“Bleeding” is not the word: Autoethnographic insights into abortion and the female body's adaptive ejections

Waiting in Limbo

The waiting period before the hospital abortion committee was excruciating. It felt like a form of limbo—suspended between an unwanted pregnancy and the possibility of release, marked by both physical discomfort and profound psychic distress. The delay itself became a torment, intensifying the sense of being trapped within my own body. This sense of temporal limbo resonates with recent phenomenological work on unchosen pregnancy, which describes it as a disorienting and polytemporal experience—one in which bodily, psychological, and institutional timelines unfold out of sync, thereby disrupting linear reproductive temporality (Shalem & Rozmarin, 2025). In my diary at the time I wrote:

Yesterday I thought to myself that I am in some kind of hell. This morning I woke up and realized it is true. I should have gone to Haifa right away. Maybe they would have given me the pill immediately, and now I would already be past it. Instead I am in hell for a whole week—a wasted week—waiting for Thursday, when they will approve the abortion. Who knows when they will actually give me the pill.

The waiting was thus not an empty pause but a charged experience: a state of embodied suspension in which the body already changed, the mind resisted, and the language of “limbo” and “hell” became the only way to capture the intensity of being caught between decision and action.

The Uterus Unleashed: From Limbo to Cathartic Ejection

The experience of the medication itself unfolded in two stages. The first pill, mifepristone, produced an uncanny limbo of its own—a sense that the pregnancy had been suspended but not yet released. I wrote in my diary that the nausea, dizziness, and malaise were “horrifying,” a sickness unlike the pregnancy symptoms I already knew. I was skeptical, even fearful, about what the second pill, misoprostol, would bring, since every source I consulted emphasized its intensity.

Yet there was also anticipation. I noted with a sense of almost relief that I would spend the day in a hospital bed, with time to myself to read, while waiting for the process to be over. When the contractions began, about 3 hours after the second pill, I found myself confronted with the body's sheer expulsive power. In my diary I described it in visceral terms:

It was like giving birth to pieces of congealed liver, expelled in strange and shifting sizes, falling into the toilet bowl or onto the floor. They were enormous clots. I could not believe this was inside me. My abdomen had not even looked so large. Where did all of this come from?

“Bleeding” is Not the Word: A Feminist Critique

In both medical discourse and everyday language, the term most often used to describe a medication-induced abortion is “bleeding.” Yet this term is profoundly inadequate, a sanitized label that obscures the embodied reality of what actually occurs. Even the US Food and Drug Administration's official Medication Guide for mifepristone refers to bleeding 18 times, while alternatives appear only once, in these two sentences: “Your bleeding may be similar to, or greater than, a normal heavy period. You may see blood clots and tissue. This is an expected part of passing the pregnancy” (U.S. Food and Drug Administration, 2023). In my diary I wrote at the time:

They call it “bleeding.” But it is not bleeding. It is giving birth to enormous clots, grotesque masses that emerge from within. And no one says this. They call it by the euphemism “bleeding.” But this is not bleeding. It is something entirely different. During those three hours of waiting for the “bleeding” to begin, the nurse came in from time to time to ask if it had started. Each time I said no. Then, when I finally felt something and went to the bathroom, I pulled down my underwear to sit on the toilet – and before I could, several huge, gelatinous clots fell out of me and gushed onto the floor. I was shocked. After the partial emptying, I struggled to clean the floor before returning to the room, stunned by the unexpectedness.

The surprise is central here. How could something so dramatic—tissue the size and consistency of “a giant piece of raw liver,” as I described it—not be named, not be told? How could medical and cultural discourse collapse this into the word “bleeding,” as if it were continuous with menstruation or minor injury? The absence of accurate language leaves women—and others who undergo abortion—to discover alone what will happen to them. As I noted in my diary:

A week later, another massive clot almost fell to the floor as I stood in my living room — nearly in front of a male friend of the family and my daughters. By chance I managed to cross my legs and make it to the bathroom in time. And there, it was like a crime scene. And yet no one had warned me this could happen.

At the same time, the experience is not reducible to disgust. For me, because the abortion was chosen, the expulsions carried an unexpected dimension of release and catharsis:

It was not like labor, and not as painful. It felt like emptying, cleansing, even uplifting. The abdomen lost its painful swelling. It felt good. I imagine that for women in a desired pregnancy the sensation could be experienced as devastating. For me, it was a positive emptying.

Silenced Knowledge: Shame, Secrecy, and the Scripts of Abortion

Why is there such silence surrounding the embodied realities of abortion? Why must a woman first be shocked by what happens to her body, and only afterward be reassured by friends or medical staff that “this is normal”? The phenomenon of expelling large clots during and after a medication-induced abortion is presented merely as “bleeding,” leaving women unprepared for what they will encounter. This silence is not trivial. It is sustained by cultural scripts that frame abortion as something to be regretted, mourned, or hidden, rather than as an embodied act that can carry multiple meanings.

Although my own experience was not marked by personal shame or regret, I nonetheless found myself selective in deciding to whom I would disclose it—an ambivalence that revealed the force of cultural scripts surrounding abortion. This selectivity, I realized, mirrored broader patterns of concealment: abortion as something known in whispers, spoken of privately but not openly, kept outside the realm of legitimate discourse. Feminist epistemology teaches us that such silences are not accidental; they shape what counts as knowledge, whose experiences are validated, and which embodied truths remain unspeakable (Tuana, 2006).

In the course of my ongoing research on childbirth experiences, several women spontaneously recounted memories of past abortions—memories that, like mine, centered on visceral bodily sensations and unexpected feelings of strength or release. One woman told me about her stillbirth that resulted from a deliberate choice. Already a mother of three, including a child with special needs, she found herself unexpectedly pregnant. Initially, she was convinced by her partner to continue the pregnancy. But after receiving genetic results indicating a significant likelihood of fetal anomaly, she decided to terminate, through a late second-trimester medically induced stillbirth.

“I was totally at peace with it,” she told me. “When the contractions came, it felt right.” Just before the gestational sac and fetus were expelled, her support person stepped out of the room and told her not to look—“so you won’t have nightmares.” But she did look. What she saw, she described as “a tiny doll. A form. I was fascinated.” She felt no guilt, only a quiet, curious attentiveness. And yet, when asked later whether she had looked, she lied and said no. “I knew I wasn’t supposed to find it interesting,” she explained. “I was supposed to be sad. But I wasn’t. I was relieved. Almost happy.”

Her account resonated deeply with my own. And now I believe that the shame we both felt was not personal—it was political. As Sara Ahmed (2013) writes, shame functions as “a border that sticks to bodies” that fail to align with dominant norms. Similarly, Ludlow's (2019) analysis of Diane Noomin's abortion comics shows how cultural scripts demand “respectable” stories of grief and guilt, while grotesque representations disrupt this binary expectation that abortion stories must be framed in terms of grief or guilt.

Both the woman I interviewed and I encountered the same cultural script: abortion must be accompanied by grief or guilt, and if those emotions are absent, they must be performed. Yet what we actually felt was something else—relief, curiosity, even empowerment. In these moments, the act of expulsion became more than a physiological event: it was an epistemic one, an encounter with female bodily knowledge that remains largely hidden or silenced. From a feminist epistemological perspective, such narratives are not mere data points but resonances of embodied knowledge across women's lives—knowledge that unsettles cultural expectations and demands to be recognized.

Abortion as Part of the Continuum of Female Ejection Functions

Experiencing a medication-induced abortion made clear to me that the second pill does not create something artificial but amplifies a process the body can sometimes initiate on its own. Because my decision was deliberate and desired, the experience was profoundly positive; for others who long for the pregnancy, it may instead involve grief or loss.

Yet what is common is that the biomedical term “bleeding”—echoed even in women's own narratives—conceals more than it reveals. This is where the question of the uterus's agency becomes crucial. Feminist scholars have long shown that biomedical discourses systematically strip female reproductive organs of agency by depicting them as passive, malfunctioning, or in need of management (Clarke et al., 2020; Duden, 1993; E Martin, 2001). From a feminist-material perspective, abortion is not merely a physiological outcome but an embodied action of a muscular organ evolved to contract, expel, and protect. Biomedical language flattens this complexity by erasing the intentional, forceful, and patterned nature of uterine activity and reducing an active, sometimes shocking expulsive process to the passive leaking of fluid. In doing so, it strips the uterus of its agency, neutralizes its evolutionary power, and diminishes the woman's lived experience of expulsion. As Barbara Katz Rothman (2021) argues in The Biomedical Empire, this reduction is not accidental but reflects the broader logic of biomedical rule: an “empire” that secures its authority by redefining natural bodily events as medical problems, and by supplying the language through which we must understand them. What I, and others, encountered was not “bleeding” but the forceful ejection of clots and tissue—a bodily act closer to childbirth than to a cut on the skin.

In my own case, I experienced the abortion not as bleeding or even heavy bleeding, but as the body's astonishing expulsive power—a power I had also encountered in childbirth, in lactation, and in the relentless contractions attempting to expel an intrauterine device. These experiences together made me see abortion not as an exception, but as part of the continuum of the female body's adaptive ejection functions: menstruation, childbirth, and lactation.

That power, however, is largely erased in biomedical accounts, unacknowledged in popular discourse, and even treated with embarrassment in much academic writing, which tends to emphasize mourning, loss, or shame rather than strength, connection, or possibility. Recognizing a chosen abortion in this light allows us to re-situate it within the repertoire of female physiology, entangled with meaning, agency, and experience. It is from this perspective that the next section turns toward a broader theoretical exploration of female bodies and female lives.

Ejecting Non-Reproductive Matter From the Uterus

Ejecting non-reproductive uterine content is essential for reproductive success. Menstruation and abortion can both be understood as the expulsion of tissue, eggs, or deceased embryos and fetuses that, if retained, block the possibility of conceiving again. While present in the uterus, such contents preclude new pregnancy and, in the case of intrauterine fetal death, can even threaten the woman's life if not expelled (Griebel et al., 2005).

Menstruation, for example, discards the uterine lining when no implantation occurs, triggered by hormonal changes and uterine contractions (Johnson, 2018). Miscarriage is likewise a natural and frequent process, affecting up to 20% of recognized pregnancies (Griebel et al., 2005). Medical interventions such as misoprostol provide assistance when spontaneous expulsion is incomplete, and the same drug is also used in labor induction (Bakker et al., 2017; Cubo Nava et al., 2019).

Although infertility is a complex disorder with many causes (Onwuchekwa & Oriji, 2017), today a woman with a menstrual cycle abnormality can often conceive with the help of gynecological procedures such as hormone treatment, surgical interventions, or IVF (Abrao et al., 2013). By contrast, throughout most of human evolution, women who could not eject non-reproductive uterine content (menstrual blood or an undeveloped fetus) were unable to conceive and sometimes died of a uterine infection (Ballagh et al., 1998). Today, medical protocols instruct how long a woman carrying a dead fetus may wait for spontaneous expulsion before clinical intervention, in order to minimize both unnecessary surgery and life-threatening complications (Ballagh et al., 1998; Griebel et al., 2005). If spontaneous abortion does not occur, termination of pregnancy is performed—a possibility unavailable to women in the evolutionary past.

The effectiveness of this adaptive ejection mechanism is also evident in the case of intrauterine devices (IUDs), widely regarded as one of the most effective contraceptives (Jatlaoui et al., 2017). The presence of foreign content in the uterus sharply decreases reproductive success (Goldstuck & Cheung, 2019). Adjustment to a non-hormonal IUD often involves heavier menstruation, cramping, and pain (Nahidi & Jalalinia, 2008; Unal et al., 2018), and in some cases the uterus expels the device entirely (Averbach et al., 2020). Studies comparing expulsion rates across types of IUDs highlight just how efficient the uterine ejection function can be (Goldthwaite et al., 2017; Unal et al., 2018). Manufacturers even attempt to design more resistant devices, from spherical forms (Ballerine IUD; Yaron et al., 2019) to models designed to anchor into the uterine wall (GyneFix; Wildemeersch, 2007).

From phenomenological point of view, during menstruation, the ejection of non-reproductive content from the uterus is often painful, particularly for nulliparous women, although experiences vary with individual and social factors (Grandi et al., 2012; Yang & Kim, 2016). Orgasms during menstruation can reduce pain associated with uterine contractions, whether through muscle relaxation, endorphin release, or both (Kay, 1992; Leonard, 2010; Mebin et al., 2020). Women using IUDs frequently report heavier flows and stronger cramps, sometimes leading to removal (Grimes et al., 2006).

From my own embodied experience, I was struck by how forcefully the uterus resists the presence of a foreign object. When I had an intrauterine device in place, in the first few weeks I experienced waves of contractions, reminiscent of labor pains. I wrote:

It is astonishing—almost like contractions. I feel as if my uterus is making an enormous effort to rid itself of the object inside. The pain is intense, but so is the sense of awe at the sheer power of the mechanism. What a magnificent evolutionary mechanism!

Even in the immediacy of the sensation, I found myself interpreting the experience through an evolutionary lens shaped by my scholarly background. This personal episode underscored for me that the uterus does not passively accommodate, but actively works to eject what does not belong. The same expulsive force that prepares the uterus for conception or drives childbirth can also act upon a small piece of plastic or copper. What might be dismissed clinically as a “side effect” becomes, when attended to phenomenologically, an embodied encounter with the uterus's evolved expulsive capacity—a biological function whose lived expression remains culturally and personally shaped.

Here, my use of the term “evolutionary” refers to the development of expulsive physiological functions, not to a universalization of women's experiences. The function may be shared, but its lived expression is historically, culturally, and personally mediated. This embodied recognition of the uterus's autonomous force highlights why the capacity for effective ejection has been so central to female evolutionary success. As feminist scholars such as Emily Martin (1991) have shown with the ovum's active role in fertilization, female reproductive processes mischaracterized as passive must instead be understood as sites of force, agency, and evolutionary power.

Birthing: The Ejection of the Fetus at Term

Childbirth depends on the uterus developing contractions that increase in intensity and frequency until the fetus is expelled from the female body. This natural process cannot start, proceed effectively, or end optimally without uterine contractions. Currently, there are many theories but no consensus as to what initiates the process of childbirth (Dunsworth, 2018). It is agreed, however, that birthing is both a biochemical and mechanical process: the physiology of normal birth includes an increase in the production of oxytocin and the simultaneous production of endorphins and prolactin. Oxytocin is released in pulses every 3–5 minutes in early labor; the uterine muscles respond and establish regular surges (Lothian, 2004). In a natural unanesthetized birth, if the birthing woman is not in a horizontal position, the head of the fetus contacts a nerve plexus at the front of the pelvis that triggers the backward movement of the rhombus of Michaelis, creating more space in the pelvis. This triggers the involuntary ejection of the fetus (Dahan & Odent, 2023; Sutton, 2000). It is interesting to note here that the same hormones responsible for the onset of labor and the process of childbirth, oxytocin, prolactin, and beta endorphins, are responsible for female sexual arousal, orgasm, and breastfeeding (Caruso et al., 2018; Odent, 2009).

From an evolutionary point of view, starting and completing childbirth successfully before the age of modern obstetrics was tightly connected to the ability of the uterus to contract and eject. Today, in industrialized countries, if this function is not working properly, modern obstetrics comes to birthing women's aid with medication (such as Pitocin, the synthetic form of oxytocin), instrumental delivery (such as vacuum or forceps), or Cesarean section (Dahan & Odent, 2023). Before these aids were available, women who could not birth vaginally often did not survive, nor did their child (Dahan, 2020, 2025).

From a phenomenological point of view, labor sensations overlap with menstruation in the latent phase, although the duration and intensity fluctuate between nulliparous and multiparous women (Ashwal et al., 2020). Pain peaks in the expulsive stage, yet natural birth accounts describe the experience as ambivalent—combining severe pain with joy, exhilaration, or awe (Cheyney, 2011; Kurz et al., 2019; Olza et al., 2018). A minority of women even report orgasmic sensations during birth, a phenomenon known as “orgasmic birth” (Buckley, 2003; Camargo et al., 2020; Khajehei & Doherty, 2012). This is perhaps not surprising, because uninhibited labor shares features with sexual arousal, from breathing and vocalization to uterine and central nervous system responses (Newton, 1992).

My own second birth revealed to me the visceral reality of the fetal ejection reflex. After waves of pain and mounting pressure, I suddenly felt the unmistakable force of the fetus descending. In my diary I wrote soon after birth:

I reached down and found the head crowning. I shouted, ‘It's not poop - she's coming now!’ And within seconds, standing in the bathroom, I spread my legs and caught her in my hands. I hadn’t pushed at all. She was simply ejected.

Lactation: Ejecting Milk

The milk ejection reflex is a neuroendocrine mechanism that usually involves suckling. When a baby suckles, sensory receptors around the nipple trigger signals to the hypothalamus and neurohypophysis, leading to the release of oxytocin (Johnson, 2018). Oxytocin contracts the myoepithelial cells surrounding the alveoli of the mammary glands, forcing milk outward. Importantly, this same hormone also regulates uterine contractions during and after childbirth (Leng & Russell, 2019); thus, breastfeeding not only nourishes the newborn, but also helps the uterus return to its normal size. As in other female reproductive functions related to oxytocin release (mating and birthing, see Dahan, 2019), psychological influences such as stress or uncertainty can either inhibit or facilitate this reflex, through the release of catecholamines like adrenaline (Johnson, 2018).

From an evolutionary point of view, nowadays women—and others who lactate—who cannot breastfeed their newborns can use an infant formula, which is designed to approximate the nutritional composition of human milk (CR Martin et al., 2016). However, for most of human evolution, there was no such thing. A woman who could not breastfeed her newborn largely decreased that child's chances of survival and her chances of passing her genes on to the next generation. ¹

My own first weeks of breastfeeding revealed the extraordinary force of the milk ejection reflex. I recall sitting in a doctor's office with my newborn daughter, in a small side room where I was told I could nurse her. She began to feed, then suddenly turned her head away, uninterested. Yet my breast continued to spurt uncontrollably. As I later wrote in my notes:

It was like an unruly hose—streams arced across the room, reaching surprisingly far, until I managed to cover my breast while holding the baby. It was hilarious, grotesque, and embarrassing all at once. I silently hoped no one would walk in and witness the scene.

As Kate Boyer (2018) observes, lactation is cast as something that “ought to happen” yet “must remain unseen.” The uneasy echo between secret and secretion captures how the milk-producing body is framed not as powerful, but as leaky, unruly, in need of concealment. My own experience testified to this double bind: what was natural and powerful became shameful. The same logic is at work in the medical reduction of abortion to “bleeding.” In both cases, the female body's adaptive expulsions are rebranded as mere leakage, their force denied, their agency obscured—even as the body insists otherwise.

From a phenomenological point of view, breastfeeding, too, is marked by sensations that evolve over time. Early on, many women experience painful uterine contractions, ranging from menstrual-like cramps to labor-like pain, especially in multiparous mothers (Holdcroft et al., 2003). Once lactation is established, breastfeeding usually becomes enjoyable, with stress reduction and improved maternal mood documented (Borra et al., 2015). Some breastfeeding individuals report sexual arousal or orgasmic pleasure during extended breastfeeding sessions (Komisaruk & Whipple, 2011; Lee, 2018), a phenomenon recognized for decades (Campbell & Petersen, 1953). Neurobiological studies confirm that lactation strongly activates the dopamine reward system, sometimes even more than addictive substances (Cárdenas et al., 2020; Ferris et al., 2005; Lee et al., 1999).