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After the
abortion
by Anne Neville
R.N., R.M., Dip. Past. Psych., Dip. Marriage & Family Therapy, C.P.C.,
Accredited N.A.L.A.G. Counsellor. M.A.S.T.S.S., A.M.C.C.A.
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“It is not unusual
for the woman to find herself restless, agitated and grieving
around the anniversary date of the abortion, and also around
what would have been the baby’s birthday.” |
Impact of
crisis pregnancy on decision-making ability
Coping
mechanisms after abortion
Post abortion
symptoms
High risk
factors for post abortion trauma
Anniversary
grief
Men and
abortion
Replacing the
loss
Factors
underlying crisis pregnancy
Recommendations
Case examples
There are many opinions as to the impact that an abortion decision may
have. An abortion is often seen as the logical answer to an unplanned
pregnancy and the only option; the outcome is aimed at turning back
time. It is a decision that is influenced by any number of pressures and
unfortunate circumstances. It is rarely an easy decision.
The effects of an abortion are debated, questioned, denied or even
trivialized. So much is hidden and secret. It is not a topic that is
freely discussed by those who have abortions in spite of it being so
freely available. This may be for a variety of reasons - wanting to put
it in the past and move on, not believing people will understand,
religious reasons, feeling a sense of shame or perhaps because it stirs
memories of a time when one’s life felt out of control. There can be
many unpleasant associations with an abortion experience.
There are many for whom the impact of the procedure is minimal and who
seem to be relatively untouched by the experience. There are those who,
because they don’t have an outlet for their grief, suppress it and try
and get on with their lives but suffer nonetheless. Then there are
others whose lives are profoundly affected.
Abortion is a subject that can engender emotion in the extreme from both
the personal and public perspectives.
In order to understand what it can be like for someone who has had an
abortion, I would like to share with you a little of one woman’s
experience. These words are taken from a personal testimony written by
“Catherine” (not her real name) who wrote her story as part of her
coming to terms with an abortion decision. Her thoughts, feelings and
reactions are common to many women who have made an abortion decision
and are left to struggle with their pain.
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“I had an abortion because I couldn’t imagine how I would
have managed if I continued with the pregnancy. I didn’t
want an abortion, but I didn’t want a baby in my
circumstances. It seemed less hard to have an abortion than
face months and years of hurdles known and unknown.
Retrospectively none of the problems seem insurmountable,
but at the time in my confused and emotional state, I was
unable to see a way through them. I just wanted to get some
certainties back in my life. I know the alternatives to
abortion would have been hard too. It’s too late for easy
options when you are already pregnant, but I wish I had been
supported to feel I had real choices. I think I would have
seriously considered adoption if someone could have offered
a safe haven to hide away in for 9 months.
I was struggling on a day-to-day basis and I just wanted all
the confusion to stop. Sadly, I decided that an abortion
would remove all the problems, both real and imagined. Then
I could get back to being me - the pre-pregnant me, not
realising that I could never be that person again.
Imagine yourself on an out-of-control roller coaster. You
are going up and down and feeling sick and scared. There is
a dark tunnel up ahead but you can’t see how long the tunnel
lasts or what is at the other end. Just before the tunnel is
a station marked “ABORTION”. What do you do? Do you take
your chances through the tunnel? Or do you jump off at the
station?
I jumped.
In the first few days and weeks after the abortion I had
extremes of feelings that sometimes appeared to be
contradictory. The anticipated sense of relief that I was no
longer pregnant and the hope that things could now return to
normal never happened for me. Instead I felt terribly empty
inside and had quite a sense of horror at what I had done. I
couldn’t quite believe it. It didn’t seem real.
Even though I felt empty, I was fantasising that I was still
pregnant. My breasts were returning to their familiar feel
and size ... I continued to hope that somehow I was still
pregnant. I remember thinking that if my baby really wanted
to live, really wanted me as its mother, then it could have
escaped the suction device and might be still there.
While I was thinking and feeling this some of the time, at
other times I was filled with anguish and despair. In
private I would cry and cry with body racking sobs. I would
cry for the baby ... and myself. I felt like an injured
animal that just wants to curl up and lick its wounds. I
felt I was going mad. I was scared and yet insanity would
almost have been a welcome alternative to the hell I was
living. I found it impossible to look to the future and
envisage feeling better. I started thinking suicide was the
only way to stop this incessant hurt. My depression was all
consuming and everything else seemed trivial. I didn’t feel
able to share my feelings with anyone or confide in anyone
about my distress”. |
Society tends to play down the suggestion that abortion has any profound
and long lasting effects. Research on the emotional and psychological
effects of abortion has been inadequate, to say the least, and, because
of the tendency for women to avoid recontact with the abortion provider
if upset, the myth that abortion does not cause any difficulties has
been perpetuated. It is only more recently that some consideration has
been given to the fact that some aborted women may indeed suffer serious
emotional, psychological or psychiatric disturbances.
A woman faced
with an unplanned pregnancy is in a state of crisis. She often feels
overwhelmed by the unexpected news and struggles to come to a decision
that is influenced by a variety of pressures and constraints. Her
decision-making capacity may be severely compromised and she may be very
susceptible to any pressure to abort. The adolescent is particularly
vulnerable. All too often medical advice and the opinions of parents and
a partner may override a desire by the teenager to continue the
pregnancy.
Alternatively, the woman may feel the only option is to abort if she is
to preserve any semblance of life for herself. News of a pregnancy can
seem like a personal death sentence - the end of her future. Her plans
are thrown into disarray and she can see no future for herself in having
to manage with a baby. She sees only hardship and impossible obstacles.
An abortion decision can become a question of personal survival. The
opinions of others can override her own judgement as can the perceived
obstacles. She may also be pressured to have an abortion by a partner or
other significant people.
So many
girls/women report feeling powerless once they enter an abortion clinic
- as if there can be no turning back. They feel that they can not change
their minds. Put this together with other pressures such as being thrown
out of home (perceived or real) or a partner threatening to leave and
the girl/woman may see herself as totally helpless and having only one
option.
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To quote “Catherine” again - “Everyone else seemed to assume
abortion was the only path to take. No one suggested that I
would manage (or even thrive?) if I had a baby. And
certainly no one expressed confidence that I would manage
without a partner if need be. For whatever reason, this
confidence that was missing in other people’s attitudes
towards me was also lacking in my own feelings about myself.
Abortion seems like such a selfish choice, but a large part
of my decision was altruistic. I thought of the child and
how unfair it would be to bring it into the world knowing
its father wanted it aborted. I thought it would be
resentful because I couldn’t provide finances, a father,
extended family etc. I so wanted the best for this baby of
mine. It didn’t dawn on me that abortion offered no future
to the child - only death. I thought I was doing the best
thing for everybody including the child. The outcome for me
was almost a secondary consideration.” |
These words illustrate the mixed feelings and distorted way of thinking
that is so much a part of the crisis response. The reasons for
“choosing” abortion are many and varied.
The lack of time is often a critical factor of the decision making
process. A number of our clients, particularly the more ambivalent or
indecisive, have found the emphasis on making their decision quickly
very difficult. Medical opinion usually stresses that an abortion is
“best” performed as early as possible - however this leaves little time
for the woman to really explore what a pregnancy means for her, how she
feels both emotionally and spiritually, what supports she may have to
continue the pregnancy or what other options there are.
“Catherine”
said,
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“When my pregnancy was confirmed at the community health
centre, I was given a list of abortionists but no
information about the foetus, operation or after-effects or
alternatives to the abortion. When I went to the clinic on
the appointed day to have the abortion I was given a printed
information sheet by a nurse. There was a lot of information
to absorb yet it was given to me about 5 minutes before the
procedure. I was dressed in a flimsy theatre gown and was
feeling sad, ashamed, nauseated and hungry - not the optimal
physical or emotional state to receive and absorb important
information.” |
So many
women say that they did not realise the stage of development of the
baby. Many believe there is nothing discernably human present. They
do not expect any form of emotional attachment to be in place.
Therefore what they feel does not reconcile with what they believe
they have lost. This makes grieving very difficult.
In many cases attachment to the unborn baby is unavoidable, almost
an automatic response, and, therefore, grief is inevitable (Ney,
1997). At Open Doors we have observed protective behaviours in many
women considering abortion e.g. body language which the client
acknowledges as shielding the baby, eating better, smoking less and
reducing alcohol intake.
Many women worry that they are “going mad” because of the unexpected
feelings they encounter. They feel abnormal because what they feel
is not in line with what they have been told or what they had
expected. Others report being told “You may feel a bit teary for a
day or two but you’ll soon get back to normal.” For the woman whose
teariness persists or who perhaps finds herself becoming more
depressed, a profound sense of confusion can result.
“Catherine” said:
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“I had no idea that having an abortion could lead to major
depression and suicide ideation. No words could have
imparted to me the misery and torment that is depression.
But, had somebody tried, then at least when that did happen
to me I wouldn’t have felt abnormal”. |
This
confusion can isolate women, and indeed may make it difficult to
access the help they may need.
Other reasons given for not seeking help are:
The major
coping mechanisms of post abortion grief are denial and suppression.
An abortion may be followed by years of unrecognised negative
symptoms, which the woman does not consciously associate with the
abortion. The onset of delayed symptoms is often precipitated by a
triggering event, such as the birth or loss of another child or some
other event associated with children or reproduction, anniversary
dates, the death of a loved one or the deterioration or break-up of
a relationship.
Post abortion symptoms tend to be accumulative and longer ranging
and are often not identified and reported to health professionals
until well after the procedure. Therefore symptoms are often not
connected with an abortion but may be attributed to some other event
or illness.
Those who are more likely to be “at risk” for post abortion difficulties
are women who:
That is not
to say that all women who have post abortion difficulties fall within
these categories. Women who have, up to this point, lived relatively
normal lives can find themselves struggling with emotional problems
after a termination.
The loss of a child in pregnancy results in a grief
response like any other significant loss. The woman, who expects that
she will be fine, who is unaware that she may encounter some of these
symptoms or is told that she may only feel teary for a day or two, may
try and deny her grief. She may push her feelings aside and attempt to
resume her earlier lifestyle. Often this is not possible as she
struggles to deal with and overcome a whole range of thoughts, feelings
and symptoms.
When the grief response is stifled in some way, complicated grief
usually results. For many the effects are profound and far-reaching.
Many women report carrying a persistent pervasive sadness with them that
undermines their ability to invest fully in life and restricts them
profoundly in their relationships.
A prolongation of grief is likely to occur in situations where there was
minimal support at the time of the loss, and particularly when the loss
is socially unspeakable or unacceptable to others (Lamb, 1988).
I have worked with women who had their abortions many, many years ago
and who, when encouraged to speak of their sadness and grief, pour out
their pain as if the loss happened yesterday. So many have said that
they thought they were not entitled to grieve because, after all, they
had “chosen” abortion. One woman recently told me that she could not
believe that anyone would actually encourage her to talk about her
experience and support her in her grief. She found it difficult to be
accepting of herself and so had concluded that no one else would.
There may be certain situations, events and times that
may touch off this grief. Many women find it difficult to face a newborn
baby, can’t bear to hear that someone else is pregnant or even walk
through a baby wear department.
Anniversary dates are very significant. It is not unusual for the woman
to find herself restless, agitated and grieving around the date of the
abortion and also around what would have been the baby’s birthday.
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As “Catherine” says: “I was overcome with fresh waves of
grief on the day that would have been the baby’s first
birthday - had I not aborted it. It was a very emotional day
for me and I had the need to mark it with a symbolic
gesture. I went to a cemetery, which seemed appropriate for
remembering the dead. I spent about 3 hours wandering among
the graves and crying. I talked to my baby and apologised
for what I had done. I spoke to some of the other graves and
asked their spirits to look after my baby. The headstones
with photos were good for this. I could look at a kindly
face and imagine them with my child.” |
There may be a tendency to dream about the events
associated with the decision, the abortion itself and babies. Many women
do not always tie in their discomfort with the abortion or, if they do,
they try and ignore their feelings and struggle on as best they can.
Many of our clients at Open Doors find it a great relief to be able to
explore the power of these reactions and find a freedom in having their
grief and fears acknowledged and explained and their responses
normalised.
The effect of abortion on men is something that is often not considered.
However, they too are often profoundly affected. Many men suffer deeply
from the effects of a decision that they are often given no opportunity
to participate in - after all it is up to the woman whether or not the
pregnancy is to continue. No man can insist that his partner continue a
pregnancy even if he is willing to raise the child himself or have the
child adopted out. Men often experience an enormous degree of
helplessness in this situation - after all men have traditionally been
the caretakers, the protectors of their partners and children. Where a
man believes that abortion is wrong it is not unusual for him to feel a
profound sense of loss and anger.
Men are so often left with their grief trapped inside them because of
social conditioning which urges them to be strong. From an early age men
have been encouraged to hold their feelings in. When a man experiences
emotional distress he may automatically deny his pain and isolate
himself. This may indicate to others that he is coping well, is strong
or, in many instances, may signal to his partner that he is unaffected
by the loss.
For some men it is very difficult to express sadness openly and permit
themselves a period of mourning. Many men will throw themselves into
their work as a means of avoiding the pain and frustration which may lie
unresolved for many years. Relationship difficulties may arise
particularly where differences in grieving styles exist between a
couple. One may perceive the other to be unsympathetic or unaffected by
a loss when this may not be the case at all.
Men may experience a sense of inadequacy and guilt seeing their
partner’s distress and not being able to find some rational way to
alleviate this. This is a particular issue if he has exerted any
pressure on the woman to terminate the pregnancy and she is now grieving
unexpectedly. He may feel a great sense of responsibility not only for
the loss of his child but also for the distress of his partner.
Some women
will actively seek to become pregnant again soon after an abortion. It
is not unusual that others will “find themselves pregnant” again within
six months of the abortion. Many recognise this as an unconscious
attempt to “undo” the abortion and replace the lost child. Quite often
the second pregnancy is maintained.
One of the difficulties with this is that the mother has not resolved
her attachment to the aborted baby in order to be able to invest in a
relationship with a subsequent one. So often relationships with other
children are affected - the mother is not as emotionally available to
them or she may become overly protective. The cycle of grief is
perpetuated and siblings are affected.
It is not uncommon to find that a woman who has had an abortion
conceives around the due date of her baby or the anniversary date of the
abortion. The unconscious desire to replace the baby who was lost can be
very strong.
If a woman
who has had an abortion experiences a miscarriage in a subsequent
pregnancy she often interprets it as a punishment. Even women who have
seemingly not been affected by their abortion decision have raised this
question in the context of seeking counselling for a miscarriage.
Following an abortion experience, individuals sometimes give up hope.
Life can seem empty and meaningless - hopeless. The baby is gone;
nothing can bring the baby back. Relationships that the abortion was
meant to preserve have been broken, many beyond repair. The woman may
feel worthless, discouraged, ashamed and hurting. She may believe that
because she has participated in an abortion decision, or because she did
not resist pressure to abort, she is doomed to a lifetime of painful
memories. This may be so for some as they try to come to terms with
their decision.
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“Catherine” said, “even the happiest events of my life are
now shadowed by a secret sadness”. |
The loss of a child through abortion is an event that for many produces
grief - usually a secret grief. By having the impact of abortion
acknowledged and working through all that is associated with it, the
abortion can be grieved. It is important to educate those affected by
abortion about its effects in order to normalise the thoughts, feelings
and reactions. Subsequently, to be able to acknowledge the child, attach
to him/her, personalise the child by giving him/her a name and mourn as
is fitting, is to be able to place the abortion within the context of
their whole of life experience.
After initially not being clear about the gender of her baby,
“Catherine” later gained the impression that her baby was a girl. She
speaks of an experience one day sitting on a bench thinking and having a
cry.
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“It was then I saw a little girl skipping through the
grass”. |
Acknowledging the child’s sex took her attachment in her mourning to a
more personal level. It allowed for a relationship with her baby to
continue - important if grief is to have a healthy expression. It gives
a more tangible focus to the grieving.
Just because a life ends the relationship does not. If we think about
this in terms of a known loved one dying we know how we use our memories
both to grieve and to comfort us.
An abortion can never be totally eradicated from a woman’s memory but
its pain may be made less acute, allowing her to renegotiate life.
Self-forgiveness plays a great part in coming to terms with a decision
that may have been made within the context of many difficulties.
“Catherine” has found several practical ways of creating a legacy for
her child. One has been to provide a gift for a needy child under a
community Christmas tree each year and the other was to sponsor a little
girl in Africa. She also believes her sense of “compassion” has been
developed and also her awareness of the importance of communication.
There probably are a number of women like “Catherine” struggling with
their grief after an abortion. If her story can help others she may
consider her experience has yet another more positive outcome.
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Catherine's Story -
Click to read the article
A journey through abortion
“So I hurtled towards abortion with my mind and body in turmoil,
hoping that when it was all over I would wake up and discover
that the whole thing had just been a bad dream.” |
Lamb, DH (1988) Loss and grief: Psychotherapy strategies and
interventions. Psychotherapy, 25, No.4. 1988.
Ney, P (1997)
Deeply Damaged. An Explanation For The Profound Problems Arising From
Infant Abortion And Child Abuse. Pioneer Publishing Co., Ltd. 1997
Raphael, B
(1972) Psychological aspects of induced abortion. Mental Health
in Australia. 5, (1) 1972.
Reardon, D.
(1987) Aborted Women Silent No More. Crossways Books.
Westchester, Illinois. 1987.
Scully, E.
Jean (1985). Men and Grieving. Psychotherapy and the Grieving
Patient. Ed. E.Mark Stein, Harrington Park Press Inc., N.Y. 1985.
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