ABORTION NURSING. HOW DID I FIND MYSELF HERE?

I have said it before, but one of the things that makes me most proud of Mother of All Lists is that it has become a safe space for women’s voices to be heard and that even the most difficult subjects are handled respectfully by readers.

This is one of those subjects. I have huge respect for Emily Lawler for sharing this insight into her important career choice and what it means to her.

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• I feel nervous writing this.
• I am beyond proud of the work I do but I know there are people in the world who still believe it is immoral to end a pregnancy and I am bracing myself for anonymous abuse.
• I once mentioned my work in a very indirect way on twitter and was told I would need to explain myself ‘at the pearly gates’ like that’s an actual place.
• If you’re reading this and your back is already up then maybe just close your browser? Bygones.
• The recent sea change in Ireland regarding abortion has motivated me to talk more openly about what I do for a living.
• I’ve always been pro choice but two experiences have solidified my stance on unwanted pregnancies and my desire to support people with terminations. A nursing placement in a country where abortion is illegal, and the birth of my son. 
• While I was training to become a nurse I travelled to a placement in the Philippines, a catholic country where abortion is illegal and attempts to end pregnancies at home are common.
• During my obstetrics and gynaecology week I held the hand of 17-year-old girl whilst she underwent dilation and curettage, this is where the cervix is dilated and any retained tissue that can cause infection is scraped out. She endured this procedure due to a botched home abortion, completely conscious, without adequate pain relief, screaming for her mum. All I could do was comfort her, as I wasn’t in a position of authority to challenge the standard practice. Many years later, her face is still etched in my mind. 
• The reality is that outlawing abortion doesn’t eradicate abortion; it just makes it more dangerous and more traumatic. 
• The second turning point in my decision to work in abortion care was my own difficult high-risk pregnancy and subsequent traumatic birth.
• No one should ever have to be pregnant if it is not 100% what they want. It’s hard enough even if you do. It seems like a form of torture to me to force that upon a person.
• People, even other nurses, make a face when I tell them what I do, sometimes it’s a sad face and other times it’s a grimace but it’s maybe the best nursing job I’ve ever had. It’s one area where things can’t be rushed. We have time with patients to talk through ambivalence, to make sure they’re sure. To let them cry. To talk shite about celebrities while they’re having their scans. To talk about what nice thing they’re going to do for themselves later. To set up counselling. But lots of people decline it. Lots of people just want to get on with it and are hugely grateful for the kindness they receive from the service. 
• Every day people specifically thank me for ‘being so nice’ and it warms my heart.
• Even within healthcare, abortion services are still somewhat shrouded in secrecy. Before I worked in this job I didn’t even really know what it entailed.
• An early medical abortion involves a number of steps and can take place up to 9 or 10 weeks gestation. You’re not just in and out, it’s not over that quickly.
• Step one. Paperwork and a transvaginal scan to ensure the pregnancy is not ectopic, can be terminated and to check the gestation. If the pregnancy is too early and cannot be seen on the scan you’ll come back next week and we’ll try again. 
• Step two. The medication that stops the pregnancy from growing further and antibiotics. These can make you feel sick and it might make you bleed but not fully miscarry. If you vomit the tablet back up twice you will be referred for a surgical procedure instead. 
• Step three. The medication that causes the miscarriage. This is inserted into your vagina and pushed underneath your cervix. It’s not very comfortable but it’s not much worse than a smear test. We’ll give you some diclofenac – a prescription muscle relaxant to manage the heavy cramping that usually starts about half an hour after the medication is inserted, it’s a rectal suppository, yep, in your bum. Lots of people decline this and just try and cope with the pain but I try really hard to convince patients to take it, because I want them to be as comfortable as possible.
• The two stages of medication should happen at least 24 hours apart at the clinic I work at, but in some places all the medication is given at once. We have a rule that you have to go home by taxi and sign a form to confirm you will. Not everywhere does this and not every one can afford a taxi or has a lift.
• Some people miscarry on public transport.
• After that they can then bleed for up to a month on and off. Unless there are complications.
• There’s about a 5% chance of retained products which require further treatment.
• There is currently a campaign to give women the right to insert the second stage of tablets at home by themselves, which has just been passed into law but it’s not trickled down into practice yet. 
• People have a picture of the type of person who terminates a pregnancy but it’s really not all teenagers. Teen pregnancy rates have dropped considerably over the last 30 years and the vast majority of people who come to see us are married, in their 30s, and are already mothers to at least one child.
• Often, they’ve not had sex in a year and it’s come as a huge shock and financial strain to consider a 3rd or 4th child. 
• Sometimes people wring their hands at the prospect of women using abortion as contraception, which I find really frustrating because in my experience, it’s quite rare.
• No method of contraception is 100% effective.
• People get pregnant on the pill, people get pregnant with a coil in, condoms break and if you’re advocating abstinence then you’re just not living in the real world.
• Most people are worried about weight gain with hormonal contraception over almost all other side effects, even depression.
• As a society we tell women to prioritise thinness over their pregnancy risk. We need better contraception options for both men and women. 
• Lots of people have no problem with hormonal contraception but it can affect your mood, it can make you feel sick.
• Each method won’t be right for each person and it is a rollercoaster of trial and error trying to find the right option. 
• Natural methods of contraception like apps that monitor your cycle claim to be a method of contraception and a lot of women in their twenties have really bought into it as an alternative to the pill.
• It’s understandable to want to avoid hormones for a host of reasons but when women rely on methods like this which are only 70% effective (meaning you’ve got a 30% chance of falling pregnant with the app or any form of ‘natural’ family planning) unwanted pregnancies are going to happen. I’m not a betting woman but if I had a 30% chance of winning the lottery, I’d play every week. 
• Sometimes patients tell me that they think what they’re doing is murder and they’re going to hell. I tread a very difficult line in explaining to them that I don’t believe that that is true because it’s not appropriate as a nurse to challenge religious beliefs. We break down the conversation to try and decipher if they’re truly ambivalent or just upset with themselves. I try to focus on discussing what decision they feel is best for them. Even people who are completely anti abortion sometimes need to have an abortion. 
• People often come to us thinking that they will never have sex again and it can be really hard to convince them that the trauma they feel now will fade and they almost certainly will. It can be harder to get them to take a new form of contraception home with them. There’s just so much to take in at one time. It can be really overwhelming for people.
• Most importantly, terminating a pregnancy is about informed choice in a judgement free environment.
• If you need an abortion, it’s ok.
• We’ll look after you. Lots of women come to us unsure of what to do next and half the time, request a copy of their first scan and head home deciding to continue the pregnancy. If you’re reading this and you need support or advice around anything I’ve written, all of these organisations will be able to help you further: https://www.bpas.org/ or https://www.mariestopes.org/ or https://www.nupas.co.uk/