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Jul 16 2013

A Taste of Things to Come – Rise of the Backstreet Abortionist

American women have lost a great deal of freedom in the past few weeks. All across the USA various states are planning to either reduce funding to bodies such as Planned Parenthood or to try and make abortions more difficult to perform and obtain. South Dakota has passed laws to reduce the period of abortion to just 20 weeks. Women have to undergo a series of unnecessary and traumatic procedures just to decide what to do with their own bodies. Recently we have seen the rise of “stealth” pro-life and the shutting down of clinics by making other laws hard to abide by.

Warning!

TW – Abortion/Experiences

The most recent one being Texas. After the epic filibuster by Wendy Davis, hopes were up that women in Texas would be safe but it was not to be. Rick Perry pushed the bill through. Women in Texas are not allowed to get proper basic healthcare any more.

That’s right. Abortions are considered BASIC Obstetric and Gynaecology. The right to one is basic control over reproduction. Many of my patients have BETTER (read it and weep America) access to contraceptives, real honest sex education, family planning and abortion than Texan women. 

And let us not kid ourselves. Rick Perry and his friends aren’t doing this for the future of Texans! If they did they wouldn’t be dicking around with religion in science class or cuts to education or be unwilling to subsidise higher education or healthcare. It’s like saying that you care about dogs because you think puppies are cute as you are caught abandoning your dog at a street corner.

I am rewriting a piece I did when the Republican Majority was planning to defund Planned Parenthood. Where Cheap Obs/Gynae care, vaccinations, Child Wellness, Contraception and indeed Abortion were deemed as unessential. You can claim it is cost cutting but these programs save money in the long run by prevention of disease rather than cures.

The arguments boil down to the presence of a human soul. Some say it’s divinely manifest to human beings at birth. Others specify an arbitrary month from which the baby is considered alive. I say it’s an illusionary concept brought on by the wish that we could live forever. The soul is the idea that our consciousness can transcend death and live forever maintaining our experiences and personalities. However, we know that it’s just an illusion brought on by the complexity of our brain and the fact that we are self aware. Our personalities, our thoughts our experience are all part of the hardware of our brains, consisting of millions of neurons. We know that damage to these neurons changes our personality and our ability to control our body. The human soul is sadly wishful thinking and the desire to preserve our mind beyond death, an extension of the desire to live forever and escape the failure of flesh. And this must begin at some point after all!

An abortion is a terrible thing; in an ideal world we wouldn’t need any. No woman WANTS an abortion unless necessary. The people deciding the fate of women’s reproductive health are men who have no idea of the thought that goes into an abortion and the cost of said abortion on the woman’s body and indeed on her own psyche. Not to mention they have no idea of the cost they are now forcing women to pay by forcing them to term and making them jump through the various hoops in a decision that is already difficult. Making it more difficult just hurts women rather than saving the children.

The men who support this movement do so often out of blind faith or worse without understanding the issues. The women who support the pro-life movement often cannot see a reason why any other woman would choose to end a foetus’s potential life. It’s a movement of privilege and of a lack of perspective in the reality of the world.

However we do have a world where there are some countries where abortion is illegal and sex education are talked of in hushed tones and in the words of abstinence rather than contraception and rhythm methods rather than the oral contraceptive pill. It is from here we can see what a world with no access to tested sex education and contraceptions is really like.

Internationally, the struggle for abortion rights continues. From 1994 onwards the right to abortion has been regarded as part of the Reproductive Health and Rights as laid out at the International Conference on Population and Development. It is estimated that roughly 19 million non-medical abortions a year occur and that roughly 13% of maternal deaths are due to such an abortion. In addition there are huge medical bills generated by treating women who have had complications from such an abortion. Across most of the world little priority is given to reducing unplanned pregnancy and reducing unsafe abortions by increasing contraception and education. In fact in a lot of the world there exist entities that seeks to prevent such information, most famously the Catholic Church.

Specifically in the Philippines, where the catholic church’s campaign to ban contraception and active campaigns to prevent their use also coincide with a massive anti-abortion drive with the provision of medical abortions being illegal. While a lot of progress has been made since I first wrote this article, the historical treatment of women has been nothing short of horrid. In the next 30 years, it’s estimated that the population in the Philippines will double to 170 million people. In perspective this is half the population of the USA on an area of land slightly smaller than Italy. It is estimated that 35% live in the slums and below the poverty line. Often living on rubbish dumps and in landfill sites and with little to no hope of a solid income. Starvation is common with many families eating less than 3 meals a day. Close to 40% of the population are under 15 and this demography is rising. Many families have more than two children. A doctor was required to prescribe contraceptives and can chose to not do so. Many doctors refuse to give out contraception to single women. Doctors are often encouraged to tell their patients to use catholic approved methodology both by their churches and by their superiors and many government clinics ban dispensation of condoms. However many doctors provide such services illegally.

The church believes that there is no real problem with this even proudly stating that because of the huge population, the Philippines is a major source of man power the world over. Many politicians in the government believe this and enforce bans to encourage the pro life movement. The Philippines actually has a problem where there are insufficient local jobs forcing the economy to be reliant on overseas investment from it’s own nationals. They are less forthcoming about the treatment of the Philippine people in the Middle-East where they are often treated as little better than slaves or whether a population export business is really sustainable in the long run.

For many in the American Religious Right Wing, it has become a testing ground for their hypothesis on family planning. Many pro-life support groups fund education in “natural” contraception and abstinence education here. Operation Outcry is one such centre which spreads misinformation.

My time was spent with groups such as Likhaan Centre for Women’s Health who used to receive aid from the US government. The Rise of the Bush administration caused a cut to the international aid budget to organisations that encouraged contraception over abstinence.

Despite abortion being illegal, there are medical practitioners who provide safe clandestine abortions. Sometimes at cost, sometimes for charities risking their licenses and jail terms to ensure women are safe. The cost of such an abortion is between £40 to £60, which is a large sum of money when you live on a garbage dump. However the majority of abortions are unsafe.

The vast majority of abortions that occur are performed by local healers and are via abdominal massage which can cause incredibly painful abortions and severe damage to the uterine wall that can cause death. These are done without anaesthesia and any modern medical support. It is the equivalent of being punched in the stomach. Many hospitals do not report abortion attempts to the police. It would scare the few women who do come in and increase the death toll.

Some of the testimonials I have found looking through literature from Likhaan and their involvement with Unreported World are heart breaking, I have reprinted some.

“Remy has had two attempts at abortion, where she tried to induce abortion by massaging her own abdomen, but she gave birth each time to a son. The third time she took bitter herbs and threw herself out of a window. When that didn’t work she continued to massage her abdomen until one day she felt her water break and watched blood flow down. She blacked out from the pain. She bitterly wished she had access to contraceptives earlier in life. In the eyes of the church, she had committed a crime, a mortal sin by killing her own flesh and blood. She couldn’t afford to have this child; she already had two children she could not afford to feed. To bring a third into this world would have been a crime in itself.”

“The abortionist is not medically trained; she says she learnt how to do the procedure when working with another doctor who used to perform back alley abortions. However she can only do abortions up to 8 weeks, beyond that and the procedure becomes dangerous.  The girl she is treating is crying, even though she is under anaesthetic for the loss of her baby. The baby is 11 weeks old, this time she is lucky but other women have had to be taken to the hospital”

“Many women are scared of coming to the hospital, many leave it so late that they are on the verge of death. Most are bleeding profusely, have infections or are septic. Often have tried to induce abortion using a sharp bamboo stick or a guava tree branch or consumed cytotan which induces contractions”

It is estimated that nearly 400,000 medically unsafe abortions take place annually here with nearly 80,000 women hospitalised yearly, and that 12% of maternal deaths occur due to unsafe non-medical abortion. (sourced from Juarez, Fatima et al.)

This was in 1994; it is believed that the number has risen every single year. It is impossible to hold any survey without risking the women involved and the abortion providers themselves are operating outside the law. The back street abortionists see themselves as providing a essential service and alleviating suffering by stopping that of the others despite being staunch catholics themselves.

These are not crimes of hatred but the efforts of loving mothers who don’t wish to bring a child into a world where they cannot feed and clothe the child. Each one is wracked by incredible guilt due to the actions of their faith without realising the cause for their suffering is the catholic restriction on contraception, education and abortions. Many of the women believe that the fact they survive the harrowing abortion process is testament to the fact that God forgives them for their sin and that god understands why they did it. To them undergoing their back street abortions is literally putting their lives in God’s hands and akin to a religious experience. Many of the abortionists ply their trade just outside the largest churches, many of them see themselves as doing “god’s” work.

What would we see in the USA? How many doctors would take to providing abortions in places where it was banned? How many nurses and how many quacks? How many women will have to throw themselves down stairs or from windows?

This legislation builds on the strong and unwavering commitment we have made to defend life and protect women’s health. I am proud of our lawmakers, and citizens who tirelessly defended our smallest and most vulnerable Texans and future Texans – Rick Perry

If you cared for the future texans you would offer all mothers free healthcare, proper sex ed, proper abortions, free creche services and a decent education system rather than trying to insert Jesus into any place you can fit him. The cynic in me suggests that Rick Perry’s been investing in coat hanger futures.

Oh… Classy!

Oh don’t get upset! He’s got a comeback!

Oh man! The Burn!

Except Erick here assumes that the world boils down to coat hangers and child decapitation. Foetal decapitation is done to abort a late term baby with minimal distress to the mother. The ultimate irony was that it’s mainly done in the USA because they halted partial birth abortions. So we have to dismember the foetus and remove it during late term abortions rather than simply collapsing the skull.

These are rare abortions. less than  5% of all abortions take place after the 20th week. But those are the abortions that are the most needed. I will give you an example later.

I have seen a coat hanger abortion. I have met it’s survivors. They are the ones who endure throwing themselves down stairs and the like. I am sure a lot of people would say that they should have kept their legs shut. Maybe. Those people should keep their mouths shut, yet we still have to listen to them.

What you call a “Coat Hanger Abortion” is an unsafe abortion classed as “ROM” or “Rupture of Membrane” (RUM sometimes Rupture Uterine Membrane). It is part of a safe abortion too, except the person doing it is a skilled doctor with over 7 years of basic education, 3 years of clinical experience MINIMUM and either under supervision of a doctor with the skills and training or has trained over another 5 to 7 years to call themselves and Obs/Gynae. In short they are as skilled as you can get in the field.

The unsafe version is done by someone who’s shoving a sharp bit of anything in the hope of hitting the cervix and puncturing the membrane. It’s the difference between skill and someone who owns a speculum vs. the mother often self aborting.

This style of unsafe abortion is generally done solo in the west. In Asia it’s often assisted and is a “traditional” method of abortions. The solo nature of this makes it dangerous. A doctor will rupture the membrane using a speculum to visualise  the cervix and with the patient immobilised in stirrups in the lithotomy position (AKA The Position that every woman ever depicted in an Obs/Gynae uses). This is a luxury among women without access to the talents of baby killers and so they must make do.

The coat hanger we are discussing is the wire afffair. It’s rather hard to actually do it with the plastic affair unless you break it apart.

To put it into perspective. It’s like trying to thread a sharpened object into a balloon if the walls of the balloon were made out of cake. If you touch them with the sharp bit you lose, good game have fun.

The solo self abortionist while unskilled is enthusiastic. It’s almost as if such an individual doesn’t want the baby. To this end she has to thrust the coat hanger into her vagina with the hope of threading it through the cervix. Most women who do this and who come in have no idea why they were doing it. They just figure it would cause the foetus to stop developing or cause a miscarriage. They hear about it from word of mouth.

It’s why I specifically learnt all my medicine from strange men in the pub rather than a university. Because word of mouth is an excellent teacher of clinical skills. No wait… It’s not.

So she doesn’t know what she is doing, merely hoping that something happens. The waggle it about and hope it works methodology of medicine. What she is hoping is to pass the point of the object through the cervical opening, rupture the membranes and cause the leak of amnion liquor. This will eventually cause the foetus to die and be miscarried. Stressful but less so than having the baby.

The uterine wall is soft and spongy during pregnancy. It’s thick but not very muscular. It’s richly supplied with blood vessels as it forms part of the exchange surface with the placenta (which helps the baby breathe). Now you can rupture ANY of these with a sharp object that is blindly inserted. This leads to massive blood loss. Not helped by the fact that pregnancy causes physiological strain that reduces a woman’s capacity to tolerate blood loss.

Due to the nature of handedness, chances are the blood vessel hit is the uterine artery. Arterial bleeding is powered by the heart. You can bleed out in minutes. Shock ensues followed by death if there is no medical staff present to control it.

Which is one scenario.

The other is rather more anatomical and while rare has been noted.

Posterior to the uterine wall lies the colon and bowels. These are relatively less innervated. A posterior puncture on the uterus may perforate the bowel. Faecal matter slowly escapes and causes peritonitis and localised infection.

The treatment of which requires major surgery and medical care. Abscesses need to be drained, bowel needs to be removed. Some patients require a colostomy. The uterus due to the tracking effect will also be contaminated and require a hysterectomy. Patients can die from this. Die slowly.

But Avi! What if she gets it right!

Well, if she hits the membrane alone we must remember that a coat hanger is not sterile. Which is why I don’t use a coat hanger for any medical procedures apart from the one where I use one to hold up my white coat. She can easily pass a pathogen into the uterus which is what causes the miscarriage. The bacteria however can cross into that blood rich medium that is the uterus and cause septicaemia. She may live.

This is a gamble. Women are gambling with their lives. Women gamble with their lives everyday.

And in the minds of the pro-lifer women do this because they hate foetuses. That their hatred is so much that they would rather kill it with a coat hanger and risk death than spend just one more minute carrying it. Or you know. We can live in the real world where women do this because they are not ready to care for a child and don’t want to bring a child into a world with an unprepared parent or when they do not have the resources to take care of it. You know. When they are being responsible and adult.

The pro-life argument is the argument of 8 year old girls who have spent their lives playing with dolls and who think real babies are just that.

But Coat Hangers are funny right? Ho Ho Ho.

I speak as someone who would be classed as a baby killer.

“Put in a double IV”

That was the first thing they said to me. I quickly grabbed two venflon ports and started to roll up her sleeve.

“Take some blood.” they screamed as an after thought.

3 minutes later the nurse is running away with a syringe of blood and the first line has started. The second line is ready in another 2 minutes. The woman is pregnant. and has been pregnant for 24 weeks. She’s bleeding from the vagina. It’s a shocking amount of blood. The woman is struggling to breathe and her BP is still dropping.

We prep for surgery and while doing so we take her foetal heart rate.

We fear for placenta praevia. So we don’t do an examination.

Placenta Praevia. A placenta lying on top of the cervical outlet. The baby’s movements have ruptured the arteries. At this rate the woman and the baby will both die. You cannot do nothing. You should NOT do nothing. We quickly get a ultrasound machine in. This woman had no idea she was having a ticking time bomb. A PV exam would cause a haemorrhage.

We cannot save the foetus. The blood loss is too great. So we abort it. The foetus is delivered along with the placenta. If the exsanguination didn’t kill it then the surgery to save her life did. 24 weeks is too early in India to save the foetus and honestly the prognosis for such a foetus is not great. Life is important, so is quality of life. If you live after being anoxic for 20 minutes then what wakes up will be a shadow of what you were.

But in the eyes of the pro-lifer we are murderers. We didn’t try and let “nature” take it’s course. Or pray to their god to intervene.

The woman lived.

This year a girl called Kuzhali was born. 2.8 Kg. Her mother will tell her she nearly had an older brother. This was not  an unwanted child. I know. I made the footprints for her. I never asked what name she wanted. I just gave it to her. We did what we could so that she could have a second chance and bring someone into the world who she could love and be proud of.

We cannot demand women to go down with their foetuses like the captain of the Titanic. We cannot claim that a “good” mother would never have an abortion because we are boiling down motherhood into “possession of a child” rather than everything else that entails.

Today I got to lead a team in a simulation doing this. I got to make the decisions. I did “poorly”. It was my first go. I will get better. I felt it was fitting.

I have seen 3 cases of this. Each time the foetus did not make it.

So tell me again>? Who is pro-life here? How are we protecting the lives of the baby by risking it with the mother? Are we going to ban masturbation as it is a waste of future Texans? Is every egg so sacred that the mere act of not having a baby be equated to murder? How can you menstruate? Don’t you know that’s a future Texan?

Deal with the real living Texans first Mr. Perry. Be less pro-life and more pro-living.

13 comments

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  1. 1
    Ophelia Benson

    Many of my patients have BETTER (read it and weep America) access to contraceptives, real honest sex education, family planning and abortion than Texan women.

    I know, right? I made the same point in Dublin – “don’t go thinking Ireland is uniquely terrible, and by the way the US is way more terrible than most people realize.”

    It’s shaming.

  2. 2
    Omar Puhleez

    Clerics seem to have a hard time feeling that they are in control of ‘their’ community unless at the same time they control everyone outside it as well.

  3. 3
    Giliell, professional cynic -Ilk-

    An abortion is a terrible thing; in an ideal world we wouldn’t need any. No woman WANTS an abortion unless necessary.

    No, sorry, I don’t like that framing.
    The need for an abortion might be terrible. The abortion itself is a neutral medical procedure. We don’t frame a root canal or open heart surgery as “a terrible thing”. Sure, we’d like there to be less need for them, but we don’t think that they’re terrible things.
    And I’m speaking as somebody who had one of those abortions where the reasons were terrible because the wanted fetus died.
    Apart from that: Yes.

  4. 4
    irisvanderpluym

    Excellent, epic rant, Avi. Well done.

    That said, I strongly agree with Giliell. The whole paragraph from which she took that line could use a rewrite or a redact, except for the last sentence:

    An abortion is a terrible thing; in an ideal world we wouldn’t need any. No woman WANTS an abortion unless necessary. The people deciding the fate of women’s reproductive health are men who have no idea of the thought that goes into an abortion and the cost of said abortion on the woman’s body and indeed on her own psyche. Not to mention they have no idea of the cost they are now forcing women to pay by forcing them to term and making them jump through the various hoops in a decision that is already difficult. Making it more difficult just hurts women rather than saving the children.

    Unless you are using “terrible” to mean “not fun,” this is inaccurate. Many women who have early term abortions (surgical or pharmaceutical) feel little more than inconvenienced. (Root canal and open heart surgery are way more “terrible,” with respect to pain!) Further, frequently an abortion poses little or no cost to a woman’s psyche. Sometimes quite the opposite: more like enormous relief. Last, the decision to terminate a pregnancy is not always a difficult one…at all. In cases ranging from a lethal fetal abnormality to a woman struggling to feed her existing children to a medical student, for certain women in certain circumstances it’s a no-brainer.

    Your perspective may just reflect your own clinical and personal experiences, and understandably so. But you should know that there are many women who have abortions—probably universally those with safe, legal access to abortion services, unlike more and more women in the U.S. every day—who do not share those perspectives.

    One more thing: in case your readers are interested, here is a link you kindly sent me a few years back to video from The Unreported World (2006): Philippines – City of Guilt (1 of 2) (2 of 2). [TRIGGER WARNING: as horrific and disturbing as it is important and informative, this documentary depicts the living hell on earth the Catholic Church wants for all of us.]

  5. 5
    Giliell, professional cynic -Ilk-

    Many women who have early term abortions (surgical or pharmaceutical) feel little more than inconvenienced. (Root canal and open heart surgery are way more “terrible,” with respect to pain!) Further, frequently an abortion poses little or no cost to a woman’s psyche. Sometimes quite the opposite: more like enormous relief. Last, the decision to terminate a pregnancy is not always a difficult one…at all. In cases ranging from a lethal fetal abnormality to a woman struggling to feed her existing children to a medical student, for certain women in certain circumstances it’s a no-brainer.

    This, so much.
    The abortion procedure itself wasn’t too bad. Worst were the after-effects of the narcotics since I needed a D&E. The psychological hurt was caused by the circumstances that it was a wanted pregnancy. The procedure itself was what I really, really, really wanted and was really, really grateful for getting that very same day.
    Costs on women’s psyches usually are caused by either circumstances like mine, or by women wanting children but being aware that right at that moment it would be an irresponsible action. If pro-lifers wanted to avoid those abortions they would lobby for massive funding in medical research, sex-ed and contraception and of course social security. But they don’t.
    And then there those adverse effects that are solely caused by telling women that they should feel bad about it. framing abortion as a “necessary evil” adds to that, even when done with the best intentions. That’s why “safe, legal and rare” is problematic. We don’t talk like this about root canals.

  6. 6
    Randomfactor

    Tonight, I’ll be attending a local government meeting to help fight an amateurishly-written city ordinance which would allow local god-botherers to sue Planned Parenthood doctors for performing abortions. Or pharmacists providing Plan B. Or doctors removing a dead fetus. Or, quite possibly, anyone selling condoms. It’s that badly written. It will be challenged in court, and almost certainly cost the city considerable attorney fees in the process.

    This action is being attempted in a fairly major city within one of the richest and best educated states in the US (well, counting the rest of the state, my fellow citizens are of fairly low literacy.)

    The local government is so stupid as to think this is a good thing despite warnings. Those fellow citizens of low literacy? They keep re-electing them.

  7. 7
    irisvanderpluym

    Thanks for fighting, Randomfactor.

  8. 8
    Avicenna

    @Randomfactor

    I may have a little show for you…

    https://www.youtube.com/watch?v=uX2Bgc5VKzU

    This is one of the realities of the Philippines.

    It’s pretty harrowing. Like Trigger Warnings.

    I went to a HIV conference there, it was… weird seeing a pro-life anti-contraception conference. It was nearly as bad as the infamous South African Salad Bar.

  9. 9
    Randomfactor

    Update: Fuller report here:

    http://www.dailykos.com/story/2013/07/17/1224583/-It-s-Not-Just-Texas

    …but a synopsis: Good turnout, about two-to-one against the ordinance. I’m told it’s unlikely to pass in its present form and will likely be neutered to some sort of “feel-good” pro-life statement on behalf of the City Council that will have as much practical effect as declaring “I Love Puppies Week” does on the local animal shelter. But then again, this is Bakersfield, CA, which is legitimately a part of the third world as expressed in the United States.

  10. 10
    irisvanderpluym

    Interesting that the d00d behind the bill did not speak. Maybe he got off on the spectacle, knowing that it resulted from his actions. When you spend a lot of time focused on imaginary beings (gods, unborn “babies”) on a regular enough basis, I can see why it might become a psychological imperative to have your existence acknowledged by actual humans.

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