Abortion
Abortion
is the
termination of a pregnancy. There are two major categories of
abortion. Spontaneous abortion, called miscarriage if it occurs
after the first few weeks of pregnancy, is the natural loss of a
fetus without intentional human intervention. It is an extremely
common event, often occurring before a woman even realizes that she
is pregnant. Induced abortion, by contrast, is initiated
intentionally. Induced abortions are of various kinds, including
nonprofessional efforts by the pregnant woman or others to end an
unwanted pregnancy. Medical abortion can be done using established
medical procedures by a trained medical practitioner, by the use of
hormone combinations, or by taking a drug called RU-486, which is
available in the U.S. only on a trial basis.
There are three main
types of medical abortion. By far the most common procedure involves
insertion of a cannula through a woman's cervix and removing the
fetus and placenta using vacuum aspiration. This procedure generally
is used in the first trimester (i.e., the first three months after
conception) and accounts for about 90% of all medical abortions. In
this procedure, which takes about 5 to 10 minutes and can be
performed in a physician's office, the woman lies on an examining
table with her feet in stirrups. A local anesthetic is administered
to numb the woman's cervix. In some cases, a general anesthetic may
be used to induce sleep, but this is usually not necessary. The
first step in the procedure involves the insertion of a speculum to
hold the vaginal walls apart, followed by insertion of a cannula
through the dilated cervix. The cannula is connected to a mechanical
aspirator. The sucking action of the machine, similar to the device
used by dentists to remove excess saliva during dental procedures,
removes the contents of the uterus. To insure that the abortion is
complete, the physician may insert a spoon-like instrument, called a
curette, and checks the walls of the uterus. This ends the
procedure.
About 10% of
abortions are performed after the 12th week of pregnancy. Two
alternative procedures are used with later-term pregnancies. The
first is quite similar to the procedure described above, but,
because the fetus is larger and more firmly attached to the uterine
wall, in addition to using suction the physician inserts a forceps
to remove fetal parts that may be too large to be successfully
aspirated. The procedure takes up to 30 minutes and may involve the
administration of pain medication to the woman. Alternately, in
pregnancies that are past the twenty-second week of development, it
is possible to induce labor chemically causing the fetus to be
expelled through the vaginal opening. Unlike the other procedures,
this procedure is generally performed in a hospital. A needle is
inserted through the abdominal wall into the uterus and a
labor-inducing medication (such as prostaglandin, urea, or saline
solution or some combination of these) is injected. Within a few
hours, the woman begins labor and the fetus is expelled.
Regardless of the
method used, women who have undergone an abortion should be checked
for blood pressure and heart rate, and monitored to insure that
bleeding and discomfort are limited. One or more follow-up
appointments may be arranged several weeks after the abortion to
insure that the procedure has been successful and that the woman is
healthy. In abortions performed before the 13th week of pregnancy,
some follow-up surgery, for example, to remove a blood clot or to
repair a tear in the cervix, is needed in only 0.5% of cases. In
abortions performed between13 and 24 weeks, complications are
somewhat more frequent, in part because of the use of a general
anesthesia. The death rate for women who have medical abortions is
one in 160,000. By comparison, in full term pregnancies, the death
rate is one for every 16,000 successful deliveries.
In the years before
abortion was legal, from the late 1800s until the famous Roe v. Wade
Supreme Court decision of 1973, more pregnant women died from
infections, retained placentas, poisoning, shock, profuse bleeding
and other complications brought on by self-induced abortions or
abortions performed by unqualified practitioners than from any other
single cause. In parts of the world where abortion is still illegal,
these remain a leading cause of maternal death. By contrast, today's
legal medical abortion is one of the most common and safest surgical
procedures in the U.S. Approximately 1.3 million women choose to
have a medical abortion performed each year. Major complications and
side effects occur in only about 1% of medical abortions. Some women
experience menstrual-like cramping during an abortion and for up to
an hour afterward. Most women report that this cramping is
uncomfortable but not painful. Vaginal bleeding, similar to a
menstrual period, generally occurs after an abortion is completed.
For the most part, the earlier in pregnancy an abortion is
performed, the less likely there will be medical complications.
Despite the limited
complications and risks involved, medical abortion is one of the
most controversial domestic issues in American society.
Sex
