||The key to moving on from the pain and loss is awareness and understanding|
Newsletter Excerpts 2017
Celebrating 20 Years
P.A.T.H.S. has been operational for 20 years in December this year. That is a huge milestone and what a journey it has been and continues to be.
Numbers of not-for-profit counselling agencies have closed and others are struggling, even though their services are much needed by the community. That P.A.T.H.S. has survived this long is credit to the wonderful people who have contributed their time and expertise to both governance, co-ordination and provision of services.
It is also thanks to funders who have supported the work over the years. We have had regular funders and donors who have consistently encouraged us with their contributions. We have had others who have given money at different times for special projects, and private donors who have supported us faithfully. A huge thank you to you all.
There are too many people to thank individually for their involvement with P.A.T.H.S. over the last 20 years. From myself and the current Trust however, I would like to say a massive THANK YOU to everyone who has supported this outreach and service and made it possible.
In recent years I have needed to step out of various roles of responsibility and have felt heartened that others have stepped up to assume various roles.
Thank you to those who have served on the Trust, helped with administration, the Prayer Network and outreach. Thank you to Gay White for continuing on the Trust this year, and thanks to Karen Holmes and Averil Ewart-Jones for picking up the Trust’s reins and holding the vision of P.A.T.H.S. for the foreseeable future.
Heartfelt thanks to our PCPs around the country for growing with us through the changes in the service and continuing to be available and provide much needed counselling. The move to weblistings for PCPs will, hopefully in time, increase the number of clients able to access help, and with greater ease.
Thank you to those who facilitated support groups and connect groups, over many years. These are currently on hold as P.A.T.H.S. is going through another period of change. When the demand arises these can begin again, or we can refer and link people in with other support groups and programmes if that is more practicable.
Thank you to our Facebook teams past and present. The private Facebook group is a safe forum which helps to break the sense of isolation that many post abortive women feel. It is hoped that more sharing will happen as we move forward.
For me the journey over 20 years has definitely had its highs and lows. It has been a real faith journey and certainly had its share of struggles. As founder it has been a privilege to be a part of something so worthwhile.
I am reminded of cycles and seasons. This year P.A.T.H.S. has once more been going through a time of transition and change. We have returned to voluntary roles on the Trust and Co-ordination Team meantime to enable the work to continue.
P.A.T.H.S. is in good heart. The way forward is reliant on each and every one of us. And the question is how do we continue to grow P.A.T.H.S. as a service from this point?
The call to healing for those negatively impacted by abortion is what touches our hearts and draws us into the work and invites us to continue to offer ourselves in service to P.A.T.H.S. and those we are endeavouring to support. We each have qualities and strengths and together we can grow P.A.T.H.S. more and respond more effectively to the needs of those we serve.
For myself I wish to focus on the education and training role and I hope that there will be more opportunities to do presentations, workshops and seminars, to write articles and disseminate information as part of our outreach.
Thank you to all who have been and are part of the life and journey of P.A.T.H.S., and I look forward to continuing my association with each of you and with P.A.T.H.S. as a whole. Let us work together to continue to bring hope and healing, and be a voice for those impacted by or hurting after an abortion.
Soon we begin another year and what will it bring? Watch this space.
- Carolina Gnad
MEN HAVE THEIR OWN EXPERIENCES and STORIES
Although the focus when talking about abortion is mostly on women, we have always been aware that abortion affects men as well. Men’s experiences are real and also need to be heard.
Some men access help through our service, but certainly not as many as we imagined might want support. Men’s experiences are so undervalued and underacknowledged in society. In the current climate it is increasingly hard for men to find and give voice to their experiences.
With each abortion there is a man involved. Scenarios for men may vary. He may have been supportive of the woman to have an abortion out of respect and deference to her wishes, or for self interest or self preservation; he may have left the decision for her to make; he may have wanted to keep the child and found he had no legal rights and little power to persuade her to keep the baby. There are as many scenarios as there are men with abortion in their history. Whatever the scenario, every man who has a story of abortion has feelings or aspects that may have impacted him. He may be left with questions as to what this meant then, and what it may mean now for himself. The memories may surface in future relationships, or when he has a family, or suffers another loss.
A man’s reactions and behaviours may signal he is more affected than he realises or admits. Anger, risk taking behaviour, difficulty with intimacy, relationship issues, numbing through alcohol and drug misuse, or escaping through workaholism, obsessiveness over fitness and needing to be in control. He may suffer depression and anxiety which he may be covering claiming he is okay, just getting on or displaying an “I don’t care” attitude.
It can be a powerful thing to open up and tell your story. The hope is that some men may be willing to come forward and simply share what happened for them and where they are at with the experience. It is usually the first step in the journey of making sense of your experience and dealing with impacts.
If you are a man with an abortion experience, or know someone who may like to share their story, feel free to write in to email@example.com. Stories will be held in confidence and no publication or sharing of your story will happen without your consent. If anything is published or shared, in training areas for example, every endeavour will be made to protect people’s identities.
Start a healthy conversation
When director Punam Kumar Gill and producers Drew and Joses Martin heard that the health information being given to women prior to an abortin was subject to the politics of the people involved, they determined to put aside individual ideology and take an honest, scientific look, at the highly disputed and politicised information around abortion’s long term effects on women’s health.
What is uncovered in the process for them is interesting and may be of interest to you.
If you would like to purchase your copy of this DVD visit the webstore.
This DVD will certainly stimulate lots of conversation which in my view is much needed. The taboo surrounding talking about abortion and the effects for those impacted, is certainly something that is still present and needs challenging in our society. As a society we don’t want to talk about it... it is too contentious, we might offend, it makes us uncomfortable. This DVD will hopefully stimulate conversation on the subject and open up new awareness.
At some level as well, for those who are negatively impacted by a past or recent abortion experience this DVD may feel validating and affirming of their experience. It may support them to know that they are not alone, and that what they are feeling or going through is not unusual. It may help them to share their stories more openly, and if they are struggling they might feel encouraged to seek help, realising that this is a natural grief from an unnatural event.
In my experience, it is not only the experience of the actual abortion process or procedure, and the reality of what it does and means that affects people, it is the whole situation of who they are, their past, present and future self, their background, history, culture, spirituality and/or religion or views and beliefs, circumstances, relationships, and much more that contribute to effects. All these things contribute to feelings, conflicts and disconnect, and relate to the person’s overall experience and the story we are hearing and responding to.
In terms of the link between abortion and breast cancer, what is presented makes sense, however there is dvisiveness in the research from different quarters on this subject. Everyone claims to be working for the interests and wellbeing of women, so it is curious that there no agreement possible on these matters? Such are the politics of abortion!
My hope with this DVD is that we can open up this issue more and promote open discussion particularly around the needs in post abortion healing. We need to acknowledge that, with the numbers of women having abortions each year, we may be facing a significant problem in terms of the long term health, and mental health, problems for women.
- Carolina Gnad
As always when something around abortion and the effects of abortion comes out there will be opposition and efforts to discredit.
David A. Grimes, author of Every Third Woman in America: How Legal Abortion Transformed Our Nation and former Chief of the Abortion Surveillance Branch at the Centers for Disease Control (CDC) is one such opponent discrediting the work in a blog post 9/2/16, entitled Hush: the Documentary — Hubris and Hypocrisy about Abortion.
Sophistry: First, the film alleges unique insights into gynecology and epidemiology, the study of the causes of disease. The director, Punam Gill, and producer, Joses Martin, claim to hold “the truth” about the health effects of abortion, despite their admission that, “We aren’t scientists.” The film discounts the world’s medical and public health communities, which, after decades of careful study, agree that abortion is safe. Indeed, within three years after the landmark Roe v. Wade decision, the U.S. Institute of Medicine (now National Academy of Medicine) had established the safety and public health benefits of abortion. Over subsequent decades, researchers at the U.S. Centers for Disease Control and Prevention and World Health Organization have repeatedly confirmed this finding.
The criticisms continue and it leaves one feeling rather confused as to what to believe and what not to believe. Certainly much of what the Hush DVD portrays are experiences and questions we hear in our counselling rooms from clients. Many of our clients have short and long term impacts from their abortion/termination experiences. We need neither research nor documentaries to prove that to us. The evidence is before us in the person seeking support to cope with symptoms of depression, anxiety, and wanting to work through issues of loss and trauma, relationship issues, self esteem issues, relating to their experience and the situation surrounding them at the time of the pregnancy, decision-making, the procedure and beyond.
So what are we to make of the Hush DVD and the criticisms of it? Sifting and sorting what fits with our counselling experiences in any piece of research can be hard work. Different research may validate our experiences with clients, or may invite us to question things more. That is helpful. As if we are not wrestling with the issues there is something wrong.
For me personally, in terms of scientific veracity or truth of different studies I cannot comment - I am not a scientist or researcher. I do understand and appreciate how fraught research is around the effects of abortion/termination, because of methodological issues and limitations; and the biases of the researchers and the interpretations of various research. However I like to think I am able to filter some of it to see what makes sense and what matches my experiences of encounters with post abortive women over 20 years working in this area of healing. I intentionally keep focus on each of my clients’ stories, and issues, and avoid using any research to validate or minimsie a client’s experience. I rather work with what is present in the room and what is significant for the client.
If clients have medical concerns they need to see a doctor and have it checked. It is not my place to make a call as to what is going on, or claim cause, or engender fear, nor am I to deny their concerns. If there are health concerns they ought to be addressed by the appropriate health professionals, and I can support them as best I can in dealing with these.
I have come to see and acknowledge how numbers of women adjust and cope with few problems after their abortion/termination experiences, and not all women experience high levels of grief or trauma, but there are numbers who struggle and seek help. Others I do believe, may be suffering or struggling but do not access help because either they do not know help is available, or the secrecy, stigma and shame is too much. For some too, if they are struggling afterwards, they may believe they deserve to suffer for what they have done, so are stuck in guilt and may be shame bound. The shame they carry may not be just relating to their abortion/termination experience, as some women who have had abortions also have histories of abuse and trauma. It is all very complex.
As a counsellor what is most important is that I can meet a post abortive woman where she is at, really hear her story without preconceived ideas or judgement, and support her in her process of unpacking her experience, journeying through grief and dealing with any trauma issues.
What Hush or any research invites me to is an openness of awareness in my reactions and responses to people who have abortion/termination experiences and to be cautious and sensitive in how I respond.
- Carolina Gnad
Changing Laws and Health Issues Around Abortion
The debate around changing the law risks confounding health perspectives.
Traditionally legalising abortion in most countries has centred on women’s rights agenda as part of a human rights initiative. This has effectively marginalised those impacted deleteriously by their abortion experiences.
The common view of abortion as a “right” embodies the precept of freedom to choose. However in reality, for many faced with an unplanned, unwanted or difficult pregnancy, abortion has become the solution of choice, and is not only offered but in many areas promoted as the best option or the only viable alternative, often at the expense of other alternatives being equally supported. In some situations women are pressured and co-erced to their detriment which can create more negative reactions afterwards. The layers of politico-legal and politico-medical considerations, potentially shroud the often deeper concerns and impacts for people after an abortion or termination experience.
The view that abortion is generally innocuous is a misnomer. Unlike other medical/surgical procedures such as appendectomy or tonsillectomy, abortion is a deeply human relational experience. The commonly taouted belief that abortion promotes wellbeing as it gets rid of the problem and allows a person to resume life, precludes the lived experience of numbers of women, men and family afterwards for whom abortion has been a turning point in their lives, has had unanticipated consequences and unwelcome effects on wellbeing and function.
Any pregnancy-baby loss has the potential for grief and trauma. This applies equally, or often more so, to abortion, which is an artificially- induced termination of a pregnancy. The context and complexity surrounding situations and decision making for those availing themselves of the procedure to end a pregnancy, can be difficult and stressful, and emotions can be intense, tumultuous and confusing. When a pregnancy is unplanned, unwanted or difficult, it can send a person into crisis mode, and decision-making becomes fraught. Thinking may be distorted, the ability to process both long and short term consequences is usually compromised, and the space to explore the ins and outs of what is happening, and to align a decision with personal values and beliefs, is often missing.
The reality of the experience and what it means for a person may only be discovered afterwards. Some adjust well from this life event and it has no obvious impact. However, the effect of utilising coping strategies, such as avoidance or rationalisation, to help hold the experience safely can alter a person all the same. There may be flow on effects on the person, their life and relationships, which even the person themselves may not recognise or acknowledge. Often in counselling women and men after abortion, the true effects only become apparent through the unpacking of the experience, attending to the emotions, and addressing conflicts and relational aspects in more depth.
For some women, and men, especially where there was ambivalence, or the decision was a pressured pragmatic response to the situation, or they had ad have inadequate internal and external supports and resources, this can be a significant event, sometimes life-altering.
Symptoms of depression and anxiety are hallmarks of negative abortion/termination reactions. It seems that depression and anxiety is becoming more prevalent in wider society, but being done to identify if there are possible correlates with depression and anxiety to a recent or past abortion/termination, particularly in women.
The failure to deal with the inherent grief associated with the experience, or the possible trauma incurred can mean feelings become suppressed and trauma material internalised, which can affect the person’s wellbeing and functioning, physically, mentally, emotionally, spiritually, relationally and socially. Avoidance of pain is a normal human response to challenging situations and psychological defences are used to keep painful memories at bay. This does not discount impacts from the experience, rather acknowledges the strategies employed to “maintain control” and endeavour to continue to function. Whether that functioning is at an optimum and whether the person is wholly healthy, or not, is another question.
The reality is, that many women, young and old, who have availed themselves of an abortion or termination, are irrevocably changed by the experience, and can struggle afterwards in silence, secrecy and shame. The abortion is not much talked about and those affected often go unheard.
P.A.T.H.S. continues to work to support those affected negatively by their abortion / termination experiences, and to be a voice to raise awareness around post abortion issues, so that more people who are impacted can come for help, and those in the community and health circles can respond openly and sensitively to them.
- Carolina Gnad
Medical Aspects of Ectopic Loss
by Sunny Martin
This article has been written to give a brief explanation about ectopic pregnancies and the general management of them. To better inform woman of what ectopic pregnancies are and equally to inform those supporting women who have had an ectopic pregnancy in how better to support and care for them. Ectopic pregnancies are not just a potential medical emergency, it is also a significant loss of a child.
Ectopic pregnancies are said to occur in 1% of all pregnancies in the developed world. The word ectopic comes from the Greek word meaning ‘out of place’. An ectopic pregnancy occurs when the fetus begins to grow out side of the womb (uterus).6 95% of ectopic pregnancies occur in the fallopian tube. Unfortunately, if left undetected, these pregnancies are not viable and because the fallopian tube can rupture and can endanger the life of the mother.
Awareness of ectopic pregnancy is important for any woman of child bearing age. The symptoms may be many or very few. Most women will begin the pregnancy with the same pregnancy symptoms as any other pregnancy. She may feel nauseated or have breast tenderness or an aversion to certain foods.5 There may be other symptoms such as dark red spotting, increasing abdominal pain, shoulder tip pain, nausea or vomiting, dizziness or faintness.4 If you are aware that you are pregnant and are not sure of your symptoms, seek medical advice.
There are a number of tools used to diagnose an ectopic pregnancy. A medical history will be required for anyone presenting with lower abdominal pain or vaginal bleeding. A physical assessment will also be undertaken.1 Taking blood to measure Human Chorionic Gonadotropin (HCG), which is the hormone the body produces when pregnant, will confirm a positive pregnancy. More than one blood test may be taken over a number of days to see the pattern. In the first trimester of an intra uterine pregnancy (where the embryo has implanted in the womb) HCG usually doubles every 48 hours. The pattern of HCG levels will help with a correct diagnosis.6
A highly accurate tool used is an ultrasound to see were the pregnancy is located.7 A transvaginal ultrasound can detect as early as 5.5 weeks gestation a small sac in an intrauterine pregnancy.3 If the pregnancy has been confirmed and the ultrasound image is showing an empty uterus the pregnancy must be found and an ectopic pregnancy must be ruled out.7 Further investigation around the ovaries and fallopian tubes may show a growth and/or free pelvic fluid may also be seen and this will increase the likelihood of an ectopic pregnancy.6 An ectopic pregnancy cannot be ruled out until the pregnancy has been located. A second ultrasound may be required on another day to rule out an ectopic pregnancy if no pregnancy has been found.7
As mentioned, sometimes a gestational sac cannot be located immediately. In this situation, doctors will watch and wait. They may monitor your blood HCG levels and see if they are falling which would indicate a spontaneous end of pregnancy, insure you are stable and not at risk of internal blood loss, or if there is an absence of a foetal heart beat.8 Sometimes, the ectopic pregnancy may resolve by itself and no intervention is needed. If symptoms persist or get worse, you will need to seek medical assistance straight away.
90% of women who have an ectopic pregnancy will need some intervention.7 The management of an ectopic pregnancy can also be done in different ways. Medical management using a particular drug can be taken to dissolve the pregnancy.5 This way the fallopian tube can be saved but usually only used before 6 weeks gestation. It is an effective course of treatment but has some side effects.1
The surgical management of ectopic pregnancy may be necessary if the medical management is not the best option for the mother. A specialist will conclude which is the best course of action for the mother with the best outcome. A laparotomy or a mini laparotomy is where the surgeon makes an incision along the woman’s bikini line to obtain access to the ectopic pregnancy. This is a much more invasive procedure and recovery time is longer.7
A much less invasive alternative is a laparoscopy is where a tube is inserted into the abdomen via small cuts. The recovery time is much quicker, less blood loss, less analgesics needed, shorter hospital stay and faster recover.6
The pregnancy must be removed and this reality may come with unfamiliar emotions and even grief. A salpingostomy is where the pregnancy is removed without the fallopian tube. This is a less invasive procedure but it can increase the risk of further ectopic pregnancies. A salpingectomy is where the fallopian tube is removed with the pregnancy. Although there is risk of adhesions or internal scarring it may be necessary if a woman has uncontrolled bleeding, recurrent ectopic pregnancy in the same tube or if the tubal gestational sac is greater than 5cm in diameter.7
Around 60% of women will go on to have a viable pregnancy after an ectopic pregnancy. It is imperative that a woman who does conceive after an ectopic pregnancy has an early scan to exclude a recurrent ectopic pregnancy.1 The risk of a recurrent ectopic pregnancy is about 5-20%.6
A woman’s physical treatment and healing process may take some weeks to recover from after an ectopic pregnancy. However, it is important to be aware of the emotional and mental recovery that may take much longer. For health professionals and others who support the woman after an ectopic pregnancy, it is imperative to acknowledge the loss to the woman. The grief process is often complicated; a lot has been lost in such a short time. A couple may have only recently learnt of their pregnancy and now have to come to terms with the loss of it. There may be grief not only associated with the loss of a child but also loss of fertility and the unknown future.5
A follow up visit should be offered to all women who have experienced an ectopic pregnancy, whether they take up the offer or not. A choice of location should also be offered, her relationship with her GP may be better and more conducive to effective communication and recovery than to see an unknown specialist in the hospital where she lost her child, for instance. There are a lot of questions that may not come up whilst a woman is in hospital, but later, once reality has sunk in. Allow a woman to ask those questions in a non-judgmental way, allowing her to ask the questions even if there are no answers.9
Every woman may react very differently to her loss but must always be treated with dignity and respect. Her partner or husband may also be feeling deeply grieved by the loss also. Women who have had an ectopic pregnancy have experienced a loss of a child different from a woman who has miscarried and this distinction and understanding should be used when giving individual and appropriate support.9
Women who have endured a deep loss must be given time to emotionally and physically heal. They need to be supported and assured that it is ok and healthy to grieve. Encouraging them to talk about their grief or suggesting they write their thoughts and feelings down on paper. It is important to be aware that depression, anxiety and Post Traumatic Stress Disorder may not present immediately after the loss, but some weeks or months later.10 Woman and their partners should be given helpline numbers, brochures and web sites to be able to access support and help if she chooses to. Places to contact for support would be SANDS (Stillbirth and Neonatal Death Society) www.sands.org.nz or P.A.T.H.S. (Post Abortion Trauma Healing Service)
Women with an ectopic pregnancy undergo a traumatic experience, with the tests, the unknown, the potential treatment and surgery and further monitoring. They also experience a very real loss of a child. A woman with an ectopic pregnancy should be treated with care, respect and dignity. Her treatment should be carefully considered and fit to her symptoms and condition.
Health professionals and all those supporting the woman and her partner/husband should be aware of the physical as well as the emotional and mental impact this will have on her at the present time and further into the future.
1. National Women’s Health Clinical Guideline/Recommended Best Practise. Ectopic Pregnancy. 2012. Retrieved from, nationalwomenshealth.adhb.govt.nz
2. The New Zealand Pocket Oxford Dictionary. 2nd Edition, 1997
3. Histed, S. N., Deshmukh, M., Masamed, R., Jude, C.M., Mohammad, s., Patel, M.K. Ectopic Pregnancy: A Trainee’s Guide to Making the Right Call. RadioGraphics. 2016;36:2236-2237. Retrieved from, http://pubs.rsna.org/doi/pdf/10.1148/rg.2016160080
4. Capital and Coast District Health Board. Expectant management of an ectopic pregnancy: Patient information. 2015. Retrieved from https://www.healthpoint.co.nz/public/obstetric-and-gynaecology/capital-coast-dhb-womens-health-gynaecology/ectopic-pregnancy/
5. Hinton, C. What is an ectopic pregnancy?. 2002. Retrieved from http://www.silentgrief.com/articles/index.cgi?view_records=1&Category=Miscarriage&ID=55
6 Sivalingam, V.N., Duncan, W.C., Kirk, E., Shephard, L.A., Horne, A. W. Diagnosis and management of ectopic pregnancy. Journal of Family Planning and Reproductive Health Care. 2011;37:231-240. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3213855/
7 Murray, H., Baakdah, H., Bardell, T., Tulandi, T. Diagnosis and treatment of ectopic pregnancy. Canadian Medical Association Journal. 2005;173:905-912. Retrieved from, http://www.cmaj.ca/content/173/8/905.full
8 Canterbury District Health Board. Ectopic pregnancy: Health info Canterbury/Waitaha. 2014;59482:1-2
9 National Collaborating Centre for Women’s and Children’s Health. Ectopic pregnancy and miscarriage: Diagnosis and initial management in early pregnancy of ectopic pregnancy and miscarriage. 2012. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK132775/pdf/Bookshelf_NBK132775.pdf
10 Farren, J., Jalmbrant, M., Ameye, L., Joash, K., Mitchell-Jones, N., Tapp, S., Timmerman, D., Bourne, T. Post-traumatic stress, anxiety and depression following miscarriage or ectopic pregnancy: a prospective cohort study. British Medical Journal. 2016;6:eO11864. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5129128/
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