Pelosi Rocks

Nancy Pelosi articulately fields a question from NBC reporter Luke Russet about whether or not she felt like not stepping down to make room for "young leadership" was bad for her party. Congresswoman Pelosi correctly points out 2 things: that men in Congress are never asked to step aside based on their age and that she came to Congress later than she might have if she were a man because she only ran for Congress after her fifth child was about to go off to college.

As one of the most successful Speakers of the House - and the person we really need to thank for promise and hope given by the Affordable Care Act, among many other things - it seems perfectly reasonable for her to continue her incredible career.

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"Let's for the moment honor it as a legitimate question, 

although it's quite offensive but you don't realize it, I guess"

- Nancy Pelosi (D-CA, Minority Leader)

the turnaway study

*according to this new study, this woman is very wrong.

One of the hypotheticals that is always touched on in reproductive rights discussions is what would happen if we simply did not allow women to have abortions?  Well, the Turnaway study from San Francisco-based research group Advancing New Standards in Reproductive Health (ANSIRH), investigated that question and just presented their first results.  

There's a great overview on the Slate XX blog to check out.

In brief, the group followed over 1000 women across the country who went to have abortions.  Most were able to obtain abortions (97% had no regret), but almost 200 women were not able to have abortions, usually because they were farther along in their pregnancies than the places they went to have abortions would perform the procedure.  The researchers interviewed these women extensively and compared them with the group who was able to obtain abortions.  

A few (of the many) things worth mentioning:

1. women not able to have abortions were more likely to be financially struggling a year later.

Compared to the group who did have abortions, a year later (the study is ongoing) those who were "turned away" were more likely to be on government assistance, living beneath the poverty line, and less likely to be working full time.  

2. women not able to have abortions were more stressed.

They also reported more stress and were equally as likely to be depressed as the other group of women (as in, no happier).  

3. women not able to have abortions had more medical problems.

Including pregnancy complications and postpartum complications (abortion is almost always safer than pregnancy, as is birth control).  

4. women not able to have abortions were more likely to be victims of domestic abuse.

The researchers attribute this not to the "turn-aways" being more likely to enter into abusive relationships, but being less able to get out of them while pregnant/with a new baby.  But this didn't mean that men were more likely to stick around - they found that "men were no more likely to live with a turnaway who'd borne their children than they were to live with a woman who had an abortion".

This study is excellent data to add to the discussion of women's reproductive rights - showing that the consequences of our reproductive choices are far-reaching and longer lasting than just 9 months.

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"As women's access to abortion care...becomes increasingly restricted, it is extremely important to document the effect of unintended pregnancy on women and their families.  The Turnaway Study is an effort to capture women's stories, understand the role of abortion in women's lives, and contribute to the ongoing public policy debate on the mental health and life course consequences of abortion and unwanted childbearing for women."

- taken from the Turnaway study website, under Why this study is Important

(*I copied this image from the Slate XX blog review of the turnaway study, because it was just so good)

believing the whole concept

Back to Sarah* (*obviously not her real name) and our counseling session.  Sarah started the session by listing quickly - before we could even ask her any questions - all the reasons why terminating her pregnancy was the right thing.  Reasons that she - and many other woman- have cited included that her "life is a mess" and she could not responsibly bring a new life into it.  Sarah* was living with an on again/off again boyfriend who she loved, but struggled with uncontrolled and unpredictable bipolar disorder.  The two of them had been living in a van under a bridge for the past several months.  They were both having a hard time finding work.  Neither one of them had any support from or connection to family in the area, nor did they have any other resources to draw on.

She went on for several minutes listing these reasons and more.  We listened.  Then she stopped and paused, looking at us to see if we had anything to say, almost looking for our agreement with her reasoning.  But the very wise and experienced counselor said nothing, just waited.  I wasn't sure what to do, so I said nothing, and waited.  Then Sarah* said, "but the truth is, I want to be a mother more than anything else in the whole world.  Even though it doesn't make sense.  Even though it's not responsible.".

And that's when the counseling began, as the counselor started asking questions to help Sarah* work out what she thought and felt.  To help her see her situation in the truest light - without judgement, but without rose colored glasses either.

Sarah* said that she was concerned that if she terminated her pregnancy, that in several months - when the baby that would have been actually would have been - what if her life was better?  What if it was now responsible for her to bring a new life into it? What if she and her boyfriend had figured out jobs, had found an apartment, had organized their lives - would she then feel incredibly guilty and regretful that she had ended the pregnancy?

The wise counselor listened and finally said, "You know, Sarah*, no matter what you decide to do in this situation, your life will be different in several months.  And if you decide to end the pregnancy and your life is better in several months, how will you know that this decision didn't help you to make your life better? And if you decide not to end the pregnancy and your life is better in several months, how will you know that this decision didn't help you make your life better?  We just have no way of knowing how our lives would have turned out if we made other decisions, but I can tell you that this decision you are making now will absolutely affect your life over the next few months - because it will be very different if you are pregnant and expecting a baby than if you are not.  Only you can make this decision, but once you have made it, don't judge yourself for it, or think of all the other possibilities that could have been - because it will be different."

Later, after Sarah* left, without terminating her pregnancy, to think more about her decision, the wise counselor and I debriefed.  We talked about how even though her reasons for why she should not be a mother right now make logical sense to us - that if we really believe in a woman's right to choose, a woman's right to make decisions about her own body, then we cannot judge her decision, we cannot think to ourselves that she should make one decision over the other.  Our role is to help her make the best decision for her, in a non-judging, non-assuming way.

It's definitely hard, but feels incredibly important.

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"A woman's life can really be a succession of lives, each revolving around some emotionally compelling situation or challenge, and each marked off by some intense experience"

-Wallis Simpson, Duchess of Windsor (1896-1986)

Choosing What We Show

Recently, I interacted with a woman around my age who had come to the clinic where I was working with the intention of terminating her pregnancy.  It's been so long I can't remember how many weeks along she was, but not far.  Women enter these difficult and emotionally wrought visits with a clinician in all styles.  Some openly weep, some list all the reasons why this is the right decision - as if convincing themselves, some are silent and refuse to make eye contact, many are curious - about the pregnancy, about their options, about what they might see or not see, how their lives may be different depending on how they choose.

I feel so lucky to live in a country, in a time, when women get to make these decisions - though saddened that their decisions were not instead the less emotionally draining one of choosing effective birth control or choosing not to have sex in the first place.  I feel even more lucky to have worked in a clinic that allowed women the space to feel, think, and process whatever they needed.

This woman, let's call her Sarah* (*obviously not her real name), knew she was pregnant but was not sure how many weeks - so we did an abdominal (on the belly) ultrasound to take measurements to date her pregnancy.  There has been a good deal research on interactions with ultrasound technicians by women considering termination and the data is surprising.  But first, because ultrasound is a tricky subject these days, let me set the facts straight: everyone who is seeking or considering a termination usually has an ultrasound to date the pregnancy, because this determines many things about the possible procedures and counseling.  In the vast majority of cases, this ultrasound is done abdominally (on the belly) and is only done transvaginally (in the vagina) if the pregnancy is too early, and therefore the uterus too low in the pelvis and too small to see through the abdomen.  There are some people trying to pass laws about ultrasound and pregnancy termination that require very different things, including transvaginal ultrasounds, narration of ultrasounds, listening to heart beats, seeing moving images, etc.  This has not been my experience.  

In research investigating how to interact with a woman considering termination when conducting an abdominal (on the belly) ultrasound, the results are surprising in that many women are interested in seeing the image, many would even like an image printed to take home.  Even more fascinating is that there does not seem to be a pattern with the choices women make (in terms of keeping the pregnancy or terminating the pregnancy).  Additionally, when ultrasonographers (the people who do the ultrasounds) and clinicians are interviewed, they largely believe that women should not see the ultrasound if they are considering or have decided to terminate a pregnancy.  There are still many questions to be answered - including if the age of gestation matters (many of these papers were only involving women who were intending to have first trimester terminations), larger sample sizes, longer term effects, correlation with other factors such as parity and reasons for termination.

Planned Parenthood has a national policy where every woman is asked, before stepping into the ultrasound room, if she would like to know if she has more than one pregnancy (twins, triplets, etc), and if she would like to see any images.  Anecdotally, I have been told that most other clinics don't ask and do not offer unless the woman asks explicitly to see a picture.  

As I have had more experience with this, and after hearing an amazing presentation on some soon to be published data on women's experiences of ultrasound before a termination, I decided that I am going to ask women if there is anything they would like to see or not see, know or not know.  And I have been fascinated by the results.  

Which brings me back - finally - to Sarah*.  Sarah was very quiet when I brought her to the ultrsound room.  I had already asked Sarah the same question I ask everyone and she had said she would like to see an image.  Again, based on experience, the teaching I have received, and the data I have seen, whenever I show anyone an image, I zoom out so that there's slightly more realistic perspective of the size of the pregnancy, and I point out the abdominal wall, the uterus, and the pregnancy, as well as any other obvious structures.  When I did this for Sarah, she started crying.  In my desire to comfort her, I quickly turned the ultrasound away from her and sat in a chair next to her.  I asked her what was going on her in head at that moment, and if there was anything I could help with.  When she shook her head No, I put my hand on her back and reminded her that the next step at our clinic is to talk in depth with a counselor.  I asked her if she wanted to see any other images, and when she said No, I walked with her to the counselor's office, where the three of us sat and talked for a long time.

To be continued in the next post, as it takes this thought in a slightly different direction.

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"I pointed out that she was, by definition, pro-choice.  In its simplest form all it means is that the woman gets to decide".

-Susan Wicklund, Physician and Author of This Common Secret

(click the link to see a NYT review of her book)