After the abortion

by Anne Neville
R.N., R.M., Dip. Past. Psych., Dip. Marriage & Family Therapy,Cert. Interpersonal Relationship Therapy,  Accredited Grief & Loss Counsellor National Association of Loss & Grief (Vic) Clinical Member CAPAV. PACFA Reg: 21127

“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
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Coping mechanisms after abortion
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Post abortion symptoms
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High risk factors for post abortion trauma
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Anniversary grief
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Men and abortion
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Replacing the loss
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Factors underlying crisis pregnancy
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Recommendations
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Case examples
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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.

“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 crisis: A Decision

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.

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 partof 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,

“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:

“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:

  • Because of the belief that their “choice” negates the right to seek comfort in their distress
  • Not knowing where to seek help
  • Fear of being judged which usually co-exists with a feeling of self-condemnation and guilt.

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.

Common post abortion symptoms

  • Depression and sense of loss
  • Feelings of guilt and remorse
  • Emotional numbness and withdrawal
  • Loss of self-esteem
  • Generalised sadness
  • Extreme or chronic rage
  • Anxiety attacks, feelings of panic
  • Persistent fears, fear of a nervous breakdown
  • Inappropriate emotional responses
  • Frequent bouts of weeping (often unexplained)
  • Memory loss
  • Sleep disorders, nightmares
  • Flashbacks
  • Negative and jealous feelings (towards others with children)
  • Feelings of victimisation
  • Repeated unusual thoughts
  • Relationship problems (partner, children – current, future)
  • Intense interest in babies/avoidance of babies and children
  • Preoccupation with becoming pregnant again (the atonement child)
  • Personality changes
  • Self-destructive behaviour – alcohol, drugs, eating disorders, self-mutilation and suicide.

High risk factors

Those who are more likely to be “at risk” for post abortion difficulties are women who:

  • Have already had children – difficult to deny the reality of what it is they are terminating
  • Have inadequate social support – perceive that they have no option but to terminate the pregnancy
  • Feel forced by emotional, physical, financial or social circumstances
  • Make a decision with inadequate information
  • Have a history of previous abortions
  • Adolescents
  • Are emotionally fragile or immature
  • Have a history of sexual abuse or assault
  • Have a history of psychiatric illness
  • Have a diagnosed foetal abnormality (Raphael, 1972; Reardon, 1987; Ney, 1997)

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.

Complicated grief

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.

Triggers and anniversaries

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.

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.

Men and abortion

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.

The atonement / replacement child

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.

“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.

“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.

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.”

References

Lamb, DH (1988) Loss and grief: Psychotherapy strategies and interventions. Psychotherapy, 25, No.4. 1988.
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Ney, P (1997) Deeply Damaged. An Explanation For The Profound Problems Arising From Infant Abortion And Child Abuse. Pioneer Publishing Co., Ltd. 1997

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Raphael, B (1972) Psychological aspects of induced abortion. Mental Health in Australia. 5, (1) 1972.

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Reardon, D. (1987) Aborted Women Silent No More. Crossways Books. Westchester, Illinois. 1987.

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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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