This is a transcript of one of the videos leaked from the National Abortion Federation convention. These videos were recorded in secret by David Daleiden
The National Abortion Federation filed suit to keep all the videos taped at their conference away from the public, but an individual unaffiliated with the Center for Medical Progress leaked them.
I have composed this transcript after listening to the video. It may not be accurate in every detail. When I have been in doubt, I have inserted a question mark. There may be errors in this even though I did my best to be accurate.
The video is of a panel discussion entitled “2nd Trimester Providers Self Care” which featured several different speakers. I am making a separate post for each speech.
The abortionists who spoke at this panel do second trimester (or later) abortions, killing babies like the one below.
They are usually aborted by the D&E procedure, although some may be poisoned, after which the mother will go through labor to expel the dead baby.
… If you attend NAF frequently enough, you realize there are only a certain number of ways that you can actually approach 2nd trimester abortion, and there are some things that come up routinely like complications, procedural methods, cervical ripening and whatnot and one issue that arose this year that several people recommended that we approach that had not been approached frequently or at least recently was the issue of Abortion Provider Self-Care. What people were interested in hearing about is how we take care of ourselves, our families, our staff, the people that we train, particularly given all of the internal and external pressures that we confront. So we decided to approach that topic. We have assembled, cajoled, persuaded, a wonderful panel of people who will follow the following format today in what we want to be a discussion. We will initially have each of the panelists give a very informal presentation regarding their particular view given their position as a provider or a director or a manager or whatnot, of 2nd trimester abortion self-care. I will introduce each of the panelists immediately before they make their comments. Again these presentations are not intended to be formal, in fact I have promised some of the people presenting that these can be informal remarks, and they are there so that they can name topics that after the presentation will serve as a jumping off point for all of us to discuss our own perspectives, our own prescriptions, for what we have learned will help us take care of ourselves and our families and our staff and those we train whenever we’re doing 2nd trimester abortions.
So, with that as an introduction, I want to introduce our 1st panelist,
Doctor Lisa Harris is well known to anyone who has attended NAF meetings. She originally trained at Harvard followed by residency at UCSF in obstetrics and gynecology and has now spent the majority of her academic career at the University of Michigan. She is not only a highly accomplished physician and running a very important, very productive family planning program, but she also has her PhD and is an important member of the women’s studies program at the University of Michigan.… She’s one of the people I know who every time she speaks she always says something intelligent. Nothing unintelligent ever comes out of her. I really admire her for this. I think all of us know that her area, which she has gained national notoriety for is abortion stigma and the internalization of stigma not only among society at large but also among providers. So I think this is an important place for us to start, let’s welcome Doctor Harris…
Thank you. Actually today I was planning to say something unintelligent. [Laughter] So I have been an OB/GYN and abortion provider for about 20 years, most of that time in Michigan. And I’m also a researcher, and as you heard, I study among other things, other people, abortion providers. And I never actually set out intentionally to study abortion providers, so I guess I had an unplanned but desired research career [laughter]. So that part of my journey studying providers really began over lunch, with Laura – –. I don’t know if she’s here, but she’s a physician that I worked with in Michigan and we had lunch together the day I went to buy a crib for my unborn fetus. Subsequent daughter, the one who’s controlling the display area and picking up candy, and over lunch I very hesitatingly asked the doctor what it was like for her when she was pregnant doing abortions, because she had just had a baby a few months before me. And out of us spilled all of these stories and experiences about doing the work that we did. Its sacredness, and its great rewards, and also its burden. And neither of us had ever had a conversation like that before. And from that, that conversation turned into a small private research project. Where, what eventually turned into what I now call the provider share workshop were a group of abortion providers, and I define providers broadly to include anybody who considers themselves part of a woman’s experience of abortion. Whether that means you answer the phone and set up appointments or whether that means you are a nurse in the recovery room, or physician doing procedures. So all providers. And that turned into a pilot study where providers gathered 6 times over 2 months, guided by an experienced facilitator to talk about their experiences with doing the work. And with each session there was a new theme. And then that pilot study turned into a bigger study which turned into another study and ultimately at this point over 400 US providers
….So what I want to do with the few minutes I have now is share the most important things that I’ve learned from listening to providers over these past 6 years. And I told you will of that background really so that you know that the great deal of humility that I have as I sit here now because anything I have learned about the experience of doing this work I have learned from you, and from people who have participated. Everything I’ve learned has really come from your voices. You always already know what I am about to say and all I’m doing right now is giving it voice. And if my voice turns out to be the most important theme across all of the workshops. [?]
So I’m just going to kind of list some of the most interesting things that I’ve heard to give you a bit of a conceptual framework about how to think about the rest of the conversation. The 1st, the news is really reassuring that as individuals we have really good esprit de corps. Compared to other health workers across the range of disciplines we have higher compassion satisfaction, meaning the pleasure that we get from doing our job, taking care of patients, is higher than it is for all other healthcare providers who have… taken similar surveys. So ER nurses and physicians in other disciplines. So that’s really good news.
The other thing is that we also have lower burnout. You may be surprised to hear, but we actually have, so lower long-term exhaustion and loss of interest in our work than other healthcare providers do. So that’s more good news.
That said, we feel stigmatized. Meaning, we feel marked in a negative way by our work. Marginalized, discriminated against. So I want to share now a little bit more about what this marking looks like, what this stigmatization looks like. It can take a range of forms and be experienced in a lot of levels, so we experience it in [inaudible] when I park my car in the parking lot of the hospital every day I have to go by that bumper sticker that says “Choose Life.” You know, or “Abortion Stops Beating Heart.” Ah! I’m so mad, because why, I’m just going to work, why do I have to deal with this? So that sort of stigma on a broad, discourse level. But, we feel it structurally in law and policy so I feel it in Michigan when they tell me insurance can’t pay me for abortion now or when legislators try to say I need a million-dollar liability malpractice liability insurance, of course, because I am so uniquely dangerous compared to all other physicians. I feel it in organizations, hospitals, right, when my hospital might not want to deal with having its own abortion clinic, uh, in the hospital. Other people may feel it in their churches or synagogues. We experience stigma in our communities or in our family and our friends. You know how willing are we to talk about our most recent case, at, say, Thanksgiving dinner when people are asking us how work is going or how we’re doing. So in all of these sort of layers and concentric circles we feel stigma.
The main consequences of that are disclosure dilemmas. Meaning, we have to make decisions constantly, consciously, unconsciously, about who we tell about our work and under what circumstances. And this is actually something that anybody who has an invisible stigmatized attribute has to do.… If it’s not apparent, what your stigma is, then you have to decide are you going to talk about it or are you not. On elevators, on planes, when you’re coming to do your slide presentation on the airplane and you can’t quite move your computer so someone can’t see your slides. [Laughter] So, disclosure, people knowing what we do comes with risks that I don’t need to enumerate for you. It comes with the risk of being judged. It comes with the risk of creating rifts and ruptures in our relationships and of course it carries the risk of harassment and violence. Although we probably feel that out of proportion to what it might be because that’s how terrorism works. But nevertheless it’s real. But if there’s one thing I’ve learned over and over in the workshop it’s that while the risks of disclosure are particularly obvious, the risks of nondisclosure are really big too. But we don’t see them so much. And this is a point that I really really want to emphasize. There are costs to us when we don’t talk about our work. People don’t know who we are, we lose connections, we lose getting to share the satisfaction of what we do, and when we don’t represent ourselves to others they represent us and those depictions are not so flattering.
This was dramatized for me just a few weeks ago actually, I was in Hawaii, doing a small speaking gig and vacationing, and so I flew back overnight, from Honolulu to Seattle, changed planes in Seattle at like 6 in the morning having not slept, I was traveling with my daughter also. And I get on the plane really wanted to go to sleep for the next flight, and this man took up a little of my seat plus his seat sitting down beside me… And so, what you do, wants to know all about me, and at that point I really didn’t want to engage, so I said, “I teach. I teach at the University of Michigan.” Have you ever not said everything you do…? So He was very persistent and he wanted to know more. So I said I’m an OB/GYN and I also teach in the women’s studies department, and he kept pushing and pushing. So then I stopped it all by saying, “what do you do?” At that point, he did the thing I usually did. He kind of went really sheepish. And he said, “oh, well I work in the court system in Michigan.” [Laughter] oh, tell me more. And eventually, he discloses that he’s a judge. And at that point I said, oh, do you see minors at all? “Sometimes.” Well I work at Planned Parenthood. “Are you judge — and he said yes.” And so what just happened is the judge who’s been signing all my judicial bypasses is sitting next to me on the plane, and we spent the entire flight talking about this. He had never told anybody about that aside from his wife. Even people in the courthouse did not know because they have a special code, which I won’t say because it’s a little bit demeaning, for what the bypass cases are, so that even the people scheduling the bypasses don’t know what those cases are about. He, it turns out, does more bypasses than almost any judge in the country and he has never told anyone about it. He didn’t talk about it. And he all of a sudden, boom! He had this big chance to talk about it, and it was such a, it really traumatized me the importance of how we make connections, and we don’t let fear dictate our disclosures, though I understand why that happens when it happens. It just drove it home again for me. You know, there’s tremendous value in sharing.
Just a couple more points and I’m done. And then I’ll turn it over. A few other things that are really salient. If we have young kids we’re really afraid. We’re afraid that our work will adversely affect them, that they will be marked just like we’re marked, or that something will happen to us because of our work and we won’t be there to raise them. And more tears were shed in those conversations I think than in any others in the focus groups. If we don’t have kids, or as our kids get older and self-sufficient, we tend to get more bold.
Another reason we choose silence, besides protecting ourselves and our kids, is to protect the pro-choice movement. And I talked a little bit about this morning. Our stories don’t really have a place in a lot of pro-choice discourse and rhetoric, right? The heads that get stuck that we can’t get out. The hemorrhages that we manage. The patients having their 8th abortion. The patients that really fit any of the stereotypes that antiabortion people like to talk about. You know, those are all parts of our experience, but there’s no real good place for us to share those. Not only do we have self-censorship… We also have this burden of censorship because we care about this movement and we don’t want to be danger to it.
We also may not talk about our work because we suffer from overwhelmed identity. I also mentioned earlier today, meaning people will always see us as abortion providers and nothing else. Even if it’s a positive view. There’s only so many cocktail parties you want to go to or soccer games you want to go to, where everyone’s like “I’m so happy about what you do, you’re such a hero!” [laughter] you know? It’s lovely to hear but you don’t need that all the time.
If we’re physicians we often don’t disclose because we are marginalized within medicine. We feel look down upon technically or morally, by our peers in medicine. We dread complications, not just because of what it means for patients, but because of what we imagine people will say about us to our patients or to each other when those patients present to the emergency department, we dread morbidity and mortality presentations where we feel that our complications will be judged more harshly than a similar conversation, a similar complication outside abortion.
So then the point I want to end on with is – so what? Why does was stigmatized recognizing the way in which we’re stigmatized have the effect that it has on us? Why does it matter? Isn’t that a little narcissistic? Our work – this is about our patients, it’s not about us.
So I think it’s important as an end in itself, that we have these spaces to have conversations. But even if you don’t, let me just present a few other pieces of data. Guess what is best correlated, although we’re okay on burnout and compassion satisfaction, guess what is best correlated with burnout and compassion satisfaction.… Stigma. Right? The higher levels of stigma, higher levels of burnout, higher levels of compassion fatigue – lower levels of stigma and its inversely correlated with compassion satisfaction, meaning the lower our stigma, the higher our compassion satisfaction.
So I would say, even if you don’t care about self-care, if you want to work more [inaudible] for our patients, you need to pay attention to how stigma affects us as people. The other thing is that stigma can be managed, and the workshops that my research team ran, we were able to show that stigma actually declined before and after the workshops, and that effect held up a year after the workshops finished. Which is not to say there aren’t 10 other great stigma interventions out there, but if we do something, we can strengthen our recourse and make it more resilient. I think we owe it, we owe it to ourselves, but we owe it to our patients too. If you don’t want to think about yourself, think about our patients.
And then the last thing I want to say is that self-care, my experience in these workshops is that self-care is a bit of a misnomer. Because isolation and disconnections and voicelessness are the main things that we suffer from as a community. And to heal those things requires connection. So I don’t think there is “self-care.” I think there is group care, I think there is care and connection, I think there is team care. And that when we think about what needs to happen to take care of ourselves, it’s not that we all get a therapist, although I’m sure that would help, it’s not that we all get massages or work out or do all those other things to be good to ourselves. It’s that we come together. And I think that’s why NAF is so powerful, the spaces that we have to do that are so powerful. And, to me, self-care is connection. And that is what we need.…
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