When Rachel heard that RU-486 had been approved, she dropped the laundry basket and ran downstairs to turn on the TV. As the newscaster announced the "breakthrough," Rachel was thinking: "If I hadn't taken it, right now I'd have a newborn in the house; which room would he or she sleep in?"
Those broadcasts Rachel saw last month described the Food and Drug Administration's approval of the new abortion method as the greatest leap for women's health since the birth control pill. Its very nickname--"the abortion pill"--implies convenience and ease, liberation from the hassles and stigma of surgical abortions.
But as Rachel and other women who've taken the pill can vouch, there's little that's easy about RU-486. American women who've used the drug describe as it as less convenient and more messy, and sometimes more painful, than surgical abortion, according to doctors who have conducted trials on 9,000 women so far.
Yet many chose it not despite those obstacles, but because of them. The pain factor made it seem more "natural," doctors report their patients as saying. Taking the pill at home gave them a greater sense of control. And some even said the control and suffering served as a way to confront their own moral dilemmas--a personal version of what they might face from abortion protesters.
"When I'm doing the initial counseling and a woman says she really wants it over with quickly or or she has a very busy schedule, she will generally not end up using [RU-486]," said Kathy Rogers, a researcher at Johns Hopkins University in Baltimore, one of 18 sites for the latest clinical trials. "Because it's not just a pill; it's a process. And it's not going to be easy or fast or simple."
In demographic terms Rachel--who agreed to be interviewed if her name were not disclosed--is not the prototype RU-486 user. She is six years older than the average age of 28, and is married, with two children. But judging from interviews and published studies, her reactions are quite typical.
She absorbed her nurse's warning that taking the pill would be "more painful, with all the bleeding and cramping." Still, she chose it because "it gave me a sense of control. Because it's something that I choose to do, rather than something that's done to me."
By that she means common medical concerns about invasive surgery, and the physical trauma to the body. But she also means something more personal, more emotional--a feeling the pill's advocates don't like to talk about but which nonetheless seems common to the women who have chosen the new method.
It served for her as a form of penance, a way of grappling with her ambivalence over any kind of abortion.
"It was like, if I'm going to do this I have to take the responsibility and do it myself, and I have to put myself through something hard," she said. "It would have been cowardly to have someone fix it for me in some easy, safe way. It would not have felt right.
"You know, I still think about it almost every day," she continued. "I will always wonder what this baby would have been like. I still don't think I did the wrong thing, but I wish the whole thing had never come up."
It is these private twinges of conscience that anti-abortion protesters say they will depend on to keep the stigma of abortion alive.
Doctors don't call it guilt. "That's a red flag for us, if a woman is overwhelmed by guilt," Rogers said. But they often hear some form of Rachel's personal calculation.
"The logic is, even if takes longer, even if it hurts more, there's a sense of doing it yourself, rather than being done unto," said Carolyn Westhof, who conducted the trials at the Columbia Medical School in New York. "Often it's not really a medical decision, but a psychological one."
"More natural," "greater control" and "more privacy" are the reasons that came up most often in the largest of the clinical trials conducted over the last six years by Eric Schaff at the University of Rochester. By privacy, women meant the comfort of choosing their own locations, their own support groups. But they also meant avoiding the guilt-inducing protesters at abortion clinics, said Schaff, who is Rachel's doctor.
"Privacy is so important to these women," said Schaff. "They feel going to [a clinic] will make them an easy target for the anti-abortion protesters. And they don't want to have to walk that gantlet."
Yet much about Rachel's experience suggests that RU-486 may not change the abortion climate in America quite as much as expected. Not at the political level, between abortion advocates and opponents, and especially not at the personal level, where a woman confronts her doctor, her neighbors, her family and her conscience.
When Rachel found out she was pregnant just before New Year's Day 2000, she pretty quickly, although not at all painlessly, decided she could not have the child.
"When I discovered it I thought, 'Oh my God I can't do this,' " she recalled. "My second child turned out much more demanding; I scream at her almost every day. And I thought, what's the next step? I'll start hitting somebody. I was really concerned I might become an abusive mother."
She stayed up until 3 a.m. talking it over with her husband, and by the end of the second day they'd made up their minds.
The next morning she immediately called her obstetrician, who had seen her through two pregnancies. This is the stage that must go smoothly if RU-486 is to be a real breakthrough. Physicians who currently do not perform surgical abortions must be at least somewhat comfortable with the concept of ending a pregnancy for RU-486 to accomplish what its advocates hope: changing abortion from a stigmatized procedure to a routine part of medical care carried out by a doctor a woman knows and trusts.
But here Rachel encountered only frustration. "I made it clear I wanted to talk to someone about terminating the pregnancy," she recalled. "Maybe I was being oversensitive, but the voice at the other end just went cold. They were not helpful at all, and I was almost in tears when I got off the phone. . . . I would never call them again."
Rachel looked up Planned Parenthood in the phone book. She called, and the counselor on the phone "let me cry and let me talk. It was like talking to an old girlfriend." Once she determined that Rachel was in the first weeks of pregnancy, the counselor led her to a local clinic that was conducting trials on RU-486.
She made an appointment for the first day she could, the Tuesday after New Year's. There, another counselor ran through the two options, surgical and medical, explaining how each works. Rachel sat silent for a few minutes, weighing her options.
She first sifted through her emotional state. "Finding out I was pregnant and not wanting it made me feel I was losing control of my life. All New Year's I kept thinking of the same sentence: 'Stop the train, I want to get off.' "
RU-486 seemed the way to "regain that control," she said. "I thought about the differences; about going into a room in a paper gown and having someone do something to me with instruments. Ugh. As opposed to keeping my clothes on and taking the pill myself. Me doing it, to myself."
Then she began to think about natural cycles of recovery--physical, psychological and spiritual. After her first child was born by caesarean section, "it took forever to recover." The abruptness of the surgery shocked her body.
From the counselor's descriptions, Rachel concluded RU-486 "was just like having a miscarriage. It might be painful, I might bleed," she thought, "but it will be more natural; my body will be doing it to itself."
And then her final thought before she gave her answer: "I thought the least I could do was suffer a little."
She took the first of two pills in the doctor's office that day and "felt a huge weight lifted off my shoulders. I could literally feel it. It was the first time I understood what that phrase meant."
But no moment since has been quite so weightless. If abortion opponents worry that RU-486 will take the stigma out of abortion, Rachel's experience shows they have little to fear.
She still hasn't told anyone except her husband about what she did. Not her best friends, not her two children, certainly not her mother who, like Rachel herself, "would spend the rest of her life wondering what this child would have been like."
Her heart still jumps every time she passes the house next door, the house of a man "who is very religious and I don't want to think about what he would do if he knew I'd had what I'm sure he considers just plain old abortion."
She considered going public until she scanned the Internet the day the news broke and read the reactions of abortion opponents: "They talk like we make this decision so cavalierly. Yeah, right. Like they need to make us feel guilt. Like there isn't plenty of that already."
And she still remembers most vividly the last moment of the whole ordeal; when she woke up for the millionth time and went to the bathroom the morning after taking the second pill, feeling crampy and achy. She looked down and saw the bit of pink tissue.
She looked at it for a long time because it was bigger than she expected. She stared for what seemed like an hour--frozen, tired.
"It seemed rude to flush it," she thought to herself. "I should be having a burial or something."
But then she heard her daughter awaken and thought: "Well, you have to get on with your day."