I’m in Denver this weekend for work, which is loopy. Denver is a strange place! It’s very bright here. They are very into having mountains and being rural, every piece of public architecture draws attention to the mountains, lest you forget they are *right there, out your window,* but the coffee is still $6 and there’s local charcuterie plates and I shit you not, weed sommeliers for them. It’s Los Angeles, without the actors. Sort of.
In later abortion news, Dr. LeRoy Carhart passed earlier this week. He was a complicated man and a giant in later abortion care (not always in a good way). The Washington Post published a wildly bad obituary of him, which you can read my thoughts on here.
Today I’m bringing you an interview with Kate Carson. Kate is a Massachusetts-based love, sex, and relationship coach specializing in pregnancy and infant loss (called “babyloss” within the community). She is also a grief worker, peer support counselor, and a longtime moderator of the Facebook community, Ending a Wanted Pregnancy. (I have also been a member of the group since 2018).
EWP is one of the oldest, largest, and best known support groups for “TMFR,” an abbreviation for “termination for medical reasons.” (For example, an abortion because you have HELLP syndrome at 19 weeks=TMFR. An abortion for reasons including poverty, rape, or domestic violence=not TMFR.) Usually, though not always, TMFR patients have ended a wanted pregnancy.
Kate is also active on r/abortion and r/tmfr_support, two Reddit communities that support abortion patients while providing evidence-based guidance on care through OARS (Carson is not affiliated with OARS).
In 2013, Kate had an abortion at 36 weeks. Below, I interview her about her journey through loss to advocacy and peer support, grief taboos in American culture, the complicated politics of support spaces, and reclaiming sexuality after loss.
Kate and I don’t always agree, as you will see below, but her practical experience with thousands of patients’ fertility journeys for the months and years after their abortions makes her insights on abortion grief unparalleled in the pro-choice community.
As always, if you are enjoying the newsletter please subscribe and consider becoming a paid supporter if you are able! I’d love to do more traveling for profiles of providers and clinics doing exciting work in this time of crisis, but hotels and airfare ain’t cheap.
MINISTRY
You practice kindness and generosity and love until the point where you can give it to yourself.
Tara: I have no interest in talking about your abortion today.
Kate: I love that.
Tara: So you came home from your abortion eleven years ago in June, but can you walk me through how you got involved with Ending A Wanted Pregnancy, after you came home? How did that happen?
Kate: I don't think I joined until two months out. I knew it existed because I found it when E., my eldest daughter, screened high risk for Down Syndrome. I had found it during that moment of freak out, but I didn't get in because a screening result does not get you in the door [of the group]. I knew it existed, but I was, like, not ready for a support group until about two months out. And I was in such a low place, two months out than I was right when the crisis had ended. I was really desperate, and I reached out for help. It [the group] was called A Heartbreaking Choice at that point.
And I used it a lot. I'm an internet forum person--I was raised in internet forums, which is embarrassing. But it was a very comforting space. I find a lot of value in my own healing in helping other people. What I find [about loss] is that like sometimes when we're not able to be kind to ourselves, we are able to be kind to people who are directly adjacent to us. And so that to me is the power of support. You practice kindness and generosity and love until the point where you can give it to yourself.
Tara: So were you working full time at this point? Was your oldest in school?
Kate: She was in three days a week of daycare. I was right out of grad school and took a few months off [after the abortion].
Tara: A lot of days where you were alone in your house and spending a lot of time on this forum.
Kate: I would read all the posts. Every single one. I would always read and respond. And it was better for me than therapy. For some people, that’s not the case. But I had this deep feeling of I’m the only one, I’m the only one, and of course I was not only one. But it’s hard to find each other.
Tara: When you’ve talked about this early period [in group] it sound like you had some serious depression.
Kate: You know what's funny? The word depression doesn't quite fit but it was very low. I can't quite describe why I think depression doesn't fit because like I knew exactly why I was low, right? My life was terrible. I felt really bad for a long time. It was almost intolerable at eight weeks right after the loss. How do I even get out of bed? Why is my heart still beating? Why is my body still breathing? Why won't I just die? It feels that strong when you're in it. It wasn't until I got to three years [after the abortion] where I didn't feel like I had an extra layer of processing my baby died, my baby died, over everything.
Tara: And you continued to spend a lot of time on the forums during that period? When did you take on more of a leadership role?
Kate: Yeah, I did. Within my first year I was an admin. I was a moderator first, within a few months. To be a moderator you have to be invited. So hand-picked me and said, ‘we like the way you talk to people, would you like to do this’? And I did want to. Meaning-making is something that appeals to me. One of the major prongs of my activism is peer support because the world doesn't make it easy to be an abortion patient, particularly a third trimester abortion patient. It’s not very socially acceptable. It is scary. So, breaking down the taboo part [of abortion] is all about building connection and combating the shame, the cultural shame.
Tara: At the time, did you think of it as grief work? Or support work?
Kate: Grief and support work for sure. Over time it became activism. I felt strongly drawn to action from an early time. But my husband is very private. So I wanted to go talk to the press and he didn't want me to and that was sort of how it [my work as a peer counselor] started. I would try on other things that weren't that [talking to press]. One of the things I was trying on that was really working that I didn't even really define as activism was the support group.
But another thing that I started trying on was going to talk to groups of people that weren't necessarily public. So After Tiller had a showing at Harvard Law School and I texted the organizers and they had me be part of the Q &A at the end. That was my first storytelling activism. Something in me knew that the story was gonna be the thing. But I tried a bunch of things, Tara! I got certified as an abortion doula by the Boston Doula Project in 2015.
Tara: When was that? Did you wind up practicing?
Kate: No—they didn't really get into the hospitals ever during the time I worked for them. But I did a grand rounds [as a storyteller]. So I was talking to obstetricians. They called me once when they had [an abortion] a patient who had no one and I went to the hospital to attend a patient at the doctor's request. I also ended up attending by text a bunch of medical abortions at home.
Tara: So in the few years following your abortion you’re trying on different ways to make meaning out of what happened to you. The word I always think about when I think about the grief work that you do is ministry—it feels like this is your ministry. I’m not sure why. What do you think about that word?
Kate: I love that. That feels right because it feels like purpose driven work. It feels like something bigger than me. Right? And then ministers do show up like that. Being with women after [abortion] ended up being the work. It’s funny because then the other part of my ministry, the storytelling, is more like preaching, right? I do a lot of that as well. The thing that really didn't work for me was politics. I like to be as far away from politics as I can while still making it an impact. I really hate working with politicians.
THE BODY KEEPS THE SCORE
Tara: So can you just sketch out the arc of your support and advocacy work through to the pandemic for me?
Kate: In 2012 I'm a wreck but I'm online in support group getting and giving support and it feels very reciprocal. By 2013, I've like started storytelling and I'm starting how to be an abortion doula and I'm talking at events. Then I went against what my husband wanted me to do and I did my first big public-facing piece, a ghostwritten piece for Yahoo News, in October, 2016. Then I got pregnant again and L. came. When the pandemic hit in 2020, I was working a full time job [teaching math at a private high school]. I was storytelling to the press and I was still doing [support group] admin work.
Then COVID hits and teaching is awful. My kids are having dumpster fire experiences [with Zoom school]. So I quit in June 2020 and homeschooled. I had been eyeing a relationship coaching program for awhile, but I was like, Kate, you don’t have any money!
And I said to myself, you know what, Kate like, you don't have any money right now, but you have time and you will find the money. I signed up with Layla Martin to become certified as a coach.
Tara: Can you speak to how this decision to become a coach was connected to your peer counseling work?
Kate: Totally. We’ve been talking about grief support, but I saw huge holes [in support group] around body, love, sex. Around marriage. These are all places that were major pain points for our [support group] members.
I noticed a huge pattern around dissociation from the body. In other words, “I hate my body but I don't hate it like when I was a teenager and I hated it. It built a broken baby and I want to destroy it because I'm so mad at my body.” Obviously we live in our bodies. So you’ve got to make peace with the body, because if you don't, that's a miserable path for the rest of your life.
Another huge trend I see is, “my marriage is falling apart because my husband and I are grieving differently and it seems like he doesn't even care, like he goes to work and he functions, does he even care that we lost the baby?” And folks say, “I can't get out of bed and he looks at me and he seems so disappointed with me because I'm just sad all the time.” We do see some couples where the genders are not fixed like that. But it is a problem.
There are no examples of realistic, shared grief models in our culture. I cannot think of one one movie where I'm like, oh yeah, this couple lost a child and they are grieving in a realistic way. We [loss parents] all basically all in this fraught, lonely tension in the marriage situation. But then we're judging ourselves because we and our spouse are supposed to grieve together. But let me tell you, grieving together is not a thing.
There are no examples of realistic, shared grief models in our culture.
But we have to learn this for ourselves. So that's the marriage piece. Let me just say though, not all marriages should be saved. Sometimes loss is a stress on a relationship that makes one person act like cruelly to the other and that marriage should not be saved.
As far as sex, that's a very common one. I would say most people have like a long dry spell after [aborting a wanted pregnancy]. But on the other hand, “all I want to do is have sex” also happens. It changes the way people relate to sex because this whole thing happens in our pelvis. It [abortion] happens in the sex organs. You have to have pelvic procedures to lose your baby. And it all happened because you had sex in the first place (unless you're getting IVF). And if you're not getting IVF, it's because the sex didn't work in the first place. So sexuality is really intertwined with this particular loss and grief. And if there are any prior wounds around not being enough as a woman, that often is tied into sexuality as well as the failure of the pregnancy.
Ultimately, I was looking around and seeing all of these pain points around sexuality. I'm quite passionate about healthy sexual education and I used to teach sex ed. So that’s why I chose a sexuality based coaching program.
Tara: So what did you learn about how to talk to loss parents about sex and how to get them back into their bodies again?
Kate: Not all of my clients have sexually oriented desires, but a lot of them do. Let’s say a client has a sexually oriented desire. It might be , we haven't had sex in a really long time and now I'm afraid to. It’s been a long time to the point where it's scary and intimidating and I don't know how to get out of the habit I'm in. So then I say, ok, well, why do you want to have sex? What else will you have when you have sex? What is sex to you like? It’s a lot of asking these questions and figuring out what thriving would look like for this person.
But often clients are terrified of getting what they want, either because they're legitimately afraid to have sex, or because they don’t feel they deserve the happiness sex would bring, especially around baby loss. Do I deserve to be happy if my baby died and it was my decision? People don't feel that they deserve to have what they want. What I work on is integrating the parts that are not aligned—let’s become friends with the part of you that wants to punish you. Let’s talk to it, let’s negotiate with it. Let’s not make it wrong. It’s very similar to family systems therapy.
Do I deserve to be happy if my baby died and it was my decision? People don't feel that they deserve to have what they want.
Tara: Are all your clients baby loss clients?
Kate: No, but many are.
Tara: Can you talk about how it feels for your clients to have all this grief come up around an incredibly politicized issue?
Kate: Living in this culture as a grieving person and particularly as a grieving abortion patient…the taboo of it is very heavy. You’ve got the taboo of grief where people want you to be feeling better sooner than is really realistic just because they just want to cheer you up. But you're gonna be sad a long time. I'm lucky that my own personal networks were very understanding about grief but not everyone's are. and that's taboo because you're sad all the time.
Living in this culture as a grieving person and particularly as a grieving abortion patient…the taboo of it is very heavy.
And then you've got the taboo of, I had an abortion and with it the taboo of a health crisis and whatever decisions you made around [fetal] disability. The taboos are just adding up and then if you're having problems in your sex life, that's a taboo too. Talking about the sex itself is a taboo and having problems with it is somehow even a bigger taboo. Right? So the weight of it [these interconnected issues around abortion for medical reasons] is just enormous and there's no freedom to just purely grieve because it's such a tangled mess.
AFTER DOBBS
Tara: Tell me about that transition after Dobbs hit—how did it effect your work, both with paid clients and with the support group?
Kate: There is so much grief from, from the loss of Roe, from Dobbs. Wounds that had been healed just got torn open again. In support group, all of these people came back, we got inundated with applications. A lot of applications were, I used to be a part of this group, but I left because like I moved on with my life, but I need back in right now. I had people saying, my abortion was 20 years ago and I felt like it was over, but now it's not.
I had people saying, my abortion was 20 years ago and I felt like it was over, but now it's not.
We got inundated with people coming back for support, just like looking for connection. And then it got very complicated on the support side. Without going into too much detail of what we're doing behind the scenes , I’ve had to really think about digital security and whether it’s safe for our members to seek support on a Facebook group if they are from, say, Texas, and to be very mindful about our record keeping.
Tara: OK, so people are flooding back into this support group you’ve been a part of for a decade. Security is a worry. Are you seeing different kinds of trauma come up for new clients or members?
Kate: What's really cool is that I got a whole new round of clients who want to do empowerment work to be the most impactful activists they can be. So we work together on their activism. I'm getting more clients who are physicians themselves. Not all of them have ended pregnancies for medical reasons, but a lot of them want to change the system.
WHOSE SPACE IS IT, ANYWAY?
Tara: So let’s talk more about the future of this support group, Ending a Wanted Pregnancy. Abortion and ART [Assisted Reproductive Technology] are really intertwined, right? And many queer couples need ART, need IVF and so on. But I don’t see them finding the group. It feels like a very straight space. Are there any plans to actively make it more queer-friendly?
Kate: I agree. It's a very straight space, more so than your average population. We have had a slight uptick in the number of lesbian couples lately. Do you have any suggestions for how to make it more queer friendly?
Tara: I think you could reach out to like queer parent support groups. Or to some of the religious queer groups because a lot of members may be going through IVF and that way they would have the name. Maybe add “trans people,” more gender neutral language explicitly to some of the language used by mods within group, as a signaling thing.
Kate: I like that idea about queer parent groups. I can’t tell you about this [changing language] issue because I am actually the one who's like, no way. Am I going to tell you what words to use [about abortion]? No way. Am I going to be in a space where people tell me what words to use? No. I will leave [the group] if I am told what words I have to use. I have a very strong connection to the word mother, for instance. What I like is when everyone uses the language that feels authentic to them and you get some people coming in and saying pregnant people, and some not, and it makes a more diverse linguistic case.
Tara: I agree that the impulse to smack people when they use “incorrect” language is a problem because it doesn’t allow people to be on a journey, to not come into this with a perfect politics.
Kate: I mean, what is “correct”? It depends on your context. I have a pretty strong aversion to language-first activism, because it feels extremely artificial and disempowering to me and I've had very bad experiences with words in radical spaces in the past. I've had bad experiences when I used the "wrong" words in a certain group, but even worse experiences when I used the "right" words in radical space but they felt like they weren't my words. People can smell inauthenticity a mile away, and it isn't actually what anyone wants.
I do think that if I, as the most public-facing mod [of EWP], were to change my language, it might very well signal safe space to new queer members. However, I prefer to be the welcome and the support that they are looking for rather than to signal it.
This is important: in our space at Ending a Wanted Pregnancy, not everyone is pro-choice. Not everyone votes Democrat. Not everyone is liberal, either socially or politically. We are, officially, a pro-choice space. Being a pro-choice space does not mean that you can only join if you are pro choice. You can only join if you have had an abortion in a medical crisis. However, if you had an abortion in a medical crisis and are politically conservative or ethically pro-life, you are welcome. But we hold the line of pro-choice leadership. This means that our pro-life members are a cultural minority who ALSO need to feel welcome in our space. If leadership takes on woke signaling language for the sake of inclusivity of LGBTQ+ community, we will also be signalling that this is not a space for our more conservative members.
Now, here's my own personal subtle distinction: I want people to use the words that feel authentic to them at EWP, including leadership. And what I think happens when we do this is that, first, we all sound real and we don't sound like an organization. It's safer for deeply emotional sharing. Second, we get a diversity of words in our space, which hopefully gives everyone a little bit of what they need and help people find their own alliances.
So I won't be changing how I talk until what feels authentic in me changes.
Tara: I know that the discussion around what is a “wanted” pregnancy and what is an unwanted pregnancy is changing in advocacy circles right now, moving away from the idea that only an abortion for medical reasons counts as “ending a wanted pregnancy” or “making a heartbreaking choice.”
Has there been any discussion among the leadership of the group to be more inclusive of, say, domestic violence victims who had an abortion because their partner was abusive, or folks facing poverty who might really have wanted a baby but have other children to feed, and so forth?
Kate: We do occasionally get people who would like to join under those circumstances. And the line has always been hard from the administrative team that it has to be a medical crisis of either mother or child. I hate turning people away. We don't just drop you. We will always connect you with different resources. But I don't see Ending a Wanted Pregnancy becoming more inclusive in that way.
Tara: What’s the reasoning behind that?
Kate: It’s for the sake of women in our group who won't even say they've had an abortion. I believe it's to preserve the space for them to come to terms with that. They would disappear if it were a more inclusive group. What I see over time is that women soften towards themselves and when they soften towards themselves, they can soften towards people outside of the group. So first you soften to your sisters of circumstance and then you soften to yourself and when you can love and forgive yourself so much, then you can look outside of the group and be like, actually that [abortion] is really not that different.
Tara: I mean, I do think the flip side here is that you wind up disappearing these other women who had an abortion because their boyfriend wouldn’t stop hitting them.
Kate: I have a contact who does work around domestic violence and she herself had an abortion. So I send people to her. We also do sometimes connect those people to people in our group who are willing to connect one on one We have women in our group who were in domestic violence situations and had abortions at that time of their life and then had a medical crisis at a different time in their life. Sometimes I will reach out to one of them.
I think there have to exist both kinds of spaces in the world, and that the solution isn't always a modification of one space to be different and more open than it was, but rather more groups all the time, which is a trend that I'm seeing in the TFMR [termination for medical reasons] space in particular, but I would like to be part of extending that trend to broader womb-grief. (I'm calling it womb-grief for lack of a better term.) Because I really do think that all those moms who can't even call it an abortion and have to call it a termination or TFMR need the exclusive integration space of [Ending a Wanted Pregnancy] to process that particular experience. And I would like to see exclusive and inclusive spaces carved out for others in their own emotionally similar situations.
One thing I want to do is to establish a network of abortion integration live retreats. At the moment, the only one I know of is "Rachel's Vineyard" -- which is led by Priests for Life. It is a repentance retreat, and it boils my blood every time I see someone in our group say "My therapist told me about Rachel's Vineyard. Has anyone gone?" I hope those therapists are simply negligent, because if they're not negligent they're abusive. I would like to offer something better. But again, early days, big dreams.
Tara: Thanks, Kate. Before I let you go, anything else you want to tell me about your coaching business?
Kate: My business is Night Bloom Coaching and you can find me at nightbloomcoaching.com. My intro package is $3600 for a 12 week package. After that, we can do maintenance packages if needed. But the promise of the intro package is that if you come to me with your goals you're going to get at least one of your goals and you're going to make progress towards the others to the point that you know how to get to them on your own.