IVF, Miscarriage and then Abortion at 46

0:00 | The Softouch procedure at Early Options

Doctor Joan Fleischman: So you just finished the procedure about 20-30 minutes ago?

Early Options Patient: Yes.

D: And how are you feeling?

P: I feel fine, within 5 minutes after the procedure I would say on a scale of 1-10 the cramps were a 5. I know everybody is different, but here I am 20 minutes later and I’m totally fine, I feel almost nothing.

I don’t even cramp during my period, but these were like first-day minor cramps. And the procedure was over before I knew it. Shanta [EO Clinical Assistant] talked me through it and distracted me. It wasn’t un-painful, but it was absolutely tolerable. It was the right thing to do.

D: Great, so I wanted particularly to interview you for a couple of reasons. One is your age. You’re in your mid 40’s?

P: I’m 46, I’ll be 47 in November. 

D: And it’s actually not uncommon for me to see women in their 40s, it’s quite common.

P: Which boggles the mind, yes.

D: And you’re somebody who even had some fertility treatments at some point.

P: I did have fertility treatments, but I was trying to have a baby naturally for 2 years and we could not get pregnant. And, we just kind of stopped being really intense about it. Then I did get pregnant about 9 months later and I had a miscarriage at 12 weeks. I was 43 at that time. 

And I think at the time after we stopped trying really hard and thinking about it, you know it’s one of those classic things, you stop trying, or you stop thinking about it and then you get pregnant because you’re relaxed and you’re not concentrating on it constantly. 

At the time I kind of put a wall down, I was like, “I don’t want to be pregnant at 44–so if I’m not pregnant by February of my 43rd year I’m not going to do it.” And there I was, September of my 43rd year, pregnant. 

We were really happy and I was just about to go through all of the testing. It was 11 weeks, I think I was going to do 12-week testing and I started spotting one day and had a miscarriage at home. 

Sort of in consultation with my midwife over the phone and I did not do an aspiration after. I’m glad I did it at home [naturally passed miscarriage]. I’m not squeamish, so I was sort of interested just to sort of go through the process. It was intense but – saying that – I would not want to do it again at home. At that point, we were just like “maybe this isn’t the time.” 

I did a progesterone test 3 months later. Actually, my progesterone wasn’t low, it was in the 12-13 range. It wasn’t terribly low, but you know just between the idea of doing treatments or giving myself shots–it was just too much at that point. I’d stayed home for almost 5 years to take care of my son and it was time to go back to work. 

We just kind of made the decision, so having this happen now was just kind of like “no.” I can’t, it’d be nice 4 years ago but I can’t back up now, stop working, or risk work stuff again. 

It wasn’t a difficult decision to make. Well, these are never easy decisions, but learning about this process and knowing I could do it very early definitely takes some of the emotionality out of it. 

It was a Godsend; it was the right thing to do. 

I’m so grateful, having been an abortion advocate in college and taking women to clinics and seeing the bad part of it firsthand. Having an experience like this is amazing and should be a much more widely promoted option for women. 

D: Your son is now 9.

P: Yes.

D: Do you want to just say some of the differences you’re feeling from 3 years ago to now as far as making the decision?

P: Yeah, I think you know with a 9-year-old too, having a 10-year difference between kids was one of the first things that came to my mind. Even though I was fairly sure, I just didn’t want to have a kid at this point having just gotten resettled into work habits, and moved recently, and done all of these big life decisions. The second thing that occurred to me was having a 10-year difference between children. 

My mother was older when she had me. I’m 46 about to turn 47, my mother is 88 and I’m taking care of her now. She’s in her Alzheimer’s home. 

I already feel like I’m taking care of two children, between her and my son and entering that into the picture is just not an option. I have a responsibility to her now and I think that is probably the big difference. 

My mother wasn’t as sick when I got pregnant at 43 and I think we would’ve been able to manage it a different way, but now I don’t feel like I could do all of that anymore. With a 9-year-old and work and what’s happening in the world, you already feel like you can’t manage everything in New York City. Five years ago it would’ve been nice to have a baby, but now is not the time. 

D: How were the physical aspects of this in weighing into your decision? I think, in my experience, things really start to change in your 40’s. I told you I had a baby at 40 and the difference between having a baby at 40 and 26, for me, was night and day. 

P: Absolutely. Absolutely. I have an older friend who, many years ago, had gotten pregnant at 40. She was a little nervous about it but excited. And, after she had her daughter she was super pushy about me having a baby. 

She was like “Do it now, do it now, do it now.” I’m like, “I’m still figuring things out, I’m still traveling, I’m still doing all these things. I want to be careless and reckless,” and she said something to me that at the time I just ignored of course, but recognized now, she said: “You just won’t have the stamina after a certain age.” I have a 9-year-old boy and I get it now. The stamina thing is huge. 

I mean, I’m fairly fit, I don’t exercise as much as I should and I probably drink too much wine, but I can deal and keep up, but I recognize there will be a day when I wouldn’t be able to. There might be a small difference between having a boy or a girl but the idea of being 50 with a 3-year-old kid and what my son was like at 3, I don’t think I’d be able to do it. 

It’s also a huge emotional commitment. As we get older, and your parents get older, and you’re already taking care of a little kid, the emotional commitment, does one even have that much capacity to take care of all those things? Those are big decisions. There’s obviously an aspect of it being great to have a baby around but it would just be too hard. 

6:52 | Abortion Advocate in the 80’s

D: You said before when we were talking, you used to be an abortion advocate. When? What year?

P: I was in college in rural Pennsylvania in the mid-’80s. When Pennsylvania was and still is a deeply Republican, deeply conservative state. Abortion laws have loosened up a tiny bit, I think they’re kind of moving backward again in Pennsylvania, but at the time they were very restrictive. 

I went to a huge college. We had a women’s health center that by school standards or whatever laws or regulations we were not allowed on campus in the women’s health center to give women a lot of information about terminating pregnancies. It was a crazy system. 

So a group of us, some older, I mean I started doing this my first year there, I was 17 years old, but some women who had been in school longer than I had, had formed a sort of advocacy circle. 

They met in an off-campus house where some women lived and just by word of mouth and through women who worked at the health center–who couldn’t speak on record but passed the word along to women who were seeking terminations. They got ahold of our phone numbers or they came by. 

We basically had–not to be flippant about it, but we sometimes called it the “Abortion Caravan,” where a few of us had cars and we would take women to New York to get terminations because in Pennsylvania you needed parental consent before 18. It was 20 or 21 at some point, but I think at the time it was before 18. 

So we were taking 18-year-olds to New York to get abortions. And women who passed the restricted age could get abortions up to 16 weeks in Pennsylvania. We would take them to a clinic in Harrisburg, which was about an hour and a half away but it was kind of grizzly and nobody wanted to go there. We sometimes took women to Maryland where the laws were a little bit looser. 

It was a very formative experience for me. I did not have a termination in college but I did in graduate school when I was in California, where the laws were pretty fast and loose compared to Pennsylvania. I had a 12-week abortion in California, a surgical abortion. 

It was in a clinic but was actually not a terrible experience at all. In fact, they were really good, women-only staffed in San Diego in 1991. From what I saw, compared to what I experienced with women who I escorted to clinics the experience in San Diego was stellar. 

D: Did you actually go into the clinics with them?

P: Women were not allowed to have any kind of partners with them—female or male, or friends or family. You had to go into the room alone, which is just horrifying to imagine an 18-year-old or 17-year-old doing it on her own. But we did escort them in. 

In Pennsylvania, especially the clinic in Harrisburg that we sometimes took women to, there were always protesters. So we kind of formed a chain and would escort women in and that alone, just the trauma alone of entering the clinic in such a state for them was horrifying. 

No privacy whatsoever. You know a large waiting room, it felt like a DMV. It was a huge waiting room with sad women and angry women and there was an air of desperation about it. There’s also that air of shame about it. I mean, I don’t think anyone questions that, there’s this insinuation that it’s a shameful thing to do.

Having talked to a lot of women on these long drives. It turns out women are frightened to take pregnancy tests when they miss a period. They can’t even face the idea that they might be pregnant, so they put off taking a pregnancy test. In a state like Pennsylvania or Arkansas, where my sister works as a genetic counselor, you can’t get an abortion past 20 weeks. 

It’s so traumatic on every level, but no to answer your question directly, you could not go into the procedure room. If they had gone under, you couldn’t even see them until they were awake. It was just terrible. I’m glad to have done it though. In states where these restrictions are still in place, women need that kind of support. 

Even if the conditions of clinic culture don’t change, the one thing that should change is that women should have an advocate in the room with them—that is of the utmost importance, I would say. If anything could change, that should be the first thing. 

11:34 | The Past, Present and Future of Abortion Care

D: What do you think now about having gone through this particular procedure and how simple it is compared to what you were seeing and what do you make of that, in a way, that it can be this simple and what women are being put through?

P: It’s utterly shocking to me. I only learned about it myself 3 or 4 weeks ago when I first started thinking about this. It’s utterly shocking that it isn’t performed more, [that] it isn’t written about, talked about, advocated for in a way that women are aware of so they can kind of get on the bandwagon. 

I don’t know if women who have had terminations are just kind of embarrassed to come out and speak out about it. 

I mean, you don’t see that in advocacy culture or policy culture really, lots of women who are pro-choice do come out and speak but I don’t know what that cultural block is that women don’t want to come out and help advocate for it. 

The shame of being pregnant when you don’t want to be pregnant needs to be stripped away. It’s not a huge deal. Women need to be encouraged to take pregnancy tests earlier or be more aware of their own bodies and cycles so they know they’re pregnant earlier. They need options like this, there’s just nothing else to say. It’s so black and white, it’s so clear that this needs to be an option for people. 

D: I mean, my vision would be that regular family doctors…

P: Yes, the fact that a gynecologist or obstetrician can’t tell you about this or tell you that it’s an option…

D: Or do it,

P: Or practice it, I mean people go through much more invasive things in a doctor’s office than this. 

D: You’ve never had a colposcopy, but I think it’s a great comparison. A colposcopy is a little more painful because it’s a sharp, unusual pain whereas this is a few minutes of cramping but for an early pregnancy it’s no more complicated than getting a colposcopy. That’s been my challenge for the last 20 years I’ve been involved in this. 

P: So what is it about the medical community that resists?

D: In my opinion, it has more to do with the way abortion was established in the ’70s. In these clinic settings. So when I got exposed to this in 1995, I was in my residency and there was an opportunity to train at a well-known clinic. 

Family doctors for the first time ever had the opportunity to see what was going on at clinics. I personally had had an abortion at 18, but it’s really the only medical procedure that you don’t see in training because it’s completely disconnected from the mainstream medical community. 

P: Everybody has babies. How could it be divorced from…

D: Well, you see D&C’s [surgical procedure performed after miscarriage or to end a pregnancy that involves scraping the uterine lining with a medical instrument] in operating room settings in hospitals but nobody is really doing…

At that time it was really D&C’s. 

The pill didn’t come out until 2000, and then manual vacuum aspiration has been around since the ’70s but it was not part of mainstream medicine at all until around 2000 when there was a presentation made. 

Now, I think 40% of early abortion is being done with the pill, which I have many opinions about because that’s not an easy thing either. 

P: Having had a miscarriage, I can’t imagine going through that. If you haven’t gone through that. 

D: The SofTouch procedure or manual procedure is definitely as far as a miscarriage goes, by far the most humane way to go through this. The pill is a very mixed experience, but at least 40% of early abortion now is being done by the pill, whereas they don’t even count the number of manual procedures that are being done. 

The trouble is that a lot of the clinics really just aren’t invested in making the changes because you can see this is a very different culture of doing a manual procedure. It’s [SofTouch] more like a pap test. It’s very personal. We’re talking during it. It’s in a regular exam room. 

Whereas the clinics are really staffed often by surgeons, in an operating room. The culture of it is to put women to sleep, to just do as many procedures as possible. The doctor will do 20-40 procedures in a day. Whereas we’re doing 10 at the most and it’s all very relaxed in the way that you just experienced. 

So, it’s a completely different way of providing services that have been done since the ’70s and it’s very hard to impact on it. And our challenge has really been spreading the word about it in New York City, our patients are very very passionate like yourself about having been through this experience. I’ve mainly asked women to write reviews about their experience but also these interviews have been a new attempt to try to get the voices of women out, to normalize it, exactly, to make this normal.

There’s still this culture that I think women feel ashamed because they think they’re supposed to be in some extreme situation to not have a baby. In fact, for 20 years I’ve seen normal women making normal decisions.

P: Yes, making a decision for themselves. I think that’s something the wider culture sometimes has a problem seeing. 

I’m back to work now. I’ve finally established like a system with my kid, my job, my home, and my mom. It’s finally done and not having a baby right now at 47 is the right thing to do for me and for my health, and my mental health, and my son’s health. I have a sister 5 years older than me and I think we both felt growing up that 5 years was a big gap. I can’t imagine having kids 10 years apart, it kind of boggles the mind. 

D: It’s a deeply personal decision. There’s nobody else that knows your particular situation. You know your life, you know what you want.

P: Exactly. My sister is a genetic counselor, a genetic researcher who became a genetic counselor and she works at a big regional children’s hospital in Little Rock, Arkansas. They maybe have the most restrictive abortion laws in the country, and she sees families come in with children who are going to be born with horrible things. 

She’s speaking to a culture down there that is far more conservative than New York or Pennsylvania or many other places. There are just many conservative religious families who the idea of not having a baby…they don’t feel like it’s their choice. 

That’s a huge issue she faces. It’s a big difference from doing that kind of work in New York and going to a place like that, part of the reason she went down there to do it is because she knew there was this need to try to in extreme health issue cases of normalizing the idea of terminating a pregnancy. 

Instead of being a sap on state resources, and family resources, and emotional resources. It did have to be put out there as an option, instead of feeding the system. She’s had a similar like cultural shift just trying to make any kind of abortion normal, let alone in somewhat advanced New York City where we’re talking about just moving the procedure forward to normalize it. She’s kind of starting from zero.

D: Medicine, and especially women’s health has a history of not being able to make changes and progress. Especially, in making things more natural for women. On top of that, you add the stigma and politics, like you’re saying the lack of advocacy and just outspokenness that we don’t…

P: When we were doing this in college, my sister did it as well, we were vilified. It was hard to do this work. We had women who would kind of pose like they needed abortions and then the house would be found out, so we’d had to find another place to meet. It was really intense and I will never forget that work. I’m glad that I did it and anything I could do to promote or normalize this procedure I would be happy to do. 

D: I’m really happy to meet you and thank you so much.

P: Likewise, your staff is amazing, thank you.