First a little background. Planned Parenthood’s mission is not solely to provide abortions. Fully 95% of their practice involves healthcare, family planning advice, dispensing birth control, screening for STD’s, etc. That’s right, only 5% of patients are seeking an abortion.

At my clinic, around 30% of women choose a medical abortion (RU-486).

The women I see span every age range, income level and social class. Approximately 50% of these women find themselves at the clinic because of birth control failures. About half are married and have children at home.

Getting an abortion is an all-day experience. The woman has to take a day (or two) off from work or school, find childcare and a friend to drive them home. I live in a state where getting an abortion is not difficult but the time factor in prepping a woman for the procedure is onerous no matter what.

Before this day, she will have had extensive counseling about her options. If she chooses abortion, she is informed in detail what to expect. No one enters the procedure room uninformed. Once her choice has been made and she arrives at the clinic, she is taken for an ultrasound to determine the size of her uterus and how far the pregnancy has advanced. Abortion can be done in a Planned Parenthood clinic up to 14 weeks.

At this point, she is pre-medicated. Medication ranges from a couple of ibuprofen to Ativan and Vicoden. If the pregnancy is quite advanced a drug is given to soften the cervix. At this point, she waits. Most days the lag time between coming to the clinic and entering the procedure room is 4 or 5 hours.

Once I have called her back, I check her ID bracelet and ask her if she needs to use the bathroom. Many times the woman is quite loopy from the medication. More often than not, she is nauseous. Think about it, she’s pregnant, she hasn’t eaten since the previous day, she’s been sitting down for hours and she’s been given the codeine-based drug, Vicoden on an empty stomach. Codeine makes people hurl even under the best of circumstances. I’ve had days where the bulk of my job is rubbing backs and holding back hair as a miserable woman tries to get some relief.

Once the woman has disrobed and covered herself with a drape, the procedure goes fairly quickly. Some women choose IV medication to further dull pain, but most opt not to do this. The doctor or nurse practitioner comes in and introductions are made. He/she is often accompanied by a medical resident who will actually do the surgery under observation. Most days, the patient is also asked if a medical student might be allowed to observe. If the patient has a companion with her, there are times when 6 or 7 people are packed into one tiny room. Despite the fact that only 15% of medical schools offer abortion training as an elective, our local med school does offer it and uses it well. I’m always glad to see new people interested in learning to do this procedure quickly and safely.

The resident will tell the patient everything that she is doing during the procedure. First, there is a manual exam to determine the size of the uterus. Despite the ultrasound, this is done to train the doctor to use her own senses in case she is working someplace where ultrasound is not available. It’s kind of like being able to do math without a calculator.

She then inserts a speculum, takes a swab to test for Chlamydia (this is done on all patients) and swabs the cervix with soap. At this point, the cervix is numbed with Lidocaine. This is several injections and can sometimes be uncomfortable.

At this point, dilation begins. The dilators are a series of graduated rods that gently open the cervix. This part will produce the beginning of sometimes severe cramping. The ultimate size of the opening is determined by how far the pregnancy has advanced.

The last step is scraping the uterus and suctioning out the contents. The suction can be done by machine (I think the sound of the machine can be somewhat disconcerting) or can be done manually, a quieter method. After the contents have been removed, the speculum is removed and the doctor will take the contents to the lab and check to make sure the procedure is complete. If the gestational sac is observed as intact the procedure is over. In extremely rare circumstances, the procedure must be repeated if the sac can’t be found. If the woman is early in her pregnancy, the sac is too small to see with the naked eye and she will have to return in 3 days to have her blood tested for beta-HCG. A drop in this hormone level will determine the success of the procedure. Occasionally, a woman will ask to see the products of conception. The vast majority of what she will see once the blood is rinsed away is endometrial tissue. If the resident can see the sac, she will separate it away. What there is to see is not much. The sac is a yellowish glob of mucous-like material. There is no fully formed infant looking back at us.

From start to finish, the entire procedure outside recovery takes less than 10 minutes.

Finally, I lead the woman back to recovery, settle her into an easy chair, place a heating pad on her lap to ease the cramping (which starts to subside 5 to 10 minutes after the procedure is done) and feed her juice and cookies if she’s feeling up to it. Half an hour later, she checks for excessive bleeding, confers with the recovery nurse and goes home….hopefully to a good dinner and a night of watching videos on the sofa.

I know there’s a lot speculation here about the woman’s mental or emotional state. I think a lot people imagine a lot of sobbing and remorse and rending of garments. I’m sorry to inform you, this is just not the case. Most women are nervous about the unknowns of the procedure itself. None have actually changed their mind once they are in the room. Some women walk in and out as fresh as though they’ve had a day at the spa with little pain or nausea. Some women look like they’ve been dragged through a shrub backwards by the time they go. In all my conversations with these women, we have never discussed the moral ramifications of their decision and believe me, these women talk about why they are there.

Women are very rational beings. For a lot of reasons, we have been aborting our babies for thousands of years. Although we never consider it, could it be in our DNA? In the animal kingdom, the female won’t even go into estrous if environmental conditions are not right. Infanticide (a mother eating her young) is commonplace. I have witnessed the matter-of-fact determination of literally hundreds of women to NOT bring a child into a world where it is not wanted or couldn’t be adequately cared for. I realize that unlike animals we as humans are capable of making “moral” choices. I think that as a society, we are not judging morality by the same metrics. Is it immoral to “destroy life” or is it immoral to preserve life then neglect it?

I’m devolving off into the usual DailyKos obsession with morality here but I think if people actually knew what happened in an abortion clinic and could witness for themselves how women handled it they would question some of their preconceived notions. There is little connection between reality and propaganda in this case.