Most of us learn the word "elective"
in high school, when we find ourselves with the newfound freedom to
take a course like AP music theory, or advanced sculpture, or yoga.
Elective implies freely chosen, life-enhancing. Laser eye surgery is
elective. Tattoos are elective. But the vast majority of so-called
"elective" cesarean sections are not, and it is inappropriate and
disingenuous to call them so in the medical literature, as did the
recent study in this month’s New England Journal of Medicine,
"Timing of Elective Repeat Cesarean Delivery at Term and Neonatal
The large study made headlines last
week in papers large and small, was mentioned on NPR, went viral on
the web, and even made national TV news. It found that when babies
are extracted prior to 39 full weeks in the womb, they are less
likely be born breathing on their own, more likely to start life in a
neonatal intensive care unit, and more apt to have infections and
lingering health problems.
We already knew this from previous,
smaller studies, and the American College of Obstetricians and
Gynecologists’ recommendation is to wait until the 39-week mark. But
the study, which culled subjects from the National Institute of Child
Health and Human Development network—presumably those hospitals
most likely to follow best practices—found that a whopping 36
percent of scheduled, repeat cesarean sections were booked before
Ah, but these are "elective" repeat
cesareans, so women must be requesting them early! That’s what the
study’s authors tell us: lead researcher Alan Tita, MD, said that
women "usually" want to deliver "as soon as they hit" week
37. "Women should wait to have an elective cesarean until 39
weeks," he told Time magazine. Study coauthor Catherine
Spong, MD, elaborated for the Washington Post: "Sometimes
a patient is bonded to their physician…and says, ‘Can we schedule
it when you’re in town?’…Sometimes her in-laws are coming at a
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And the media dutifully followed the
physicians’ pointed fingers—toward mothers: "Thousands of
women put their babies at needless risk of respiratory problems,
hypoglycemia and other medical ailments by scheduling C-section
deliveries too early…" began an L.A. Times story. "The
findings could help diminish a widely popular practice…in which
mothers choose to schedule c-sections, or surgical removal of the
baby," reported the Wall Street Journal. "Some women
opt to deliver a little earlier for a variety of reasons, including
being eager to see their baby, being tired of pregnancy or for
convenience," explained the Washington Post. Time
magazine castigated those mothers: "Today, a trend toward elective
cesareans is presenting doctors with another problem—women who insist on delivering earlier than they should, with potential
risks to the newborn" (emphasis added).
To be clear, the researchers did not
survey the women in this study—they were looking strictly at the
health outcomes of newborns. And previous surveys of women have found
no evidence of a "trend toward elective cesareans." But in
classifying the deliveries as "elective," they imply
patient-choice. "These are all elective repeat Caesareans
without a medical indication and without labor," Spong told
It’s true: scheduled, repeat cesareans
are not "medically indicated," at least not according to the
research evidence. After a cesarean birth, a woman is left with a
scar on her uterus, and there’s a small risk of that scar rupturing
in subsequent deliveries, which has led to concerns about vaginal
birth after cesarean (VBAC). But a VBAC baby has excellent odds—the
risk of severe harm or death is 1 in 2000—the same odds as for a
baby born vaginally to a first-time mother.
However, in spite of the true risk,
VBACs are often vehemently discouraged. In fact, many obstetricians
now refuse to attend them, and hundreds of hospitals have officially
banned them. And malpractice liability fears are a strong motivation
to schedule the surgery early, so as to avoid the possibility of
labor—and vaginal birth. The fact is that VBAC is inaccessible to
So, if a woman with a scar from a
previous cesarean goes to her OB and is recommended to schedule a
repeat cesarean—and is told that a vaginal birth would be risky,
and that anyway it won’t be done by this doctor, this practice, or
this hospital—can the surgery possibly be called "elective?"
There are risks to VBAC and risks to
repeat C-section—even those done after 39 weeks—and women should
be weighing the risks and benefits with objective care providers who
will support their decision. But this is not what’s happening. In a
survey conducted in 2005, more than half of women seeking VBAC could
not find a willing provider or hospital.
This is not about women "electing"
to put their babies at risk. This is about women being backed into a
corner and told what’s best, then publicly shamed for "asking for
My life’s work has been to transform the conversation about abortion, so I am overcome with joy at the Supreme Court ruling in Whole Woman’s Health v. Hellerstedt. Abortion providers have been living under a very dark cloud since the 2010 elections, and this ruling represents a new day.
Abortion providers can finally begin to turn our attention from the idiocy and frustration of dealing with legislation whose only intention is to prevent all legal abortion. We can apply our energy and creativity fully to the work we love and the people we serve.
My work has been with independent providers who have always proudly delivered most of the abortion care in our country. It is thrilling that the Court recognized their unique contribution. In his opinion, after taking note of the $26 million facility that Planned Parenthood built in Houston, Justice Stephen Breyer wrote:
More fundamentally, in the face of no threat to women’s health, Texas seeks to force women to travel long distances to get abortions in crammed-to-capacity superfacilities. Patients seeking these services are less likely to get the kind of individualized attention, serious conversation, and emotional support that doctors at less taxed facilities may have offered.
This is a critical time to build on the burgeoning recognition that independent clinics are essential and, at their best, create a sanctuary for women. And it’s also a critical time for independent providers as a field to share, learn from, and adopt each other’s best practices while inventing bold new strategies to meet these new times. New generations expect and demand a more open and just society. Access to all kinds of health care for all people, including excellent, affordable, and state-of-the-art abortion care is an essential part of this.
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We’ve been under attack and hanging by a thread for so long—with our financial, emotional, and psychic energies drained by relentless, unconstitutional anti-abortion legislation—it’s been almost impossible to create and carry out our highest vision of abortion care.
Clearly 20-week bans don’t pass the undue burden test, imposed by the Court under Planned Parenthood v. Casey, because they take place before viability and abortion at 20 weeks is safer than childbirth. The federal Hyde Amendment, a restriction on Medicaid coverage of abortion, obviously represents an undue burden because it places additional risk on poor women who can’t access care as early as women with resources. Whatever the benefit was to late Rep. Henry Hyde (R-IL) it can’t possibly outweigh that burden.
Some of these have already been rejected by the Court and, in Alabama’s case, an attorney general, in the wake of the Whole Woman’s Health ruling. Others will require the kind of bold action already planned by the Center for Reproductive Rights and other organizations. The Renaissance involves raising an even more powerful voice against these regulations, and being firm in our unwillingness to spend taxpayer dollars harming women.
I’d like to entertain the idea that we simply ignore regulations like these that impose burdens and do not improve health and safety. Of course I know that this wouldn’t be possible in many places because abortion providers don’t have much political leverage. This may just be the part of me that wants reproductive rights to warrant the many risks of civil disobedience. In my mind is the man who stood in front of moving tanks in Tiananmen Square. I am yearning for all the ways to stand in front of those tanks, both legal and extralegal.
Early abortion is a community public health service, and a Renaissance goal could be to have early abortion care accessible within one hour of every woman in the country. There are more than 3,000 fake clinics in this country, many of them supported by tax dollars. Surely we can find a way to make actual services as widely available to people who need them. Of course many areas couldn’t support a clinic, but we can find ways to create satellite or even mobile clinics using telemedicine to serve women in rural areas. We can use technology to check in with patients during medication abortions, and we can provide ways to simplify after-care and empower women to be partners with us in their care. Later abortion would be available in larger cities, just as more complex medical procedures are.
In this brave new world, we can invent new ways to involve the families and partners of our patients in abortion care when it is appropriate. This is likely to improve health outcomes and also general satisfaction. And it can increase the number of people who are grateful for and support independent abortion care providers and who are able to talk openly about abortion.
We can tailor our services to learn which women may benefit from additional time or counseling and give them what they need. And we can provide abortion services for women who own their choices. When a woman tells us that she doesn’t believe in abortion, or that it is “murder” but she has to have one, we can see that as a need for deeper counseling. If the conflict is not resolved, we may decide that it doesn’t benefit the patient, the clinic, or our society to perform an abortion on a woman who is asking the clinic to do something she doesn’t believe in.
I am aware that this last idea may be controversial. But I have spent 40 years counseling with representatives of the very small, but real, percentage of women who are in emotional turmoil after their abortions. My experience with these women and reading online “testimonies” from women who say they regret their abortions and see themselves as victimized, including the ones cited by Justice Kennedy in the Casey decision, have reinforced my belief that when a woman doesn’t own her abortion decision she will suffer and find someone to blame for it.
We can transform the conversation about abortion. As an abortion counselor I know that love is at the base of women’s choices—love for the children they already have; love for their partners; love for the potential child; and even sometimes love for themselves. It is this that the anti-abortion movement will never understand because they believe women are essentially irresponsible whores. These are the accusations protesters scream at women day after day outside abortion clinics.
Of course there are obstacles to our brave new world.
The most obvious obstacles are political. As long as more than 20 states are run by Republican supermajorities, legislatures will continue to find new ways to undermine access to abortion. The Republican Party has become an arm of the militant anti-choice movement. As with any fundamentalist sect, they constantly attack women’s rights and dignity starting with the most intimate aspects of their lives. A society’s view of abortion is closely linked to and mirrors its regard for women, so it is time to boldly assert the full humanity of women.
Anti-choice LifeNews.com contends that there have been approximately 58,586,256 abortions in this country since 1973. That means that 58,586,256 men have been personally involved in abortion, and the friends and family members of at least 58,586,256 people having abortions have been too. So more than 180 million Americans have had a personal experience with abortion. There is no way a small cadre of bitter men with gory signs could stand up to all of them. So they have, very successfully so far, imposed and reinforced shame and stigma to keep many of that 180 million silent. Yet in the time leading up to the Whole Woman’s Health case we have seen a new opening of conversation—with thousands of women telling their personal stories—and the recognition that safe abortion is an essential and normal part of health care. If we can build on that and continue to talk openly and honestly about the most uncomfortable aspects of pregnancy and abortion, we can heal the shame and stigma that have been the most successful weapons of anti-abortion zealots.
A second obstacle is money. There are manyextraordinary organizations dedicated to raising funds to assist poor women who have been betrayed by the Hyde Amendment. They can never raise enough to make up for the abandonment of the government, and that has to be fixed. However most people don’t realize that many clinics are themselves in financial distress. Most abortion providers have kept their fees ridiculously and perilously low in order to be within reach of their patients.
Consider this: In 1975 when I had my first job as an abortion counselor, an abortion within the first 12 weeks cost $150. Today an average price for the same abortion is around $550. That is an increase of less than $10 a year! Even in the 15 states that provide funding for abortion, the reimbursement to clinics is so low that providers could go out of business serving those in most need of care.
Over the years a higher percent of the women seeking abortion care are poor women, women of color, and immigrant and undocumented women largely due to the gap in sexual healtheducation and resources. That means that a clinic can’t subsidize care through larger fees for those with more resources. While Hyde must be repealed, perhaps it is also time to invent some new approaches to funding abortion so that the fees can be sustainable.
Women are often very much on their own to find the funds needed for an abortion, and as the time goes by both the costs and the risk to them increases. Since patients bear 100 percent of the medical risk and physical experience of pregnancy, and the lioness’ share of the emotional experience, it makes sense to me that the partner involved be responsible for 100 percent of the cost of an abortion. And why not codify this into law, just as paternal responsibilities have been? Perhaps such laws, coupled with new technology to make DNA testing as quick and inexpensive as pregnancy testing, would shift the balance of responsibility so that men would be responsible for paying abortion fees, and exercise care as to when and where they release their sperm!
In spite of the millions of women who have chosen abortion through the ages, many women still feel alone. I wonder if it could make a difference if women having abortions, including those who received assistance from abortion funds, were asked to “pay it forward”—to give something in the future if they can, to help another woman? What if they also wrote a letter—not a bread-and-butter “thank you” note—but a letter of love and support to a woman connected to them by the web of this individual, intimate, yet universal experience? This certainly wouldn’t solve the economic crisis, but it could help transform some women’s experience of isolation and shame.
One in three women will have an abortion, yet many are still afraid to talk about it. Now that there is safe medication for abortion, more and more women will be accessing abortion through the internet in some DIY fashion. What if we could teach everyone how to be excellent abortion counselors—give them accurate information; teach them to listen with nonjudgmental compassion, and to help women look deeper into their own feelings and beliefs so that they can come to a sense of confidence and resolution about their decision before they have an abortion?
There are so many brilliant, caring, and amazing people who provide abortion care—and room for many more to establish new clinics where they are needed. When we turn our sights to what can be, there is no limit to what we can create.
Being frustrated and helpless is exhausting and can burn us out. So here’s a glass of champagne to being able to dream again, and to dreaming big. From my own past clinic work:
At this clinic we do sacred work
That honors women
And the circle of life and death.
Sen. Bernie Sanders (I-VT) seemingly signaled he is not yet ready to concede the nomination to Hillary Clinton, and he promised to help push for reforms within the party while working to keep presumptive Republican nominee Donald Trump from winning the White House.
Sen. Bernie Sanders (I-VT) isn’t bowing out of the race for the Democratic nomination after the close of the presidential primaries, and Hillary Clinton took to the Huffington Post to talk about campus sexual assault and whether women should have to sign up for the draft.
“The Political Revolution Must Continue”: Sanders Vows in Thursday Night Address to Push for Party Reform
Sanders addressed supporters Thursday night after the 2016 presidential primary season ended earlier this week. He seemingly signaled he is not yet ready to concede the nomination to Hillary Clinton, and he promised to help push for reforms within the party while working to keep presumptive Republican nominee Donald Trump from winning the White House.
“Election days come and go. But political and social revolutions that attempt to transform our society never end. They continue every day, every week, and every month in the fight to create a nation and world of social and economic justice,” Sanders said during the address, which was live-streamed online. “Real change never takes place from the top on down or in the living rooms of wealthy campaign contributors. It always occurs from the bottom on up, when tens of millions of people say loudly and clearly ‘enough is enough’ and they become engaged in the fight for justice. That’s what the political revolution we helped start is all about. That’s why the political revolution must continue.”
“The major political task that we face in the next five months is to make certain that Donald Trump is defeated and defeated badly,” Sanders continued, vowing to soon begin his role in ensuring the Republican doesn’t make it to the White House.
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“But defeating Donald Trump cannot be our only goal,” he added. “We must continue our grassroots efforts to create the America that we know we can become.”
Expressing his hope that he could continue to work with Clinton’s campaign, Sanders promised to ensure that supporters’ “voices are heard and that the Democratic Party passes the most progressive platform in its history and that Democrats actually fight for that agenda.”
That agenda included raising the minimum wage to $15 an hour, ending the gender pay gap, defending reproductive rights, and protecting marriage equality in the United States, among other things.
Sanders’ speech came just after campaign manager Jeff Weaver said the campaign is “not currently lobbying superdelegates” and doesn’t “anticipate that will start anytime soon” during an interview on Bloomberg Politics’ With All Due Respect Thursday. The next day, Weaver told the hosts of MSNBC’s Morning Joe that Sanders is still “an active candidate for president.”
Clinton Weighs in on Stanford Sexual Assault Case, Women Joining the Draft
Hillary Clinton took a stand on two notable issues during an interview with the Huffington Post this week, telling the publication that she supported a measure in the Senate torequire women to sign up for the draft and her thoughts about the Stanford sexual assault case.
“I do support that,” Clinton told the publication Wednesday when asked about the Senate’s approval of the National Defense Authorization Act, a military policy bill that would require women to sign up for the military draft once they turn 18, earlier in the week.
“I am on record as supporting the all-volunteer military, which I think at this time does serve our country well,” said Clinton. “And I am very committed to supporting and really lifting up the men and women in uniform and their families.”
As the New York Timesreported, under the bill, “Failure to register could result in the loss of various forms of federal aid, including Pell grants, a penalty that men already face. Because the policy would not apply to women who turned 18 before 2018, it would not affect current aid arrangements.”
Though the U.S. Supreme Court previously ruled that women weren’t required to register for the draft as they were not allowed to serve in combat, the Times continued, “since Defense Secretary Ashton B. Carter said in December that the Pentagon would open all combat jobs to women, military officials have told Congress that women should also sign up for the draft.”
The draft registry has not been used by the United States since 1973, but requiring women to sign up for it has nevertheless been an issue on the campaign trail this election season. Sen. Ted Cruz (R-TX) called requiring women to register for the draft “nuts” in February prior to dropping out of the race for the White House, while other then-Republican presidential candidates Sen. Marco Rubio (FL), New Jersey Gov. Chris Christie, and former governor of Florida Jeb Bush all signaled they would support it.
During her interview with Huffington Post, Clinton also voiced her support for the survivor at the center of the controversial Stanford sexual assault case, saying she was “was struck by” the “heartbreaking power” of the letter the survivor wrote detailing her experiences.
“It took great courage and I think she has done an important service for others,” Clinton said. “What I’ve heard about this case is deeply concerning. It is clear campus sexual assault continues to be a serious problem. And I’ve said before and I will continue to say it is not enough to condemn it. We must find ways to end it.”
The presumptive Democratic nominee had previously released a platform for addressing the national crisis of campus sexual assault, which promises to “provide comprehensive support to survivors;” “ensure fair process for all in campus disciplinary proceedings and the criminal justice system;” and “increase sexual violence prevention education programs that cover issues like consent and bystander intervention, not only in college, but also in secondary school.”
What Else We’re Reading
Trump’s “endgame” could be launching a “mini-media conglomerate,” Vanity Fair reports.
“He was always very open about describing women by their breast size,” a crew member for Trump’s reality show The Apprenticetold Slate of the presumptive Republican nominee. “Any time I see people in the Trump organization say how nice he is, I want to throw up. He’s been a nasty person to women for a long time.”
In the wake of the mass shooting in Orlando at an LGBTQ club, the Southern Poverty Law Center’s deputy legal director of the LGBT Rights Project, David Dinielli, noted that “candidates on the campaign trail-and even the presumptive nominee of the Republican Party-elevate radical anti-LGBT leaders.”
Fact-checkers at the Washington Post took on both Clinton and Trump’s speeches on national security after the massacre in Orlando over the weekend.
“Regardless of your politics, it’s a seminal moment for women,” said Oprah, who offered her endorsement to Clinton on Wednesday, when speaking about the presumptive Democratic nominee. “What this says is, there is no ceiling, that ceiling just went boom! It says anything is possible when you can be leader of the free world.”
CNN’s Jim Sciutto, Tal Yellin, and Ryan Browne offer a look into the implications of Trump’s proposed plan to “suspend immigration from areas of the world when there is a proven history of terrorism against the United States, Europe or our allies.”
Republicans may have fewer women in the House next year after the election season wraps up.
Texas has already spent $3.5 million fighting multiple lawsuits over the state’s restrictive voter ID law, in what an attorney helping plaintiffs in one of the suits deemed a “shameful waste of taxpayer money.”
Ohio Gov. John Kasich (R) moved to make voting in the state easier for some this week, signing legislation that will allow residents with driver’s licenses and state IDs to register to vote online. What’s the catch? According to ThinkProgress, “the option will not be available until early next year, after the presidential election, despite the Republican Secretary of State’s insistence that the Ohio could implement the policy immediately.”