Part I

Part I

A few weeks ago, reaction set in when the Illinois Senate passed a bill that would restrict all abortions to licensed doctors working in licensed medical facilities. Proponents of the bill cite the results of Friendship Clinic on the far Southside—two deaths in two months—as support for their position.

At the same time, licensed medical facilities and doctors are failing to respond to the demand for abortions (Cook County Hospital does only 18 per week and few hospitals do more), forcing women back to black-market abortions and putting dangerous strain on facilities such as Friendship Clinic.

Doctors here have not published their abortion statistics, but more than likely they are no better than those of Friendship Clinic.

In four years of extensive dealing with licensed gynecologists and hospital obstetric wards, we found that many are archaic in their medical treatments and downright disgusting in their attitudes towards women, abortion and childbearing.

If anything, the law and the medical system should encourage the opening of clinics and the training of female paramedics to meet the crying needs of women in our society.

We were members of a Chicago women’s organization that proved by four years experience that included performing more than 12,000 illegal abortions that abortions can be performed safely, humanely and very inexpensively by nonprofessional paramedics working under often primitive conditions.

In spite of the fact that the women who came through our abortion service were largely women who had nowhere else to go—too far pregnant, too poor, too young, too oppressed, too sick, too alone; and in spite of having to work under incredible stress, with inadequate facilities and no cloak of legitimacy to protect us, our medical results over four years compare favorably with the results of licensed medical facilities in New York and California.

Our group had its foundations in women’s liberation. Our view was that all women are equals and peers; there was no hierarchical “Professional” relationship between counselor and patient—nor among counselors regardless of their responsibilities. We worked with, not on, the pregnant women who came through the service.

Counselor, patient or paramedic—we were all partners in the crime of demanding the freedom to control our own bodies and our own childbearing.

During the four years the service was functioning, we dealt repeatedly with the police and with the Mafia, we discovered highly respected doctors secretly on the take, we clashed with gun-wielding extortionists and with butcher abortionists.

But we also discovered warmth, humanity and assistance in the most unexpected places.

We learned to buy medical instruments and drugs in the black market; and we also learned that drugs were often unnecessary—mutual understanding, compassion and trust between the patient and the service were more effective pain preventers.

We all—patients and counselors— learned about how our own bodies work. We learned how the bureaucratic and money-oriented medical system, in partnership with the law, works to control the bodies and neglect the needs of women.

We believed in life and we dealt with death—and with all manner of religious and political rhetoric in-between.

Is a fetus a person? Is abortion murder? If so, when does it become murder? Two days? Six months?

We heard the views of Catholic priests and right-to-lifers, and the calculating statistics of population fanatics. Black revolutionaries accused us of genocide, while weary black women pleaded for ‘‘no more kids!’’

We could never resolve the contradictions, but we held fast to the political principle that freedom of choice for the living woman was our first priority.

During the first 18 months, the responsibilities of the women in the service evolved from counseling and referring, then to medically assisting established abortionists and finally to doing the entire procedure. During that time, the average charge dropped from more than $400 to less than $100.

We learned to give shots, to take blood pressure, to take and read pap smears for cancer. We performed abortions on pregnant 11-year-olds and on pregnant 50-year-olds.

We learned to do a D and C—standard dilation-and-curettage—and to use a vacuum aspirator for the operation.

We learned to induce a miscarriage for women 15 weeks or more pregnant. When we learned that hospitals would turn away a woman in induced labor—or turn her over to the police—we set up our own midwife service, so that women who were induced wouldn’t have the additional hassle of hospitals and police.

We learned from similar experiences in our political pasts, from books and doctors and drug circulars, from the Clergy Consultation Service, which had been doing counseling and making abortion referrals for several months, and from identifying and understanding feelings in our own bodies and then trying to relate them to another woman’s problems and feelings.

We learned a great deal from a male abortionist with whom we had a very close, painfully contradictory relationship that evolved over several years.

And we learned by trial and error— plunging in with brazen daring when there seemed to be no other alternatives for our sisters or ourselves.

Experience taught us that good counseling, not medical mechanics, was by far the most important aspect of the service.

Whether a woman was to have an abortion in a hotel room or in a clinic, whether it was to be done by a man or woman, whether it was to be done direct or by induced miscarriage, the whole experience would be infinitely better if she was prepared for it—intellectually, physically and emotionally-and if she knew she could depend upon her counselor for understanding and support.

On the other hand, careful counseling served as a screening process to protect the service. Individual counseling could pick up the unreconcilable doubts and guilt, the religious conflicts, the boyfriend or parents who were forcing the issue—all of which led to both physical and emotional problems afterwards

The object of counseling was to make abortion available, but never to promote abortion; to provide the woman with an alternative, and then to give her support, whatever her choice.

The abortion counseling service was organized in 1969 by a small group of women who had been active in local radical politics and wanted to work In the then infant women’s liberation movement.

At first we had doubts about abortion as a women’s organizing issue—too unpopular, too illegal, too dangerous and too politically ambiguous.

But several women who had been doing informal abortion counseling and referral for several years convinced us of the political value and the practical need for an organized underground abortion service.

We spent two months meeting and talking. Four years ago, the climate surrounding abortion was very different than today. We wanted to understand our own feelings about it before we began counseling other women.

Several of us had abortions, several of us had children, one of us had been trying for years to become pregnant, several intended to remain childless.

We discussed our views on marriage, on family, on freedom of choice. We tried to build a political theory that would tie the issue of abortion solidly to the issues of women’s liberation.

Women in our society were caught in a three-way trap; social pressures to be glamorous and available, moral and economic stigmas against unwanted pregnancies and "illegimate" children, and legal and religious taboos against abortion.

Our political goal became to provide a positive alternative-and in the process to organize women to fight for their own rights.

We discussed the compromises and tensions that would be involved in working with established illegal abortionists, most of whom were male, and all of whom were in It for the money. These mysterious and anonymous men came well referred, and they all claimed to be a doctors, but we had doubts. 

The medical profession portrayed them as incompetent butchers who punctured uteruses, caused hemorrhages and infections, and then left their poor victims emotional wrecks after taking their life savings.

We had no experience to separate myth from fact.

We discussed at length how we would deal with various medical problems should they occur (oh, our innocence!), and whether we believed enough in our undertaking to accept responsibility for drastic consequences—such as death of a patient or jail for ourselves.

We set out an outline for counseling and practiced with each other. We composed a four-page flyer to be used as a counseling aid and a way of advertising the service.

The brochure briefly covered the political purposes of the service, the reasons why illegality made abortion so expensive, and a physical description of abortion and possible side-effects. It closed with a few punchy paragraphs on a woman’s right to determine her own childbearing.

The brochure became a classic piece that, with minor changes, remained relevant throughout the years.

Word of mouth was to be the medium for advertising the service. We announced its existence at select meetings and we distributed the brochure to sisters in the movement.

The quick response was testimony to the need.

The exorbitant cost of abortion presented the toughest problems. Going rates were well upwards of $500, and that was for a cloak-and-dagger style abortion— women being picked up and dropped off at street corners with no advance counseling and no follow-up.

Could we morally collect $500 from a sister-in-need and then pass it on to the man? Did we become partners to the economic crime or were we making it easier for the woman by providing connections, counseling and security?

Somehow the service would have to bring the price down in order to help women without money.

At one point a friend of the group suggested that we could drop prices by learning to do the abortions ourselves. We were shocked at the suggestion. We were too brainwashed by the medical mystique to have any conception of the paramedic.

We decided to get started in the existing market, and to deal with dropping the price when the opportunity d arose. In addition, we would ask for contributions of $25 from every woman who could pay in full , and try to build up an abortion loan fund.

The goal of making abortions available to all women, regardless of ability to pay, was to consume enormous amounts of energy and cause major headaches over the years.

It also proved a major impetus for change and progress in the activities and politics of the service.

And it was a major factor in choosing which abortionists we could begin to work with—and continue to work with over the years.

“Jane” was the pseudonym we chose to represent the service. A phone was opened in her name and an answering service secured, later replaced by a tape recorder. Jane kept all records and served as control/central.

For four years, Jane kept the same phone number—643-3844. At first she received only eight to ten calls a week. A year later she was receiving well more than 100 calls a week.

All phoned in messages were returned the same day: “Hello, Marcia? This Jane from women’s liberation returning your call. We can’t talk freely over the phone, but I want you to know that we can help you.”

Then Jane would refer the name to a counselor, who would meet personally with the woman and talk with her at length about available alternatives.

The counselor would also help the woman arrange finances and, whenever possible, collect a $25 donation for the service loan fund. The counseling session was also a screening process for detecting conflicts and potential legal threats.

If the woman chose the alternative of abortion, the counselor would turn the information over to another counselor who was handling doctor contacts for the week. She, in turn, would make specific arrangements with the abortionist.

The abortionists all insisted at first on dealing independently with the woman, as far as setting a meeting place and collecting money. They didn’t trust us and we didn’t trust them.

But such factors became negotiating issues in deciding which of them we would work with.

When a woman is looking for an illegal abortionist, she doesn’t just check the Yellow Pages under A.

Our original contacts with abortionists came by word of mouth. One was recommended by Clergy Consultation, two had been used by the women who did pre-service counseling, several were recommended by other women who had used them—and some contacted us soliciting our business.

They each wanted the most possible money, the greatest possible anonymity and the fewest possible problems. They each also wanted the greatest possible freedom of action and the most possible freedom from responsibility. They all preferred to be called “doctor.”

Aside from these standard features, are they each had their good points and their bad points. From our vantage point, it was a matter of choosing the combination of least evils. One price of our purpose was to tie ourselves and other women who put their trust in us to these strange bedfellows whose purpose was so different from ours.

One of the things we soon learned was that the syndicate had recently become aware of the profits in black market abortions, and had obtained a piece of the action.

Most of the abortionists that we dealt with paid hundreds of dollars each week for police protection. Those who didn’t pay ended up spending even more to buy their way out of an abortion conviction by greasing the criminal justice system.

We made it clear from the outset that - that we would never pay money directly to the outfit and, to the extent that we had a choice, would not work with abortionists who did. We decided that, after certain health and safety factors were guaranteed, we would opt for the situation that gave us the most control.

It was a hard choice.

Take Doctor Number 1: He works in a nearby suburb in a nice, clean hi-rise apartment. He charges $500 per case, but will take $400 per case if we guarantee a certain number of cases each week. Women who have gone to him say he’s pleasant enough, his medical reputation as an abortionist is good, and he works with a woman assistant.

However, he will only take cases 10 weeks and under. In addition, since he only works in one place, he has to conceal its whereabouts from the patients. This means women will be picked up at a bus-stop and driven in a roundabout -fashion to the building. Black and Spanish women are especially conspicuous in this neighborhood.

But most important. we can never contact him in person. All our contact with him has to be through a middle-woman, and then only on the phone. This meant we had no place to call to check on a particular patient or to get help with a problem. It also meant there was no way of negotiating directly in regard to money in special cases. It meant that control was low and learning possibilities were few.

We did not totally reject Doctor 1. We described the situation and made it available for women who preferred that alternative. We had few complaints and few problems, but then few women went there.

Doctor Number 2 works out of his West Side medical offices. He must pay police protection, because his name is right on the door. Medical conditions seem good, but he has several times become drunk in front of patients and reportedly made sexual favors a condition of the abortion.

"Here’s my offer" says Doctor Number 3. "We’ll keep the price at $500, but if a woman really can’t afford to pay, we’ll do her for free."

“Come down to $400 base, and we’ll skip the free ones,” we countered.

“That wouldn’t be fair. An abortion is worth $500 and I deserve it. But how does this sound: We’ll keep the price at $500, do an occasional free one, and if you have a special deal on a special case, we’ll make an exception. But we want to be able to charge more for the ones that are 12 weeks or more.”

Doctor Number 3 will do abortions direct up to 13 weeks, and will induce miscarriage in long-term pregnancies. He would prefer to go to a woman’s house to perform the abortion, but also works in motel rooms. He says that motel rooms are a clean, safe place to work, and it is better for a woman to have her own room where she can rest than for her to have to get up and out right away. It sounds reasonable. He also works with a woman.

We have reservations about the medical competence of Doctor 3, because we have heard that a D&C can’t be done after 10 weeks, and because we know nothing about induced miscarriages.

He says that know-how is the key, and he would be happy to explain the procedure to us or answer any questions we have. But he’ll only talk to one person at a time. Three makes a conspiracy. He warns us that we should never talk to the police.

Doctor 3 seems a little slick and overbearing, but more flexible than the others, and more willing to seek mutually satisfactory ground. More of him later.

Doctor Number 4 was foreign-born and educated, and claimed he had a unique European technique that was painless and much safer. He came highly recommended by a local physician’s receptionist, who said she had used him twice. He agreed to do abortions up to 12 weeks for only $150 a piece.

At this point, on the one-month anniversary of the opening of the service, there were a number of women waiting who couldn’t scrape together the money. The loan fund was empty. And two women were eager to give this new doctor a try, even though he was an unknown.

The first case turned out fine. The second, a young black woman, wound up in the hospital with a lacerated cervix, and her black revolutionary parents and friends wanted the blood of the Nazi who did it.

The police were interrogating the woman and her family, and the infant service was already in trouble. It was saved partly by the intervention of a young black civil rights worker who kept the peace for a week and convinced the parents not to talk, but it was mainly saved by the woman’s full recovery.

It was with Doctor Number 3, however, that we ultimately established our closest relationship. While we were involved in thousands of abortions with him, we all learned basic medical skills of assisting.

A number of us also learned to perform abortions.

When women in the service became able to provide all services from counseling to midwifing induced abortions, we reached a new stage of autonomy and a new level of politics. Our first move was to drop the price, and the bottom fell out of the abortion black market.

But learning and becoming self- sufficient was not an overnight process. While the abortionist was still taking responsibility for medical procedures, we were learning other skills: how to deal with doctors and hospitals, how to talk to the police, how to buy drugs and instruments, how to counsel more effectively, how to recruit and train new counselors, and how to maintain democracy, efficiency and sisterhood among a group of women who worked together under incredible stresses.

Part II

Part II

During the first several months of work with Dr. C, who was our final choice among the abortionists interviewed to work with the new service, most of the abortions were performed by him and a nurse in motel rooms or the patient’s home.

After a woman was counseled, we would tell them her name, her phone, how much money she had, and relevant medical Information we had learned. They would take it from there.

The nurse would tell the patient when and where to meet. They would perform the abortion and call us when it was all over. They were doing about 10 abortions a week for us at this time, up to three on a given day.

The wall of mutual distrust was high at first. Although Dr. C agreed to let us know when a particular woman would be done, he would not let us know where. We could know him and the nurse only by code names and could reach them only through their answering service. He kept medical techniques a top secret, but was always reassuring and readily supplied general information.

They supplied and dispensed all drugs. We knew the names and properties of the drugs, but had no idea of how they were obtained.

We had few medical problems with Dr. C in the first few months. Occasionally women complained of cramps, and there were one or two with minor infections. But for the most part, the women were well satisfied.

In addition, Dr. C kept his word and did an occasional free case. According to reports from the women, free cases were treated no differently than the paying ones.

For several months, while the medical situation was stable, we concentrated on organizing the counseling service—recruiting and training new counselors, spreading the word to new groups of women, raising money for the loan fund and trying to figure out some way to deal with long term abortions.

During the organizing period, we struggled continually to relate the politics of abortion to the rapidly growing women’s liberation movement. One strong faction In the movement considered any service organization to be charitable rather than political. Several groups considered abortion to be genocide.

While we could accept being illegitimate before the law, we needed a solid base of support in the women’s movement to survive, emotionally as well as operationally.

Then the coalition that was to become the Chicago Women’s Liberation Union formed and quickly made clear its support for the service. While we decided not to affiliate formally with the Union, we worked together closely, the union organizing support groups and working to change public opinion about abortion while we worked to make abortion available.

Two major factors caused us to re-direct our attention from counseling and making referrals to specifically arranging abortions and handling medical details.

• First was the increasing number of women who sought the service. Second was the problem of long-term pregnancies of 12 weeks or more.
• We were now referring up to 12 abortions a week to Dr. C. The higher volume and Jane’s demands for quality care and follow-through put strains on him.

Occasionally he lost a phone number and the woman would become frantic; some women were rushed by the nurse and became rightfully angry at us.

So we pushed for more responsibility, more authority and more control, and Dr. C gradually and reluctantly assented.

We began to set up schedules ourselves, and to personally deliver women to a motel and pick them up afterwards. Sometimes we would reserve one room and schedule several women for it, saving them the additional cost

Jane—our code name for the counselor who was taking calls and coordinating activities on any given day—became the contact point on working days. She knew where each woman was supposed to be and how the abortionist’s schedule was running. If there was to be a long wait, a counselor would wait with the woman.

Dr. C still insisted on protecting his secret identity. We had to leave the motel room before they arrived, and stay away till they had gone. It was important, he maintained, that no one ever see him in connection with any actual abortion— that way no one could be forced to identify him in court.

We were still a long way from doing paramedical work, but we were learning more about abortions. For example, we learned a simple D&C took no more than one-half hour from the time the nurse knocked on the motel door until they both left.

We saw women ten minutes after their abortions were completed, and they were healthy and happy. They were up and about, bleeding very little, and very hungry. It gave us confidence, as well as the desire to expand our scope.

About one month after we began doing the scheduling, we had an experience that made use quit using motel rooms altogether.

A woman named Marie was being done in a fancy Southside motel one busy Saturday. She was only about 10 weeks pregnant, very cooperative and there seemed to be no problems; But halfway through the abortion there was a heavy pounding on the door and a man’s voice yelled:

“Come on out of there, baby killer!”

The woman whispered, ”Oh, no. That’s my husband. He promised he would stay away.” The pounding stopped momentarily and then started again. The nurse tried to quiet the man through the chained door, while Dr. C worked to finish the scraping. (Most problems with early abortions are caused by an incomplete job.)

By the time the abortion was completed, the man was screaming that people in the motel room were killing his wife. The nurse helped Marie clean up, while Dr. C threw the instruments into a bag.

There was a silence outside, so they grabbed the bag and got ready to make a getaway. But as soon as they unlocked the door, the man pushed his way in, yelling that he was going to kill the baby killer.

Suddenly the woman jumped out of the bed, pushed past all three and ran down the hall in her bathrobe. Her husband ran after her while Dr. C and the nurse took off in the opposite direction, around the corner and down the elevator to the lobby, trying to look calm and inconspicuous.

As they entered the lobby, the man was coming down the stairs. He saw them and yelled in the crowded lobby: “There’s the baby killer! I’m going to kill you.”

Dr. C clutched his bag and ran out the door, the man in hot pursuit. He dodged through cars in the parking lot, jumped across hedges and ran for blocks between buildings and down alleys before he escaped.

He called Jane, breathless, from a gas station, and within moments a counselor picked him up and took him to her house. The nurse arrived a few minutes later.

By now, all pretense about concealing the identity of the abortionist was over. It felt so safe to be in a private home instead of a motel that everybody— several counselors, the nurse and the abortionist—all relaxed together.

It was immediately agreed that we would have to find an alternative to motels.

It was also understood from that time that the service and the abortionist would have to work together more closely—as a team rather than as adversaries—-in spite of the obvious conflicts and problems.

We had not heard the last from the angry husband. He called Jane the next day to say his wife was ill and he wanted his $500 back or he would go to the police. We arranged to meet him downtown the next day. Meanwhile, Marie’s counselor learned she was fine.

When we met him, he looked like a mild-mannered business man. We offered him a $250 refund if he signed a statement saying the abortion was done with his full knowledge and consent.

He refused, so we told him to send us the hospital bills and walked away. That night he threatened to come after us with a gun if we didn’t pay the whole thing. We told him we would call the state’s attorney and charge him with extortion if we ever heard from him again. We never did.

The incident taught us never to compromise with extortionists, whom we ran across repeatedly through the years. We consistently refused all demands for money, but agreed to pick up medical bills resulting from the abortion.

The next time the abortionists worked, it was at the home of a counselor. And in spite of their discomfort at being so overexposed, the atmosphere was as delightful as any abortion parlor could be.

Seven women were done that day, in a setting where they could relax and talk with other women in a similar predicament and when women walked out of the bedroom, feeling fine and no longer pregnant, the other six were noticeably relieved. They asked her questions and got first-hand answers.

A counselor was there all day also, answering questions, coordinating with Jane, and generally helping out. Clearly, it was a better way to do illegal abortions.

We worked in private apartments and homes for the next six months, taking on more and more responsibility for minor medically-related jobs. We were now scheduling as many as 15 abortions a day, two days a week, and it became necessary for the counselors to help with such jobs as cleaning the rooms and sterilizing the instruments between patients.

The nurse was too busy now to sit and talk with the patients while the abortion was being done, so counselors insisted on taking over that job. Dr. C at first resisted giving up yet another area of his private domain. When he finally agreed, he treated the counselor as a member of the team, but reserved the right to limit the counselors to those he knew and trusted.

Thus, several of us who had been doing abortion counseling for almost eight months could finally see an abortion first-hand. The procedure was simpler, cleaner and faster than any of us had imagined.

The job of holding hands and talking with patients, we soon realized, was as important to many patients’ physical and mental welfare as performing the-abortion competently, or as good counseling and follow-up care.

We learned a lot from watching Dr. C talk with the patients, putting his initial effort into striking up a real two-way conversation before the actual abortion was begun. He said it made the job more interesting for him, as well as the patient.

Sometimes the conversations were light-hearted and silly, sometimes controversial—he might see a “peace now” button on her coat and say, “Listen, l think every young man should have the opportunity to go to war.” We saw women laughing during their abortion ... or arguing politics. .. or singing.

We copied his style at first, then developed our own. The most basic rule was: talk to the person, relate to her needs and interests. We tried steering the talk to women’s liberation, and discovered that most women were intensely interested in that issue, although many had never thought about it before being faced with an unwanted pregnancy.

Some women wanted a detailed, step-by-step description of the abortion as it was going on, and others wanted to talk about anything but the abortion.

It was good to have the opportunity to pick up on special personal or medical problems and report them back to the woman’s counselor and Jane. For example, a woman who insisted during the abortion that she wanted the baby but her mother wouldn’t let her keep it was much more likely to have all kinds of problems afterward.

It was also nice to be able to say to apprehensive women in a counseling session: “You will never be alone. A counselor from women’s liberation will be with you all the time, holding your hand and answering your questions.”

It was a practice that the medical system could well institute—having a person in the room at all times whose primary job is to attend to the emotional needs of the patient.

About this time, we learned for certain that Dr. C was not a doctor, as he had so vehemently maintained.

Having to deal with this new knowledge pushed us into making more major changes in the politics and activities of the service ... at a time when the status quo was challenging enough.

Most of the original counselors suspected this from the beginning—his attitudes and manner, his conflicting stories about medical training, his limited knowledge about medical subjects not related to abortion just didn’t fit with “Doctor.”

But as months went by and he did more and more abortions with relatively few problems, we gave very little thought to the “doctor” question.

But we were to learn that the question was very relevant to several new counselors. Many of them had come into the service after it was already functioning, and they apparently accepted the use of the phrases “Doctor C” and “Doctor A” at meetings and training sessions-

The original organizers had never stressed the question to new recruits... maybe because there was so much other essential information to communicate to new counselors in training sessions ... maybe because we realized it was a potentially explosive issue and felt it was more important at that time to build confidence and keep things running smoothly.

Part III

Part III 

The knowledge gap between older and newer counselors was a continuing internal problem, one that was hard to bridge in such a high pressure and emotionally contradictory underground organization. There were so many things that could not be spelled out to newcomers for security reasons and so many other things that could be learned only by experience.

At any rate one day a newer counselor became convinced for her own reasons that Dr. C was not a doctor.

She raised the question angrily at the next meeting of the service and added that she didn’t want to work with the service if it didn’t use legitimate medical people.

Several other counselors echoed her concerns. They felt they had been misled by “elitists” in the service who had full knowledge they didn’t and as a result new counselors passed on misinformation to the women they counseled.

The “elitists” said that they actually did not know the answer. But they agreed to talk with Dr. C. and report back at the next meeting.

Doctor C was totally opposed to our breaking the news that he was not an M.D.

He said it would destroy the confidence of the counselors in him and jeopardize his job. Patients who believed in the infallibility of doctors would have less confidence and more problems if they knew the truth. Also if some disillusioned counselor or patient turned him in, the police would be harsher on a paramedic, and he felt be would no longer be treated by counselors or patients with the respect he deserved.

But one old-time counselor was as insistent about telling the truth as Dr. C was about maintaining the myth. And although the repercussions of their clash echoed for years. the political consequences of her unbending position were momentous.

At the next meeting we laid out the a facts—our abortionist was not a doctor and the nurse was not a real nurse. They were lay people who had extensive training and experience doing abortions.

We told the new counselors how we had searched among available abortionists and felt that their person was the best available.

Two counselors quit our the spot.

But most of the 20 counselors were fascinated rather than shocked. They spent hours that night exploring the doctor mystique and the concept of paramedics.

They compared feedback from the women they had counseled and became more convinced more than ever that the service was providing an essential alternative — and was providing it with more humanity, efficiency and competence than was available anywhere else.

In addition we were now providing abortions for women who simply couldn’t afford to obtain them elsewhere. The basic price was down to $400 plus an increasing number of free and low-cost abortions.

While money was a constant source of conflict between the service and the abortionists, the increased volume of cases and our assumption of many of the risks and responsibilities made the weekly payment satisfactory to them.

The service decided to drop the word “doctor” from counseling sessions and instead to stress to the women that they would be done by a competent paramedic who had been specially trained to do abortions.

To our surprise found that most of the women we counseled were not the slightest bit disturbed. Their prevailing concerns were “Can he do the job?” and “Do you counselors trust him?”

They had been burdened long enough with their unwanted pregnancy, and had been unable to find help through the legitimate medical profession. They just wanted to turn the responsibility over to someone they could trust.

Once we had discovered and dealt with the matter of paramedic abortionist it was a short step the question “If he can do it then why not me?”

But by the time we integrated the concept of the paramedic intellectually and politically, we had already had significant paramedic experience of a different type in our dealing with long-term pregnancies.

The search for a way to handle long-term pregnancies led us into totally unforeseen activities into new political perspectives and into more trouble. frustration and pure exhaustion than any other problem.

At some magical mark in her pregnancy—ranging anywhere from eight weeks to fourteen weeks depending upon the place and the abortionist— a woman suddenly lost all options except the choice whether to raise the baby herself or give it up adoption.

Her chances of obtaining an abortion— either legally or illegally—were almost nil, and when one could be obtained it was financially prohibitive for most women ..upwards of $800. The problem was complicated by the increased pain, risk and time commitment of an induced miscarriage and the decreased chances for sympathetic port-abortion medical care.

To complete the woman’s trauma there was an implicit attitude of contempt and distaste for her. “How could she be dumb enough to wait this long?” and “If she’s waited this long, she might as well go ahead and have the baby,” were the prevailing attitudes.

In fact many of these women had already been through weeks of red tape to wind up at a dead end. Others waited weeks crucial weeks while getting a series of shots to “bring down a period” from their private doctors or one of several local gynecologists who profited from the business.

Others wasted weeks trying to get the money but were short on money, but still long on pregnancy. Women in their forties who thought they were “going through the a change” when they missed several periods in a row suddenly learned they were four months pregnant.

And then there were the young girls who totally denied the condition in the hope that if they ignored it, it would go away. Finally a friend or relative noticed their enlarged abdomens and make them face up to the problem.

The reasons were many, and by the time many of these women reached Jane, their situations were desperate. The first thing Jane did was to rush all women who were 11 to 13 weeks pregnant to the front of the line, postponing money problems and setting up emergency counseling sessions, so that these women could still obtain a D&C if possible.

For the increasing number of unmistakable long terms-14 weeks and more—we had to find a method and a system for taking care of them.

Even today, after more than four years experience with various methods for inducing long-term miscarriages we still find it hard to evaluate which methods are best. Each seems to have its advantages and its complications.

Some are more practical in an illegal setting there others. Perhaps we should unanimously condemn the catheter as a method for inducing a miscarriage, but then it sure beats a rusty coathanger.

Our first experience with a long-term was a 19-year-old who drove down from Minneapolis about six weeks after the service opened. She was six months pregnant and Catholic, and she insisted that her father would have a heart attack if he found out she was pregnant.

The abortionist met with us and explained in detail the method he used to induce a miscarriage: break the water bag, extract all the water, and wait for labor to begin. In addition, he used antibiotics to fight infection, oxtoxins (pitosin) to induce the labor, and ergotrate to control bleeding.

The labor would be the same as for having a baby, beginning with mild cramps and progressing to heavy rhythmic contractions. Then, in a heavy contraction. the woman would pass the fetus. After a short while, the contractions would begin again, and she would pass the placenta.

She would have to be attended constantly during labor, and then watched carefully after she miscarried. The fetus would have to be disposed of.

In the next day or so she would receive a D&C to make sure her uterus was clean because retained placenta was a major cause of complication. The cost for the induced miscarriage and the follow-up D&C were usually $1,000, but since this was the first care, he would do it for only $600.

“It’s nothing to worry about,” he assured us. “Women go through it alone all the time. Miscarriages are common. The most important thing is to keep the women calm and in self-control.” But we were staggered by the medical implications and the responsibility, and we felt (rightfully) that he was oversimplifying.

We met with the woman, explained the entire procedure and emphasized our uncertainty.

She reluctantly decided to have the baby, and returned home to tell her parents. Her father had the predicted heart attack and she had the baby and gave it up for adoption.

The only positive note the whole story was that her sister became active in abortion counseling end set up a service modeled after ours in Minneapolis

Clearly the way to deal with long-term pregnancies was not to avoid them.

The next longterm pregnancy was an 18-year-old Puerto Rican woman, four and one-half months pregnant and determined to have an abortion. We made arrangements for her to stay at a counselor’s house during labor, and to be in constant telephone contact with the abortionist in case of an emergency.

She was induced in the morning—with no problems.

That night our abortionist left town under threat by the Mafia for refusing to pay protection.

Two days later, the woman was in heavy labor, and as her pains got heavier, her temperature fluctuated between 99 and 102. The counselor had no one to call for advice, and finally in desperation called her own gynecologist and lied to him that her friend seemed to be having a miscarriage.

He arranged to meet them at the hospital, where things went as smoothly as a prepared script. The gynecologist examined her, said a few words to emergency admissions, and had her sent up to gynecology. They gave her some antibiotics and some pitocin, and she miscarried without problem in two hours.

The next day, the counselor caught hell from her gynecologist, who had learned about the abortion from the patient.

This was typical of the response that we got from most doctors when we asked them for help with induced miscarriages. Although providing post-abortion help was not illegal, they felt that admitting such cases to the hospital was a nuisance and jeopardized their reputations.

With a few significant exceptions they not only refused to help but condemned others who tried to fill the medical void. Abortion was illegal. If women were using quinine and coathangers on themselves in desperation that was a situation most gynecologists choose to ignore.

Hospital emergency rooms were no better. If they suspected an abortion. they often called the police before they even examined the woman in labor. Sometimes they would admit a woman and then withhold drugs from her unless she talked. Sometimes they flatly refused to admit her, even though she was in heavy labor.

After several such experiences, the service decided that more than ever it wanted to take care of long-term pregnancies, and that it would simply have to figure out ways to manage without help from the medical profession.

That decision initiated a year during which we expanded our activities with “Dr.” C and simultaneously set up a system that induced, midwifed and arranged post-abortion care for more than 200 long-term women.

Our first breakthrough came when Jane received a call from a “doctor” in Detroit who was soliciting abortion business.

He told Jane he would do D&C's up to 12 weeks- in his Detroit clinic for $400 “but long-terms would cost $250 just to be induced, and $600 if the miscarriage took place in the clinic.”

The abortionist (whom we came to call Nathan Detroit) described a method for inducing an abortion called “Leunbach” that be said was widely used in Scandinavian countries. A sterile oxytoxin paste was introduced into the uterus through a hollow cannula, which is inserted barely through the cervix.

The paste or jelly he said, separates the placenta from the wall of the uterus and caused a miscarriage. He said the method was painless and required no dilation or drugs at the time of insertion the paste. Labor would follow within 4 hours. The method could be used to introduce miscarriage at any time in the pregnancy.

A bonus feature was that this method looked like a normal miscarriage. A woman went to the hospital in labor there would be no way to tell she had been artificially induced.

He invited Jane to visit his clinic in get first-hand information. She accepted for the next week. In the meantime, the counselor who volunteered to make the visit spent several days in the library trying to research Leunbach paste.

It was mentioned in a number of medical publications, but about as briefly as Nathan’s description of it. We found this to be true whenever we researched methods of abortion. In a country when abortions are illegal, there are no text hooks on how to do them.

The counselor was duly impressed with the clinic, which was set up in the upstairs of a big old Detroit house. She observed one D&C and one Leunbach paste insertion. It really was painless. She also talked with one post-miscarriage patient who was awaiting a follow-up D&C. The patient described the labor a “just like having a baby”.

Nathan said that the follow-up D&C was done in the clinic as an added precaution, it was unnecessary most cases. In fact, he said, even a lay person could tell if the miscarriage was complete by looking at the miscarriage placenta and observing whether it was intact or there were pieces missing.

He knew of the volume of calls Jane was receiving, and was apparently anxious to get a piece of them, for he volunteered to come to Chicago the next week to help us out. If we arranged the places he would put the paste in as many long-term women as we could set up in one day and would charge us only $1000 for the day But from that time on he added, the charge would be the regular $200 each.

He arrived at the airport the next week with all of this equipment in one tiny briefcase. Six women, ranging from 10 to 18 weeks pregnant had been counseled, had paid Jane $175 each, and were awaiting to be induced, four at their own homes, two at a counselors house, where they would stay during labor.

If the day hadn’t been so exhausting it would have been comical. Every one was in a third floor apartment and Nathan was terribly out of condition. He insisted that the kitchen table was the only place to start the abortion and in each case took on the ludicrous atmosphere of the kitchen it took place in. A small flashlight provided illumination.

Nathan took for granted that the counselor with him was experienced in medical matters (she had in fact seen her first abortion at his clinic the week before), and he barked orders at her all day. But the cases were started without problem, and he left that evening with $1000 in his pocket.

The same night we got a call from one of the patients who was having labor pains. She had several children and a previous miscarriage and said she and her sister could handle the whole thing by themselves. The anxious counselor kept in close phone contact with the woman and by 3 am, she had passed both the fetus and the placenta and was in bed asleep.

Two of the women decided to go to the hospital when their labor pains began. They were both coached to stick to their story, no matter what the hospital said: that they were pregnant and suddenly that day they had begun having cramps and bleeding.

One other woman miscarried at home after a ten hour labor. and two others miscarried at a counselor’s home, with several extremely apprehensive counselors present.

It is impossible to describe to someone who hasn’t experienced or been present during a labor the trauma a woman goes through. The pains gradually get bad, then they get worse, then they get totally unbearable, and then they get still worse before the baby/fetus is delivered.

Although both miscarriages were normal, the counselors (one of whom had no children) were astonished at the strength and intensity of the labor pains, and with the gush of blood that came with the passage of the fetus. They were also amazed at the total relief from pain both women felt as soon as the fetus was passed.

In both cases the women were remarkably strong during labor. Shortly after the miscarriage, the placenta was passed and the bleeding stopped almost entirely.

After witnessing the pain of an induced miscarriage, one counselor experienced in the use of LaMaze (natural childbirth techniques) taught the basis of those techniques to all counselors who attended longterm miscarriages. The effect of even brief counseling in LaMaze upon women in labor were amazing. Armed with the technique, they could deal with even the most severe labor pains without drugs.

Seeing her first fetus was a totally shocking entry into reality for every counselor who attended a long term miscarriage. A 16 week fetus is a fully formed human being with fingernails and sex organs.

Few counselors could maintain such emotional distance that they did not spend sleepless nights wondering about life and death, about freedom of choice,about killing, about the end justifying the means.

But seeing the relief of the women—young, old, rich, poor — after the miscarriage was the overriding experience. These women had been carrying an unwanted body in their own bodies for months, trying to get rid of it in that time, and suddenly they were free. They had a new lease on life.

But in the case of the women who had miscarried outside the hospital, the new lease was short. Within several days, they each had severe cramps and intermittent bleeding.

Each had to go to the hospital, where the problem was diagnosed as a retained placenta and treated with a cleanup D&C. The hospital charges for the D&C plus drugs and extras ranged from $250 to $450, taking the total cost of the abortion well out of the bargain range we had hoped for.

When we complained to Nathan, he insisted that the incomplete cases were coincidences, but he offered us an alternative plan for saving money. We could buy tubes of Leunbach paste from him for $50 each, he would throw in a cannula and we could administer the paste ourselves.That way, even if the woman had to pay for a cleanup D&C, the total cost would be under $350.

The suggestion astounded us- we are simply not yet bold enough to perform a major medical procedure ourselves. But we bought a dozen tubes of the paste and stored them in the refrigerator as directed. 

(Editor's Note: The paragraph that goes here was indecipherable in the copy we have, but involves how the service could use “Dr.” C) 

We were saved from the immediate dilemma of whether to insert the paste ourselves when were approached by a group of Northside abortionists who agreed to insert the paste (their own) and do a followup D&C in their Northside office for $400. They would also help care for women in labor if we provided a place. As part of the bargain, we would have to throw in a few short-terms each week for the same price.

This group of abortionists came recommended by several local MD’s, but in a system that turned on payoffs and kickbacks, references were meaningless.

In desperation for a way to take care of longterms, we decided to give them a try. Two short-term patients volunteered, and their reports were tolerable, if not enthusiastic. They said that only men were present during the abortion, and that their manner was cold and secretive, but the place was clean and the medical results were satisfactory.

We decided to use them for longterm miscarriages, and to keep the number of short-term cases we sent them to the absolute minimum.

In anticipation of the induced miscarriages, a counselor volunteered her large apartment for the women in labor. She and another counselor (who had joined the service after a horrendous experience with a catheter induced abortion) also volunteered to study midwife techniques and to sit with women in labor.

The anticipated expansion also meant that we had to drop our 16 hour answering service for a system that could receive messages any hour of the day or night.

We mentioned the problem to "Dr." C one morning and mere hours later, a fancy tape arrived at Jane’s home, complete with a portable beeper that enabled her to pick up tape messages from any phone. The new system greatly increased Jane’s flexibility and unquestionably built up credits for “Dr.” C

The Northside abortionists were to distinguish themselves during the next few months we worked with them by sending away women who were a little short of funds, by being awed and incompetent in the presence of women in labor, and by somehow dodging most cleanup D&C’s, so that cases with retained placentas ended up in the hospital anyway.

We soon learned that they were one of the biggest abortion outfits in the city and that they paid protection to the Mafia, and that they were unscrupulous in their pursuit of money.

Apparently their protection was not sufficient, for two months after our first contact with them, they were arrested with two of our patients in their apartment, making front page headlines in all four dailies.

Ultimately they got off the bust by paying the police and the court about $30,000. Before the settlement, the states attorney called and questioned Jane several times...without success. After the settlement we heard from him no more.

The Northside group was soon back in business, but we refused to have any further dealings with them.

On the whole, our generally negative experience with them proved valuable. In the face of their incompetence, several counselors became very competent in attending women in labor. We attended about 18 miscarriages in this period, and sometimes had as many as 4 patients in the apartment at one time in various stages between induction and followup D&C.

We learned to speed up sluggish labor with special exercises (old wive’s remedies that really worked), we learned to ease the pain of harsh labors with Lamaze breathing and sympathetic care, we learned to control post miscarriage bleeding with shots of ergotrate, icepacks and gentle massage of the abdomen.

We also learned when a situation was beyond our competence, and we had to take a woman to the hospital. Fortunately, for the first few months, these situations were limited to excessively long labors, to cases where the placenta did not pass and to cases of mild but continual bleeding.

Facing hospital staffs in such situations continued to be a frightening, humiliating and often legally threatening experience — but unavoidable.

Most importantly, our experience with the Northside Group convinced us that if these incompetent, inhumane men could clear $400 for simply administering the paste, we could also do it...for our cost alone.

So that fall, one full year after the service began, we finally took speculum, flashlight and cannula in hand and induced our first abortion.

Our hands shook so bad that we could not even put the speculum in straight, and we emptied the first tube of Leunbach paste ($50 worth) onto the floor. But our two young volunteer patients were good humored and encouraging, and the job was finally done.

And it was so simple! So damn simple, after avoiding it all these months. Just slip the tip of the cannula through the opening of the cervix and gently squeeze the paste in. No pain, no blood, no problems. And a happy, friendly, less costly experience for the women.

The two women went to a counselor’s apartment where they were closely attended. We somehow expected special problems because we had overstepped our bounds by performing a medical procedure.

But both miscarried within three days. One required no cleanup D&C and the other relieved a D&C from "Dr." C. Total cost: $400 for both, which they split.

We were excited, of course. Putting in Leunbach paste through a cannula was hardly a complicated medical procedure, but it was still an abortion...and we did it ourselves.

Armed with our new techniques, we began to take on more long-terms and to intensify our training and organization for midwiving women in labor.

After the Northside bust, we had to abandon the midwife apartment, which was being watched by the police. Instead the counselors who chose to counsel for long-term miscarriages arranged a place for each of their patients. Sometimes it was their own or another counselors apartment, sometimes the home of the patient.

To each long-term was offered the following alternatives: to be induced by a woman from the service by Leunbach paste or to have their water bag broken by “Dr.” C, to go through labor at a counselor’s house or at their own home under the care of a counselor or to go directly to the hospital when their labor began; and finally, to go to the hospital for a cleanup D&C or to come back through the service and have it done by “Dr.” C.

About three women a week chose to be induced by us for a charge of $50 plus the $250 by “Dr.” C. or a hospital D&C. An equal number chose to be induced by “Dr.” C. who now agreed to break the water bag and later do a followup D&C for the regular short-term charge of $400.....if we took responsibility for the labor and miscarriage.

Of these five or six anticipated long-terms at least two each week had insurance or a welfare green card and chose to go the hospital for the miscarriage...sticking to the well-rehearsed story that it was spontaneous.

The other women were our responsibility. and each made details plans with her counselor about what to do and where to go when the labor pains began.

About two women a week went through the service for a D&C, but turned out to be more than 14 weeks pregnant.

These women had not been counseled for an induced miscarriage. and they often had to make a last minute decision whether to go ahead with the abortion. Worse, sometimes only after the abortion was started did we discover that the woman was too far along to be done by D&C.

Part IV

Part IV

For the first year and a half of the service, we steadily learned more about abortions and specific medical techniques, the use of drugs and instruments, and we performed minor paramedic procedures.

We became more competent as counselors and organizers, and we recruited many new counselors as the number of patients and scope of activity grew. Fees for a D&C dropped form $500 to $350, with the number of free abortions growing as volume increased.

But we still relied on our male abortionist (“Dr.” C) to do the more than 30 D&C’s a week. We in the meantime, concentrated on expanding our service, while we were continually developing the skill and the confidence to do D&Cs ourselves.

Our biggest headaches came from the two or three cases a week when a woman turned out to be more pregnant than expected and we suddenly had to deal with an induced miscarriage instead of a simple D&C.

Even with written notes from a doctor and pelvic exams beforehand, it was impossible always to predict the length of pregnancy. Some women menstruated for the first several months of their pregnancy.

Suddenly, the woman had to make major changes in plans under extreme stress. She had to deal with a process that would take days instead of minutes and involve more pain, more risk and often more money.

Suddenly, there was no way to keep the abortion a secret from an intolerant parent or boyfriend, husband or employer. Women on welfare stood to lose their payments if the caseworker found out they had an abortion. Women had to find baby sitters and arrange time off work—often this meant loss of job or income.

The counselor would have to be on call around the clock till the woman safely miscarried. She would have to arrange a place for the woman to stay while she was in labor; or if the woman had no one-else to turn, the counselor would have to fill in as babysitter, housekeeper and midwife till the ordeal was over.

Sometimes she would receive a frantic call from a woman in labor and rush to the woman’s house regardless of the hour of day or night, only to be confronted by angry husband or parents whose only response to the crisis was to yell recriminations or threaten to call the police, while the daughter or wife was in heavy labor in the bedroom.

Fear of arrest or lawsuit was only a minor consideration at times like these— the counselor’s first concern was to take care of the woman.

The lack of mutual support and trust between parents and daughter was sometimes astounding. Now, when their child needed help and understanding more than any time in her life, many parents chose to vent accumulated hostilities.

But for many young girls, the crisis reestablished long-lost communication with their parents. To their surprise, parents were beside them, comforting and helping.

Counselors encouraged minors to tell their parents once the miscarriage had been induced. Usually the parents found out anyway, and often they turned out to be more supportive than the girl suspected. But ultimately, we relied on the young woman’s judgment of how to handle the family scene.

For short-term D&Cs, however, we never pushed women to tell parents or relatives beforehand. They were welcome to bring a relative or friend to the counseling session, but never forced to, regardless of their age. Too often, especially for young Catholic girls, telling their parents meant they would be sent to a home, forced to carry a baby to full term against their will and then forced to give it up for adoption.

Many older women who came through the service had been scarred into permanent bitterness by such an experience when they were younger.

Understandably, the temptation was great to do borderline pregnancies (13 to 16 weeks) by D&C rather than by induced miscarriage.

It saved the patient days of waiting, hours of pain and extra cost. It saved the counselor the extra worry and arrangements. And it spared the service potential unpleasant encounters with hospitals and police.

Equally important, it made us all feel good. Women who were dreading a miscarriage were overjoyed when they learned they were being done direct, and would not have to go through labor.

(And unspoken, but in the back of some minds: “Thank God! No 16-week fetus to wrap up and throw in the nearest city trash can.”)

When the woman was expecting to get a short-term D&C, but turned out to be a borderline, the temptation to do the abortion direct was even greater. Then there were the special cases—the woman who was 16-weeks pregnant, but whose husband had a vasectomy a year ago.

Or the woman sent to us by a local gynecologist—she had a cancerous kidney removed just months before, but had been refused a therapeutic D&C by the hospital board. Her doctor felt that going through with the pregnancy would kill her.

Her D&C was a rough experience, but three weeks later she gained ten pounds and was well. Her physician told us she would probably be dead now, but for us.

Other abortionists in the city and in clinics in Washington, D.C. and later in New York said flatly that a D&C couldn’t be done past 12 weeks. But in central Europe they were being done routinely up to 16 weeks.

We knew it could be done. In the four years of the service, we did more than a thousand successful direct abortions on women 13 or more weeks pregnant.

Doing a 15- or 16-week D&C was no picnic. A D&C at eight weeks takes five minutes and the dangers are minimal. But at 15 weeks, it takes from 20 to 45 minutes. If it’s an unexpected borderline, then all other women who are waiting to be done that day are all delayed at least 45 minutes.

It’s an exhausting experience for all concerned- Even the most cooperative women get tired of lying so long in one position with instruments being pushed in and out of their bodies. It’s often painful. But the bravery and commitment of most of these women gave us encouragement and support.

For the abortionist, the pure physical strain is remarkable. Pulling large pieces of fetal material through a resisting cervix takes a lot of strength. Huge blisters on hands are an occupational by-product— one can frequently identify an abortionist by placement of calluses caused by the instruments.

The psychic drain is also enormous— trying to concentrate on the physical procedures, while the assistant is tending to the woman’s emotional needs.

The room is charged with tension. Time pressure is constant. In a 15-week abortion, the possibility of hemorrhage is greater. If heavy bleeding starts during the abortion, the only way to stop it is to get the uterus clean . . . fast. So if bleeding starts, the work is accelerated, not stopped.

Fortunately, we never had a situation during a borderline where heavy bleeding could not be stopped.

Jane usually scheduled two or three borderlines in a day of 20 or so abortions. But some days, unexpected borderlines seemed to come one after another. Sometimes a woman who was scheduled for an induced miscarriage would plead to be done direct, because the effects on her life situation of a long-term miscarriage would be so tragic. The decision was often hard to make.

There were days when our judgment faltered. When, because of pure exhaustion, we induced a woman who could have been done direct. Or worse, those few occasions when we took on a longer case than could be done direct, and would up with an incomplete borderline D&C.

The best thing that can happen with an incomplete abortion at 15 weeks is that the woman will pass the remaining material without problem in a minor labor. The dangers are that the retained material will cause an infection, or worse, that a broken fetal bone will puncture the uterus during a heavy contraction.

So we almost always insisted that incomplete D&Cs be taken to the hospital where the procedure could be completed under more controlled conditions. It’s one- thing to explain to the emergency room personnel that a woman is going through a spontaneous miscarriage—quite another to have to account for only half of a retained fetus.

Some hospitals were more accepting of such situations than others—Cook County encountered so many attempted abortions that they took them in stride.

But we had to warn all women who went to the hospital with an induced miscarriage or an incomplete D&C to resist surgery unless they got a consulting opinion from a private doctor.

If a woman was Black or Spanish or on welfare, and had several previous pregnancies, the hospital would sometime attempt to give her a complete hysterectomy—obtaining her permission while she was in heavy labor and unable to make a clear decision, or insisting to her that the radical operation was necessary to save her life.

Several women who came through the service subsequently had hysterectomies because of incomplete abortions or problem miscarriages. All but two of these we considered medically unjustified, and had strong medical opinions supporting our view. Some medical facilities, we learned, justified the operation on the basis of the woman’s repeated “immoral behavior.” Blacks recognized it as “genocide.”

One prominent Chicago gynecologist confided to us that he had punctured nine or ten uteruses in the operating room that he knew of. "It’s inevitable,” he said “When it happens, I just watch the woman very carefully for infection or inflammation. Usually the uterus heals without problem.”

Of course, for women who chose to come to our women paramedics for an induced miscarriage with the Leunbach paste, rather than through “Dr.” C, there was never any question of a borderline D&C. They were all counseled and prepared for a long-term miscarriage. We set aside Thursday morning as “woman’s day” for inducing long-terms.

We induced and midwifed our first nine miscarriages without incident . . . then we ran out of the paste.

When we confided the problem to “Dr.” C, he said that he would rather not deal with long-term miscarriages anyway. Then he casually mentioned that he had a gallon or two of the paste in a friend’s house, and we were welcome to it.

So we rented another midwife apartment and made plans to stay in the business of induced miscarriages, at least for the time being.

The limited revenues we received from the long-terms were a great boost for the morale and the efficiency of the service. For the first time, we could pay our phone bills and expenses without asking for an allowance from “Dr.” C.

We had midwifed about a hundred miscarriages safely during the first 18 months of the service, and we were becoming quite confident about our judgment and ability. Then a single incident shook the foundations of our confidence and forced our hands medically.

It had been a long Saturday—21 D&Cs and three induced miscarriages. “Dr.” C and two counselors decided to stay for half an hour at the work place and have a bottle of wine, a rare occurrence, for usually everyone was in a big hurry to get out.

Then the phone rang. It was Carolyn. An unanticipated long-term from the day before. She was in labor and couldn’t find her counselor (the counselor was, in fact, attending another long-term at the time).

We were glad we were there when she called, but also wearily regretful we hadn’t left five minutes earlier. We corked up the bottle and brought Carolyn back to a counselor’s house

Carolyn was a delightful young woman. We sat around and rapped for several hours until her labor pains got so heavy she had to lie down. “Dr.” C, out of amused curiosity, decided to stick around to observe the action that night.

Carolyn had a hard but relatively short labor. After three hours, in a heavy contraction and a tiny spurt of blood, she passed a 15 week fetus. She was exhausted, but otherwise felt fine.

We made her comfortable in bed until she began contractions to pass the placenta. She wasn’t bleeding at all. One of us disposed of the fetus—an onerous task for those of us who had conflicts about abortion and the status of fetal life.

Ten minutes later, the counselor with Carolyn noticed a narrow trickle of blood down the sheet. Pulling aside the cover she saw that Carolyn was lying in a pool of blood.

She called the other counselor. One hurried for ice trays to place over the uterus, while the other gave Carolyn a shot of ergotrate to control bleeding and then massaged her uterus. She was contracting steadily, but not heavily, and she was still not passing the placenta—just blood.

We tried to tug gently on the cord and to pull out the placenta by hand, but small pieces broke off and the bleeding continued. Blood soaked up the bed, saturated towels and ran all over the floor. Blood was everywhere.

When we first called “Dr.” C for help, he chuckled and said, “Come on, girls. You know that it always looks like more blood than there really is. Give her another shot of ergotrate.”

Less than a minute later we called him again. He strolled calmly Into the room . . .and paled.

Two seconds later, his color was back and he was giving orders calmly and smoothly, "Hey, you're a mess.Let's get you cleaned up a little.”

And to us: “Get the instruments ready. Don’t take the time to sterilize them.”

While we put new sheets on the bed, he carried Carolyn to the bathtub—a heavy stream of blood marring their path—hosed her down, and carried her back to the clean bed. By this time the instruments were sitting next to the bed. About two minutes had passed . . . and at least a pint of blood.

He said, “Okay, now we have to put the speculum in again. It won’t hurt much.”

Carolyn was so weak, she didn’t care about pain. She did what she was told, knowing there was nothing she could do for herself.

“Dr.” C looked in with the headlamp, reached in with the forceps, then sat back and said to us: “Come here and take a look.”

Blood was still pouring as heavy as ever, and we didn’t think this was the time for a lesson, but he wouldn’t go ahead till we came to look. He slowly began pulling away pieces of bloody tissue that filled her vagina, and soon we saw that the cervix was being held wide open by the same bloody mass, which was pouring blood like a sponge with water pouring through it.

“The placenta is stuck in the cervix,” he explained. The contractions are too weak to pass it.”

He grasped the mass with a large forceps, and in one slow tug pulled out the entire placenta. The cervix virtually snapped shut behind it, and the bleeding slowed to mere spotting.

Carolyn was ashen but alive, and she whispered to us, “I’m okay.”

“All right, let’s get this place cleaned up. Keep her warm and get her some orange juice to drink,” Dr. C. ordered— smuggly we thought. But then we saw that his hands were shaking.

Some accidental or intuitive or holy combination of circumstances came together that night to save that woman’s life (and to save the service, as well). Chance, we realized, plays a big part, even in matters of life and death. A year later, when we were better equipped to accept it, an equally coincidental set of circumstances was to combine to cause tragedy.

We had formed the service to do good, not harm. We knew and often discussed the fact that we weren’t perfect, we made mistakes.

We had to learn from both bad and good experiences trying constantly to reduce the elements of chance, to find the right combinations. But in matters of life and death, sickness and health, we always found it hard to shrug and say, “Well, we learned from that mistake.”

Medical schools prepare their students to deal with their mistakes. We had no protective training or legal shroud. We had only the support of each other and the belief that, on balance, our cause was good and our service was essential.

At this point, the women who worked as assistants were still limited to the eight or so who had gained the trust and approval of “Dr.” C.

They had become familiar with the tools and techniques for a D&C, although they had not attempted one themselves. They had been observing abortions for about 10 months and were proficient at giving shots, inserting a speculum, administering injections of novacaine around the cervix and taking pap smears to determine infection and cancer.

But when it came time to dilate and use a forceps or curette, the counselor/ assistant stepped aside and “Dr.” C took over.

As we assumed more and more assistant duties, and were now setting up working places and taking over safety precautions—-formerly his concerns— “Dr.” C grew more bored. His energy now went into increasing pressure for speed and efficiency.

Instead of working in one-bedroom apartments, he insisted that we find apartments with two bedrooms, so that a patient could be prepped and cleaned up in one room, while the actual abortion was being done on another patient in the other room.

“Dr.” C had been commuting into town to work. on Fridays and Saturdays ever since the Mafia had driven him out for refusing to pay protection. The number of patients that we could handle each of those days jumped from about 12 to 20 with the addition of the extra room, still not keeping pace with Jane’s increasing volume of calls. The four or five long-terms that we induced on Thursday mornings relieved the work load only slightly.

We all felt the pressure to find a way to handle the increasing volume of abortions, more and more of which were “hard” cases—the very young, the very poor, the very far pregnant.

“Dr.” C was appreciating the money he was getting from the volume of abortions, but he was also feeling the pressure and responsibility of the workload, especially since he had a family and a life to maintain in another place. While he indicated no immediate plans to step out, he warned us repeatedly that he would not be available forever.

It was clear that if we were to handle our increasing volume, we would either have to hire another abortionist or learn to do them ourselves. We were reluctant to repeat our unpleasant experience with the Northside abortion ring.

Clearly, learning to do a D&C ourselves, from start to finish, was the final essential step in having a service that could be controlled and run by women.

It was never clear at any given time whether “Dr.” C was motivated to teach us to be relieved of responsibility, because of a surge of commitment to a political idea he felt was sound, because he didn’t want us to hire another abortionist, or because of that restless energy and impatience that made him constantly uncomfortable with the status quo.

One thing was clear—the pressure to teach and the pressure to learn created great conflicts—both within us and between us. For if we learned to do abortions, we would certainly use our knowledge. And that would inevitably cut into his job and his status.

Sometimes “Dr.” C seemed driven in his desire to teach .. as though he had to do it quickly, while he had a rush of commitment. And when those rushes came, those of us with the desire and the aptitude would have to be on hand to learn.

Sometimes he would turn to the assistant, curette in hand, and say, “Here, you scrape around and check to see if it’s clean.” When, we took curette gingerly in hand, he would order, “Harder. Harder. Hold it this way. Pull toward you. You can’t be afraid to use your muscles, and you can’t be so afraid to cause pain that you don’t do the job right.”

Sometimes, if a patient was bleeding slightly more than normal, but not dangerously, he would hand the assistant a forceps and say, “There must be a piece of placenta still in there. Get it out, will you?” And then he would step back, making it clear that he would do nothing about the situation until the assistant had at least tried.

We were all on a rush. Paranoia and tension among us was high. Certain women who had the favor of “Dr.” C were being pushed to learn, while others felt left out. “Dr.” C often expressed subtle fear and, resentment over the encroachment on his trade secrets and his domain of authority, and yet he constantly pushed to teach just as we constantly pushed to learn.

And so we learned—in bits and pieces— grabbing the opportunity, even while we had doubts about our moral rights to place our inexperienced hands on another sister’s body.

But for the first few months, “Dr.” C was always in the background, apparently nonchalant and confident of us, but always ready to step in if the need arose.

And so, we were armed with tools and knowledge for doing a D&C months before we were to attempt one on our own. We lacked the expertise that goes with repeated experience, and the daring to do it without that experience.

When it finally happened, it was an accident. Four counselors were working at the apartment one Thursday, breaking water bags and inserting Leunbach paste for long-term miscarriages. The fourth and last patient for the day was a 19-year-old black woman, about 14 weeks pregnant fully counseled and prepared for a labor and miscarriage.

We were all glad this was the last patient—four in one day was a lot of responsibility and severe emotional drain. We were not fully sure of ourselves yet, even for this simple procedure. We dilated the patient and reached in with a forceps to break the membrane. Two other counselors were talking to the patient and watching.

There was the usual gush of water slightly pink with blood—and in the teeth of the forceps the arm of a 14-week fetus.

The counselor who was doing the abortion looked silently at the forceps and its contents for a full ten seconds. The other counselors were silent... watching.

Finally the woman asked, “Is anything wrong.”

“Not at all,” the counselor replied. “In fact, I think we’ll do you direct and get the whole thing over with today.”

Suddenly the room was charged with energy again. One counselor began talking animatedly to the woman, explaining a D&C, while the other stood ready to help. The patient remained calm and confident.

“Okay—this is one of those times when there is no choice but to... so go.

. . . Remember... be cool... we’ve seen it done a thousand times.. . reach in again with the forceps. .. gently explore the wall of the uterus ... feel for loose material . . . twist ever so gently to make sure it’s loose . . . pull slowly through the cervix.

...Another arm and hand...a big piece of placenta . . a leg . . . an endless length of tiny intestine . . . a large bone that comes with a stronger tug—a shoulder . . .

. . . The woman winces as a hip bone is pulled through the cervix . . . the other leg . . . the ribs . . . a two inch length of backbone.

. . . Now with each tug, there’s a small gush of blood. Only the head is left. Forget that for now and get the placenta off the wall so the bleeding will stop— switch to a curette and scrape the placenta down towards the opening.

Now . . . back to the forceps—in and out, in and out—pulling the loose placenta out. The bleeding stops almost entirely.

Now feel with the forceps, find the head, crush it and pull. Harder. The patient moans softly as a piece of skull is pulled out, then the next piece, and finally the last piece.

“Okay. Once more around with the curette to make sure the walls are clean and it’s all over.” Already the uterus is starting to contract and become firm, and the final curetting is complete.

Unscrew the speculum and slowly pull it out.

“There. All done.”

Twenty minutes had passed. And an eternity.

Suddenly the room is in bedlam. One counselor is jumping around and yelling, “We can do it ourselves! From now on, we can do it ourselves!”

Part V

Part V

The women of Jane, the abortion service, performed their first complete dilation and curettage quite unexpectedly, on a delightful young patient who was scheduled for an induced miscarriage, but turned out to be only 13 weeks pregnant.

The D&C was uncomplicated, the patient was cooperative, and the reactions of the four counselors present ranged from awe to ecstasy over the act and its implications.

As soon as the new “abortionist” pulled out the speculum and said, “There, all done,” the room turned into bedlam.

One counselor jumped around and yelled: “We can do it ourselves! From now on, we can do it ourselves!”

A second counselor cleaned up the patient and explained to her that she had been done by D&C and wouldn’t have to go through a miscarriage, then added offhandedly that she was the first D&C to be done from start to finish by a woman from the service.

The patient started giggling and said, “No kidding? It’s all over? I’m really your first?”

The fourth counselor heard the noise and came in to find people laughing and chatting. The scene looked to her like a party.

But she and the counselor who had performed the abortion couldn’t join wholeheartedly in the celebration. Both old-timers in the service, their enthusiasm was tempered by the view that abortion was only the best of two tragic choices.

More important, they knew that this new achievement would mean more drastic changes in the activities and policies of the service, which was already going through changes so fast that the organizers were under unrelenting heavy pressure.

Even though we had been inducing and midwifing miscarriages for more than six months, we had avoided thinking of ourselves as actual abortionists. Inducing a miscarriage was simple, and the miscarriage itself was a matter of nature taking over. We counseled, comforted and watched for complications-we considered ourselves midwives rather than abortionists.

And in our year of work with “Dr.” C, who was now the only abortionist we dealt with, we considered ourselves counselors and medical assistants. True, we were developing the skills to do abortions, but “Dr.” C always took primary responsibility for the medical end.

However, doing a D&C on our own put us in the unquestionable category of abortionist. Armed with this new competence, we had no excuse for not using it . . . if the need was there.

The need was growing daily. Jane was getting upwards of 100 calls a week now, and more than one-third of these women were poor.

They were desperate for abortions, and had neither the money nor the connections to have it done through medical channels. Many of these women would choose catheters, quinine or coathangers rather than another baby.

Under our existing setup with “Dr.” C, there was no way to continue to provide abortions for the volume of women who could not pay. Our current price was $350, most of which went to “Dr.” C and his nurse. Each Friday and Saturday, he did from 15 to 20 abortions—two or three each day for free.

But as more and more nonpaying patients came through the service, we had increasing conflicts with “Dr.” C over money. He demanded that his total take for the weekend be above a certain amount, regardless of volume. When it fell below that amount, he became angry, sometimes hostile.

We maintained that we would not turn women away for lack of money, but he countered that most women could come up with more money if they were pressed harder.

After each major clash with “Dr.” C the service would devote most of its next meeting to: MONEY.

“Our abortionist is upset about his finances,” someone would tell the group, launching a discussion of how to present the matter of money to a woman, how to help her find money if she had none, how to distinguish between the woes of the poor college student from Winnetka who had empty pockets but rich friends, and the crisis of the black woman from 47th and Cottage, who had absolutely no one to turn to.

Taking a firm line on money required a sensitive balance, especially for new counselors. If we stressed money too hard or too soon, we sometimes scared away the most desperate of women—to what or whom we never knew.

And it caused moral conflicts for all of us. After all, we joined the service to help women, not increase their hardship. Getting an abortion was a tough enough ordeal without additional crippling financial worries.

It is rhetoric to say that we felt continuing moral outrage over the sexist society which kept abortions illegal and black market prices high. Of course we did, when we had extra energy to indulge in moral outrage.

In the meantime, we were working in that system. The practical fact was that the bills had to be pald, and as long as we were working with “Dr.” C or any other abortionist, the biggest bill would be his fees.

Sooner or later during these recurring discussions of money, a new counselor would ask: “Why should we be squeezing out some poor woman's last nickel, when our abortionist is collecting more than $7,000 each weekend?” Our only response was that we had no choice—we needed him, just as he needed us.

So finally, when the news broke that women in the service had done a D&C by themselves, and had done many others in the presence of “Dr.” C, sentiment was unanimous: we had to set up to do them ourselves.

We were at this time working on Fridays and Saturdays assisting “Dr.” C, and also independently inducing about six miscarriages each Thursday.

Jane began steadily to add short-term D&Cs to our Thursday workload. Within a month, we were doing a total of 12 abortions each Thursday, with no problems, as well as working with “Dr.” C.

By the end of two months, the counselor who had performed the first D&C felt quite competent at the procedure . . . or at least as competent as any of us ever were to feel, taking another woman’s life into our hands.

The process of training other counselors to be abortionists began almost immediately and continued for the life of the service. Each abortion became a training session, with patient, abortionist, assistant or trainee all participating.

The tone was markedly different than learning with “Dr.” C, where there was a high degree of pressure and anxiety, and often of secretiveness—all of us tried to act blasé so the patient would not think she was being used as a guinea pig.

But now learning became part of the political component of the abortion for everyone involved. We would explain to the patient the need for having other women learn, and ask her cooperation.

If she agreed—and many patients agreed enthusiastically—then the trainee could slowly and carefully begin to learn the feel of the instruments.

Now we could say freely, as a trainee abortionist took curette in hand: “Pull the curette toward you all the way around. Never push. Now scrape harder, until you hear the rasping sound—that means the uterus wall is clean.”

And to the patient: “Can you hear the sound when we scrape on top? Does it feel any different? Does it hurt?”

We learned to use pain as an indication of the status of the abortion. Scraping a clean uterus wail with the curette produced a cramping sensation, while scraping a wall covered with soft placenta usually produced no sensation.

A conscious, lucid patient, we became convinced, contributed to the success of the abortion. We felt that we owed our remarkably successful medical record over the years in large part to patient participation. Total anesthesia, still used for D&C's in many hospitals, adds danger and expense and prevents the valuable commentary of the patient.

For example, we might feel a strange ridge or pocket on the inside of the uterus with the curette. After questioning a number of patients with the same condition, we learned that this occurred with women who had once had a certain brand of intrauterine device for birth control. Unless these pockets were scraped thoroughly, they became pockets of infection.

Tiny clots of dark blood sometimes appeared in an otherwise normal D&C.

We learned by questioning the patient that these were caused by oral doses quinine, which the woman had taken to self-abort. After many similar cases, when we saw the clots we would ask: “Did you take quinine?” And she usually responded, “Yes, How did you know?”

Although the pure mechanics of doing an abortion are simple—dilation, removal of solid material with a forceps, scraping with a curette—it seemed to require an almost intuitive sense as well.

Working in an unseen area, an abortionist must depend on touch via an instrument, on sound and on visual observation of what is removed. We couldn’t look at the uterus wall to tell if it was clean.

Two other qualities were essential to a competent abortionist: ability to relate to the working team—patient, assistant and trainee—and experience, lots of it.

As more of us became potential abortionists, we were faced with a new political dilemma: the status that went with being “the abortionist.”

For a number of reasons, a few of the counselors were more adept than others at performing a D&C. They combined physical coordination with the ability to mentally visualize the inside of the uterus.

Most important, they were able to concentrate, to put moral and emotional conflicts aside while the abortion was being performed. They could relate to the team, but put top energy into the physical job at hand.

The best abortionists did not necessarily make better counselors, better coordinators or better political leaders. The abortionist was just another link in a chain where a weakness at any point could cause tragedy.

And yet, the authority and status that the abortionist commanded while the medical procedure was being performed carried over into other areas of the service.

In fact, several counselors with the most remarkable of other talents felt extreme disappointment and embarrassment at not being able to perform an abortion well.

Perhaps it was because the medical mystique had been ingrained into us, perhaps because a certain few strong personalities had both the opportunity and the aptitude to learn to do a D&C, perhaps because our two years of having to cater to male abortionists made us think of any abortionist as “the boss.”

We tried at our weekly meetings to deal with the problems of elitism in the service. We always felt the need to set aside more time for personal and collective gripes. But such discussions usually took second place to more immediate work.

Rap groups were very popular in the women’s movement at the time. Most of us resisted having the service become a rap group at the expense of efficiency and patient welfare.

We lost and gained in the process. Many issues that should have been discussed at length, especially with new counselors, were slighted. But we also discovered that a collective group built on work and action develops its own type of mutual personal support.

So, forsaking sensitivity sessions, the service sought operational ways of equalizing the status of abortionist, assistant, counselor and patient.

For one thing, we used the term “paramedic” whenever possible to refer to anyone in direct medical contact with the patient, whether abortionist, assistant or trainee.

For another, every counselor, after serving an apprenticeship counseling with experienced counselors, was given the opportunity to work at the apartment where the abortions were being done. She was encouraged to perform simple paramedic functions—giving shots, inserting a speculum and taking pap smears.

We also switched jobs during the abortion to break down impressions of individual status. At the beginning, one counselor would hold the patients hand and talk to her, while another inserted speculum, took a pap smear and injected Novocain. Then the counselors changed places, and the one who was talking to the patient and getting to know her completed the abortion.

Not only did this system diffuse status, but later, when several of us had to face a judge after a major arrest, it diffused responsibility. Former patients who had been subpoenaed could not point to a single woman and say, “That's the abortionist.”

And for the patient, the experience of dealing with several women in a paramedic capacity both broke down the medical mystique of any particular job and heightened her respect for women in general, herself included.

Observing abortions firsthand, many counselors understood the process better, felt less mystery and drama in regard to it, and could counsel better as a result.

Other counselors held full-time jobs and could not participate during the day. Some felt uncomfortable watching the medical procedures, but still felt competent to explain the process to women they counseled, it became clear that medical know-how was not, the primary criterion for being a good counselor.

The service refused on political grounds to offer a bargain price for abortions done by us, while those done by “Dr.” C still cost top dollar. We didn’t want to enhance the sexist impression that some abortions were “worth more” simply because they were done by a man.

On the other hand, we wanted to take advantage of our own cheap labor and make abortions available to poor women at a lower cost.

The challenge was not just to take care of low-money cases, but to set up a system in which no woman would get special treatment because of her financial status.

We decided not to offer any choices as to abortionist, and not to mention that one cost less than another. Instead, each woman was counseled that she would be done either by a man or a woman, both of whom had substantial experience doing abortions, and was charged according to her ability to pay.

Then we left it to Jane to schedule more low-money cases for Thursday than for the weekends, but also to make sure that there were at least two paying and two nonpaying patients on each day, no matter who was the abortionist.

Money was collected from each woman by the driver, before she arrived at the abortion place. The paramedics who did the abortions, whether us or “Dr.” C, never knew how much any woman paid.

The system met the collective immediate needs—the volume of paying cases was high enough to keep “Dr.” C relatively satisfied, and we had a means for taking care of real financial hardship cases.

The other changes that resulted from our being independent abortionists, at least part-time, were more sweeping:

• Internally, for better or worse, we had a sudden abundance of money for running the service.
• Operationally, we had to find sources for drugs and supplies—how does a lay person obtain a dilator and a set of curettes—or 1,000 ergotrate tablets... or 500 syringes?
• Legally, we had to face the fact that we would be considered full-fledged abortionists in the eyes of the law. We could no longer hide behind the label of “counselor,” and we no longer could expect “Dr.” C to act as a buffer, with his know-how and his ready cash for dealing with a bust.
• Personally, we had to cope with a range of problems, including anxiety and guilt, strains on family and friendships, and social disapproval.
• And morally, we had to be ready to accept the full consequences of our activities, even if they resulted in illness, personal tragedy or death.

Dealing with death was a daily moral issue for some counselors, while for others the issue arose only once-when a woman who came through the service died.

Part VI

Part VI 

We performed our first complete abortion!

The changes that resulted from our being able to do them, independent of ‘Dr.” C, our male abortionist, were sweeping:

• Internally, for better or worse, we had a sudden abundance of money for running the service.
• Operationally, we had to find our own sources for drugs and supplies.
• Legally. we became full-fledged abortionists in the eyes of the law. We could no longer hide behind the label of “counselor” or expect “Dr,’ C to act as a buffer, with his know-how and ready cash for dealing with a bust.
• Personally, we had to cope with a range of problems, including anxiety and guilt, strains on family and friendship, and social disapproval.
• And morally, we had to be ready to accept the full consequences of our activities, even if they brought illness, personal tragedy or death.