The knowledge gap between older and newer counselors was a continuing internal problem, one that was hard to bridge in such a high pressure and emotionally contradictory underground organization. There were so many things that could not be spelled out to newcomers for security reasons and so many other things that could be learned only by experience.
At any rate one day a newer counselor became convinced for her own reasons that Dr. C was not a doctor.
She raised the question angrily at the next meeting of the service and added that she didnt want to work with the service if it didnt use legitimate medical people.
Several other counselors echoed her concerns. They felt they had been misled by elitists in the service who had full knowledge they didnt and as a result new counselors passed on misinformation to the women they counseled.
The elitists said that they actually did not know the answer. But they agreed to talk with Dr. C. and report back at the next meeting.
Doctor C was totally opposed to our breaking the news that he was not an M.D.
He said it would destroy the confidence of the counselors in him and jeopardize his job. Patients who believed in the infallibility of doctors would have less confidence and more problems if they knew the truth. Also if some disillusioned counselor or patient turned him in, the police would be harsher on a paramedic, and he felt be would no longer be treated by counselors or patients with the respect he deserved.
But one old-time counselor was as insistent about telling the truth as Dr. C was about maintaining the myth. And although the repercussions of their clash echoed for years. the political consequences of her unbending position were momentous.
At the next meeting we laid out the a factsour abortionist was not a doctor and the nurse was not a real nurse. They were lay people who had extensive training and experience doing abortions.
We told the new counselors how we had searched among available abortionists and felt that their person was the best available.
Two counselors quit our the spot.
But most of the 20 counselors were fascinated rather than shocked. They spent hours that night exploring the doctor mystique and the concept of paramedics.
They compared feedback from the women they had counseled and became more convinced more than ever that the service was providing an essential alternative and was providing it with more humanity, efficiency and competence than was available anywhere else.
In addition we were now providing abortions for women who simply couldnt afford to obtain them elsewhere. The basic price was down to $400 plus an increasing number of free and low-cost abortions.
While money was a constant source of conflict between the service and the abortionists, the increased volume of cases and our assumption of many of the risks and responsibilities made the weekly payment satisfactory to them.
The service decided to drop the word doctor from counseling sessions and instead to stress to the women that they would be done by a competent paramedic who had been specially trained to do abortions.
To our surprise found that most of the women we counseled were not the slightest bit disturbed. Their prevailing concerns were Can he do the job? and Do you counselors trust him?
They had been burdened long enough with their unwanted pregnancy, and had been unable to find help through the legitimate medical profession. They just wanted to turn the responsibility over to someone they could trust.
Once we had discovered and dealt with the matter of paramedic abortionist it was a short step the question If he can do it then why not me?
But by the time we integrated the concept of the paramedic intellectually and politically, we had already had significant paramedic experience of a different type in our dealing with long-term pregnancies.
The search for a way to handle long-term pregnancies led us into totally unforeseen activities into new political perspectives and into more trouble. frustration and pure exhaustion than any other problem.
At some magical mark in her pregnancyranging anywhere from eight weeks to fourteen weeks depending upon the place and the abortionist a woman suddenly lost all options except the choice whether to raise the baby herself or give it up adoption.
Her chances of obtaining an abortion either legally or illegallywere almost nil, and when one could be obtained it was financially prohibitive for most women ..upwards of $800. The problem was complicated by the increased pain, risk and time commitment of an induced miscarriage and the decreased chances for sympathetic port-abortion medical care.
To complete the womans trauma there was an implicit attitude of contempt and distaste for her. How could she be dumb enough to wait this long? and If shes waited this long, she might as well go ahead and have the baby, were the prevailing attitudes.
In fact many of these women had already been through weeks of red tape to wind up at a dead end. Others waited weeks crucial weeks while getting a series of shots to bring down a period from their private doctors or one of several local gynecologists who profited from the business.
Others wasted weeks trying to get the money but were short on money, but still long on pregnancy. Women in their forties who thought they were going through the a change when they missed several periods in a row suddenly learned they were four months pregnant.
And then there were the young girls who totally denied the condition in the hope that if they ignored it, it would go away. Finally a friend or relative noticed their enlarged abdomens and make them face up to the problem.
The reasons were many, and by the time many of these women reached Jane, their situations were desperate. The first thing Jane did was to rush all women who were 11 to 13 weeks pregnant to the front of the line, postponing money problems and setting up emergency counseling sessions, so that these women could still obtain a D&C if possible.
For the increasing number of unmistakable long terms-14 weeks and morewe had to find a method and a system for taking care of them.
Even today, after more than four years experience with various methods for inducing long-term miscarriages we still find it hard to evaluate which methods are best. Each seems to have its advantages and its complications.
Some are more practical in an illegal setting there others. Perhaps we should unanimously condemn the catheter as a method for inducing a miscarriage, but then it sure beats a rusty coathanger.
Our first experience with a long-term was a 19-year-old who drove down from Minneapolis about six weeks after the service opened. She was six months pregnant and Catholic, and she insisted that her father would have a heart attack if he found out she was pregnant.
The abortionist met with us and explained in detail the method he used to induce a miscarriage: break the water bag, extract all the water, and wait for labor to begin. In addition, he used antibiotics to fight infection, oxtoxins (pitosin) to induce the labor, and ergotrate to control bleeding.
The labor would be the same as for having a baby, beginning with mild cramps and progressing to heavy rhythmic contractions. Then, in a heavy contraction. the woman would pass the fetus. After a short while, the contractions would begin again, and she would pass the placenta.
She would have to be attended constantly during labor, and then watched carefully after she miscarried. The fetus would have to be disposed of.
In the next day or so she would receive a D&C to make sure her uterus was clean because retained placenta was a major cause of complication. The cost for the induced miscarriage and the follow-up D&C were usually $1,000, but since this was the first care, he would do it for only $600.
Its nothing to worry about, he assured us. Women go through it alone all the time. Miscarriages are common. The most important thing is to keep the women calm and in self-control. But we were staggered by the medical implications and the responsibility, and we felt (rightfully) that he was oversimplifying.
We met with the woman, explained the entire procedure and emphasized our uncertainty.
She reluctantly decided to have the baby, and returned home to tell her parents. Her father had the predicted heart attack and she had the baby and gave it up for adoption.
The only positive note the whole story was that her sister became active in abortion counseling end set up a service modeled after ours in Minneapolis
Clearly the way to deal with long-term pregnancies was not to avoid them.
The next longterm pregnancy was an 18-year-old Puerto Rican woman, four and one-half months pregnant and determined to have an abortion. We made arrangements for her to stay at a counselors house during labor, and to be in constant telephone contact with the abortionist in case of an emergency.
She was induced in the morningwith no problems.
That night our abortionist left town under threat by the Mafia for refusing to pay protection.
Two days later, the woman was in heavy labor, and as her pains got heavier, her temperature fluctuated between 99 and 102. The counselor had no one to call for advice, and finally in desperation called her own gynecologist and lied to him that her friend seemed to be having a miscarriage.
He arranged to meet them at the hospital, where things went as smoothly as a prepared script. The gynecologist examined her, said a few words to emergency admissions, and had her sent up to gynecology. They gave her some antibiotics and some pitocin, and she miscarried without problem in two hours.
The next day, the counselor caught hell from her gynecologist, who had learned about the abortion from the patient.
This was typical of the response that we got from most doctors when we asked them for help with induced miscarriages. Although providing post-abortion help was not illegal, they felt that admitting such cases to the hospital was a nuisance and jeopardized their reputations.
With a few significant exceptions they not only refused to help but condemned others who tried to fill the medical void. Abortion was illegal. If women were using quinine and coathangers on themselves in desperation that was a situation most gynecologists choose to ignore.
Hospital emergency rooms were no better. If they suspected an abortion. they often called the police before they even examined the woman in labor. Sometimes they would admit a woman and then withhold drugs from her unless she talked. Sometimes they flatly refused to admit her, even though she was in heavy labor.
After several such experiences, the service decided that more than ever it wanted to take care of long-term pregnancies, and that it would simply have to figure out ways to manage without help from the medical profession.
That decision initiated a year during which we expanded our activities with Dr. C and simultaneously set up a system that induced, midwifed and arranged post-abortion care for more than 200 long-term women.
Our first breakthrough came when Jane received a call from a doctor in Detroit who was soliciting abortion business.
He told Jane he would do D&C's up to 12 weeks- in his Detroit clinic for $400 but long-terms would cost $250 just to be induced, and $600 if the miscarriage took place in the clinic.
The abortionist (whom we came to call Nathan Detroit) described a method for inducing an abortion called Leunbach that be said was widely used in Scandinavian countries. A sterile oxytoxin paste was introduced into the uterus through a hollow cannula, which is inserted barely through the cervix.
The paste or jelly he said, separates the placenta from the wall of the uterus and caused a miscarriage. He said the method was painless and required no dilation or drugs at the time of insertion the paste. Labor would follow within 4 hours. The method could be used to introduce miscarriage at any time in the pregnancy.
A bonus feature was that this method looked like a normal miscarriage. A woman went to the hospital in labor there would be no way to tell she had been artificially induced.
He invited Jane to visit his clinic in get first-hand information. She accepted for the next week. In the meantime, the counselor who volunteered to make the visit spent several days in the library trying to research Leunbach paste.
It was mentioned in a number of medical publications, but about as briefly as Nathans description of it. We found this to be true whenever we researched methods of abortion. In a country when abortions are illegal, there are no text hooks on how to do them.
The counselor was duly impressed with the clinic, which was set up in the upstairs of a big old Detroit house. She observed one D&C and one Leunbach paste insertion. It really was painless. She also talked with one post-miscarriage patient who was awaiting a follow-up D&C. The patient described the labor a just like having a baby.
Nathan said that the follow-up D&C was done in the clinic as an added precaution, it was unnecessary most cases. In fact, he said, even a lay person could tell if the miscarriage was complete by looking at the miscarriage placenta and observing whether it was intact or there were pieces missing.
He knew of the volume of calls Jane was receiving, and was apparently anxious to get a piece of them, for he volunteered to come to Chicago the next week to help us out. If we arranged the places he would put the paste in as many long-term women as we could set up in one day and would charge us only $1000 for the day But from that time on he added, the charge would be the regular $200 each.
He arrived at the airport the next week with all of this equipment in one tiny briefcase. Six women, ranging from 10 to 18 weeks pregnant had been counseled, had paid Jane $175 each, and were awaiting to be induced, four at their own homes, two at a counselors house, where they would stay during labor.
If the day hadnt been so exhausting it would have been comical. Every one was in a third floor apartment and Nathan was terribly out of condition. He insisted that the kitchen table was the only place to start the abortion and in each case took on the ludicrous atmosphere of the kitchen it took place in. A small flashlight provided illumination.
Nathan took for granted that the counselor with him was experienced in medical matters (she had in fact seen her first abortion at his clinic the week before), and he barked orders at her all day. But the cases were started without problem, and he left that evening with $1000 in his pocket.
The same night we got a call from one of the patients who was having labor pains. She had several children and a previous miscarriage and said she and her sister could handle the whole thing by themselves. The anxious counselor kept in close phone contact with the woman and by 3 am, she had passed both the fetus and the placenta and was in bed asleep.
Two of the women decided to go to the hospital when their labor pains began. They were both coached to stick to their story, no matter what the hospital said: that they were pregnant and suddenly that day they had begun having cramps and bleeding.
One other woman miscarried at home after a ten hour labor. and two others miscarried at a counselors home, with several extremely apprehensive counselors present.
It is impossible to describe to someone who hasnt experienced or been present during a labor the trauma a woman goes through. The pains gradually get bad, then they get worse, then they get totally unbearable, and then they get still worse before the baby/fetus is delivered.
Although both miscarriages were normal, the counselors (one of whom had no children) were astonished at the strength and intensity of the labor pains, and with the gush of blood that came with the passage of the fetus. They were also amazed at the total relief from pain both women felt as soon as the fetus was passed.
In both cases the women were remarkably strong during labor. Shortly after the miscarriage, the placenta was passed and the bleeding stopped almost entirely.
After witnessing the pain of an induced miscarriage, one counselor experienced in the use of LaMaze (natural childbirth techniques) taught the basis of those techniques to all counselors who attended longterm miscarriages. The effect of even brief counseling in LaMaze upon women in labor were amazing. Armed with the technique, they could deal with even the most severe labor pains without drugs.
Seeing her first fetus was a totally shocking entry into reality for every counselor who attended a long term miscarriage. A 16 week fetus is a fully formed human being with fingernails and sex organs.
Few counselors could maintain such emotional distance that they did not spend sleepless nights wondering about life and death, about freedom of choice,about killing, about the end justifying the means.
But seeing the relief of the womenyoung, old, rich, poor after the miscarriage was the overriding experience. These women had been carrying an unwanted body in their own bodies for months, trying to get rid of it in that time, and suddenly they were free. They had a new lease on life.
But in the case of the women who had miscarried outside the hospital, the new lease was short. Within several days, they each had severe cramps and intermittent bleeding.
Each had to go to the hospital, where the problem was diagnosed as a retained placenta and treated with a cleanup D&C. The hospital charges for the D&C plus drugs and extras ranged from $250 to $450, taking the total cost of the abortion well out of the bargain range we had hoped for.
When we complained to Nathan, he insisted that the incomplete cases were coincidences, but he offered us an alternative plan for saving money. We could buy tubes of Leunbach paste from him for $50 each, he would throw in a cannula and we could administer the paste ourselves.That way, even if the woman had to pay for a cleanup D&C, the total cost would be under $350.
The suggestion astounded us- we are simply not yet bold enough to perform a major medical procedure ourselves. But we bought a dozen tubes of the paste and stored them in the refrigerator as directed.
(Editor's Note: The paragraph that goes here was indecipherable in the copy we have, but involves how the service could use Dr. C)
We were saved from the immediate dilemma of whether to insert the paste ourselves when were approached by a group of Northside abortionists who agreed to insert the paste (their own) and do a followup D&C in their Northside office for $400. They would also help care for women in labor if we provided a place. As part of the bargain, we would have to throw in a few short-terms each week for the same price.
This group of abortionists came recommended by several local MDs, but in a system that turned on payoffs and kickbacks, references were meaningless.
In desperation for a way to take care of longterms, we decided to give them a try. Two short-term patients volunteered, and their reports were tolerable, if not enthusiastic. They said that only men were present during the abortion, and that their manner was cold and secretive, but the place was clean and the medical results were satisfactory.
We decided to use them for longterm miscarriages, and to keep the number of short-term cases we sent them to the absolute minimum.
In anticipation of the induced miscarriages, a counselor volunteered her large apartment for the women in labor. She and another counselor (who had joined the service after a horrendous experience with a catheter induced abortion) also volunteered to study midwife techniques and to sit with women in labor.
The anticipated expansion also meant that we had to drop our 16 hour answering service for a system that could receive messages any hour of the day or night.
We mentioned the problem to "Dr." C one morning and mere hours later, a fancy tape arrived at Janes home, complete with a portable beeper that enabled her to pick up tape messages from any phone. The new system greatly increased Janes flexibility and unquestionably built up credits for Dr. C
The Northside abortionists were to distinguish themselves during the next few months we worked with them by sending away women who were a little short of funds, by being awed and incompetent in the presence of women in labor, and by somehow dodging most cleanup D&Cs, so that cases with retained placentas ended up in the hospital anyway.
We soon learned that they were one of the biggest abortion outfits in the city and that they paid protection to the Mafia, and that they were unscrupulous in their pursuit of money.
Apparently their protection was not sufficient, for two months after our first contact with them, they were arrested with two of our patients in their apartment, making front page headlines in all four dailies.
Ultimately they got off the bust by paying the police and the court about $30,000. Before the settlement, the states attorney called and questioned Jane several times...without success. After the settlement we heard from him no more.
The Northside group was soon back in business, but we refused to have any further dealings with them.
On the whole, our generally negative experience with them proved valuable. In the face of their incompetence, several counselors became very competent in attending women in labor. We attended about 18 miscarriages in this period, and sometimes had as many as 4 patients in the apartment at one time in various stages between induction and followup D&C.
We learned to speed up sluggish labor with special exercises (old wives remedies that really worked), we learned to ease the pain of harsh labors with Lamaze breathing and sympathetic care, we learned to control post miscarriage bleeding with shots of ergotrate, icepacks and gentle massage of the abdomen.
We also learned when a situation was beyond our competence, and we had to take a woman to the hospital. Fortunately, for the first few months, these situations were limited to excessively long labors, to cases where the placenta did not pass and to cases of mild but continual bleeding.
Facing hospital staffs in such situations continued to be a frightening, humiliating and often legally threatening experience but unavoidable.
Most importantly, our experience with the Northside Group convinced us that if these incompetent, inhumane men could clear $400 for simply administering the paste, we could also do it...for our cost alone.
So that fall, one full year after the service began, we finally took speculum, flashlight and cannula in hand and induced our first abortion.
Our hands shook so bad that we could not even put the speculum in straight, and we emptied the first tube of Leunbach paste ($50 worth) onto the floor. But our two young volunteer patients were good humored and encouraging, and the job was finally done.
And it was so simple! So damn simple, after avoiding it all these months. Just slip the tip of the cannula through the opening of the cervix and gently squeeze the paste in. No pain, no blood, no problems. And a happy, friendly, less costly experience for the women.
The two women went to a counselors apartment where they were closely attended. We somehow expected special problems because we had overstepped our bounds by performing a medical procedure.
But both miscarried within three days. One required no cleanup D&C and the other relieved a D&C from "Dr." C. Total cost: $400 for both, which they split.
We were excited, of course. Putting in Leunbach paste through a cannula was hardly a complicated medical procedure, but it was still an abortion...and we did it ourselves.
Armed with our new techniques, we began to take on more long-terms and to intensify our training and organization for midwiving women in labor.
After the Northside bust, we had to abandon the midwife apartment, which was being watched by the police. Instead the counselors who chose to counsel for long-term miscarriages arranged a place for each of their patients. Sometimes it was their own or another counselors apartment, sometimes the home of the patient.
To each long-term was offered the following alternatives: to be induced by a woman from the service by Leunbach paste or to have their water bag broken by Dr. C, to go through labor at a counselors house or at their own home under the care of a counselor or to go directly to the hospital when their labor began; and finally, to go to the hospital for a cleanup D&C or to come back through the service and have it done by Dr. C.
About three women a week chose to be induced by us for a charge of $50 plus the $250 by Dr. C. or a hospital D&C. An equal number chose to be induced by Dr. C. who now agreed to break the water bag and later do a followup D&C for the regular short-term charge of $400.....if we took responsibility for the labor and miscarriage.
Of these five or six anticipated long-terms at least two each week had insurance or a welfare green card and chose to go the hospital for the miscarriage...sticking to the well-rehearsed story that it was spontaneous.
The other women were our responsibility. and each made details plans with her counselor about what to do and where to go when the labor pains began.
About two women a week went through the service for a D&C, but turned out to be more than 14 weeks pregnant.
These women had not been counseled for an induced miscarriage. and they often had to make a last minute decision whether to go ahead with the abortion. Worse, sometimes only after the abortion was started did we discover that the woman was too far along to be done by D&C.
by the Hyde Park Voices