Surgical Abortion Procedures Explained

Abortion is a very controversial issue, but, through education and better understanding of the facts, we can make more informed decisions concerning abortion and pregnancy.

First Trimester (6–14 weeks)

  1. Suction Curettage. The physician dilates (opens) the cervix (the opening to the uterus or womb) with a series of gradually larger dilators or the physician may choose to use the laminaria (a porous material which expands with moisture in order to open and soften the cervix) procedure. During the abortion, the doctor attaches tubing to a suction machine and inserts the tubing into the uterus. The suction created by the vacuum pulls the pre-born’s body apart and detaches the placenta from the wall of the uterus, sucking the fetal parts and placenta into a collection bottle.
  2. Manual Vacuum Aspiration (Menstrual Extraction). This method is only done up to 7 weeks. The cervix is dialated and the uterus is emptied with a handheld syringe by applying manual suction.
  3. Dilation and Curettage (Damp;&C or sharp curettage). This method is not common since it is considered less safe than suction curettage. The cervix (the opening to the uterus or womb) is dilated and a curette, or loop-shaped tube, is inserted into the uterus to pull the pre-born’s body apart and detach the placenta from the wall of the uterus. All body parts and membranes are then scraped out of the mother’s body.
What are the physical risks of first trimester surgical abortions?
  • Infection,local and systemic (sepsis).
  • Hemorrhage and shock, especially if the uterine artery is torn.
  • Retained tissue, indicated by cramping, heavy bleeding, and infection.
  • Post-abortal syndrome, referring to an enlarged, tender, and soft uterus retaining blood clots.
  • Cervical tearing and laceration from the instruments.
  • Perforation of the uterus by instruments. May require major surgery, including hysterectomy.
  • Scarring of the uterine lining by suction tubing, curettes, and other instruments.
  • Failure to recognize an ectopic pregnancy. This could lead to the rupture of a fallopian tube and hemorrhage. The result could be infertility or death, if treatment is not provided in time.
  • Anesthesia risk, the same as the risks of undergoing anesthesia for any other procedure.

Getting accurate statistics on abortion complications and death rates is difficult. Reporting on abortions is strictly voluntary in most states.

Second Trimester (13–24 weeks)

  1. Dilation and Evacuation (D&E). At this point in pregnancy, the pre-born’s body is too large to be broken up by suction and it will not pass through the suction tubing. The cervix (the opening to the uterus or womb) must be more dilated (opened) than in a first-trimester abortion. This is usually accomplished by inserting laminaria (a porous material which expands with moisture in order to open and soften the cervix) a day or two before the abortion. The physician then dilates the cervix and dismembers the body by crushing the skull and spine to facilitate removal.
  2. Saline, Prostaglandin, and Urea instillation. These methods, more common during the 1970s and 1980s, are rarely used now.
What are the physical risks of a second trimester surgical abortion?
Dilation and Evacuation (D&E)
  • Retained tissue, including the placenta.
  • Uterine perforation, possibly resulting in severe pain and blood loss, this may require major surgery, including hysterectomy.
  • Cervical laceration, perforation, and heavy bleeding (hemorrhage).
  • Infection.

Third Trimester (22–36 weeks)

Dilation and Extraction (D&X). This technique, does not dismember the fetus; rather, the fetus is delivered intact, without infusions. As described and performed by abortion doctor Martin Haskell, D&X abortions take three days to complete. In the first two days, the woman’s cervix (the opening to the uterus or womb) is dilated (opened) with laminaria (a porous material which expands with moisture in order to open and soften the cervix) in two or more sessions, with medication given for cramping. On the day of the procedure, the laminaria are removed, and the patient is injected with Pitocin to induce contractions. The abortion doctor next determines the position of the fetus in the uterus through ultrasound and locates the legs. Grasping a leg with large forceps, he pulls the leg into the vagina and delivers the baby up to the baby’s head with his hands. The doctor then slides his hand up the baby’s back and hooks his fingers over the shoulders of the baby while a pair of surgical scissors are inserted into the base of the skull to create an opening. Removing the scissors, he inserts a suction catheter into the opening and suctions out the skull contents. Minus the brain, the skull decompresses and is easy to remove. Finally, the abortionist removes the placenta and scrapes the uterine walls with a suction curette to make sure the uterus is empty.

What are the physical risks of a third trimester surgical abortion?
Dilation and Evacuation (D&X)
  • Retained fetal parts, and products of conception such as portions of the placenta leading to infection and/or hemorrhage that could cause damage to the uterus and nearby organs, such as the bowel and bladder.
  • Laceration and perforation of the uterus and/or cervix by the instruments used.
  • Risk of hemorrhage or blood loss requiring transfusions.

Psychological Risks

What are the psychological risks of abortion?

Over the years many studies have shown some degree of post-abortion trauma or negative effects. Some studies have demonstrated that these effects extend even to men involved in abortions as well as siblings of the aborted fetus. Such symptoms may include the following:

  • Guilt
  • Anxiety
  • Psychological “numbing”
  • Signs of depression such as unexplained feelings of sadness; sudden and uncontrollable crying episodes; poor self-concept; sleep, appetite, or sexual problems; reduced motivation; conflicts in relationships; and thoughts of suicide
  • Anniversary grief (on the anniversary date of the abortion or due date of the aborted child)
  • Flashbacks of the abortion
  • Preoccupation with becoming pregnant again
  • Anxiety over fertility and childbearing issues
  • Interruption of the bonding process with other children
  • Survival guilt
  • Eating disorders
  • Alcohol and drug abuse
  • Other self-punishing or self-degrading behaviors
  • Brief reactive psychosis

Former surgeon general C. Everett Koop acknowledged that a woman may feel relief and restoration immediately after her abortion, but suffer negative reactions months or years later. He added that “there is no doubt” that there are detrimental effects to abortion, and “as a doctor, I have counseled women with this problem called post abortion syndrome, or adverse psychological reaction to abortion, over the last 15 years.”

As with the physical complications, the psychological risks of abortion also need more study, especially in light of the great amount of anecdotal evidence that many people suffer emotionally as the result of an abortion.

Non-Surgical Procedure Explained: RU 486 (Medical Abortion)

What main chemicals are used?
Mifepristone (RU486) and Misoprostol (prostaglandin).
When is it used?
FDA has approved Mifepristone for use up to 49 days from the beginning of your last menstrual period.
How does it work?
Upon taking the drug, the uterine lining softens and breaks down, causing the pre-born to be expelled from the uterus. In most cases (95%), these contractions begin within 1–4 hours and the pre-born, tissue, and blood will come out of your vagina within 24 hours. About 12 days later, the doctor will need to examine you to make sure you are no longer pregnant.
What is involved?
You will take a single oral dose (3 pills or 600 mg) of Mifepristone. If the abortion does not occur within 2 days, you will need to return to the clinic and take another drug called Misoprostol, which causes the uterus to contract.
How effective is it?
In a U.S. clinical study, 5–8% of women using the Mifepristone/Misoprostol combination failed to result in a chemical abortion, and a surgical abortion was recommended.

Morning-After Pill (Emergency Contraceptive) Explained

When is it used?
Within 72 hours of unprotected intercourse.
How does it work?
The Morning-After Pill works in the same way as other hormonal methods of birth control, by suppressing ovulation. If ovulation has already occurred, the drugs work by making the uterus inhospitable to the embryo, preventing implantation and causing the embryo to be expelled (aborted). The drug also interferes with the natural movement of the ovum.
How effective is it?
Your risk of becoming pregnant during your most fertile days (halfway between two menstrual periods) is as high as 30%. Using the Morning-After Pill decreases your chance of becoming pregnant by about 75%. It is not 100% effective because, if ovulation has already occurred, implantation of a fertilized ovum may not be prevented.
What is involved?
Two doses of pills, taken 12 hours apart.
What are the health risks and side effects?
Common side effects are nausea and vomiting. Health risks include increased risk of ectopic (tubal) pregnancy, which can be life threatening.
What main chemicals are used?
High doses of estrogen/progestin pills (oral contraceptives).
Should I come in for a pregnancy test?
Yes, you should follow up with a pregnancy test 7–10 days after using the morning after pill to determine if you are pregnant.