Do you know what an abortion is?
Before you scoff, mutter “of course I do!” and move on to the next thing in your news feed, I want to ask you again, but differently. Do you know precisely what happens during an abortion?
It’s worth exploring, isn’t it? I know there were gaps in my understanding before I sat down to write this article. And this is the danger. Abortion is debated back and forth, the word kicked to and fro like a soccer ball, but I wonder if women – intelligent, thinking women – find themselves in abortion clinics sometimes, faced with an unexpected horror.
Do we really know what abortion is?
Abortion is not one-size-fits-all. Depending on gestation, there are different methods. Let’s take a look.
Conception to nine weeks.
Mifepristone (RU486 or the “abortion pill’) can be used to terminate (end) a pregnancy up to nine weeks. It is taken in combination with a second drug, misoprostol, which expels the embryo from the uterus.
GPs can now prescribe the two-step termination drugs so that they can be purchased at a pharmacy and self-administered by the woman at home.
The second dose of tablets, containing misoprostol, is taken 24 to 48 hours after the first dose (mifepristone) to soften the cervix and help the uterus contract and expel the embryo. The drug (called MS-2 Step Mifepristone) information stipulates that, “Even if no adverse events have occurred all patients must receive follow-up 14 to 21 days after taking mifepristone.”
Physical side effects
- Nausea or dizziness for a short time
- Bleeding from the vagina about 12 hours after treatment
- Bleeding and cramps that feel like a painful period (women who usually have painful periods are more likely to have severe cramping, but these symptoms usually lessen once the abortion is complete)
- Headache, diarrhoea and chills (women who need further treatment with prostaglandin are more likely to have these symptoms).
*A recent Australian study has found that the risks associated with medical abortion are significantly higher than those associated with surgical abortion. The study shows that 5.7% of women undergoing medical abortion require admission to hospital due to complications compared to 0.4% of women following surgical abortion. Infection rates following medical abortion are 1 in 480 for medical abortion compared to 1 in 1500 for surgical abortion. Risk of haemorrhage (severe bleeding) is 1 in 200 for medical abortion compared to 1 in 3000 for surgical abortion.
7-12 weeks pregnant.
Suction curettage is the preferred method of abortion from 7 weeks to about 12 weeks of pregnancy. Women are usually given either a local or light general anaesthetic for the procedure.
The cervix is dilated with a series of rods of progressively larger sizes being inserted. A tube with suction is then inserted into the uterus, and the fetus and placenta are suctioned out. The lining of the uterus is then scraped to ensure all the contents have been removed.
12-16 weeks pregnant.
Dilation and Evacuation (D and E) is used for pregnancies greater than 12 weeks, usually 12-16 weeks. This method requires the use of vacuum aspiration, dilation and curettage and the use of surgical instruments, including forceps, to remove the fetus in pieces. A local or general anaesthetic will be used.
The cervix is gradually dilated over a period of time with the use of plastic dilators or laminaria. (Laminaria is made of sterile, match-stick sized rods, derived from seaweed, which are inserted in the cervix and as they absorb moisture, they slowly expand to dilate the cervical canal.) The evacuation procedure is performed with a combination of suction aspiration and surgical instruments such as small forceps and the curette, a narrow, spoon-shaped instrument.
17-20 weeks pregnant.
Prostaglandin (a hormone the body naturally produces before labour) is inserted into the vagina or injected into the uterus, and induces uterine contractions and cause the cervix to dilate. The woman is awake during the procedure, but may choose to have an epidural block. The infant may die in utero due to strong contractions or from prematurity.
Women may require curettage after delivery.
After 20 weeks pregnant.
Dilation and Extraction (also known as D and X, Intact D and X, Intrauterine Cranial Decompression and Partial Birth Abortion) is used for aborting babies beyond 20 weeks. Two days before the procedure, laminaria is inserted vaginally to dilate the cervix. During the procedure, the fetus is rotated and forceps are used to grasp and pull the legs, shoulders and arms through the birth canal. A small incision is made at the base of the skull to allow a suction catheter inside. The catheter removes the cerebral material until the skull collapses. Then the fetus is completely removed. To our knowledge, partial birth abortions are not performed in Australia.
Intercardiac Injection Abortion may also be performed on pregnancies beyond 20 weeks. A long needle containing potassium chloride is injected through the mother’s abdomen and into the baby’s heart. Labor is then induced using prostaglandins.
General risks and complications.
The complications of termination rise as the pregnancy progresses. Truly informed choice means you are aware of the myriad complications associated with abortion, and the impact it may have on your future health, fertility and emotional wellbeing. We want people to know the truth: that abortion is bad for women and their babies, not to mention the greater community. Here are some of the risks.
Infection: Up to 10% which, if left untreated, can lead to future infertility.
Retained contents: in around 1-2% of cases, not all the contents may be removed and a further surgical procedure may be required.
Trauma to the Cervix: Occurs in less than 10% of cases
Perforation of the Uterus: 1-4 women per 1000 can be affected. This may require a surgical repair, and on rare occasions, a hysterectomy (complete removal of the uterus)
Severe bleeding requiring a transfusion: Up to 2 in every 1000 women
Cervical Stenosis: Approximately 1 in 500 women will develop a small amount of scar tissue at the opening of the uterus. This stops the blood from leaving the uterus. In the majority of cases, this can be treated, but in rare cases can lead to extensive scarring (Aschermann’s Syndrome) and lead to untreatable infertility.
Psychological Disturbances: Significant psychological problems following termination are more likely if the woman has suffered psychological problems in the past, if she feels pressured or coerced into having a termination, or if having a termination is in conflict with her own morals or beliefs. Some women do experience severe psychological and emotional difficulties following abortion.
Retained products of conception: It is possible for the abortion procedure to fail to remove all the contents of the uterus. This may cause prolonged or heavy bleeding and can require a repeat curette to be undertaken. Symptoms include pain, heavy or prolonged bleeding or the passing of clots.
Perforation of the Uterus: During the operation a small hole or tear can be made in the lining of the uterus. This will usually repair itself, but not always. If not, a further operation will be required to repair it. Rarely, a hysterectomy (complete removal of the uterus) may be required.
Failed abortion: Abortion doesn’t always work, or work the way it’s meant to. Babies are sometimes born alive in which case, they are often not attended to and are left to die alone. Last year it was revealed that, in 2015, 27 babies were born alive and left to die in Queensland after failed late-term abortions (past 20 weeks gestation).
Pregnancy Help Australia offers 24/7 phone counselling:
1300 792 798 (QLD, NSW, VIC, ACT)
1300 655 156 (TAS, SA, WA, NT)