"Any other pregnancies?"
Such a simple question. She was cuddling her five-week-old, happily describing how much help she had from her ten-year-old daughter. I could tell as soon as I asked that the answer wasn't so simple. I could tell from the look on her face, from the hesitation as she answered me. I have learned to identify the body language of loss. I made sure I wasn't clicking my pen, or tapping my foot, or in any other way expressing impatience. I waited quietly, openly, and after a minute she said "Well, I had an abortion a few years ago. And I pray every day to God to forgive me".
I'm used to that, to women who believe the messages that they have failed themselves and their God by making this most difficult of choices. I'm used to hearing about the grief and guilt and the tears that show up every year on the day the baby would have been born. And no, this doesn't happen to every woman who has an abortion and no, it's not "post-abortion syndrome". It's the logical result of a traumatic experience brought on, at its root, by a cult of motherhood and femininity that serves the patriarchy by demonizing women. I hate it - I am sickened by it - but I'm used to it. It was her next comment that stopped me cold:
"My last doctor told me I shouldn't tell anyone that, even a doctor. He said I should say I had a miscarriage. But I didn't, and I figured you need to know the difference. And you're a doctor. Doctors aren't supposed to judge people".
He told her what? That she'd done something so shameful, so awful, that she couldn't even include it in her medical history? That she should forget about it, pretend it never happened? Protect herself from being judged by other idiots like him? And no, we're not supposed to do that.
First, do no harm. Sure, "do no harm" means "don't prescribe the wrong medicine" and "don't use patient's suffering for your own ends". But it also means we need to watch our own biases, and our judgments. We can wound with our words as surely as with a scalpel.
It's bad enough that contraception isn't generally covered by insurance and that women who live in poverty often can't access preventive gynecological or prenatal care. It's bad enough that women are assaulted with the dual messages of our culture: be sexual, be "hot", be available, but if you prepare for sex you're a slut, and if you have sex you should be prepared to "suffer the consequences" by having a child you can't afford. It's bad enough that women can't afford to have children because mothers earn less, and are often still responsible for so much of the child care that they can't work full-time. It's bad enough that we have a president who continues to promote abstinence-only sex education despite good evidence that these programs don't work. But I hold my colleagues to a higher standard. We're supposed to put our patients above everything else.
First, do no harm.
Friday, August 24, 2007
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20 comments:
As a woman who has had an abortion, it's damn near impossible to put aside those cultural messages and think about what you as an individual feel is right or wrong for you and your family. There was going to be guilt and anger and trauma and sorrow for me whatever road I took -- but I took the road that gave me a bonus portion of judgment too.
When I take an initial history, I also ask women, "any other pregnancies?" They almost all look surprised that I asked, as if I read their minds about what else might lurk in their personal story. But they also almost always are glad to tell their story and it always makes up an important chapter in one way or another that I would have really missed in knowing them had I not known.
I do see women in the office - and have women as friends - who seem entirely at peace with having had an abortion. And for many women, grief will be inevitable. It's really the shame that bothers me - shame is toxic, and always externally induced.
Poor woman, that is awful. That doctor should be struck off. I hope she felt better after some care from you :)
I work and have worked most of my professional life in a VA hospital, so with a fair number of patients, mostly male, with disturbing and violent histories. I've had patients tell me that they've attacked and/or want to kill their partner or child. I've had patients tell me that they hate various minorities (which is kind of scary for a passing mixed race person sitting alone in a room with a guy trained to kill, but that's a different rant). I've had patients admit to war crimes. All more or less without shame. And your poor patient can't admit to an abortion without feeling judged? There's something deeply wrong with a society in which a man can say casually and without embarressment, "We got shot at from behind a tree so we went and killed everyone in the village. One of them must have been doing it, because it stopped happening" (which is a composite paraphrase, not an actual quote...quite apart from HIPPA, posting some of the actual quotes might trigger) but a woman who has had an abortion is too ashamed to admit it even in confidence to her doctor.
When I went with my girlfriend to the dr after we decided to get an abortion, he was all like "why are you doing this now". I can't imagine what it would have been like if I wasn't there as well.
I have had 3 terminations in my life and only regret one. I am sick to my soul that the idea of forcing a woman to have an unwanted child or being an unwanted child is not the most abhorant concept.
I had an abortion in 1972, before Roe v. Wade, in Madison, WI where a UW Medical School faculty/staff physician was openly challenging the law prohibiting Ab. The day my husband and I were at the clinic there were two other patients in the waiting room. One appeared to be a teen with her parents, the other a middle-aged (menopause baby?) with her husband. I was there with my husband because I had a Dalkon Shield in place and was pregnant. I had a colicky first-baby at home and my husband and I definitely were not prepared to take on another but we also did not know if/how this Dalkon Shield might/would be embedded in a developing fetus. Thus we sought an Ab and have never, and I do mean never, had a twinge of guilt or regret. I defend abortion as the most important right of personal, jurisdictional control that one has. I 'own it' and I share it with my care providers and others when appropriate.
Thank you to all care providers who take their 'first do no harm' oath to heart.
"As a woman who has had an abortion, it's damn near impossible to put aside those cultural messages and think about what you as an individual feel is right or wrong for you and your family."
No kidding! I have been pro-choice and feminist, and independent, etc. my whole life, and while the decision to abort was easy, it was wrought with consequences. Not post-abortion consequences, but the cultural implication that I aborted out of fear, necessity, etc. was too much. I didn't want a baby. Why isn't that enough?
I found this post and your blog through MPJ's blog. I'm glad I did.
I had an abortion myself almost 17 years ago. I am no longer ashamed, but it took a long time to get to that point.
Shame on that stupid doctor! If there is one place where we should be able to be completely honest, it's a the doctor's office. It is hard enough for a lot of women to get past that guilt, and that is without factoring in a judgmental doctor!
I had an abortion last year, and I can attest to the HUGE pressure I face to keep it secret. I have no regrets whatsoever, but everybody else seems to think it's something so shameful that I feel hesitant admitting it. I've yet to tell anybody other than my husband and my best friend, but I volunteer anonymously on an online forum to help other women out by answering their questions about the procedure. I get about 3-4 questions every day. At least 90% of the questioners express fear that having an abortion will leave them sterile; almost all of them seem to have believed SOME scare-tactic of the anti-abortion crowd. They're so thrilled when I am able to cite studies and give them references to see for themselves that their fears are unfounded.
In January I went for a routine physical exam, and the doctor asked me to list any surgeries that I may have had in the past year. I took a deep breath and told him I had an abortion, and I was SO SHOCKED when he just noted it down without comment and moved on as if nothing happened! I immediately switched to him as my primary care physician.
I think there really needs to be a bigger movement to help women come out of the abortion closet. Many women who write to me think they're alone in doing this shameful thing... when in reality 40% of American women have an abortion at some point in their lives. We shouldn't be ashamed of it.
There is a website called imnotsorry.net, where women share their stories about their abortions, and instead of the usual tearjerker-guilt-repentance theme, all the stories on this site are from women who have no regrets. I think it's a great website. My story is archived there as well, under the name "Wendelin".
-Wendelin
I had an abortion four years ago, and no one knows except my husband and the clinic where it was done. I have lied to every doctor I've seen since then. I've worried that maybe not telling my docs has compromised my care (although I don't have any serious health problems). Honestly, though, I think I'm more worried about what happens if I *do* tell them. I don't regret my decision to have an abortion. It was a difficult choice, and in some ways, I still grieve that choice. But that is made more difficult by the fact that I feel like even when it would be important to tell the truth - like when I get a physical - it's too risky to do it.
Terrific post!
Well, if "Do No Harm" is the motto, then abortion is the ultimate harm and is inconsistent with said motto.
Anonymous from 10/25: "do no harm" to living people. Not potential people, actual people.
I hope from your opinion that you support increased access to WIC, subsidized day care, sCHIP and comprehensive parental leave, and that you hold the male parent as responsible as the female parent. Actual people. Living people.
Jay, I just wanted to applaud your response that anonymous comment. Perfectly-put!
What is the possible consequence of not telling my doctor about having this done in my past? I have a polyp she needs to remove, does she need to know? I too am afraid to have this on my record.
To the most recent anonymous,
If you had a first-trimester abortion without complications, then I doubt there would be any real impact on the removal of the polyp, but if you had a termination beyond 12 weeks or if you had any problems with the anesthesia or bleeding afterwards, then the doctor needs to know about that to prevent further problems.
I wish you had a doctor you could trust. You could ask the doc to enter it a a D&C, which is accurate, without identifying it as an abortion per se.
You deserve more support that it sounds as if you're getting.
Thank you so much for replying so quickly. And thank you so much for your compassion. It was in the tenth week. She is going to do an ablation after she removes the polyp to try and prevent more from forming. I am 46.
you shouldn't ask about 'any other pregnancies' medical records are privy to many many people. Many types of doctors too. As a woman who has been shamed, tortured and humiliated by a doctor, I know, you can never fully trust them all. If you can even find one you can fully trust, hang on with your life! I'm still looking.
If there is no medical reason why they need to know, then stop asking please, you are bringing up something we would rather just forget. Please let us.
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