4 5 6
We became more competent as counselors and organizers, and we recruited many new counselors as the number of patients and scope of activity grew. Fees for a D&C dropped form $500 to $350, with the number of free abortions growing as volume increased.
But we still relied on our male abortionist (Dr. C) to do the more than 30 D&Cs a week. We in the meantime, concentrated on expanding our service, while we were continually developing the skill and the confidence to do D&Cs ourselves.
Our biggest headaches came from the two or three cases a week when a woman turned out to be more pregnant than expected and we suddenly had to deal with an induced miscarriage instead of a simple D&C.
Even with written notes from a doctor and pelvic exams beforehand, it was impossible always to predict the length of pregnancy. Some women menstruated for the first several months of their pregnancy.
Suddenly, the woman had to make major changes in plans under extreme stress. She had to deal with a process that would take days instead of minutes and involve more pain, more risk and often more money.
Suddenly, there was no way to keep the abortion a secret from an intolerant parent or boyfriend, husband or employer. Women on welfare stood to lose their payments if the caseworker found out they had an abortion. Women had to find baby sitters and arrange time off workoften this meant loss of job or income.
The counselor would have to be on call around the clock till the woman safely miscarried. She would have to arrange a place for the woman to stay while she was in labor; or if the woman had no one-else to turn, the counselor would have to fill in as babysitter, housekeeper and midwife till the ordeal was over.
Sometimes she would receive a frantic call from a woman in labor and rush to the womans house regardless of the hour of day or night, only to be confronted by angry husband or parents whose only response to the crisis was to yell recriminations or threaten to call the police, while the daughter or wife was in heavy labor in the bedroom.
Fear of arrest or lawsuit was only a minor consideration at times like these the counselors first concern was to take care of the woman.
The lack of mutual support and trust between parents and daughter was sometimes astounding. Now, when their child needed help and understanding more than any time in her life, many parents chose to vent accumulated hostilities.
But for many young girls, the crisis reestablished long-lost communication with their parents. To their surprise, parents were beside them, comforting and helping.
Counselors encouraged minors to tell their parents once the miscarriage had been induced. Usually the parents found out anyway, and often they turned out to be more supportive than the girl suspected. But ultimately, we relied on the young womans judgment of how to handle the family scene.
For short-term D&Cs, however, we never pushed women to tell parents or relatives beforehand. They were welcome to bring a relative or friend to the counseling session, but never forced to, regardless of their age. Too often, especially for young Catholic girls, telling their parents meant they would be sent to a home, forced to carry a baby to full term against their will and then forced to give it up for adoption.
Many older women who came through the service had been scarred into permanent bitterness by such an experience when they were younger.
Understandably, the temptation was great to do borderline pregnancies (13 to 16 weeks) by D&C rather than by induced miscarriage.
It saved the patient days of waiting, hours of pain and extra cost. It saved the counselor the extra worry and arrangements. And it spared the service potential unpleasant encounters with hospitals and police.
Equally important, it made us all feel good. Women who were dreading a miscarriage were overjoyed when they learned they were being done direct, and would not have to go through labor.
(And unspoken, but in the back of some minds: Thank God! No 16-week fetus to wrap up and throw in the nearest city trash can.)
When the woman was expecting to get a short-term D&C, but turned out to be a borderline, the temptation to do the abortion direct was even greater. Then there were the special casesthe woman who was 16-weeks pregnant, but whose husband had a vasectomy a year ago.
Or the woman sent to us by a local gynecologistshe had a cancerous kidney removed just months before, but had been refused a therapeutic D&C by the hospital board. Her doctor felt that going through with the pregnancy would kill her.
Her D&C was a rough experience, but three weeks later she gained ten pounds and was well. Her physician told us she would probably be dead now, but for us.
Other abortionists in the city and in clinics in Washington, D.C. and later in New York said flatly that a D&C couldnt be done past 12 weeks. But in central Europe they were being done routinely up to 16 weeks.
We knew it could be done. In the four years of the service, we did more than a thousand successful direct abortions on women 13 or more weeks pregnant.
Doing a 15- or 16-week D&C was no picnic. A D&C at eight weeks takes five minutes and the dangers are minimal. But at 15 weeks, it takes from 20 to 45 minutes. If its an unexpected borderline, then all other women who are waiting to be done that day are all delayed at least 45 minutes.
Its an exhausting experience for all concerned- Even the most cooperative women get tired of lying so long in one position with instruments being pushed in and out of their bodies. Its often painful. But the bravery and commitment of most of these women gave us encouragement and support.
For the abortionist, the pure physical strain is remarkable. Pulling large pieces of fetal material through a resisting cervix takes a lot of strength. Huge blisters on hands are an occupational by-product one can frequently identify an abortionist by placement of calluses caused by the instruments.
The psychic drain is also enormous trying to concentrate on the physical procedures, while the assistant is tending to the womans emotional needs.
The room is charged with tension. Time pressure is constant. In a 15-week abortion, the possibility of hemorrhage is greater. If heavy bleeding starts during the abortion, the only way to stop it is to get the uterus clean . . . fast. So if bleeding starts, the work is accelerated, not stopped.
Fortunately, we never had a situation during a borderline where heavy bleeding could not be stopped.
Jane usually scheduled two or three borderlines in a day of 20 or so abortions. But some days, unexpected borderlines seemed to come one after another. Sometimes a woman who was scheduled for an induced miscarriage would plead to be done direct, because the effects on her life situation of a long-term miscarriage would be so tragic. The decision was often hard to make.
There were days when our judgment faltered. When, because of pure exhaustion, we induced a woman who could have been done direct. Or worse, those few occasions when we took on a longer case than could be done direct, and would up with an incomplete borderline D&C.
The best thing that can happen with an incomplete abortion at 15 weeks is that the woman will pass the remaining material without problem in a minor labor. The dangers are that the retained material will cause an infection, or worse, that a broken fetal bone will puncture the uterus during a heavy contraction.
So we almost always insisted that incomplete D&Cs be taken to the hospital where the procedure could be completed under more controlled conditions. Its one- thing to explain to the emergency room personnel that a woman is going through a spontaneous miscarriagequite another to have to account for only half of a retained fetus.
Some hospitals were more accepting of such situations than othersCook County encountered so many attempted abortions that they took them in stride.
But we had to warn all women who went to the hospital with an induced miscarriage or an incomplete D&C to resist surgery unless they got a consulting opinion from a private doctor.
If a woman was Black or Spanish or on welfare, and had several previous pregnancies, the hospital would sometime attempt to give her a complete hysterectomyobtaining her permission while she was in heavy labor and unable to make a clear decision, or insisting to her that the radical operation was necessary to save her life.
Several women who came through the service subsequently had hysterectomies because of incomplete abortions or problem miscarriages. All but two of these we considered medically unjustified, and had strong medical opinions supporting our view. Some medical facilities, we learned, justified the operation on the basis of the womans repeated immoral behavior. Blacks recognized it as genocide.
One prominent Chicago gynecologist confided to us that he had punctured nine or ten uteruses in the operating room that he knew of. "Its inevitable, he said When it happens, I just watch the woman very carefully for infection or inflammation. Usually the uterus heals without problem.
Of course, for women who chose to come to our women paramedics for an induced miscarriage with the Leunbach paste, rather than through Dr. C, there was never any question of a borderline D&C. They were all counseled and prepared for a long-term miscarriage. We set aside Thursday morning as womans day for inducing long-terms.
We induced and midwifed our first nine miscarriages without incident . . . then we ran out of the paste.
When we confided the problem to Dr. C, he said that he would rather not deal with long-term miscarriages anyway. Then he casually mentioned that he had a gallon or two of the paste in a friends house, and we were welcome to it.
So we rented another midwife apartment and made plans to stay in the business of induced miscarriages, at least for the time being.
The limited revenues we received from the long-terms were a great boost for the morale and the efficiency of the service. For the first time, we could pay our phone bills and expenses without asking for an allowance from Dr. C.
We had midwifed about a hundred miscarriages safely during the first 18 months of the service, and we were becoming quite confident about our judgment and ability. Then a single incident shook the foundations of our confidence and forced our hands medically.
It had been a long Saturday21 D&Cs and three induced miscarriages. Dr. C and two counselors decided to stay for half an hour at the work place and have a bottle of wine, a rare occurrence, for usually everyone was in a big hurry to get out.
Then the phone rang. It was Carolyn. An unanticipated long-term from the day before. She was in labor and couldnt find her counselor (the counselor was, in fact, attending another long-term at the time).
We were glad we were there when she called, but also wearily regretful we hadnt left five minutes earlier. We corked up the bottle and brought Carolyn back to a counselors house
Carolyn was a delightful young woman. We sat around and rapped for several hours until her labor pains got so heavy she had to lie down. Dr. C, out of amused curiosity, decided to stick around to observe the action that night.
Carolyn had a hard but relatively short labor. After three hours, in a heavy contraction and a tiny spurt of blood, she passed a 15 week fetus. She was exhausted, but otherwise felt fine.
We made her comfortable in bed until she began contractions to pass the placenta. She wasnt bleeding at all. One of us disposed of the fetusan onerous task for those of us who had conflicts about abortion and the status of fetal life.
Ten minutes later, the counselor with Carolyn noticed a narrow trickle of blood down the sheet. Pulling aside the cover she saw that Carolyn was lying in a pool of blood.
She called the other counselor. One hurried for ice trays to place over the uterus, while the other gave Carolyn a shot of ergotrate to control bleeding and then massaged her uterus. She was contracting steadily, but not heavily, and she was still not passing the placentajust blood.
We tried to tug gently on the cord and to pull out the placenta by hand, but small pieces broke off and the bleeding continued. Blood soaked up the bed, saturated towels and ran all over the floor. Blood was everywhere.
When we first called Dr. C for help, he chuckled and said, Come on, girls. You know that it always looks like more blood than there really is. Give her another shot of ergotrate.
Less than a minute later we called him again. He strolled calmly Into the room . . .and paled.
Two seconds later, his color was back and he was giving orders calmly and smoothly, "Hey, you're a mess.Let's get you cleaned up a little.
And to us: Get the instruments ready. Dont take the time to sterilize them.
While we put new sheets on the bed, he carried Carolyn to the bathtuba heavy stream of blood marring their pathhosed her down, and carried her back to the clean bed. By this time the instruments were sitting next to the bed. About two minutes had passed . . . and at least a pint of blood.
He said, Okay, now we have to put the speculum in again. It wont hurt much.
Carolyn was so weak, she didnt care about pain. She did what she was told, knowing there was nothing she could do for herself.
Dr. C looked in with the headlamp, reached in with the forceps, then sat back and said to us: Come here and take a look.
Blood was still pouring as heavy as ever, and we didnt think this was the time for a lesson, but he wouldnt go ahead till we came to look. He slowly began pulling away pieces of bloody tissue that filled her vagina, and soon we saw that the cervix was being held wide open by the same bloody mass, which was pouring blood like a sponge with water pouring through it.
The placenta is stuck in the cervix, he explained. The contractions are too weak to pass it.
He grasped the mass with a large forceps, and in one slow tug pulled out the entire placenta. The cervix virtually snapped shut behind it, and the bleeding slowed to mere spotting.
Carolyn was ashen but alive, and she whispered to us, Im okay.
All right, lets get this place cleaned up. Keep her warm and get her some orange juice to drink, Dr. C. ordered smuggly we thought. But then we saw that his hands were shaking.
Some accidental or intuitive or holy combination of circumstances came together that night to save that womans life (and to save the service, as well). Chance, we realized, plays a big part, even in matters of life and death. A year later, when we were better equipped to accept it, an equally coincidental set of circumstances was to combine to cause tragedy.
We had formed the service to do good, not harm. We knew and often discussed the fact that we werent perfect, we made mistakes.
We had to learn from both bad and good experiences trying constantly to reduce the elements of chance, to find the right combinations. But in matters of life and death, sickness and health, we always found it hard to shrug and say, Well, we learned from that mistake.
Medical schools prepare their students to deal with their mistakes. We had no protective training or legal shroud. We had only the support of each other and the belief that, on balance, our cause was good and our service was essential.
At this point, the women who worked as assistants were still limited to the eight or so who had gained the trust and approval of Dr. C.
They had become familiar with the tools and techniques for a D&C, although they had not attempted one themselves. They had been observing abortions for about 10 months and were proficient at giving shots, inserting a speculum, administering injections of novacaine around the cervix and taking pap smears to determine infection and cancer.
But when it came time to dilate and use a forceps or curette, the counselor/ assistant stepped aside and Dr. C took over.
As we assumed more and more assistant duties, and were now setting up working places and taking over safety precautions-formerly his concerns Dr. C grew more bored. His energy now went into increasing pressure for speed and efficiency.
Instead of working in one-bedroom apartments, he insisted that we find apartments with two bedrooms, so that a patient could be prepped and cleaned up in one room, while the actual abortion was being done on another patient in the other room.
Dr. C had been commuting into town to work. on Fridays and Saturdays ever since the Mafia had driven him out for refusing to pay protection. The number of patients that we could handle each of those days jumped from about 12 to 20 with the addition of the extra room, still not keeping pace with Janes increasing volume of calls. The four or five long-terms that we induced on Thursday mornings relieved the work load only slightly.
We all felt the pressure to find a way to handle the increasing volume of abortions, more and more of which were hard casesthe very young, the very poor, the very far pregnant.
Dr. C was appreciating the money he was getting from the volume of abortions, but he was also feeling the pressure and responsibility of the workload, especially since he had a family and a life to maintain in another place. While he indicated no immediate plans to step out, he warned us repeatedly that he would not be available forever.
It was clear that if we were to handle our increasing volume, we would either have to hire another abortionist or learn to do them ourselves. We were reluctant to repeat our unpleasant experience with the Northside abortion ring.
Clearly, learning to do a D&C ourselves, from start to finish, was the final essential step in having a service that could be controlled and run by women.
It was never clear at any given time whether Dr. C was motivated to teach us to be relieved of responsibility, because of a surge of commitment to a political idea he felt was sound, because he didnt want us to hire another abortionist, or because of that restless energy and impatience that made him constantly uncomfortable with the status quo.
One thing was clearthe pressure to teach and the pressure to learn created great conflictsboth within us and between us. For if we learned to do abortions, we would certainly use our knowledge. And that would inevitably cut into his job and his status.
Sometimes Dr. C seemed driven in his desire to teach .. as though he had to do it quickly, while he had a rush of commitment. And when those rushes came, those of us with the desire and the aptitude would have to be on hand to learn.
Sometimes he would turn to the assistant, curette in hand, and say, Here, you scrape around and check to see if its clean. When, we took curette gingerly in hand, he would order, Harder. Harder. Hold it this way. Pull toward you. You cant be afraid to use your muscles, and you cant be so afraid to cause pain that you dont do the job right.
Sometimes, if a patient was bleeding slightly more than normal, but not dangerously, he would hand the assistant a forceps and say, There must be a piece of placenta still in there. Get it out, will you? And then he would step back, making it clear that he would do nothing about the situation until the assistant had at least tried.
We were all on a rush. Paranoia and tension among us was high. Certain women who had the favor of Dr. C were being pushed to learn, while others felt left out. Dr. C often expressed subtle fear and, resentment over the encroachment on his trade secrets and his domain of authority, and yet he constantly pushed to teach just as we constantly pushed to learn.
And so we learnedin bits and pieces grabbing the opportunity, even while we had doubts about our moral rights to place our inexperienced hands on another sisters body.
But for the first few months, Dr. C was always in the background, apparently nonchalant and confident of us, but always ready to step in if the need arose.
And so, we were armed with tools and knowledge for doing a D&C months before we were to attempt one on our own. We lacked the expertise that goes with repeated experience, and the daring to do it without that experience.
When it finally happened, it was an accident. Four counselors were working at the apartment one Thursday, breaking water bags and inserting Leunbach paste for long-term miscarriages. The fourth and last patient for the day was a 19-year-old black woman, about 14 weeks pregnant fully counseled and prepared for a labor and miscarriage.
We were all glad this was the last patientfour in one day was a lot of responsibility and severe emotional drain. We were not fully sure of ourselves yet, even for this simple procedure. We dilated the patient and reached in with a forceps to break the membrane. Two other counselors were talking to the patient and watching.
There was the usual gush of water slightly pink with bloodand in the teeth of the forceps the arm of a 14-week fetus.
The counselor who was doing the abortion looked silently at the forceps and its contents for a full ten seconds. The other counselors were silent... watching.
Finally the woman asked, Is anything wrong.
Not at all, the counselor replied. In fact, I think well do you direct and get the whole thing over with today.
Suddenly the room was charged with energy again. One counselor began talking animatedly to the woman, explaining a D&C, while the other stood ready to help. The patient remained calm and confident.
Okaythis is one of those times when there is no choice but to... so go.
. . . Remember... be cool... weve seen it done a thousand times.. . reach in again with the forceps. .. gently explore the wall of the uterus ... feel for loose material . . . twist ever so gently to make sure its loose . . . pull slowly through the cervix.
...Another arm and hand...a big piece of placenta . . a leg . . . an endless length of tiny intestine . . . a large bone that comes with a stronger tuga shoulder . . .
. . . The woman winces as a hip bone is pulled through the cervix . . . the other leg . . . the ribs . . . a two inch length of backbone.
. . . Now with each tug, theres a small gush of blood. Only the head is left. Forget that for now and get the placenta off the wall so the bleeding will stop switch to a curette and scrape the placenta down towards the opening.
Now . . . back to the forcepsin and out, in and outpulling the loose placenta out. The bleeding stops almost entirely.
Now feel with the forceps, find the head, crush it and pull. Harder. The patient moans softly as a piece of skull is pulled out, then the next piece, and finally the last piece.
Okay. Once more around with the curette to make sure the walls are clean and its all over. Already the uterus is starting to contract and become firm, and the final curetting is complete.
Unscrew the speculum and slowly pull it out.
There. All done.
Twenty minutes had passed. And an eternity.
Suddenly the room is in bedlam. One counselor is jumping around and yelling, We can do it ourselves! From now on, we can do it ourselves!
(Continued) On to Part V