A for Abortion: The Weaponized Vocabulary of a Medical Procedure

Lauren A. Mitchell//   The OED defines Abortion as, “The deliberate termination of a human pregnancy, most often performed during the first 28 weeks of pregnancy; The expulsion of a fetus from the uterus by natural causes before it is able to survive independently; An object or undertaking regarded by the speaker as unpleasant or badly made or carried out.” It may also be known to readers through its insurance billing code, “unwanted intrauterine pregnancy.” I would also add: “an uncomplicated medical procedure that often and understandably ties to large emotions, bureaucracy, unnecessary political discourse, relief, and the life you might imagine if you were to carry this pregnancy through.”

The textbook definitions leave out the many layers of story that go into the decision to end—terminate—a pregnancy, that may or may not have actually been “wanted,” but cannot come to fruition at this time. With Georgia, Alabama, Missouri, Ohio, and Louisiana producing “Heartbeat Bills” (Texas and Tennessee are on deck), which would make procedures illegal once a fetal heartbeat would be detected on ultrasound at about six to eight weeks—or, within about a month after a first missed period, if one has regular periods—the “A” word has been getting a lot of news coverage. Given that a pregnancy cannot even be fully confirmed on ultrasound until there is a small blinking indication of blood flow, labeled “heartbeat,” these laws effectively obliterate all possibility to obtain an abortion.

I worked in reproductive choice care as a counselor and a full-spectrum doula in New York City and in Tennessee for many years, where my colleagues and I trained dozens and dozens of other doulas, activists, medical students, and providers to mirror the language of their patients, who may or may not have chosen to use the word abortion to describe their experience. We called them “procedures” until we were told otherwise. In fact, many of the patients were having abortion procedures to remove abnormal pregnancies or miscarriages, muddying the word further.

I can’t tell you exactly how many people I’ve served through their abortions, miscarriages, stillbirths, adoption plans, and births.  It’s been a whole hell of a lot;  I think it’s about two thousand or so within twelve years, and within that my accidental “specialty” became working with parents who had stillbirths. The influx of public discourse around abortion laws, which affect all parts of reproductive care, has dredged up voices, stories, memories of what people have to go through to get these procedures, even under the best of circumstances.  I cringe to think of how many people must feel needlessly ashamed and scared, forced to confront memories of decisions that they may or may not have been at peace with.  Many of my clients told me stories about their children, and would show me pictures of them before they left.  “I did this for the baby I already have,” they would say.  And I would reply, “Your baby is lucky to have such a generous and brave mother.”  It was always true.  And then we would hug, she would leave, and I would go to the next patient.

Poet Shira Erlichman has written, “Language is oppression’s greatest ally.”  There is a rhetorical violence that shapes anti-abortion laws. Below is what you might call a “reflective glossary” of the long list of ugly words and veiled threats that pepper these proposed laws, some of which have already been signed. These terms, often misused, appropriated, or falsified, shape conflicts between pregnant people and the children they may or may not be ready to have.

Birth policies will invariably be affected by abortion legislation; though many people like to think of these as separate reproductive decisions, they both legally rely on a discussion of how much bodily autonomy a pregnant person should have, verus how much the fetus needs to be protected from its mother. I think back to the nightmarish day that I saw that my client-centered birth politics as a doula align with Duggar-family matriarch, Michelle (you know, of 19 Kids and Counting), who claims to think that birth should be a mother-centered experience. I wonder if she realizes that you can’t put laws in place to protect a fetus at 6-weeks gestation, and not one at term, without legally sanctioning court-ordered c-sections for mothers. See also: Fetal Personhood

The unnerving moves that these new laws are making is that they seek to Criminalize providers and people who seek abortions, and as well as those who are suffering miscarriage or stillbirth.  Perhaps counterintuitively, there is immense legal skepticism toward people having miscarriages.

The phrase “Death Penalty” for people who seek abortions and providers who offer them has slipped into proposed laws in Georgia, Alabama, and Texas. The caveat of “proposed” is important, because they have not gone into effect, and it is unlikely that a death penalty caveat could actually legally go through, even if a given state bans abortion. But the actual enforcement of the death penalty for abortion isn’t the issue; it’s the rhetorical gesture that keeps people scared that is. Quoth the gods of twitter: “So pro-life, they’ll kill ya.”

Ectopic pregnancies, wherein a pregnancy attaches to the fallopian tubs, ovaries, or in particularly weird cases, abdominal organs, are non-viable, and cannot under any circumstances be moved into the uterus, no matter how much Ohio representative John Becker thinks they can. Of note, he is not a scientist. Could you tell?

In reality, the worst thing to fear is not that Roe v. Wade flips, but that Fetal Personhood and Fetal Assault laws go into place—laws that do what it sounds like they do: bestowing human rights to fetuses, holding pregnant people accountable to have medically perfect pregnancies, and rhetorically creating antagonism between the pregnant person and her baby, even if she plans to parent.  The laws that claim seeking an abortion out of state is “conspiracy to commit murder” and charge people who have miscarriages with “attempted feticide” all speak to Fetal Personhood laws, which as of now are technically unconstitutional.  As of now, laws that are categorized as Fetal Personhood laws could not easily be enforced, and yet their violent, empty promises to make pregnant people property of the state are chilling. See also: Birth; Miscarriage

Until ten years ago, George Tiller provided abortions in Kansas late into pregnancy, often for people in dire circumstances (think: undiagnosed fetal anomalies; 12 year olds who were raped and didn’t realize they were pregnant; people escaping violent relationships).  He was murdered by a “pro-life” (see the irony?) white supremacist as he was leaving church.  May Dr. Tiller be remembered for all of the important work he did that no one else wanted to do.  Also see: the film After Tiller.

The Hyde Amendment is the most important and overlooked revision to Roe v. Wade. While Roe may have made abortion a federally protected right in 1973, the Hyde Amendment, which went into effect just three years after Roe passed, prohibited the use of any federal funds to pay for abortions, making the procedure unattainable to anyone who is unable to pay for it out of pocket. Abortion already is inaccessible to: poor folks who are disproportionately people of color, people who have medical problems too risky to have procedures in free-standing clinics, disabled people, those who are undocumented, those who are gender non-conforming. People who can afford to get an abortion will always be able to find a way to access it.

You may be wondering what people who have no money and who want an abortion do when they want anesthesia they can’t afford (also, it is not uncommon for insurance to cover abortion, but not the anesthesia); when it’s December, close to Christmas, and they have children who want presents; when they have to travel hours and hours to get to a clinic; when they are teenagers.

Most pregnancies, and therefore most abortions, are not a result of Incest and rape. This doesn’t mean that, in the face of bans, people who have suffered such trauma shouldn’t have access to the services they need, but to suggest that we might be doing ourselves a disservice for only advocating for abortions in extreme cases. But while we’re on the topic, in Alabama, you face more punishment if you report a rapist and your case is determined to be “false reporting” than if you’ve actually raped someone.

The clergy of Judson Memorial Church in New York City was instrumental in putting pregnant people in touch with abortion providers who could help them and in becoming a safe haven to those who needed care. They offered support and, most importantly, kindness. The Jane Collective in Chicago, and pre-Roe group of non-doctor activists who learned to provide abortions, did the same. How bittersweet, that two non-medically trained collectives could take the helm of abortion access.

Brett Kavanaugh, who unapologetically “really likes beer” and is unafraid to throw tantrums in public, is less important as a person than he is as an icon. Like the current president, his presence in political office represents a public agreement in which the trauma of sexual assault is less important than republican victories. During his hearing, I was among the many—the “most,” in fact—who found that past traumas were forcibly coughed up, brought to the surface, as people shared their stories publicly with an urgency that was liberating and horrifying at the same time. This seems to have created a template for public story-sharing that has reappeared in the wake of such abortions bans.

The phrase “Late-term abortion” isn’t a medical term; it’s a political term to describe abortions that are performed in the second trimester (14 weeks gestation or after). According to the Guttmacher Institute, these make up only 9% of total abortions. I have worked in several clinics in several states that support patients through procedures at this point, and they are rare and necessary in equal measure. In answer to the question of why people wait so long: “None of your damn business.” But also, in my experience the number one reason was tied: raising money to pay for the procedure and other bureaucratic issues, or perinatal loss and anomaly. See Stillbirth.

Misoprostol, otherwise known as cytotec, is a stomach ulcer medication that moonlights as an effective cervical softener, used during birth, miscarriage management, and medical abortions. Often not covered by health insurance, unlike viagra, which is.

The News cycle often makes me feel a little queasy, and turning away is an inexcusable privilege. So I don’t. I give myself the permission to become angry. I let it burn, let it shape me, and also think about ten years and thousands of clients who have shaped me, who almost always needed the same thing regardless of their circumstances: validation, care, to be seen and heard, to be reminded that they are worthy to be held with both hands. I sometimes wonder to myself when I feel bleak, where will all that go? Offering compassionate care for people having abortions is useless if people can’t have abortions.

The collective The Order of the Good Death recently wrote a phenomenal piece regarding the legislative push in Indiana, Texas, and other states, to assert that fetuses should be cremated or buried. The courts in Texas found this to be unconstitutional because, as The Order points out, it is bound in other body disposal policies that are not as politicized as abortion. In Indiana, law asserting fetal funerals is sticking. More than practice, the laws are emotionally symbolic, for think of what one might imagine in a fetal funeral.

One could argue that Partial Birth Abortion Ban, produced during the Bush administration, was an earlier iteration of the rhetorical violence that we are seeing now. This is a false term given to a procedure called a “Dilation and Extraction,” which is widely considered the safest way to perform an abortion in the second trimester, whether the person has chosen to terminate a pregnancy for life circumstances, or for “fetal or maternal indications.” There is no such thing as as “partial birth.”

For hundreds of years, before the days of ultrasound, it was normal to wait until the “Quickening,” or when the mother feels the fetus move around 16 to 18 weeks, to consider it as a viable, potentially separate being.

Restrictions do not knock Roe v. Wade out of effect, technically, but they do render procedures inaccessible for a great many people. These restrictions include mandating multiple visits to clinics, forcing people to read or listen to anti-abortion statements, gestational age limits, and parental consent laws. TRAP laws (Targeted Regulation of Abortion Providers) also places severe limitations on who can provide abortions, and where they can be offered (example: in some states a midwife cannot legally offer patients medication abortions). Of note: many of my former patients have had to undergo procedures in hospitals because they had too many medical problems to safely go to a free-standing clinic, like a Planned Parenthood. See also: Hyde Amendment.

You may have read several horror stories in the last few years, where women have been arrested for Stillbirths and miscarriages under the guidance of Mike Pence. You see, under laws that restrict and attack abortion there, there is a general assumption that women will try anything to harm their babies. I wonder if the legislators putting these laws in place realize that antenatal anatomy ultrasounds, and genetic testing (for lethal anomalies that are not Down’s syndrome) also happen in the second trimester, such that if one were to find out that they are pregnant with a baby that has no brain, they will be legally required to carry their non-viable pregnancy to term. I truly cannot imagine the bleak moral compass that guides anyone to want to further the suffering of someone who has lost a baby.

Trigger warnings have been criticized as a form of rhetorical policing, of pandering to an oversensitive, politically correct public. I have always disagreed. And as abortion debates become aggressively politicized, I can only imagine how many people are walking through the world with memories of potential difficult decisions or uncomfortable medical procedures, having a personal decision publicly, loudly, scrutinized.

This series “Heartbeat Bills” is not the first time Ultrasound technology has been leveraged to negatively impact abortion access, or to otherwise shame or frighten people seeking abortions. Indeed, the concept of a “fetal heartbeat” is complicated—the presence of a “heartbeat” is simply the presence of a regulated bloodflow, nothing more and nothing less—but the last time ultrasounds came into play was in 2013 or so, when some state legislation asserted that people who seek abortions should be forced or required to have a transvaginal ultrasound (shaped like a long probe), using thinly-veiled rapey language, in addition to requiring doctors to give a detailed description of the size and features of the fetus on screen. Fun fact: ultrasounds are a normal part of abortion care, and many people responded to the law by advocating against the ultrasounds rather than by advocating against the rhetorical appropriation of it. In other words, we were duped into advocating against our own best interests.

The Vacuum suction procedure to empty the uterus of its contents is not exclusively used for abortions. It is also used to remove pregnancy tissue after a miscarriage, which is unlike to expel on its own the further someone gets into their pregnancy. It is an elegant procedure, unique insofar as it requires a different set of skills than nearly any other surgery. If abortions are banned, it’s unlikely that many people will be trained to do them, and so what happens to people who are suffering miscarriage in their second trimester? They will have to wait, and waiting will increase risks for hemorrhage, in addition to emotional trauma.   See also: doctors are not exactly chomping at the bit to become abortion providers.

We are built as individuals through community. And for those of us who see reproductive justice as a human necessity, we have to hold each other tight and hold each other accountable, call white supremacy the sickness that it is, make ourselves available for others to lean on, and to be brave by asserting our vulnerability.

Groups like the Yellowhammer fund, SisterReach, the ACLU, and red state-based abortion funds need your help more than ever now. If you want to help, donate. People are going to have to travel a long way to get what they need now.

The current Zeitgeist tends to be mournful: a long list of things to worry about, from climate change, to children at the border, to racism, to the horror that so many people are in denial about these issues, while at the same time we must move through our own lives.  I am haunted by stories of patients I have cared for.  Language feels insufficient.

People say that St. Jude is the saint to whom you pray at times of great desperation, when all other hope is lost. I am not a pray-er by nature, but I sometimes I think I see him on the horizon.  And yet I come from a community of doulas who rush forward, arms open, ready to hope and fight and do whatever we can to keep each other and our communities afloat. And all I can offer is this: a willingness to keep going even when it’s exhausting and a big, soft, trembling heart that is still here, still going, eyes wide and waiting, waiting, waiting, for whatever happens next.

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