Reply to Comments on "Women's Health In Women's Hands: Menstrual Extraction"

By Carol Downer

Reply to comments on "Women's Health In Women's Hands: Menstrual Extraction"

TO WOMEN WHO

• UNDERSTAND THE REVOLUTIONARY SIGNIFICANCE OF LEARNING TO DO MENSTRUAL EXTRACTION;
• WHO ARE COMMITTED TO DEVELOPING A MENSTRUAL EXTRACTION GROUP; AND
• WHO ARE  WILLING TO SEARCH OUT ANSWERS FOR THEMSELVES:

I want to encourage your interest in safely reducing or eliminating the discomfort of your menstrual periods-or the periods themselves if you wish through the use of the Del’em (or similar device) that Lorraine Rothman developed in 1972.   

MENSTRUAL EXTRACTION IS NOT ABORTION
Many times, people have confused this procedure with abortion, or think that the feminists who pioneered it were simply using a semantic trick to disguise their true purpose of doing abortion. It’s true that menstrual extraction was discovered in the process of learning how to do vacuum aspiration abortion, and it’s also true that in the very early stages of pregnancy, using the menstrual extraction technique will vacuum out the fertilized egg or embryo.  

And it is further true that unless the woman wants to carry any pregnancy to term, the group doing the menstrual extraction are concerned with determining whether the procedure is an abortion only to the extent that, if it is an abortion, they will switch gears from doing a menstrual extraction to doing an early abortion, and they will make any appropriate changes in the procedure.  

DIFFERENCES BETWEEN MENSTRUAL EXTRACTION AND ABORTION   
Menstrual Extraction consists of inserting a narrow, flexible plastic cannula attached to a plastic tubing into the uterus 2 to 3 inches through the os of the cervix and then using suction to extract the period.  Very early abortion can be done using the same equipment in much the same way.  The procedures are very different, however, in terms of:

• the setting, 
• equipment used, 
• amount of preparation needed, 
• amount of skill needed, 
• amount of time it will take, and
• follow-up needed.

In our patriarchal society, some of the differences between the two procedures arise from the problematic legal status of women directly exercising reproductive control using equipment to extract their periods or doing an abortion.  The legal status of a group of women doing menstrual extraction among themselves has never been established, nor has any group of women doing abortion among themselves been arrested or tried for any crime.  

If the group is concerned about legal repercussions, they will take precautions against possible discovery by the authorities.  This mainly means establishing a network of committed feminists who are trained in the method and committed to providing support to defend menstrual extraction.

Being prepared also means having back-up arrangements with sympathetic medical personnel for consultation if something unusual comes up, so that if necessary, the woman undergoing the procedure can be admitted to a medical clinic facility for any follow-up needed.  (This has rarely happened and has always occurred when the group misjudged the length of gestation, and the Del’em was not adequate for the procedure.  What was needed was a more experienced operator and other equipment.  The procedure then was successfully completed.)  

Setting:  

Menstrual extraction is generally performed within a circle of friends who have learned the technology by using it with one another when their periods came or were expected soon. 

Abortion using this equipment is usually performed within a circle of friends, even though the woman getting the procedure may be a relative or friend of one of the women.  It is usually performed by the more experienced persons in the group   

Equipment: 

Menstrual extraction can be done using the Del’em which consists of a 4 mm cannula attached to a long tubing (3 feet or more) which goes into a Mason jar through a hole in a rubber stopper.  The stopper has another hole.  Another tubing (2-3 feet long) protrudes from the other hole and goes to a one-way valve that is attached to a 50 cc. syringe.  

Abortion can be done using the Del’em may consist of a 4mm cannula, or sometimes a 6 mm or even an 8 mm. cannula.  The reason the larger cannula may be used is because a woman’s cervix softens and becomes more pliable by the second or third week of pregnancy and a larger cannula can be used without undue discomfort.  If it is an abortion, the larger cannula makes the procedure go faster because small clumps of tissue can pass through easily. 

Additional equipment:

Some menstrual extraction groups utilize surgical tools, such as an O-ring forceps to hold the cannula, or serrated forceps to stabilize the cervix.  These metal tools can be modified or stretched open so that they do not close completely, thus preventing the possibility of pinching the lip of the cervix. 

NOTE: Problems with the Del’em: 
Unfortunately, the company manufacturing the one-way valves has discontinued production, and only those groups that already had equipment are able to use the features of the Del’em.  However, over the forty years since its invention, ingenious women have found other equipment that can be modified to ensure that the flow of air can never be reversed so that air would be introduced into the uterus.

Amount of Preparation:

In Menstrual Extraction, since the women in the group know each other well and have been examining each others cervixes monthly or even weekly, they know whether the woman is having penis-vagina sex and whether she has any health problems.  Even if she is pregnant without any signs of pregnancy, they know they would only be dealing with a very early pregnancy, therefore the usual bimanual uterine size check would be sufficient, and they don’t have to have any medical back-up arrangements made, etc.

In Abortion: if the woman getting the procedure is not an ongoing member of the group, it is vital that the group establish that the woman is not further along in her pregnancy than she states or that she herself is aware of.  This requires much more careful examination and checking of the reliability of the information.  The group considers the social, legal and political environment to decide whether to continue or to refer the woman to an abortion facility.

Amount of skill needed:
The use of the Del’em required a lower level of skill than a vacuum aspiration done by an individual operator in a medical setting.  The long tubing between the cannula and one-way valve and the collection bottle allows one woman in the group to sit comfortably at the foot of the table and insert the cannula into the vaginal cavity (the vaginal walls are kept apart by a speculum).  Similarly, the long tubing between the collection jar and the syringe allows another woman to stand at the woman’s side and pump the syringe to create the vacuum.  This separation of functions dramatically reduces the skill level.  Many times another member of the group will stand at the woman’s other side and keep her posted as to the progress of the procedure, maybe even helping her to hold a mirror so that she can visualize the material coming down the tube.  Or, this woman may massage her uterus to ease any discomfort and to stimulate the uterus to contract. 

Menstrual extraction is not usually as easy to do as an abortion, because the os has not softened and opened up as much.  The woman may feel some pain on insertion of the cannula.  She may need extra time to adjust, or to be massaged, etc.  Or, she may decide not to continue the procedure.  The necessary skill of inserting the cannula is higher, but the amount of skill in manipulating the cannula within the uterus is less.  

Abortion: Any pain in the insertion of the cannula is usually quite tolerable; in fact there may be none.  The necessary level of skill of manipulating the cannula is somewhat higher, because it’s important not to perforate the uterus.  Risk of perforation is very low because in early pregnancy, the uterine wall is thick and tough and the unsedated woman is able to say, “That’s it; I feel it on the back wall; don’t go any further”.  

Amount of time Needed:
Menstrual Extractions can take a long time.  The menstrual material is viscous and moves very slowly through the tubing. Of course, since this is an elective procedure, we usually take our time and manipulate the cannula very gently.  Sometimes people in the group just run out of time and decide to stop the procedure, because they have to get home to a baby-sitter or something.  The material, when it comes out into a bowlful of water in the sink, forms tubing-width coils, looking something like spaghetti.  The tip of the cannula can be felt sliding against the slick inside of the uterus. 

Abortion:  After the cannula is inserted and the procedure begins, the material often then comes down the tubing at a fast pace.  It’s watery & clumpy and not sticky, like a ME.  If the group was uncertain if the procedure was an abortion, they usually know at this point that it is an abortion.

Follow-up
Menstrual Extraction usually requires very little follow-up.  The menstrual material is discarded and the woman either continues to have some menstrual flow or she has no further flow.  All symptoms of menstrual go away.

Abortion: The material that is extracted is placed in a basin of water and additional water is poured into the bowl until it overflows and the solid pieces of material are gradually rinsed off and then examined.  If it is a very early abortion, the bits of material will look pale pink and fern-y.  Rarely can any particle be seen that looks like a part of a embryo.  If there is any doubt that there is still products of conception in the uterus, the group may do another aspiration either then or the next day, using another sterile cannula.  The person doing the abortion can feel the cannula rubbing against the ridged inside of the uterus, almost hearing a “scraping” sound.  The uterus will have contracted and it may be hard to extract the cannula because the os will have tightened around the tubing, grabbing it.

In the next week after the procedure, the group will keep close track of the woman who got the procedure.  If she starts having any pain, or any discharge from the uterus, they will want to get together and re-aspirate the uterus and extract any leftover tissue. If they do a thorough job, that’s usually the end of it.  Any further problem and they will want to consult will their medical back-up.  Needless to say, any excessive bleeding would be an immediate red flag.     

Legality:  If abortion is completely illegal, all of the above guidelines will be affected.  For example, even if a woman has an extra-tender cervix, she may tolerate a high degree of pain or discomfort in the insertion of the cannula.  Also, the group will bring in extra consultation, sometimes just with a more experienced member, to be absolutely sure they’re not dealing with an advanced pregnancy that might result in needing to go to a hospital to finish the procedure.

Social Network: Both Menstrual Extraction and Abortion in a Menstrual Extraction Group require close-knit groups with high level of trust.  Individuals must have a willingness to become well-trained and to be resourceful.  This is not a procedure to be performed by a loner or person who’s doing it for superficial motives, such as avoiding heavy periods or “helping out a friend”. 

STARTING A MENSTRUAL EXTRACTION GROUP 

In the past, menstrual extraction groups have typically formed in communities where women are geographically and philosophically close.  Communes, women’s health activists, small rural communities, college groups; these are possible places to start a menstrual extraction group.  

SUMMARY: Any group of motivated and conscientious women can learn and perform menstrual extraction (and early abortion) using the Del’em with a high degree of safety.  The real challenge facing such groups is to recruit and train a stable, disciplined group and build community support in the broader community, including sympathetic medical and legal personnel.    

June Newsletter: Feminist Abortion Counseling and Abortion Doulas

Women's Health in Women's Hands

June Newsletter

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Women’s Health in Women’s Hands is a website by Carol Downer.  It features DIY Gynecology, with lots of woman-to-woman information about our reproductive and sexual anatomy, safe and effective birth control, abortion, menstruation, menopause, and menstrual extraction—told frankly from an independent woman’s point of view.

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Newsletter Features: Feminist Abortion Counseling and Abortion DoulasThe Beautiful Cervix Project www.beautifulcervix.com; Radical Doula radicaldoula.com; Janna Blair Slack goo.gl/LGTGo; AUTONOMOUS COMMUNITIES FOR REPRODUCTIVE & ABORTION SUPPORT (ACRAS) acras.weebly.com; Human Rights in Childbirth www.humanrightsinchildbirth.com; and articles by Carol Downer

Benefits of the Full Spectrum Approach

By Janna Blair Slack

I submitted the following essay to Midwifery Today for the Winter 2012 “Doula Issue.”  My friend, an editor at the publication, let me know they could not print it because it discusses elective termination, a subject they do not broach.  Midwifery Today has every right to its editorial decisions and perhaps this policy prevents unproductive flame wars amongst its subscribers.  Here is the original essay I submitted, discussing the growing full spectrum doula movement.

Benefits of the Full Spectrum Approach

copyright Janna Blair Slack

Full spectrum doulas support pregnant people regardless of the outcome of their pregnancy or their ability to pay.  This approach to doula work requires us to peer into the power structures of our society, discover places where insufficient support contributes to human suffering, and find avenues to provide that support.  To reach these places, we partner with institutions (i.e. hospitals, clinics, prisons), larger organizations (Planned Parenthood, community-based healthcare), and agencies (adoption, public health).

Since 2007, full spectrum groups have established themselves in at least fifteen states to support the spectrum of human pregnancy experience.  I am a full spectrum doula though I remain wary of the limiting potential of any title.  I knew I wanted to do this work before I signed up for my 2009 DONA birth doula training.  This is my description of this work from personal experience, as well as a vision for its future.  As increasing numbers of doulas are called to full spectrum work, the definition and potential of our profession will change for all of us.

Shedding assumptions, reaching out to connect

Emotionally sustainable full spectrum doula work is open, inclusive and non-judgmental.  The full spectrum approach tells us that everyone – from clients we support to staff and providers we work with – is really doing the best they can at any given moment.  Shedding assumptions provides a liberating feeling of openness and illuminates the emotional boundaries we navigate as birth workers.  I’ve become more aware of the important distinction between someone else’s journey and my own and therefore can more easily give unconditional support.

When I began to apply the full spectrum approach to my doula practice, I connected with more people from a wider range of life experiences.  I experience joy in connection so this was a serious bonus!  The first mother I supported through pregnancy termination taught me how positive this work can be.  A D&E (Dilation and Evacuation) takes a matter of minutes in the first trimester, but patients can spend hours waiting around, often completely alone.   She was sure of her decision but was anxious, crying and expressing feelings of guilt – someone had told her that according to the Bible, her toddler son would be “struck down” for what she was about to do.  She crumpled into my arms and cried.  I tried to be as present as possible and supplied her with tissues.  As we waited, she initiated conversation and eventually we were laughing and discussing the oeuvre of Kanye West.  During her procedure, I held her hands and her eyes with mine, whispering the same words I say during birth – “You can do it, deep breath, you can do it, nice and relaxed.”  Afterward, the woman I met a few hours earlier was gone and she moved confidently to gather her belongings and check out.  With a tight hug goodbye, she walked out the door with a smile on her face.  The nurses seemed thrilled at the difference in her demeanor.  I felt keyed up and soon realized I was experiencing the vibrant energy I normally associate with a “birth high.”

Some midwives and doulas feel it is macabre, even incongruous, to deal both in birth (associated with “life”) and non-birth outcomes (associated with “death,” or even “murder”).  Some worry how a broader outlook affects birth movement public relations and messaging.  All full spectrum doulas I know constantly work to give doulas a good name.  For many staff and providers we work with, full spectrum doulas are the first doulas they have heard of or worked with, and we feel the responsibility of representing the doula spirit of non-judgmental support as authentically as possible.

Providing doula employment

Bringing doula support to places it was previously unknown obligates most full spectrum doulas to work for free, proving our value to gain access.  We are dependent on volunteer energy, and the passion and dedication of our volunteers is tremendous.  Turnover and burnout are frustrating, persistent realities, but more and more we realize the unique opportunity we have created to become engines of employment in our field.  The organizations and institutions we partner with have access to funding about which an individual doula can only dream.  Doula support can often help achieve many healthcare and public health groups' goals for what amounts to a bargain.

The full spectrum approach must embrace a core tenet of financial compensation, accessed through our established partnerships, with as little headache and administrative cost as possible.  We don’t all need to become c-3’s to fundraise effectively.  Here are two examples of full spectrum organizations who have found ways to compensate their doulas: the first, partnered with a community healthcare organization in California, developed a relationship with a board member who made a gift which was nominal by the standards of western medicine but easily provides stipends for their doulas.  Portland’s Calyx Doulas are the second.  Partnered with an adoption agency, doula reimbursement will be a part of the birth-related expenses of birthparents, paid for by the adoptive families.

Surmounting socio-economic divisions in our network is crucial.  Insisting that our society’s money move toward the work that we do creates opportunities for more diverse populations to consider this as a profession.  This overarching goal complements and expands our vision.  Most of the full spectrum doulas I know come from some level of privilege and many women who want to do this work cannot for financial reasons.  We can all try to take responsibility to create opportunities for them and for all doulas seeking employment.

The endless conversation

As we feel our way into this new frontier and all it promises, we must treat ourselves with the same patience we try to provide each person we serve.  Our growth is dependent on continuous reexamination of what we do – asking ourselves how we achieve greater states of openness, compassion and inclusiveness.

If you are interested in learning more about the full spectrum approach, get your hands on a copy of The Radical Doula Guide: A political primer for full spectrum and childbirth support by Miriam Perez (published in August 2012).  “Radical” can be a scary word, but the Radical Doula Guide is not a manifesto, it’s “a starting point to understanding the social justice issues that interface with doula and birth activism.”  The RDG addresses these issues from a doula perspective, articulating philosophical aspects of the full spectrum approach.  I hope I didn’t lose you at “philosophical” because this Guide is truly readable and relatable for all of us!  I strongly encourage you to get your hands on a copy and join the conversation.

I feel especially conscious and respectful of opposing viewpoints within the birth community.  The full spectrum approach listens to, honors and learns from the concerns of our colleagues who may be opposed to our work.  As we pursue growth and expansion for all of us, your voice and thoughts on the matter are important.  If you have concerns or words of encouragement, full spectrum doulas are always open to conversation.  We are all responsible for the future of our field and for creating space for it in our culture.

CENSORED at La Leche League Conference

By Carol Downer
www.womenshealthinwomenshands.org

[Note: Carol Downer attended "LA LECHE LEAGUE OF SO. CA/NV Supporting a Breastfeeding Culture, A Parenting & Healthcare Professional Conference”, May 24-26, 2013 at the Marriott Newport Beach (CA) Hotel & Spa]

SUMMARY: We were censored!  Although we had cleared all our materials in advance, we were informed at the last minute that we would not be able to display any literature or items that dealt with birth control or abortion.  I stayed despite these limitations and talked to many wonderful women, and spread the word about Self-Help, our women’s clinics and the Pro-Woman Agenda.  I found new friends and allies, resources and gave away over 20 speculums!

ATTENDEES: Based on the high number of small children at the conference, many in the care of their fathers, I concluded that most of the attendees are breastfeeders, and that they were either LLL “leaders” (they volunteer and facilitate the monthly meetings of breastfeeding moms).  There were also a number of midwives, doulas, lactation consultants, childbirth educators, nurses.   

CENSORSHIP
I put out a call for support to come with me to set up my table, but unfortunately it was too late to get anything more than moral support.  Fortunately, the moral support that results from a women’s health movement from the last 40 years and the work that we have collectively done to fight for women’s rights to birth control and abortion strengthened me to walk into a environment hostile to women’s rights to birth control and abortion that WHWH stands for and achieve a amicable resolution with the conference organizers.  I removed from the table about one-half the items with “birth control” or “abortion” on them (including A New View of a Woman’s Body and the Del’em and pictures of the female condom) and in their place, I posted signs saying “CENSORED”.   The organizers told me that U.N. regulations prohibits La Leche League from mentioning birth control or abortion.  Other than this limitation, they were quite cordial and helpful.

SPECULUM GIVE-AWAY
Many women, especially those who appeared past childbearing years, turned down the offer of the speculum with “I don’t need that”.  Some said that they already had a speculum (usually midwives) or that they already used one.  A few women didn’t know what the speculum was.  The 20 women that took away speculums were delighted.

GUESTBOOK & VISITOR RESPONSE
Only 9 women signed the guestbook.  It seems that people are trying to keep the number of incoming e-mails down (I know that I’ve become reluctant to be on someone’s e-mailing list).  One of them, Mary Strack, is a founder of La Leche League, and very kindly offered to keep in touch with me and share what she has learned about the international breastfeeding situation; she is LLL’s international representative.  Likewise, Betty Crase, who wrote The Motherly Art of Breastfeeding” also agreed with the key words on the display [FULL SPECTRUM = PRO-WOMAN AGENDA].

After giving the visitor a copy of my card with the website info, I summed up our message, “We believe it’s important for the women’s health movement to work together on all the interrelated issues concerning women’s sexuality and reproductive rights”.  Many expressed wholehearted agreement.

Our 3 leaflets, “What to expect When You Go To The Hospital fora Natural Childbirth” by Molly Remer, “Shodhini” announcement and Cedar RiverClinics’s “Fertility Awareness for Birth Control” (Yes, they did allow that one) were popular.  The Shodhini leaflet caught the interest of a substantial number of women.  I found it very interesting that of these women, many were Latina.  Although I don’t know all the social forces that are at play, in Southern California at least, there is a upsurge of interest in learning more about our bodies and networking with other women among Latinas.  I predict that Shodhini will be getting calls.

EXHIBITORS
In addition to booths with literature from organizations that promote breastfeeding, or offered products to facilitate breastfeeding, there were several homeschooling booths, health and beauty products, and toys.  I was especially interested in one booth, “The Daily Grind”, run by two sisters who are trapeze artistes who were with Le Cirque du Soleil.  They have devised stretches and exercises to be done during the daily routine. I’m going to try to get together a group to put our money together to bring them from Mar Vista to Eagle Rock to demonstrate these to us and to help us to learn how to do them properly.

For “CONTACTS AND ALLIES” and “FOLLOW-UP” please email: whwh@womenshealthinwomenshands.org

Women's History Month: Feminist Website, Women's Retreat, and ALOUD Audio

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Women's Health in Women's Hands

March Newsletter
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Women’s Health in Women’s Hands is a website by Carol Downer.  It features DIY Gynecology, with lots of woman-to-woman information about our reproductive and sexual anatomy, safe and effective birth control, abortion, menstruation, menopause, and menstrual extraction—told frankly from an independent woman’s point of view.

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Shodhini Institute, "Birthing Our Babies", and "The Feminine Mystique"

Women's Health in Women's Hands
February Newsletter

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Women’s Health in Women’s Hands is a website by Carol Downer.  It features DIY Gynecology, with lots of woman-to-woman information about our reproductive and sexual anatomy, safe and effective birth control, abortion, menstruation, menopause, and menstrual extraction—told frankly from an independent woman’s point of view.

 View the latest email - http://eepurl.com/uMpiT

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40th Anniversary of Roe v. Wade

WHWH latest email:
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January 22, 2013 marks the 40th anniversary of Roe v. Wade the U.S. Supreme Court decision which legalized abortion.  As it stands now, women seeking abortion care must walk through crowds of protestors; abortion providers fear for their safety; states are passing laws to make women seeking abortions go through waiting periods, obtain parental or judicial permission, or view photos of aborted fetuses; politicians vote against women's reproductive rights. 

For a list of Roe v Wade events in the U.S. see Women's Health in Women's Hands latest email.  Please let us know any and all plans to commemorate this anniversary - we will include your event in this blog. Send an email - whwh@womenshealthinwomenshands.org - with the location, time, place, event, sponsor and a separate link.  Info will be added as time allows.

"Roe v. Wade Anniversary, Birth Story Film, and Volunteer Midwife in Senegal" 

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Volunteer Midwife in Senegal

Steph Mosscrop 

Crowdfunding

 

Steph Mosscrop is a student midwife in Maine. Steph is planning a volunteer trip to Senegal, West Africa. Steph tells us: "...this is a midwifery exchange program where students are taught, get to travel and is not a philanthropic trip. I am going there to learn from a group of midwives in an established clinic. While my tuition does help keep the clinic running and buy some medical supplies, it is a business model and is a source of income for the clinic. I will be paying the teaching midwives the same stipend that would be owed in any other setting..."

Staph is asking for your financial contribution. Steph will spend one month, February 15th through March 15th, volunteering at a Birth Clinic.

To Donate: gofundme.com/1oqwvk

Film Screening of Birth Story: Ina May Gaskin & The Farm followed by Q&A w/Shodhini Doulas

Film Screening of "Birth Story: Ina May Gaskin & The Farm" followed by Q&A w/Shodhini Doulas

Sunday, January 20, 2013
The Sacred Arts Center

5222 Hollywood Blvd, LA, CA 90027
$10-$15 (sliding scale)

This film tells the story of counterculture heroine Ina May Gaskin and her spirited friends, who began delivering each other's babies in 1970, on a caravan of hippie school buses, headed to a patch of rural Tennessee land. With Ina May as their leader, the women taught themselves midwifery from the ground up, and, with their families, founded an entirely communal, agricultural society called The Farm. They grew their own food, built their own houses, published their own books, and, as word of their social experiment spread, created a model of care for women and babies that changed a generation's approach to childbirth.

In the same spirit of women's self empowerment and self care the Shodhini Institute was created and has been working hard to spread their powerful message. The Shodhini Institute is a growing network of healers, bodyworkers, transmen, masculine of center womyn, doulas, midwives, nutritionists, yoginis, scholars and sheroes out to revolutionize the face of Western medicine regarding women's bodies, minds, and spirits.

Stay after the film screening to meet some of Shodhini's trained and experienced doulas. We will be hosting an open Q&A about birth work and their role as doulas. Spread the word!

Donations go to support The Shodhini Institute & The Sacred Arts Center

For more information:

Facebook Event 

shodhini.blogspot.com

www.shamansvision.org