11.21.15 – State mandates

I have officially scheduled my abortion procedure. I’m fortunate to live in an area where there are several locations near my home. In many places in Michigan, uninsured women have to travel over an hour to the nearest clinic. If I had insurance, and a primary care physician, I would like schedule the procedure at their office, but without I must find a clinic that offers affordable treatment options. With little experience on this matter, I selected the clinic with the highest Google review stars. A simple search: “Metro Detroit Abortion Services,” a brief scan of customer reviews and a phone call.

Like most medical procedures, getting an abortion is not a simple process. I think that I’ve always somewhat assumed that early-term abortion was nothing to bat an eyelash at. I’ve taken Plan B, I know many women who have terminated their pregnancy and the focus of the conversation always seems to revolve around the decision and much less about the actual medical process. Perhaps we downplay how much of an ordeal it is to get the abortion because we fear stoking the flames of the irrational? So much attention is focused on the “horrors” of late term or surgical abortion it seems that very little is said about the medical procedure, which is the most common.  Regardless of your opinion on the matter,  there is no doubt that getting an abortion is at least logistically a pain in the ass.

I spent about twelve minutes on the phone today setting up my appointment. I called and told the woman who answered the phone that I wanted to schedule an abortion. She then asked me if I wanted a medical or surgical procedure. I wasn’t really sure what either entailed, but I asked which one was more affordable. They are the same price. But, because surgical sounds more intensive – and from what I’ve read it is – I opted for medical. I asked her to explain it to me.   A medical abortion induces a miscarriage. It’s actually the same process many women undergo if they must terminate their pregnancy due to health concerns, so I suppose the stigma really does revolve around the decision rather than the reality of actually being able to carry a baby to term. There is a series of two pills (mifepristone and misoprostol) that works by blocking the hormone progesterone, which causes the uterus to break down and stop the pregnancy. The second medicine causes the uterus to empty.  The woman on the phone did not offer to explain what’s involved in a surgical abortion. I also didn’t ask.

She informed me that the medical abortion has an $800 price tag not including the additional cost of antibiotics and pain medication. Turns out that I qualify for financial assistance, bringing my out of pocket expenses down to $360.   Then, she started reading this long-winded script, which began something like, “I’m required to tell you the following information by law. The only thing you have to remember from it is today’s date and time because we will ask you for it later.” The next minute was a descriptive jumble of confusing requirements imposed by the state quickly rounded up by – “got that?” – sure, I guess.

I was told that I must print, receive by fax or physically pick up state-mandated informed consent materials at least twenty-four hours in advance of my procedure. Informed consent materials are written by the Michigan Department of Community Health rather than medical professionals and are intended to “provide a woman with accurate and unbiased information,” under the assumption that the medical professional selected by the patient cannot be trusted to do so, and that the state is more qualified to inform a woman about medical procedures than her doctor. The State of Michigan website requires women to click through and read material which includes a description of the abortion procedure, illustrations of fetal development stages (as if this was necessary), pre-natal care and a brief overview of the responsibilities of parenthood (also unnecessary).  Additionally, the State of Michigan website offers a list of “clinics offering free pre-natal ultrasounds.”  These clinics are state funded non-medical, crisis pregnancy centers whose mission is to dissuade women from choosing abortion.  In 2014, the state of Michigan allocated $800,000 to these anti-abortion centers.   If you pay taxes, you help to fund these groups.

Fortunately, I am someone who has educated herself about politicized pre-abortion “information” mandates. Many women do not know. I was told that if I were to forget to pick-up, or print off and sign the informed consent materials twenty-four hours in advance I would be sent home when I arrived for my appointment. Under the law, the clinic is unable to perform an abortion without proof that each woman has received and reviewed the state-mandated reading materials. I will need to find a place where I can print materials privately because I do not have time to drive to the clinic before my appointment and the last thing I need is for some librarian to harass me when I pay eighty cents for my copies.

With that, I set my date and the woman on the other end was ready to hang up and move on. I was not ready. I wanted to know what was involved during the appointment and I’m glad that I asked because it’s quite elaborate. She told me that I can expect to be at the clinic for about four hours and will need to complete fifteen minutes worth of paperwork when I arrive.  First, I will receive an ultrasound, then blood work, then urine test, I will have to watch a video, potentially receive a pelvic exam from a doctor who will also speak with me about my options. Someone is allowed to come with me to the appointment but they must remain in the waiting room. Before I leave the appointment I will take the first of the medications. I can expect cramping and bleeding most on the second day of medication and should plan to take the day off during the process.  I will also need a day to recover. They also recommended having someone with me during the second day in case there are any complications.

Four women have recently discussed their medical abortion experiences with me. None of the stories were easy or simple, or painless. I must admit – I’m freaked out. I’m not sure if I should keep researching or ignore these stories altogether with the understanding that everyone’s experience is unique. I would seek professional advice prior to my appointment to get the perspective of an experienced medical practitioner – but who is there to trust? A pregnancy help line? A resource with typically zero transparency regarding the organization’s motivations or funding sources? Plus, I don’t really need “help,” I would just like some impartial explanations. The politicization on both sides of the abortion debate make this process so much more difficult to navigate, discuss and understand.

21 thoughts on “11.21.15 – State mandates

  1. Nightmare. Absolute nightmare. Thank Satan that you know at least a little of what’s going on.

    I have a printer, should you need it.

  2. I understand that all of these procedures seem unnecessary, or at least a pain in the ass but I wonder if you consider the other side of the issue?

    As you pointed out, plenty of women are uneducated. They are also ignorant and ill-prepared (physically and emotionally) for termination.

    All of these procedures are to ensure that every woman seeking to terminate her pregnancy understands all aspects, to include the stage of fetal development.

    While I’ve never needed an abortion myself, I have gone through the process with other women. In the 80’s, there were plenty of my friends that weren’t very responsible with contraception. Either they were terrified of speaking to their mother’s about it (birth control needed parental consent back then) or condoms were just too inconvenient. Abortion then became the new birth-control and an expensive method at that.

    One woman just wanted it over and done with. It’s all “Yeah, yeah thanks for the information, can you just get rid of this thing already?” while the other was absolutely devastated. Even if the clinic gave her gobs of information, she blocked it mentally. It wasn’t until *after* her abortion that she felt that she had made a grave error, that she wasn’t informed properly and made a big stink with the clinic and local government over it.

    Plus, post Gosnell’s Little Shop of Horrors, there are extra steps taken to make sure the health and lives of women are at the lowest risk possible.

    Even if you consider yourself amoral, there really can’t be a one-size fits all policy on how pregnancy termination is carried out. Even if we can just get an abortion pill from a vending machine one day, there will always be complications. Whether they are biological or mental, makes no difference.

    The way I see it, these extra steps are taken to cover all bases. It just makes sense from a legal and ethical stand point. Even if I don’t personally share the ethic.

    I mean, is driving an hour away really that much of a bother? Maybe to poor women who have to take public transit. Why are they poor in the first place? Why is that our business? It can be argued that the poor socio-economic class has a lasting impact on Women’s Health issues but why not just chalk it up to social diversity and call it a day?

    The world will not always bend to your demands, this is adversity. The Satan.

    1. With any medical procedure, the patient is entitled to accurate and complete information from their physician. I’m not suggesting that we skip educating patients due to inconvenience. The state-mandated informed consent information and twenty-four-hour policy is completely unnecessary and includes inaccurate and misleading medical information. The state should not impose moral mandates upon citizens. If, they were truly concerned about educating women about the risks associated with abortion and pregnancy perhaps these topics would be essential to the sexual education curriculum within schools, and discussed frequently, but it is not. Also, I do believe that it’s a problem to force someone to travel more than an hour to receive a procedure such as abortion. Especially when there is a mandated waiting period between appointments. The burden, in this case, is exclusively placed upon the woman and there is absolutely no reason why something as essential as affordable women’s health clinics are made inaccessible to so many. Lastly, I am not sure what you are trying to communicate about poor women. However, I will say that someone’s economic status should not have an influence on accessing healthcare just as the state has no business in my doctor’s office.

  3. thank you so much for writing about all of this.
    i work for an abortion provider and just wanted to provide a little information on what a “surgical” abortion entails (we call it “aspiration” because there is no cutting, stitching, or other traditionally surgical elements involved)– in case any of your readers are curious about this type of procedure:

    Aspiration abortion is completed in a single visit. Although the entire visit may take several hours, the procedure itself is brief, usually lasting five to ten minutes. Medication is sometimes given before the procedure to ease the discomfort, which feels like strong period cramps and to help with relaxation. A local anesthetic is used on the cervix itself (sort of like novacaine for the cervix). Bleeding and cramping after the abortion procedure is light to medium.

    During the abortion visit:

    * We review your pregnancy options and confirm that you have decided to end the pregnancy (we’re not in Michigan and are not required to provide/ read a state-written script).
    * Your medical history is reviewed, the procedure is explained, and your informed consent is obtained.
    * Your Rh blood type is determined and medications are given to ease cramps and help with relaxation.
    * A dating ultrasound and pelvic exam are done.
    * A numbing medication is used in the cervix.
    * With gentle dilation, the cervix is opened slightly (a matter of millimeters). There is no cutting, scarring or stitches.
    * A straw-like tube is inserted into the cervix and the uterus is emptied using gentle suction. There are no sharp instruments used inside the uterus.
    * After the abortion you’ll go to a recovery room, where staff reviews aftercare instructions, provides preventive antibiotics, and if the patient wants to prevent future pregnancy, we’ll will provide the patient with a prescription or plan for the birth control method.
    * Most people experience cramping and bleeding (similar to a period) anywhere from one to seven days after the procedure. No follow-up is required and complications (from very mild to serious) are around 1%.

  4. I had a surgical abortion back in 1997, at 14 weeks (no medical abortions yet). I never had doubts, always knew that if I got pregnant I would have an abortion. Easiest surgery I’ve ever had, barring the fact that you had to go in the day before to get little clamps put in to stretch things out so the doc had room. I had mild cramping when the clamps were in. After the surgery, I was sore for about a day. That’s it. The worst part physically was waiting forever to stop lactating.
    However, I had to watch a video about the horrible thing I was doing, along with some women who were in fact waiting for sterilization procedures because they had too many kids as it was. They then did an ultrasound before the clamps went in (the point of no return), and they asked if I wanted to see my baby, know its gender (nope).
    The abortion – no problem.
    The headcase crap leading up to it – awful. And this is NOTHING compared to what women undergo nowadays, since the Religious Right has taken over.

  5. No librarian who respects her profession would even blink at helping you to print that job. We’ve seen far more interesting and/or horrific things.

  6. ” I will need to find a place where I can print materials privately because I do not have time to drive to the clinic before my appointment and the last thing I need is for some librarian to harass me when I pay eighty cents for my copies.”

    Not quite sure what you mean by that. Why would a librarian harass you? By and large the printing process at public libraries is completely self-service and therefore anonymous. I understand feeling self-conscious printing in a public space, but as a librarian, I resent the implication that one would bother you. We’re pretty big proponents of privacy: http://www.ala.org/advocacy/proethics/codeofethics/codeethics

    1. Jane, at the library near my house anything that’s printed is sent to a printer behind the circulation desk. Customers then must ask the desk staff to find the papers that have been printed off which they often review (and read out loud in front of other patrons). In the past, I have had trouble with printing controversial articles at this location. I apologize for not providing the context. I certianly don’t have anything against librarians. I used to work as one myself!

    2. At my library, when you print it goes to the printers located at the front desk. That is where you pay and they hand you your documents.

  7. Also, this is an incredibly brave endeavor and I respect the hell out of you for being so honest and open. We need to take abortion out of the shadows because it is just as much a fact of life as giving birth is. I just hate is when librarians are misrepresented–it’s a difficult, important and largely thankless job.

  8. Not all librarians are stuffy conservatives who would preach at you from behind bedazzled bifocals. Stereotypes are fun!

  9. Hi, I’m late to the “party” but just wanted to say I’m sorry that the circ clerks at your library are mean and judgey.
    And agree with everyone else that isn’t normal! I live in the middle of the Bible Belt and our library staff treats everyone with respect and care.

  10. Bloody Hell!
    Where is the country you’re living in? Is it Talibanistan?
    Are they going to stone you to death if you say you don’t care about those tasty embryo pics?
    I’m a guy from Europe as you can guess from my “name”, and I know abortion may be complicated in my country, but I would never have expected that one of the world leading country in science and technologies is so… Middle Age-like related to women’s live!
    Anyway what you write is very interesting. Good job. And thank you.

  11. When I scheduled my abortion here in Pennsylvania, I was required to go to a PP clinic in Harrisburg that does not perform abortions to watch a 15 minute video of a physician explaining in graphic detail exactly what each type of abortion entails, as well as showing me graphics of fetuses at different hesitations, and risks of abortion.
    I had to sign papers stating I saw the video, as did the nurse to verify I watched it.
    Then, I was required to have a vaginal ultrasound to determine how far along I was. (7 weeks). The ultrasound tech asked me if I wanted to see the ultrasound images. I was appalled, and said “No.” The tech told me she was required to ask. They also told me that I should expect to see protesters when I arrive.
    Then I had to wait 72 hours to have my abortion. At a different clinic. In Reading, PA.
    I was given an early morning appointment time and told to arrive early. It was still dark out when my BF and I arrived. And, yes, there was a shit-ton of wild-eyed, school-marm-dressed middle aged women and a few spittling, overweight men outside the clinic, some carrying signs with the usual pro-life bullshit, including one with a blown-up photo of a late-term aborted fetus. A sweet-looking, grey-haired, spectacled lady approached me, whispering that I “don’t have to do this,” and that her and her group could help me with my pregnancy, while stuffing a religious pamphlet in my hand. I wasn’t angry with her, it was plain to see that she believed in her cause and sincerely wanted to help me. There was also a 30-something woman holding the hand of a 4- or 5-year-old boy. She would nudge him, and he would yell out “Mommy, please don’t kill me. I love you!” over and over. Then there was a morbidly-obese couple, a man and woman (she was holding the fetus photo sign) who were both spitting all over themselves, enraged, crazed and screaming at me, calling me a murderer and a whore. This woman pissed me off and I spittle-screamed in her face to “back the fuck up,” and to “get [her] ugly, fat, slobby ass out of my face.” My husband (he was my BF then) told me later that he had to hold me back because I was about to smash her face in. (I don’t remember that, adrenalin and all that)
    We got in and the waiting room was standing room only. I was later told that this PP clinic only did abortions one day a week, apparently that was because of some kind of law…unsure if it is a PA law or a Berks county law, or a City of Reading law. It seems that there was also another law that required I meet a counselor before the abortion who had to ask me if I was “sure I wanted to do this,” then I had to have another vaginal ultrasound, then meet the doctor to make my abortion choice (medical or surgical) and she also had to ask me if I was “sure.”
    I decided to go the medical route, and the nurse sat down and explained to me that the PP medical abortion process is done differently than the medical community recommends based on anecdotal evidence. See, the medical community recommends that for the medical abortion, the woman comes in and gets her first pill, then goes home, comes back a day or two later and takes the next pill, goes home, comes back two days later for a gynecological exam to determine if the abortion is complete. In PA that would be a total of FOUR visits. At least for now, clinics can prescribe and instruct patients on medical abortions based on their research.
    All in all, I had to wait 6 hours total before I even got the first pill, the mifepristone. I don’t understand why the government has to make a hard decision even harder, or why they have the right to determine my medical care and choices.

    1. Tril33, that sounds absolutely awful. I had a fairly easy experience compared to that. When I had my medical abortion back in 2005, I called and made an appointment with a clinic in Austin, Texas only 30 minutes from where I live. I had to wait a couple of weeks to make sure that I was at least 6 weeks pregnant. Something to do with how the pills work, I think. My friend took me to one of those crisis pregnancy clinics to get an ultrasound. I don’t think it was required back then, but she was trying to talk me into having the baby. So did they.
      I went to my appointment and there were no protesters outside. I think I was at the abortion clinic for about 3 hours. They gave me a urine test and ultrasound and I talked to a counselor for about 30 minutes, alone. (So they could make sure my boyfriend wasn’t influencing my decision, I guess.) Then he gave me the pill and I went on my way. The hardest part was the actual expulsion of the embryo. The cramps were horrific. And my boyfriend was watching Hellboy, so now I will always associate that movie with my abortion.
      Anyway, point being that I can’t fathom what women in Texas have to go through now, 10 years later, to have a legal medical procedure. It must be a nightmare, similar to what you had to go through. Many women, especially near the Mexico border, are hours away from a clinic.

    2. Tril 33
      A decision such as the one of ending a life (doesn’t really matter in which phase of development it is, it’s a form of human life since day 1), should NEVER be a fast one, an uninformed one, or a precipitated one. So what if it takes some days or paper work? It’s probably the single most important decision in a woman’s life.

      1. I agree. However, women are perfectly capable of taking the time the need to make these personal decisions and consult their doctor’s, partners, friends, and family if necessary. The government does not need to mandate waiting periods – when a woman has made an appointment at a clinic, she has already made up her mind, and if she’s unsure, she’s able to wait to schedule to procedure. The concept that women are incapable of making responsible, informed decisions about their healthcare, and require the government to help them “think it through” is insulting.

  12. I’m so sorry you went through so much BS. We have got to fix this problem and get Christians OUT of our government and our personal lives! They are such wicked people.

    I’m so grateful that my first and only abortion was in 1992, before the right-wing fanatics took over the process in many states, including my own (Tennessee). The clinic I went to was shut down in later years, like most clinics in the South.

    The abortion was a straightforward, simple process that only involved a single visit to the clinic. Surgical abortions were the only option in those days. A few years later, I found that other clinics (an hour or two away) offered general anesthesia for a higher price, but the place I went only gave me a Darvocet and a Valium before the procedure (Darvocet! Can you imagine? Why not just give me a baby aspirin? It would work better.) They also sent me home with Darvocet. So, the pain relief could have been better, but I’ve been through so many more painful medical procedures that it seems like a minor issue.

    I was 17-years-old at the time and was dating a 23-year-old, on-and-off crack-addicted Christian man. I had lied to my parents and told them he was only 18 when we began dating the year before. He abused me physically, verbally, emotionally, and sexually. I had known for a while that I needed to end the relationship, but each time I tried, he would weasel his way back into my life, as abusive men tend to do.

    Part of his sexual abuse involved refusing to use condoms, and convincing me that if I would simply squeeze the semen out into the toilet after sex, I wouldn’t get pregnant. I believed him, and we had sex for a year like that before I finally got pregnant. My best friend got pregnant the month before me by her long-time boyfriend. She had an abortion, so the decision was easy for me. My mom was a Christian at the time (she has since rejected Christianity. Yay Mom!) but she knew my boyfriend was a drug-addicted mess, even if she didn’t know he was abusive, and she told me that the decision was mine to make. I think she was probably relieved that I wanted an abortion. The surgical abortion took maybe 30 seconds (it’s hard to remember) and was definitely uncomfortable and a bit painful, but nothing I couldn’t handle. It actually sounds preferable to the medical abortion you’ve described. Afterward, you have cramping for a day or so. I didn’t have any pregnancy symptoms before the abortion like you did. My abortion was performed at seven weeks.

    My mom took me to the clinic and my boyfriend came along. As we walked into the building, my boyfriend was whispering to me, “It’s not my baby anyway because you’re a cheating whore.” So after screwing me for a YEAR with no birth control, and even ejaculating inside me, he wants to claim the pregnancy isn’t his? Jerkwad.

    This same asshole ended up murdering a man about six months later. It was an extremely gory, brutal, stabbing death that was instigated by a gay-for-pay sexual relationship gone bad (by “bad”, I’m referring to the feelings of shame and rage that overwhelmed him after he had allowed an older man to give him oral sex several times in exchange for drug money). So the father of my aborted embryo ended up in prison for the next 22 years.

    If there was ever a decision I was glad that I made, it was the decision to not have a child with that man. He was raised very religiously, and was opposed to abortion. It was pretty clear to me that he had been trying to get me pregnant the whole time we were dating. I’m sure he thought he could trap me into staying with him forever. But f*ck him. I outsmarted him and aborted the pregnancy he tricked me into. This is the same man who tied me up and forcibly anally sodomized me, which is FAR more painful than any abortion. No way in hell did I want to be stuck with this sadistic fucker for the rest of my life, not even in a custody situation. Fuck you, Dean.

    So now, 24 years later, he’s out of prison and married with a toddler and a happy little dog. It looks like the ideal life, but I have strong suspicions that he’s already abusing his wife and will end up abusing his little boy too. One of his favorite ways to abuse me was to grab fistfuls of my hair next to the scalp and viciously shake my head back and forth. Imagine if he does that to a child. I don’t know what would possess a woman to marry a convicted killer, but they got married and pregnant within several months of meeting, and they met only weeks after he was released from prison. Whirlwind, fast-moving courtships are a hallmark of abusive relationships, so we’ll see how this one goes. He attempted to contact me a few times while he was seeing her, but I just ignored him and he stopped, thank Satan, lol (I’m not really a Satanist, but I do love what The Satanic Temple stands for. I saw the Lisa Ling show last night.)

    Sorry for getting so off-track. My abortion is really more about the backstory and everything that happened around it than the actual procedure itself. I’m so glad I made the decision to avoid getting trapped by this abusive, murdering man. I mean, I would have aborted any pregnancy at that age, regardless of the circumstances around it, but the circumstances were just so horrible, and it really emphasizes why abortion is needed. Does the world really want more children from a guy like that? I know I don’t.

    Thank you for writing this and posting it on the web. I love your domain name, by the way, lol. I’ll follow you on Twitter or Facebook if I find you.

  13. im not sure why driving an hour is a problem..im not for or against abortions its a personal choice in my opinion but an hour is not long at all..should they havr abortion clibics at every corner so anyone who ever needs one wouldnt be far from one? that just doesnt make any sence..plus people with like cancer or some desiese need to travel far further for a specialist in the area of their issue and they dont conplain..sometimes you have to travel for medical services especially for a specialty and thats kinda what abortion is..it shouldnt be a norm just a last resort so you shouldnt need one at every corner just enough in each state so someone would not have to travel to another state for one( even though that is the case for many needing other types of spwcialty medical care)

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