibly powerful exploration of the four known physicians who perform late-term abortion care in the U.S. Both times, I came away inspired by the work they do and the strength and courage of the women they serve.
The documentary is a thoughtful reflection of the complexity of the human experience–it moves beyond the black and white of abortion rhetoric and into the messy, sometimes uncomfortable realm of uncertainty and ethical questioning–all of which makes it a rich and moving experience to watch.
One of the things I was struck by on watching it the second time was the warmth and compassion and very human grapplings of each of the four providers. These are four unique human beings who come to their work out of a deeply-rooted passion for women’s choice and autonomy. Yet they clearly struggle at times with their own ethical limits. None of this causes them to doubt the foundation of their work, but it does give us a window into the nuances and challenges that come with doing this work.
There’s a lot I’m still pondering about this documentary…in particular, the juxtaposition of my identity as a reproductive justice activist and my understanding of disability justice and its intersections with abortion…there are no easy answers here, but it’s definitely something that I’ve been thinking a lot about lately.
Check out the trailer or find a showing near you.
So many articles this week! Some of the highlights: exciting news for APC’s in California, one woman’s experience of a later-term abortion, new trends in prenatal screening, a call to action to end the shameful shackling of laboring patients in prisons, and an awesome, awesome story about transgender parenting from Canada. Read on!
Gov. Jerry Brown on Wednesday expanded access to abortion in California, signing a bill to allow nurse practitioners, midwives and physician assistants to perform a common type of the procedure, an aspiration abortion, during the first trimester.
Oregon, Montana, Vermont and New Hampshire allow nurse practitioners to perform such abortions, which use a tube and suction, while several other states, including California, permit nonphysicians to provide drugs to terminate pregnancy.
But the new California law goes further, allowing a wider range of nonphysician practitioners to perform surgical abortions. While other states have passed a tide of laws restricting abortion access, California has gone against the political tide.
Stories like this break my heart…and make me angry. As an aspiring abortion provider, I can’t fathom how anyone involved in abortion care would let personal judgment get in the way of providing compassionate care for their patients, especially in situations like this. I want to believe that all health care providers bring good intentions to their work…but experiences like this remind me that we have a long ways to go.
Was I expecting too much, some special treatment because I wanted my baby, because I felt like my situation was particularly emotionally fraught? Maybe I expected the clinic to feel sorry for me, and they treated me like any other woman having a “regular” abortion. Except no abortion is a “regular” abortion, and no woman having an abortion should be treated with suspicion and disrespect. Every woman having an abortion for any reason deserves a little kindness and warmth. It could make a world of difference.
“Breakthroughs”…but with a lot of nearly impossible ethical dilemmas to ponder. I so admire the work of thoughtful genetic counselors–it’s not an easy job and the growing number of tests makes this one of the more dynamic professions in health care today. Unfortunately, this article doesn’t really delve into the ethical questions of what it means to have more testing available, however, it does touch on some of the financial aspects of testing–which really, is another ethical dilemma of its own.
In the nearly four decades since amniocentesis became widely accepted, new techniques have gradually improved the safety and accuracy of prenatal diagnosis. Prenatal tests for more than 800 genetic disorders have been developed. And the number of women who must undergo amniocentesis or C.V.S. has been greatly reduced.
The headline says it all.
One of the first women who shared her story with Birthing Behind Bars was Linda Rosa. She learned that she was pregnant with twins after entering jail in 2008. Linda Rosa recalled being shackled each time she was taken to see the doctor: “They used to shackle my hands and my legs. I would have to walk with the shackles on my legs, which would leave cuts on the back of my ankles.” Linda had to undergo a C-section and was shackled while recovering in the hospital. She recalled having stitches and staples from her c-section and shackles on her wrists and ankles when she visited her newborn babies in the ICU. “Everywhere I had to go, I had to wear shackles,” she said.
Loved. This. SO. Much. We need to hear more stories like this. It’s so important.
It took nine rounds of intrauterine insemination for Heller to become pregnant. The first four experiences at a Montreal fertility clinic had been quick and impersonal. But their fifth try was worse than usual. The doctor rushed in, never said hello or gave his name, never looked at the women. He asked “insemination?” and they said “yes.” He was quick and rough, Heller recalled, and she bled afterward, something she’d never experienced. He left the lamp on between her legs as he rushed out of the room, they say.
This week: a lovely photo essay and video telling stories about abortion experiences, a reframing of abortion beyond “women’s rights,” questioning the (dreaded) pelvic exam, a new continuing ed opportunity from Evidence Based Birth, revolutionary NICU care, and more on full spectrum doulas from a new blogger!
Love this photo essay:
I was surprised when I started talking openly with my friends and colleagues about abortion how many of them had had one themselves. I hadn’t known that 40 percent of American women will have an abortion during their lifetimes. While it’s a personal and private experience, there are 45 million women in America who share in it, and it shouldn’t be a shameful secret. The silence creates a stigma that prevents a meaningful discussion and understanding in the national debate and dialogue.
I missed this when it first came out, but was happy to come across it recently. There’s a lot of good stuff here that directly speaks to the kind of inclusive environment of care I hope to create as a nurse-midwife.
We must acknowledge and come to terms with the implicit cissexism in assuming that only women have abortions. Trans men have abortions. People who do not identify as women have abortions. They deserve to be represented in our advocacy and activist framework. Honestly, I am guilty of perpetuating that harmful myth, both in my rhetoric and framing. I often frame abortion restrictions as misogynistic attacks meant to control women’s reproductive lives, and that is true. But abortion restrictions also affect the lives of people who aren’t women, and they hinder trans men and gender-non-conforming people and others who were Designated Female at Birth (DFAB) from accessing abortion care, as well.
I know I’m not alone in wondering what the heck the point of this annual exam is…in fact, I was thrilled last year to read Feminist Midwife’s questions about it, too. This week, the NYT’s Jane Brody writes about a growing number of gynecologists who are starting to question the purpose of this exam.
These experts say that for women who are well, a routine bimanual exam is not supported by medical evidence, increases the costs of medical care and discourages some women, especially adolescents, from seeking needed care.
Moreover, the exam sometimes reveals benign conditions that lead to follow-up procedures, including surgery, that do not improve a woman’s health but instead cause anxiety, lost time from work, potential complications and unnecessary costs.
And even more stunning, yet not surprising:
How important is this exam to a doctor’s income? Slightly more than half of those surveyed ranked “ensuring adequate compensation” as very important or moderately important.
One of the most vexing problems in medicine today is the fact that doctors get paid only for performing procedures, not for the time they spend talking with patients to discuss issues of possible medical importance.
Rebecca Dekker, PhD, RN, APRN, over at Evidence Based Birth, is starting an online continuing Ed series, beginning with a class on “Big Babies.” Be sure to check the giveaway!!
This is an awesome, awesome new movement in NICU care: giving parents more responsibility in the care of their newborns.
“With family integrated care, we have done something quite different,” explains Dr. Shoo Lee, pediatrician-in-chief and director of the Maternal-Infant Care Research Centre.
“What we’ve done is to say that for all babies in the NICU, the parents should be the primary caregivers, not the nurses. And the nurses are really teachers to the parents.”
The program was instituted following a 2011-2012 pilot project in which the parents of 40 newborns were asked to spend a minimum of eight hours a day in the NICU and tasked with the overall management of their child’s care.
That included bathing and changing diapers, monitoring the infant’s vital signs, and recording feedings and weight gain on their medical chart. Nurses were responsible for the medical side of care — looking after feeding tubes, adjusting ventilation apparatus and administering medications.
The babies’ progress was compared with those whose care was primarily provided by nurses, and Lee says “the results were phenomenal.”
Full Spectrum Doula: a new blog!
A friend and fellow doula has started this awesome blog about full spectrum doula work…here’s an excerpt from her first post, The Politics of Pain, Part 1
I am very much in favor of a movement that reclaims abortion as a complex matter of the heart, just like birth. Birth and Abortion are the yin and yang of reproductive power. I know that abortion will never be a happy event in the way that birth usually is… but I know it is a powerful experience and I think even in our most “pro-choice” enclaves, we are still blowing it. We are often working to hard to “rescue” people from their circumstances, thereby failing to embrace the growth and change that come with going through something.
So I did a new thing this week, which was to write my [Friday Wrap Up] before Friday…gaspI know! But there were so many things already, I felt I had enough for a post.
Then I found a bunch of new things…so I’m back, to share a few more pieces.
Related to the theme of changing narratives around adoption…Reuters has blown it out of the ballpark with this stunning, heartbreaking series that investigates the underground “re-homing” scene.
Through Yahoo and Facebook groups, parents and others advertise the unwanted children and then pass them to strangers with little or no government scrutiny, sometimes illegally, a Reuters investigation has found. It is a largely lawless marketplace. Often, the children are treated as chattel, and the needs of parents are put ahead of the welfare of the orphans they brought to America.
The practice is called “private re-homing,” a term typically used by owners seeking new homes for their pets. Based on solicitations posted on one of eight similar online bulletin boards, the parallels are striking.
I don’t know which is more sad to me, the fact that this is happening at all…or the fact that it’s been happening for years and only now are people starting to get it. Some people might argue that articles like this will deter “good, well-intentioned” people from considering adoption, increasing the number of children in a broken system. This argument fails to do justice to the fact that it’s a broken system…and the only way we can start changing that system is by shining a strong light on it, exposing the dark side and that has gone unexamined.
The Adoption Policy and Reform Collaborative has issued an official statement in response:
The APRC is acutely aware of the unethical and dangerous “rehoming”* practices that have occurred for more than a decade. We have expressed our concerns with alarm. We look forward to collaborating, from the perspective of adult adopted persons, with other powerful change agents to fully, appropriately, and ethically address adoption disruptions and dissolutions.
*Please note: while the APRC recognizes “disruption,” “dissolution,” “displacement” and “re-homing” as industry terms, APRC members regard these terms as sanitized and rationalizing practices terminating the parent/child relationship. While using industry vernacular in this statement we do not endorse their usage for the reasons indicated.
In response to this New York Magazine article, RH Reality Check’s Martha Kempner offers this follow-up on the idea of “pulling out”, or coitus interruptus, as a method of birth control. Kempner focuses in on research around efficacy of withdrawal, condoms, and other contraceptives, pointing out the obvious, which is withdrawal, when practiced by someone who really knows their body well and has good self-control, is still better than no contraception at all. Kempner quotes Deb Hauser, president of Advocates for Youth:
“I believe that young people should be given honest, accurate information. They have the right to all of the information and when empowered with that information are more able to take agency over their sexual health. That means we should teach youth about withdrawal as an option when they don’t have anything else with them. Withdrawal is much more effective at preventing pregnancy than using nothing. To withhold that information is misguided.”
On the theme of health disparities, this is probably not new news…but still, glad to see folks are bringing it up:
A Women’s eNews analysis finds that 45 percent of U.S. Baby-Friendly hospitals are in cities and towns that have African American populations of 3 percent or less.
A full 83 percent of U.S. Baby-Friendly hospitals are in communities where the African American portion of the population is 13 percent or less.
This geographic segregation of breastfeeding care and support may play a significant role in the lower breastfeeding rates among African American mothers, which in turn means the mothers and the infants do not enjoy the health benefits of breastfeeding.
And finally, this infographic on the geography of unintended pregnancy from Huffington Post, which really speaks for itself:
Like this one opening up in Buffalo, NY!
This is pretty much what I dream of doing someday and the reasons that Dr. Morrison articulates are spot on. I am so, so thrilled to know that this clinic is opening…I hope it’s the first of many that offers true full spectrum care.
“I see a connection between respecting a woman’s right to decide to end a pregnancy and her right to determine how she has her baby,” said Dr. Katharine Morrison, the obstetrician-gynecologist who has owned Buffalo Womenservices since 2005.
“It’s no mystery that I am the person to do this,” Morrison said. “To me, it is about choice. Women have a right to say no to the interventions they get in the hospital.”
About 61 percent of abortions are obtained by women who have children, according to the Guttmacher Institute, a national organization that compiles abortion statistics. Morrison, who also runs an obstetrics practice at the abortion facility, made the case that women who obtain abortions are not a distinct group from those who give birth to babies.
“Both of these experiences – abortion and birth – can exist in a woman’s reproductive life,” she said. “Many mothers have had abortions or will have one.”