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I’m Ruth, a certified nurse midwife. At 52 years old, I’ve cared for women for half my life. I have five children, and I’ve been a gestational surrogate and an egg donor. Yes, I love babies!

When people hear what I do for a living, the usual response is, “How fun! Such a happy job with all the babies being born.” They are right 90% of the time. The other 10% is complex, often sad, and leaves its mark on me.

The complex part of my work as a midwife involves fetal loss, fetal anomalies, domestic violence, substance abuse, serious pregnancy complications, unintended pregnancies, and abortion counseling and follow-up.

Despite the challenging parts, I love what I do. It is not just my work but my calling. Supporting women is what midwifery is all about — women with women. I help women in not just the most joyful times but also the most difficult times.

I frequently counsel women, and sometimes their partners, about abortion. First and foremost, the reasons for abortion are highly personal, as is the decision on the type of abortion.

What we commonly call abortion is also called “pregnancy termination” or “therapeutic abortion.” There are many misconceptions about what an abortion is. Let’s review the various methods as I would with one of my patients.

A medical abortion involves taking two different pills to end a pregnancy. This form of abortion has been used for more than 20 years in the United States and is safe and effective. People often call medical abortion “the abortion pill,” even though it involves two different medications. You can get the pills from an abortion provider in person or from various websites.

In a medical abortion, the first medication is called mifepristone, or RU-486. This medication blocks the hormone progesterone. Without progesterone, the pregnancy cannot continue, as the lining of the uterus breaks down.

The second medication is called misoprostol. Misoprostol works to empty the uterus by causing heavy cramping and bleeding. You take it up to 48 hours after the first medication.

Medical abortions work approximately 95–99% of the time. You can use the medications up to 11 weeks, or 77 days, after the first day of your last menstrual period. Many women choose this option because they can end their pregnancy in the comfort and privacy of their own home. About half of the women having an abortion choose the medical option.

Complications of medical abortions are rare. Most of the complications are minor, such as digestive system discomfort, heavy bleeding, and fever. In some cases, an incomplete abortion may occur. This will require another dose of misoprostol or a surgical abortion.

A surgical abortion is a quick medical procedure that is minimally invasive. Even though it’s called “surgical,” it does not require general anesthesia and is usually done in a clinic. Despite the short procedure, you will be at the clinic for several hours.

The most common method of surgical abortion is the use of a suction device to gently remove the contents of the uterus. The procedure is called vacuum aspiration.

A dilation and evacuation (D&E) procedure will probably be done if your pregnancy is more than 14–16 weeks from the first day of your last period. A D&E involves using suction and medical instruments to empty the uterus.

Abortion providers can perform surgical abortions much later in pregnancy than medical abortions. Surgical abortions are effective more than 99% of the time. Possible complications include bleeding, pregnancy tissue left in the uterus, infection, tears to the cervix, and damage to the uterus. These complications are rare.

Which method will be used to end a pregnancy depends on personal preference, the time since conception, how far along your pregnancy is, and access to care.

Abortion counseling and follow-up care have been part of my practice as a certified nurse midwife. I do not perform abortions, as it has not been in my scope of practice where I have worked.

Over the years, I have gained insight into why women have abortions. I’ve learned the deep emotions involved for the women and myself. I’ve reconciled the discord between my personal beliefs and my patients’ reality.

Here are the key things I have learned.

Abortion is a personal decision

My mother raised me to believe all abortion was morally wrong. She would take my sister and me to church meetings and community events that gave every negative image and story imaginable about abortion. Until I was a young adult, I didn’t question this upbringing.

Once in nursing school, I learned about the amazing facts of conception and fetal development. I also learned about the suffering of preemies born with severe anomalies. I became aware of the serious health risks to women and the sobering life conditions for many women — conditions such as drug use, abuse, and mental health conditions.

Things became way more complicated in my mind. Then I became a nurse midwife. I encountered real women with real decisions to make.

Abortion is much more than a healthcare decision. There is a strong ethical, moral, and spiritual component that cannot be ignored. With abortion, we are dealing with starting a life or ending a potential one and the life and health of the present, living woman.

There are abortions that almost anyone would agree are required from an ethical point of view, such as for an ectopic pregnancy. These pregnancies will not develop and will endanger the woman’s future fertility and life. There are other abortions that almost anyone would agree were wrong, such as abortion at 35 weeks of pregnancy of a typical fetus.

In between, there’s an area where only the person most affected, the pregnant woman, can decide.

My role as a healthcare provider is to trust that person’s moral agency and understanding of their complex real-life circumstances. Very few people make such a decision easily, and almost no one casually. It is very different from a purely medical procedure, such as deciding to have your gallbladder removed.

Alongside the respect for a woman’s choice is a deep humility. It is not my place to be responsible for another person’s path in life, not my place to make a judgment. I am just a guide and an aide along the route that person chooses. It’s possible to be pro-life and pro-choice. But pro-choice has to come first when I’m not the one risking my life to create a life.

Ultimately, I realized abortion was a very personal decision and a vital component of healthcare. I became more comfortable talking with patients about their options. It took years to erase my early upbringing, but now I strongly advocate for my patients regarding abortion care.

Abortion does often make me sad. Seeing my patients cry and often agonize over their decision is a reason abortion brings me sorrow. Sometimes my patients’ choices differ from what I would personally do, making it hard for me. I’ve learned to compartmentalize the grief and work hard to leave it at my job. I realize the counseling and support I give are vital.

Despite the complexities of abortion care, I believe that reproductive health, including abortion, is a human right. Women deserve dignity and respect in making reproductive decisions.

Offering abortions is often vital

Maria arrived during the night at the labor and delivery unit where I worked. Her amniotic membranes (the water bag around her baby) had broken. At this point in pregnancy, her baby could not survive if he was born. He also would not develop normally in the uterus without the water around him.

The recommendation for Maria was to terminate her pregnancy. With much sadness, she agreed. The difficulty was that she came to a Catholic hospital where termination was prohibited.

Maria had to carry her fetus until he no longer had a heartbeat or until she became critically ill. While she waited in the hospital for the inevitable, she lost her income and was separated from her other children.

After about a week, Maria became extremely ill with a fever and infection. At this point, the doctor terminated her pregnancy. Because of the infection, Maria’s uterus did not contract well after the abortion. She bled heavily, requiring transfusions of many units of blood products.

Maria survived, but she was in the intensive care unit for many days. The delay in providing a medically necessary abortion endangered Maria’s life.

Maria’s story is just one example of why offering abortions is vital and why abortion is healthcare.

Abortion involves reproductive rights and health. People decide to have abortions for many reasons.

One study published in 2005 found that the most common reason for seeking an abortion was that having a child would interfere with a person’s work, education, or ability to care for dependents. Other reasons for abortion included health, financial, and relationship issues and not wanting to be a single parent.

No place for shame

Too often, when women come to me for abortion counseling, they sit in the exam room looking at the floor. They avoid eye contact with me and express self-blame for being pregnant. In short, women feel shame for having an unintended pregnancy. Abortion is stigmatized. It keeps women silent about their experiences. It leads women to feel shame and humiliation.

There is no place for shame in abortion. I tell this to my patients. I reassure them how common abortion is and that everyone’s story is unique and personal.

Legal abortions performed by trained abortion providers are safe. Unfortunately, there is a lot of misinformation on the internet propagated by antiabortion establishments. Even at abortion clinics, there are outdated materials. Some laws, such as mandatory waiting periods and required ultrasounds, don’t make sense.

Too often, safe abortion care depends on where you live and how much money you have.

There are many misconceptions about abortion. The most common myth I encounter is that abortion will cause the embryo or fetus pain.

Most abortions are performed during the first and second trimesters. Less than 1% of abortions are performed at or after 21 weeks of pregnancy. The fetus does not feel pain until 24–25 weeks. In almost all cases, a fetus cannot live outside the womb until 24 weeks.

You will have difficulty finding an abortion provider who will perform an abortion after the age of viability. Even if it’s legal, they will most likely refuse unless there is a severe anomaly with the fetus or your health is in danger.

Another common misconception is that abortion will cause infertility. The truth is that safe abortions do not affect fertility. Abortions do not increase the risk of future miscarriages, ectopic pregnancies, or fetal anomalies. Abortions also do not cause complications in future pregnancies.

If you are considering an abortion, knowing that it’s a personal healthcare decision is essential. Know the facts. Discuss your options with your healthcare professional. If you choose an abortion, consider confiding in people you trust. The more women share their stories, the less stigma there will be around abortion.

Finally, be kind to yourself. Take time to recover after the procedure and care for yourself.

Abortion care is a vital component of healthcare. As a nurse midwife, I have educated and supported women in medical and surgical abortion care. I have seen the shame that women unjustifiably experience. I have been frustrated by the misconceptions about abortion.

With the overturning of Roe v. Wade, abortion care is increasingly restricted and inequitable.

As a nurse midwife, I am committed to supporting women in their healthcare decisions, including abortion. I will educate, be compassionate, work to reduce stigma, and advocate for access to care.