Abortion Education

In this article, we provide information about abortion procedures, including the various types of abortions, and the risks involved in the abortion process. Footnotes document supporting and additional information.

Abortion Procedures

Types of abortions

There are several different kinds of abortions, each of which are used in particular stages of pregnancy.

  • Suction Aspiration first trimester
  • RU 486
  • Methotrexate
  • Dilation and Curettage
  • Dilation and Evacuation second trimester
  • Saline Amniocentesis second and third trimester
  • Urea
  • Prostiglandins
  • Hysterotomy
  • Partial Birth

Suction Aspiration

Suction aspiration abortion is used during early pregnancies and, according to some reports, may account for 95% of all abortions.(6)  A powerful suction tube is inserted into the womb through the dilated cervix.  This dismembers the fetus and tears the placenta from the uterus, sucking them into a container.

RU 486

RU 486 is a technique that uses two powerful synthetic hormones to cause an abortion during the fifth to ninth week of pregnancy.  This procedure requires at least three office visits.  First a physical exam is used to determine whether the woman is a suitable candidate for this method.  It will not be used if there is evidence of smoking, asthma, high blood pressure, obesity, or heart conditions.(7)  The hormone blocks the action of progesterone, causing the nutrient lining of the uterus to disintegrate, starving the fetus.

Thirty-six to 48 hours later, the woman returns to the abortion clinic and is given artificial prostaglandins to cause her to go into labor.  Most women will deliver during the four-hour waiting period at the clinic, but 30% go home and deliver up to 5 days later.(8)  Two weeks later, the woman must return to see if the abortion has been successful. If she is one of the 5-10% of cases in which it didn’t work, then a surgical procedure must now be used.(9)

Methotrexate

The procedure with this technique is similar to that with RU 486, except the drug is given with a shot instead of a pill.  This drug was originally designed to fight fast growing cancer cells by preventing cell division.  It has the same effect on the tissue surrounding the embryo, causing disintegration of the placenta and preventing food, fluids, and oxygen from getting to the embryo.

Three to seven days later, the woman returns to have artificial prostaglandins administered to cause her to go into labor.  If she does not deliver within a few hours, often a second dose of prostaglandin is given a few days later.(10)  The rest of the procedure and results are similar to those with RU 486.

Dilation and Curettage (D&C)

D&C is used primarily during the seventh to twelfth weeks of pregnancy.  The cervix is dilated or stretched to permit insertion of a sharp, loop-shaped steel knife used to scrape the wall of the uterus.  This cuts the baby into pieces and cuts the placenta from the uterine wall.

Dilation and Evacuation (D&E)

D&E is used up to the 24th week of pregnancy on more developed babies whose bones are too calcified to use suction or D&C.  This method is similar to the D&C method except that a forceps is used to grasp part of the larger baby, twisting and tearing parts away and pulling them out.  Then the placenta must be cut away and extracted.

Saline Amniocentesis

Saline amniocentesis or salt poisoning is used after 16 weeks of pregnancy when enough fluid has accumulated in the amniotic sac around the baby.  A needle is inserted through the mother’s abdomen directly into the sac, and a solution of concentrated salt is injected into it.  The salt burns the baby’s skin and, as the baby breathes in the fluid and swallows it, the baby is poisoned.  After about an hour the baby will stop kicking and the mother goes home, where she will go into labor and deliver a dead baby usually about 36 hours later, though sometimes it may take up to 72 hours. (11) Occasionally, a baby will survive salt poisons and be born alive but badly burned.  This method is not used as much as it used to be because of adverse affects on women.

Urea

Because of the dangers with the saline abortion technique, other chemicals, such as urea, have been inserted into the amniotic sac to produce an abortion.  Typically these are not as effective and must be combined with other chemicals or with prostaglandin to achieve an abortion.  Incomplete or failed abortions remain a problem with this technique.

Prostaglandins

Prostaglandins are hormones that assist in the birth process.  During the second half of a pregnancy, injecting concentrations of them into the amniotic sac induces violent labor and premature birth of a child usually too young to survive.  Since babies are sometimes born alive, and occasionally survive, salt or other toxins may be used to insure that the baby is delivered dead.

Hysterotomy

Similar to a Caesarian Section, this method is generally used if the salt poisoning, urea, or prostaglandin methods fail to cause delivery of the baby.  It removes the child from the mother but does not address the subject of what happens to a still living infant.

Partial Birth Abortion

Partial Birth is used on late term babies.  The cervix must be dilated quite large.  Using ultrasound as a guide, the leg of the unborn baby is grabbed with forceps and pulled down into the birth canal.  All but the head is delivered.  Scissors are inserted into the base of the skull, making an opening, and the brains are sucked out with a vacuum.  The rest of the baby is then delivered.

ABORTION RISKS

Physical Risks

While pain is not a specific complication, it is an issue to consider for informed consent.  Ninety-seven percent of women who had abortions described the procedure as being painful, even with the use of local anesthesia,(12) with more than a third describing the pain as “intense,” “severe” or “very severe.”(13) Studies show that younger women find abortion to be more painful than older women,(14) and that women found abortion to be more painful than their doctors thought it would be.(15)  General anesthesia reduces the pain but significantly increases the risk of cervical or uterine injury.(16)

The specific physical risk involved in an abortion depends partly on the type of abortion used, and partly on the experience of the abortionist.  A specific type of risk with suction aspiration, D&C, and D&E is uterine puncture, either from the suction instrument or from sharp pieces of bone being withdrawn.  Perforations may cause hemorrhaging and damage to other organs in the body.(17)  Salt poisoning carries risks of maternal poisoning, seizures, uncontrolled blood clotting, severe hemorrhaging, and problems with the central nervous system,(18) and has been outlawed in Japan and other countries.(19)  Urea commonly causes nausea and vomiting, and between 1% and 2% of urea patients develop endometritis, an infection of the lining of the uterus.(20  Prostaglandin, used with RU 486 or Methotrexate methods or alone, commonly causes severe bleeding, pain, nausea, and vomiting, and has caused serious side effects and complications, including cardiac arrest and rupture of the uterus, and these complications have been unpredictable.(21) There is evidence that RU 486 may cause birth defects or miscarriages in future pregnancies.(22)  Methotrexate is highly toxic and has unpredictable side effects, including problems with bone marrow, anemia, liver damage, and lung disease.(23)  Hysterotomy is the method with the highest risk of maternal death.(24)

While there are several different types of complications that can occur from an abortion, the most common problem after an abortion is infection resulting from fetal or placental tissue left in the uterus.(25)  Other common problems include uterine, bladder or bowel perforations, cervical lacerations, bleeding, hemorrhages, inflammations of the reproductive organs, serious infections, and menstrual disturbances.(26)  The most common complication specifically of second trimester techniques is cervical injury, ranging from lacerations to detachments of the cervix.(27)

Most of the common complications of abortion are short term and arise directly from the abortion procedure.  The number and the severity of these problems depend on the experience of the abortionist.  These kinds of complications can usually be treated and most often subside without serious physical consequences.(28)

Some complications occur later, are harder to overcome, and are more harmful to a woman’s health.  “Studies show that 20-30% of all suction and D&C abortions performed in hospitals will result in long term, negative side effects relating primarily to fertility and reproduction.”(29) Specifically, difficulties in labor and delivery, miscarriages, increased risk of tubal pregnancy, and sterility can be a result of damage to the fallopian tubes, uterus, and cervix.  Women who have had an abortion have more than double the chance of sterility,(30) and the chance of sterility increases with each additional abortion.(31)  Miscarriage, premature births, and neonatal deaths are significantly increased in women who have had an induced abortion,(32) with one study reporting a 45% increase in pregnancy failure after one abortion.(33)

There is strong evidence that abortion increases the risk of getting breast cancer.  A study of 1800 women found that abortion increases the risk of breast cancer before age 45 by 50%, and an abortion of a first pregnancy for women under 18 after the 8th week increased the risk by 800% (8 times the national average).  Women who in addition had a family history of breast cancer had an even higher rate, with 100% of the women in this category in this study getting breast cancer later.(34)

 

Psychological Risks

Abortion has been legal in some states since before 1973, and by January of 1998, 35 million abortions had been performed in this country.  This has given researchers enough time and data to discover a pattern of symptoms among post-abortive women that is called Post Abortion Syndrome.  This syndrome is considered to be a type of Post Traumatic Stress Disorder.  Typically there is a time of “denial,” which may last as long as five or ten years, before the emotional problems surface.  (35)  Often a major life event seems to trigger the onset of symptoms.  (36)

Women suffering from Post Abortion Syndrome may experience debilitating depression, grief, guilt, anxiety, low self-esteem, a sense of failure, hopelessness, or emotional deadness.  They may have flashbacks, nightmares, sleep disorders, communication difficulties, relationship problems, sexual dysfunction, repeated abortions, drug or alcohol abuse, or suicidal tendencies.  These symptoms become worse with each additional abortion.

Many times women suffer secretly with this condition for years.  Traditional psychological treatment may be helpful for some women, but others seem unable to find relief.  Support groups with other women who have experienced the pain of abortion have proven effective with many women.  (37)

The exact number or percentage of women suffering with Post Abortion Syndrome is unknown but under study.  Other studies are trying to determine which personality types or circumstances may cause an increased likelihood of experiencing this condition.  If you or someone you know has suffered from an abortion, you are encouraged to call 1-800-634-2224 and participate anonymously in a national study trying to determine these facts.

Footnotes

(6). S.K. Henshaw, “Characteristics of U.S. Women Having Abortions, 1982-1983,” Family Planning Perspectives, Vol. 19, No. 1, January/February 1987, p. 6.

U.S. Centers for Disease Control, “Abortion Surveillance: Preliminary Data-United States, 1991,” Morbidity and Mortality Weekly Report, Vol. 43, No. 3, 1994, p. 43.

(7) Janice G. Raymond, Renate Klein, Lynette J. Dumble, RU 486: Misconceptions, Myths, and Morals (Cambridge, Ma: Institute on Women and Technology, 1991), pp. 17, 34, 35.

Beatrice Couzinet, M.D. et al, “Termination of Early Pregnancy by the Progesterone Antagonist RU 486 (Mifepristone),” New England Journal of Medicine, Vol. 315 (December 18, 1986), p. 1565.

Louise Silvestre, M.D., et al, “Voluntary Interruption of Pregnancy with Mifepristone (RU 486) and a Prostaglandin Analogue,” New England Journal of Medicine, Vol. 322 (March 8, 1990), p. 645.

(8). The Population Council of New York, Release, October 27, 1994, p. 3. (The Population Council is the entity conducting tests on RU 486 in the United States.)

Diane Gianelli, “RU 486 effective, not problem-free,” American Medical News, April 12, 1993, p. 25.

(9). Elisabeth Aubeny and E.E. Baulieu, “Contragestion with RU 486 and an orally active prostaglandin,” C. R. Acad. Sci. Paris (III), Vol. 312 (1991), pp. 539-545.

Carolyn McKinley, et al, “The effect of dose of mifepristone and gestation on the efficacy of medical abortion with mifepristone and misoprostol,” Hum. Reproduc., Vol 8 (1993), pp. 1502-1503.

(10). Richard U. Hausknecht, M.D., “Methotrexate and Misoprostol to terminate Early Pregnancy,” New England Journal of Medicine, Vol. 33, No. 9 (August 31, 1995), pp. 538-539.

Eric A Schaff, M.D., et al, “Combined Methotrexate and Misoprostol for Early Induced Abortion,” Archives of Family Medicine, Vol. 4, 1995, P 4.

(11). Thomas D. Kerenyi, Abortion and Sterilization: Medical and Social Aspects, Edited by Jane E. Hodgson, (New York: Academic Press, Brune and Strathon, 1981) p. 362.

(12). Phillip G. Stubblefield, M.D., et al, “Pain of first-trimester abortion: Its quantification and relations with other variables,” American Journal of Obstetrics and Gynecology, Vol. 133, No. 5 (March 1, 1979), p. 489.

(13). Nancy Wells, D.N.Sc., R.N., “Pain and Distress During Abortion,” Health Care for Women International, Vol 12 (1991), pp. 296-297.

Stubblefield, et al, op cit, p. 493.

(14). Eliane Belander, Ronald Melzak, and Pierre Lauzon, “Pain of first-trimester abortion: a study of psychosocial and medical predictors,” Pain, Vol 36 (1989), p. 345.

Stubblefield, et al, op cit, p. 495.

(15). Tables VII, VIII, IX, X, and XIII, in Stubblefield, et al, op cit, pp. 493-496.

(16). Kenneth F. Schulz, David A. Grimes, Willard Cates, Jr., “Measures to Prevent Cervical Injury During Suction Curettage Abortion,” The Lancet, May 28, 1983, p. 1184.

Steven G. Kaali, M.D., et al, “The frequency and management of uterine perforations during first-trimester abortion,” American Journal of Obstetrics and Gynecology, August 1989, p. 408.

(17). Jane E. Hodgson, M.D., “Abortion by vacuum aspiration,” Abortion and Sterilization, op cit, pp. 256-258. (see note 11).

F. Gary Cunningham, M.D., et al, Williams Obstetrics, 19th ed. (Norwalk, CT: Appleton & Lang, 1993), p. 683.

Phillip G. Stubblefield, “First and Second Trimester Abortion,” in Gynecologic and Obstetric Surgery, ed, David H. Nichols (Baltimore: Mosby, 1993) pp. 1023-1024.

S. Kaali, op cit, pp. 406-408. (see note 15)

(18). James R. Scott, M.D., et al, Danforth’s Obstetrics and Gynecology, 6th ed. (Philadelphia: J.B. Lippincott, 1990), p.726.

(19). Thomas D. Kerenyi, Abortion and Sterilization, ed. Hodgson, op cit. p. 360.  (see note 11)

(20). Ronald T. Burkman, Theodore M. King, Milagros F. Atienza, “Hyperosmolar Urea,” in Second Trimester Abortion, ed. Gary S. Berger, et al (Boston: Martinus Nijhoff Publishers, 1981), pp. 115-116.

(21). Marc Bydgeman, M.D., FDC Report, February 6, 1978.

Willard Cates, M.D. and H.V.F. Jordaan, “Sudden Collapse and Death of Women Obtaining Abortions Induced By Prostaglandin F2 Alpha,” American Journal of Obstetrics and Gynecology, Vol. 133 (February 15, 1979), pp. 398-400.

(22). Raymond, Klein, and Bumble, Misconceptions, op cit, pp.  71-79. (see note 7)

(23). “Existing Drugs Induced Abortions But some warn about toxicity,” Newsday, October 22, 1993 (New York), p. 7.

Physicians’ Desk Reference (PDR), 47th edition (Montvale, NJ: Medical Economics Data, 1993)., p. 1245.

(24). Willard Cates, Jr. and David A. Grimes, “Morbidity and Mortality of Abortion in the United States,” Abortion and Sterilization, ed. Hodgson, op. cit. (see note 11)

Cunningham, et al op cit, p. 683.  (see note 16)

(25). Hodgson, op cit, pp. 256, 260-261. (see note 16)

(26). Abortion: Some Medical Facts, N.R.L. Educational Trust Fund, 1996, p. 21.

(27). Burkman, King, and Atienza, op cit pp. 115-116.  (See 19)

(28). Stanislaw Z. Leinbrych, M.D., “Fertility Problems Following Aborted First Pregnancy,” New Perspectives on Human Abortion, edited by Hilgers, Horan, Mall, (Frederick, Maryland: University Publications of America, 1981) pp. 120-134.

(29). Thomas W. Hilgers, M.D., testimony, U.S. Congress, Senate Committee on the Judiciary, Constitutional Amendments Relating to Abortion, R.J. Res. 17, S.J. Res. 18, S.J. Res. 19 and S.J. Res. 110, Ninety Seventh Congress, First Session, 1983, Vol. I, p. 192.

(30). Anastasia Tzonou, et al, “Induced abortions, miscarriages, and tobacco smoking as risk factors for secondary infertility,” Journal of Epidemiology and Community Health, Vol. 47 (1993), p. 36.

(31). A. Levin, et al, “Association of induced abortions with subsequent pregnancy loss,” Journal of the American Medical Association, Vol. 243, No. 24 (June 27, 1980), pp. 2495-2496, 2498-2499.

(32). J. Richardson and G. Dixon, Br. Medical Journal, 1976, 1, 1303-1304.

Am. J. Epidemiology, vol. 102, no. 3, 1975, pp. 217-224.

Wright, et. al., Lancet, June 10, 1972, 1:1278-1279.

(33). C Madore, et. al., “A Study on the Effects of Induced Abortion on Subsequent Pregnancy Outcome,” American Obstetrics and Gynecology, 1981, 139:516-521.

(34). Janet Daling, et al, “Risk of Breast Cancer Among Young Women: Relationship to Induced Abortion,” Journal of the National Cancer Institute, Vol. 86, No. 21 (November 2, 1994), pp. 1584-1592.

(35). Wanda Franz, Ph.D., testimony, U.S. Congress, House, Human Resources and Intergovernmental Relations Subcommittee of the Committee on Government Operations, Hearing on Medical and Psychological Impact of Abortion, 101st Congress, 1st Session, March 16, 1989.

Vincent M. Rue, Ph.D., Anne Speckhard, Ph.D., James Rogers, Ph.D., and Wanda Franz, Ph.D., The Psychological Aftermath of Abortion: A White Paper presented to C. Everett Koop, M.D., Surgeon General of the U.S., September 15, 1987, enclosure to testimony of Wanda Franz, Ph.D., Hearing on Impact of Abortion, 1989, op. cit.

(36). Vincent M. Rue, Ph.D., “Post-Abortion Syndrome,” First National Conference on Post-Abortion Counseling, University of Notre Dame, 1986.

(37). Abortion: Some Medical Facts, National Right to Life Educational Trust Fund, 1989, p. 6.