Offering respectful pelvic exams is not just to minimize trauma and discomfort (though those are very important goals), but to also have the pelvic exam become a positive experience, whenever possible. Not just something less awful than previous experiences, no just something tolerable or okay, but something actually positive.
If there’s one pelvic care procedure people seem to universally dread, it’s an IUD insertion. The most common words I hear when describing an IUD insertion are excruciating and traumatic. It does not need to be this way! With careful and respectful handling of the body, and knowledge of the natural mechanisms of the cervix, an IUD insertion can be as gentle as possible.
The term “D&C” describes a specific medical procedure. It is not an appropriate catch-all for any procedure that empties a uterus! It is important to use accurate medical terminology when describing the procedures people are going to receive in their body, especially with the intimacy and vulnerability of abortion care & miscarriage management. Respect people enough to trust them to hold new, nuanced information and understand their bodies best.
Lots of people approach me during and after an abortion or a miscarriage describing very normal, expected symptoms and worrying that something is wrong with them. They often feel inadequately prepared by their healthcare providers, or have been helping themselves at home without outside guidance, and are now concerned about their well-being and their bodies.
After my second miscarriage, the deepest, most meaningful healing I experienced was through sex. I’ve had four, maybe five, miscarriages. They’ve each been unique and brought their own lessons on management and aftercare. Miscarriages can be rough. Physically. Emotionally. Practically. Even with my deep knowledge of miscarriage management, I struggle with them just like anyone else. We’re human. Losing children is challenging.
PPE has significantly impacted by ability to connect with newborns. They can’t tell where my voice is coming from when my mask covers my mouth. Glare and reflection off my face shield makes them look away, and already blurry vision through a face shield makes it hard for them to make eye contact with me. When I try to bring my face closer to them to facilitate communication I often awkwardly bonk them with my shield.
Abortion care is changing right now. Due to the COVID-19 crisis, the way people access abortions, and the way clinicians provide them has come under careful consideration. In most cases, this has meant decreased in-person contact and eliminating a lot of the peripheral things that come along with abortion provision, like bloodwork, ultrasound, and counseling. As someone who has long supported out-of-clinic abortion care, these changes are encouraging, to see an abortion care system I usually perceive as rigid starting to relax and take a look at evidence-based, client-centered care principles.
One of the more important developments in research around medication abortion protocols is that misoprostol works well to induce an abortion all on its own. Sound, scientific studies have shown that even without Mifepristone, misoprostol alone is safe, effective, and (unlike Mifepristone) much more accessible and affordable.
Slowly but surely, there is a growing body of literature and medical practice around administering medication protocols for early pregnancy loss. The delay in the uptake of medications for miscarriage management is often tied to the stigma of these medications and research around them being typically used for abortion … despite the physiology between an early abortion and an early miscarriage being nearly identical.
Having had five miscarriages, I’ve become somewhat of an unfortunate expert. I’ve had a range of experiences from mysterious to practical, from labour & birth to hemorrhage, from grief and pain to relief. When I first started researching miscarriage before I started having my own, my most powerful learning came from storytelling. I hope now to add to that narrative and bring some wisdom from my losses.
To say this process has been, is, painful would be a gross understatement. The coupling of being a midwife and being unwillingly infertile is a brutal existence. While I can easily compartmentalize my individual clients’ joys, fears, and experiences from my own, the simple juxtaposition of spending all day around pregnancy and babies feel ironic at best coming home to a quiet house.
The image provokes a visceral physical reaction and evokes a societal remembering of times when women used desperate and dangerous measures to end pregnancies, and has become part of the standard vocabulary in the movement to promote access to clinic-based abortion. But it’s time we dropped the symbol!
