WOMEN’S BODIES: HOW IS ABORTION DONE?
There are several methods of abortion. Which is used depends mainly on how far your pregnancy has advanced. Occasionally some health factors influence the choice of method.
The duration of pregnancy is stated in weeks since the date of your last menstrual period (LMP). You will be examined before the operation to make sure that the size of your uterus is consistent with your dates (and to make sure that everything else in your pelvis is normal). If there is any discrepancy between dates and uterine size, you may be examined with ultrasound to see why: the pregnancy may be more or less advanced than you suspect or, less often, it may be a twin pregnancy or some other condition that makes the uterus larger or smaller than would be expected on dates.
Methods of abortion include the following.
Suction aspiration This is the simplest and safest means of abortion. It is used to terminate pregnancies up to 12 weeks from the LMP. The technique depends on the fact that the lining of the uterus (where the pregnancy is implanted) is designed by nature to separate easily from its wall beneath, and can be drawn off by a slight suction force.
The cervix is dilated by inserting metal rods of gradually increasing diameter through its canal until it is open enough to allow a flexible plastic tube with j opening near its tip to be passed into the uterus. This is rarely more than 10
mm,
usually less if the pregnancy is nine weeks or less from LMP. The outside end of the tube is then connected to a suction machine. When the suction is turned on, the lining of the uterus (containing the pregnancy) is drawn out. This takes one two minutes. Then the surgeon may also check inside the uterus with a small curette, to make sure that it’s completely empty. That’s all there is to it.
If the thought of suction bothers you, ask your doctor to demonstrate the force of the suction machine on your hand or arm. You’ll find it’s very light – about the same as you’d feel if you put a drinking straw against your skin and sucked i other end as if you were sipping.
Dilatation and evacuation (D&E)
This method is used for pregnancies from 12 to 20 weeks from LMP. The cervix needs to be dilated more widely to allow larger foetal parts to pass through. Up to 16 weeks this can usually be done with dilators, but for later pregnancies dilatation is helped by using vaginal prostaglandin pessaries or by inserting laminaria tents (narrow strips of a special seaweed that expand gradually when moistened) into the cervical canal some hours or the evening before the procedure. When the cervix has dilated enough, the
pregnancy is removed with forceps and a combination of suction and curettage. General anaesthetic is most often used. D&E is generally done in day clinics or as a day-only procedure in hospitals: if all is well you can go home a few hours after the procedure is finished.
Induction of labour
This may be done after 16 weeks from LMP by introducing into the amniotic cavity (using a procedure similar to amniocentesis) substances that will make the uterus contract so that the foetus, placenta and membranes are expelled as they would be at delivery. Vaginal prostaglandin pessaries may be used in addition; sometimes alone.
Induction of labour is the most physically and emotionally distressing method of abortion. It can take up to 24 hours for
the dead foetus and placenta to be delivered, and uterine contractions may be stronger and more painful than during delivery at full term. The complication rate, though no greater than for full-term delivery is higher than for other methods of pregnancy termination. Because D&E has ken shown to be safer, induction of labour
is less often used now, though it nay still be the best choice if the pregnancy is approaching 20 weeks.
No matter how sure you are that it’s the best thing to do, having an abortion liter 14 weeks is always more difficult emotionally than it is with an earlier abortion. Because you’ve carried the pregnancy for longer; may have felt foetal movements; may have left it late because the decision was difficult; perhaps had weeks of anxiety waiting for amniocentesis results and then had to cope with the knowledge that your foetus was defective; the pain and the time it takes; the fact that what you go through is similar to delivery of a baby: these all add up to a very tough experience. Clinics and hospitals offer counselling before, during and after the induction, with ongoing emotional support if you need it.
Hysterotomy
This is cutting open the uterus to remove the pregnancy, the same as caesarean delivery. It is used only when other methods are impossible (rare) or if the pregnancy must be terminated quickly to save the mother’s life.
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