"I was floored by the power I felt I had to change a woman's life in the process of a 5-10 minute procedure."

This story by abortion provider Debbie Bamberger is published at Refinery29.

Debbie Bamberger has a gift for art journaling. Click the picture to read more.

Debbie Bamberger has a gift for art journaling. Click the picture to read more.

When I was 19 and a sophomore in college in Worcester, Massachusetts, I responded to an ad in the local paper for phone volunteers at Planned Parenthood. I already had an affinity for Planned Parenthood. My mother’s life story included a visit to the Margaret Sanger Clinic in Manhattan at 19 to get a diaphragm — she was having sex with her boyfriend — and I had gone to Planned Parenthood to get a diaphragm myself in my hometown of Poughkeepsie when I was still in high school. Volunteering at my local clinic was a life-changing experience for me. I met women working there who opened my eyes to sexism and misogyny. I loved speaking on the phone to women seeking an abortion, providing help to them, and I appreciated the easy availability of birth control and emergency contraception. 

I knew how to prevent pregnancy and wanted to, but I was also more careless in college than I had been in high school. I haven't thought too much about my reasons for this, but I may have been testing myself and my fertility, or I may have felt cocky about the ability to have an abortion if I needed one. I had a lot of sex and took emergency contraception many times, back at a time when that meant a huge dose of regular birth control pills and subsequent nausea. But, I lucked out and didn't get pregnant.

After college, I moved to San Francisco, thinking it would just be for a year. I had continued working at Planned Parenthood for the rest of college, so it was easy, a week after moving to California, to get a job as a medical assistant and counselor with an Ob/Gyn who provided abortions. I loved it. I learned so much about abortion, about women’s reasons for having abortions, about being non-judgmental, and about life. Around that time, I was off hormonal birth control and wanting to use more "natural" methods. I got a cervical cap and took the natural family planning class offered at the clinic I worked in. I was 22, living in San Francisco, supporting myself, enjoying my work, making friends, and loving life.

I met a guy named Marcus, a photographer working in a commercial photography studio with my roommate. We were young and hot for each other. I was using the cervical cap for birth control at times when my fertility awareness methods told me I was fertile, and occasionally taking emergency contraception if I messed up.

One day my period had come late, I took a pregnancy test at work. I’ll never forget the feeling of dread when I saw that second line. I remember taking the 33 Stanyan bus home and calling Marcus. One of the things about that week that stays with me to this day is that it didn’t feel like I had a choice to make. I was pregnant and I wanted it out of me as soon as possible. 

The doctor I had worked for for almost a year, I knew how skilled, kind, and non-judgmental he was, and though I was sheepish and embarrassed, I asked him if he would give me an abortion. I didn't want anyone at work to know, so Marcus met me there at 5:00 in the evening and we went into one of the exam rooms after the rest of the staff went home. By that point I'd been in the procedure room for probably a couple hundred abortions, so I knew exactly what to expect, but I didn't know how much it would hurt. I have one of those cervixes where even taking a Pap smear sample feels like my guts are being scraped. The dilation and the suction were really, really painful, and I was barely 5 weeks. But, it was over quickly, and I went home feeling relieved.

I entered the first-ever class of the University of California San Francisco Masters Entry Program in Nursing, and graduated in 1994 as a women's health nurse practitioner. I moved to Merced, CA to participate in the National Health Service Loan Repayment Program for physicians and nurses to go work in underserved areas while getting their student loans paid off for free. The dating options for a young, Jewish, professional woman in the Central Valley were few. I met a guy one day while pumping gas at adjoining pumps, and we went out. He lived in Stockton and was an attorney. He came to my place after a date and we had sex on my living room floor. I knew we needed to use a condom, but we started without one. About 10 days later, one day late for my period, I took a test at my clinic. The positive line wrecked me. I was not suspicious about that one time we had sex, because I didn't think he came inside me. I called him from my office, ashamed at myself and pissed off at him. 

Once again, I didn't feel like I had a choice to make, I just wanted the pregnancy over as soon as possible. I was living in Merced and no one did abortions there. I had 2 Ob/Gyn colleagues I respected, and even though I knew they didn't do abortions, I knew they were capable of doing aspirations, but neither of them would. I was ashamed to admit to them that I was pregnant, being a responsible women's health provider, but I felt trapped in my small town and needed to ask them. One of them was very skittish about abortion and didn't really believe in it, though he seemed supportive of my decision. The other just didn't know how he would do it logistically. We didn't have the equipment in the clinic, and it wouldn't have been possible to do it at the local hospital. When they said no, I had to figure something else out. 

I called the doctor I used to work for in San Francisco and made an appointment, but his receptionist called me to cancel because the doctor was stuck in a surgery. Having worked in abortion already for quite a few years, I didn't want to go to the closest clinic in Modesto, because I worried from things I'd heard that the skill level of the providers was unpredictable. My friend from nurse practitioner school was working at San Francisco General and she asked her boss, the medical director, if he would take care of me as a favor to her. He agreed to see me at the end of his day. He was the chief of obstetrics and gynecology at that time, and a superstar in the field of family planning and abortion. I'd heard about him but had never met him. He came across as exceptionally kind and accepting. My friend went in with me. The Stockton dude offered to come, but I didn't want him there and never saw him again. My ex-boyfriend Steve came with me, though. The procedure went fine — I chose to get some narcotics this time — and I tried not to feel too ashamed, but I really did. I felt one abortion was "acceptable," but two, especially for someone working in the field, was absolutely not. I never talked about it or told anyone. 

After my loan repayment commitment was finished, I moved back to the Bay Area as soon as I could. I got a job working for the doctor I'd worked for before graduate school, who had done my first abortion, and shortly thereafter, I got hired to work at San Francisco General as a nurse practitioner in contraceptive clinical trials. My boss was the same doctor who had performed my abortion at San Francisco General. It had been about a year or two since he'd seen me as a patient, and he didn’t acknowledge having ever seen me before when we met for my interview. I thought about saying something to him, thanking him for the positive medical experience I had with him, but I decided to let it go and hope that he knew from our excellent working relationship that I appreciated him.

Click the picture to learn more about Debbie’s passion for art journaling.

Click the picture to learn more about Debbie’s passion for art journaling.

I spent the next 7 years working there, running the birth control trials, working in the teen family planning clinic, and doing pre-operative exams in the abortion clinic for women having second trimester abortions. I was very committed to abortion access, and I had been ruminating for several years on the idea of nurse practitioners being able to perform abortions. This is something my friends and nursing professors had talked about in graduate school, but the law in California prohibited it. I was a skilled clinician at this point, very good at laminaria placement (laminaria are dilator sticks that are placed into the cervix the day before an abortion, to dilate the cervix gently), and teaching Ob/Gyn residents how to do contraceptive implant insertions and removals. I asked my boss if he would consider training me to do surgical abortions. He told me that if I said I were moving to Montana or someplace like that, he would consider it, but since we lived in the Bay Area, there really wasn't a need. It was also against the law for anyone other than a physician to perform an abortion in California at that time, and I believe that this doctor, while fervently pro-choice, is a very moral person and would never consciously break a law. I felt mixed, but not surprised, about his response. He was always very overt about respecting my clinical skills and judgment, but the fact that he wasn't interested in helping me push my profession ahead was sad, but not unpredictable.

I continued to work at San Francisco General, and during that time I got married. After I had my first baby in 2002 and we moved to Berkeley, I decided to stop commuting to the city, and I was hired by Planned Parenthood in Richmond. It felt so good to be back at a Planned Parenthood, where the seeds had been planted at age 19 for my interest in reproductive health. I told my immediate supervisor that I had a long-term goal of helping nurse practitioners be able to do abortions. I didn't think too much about it after that, but one day, the medical director of our affiliate called me and said, "I heard you want to do abortions. When do you want to come train with me?" Planned Parenthood as an organization was thinking about access and what to do if Roe v Wade was overturned, and began planning for "miscarriage management" — training advanced practice clinicians to do uterine aspirations for miscarriages or failed medication abortions, to ensure that we had the skills that might someday be needed. 

I began my training in 2005. I took to it right away. I have good hands and lots of experience inside the uterus, and I was passionate about it. I was floored by the power I felt I had to change a woman's life in the process of a 5-10 minute procedure. We had to be creative about working within the limitations of the law — I learned to do all parts of the procedure, but the doctor would begin the suction part of the process, and then I could take over to complete it.

I found out that two researchers at UCSF were gearing up to start a study to look at training advanced practice clinicians to be abortion providers, and I had already done about 100 procedures by then. 

One of the researchers at UCSF had been my professor and knew that I had been trained, so she asked me if I'd be willing to be the study's first official trainee. I was overjoyed. Their goal was to do a very good study and use the data to help change California’s physician-only law. It took about seven years, but it worked. The researchers collected data on about 13,000 procedures, proving that advanced practice clinicians could perform first trimester abortions as safely and with as much patient satisfaction as our physician counterparts. As of January 1, 2014, after having completed 500 procedures over the course of the study, I'm a legal first trimester aspiration abortion provider. I feel so proud of participating in the study and the process of changing the law.

Meanwhile, in my non-work life, I've been in a book group with six other women for the past eight years. We know each other pretty well. Last year, my book group participated in a research study looking at women's conversations about abortion. We read a book of essays and then had a discussion about the book, which turned into a conversation about personal pregnancy experiences, including abortion. All the women in my book group knew I was an abortion provider beforehand, but only one knew that I had had an abortion. The conversation made me realize that, although I am working to help normalize and de-stigmatize abortion, I'm not at all "out" about my own abortions. 

I didn't reveal that I had had an abortion until pretty far into the discussion, after another, older member of the book group disclosed her abortion. The book group conversation made me think more closely about the stigma around abortion. In my experience, it doesn't have to be, and shouldn't be, a gut wrenching, heartbreaking decision-making process. I asked myself and my book group friends, "If abortion is part of one out of three women's lifetime experiences, why not treat it like getting your period for the first time, getting dumped, or getting in a minor fender-bender — it's something that happens to many of us, we remember it, it impacts our lives, maybe even changes our lives, but it doesn't ruin our lives or make us have to hang our heads in shame." The women in my book group agreed. Stigma hurts us. 

When I thought about writing this story, I was nervous. Nervous about using my real name, about others being able to identify some of the people in my story, identifying myself as an abortion provider, and acknowledging my abortions. I didn't want people who think highly of me to know that I had had abortions. But, after thinking about it a lot, I decided that being open about my experiences felt better than hiding. I hope other women, both the women in my life and the women I take care of, will have the freedom to speak out, too.

"Those who have had abortions before will often share that experience, like elders passing on wisdom to youth."