by Jane (October 1973) Parts
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 wouldnt 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? Its all over? Im 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 couldnt 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 abortionstwo 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 womento 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 choicewe 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 womans 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 secretivenessall 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 agreedand many patients agreed enthusiasticallythen 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 soundthat 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 simpledilation, removal of solid material with a forceps, scraping with a curetteit 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 couldnt 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 teampatient, assistant and traineeand 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 womens 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 functionsgiving 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 didnt 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 needsthe 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:
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.