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Thursday, September 23, 2010

Sometimes when I'm counseling, clients will use the session not only as an opportunity for their questions and fears about surgery, recovery, and choice, but as an opportunity to try to get information about those mysterious other women filling the waiting room. "How far can you do this to?" they ask cryptically, grammatically ambiguously. "How could someone do that?" they continue, pitting their own 6 week abortion against another possibly 23 week abortion. And then I explain choice and circumstances and sometimes they get it, sometimes, they don't. Recently, as I described to the client what to expect, anesthesia-wise, she blurted, "Why would someone want to be awake for this?! That just sounds awful. Knock me out, please."

My opinion doesn't matter, but in the interest of full disclosure and biases, if I were to have an abortion, I'd go with general anesthesia, no contest. Sure, I'd like to know exactly what's going on, partially so that I would better be able to inform clients. But I know myself, and I would be way too tense, way too uncomfortable for my own good, for the doctor's good, for anyone's good, just because that's how I am at any medical appointment. A first-trimester (6-12 weeks) abortion takes five minutes, tops. With general anesthesia, the patient is monitored by a nurse-anesthetist the whole time -- all of ten minutes. The anesthesia travels into the body through an IV in the arm -- no masks, no machines doing the breathing for you. Yes, the medications include Propofol, the notorious Michael Jackson drug, but it's not something the client takes home with her, and if there's anything slightly sketchy in her medical history, we have a long discussion about the risks and benefits of general anesthesia. But generally (no pun intended), a clinic's anesthesia is less intense than what's used for wisdom tooth removals. Clients love it because they don't feel nor remember anything, and they wake up relatively quickly. They hate it because they give up some control, they can't eat or drink anything, they need to have a driver, and because anesthesia is scary. Most of the clients at my clinic choose to be asleep.

Being awake, on the other hand, involves BEING AWAKE. Some clinics offer sedation or narcotics, but my clinic is not one of those. And some clinics offer ONLY local anesthesia -- my clinic is not one of those, either, but it illustrates just how manageable being awake can be. It isn't for everyone. But again, it's a five minute procedure, and because there's no cutting ("surgery" is a misnomer), only minimal dilation of the cervix, being awake is do-able. And in that case, the doctor administers a local anesthetic like Lidocaine via injection into the cervix. The sensitive cervix is numbed, but numbing the entire uterus just isn't possible, and the uterus is going to cramp during an abortion -- it's just the nature of the muscle. Woman have described the cramping as stronger than menstrual cramps, but not as intense as childbirth. And based on my hand-holding experience, those evaluations seem to be pretty accurate. Some women carry on conversations with a few winces, and others nearly break my hand as they scream. Some of the clients choose to be awake because they value being present in their abortion experience. It gives them some power. Others opt for a few minutes of discomfort over the nausea they historically experienced post-general anesthesia. And some just don't see the whole procedure as that big of a deal -- why be asleep for a simple, safe gynecological procedure? Other women would rather be out of it, but with no one to accompany them to the clinic, local is the only choice. And some women opt to be awake just because it's less expensive, which breaks my heart. And speaking of heartbreak, let's not even get into the mothers of teens who insist that their daughters need to be awake so that they can be punished for getting pregnant.

I'm intrigued by this aspect of abortion -- a choice within a choice, as it were. And as a fellow Abortioneer pointed out, the choice of being asleep versus awake varies widely from clinic to clinic, city to city. Readers, what are your experiences with clients' preferences? Have you, yourself, made that particular decision? Does your clinic offer anesthesia experiences other than what I described above?

And stay tuned -- in the coming weeks, we'll also explore things like abortion by pill and why some women love it, some women hate it, some providers heart it, some eschew it. And we take requests: What abortion mysteries or intricacies would you like to know more about?


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