Abortion Procedures

Strictly speaking, abortion is the expulsion of a foetus from a woman’s uterus before its development is complete enough to enable it to survive independently from the mother. Abortions may be either spontaneous (miscarriage) and naturally occuring or can be artificially induced.

The use of the term abortion most commonly refers to induced abortion or deliberate termination of pregnancy (TOP) although the subject of spontaneous abortion will also be considered in this article. Along with infanticide, abortion is possibly the oldest and historically the most widely practised method of population control known to and used by human beings. It has been estimated that approximately 30 million abortions are performed worldwide each year. In other words, one in four pregnancies ends in induced abortion. Abortion has been available from earliest times. When women cannot find another means of averting an unwanted pregnancy, they will turn to ‘back street’ or illegal abortion. In some societies, abortifacients are easily available. These are concoctions of herbs or chemicals which openly promise to abort or are sold with prominent warnings of ‘Not to be taken by pregnant women’. Such potions, if effective, work by harming the mother.

During the World War I, lead-based abortifacients became so popular in the Midlands of England that it became routine practice to examine pregnant women patients in surgeries for tell-tale signs of lead poisoning, the result of which in many cases was blindness or even death.

Another popular method of abortion was to introduce a ‘foreign body’ or material into the uterus. This would normally puncture or damage the placenta in some way, forcing the foetus to be aborted. Knitting needles, crotchet hooks, slivers of wood, wax tapers, goose quills, meat skewers and hatpin’ s were, and still are, employed. Douches of iodine, carbolic soap, vinegar, lysol and turpentine were also administered by the woman herself, a friend or an abortionist. Strenuous exercise, such as riding, running or bicycling, or massage of the abdomen have in some instances be known to cause an abortion. In all cases, if an abortion results, it is usually because the woman has made herself, or has been made, dangerously ill. The use of douches or instruments frequently led, and still leads to appalling infections. In some countries, the chief cause of maternal death is illegal abortion. If the woman survives, she may be harmed for the rest of her life and is often subsequently unable to bear a child by choice.

Modern methods of abortion

Modern medicine and surgery, however, have led to safe methods of termination of pregnancy. An abortion performed by a competent surgeon in sterile conditions and in the first trimester of pregnancy (the first 12 weeks), carries less medical risk to the woman than if she were to complete her pregnancy. In the first trimester, termination of pregnancy can be carried out by vacuum aspiration. A woman undergoing this procedure may be admitted to hospital or seen as an outpatient. For the operation she may be given a general anaesthetic but, in many cases, a local anaesthetic is all that is needed. If the operation is carried out within eight weeks of the last menstrual period, the surgeon inserts a thin plastic tube (cannula) into the uterus. The outer end is connected to a vacuum pump and gentle suction is used to draw out the contents of the uterus. These consist mainly of amniotic fluid and blood, with a little solid matter. When the uterus is empty, the surgeon will gently scrape it inside with an instrument called a curette. The use of this instrument ensures that all remaining matter has been removed.

If the abortion is carried out between eight and twelve weeks from the last menstrual period, the cervix or entrance to the uterus must be first stretched or dilated. This is because the uterus will contain more solid matter at this stage and need a wider cannula. Before inserting a cannula, the surgeon widens the entrance to the uterus with progressively larger metal dilators, the largest of which is usually the width of one finger. Once dilatation is completed, the cannula is introduced and aspiration proceeds, being followed by curettage. The operation itself takes between five and ten minutes. The patient may feel weak and have cramps afterwards, but is often able to leave after a few hours rest.

In terminating pregnancies of 12 to 14 weeks dilatation and curettage will be used together with aspiration to clear out the uterus. However, if the pregnancy has gone further into the second trimester, different techniques must be employed. After the fourteenth week, the size of the foetus means that the cervix must be dilated more than it will allow without damage. For this reason, second trimester abortions are usually performed by allowing the pregnancy to proceed to the seventeenth week and then using special drugs to induce the abortion. This can be done by injecting a saline solution into the amniotic fluid but more recently chemicals known as prostaglandins* are being used. These are naturally occuring substances which stimulate muscle contraction. If administered by injection, by drip or as a vaginal pessary, they have the effect of stimulating contractions of the uterus. The woman then goes into a premature labour and the foetus is expelled. Prostaglandin terminations are distressing and painful. Because the cervix is not yet ready to open, labour pains can be more intense than with birth. Because painkillers slow down the procedure, the woman must usually endure the cramps without sedation. The fetus when expelled is small and would not be able to survive outside the uterus, but it is still recognizably human and this can upset both patient and medical staff., After a prostaglandin abortion, the woman usually needs a curettage to ensure there are no products of conception retained in the womb that may cause an infection.