ABORTION: METHODS

March 27th, 2009

Usually a general anaesthetic is given but local anaesthesia is sometimes used. In most cases the vacuum aspiration method is used, by which the embryo is sucked out. The canal through the cervix does not have to be stretched very much during this technique, unlike older methods in which the canal was opened wider so as to introduce instruments. Overstretching the cervix can result in it becoming loose, which increases the chances of a spontaneous abortion in any subsequent pregnancy.

If the pregnancy is further advanced (14 to 15 weeks and beyond) the prostaglandin method is the one usually used. The prostaglandins, which are introduced into the uterus, encourage it to go into labour prematurely. The contractions slowly enlarge the passage through the cervix, in the same way as in labour, and the foetus is eventually passed. This slow enlargement of the passage does little or no subsequent harm to the cervix.

Apart from making the cervix incompetent the other potential physical complications of abortion are infection and/or haemorrhage. The first can lead to infertility but both are relatively rare when the operator is skilful and experienced. Similarly, the uterus may be perforated by the instruments used, the operation may fail and there are risks, however small, from an anaesthetic. These are infrequent occurrences in skilled hands, but they do occur occasionally. Failure to remove the embryo is understandable when one bears in mind how small it actually is in early pregnancy. Having the operation between the seventh to tenth week after the first day of the last period is best for this reason. Also, the operation is not done under direct vision but by touch. Some women have a double uterus or twins and these again can occasionally mislead the operator into thinking the operation has been successfully carried out when in fact a foetus remains.

Late abortions carry more risks, and unfortunately are common among the young who often ‘deny’ they are pregnant and not uncommonly even deny having had intercourse. It is only when the woman faces reality that an abortion is sought. Another situation which leads a woman to go for an abortion very late applies to older women. Since the chances of Down’s syndrome and other genetic defects rise with increasing maternal age, some obstetricians use the technique of amniocentesis to obtain cells for culture to discover whether the foetus is abnormal and then offer the woman an abortion if something is wrong. Since culturing the cells and then studying the chromosomes takes a long time such women tend to come for an abortion late. Many clinics limit abortions to before twenty weeks but legally they can be carried out until twenty-eight weeks although in practice twenty-four weeks is the limit.

A unique study was started in the 1960s in Czechoslovakia comparing the development of a group of wanted children with a group of those who were not wanted. At birth both groups were the same but as time went on it emerged that the unwanted group were less likely to be breastfed, received medical care for acute illness more often, had more minor accidents, were more likely to be admitted to hospital, were more often overweight, and were more likely to be described by their mothers as naughty, stubborn and bad tempered. At school they were less diligent, more excitable and more likely to be rejected by classmates as friends. Boys were more adversely affected than girls but the problems of both increased with time. Many left education early and by the early twenties were still showing a greater tendency to have social problems.

No woman has an abortion for pleasure and nearly all feel anxious and guilty. If a woman really wants her baby but has an abortion because of her circumstances or ill health she often gets depressed afterwards. However, the majority feel that an enormous weight has been lifted off their minds and some even feel a little guilty about their lack of distress. A woman’s relationship with her partner not infrequently improves because it is an adversity shared and surmounted. Contrary to what is often said, her partner sometimes also feels guilty about the situation in which the woman has been placed and by enduring it she earns a new respect from him. Sometimes the relationship collapses. This is especially likely when either partner made the pregnancy happen in an attempt to secure the relationship.