Monday, July 23, 2007

Guest post by Skylanda: A long story leading to a rat's ass

If you visit eBay on any given day, you can pay a couple grand and buy yourselves an ultrasound machine, the kind they use in hospitals to look at gallbladders and heart function and little babies in their respective uteri. Someone teaches you the basics of looking at a fetus through the snowfield of an ultrasound screen and you find out that wow, it's not that hard. After all, Tom Cruise could do it, so can you. And if you're slightly more web savvy that me, you can get yourself a website where you advertise your services. Pay rent at some storefront, set yourself up in business. List your name in the phone book. Maybe take out a slightly larger ad next to the one-liner, with a stylized icon of a woman and a heart. Something like that.

Unbiased pregnancy information, you can tout. You provide counseling and options. You give yourself a nice neutral name. You keep your affiliations and your agenda on the back page and the back burner. You're not an activist organization per se, you're just out there to lend a hand to pregnant women. You don't say you're a medical provider, but you don't say you're not. You just say: if you're pregnant, come to us, we can help.

So women open up the phone book, or type "pregnancy care + Any City, USA" in a browser and they find you. They can make an appointment...but you're real convenient too, you don't even require appointments and you can see women the very same day for a pregnancy test and an initial visit. Your place looks like a doctor's office, and wow, you even have an ultrasound machine. You slap that probe on a woman's belly, and see that fluttery little disc that means that baby's heart is beating. So early! You can see that already, even just a few weeks along? Wow! You smile at the woman and coo over the darling little baby in her belly, which to her still looks like a field of snow on a TV screen without an antenna, but even she can see that little fluttery beat.

She's not so sure she wants to see all that though; she's not sure she wants to be pregnant at all. In fact, maybe she's terrified of being pregnant. Maybe she's not eighteen yet, wants to graduate from high school first. Maybe her boyfriend is beating the hell out of her and her mom would never take her back home with a baby. Maybe she doesn't have a boyfriend, just had too much to drink at a party one night, never had sex before that night at all, has no memory of what happened, just knows she should have had a period by now. Maybe she's thirty and thought her birth control pills were enough to keep her from having a fourth because she and her husband are happy with three and really don't want and can't afford another, not right now, probably not ever. Maybe she even wants the baby and just found you by accident. But that's not important. Because your job is to make sure that she sees the little flutter and understands that this is not a field of snow on an ultrasound screen she is looking at, this is her baby. Her flesh, her child. A beating heart. A beating heart that will stop dead if she aborts the pregnancy.

You are, of course, a crisis pregnancy center, a pro-life outfit. Years ago you realized that plastering your rhetoric on your forehead did no good, so you've co-opted the rhetoric of the pro-choice crowd, and you use words like "unbiased" and "supportive" in your mission statement. You bury your affiliations three pages deep into your website where only the nosiest will think to look, under sub-headings like "Requirements for Volunteers." You don't mention one little fact:

That you are not a medical provider.

And this is the crux of the issue. Because we all know about the emotional manipulation - this is not news. We all know about the guilt trips and the pictures of aborted fetuses. Most of us on the pro-choice side have probably even heard stories about the false pregnancies tests - telling pregnant girls and women that they are not so that they do not seek care until it is too late to abort, and telling non-pregnant girls and women that they are so that they can be brought into the fold whereas there would be no reason for them to return to the clinic otherwise.

But there's more. All is not inevitably well when you stick a probe onto a pregnant belly. Sometimes there is major malformation - a missing limb, a missing skull. Sometimes there is not baby but tumor - tumor that secretes hormones that will make pregnancy tests turn positive. Sometimes there is baby but no heartbeat, an intrauterine fetal demise. Some of these things are very obvious to even a loosely trained ultrasound reader; some of them are not. What draws all of these scenarios frighteningly together is that by tacitly passing themselves off as medical providers without ever saying so or explicitly disclosing that they are not so, crisis pregnancy centers pose a double danger: providing comfort that a pregnancy is normal when it is not (by making women think they have undergone a standard dating and diagnostic ultrasound) on one hand; and on the other hand raising unnecessary fear and worry when a seemingly abnormal finding arises that is no more than the result of an untrained and inexpert hand at the helm of the machine. (This, incidentally, is the same criticism that has been leveled against mall-front ultrasound baby pic outlets - though to be fair, those places usually declaim their lack of diagnostic prowess up front; in the case of crisis pregnancy centers, it would belie the deception for them to freely advertise their total lack of medical training.)

Other times, women will come to you because they know that something is wrong. Bleeding, a cramping hurt that won't go away, a fever or vomiting that won't quit. They might pick you out of the phone book or off the internet because they have something that seems urgent, and these are likely to be the most vulnerable - the young, the uninsured, the scared - because they're the ones who don't have formal resources or the means to access them. They think you're a doctor because, really, who else would advertise pregnancy care? But you, you're not trained to know what a septic abortion looks like. You don't have a blood pressure cuff in the office because you're not a medical provider, so you won't see the frightening highs of pre-eclampsia or the ominous lows of a bleeding-out tubal pregnancy. You've never seen an eclamptic seizure - they're rare but not unheard of in first-world nations these days - and you don't have a stock of IV meds (or IVs) in a back closet to stop them if they occur, nor would you know one if it happened in front of you. No lab is on sight to check serial hematocrits, and you don't know the rule-of-thumb cutoff for how much blood is ok to pass during a miscarriage and how much needs to send a woman packing to the emergency room in a hurry. Because you aren't trained to know these things and you aren't required to be. You don't do the routine urinalyses that every prenatal provider performs to detect asympotmatic bacteria in the urine because it's been shown that this can lead to higher rates of first trimester pregnancy loss. Because you aren't a medical provider. You just conveniently forgot to advertise that. You just have the office, the equipment, the receptionist, the fancy name, the business cards, the works. All your missing is the training, the competence, the actual medicine.

There's a phrase for this. Some people like to call it "practicing medicine without a license." I have a different word for it. I like to call it "fraud." Because crisis pregnancy centers are not regulated by any practicing board, you do not have to have a physician present or even employed there. You don't have to disclose that fact to your clientele. You just get yourself one of those fancy machines and go to it. You just hope that you don't have ever have to answer hard questions, because that's the kind of people you are: starry-eyed, pragmatic in your one goal of stopping abortions. Nothing else matters.

I know, third-hand, of a young woman, some time ago (almost a year now), in another city far from my own. She was happily pregnant and luckily insured, but a little broke as twenty-somethings often are. Knew she needed prenatal care but wasn't sure how to get to an obstetrician covered by her insurer any time soon. She opened the phone book. She saw an ad, she called a number. They saw her that day. Her pregnancy test was predictably positive, she was roundly congratulated. An easy catch - she wanted the baby, too far along to abort anyhow. It was near the end of the office day and their usual ultrasound tech (and I use that term loosely, because US techs are highly trained technicians, and I do not vouch for that particular person's skills and certification) was already home, so another staff member agreed to a quick scan. She put the probe onto the swelling belly. She looked for a heartbeat. She looked some more. She scanned for some time and found nothing. She put away the machine and told the young woman to go to the emergency room, post-haste.

The story is open-ended. I never found out if her scare was real - and that this clinic just dumped her into the several-hour queue at the crowded ER with a dead baby in her belly and tears streaming down her face - or if it was merely a case of epically untrained reading on the part of the clinic staff, causing untold quantities of temporary (but happily resolved) heartbreak.

What I do know is that this behavior defies every tenet of professionalism ever committed to the human canon of such things. And that if it is not criminal in its encroachment on medical practice without training or licensure, it damn well should be. But most of all, it points yet again to what we all know about the pro-life drive: babies first. Women last. Babies first at the expense of women. Babies first even if it means lying to women. Babies first even if it means interfering with the sane and safe medical evaluation and treatment of pregnancies both normal and hazardous.

Babies first.


Who gives a rat's ass about them.

Kind of sums up the whole movement in one neat little package.

Cross-posted at my home blog, Loose Chicks Sink Ships.