Abortion is the early termination of a pregnancy. A spontaneous abortion (also called a miscarriage) occurs on its own. An induced abortion is the intentional termination of a pregnancy and expulsion of a fetus, whether by surgery or the administration of pharmaceuticals.
There are 2 kinds of induced abortions: surgical and chemical.
Surgical Abortion Procedures
1. Manual Vacuum Aspiration: within 7 weeks after last menstrual period
Dilators (metal rods) are used to stretch the cervical muscle until the opening is wide enough for abortion instruments to pass through the uterus. A hand-held syringe is attached to tubing, which is inserted into the uterus. The fetus is suctioned out.
2. Suction Curettage: after 14 weeks from the last menstrual period
The abortionist uses a dilator or laminaria to open the cervix. Laminaria are thin sticks from a kelp species that are inserted hours before the procedure and allowed to slowly absorb water and expand, thereby dilating the cervix. Once the cervix is dilated, the abortionist inserts tubing into the uterus and attaches the tubing to a suction machine. Suction pulls apart the fetus’ body and out the uterus. After suction, the doctor and nurses must reassemble the fetus’ dismembered parts to ensure they have all the pieces.
3. D & C (Dilation and Curettage): within first 12 weeks
The cervix is dilated. A suction device is placed in the uterine cavity to remove the fetus and placenta. Then the abortionist inserts a curette (a loop-shaped knife) into the uterus. The abortionist uses the curette to scrape any remaining fetal parts and the placenta out of the uterus.
4. D & E (Dilation and Evacuation): within 13-24 weeks after last menstrual period
The fetus literally doubles in size between the 11th and 12th weeks of pregnancy. Soft cartilage hardens into bone at 16 weeks, making the fetus too large and strong to pass through a suction tube. The D & E procedure begins by inserting laminaria a day or two before the abortion, opening the cervix wide to accommodate the larger fetal size. The abortionist then both tears and cuts the fetus and uses the vacuum machine to extract its remains. Because the skull is too large to be suctioned through the tube, it must be crushed by forceps for removal. Pieces must be extracted very carefully because the jagged, sharp pieces of the broken skull could easily cut the cervix.
5. Saline: after 15 weeks of pregnancy
This procedure is conducted in the same manner as amniocentesis (a prenatal test used to diagnose a fetus’ potential chromosomal abnormalities). A long needle is inserted into the woman’s abdomen, directly into the amniotic sac. It is at this point that a saline abortion and amniocentesis differ. In a saline abortion, amniotic fluid is removed from the woman and replaced by a strong saline (salt) solution. As the fetus’ lungs absorb the salt solution, it begins to suffocate. It may struggle and may even have convulsions. The saline also burns off the fetus’ outer layer of skin. Saline abortion can take one to six hours before the fetus is no longer viable. The woman begins labor after approximately 12 hours, and she may take up to 24 hours to deliver. Because the procedure is often quite long, many times the woman is left to labor alone.
6. Prostaglandin: after 15 weeks of pregnancy
This procedure is conducted in the same manner as a saline abortion, except prostaglandin (a hormone that causes the woman to start labor) replaces saline. Prostaglandin activates contractions. It can cause overly painful or intense labor; there have been cases in which the violence of the contractions ruptured the mother’s uterus.1 This type of abortion is not preferred by abortionists because there is a 40% higher chance of a live birth.
7. Hysterotomy: after 18 weeks
This procedure is the same as a cesarean section (in which the doctor cuts through the abdomen and uterus to deliver the baby), except that in a hysterotomy, no medical attention is given to the baby upon delivery to help it survive. Most often, a wet towel is placed over the baby’s face so it can’t breathe. Sometimes the baby placed in a bucket of water. The goal is to have a baby that won’t survive.
8. D & X (Dilation and Extraction): from 20 weeks after last menstrual period to full term. Also called “partial birth abortion.”
This procedure takes three days. During the first two days, the woman’s cervix is dilated. She is given medication for cramping. On the third day, she receives medication to induce labor. As the woman labors, the abortionist uses an ultrasound to locate the baby’s legs. The abortionist then grasps a leg with forceps and delivers the baby up to its head. Next, using a scissors, the abortionist creates an opening in the base of the baby’s skull. A suction catheter is inserted into the skull opening, and the baby’s brains are suctioned out. The skull collapses, and the rest of the baby’s body is delivered through the birth canal.
Chemical Abortion Options
1. RU-486 (Mifepristone): within 4-7 weeks of the last menstrual period.
Also called “the abortion pill.”
This drug interferes with levels of progesterone, a hormone that keeps the fetus implanted in the wall of the uterus. The woman is prescribed progesterone and then returns to the clinic two days later to receive a prostaglandin drug that induces labor and expels the dead fetus. A third visit may be required if the baby is not expelled, at which time a woman has a 5-8% likelihood of needing a surgical abortion to complete the process. RU-486 is documented to be unsafe for women.2
2. Methotrexate and Misoprostol
Methotrexate is used for treatment of cancer, and Misoprostol is used for ulcer treatment. In a chemical abortion, these two drugs are used in combination. Methotrexate causes cells in the placenta (the organ that nourishes the fetus) to die. Misoprostol empties the fetus from the uterus by causing the uterus to contract and push the fetus out. Methotrexate is a drug used in chemotherapy and has the potential for serious liver toxicity.
3. “Morning After” Pill: sometimes used in rape cases
Up to 72 hours after intercourse, a woman is administered large doses of birth control pills (or levonorgestrel, also known as Plan B) to prevent the embryo from implanting in the uterus wall. Twelve hours after the first dose, a second dose is given. Large doses of birth control pills work to prevent ovulation and hinder sperm motility.
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NOTES
1Duenhalter & Gant, “Complications Following Prostaglandin Mid-Trimester Abortion,” OB & GYN, 46:3 (1975)
2 Irving M. Spitz, C. Wayne Bardin, Lauri Benton, and Ann Robbings, “Early Pregnancy Termination with Mifepristone and Misoprostol in the United States,” New England Journal of Medicine, 338:18 (1998).