What is abortion?

Abortion is the termination of pregnancy before the fetus is ready for birth. It involves the removal of all pregnancy tissue, or the fetus and placenta. The former refers to the product of conception up to the eighth week of pregnancy while the latter is commonly used after eight weeks of pregnancy. Abortion is done due to a number of reasons including but not limited to unplanned pregnancy and if the mother’s physical and/or mental health is at risk.

There are currently only 56 countries in the world that has legalized abortion, even partly under special circumstances. With the evolution of science and technology, a number of abortion procedure options have now become available for women. The stigma on abortion remains virtually the same as it was years ago, but these modern abortion procedures are far safer than those performed centuries ago. Gone are the days when women had to hide from the public and induce abortion on their own through the use of coat hangers and knives, which are fatal.

A large number of people still believe that abortion is one of the most horrible things anyone can do, likening abortion to murder. Indeed, this dispute is reflected in the variety of laws in different states in the US and all over the world. Some people believe that abortion should only be allowed legally in cases of rape, incest, or certain death of the mother should the fetus be carried to term. Others, on the other hand, insist that abortion should not be legal under any circumstances.

Is abortion painful?

Abortion is a little different for everyone who experiences it. Some go through a hassle-free procedure while some experience excruciating pain. The level of pain one feels depends on a lot of factors like one’s level of pain tolerance, the medication and its effectiveness on the mother, and how many weeks a mother has been pregnant. For most people, the pain is similar to severe menstrual cramps.

A woman planning to terminate her pregnancy need not worry about the pain because doctors and nurses are dedicated to helping the patient feel as little pain as possible. The doctors and nurses give pain-killers, numbing medications, or even sedation to help with the pain. Cramping is usually felt after the procedure. Most women bounce back immediately the next day but this depends on the procedure done.

Before proceeding with the abortion, doctors perform tests and ask about your medical history. The doctors need to determine the gestation period, whether it is an ectopic pregnancy or not, and if the mother is Rh positive or negative before suggesting what method of procedure is best, if it can be done at all. There are specific medications to be given if it is an ectopic pregnancy to help with the abortion. Rh negative women on the other hand have to be injected by immunoglobulin to prevent Rh-related problems that may harm future pregnancies.

Abortion Procedures

There are two primary types of abortion procedures: medical and surgical; both of which are clinically certified by the World Health Organization.  A doctor can use only one or a combination of both to terminate pregnancy. The decision depends mainly on how far along a woman is on her pregnancy and the other factors stated beforehand.

Sometimes, a woman is given the chance to choose which procedure she is inclined to, with her doctor’s advice. Almost all abortion procedures don’t require the woman to stay overnight after the procedure but it is still recommended that the woman allots time for her body to recuperate.

Medical Abortion Procedure

Medical abortion can only be performed within the first 70 days or 10 weeks of gestation. Most often, two types of medication are taking during separate times as advised by the doctor or nurse. The first of the two pills to be taken is mifepristone, a drug that counters the effect of progesterone which is a necessary hormone for pregnancy. It is to be followed within 24 to 48 hours with misoprostol. Misoprostol is a drug that causes that uterus to contract (Harvard Medical School, 2019). A woman will experience cramping and heavy bleeding after 4-5 hours. 92-97% of women who have taken both pills reported to have completed abortion within 2 weeks.

There is another medication available, although less used in the United States. This drug is methotrexate and may be used by women with allergies or if mifepristone in unavailable. Methotrexate kills the fast-growing pregnancy tissues. It is injected into a muscle and 89-91% of pregnancies are aborted within 45 days, almost 6 weeks. This drug can also be used to treat ectopic pregnancies.

However, medical abortion is not recommended if the mother has existing severe liver, kidney, or lung disease, has an intrauterine device (IUD) (Ernst, 2018), has bleeding problems or is taking blood thinning medication, has uncontrolled seizure disorder, cannot attend follow-ups after the procedure, and if the woman has no access to emergency care. Medical check-ups are a must for a doctor to monitor the woman’s recovery.

Surgical Abortion Procedures

There are 5 surgical abortion procedures: vacuum aspiration, suction, dilation and curettage (D and C), dilation and evacuation (D and E), and abdominal hysterotomy.

Vacuum aspiration, also called menstrual extraction, is done within the first trimester of pregnancy. This procedure involves using a gentle suction to remove the remaining pregnancy tissue of an incomplete miscarriage. The procedure usually lasts for 15 minutes or less and does not require general anesthetic. Some women still need local anesthesia to help with the pain. This procedure is pain-free for most women. Vacuum aspiration is not recommended if the woman has an abnormally shaped or functioning uterus, blood clotting disorders, pelvic infection, or severe health problems (Ernst, 2018).

Suction, also called suction D and C or aspiration abortion’s procedure is similar to vacuum aspiration. Although unlike vacuum aspiration which is typically used as a follow-up from failed medical abortions, suction D and C is a stand-alone and is commonly done to terminate a pregnancy. And opposed to the manual method of vacuum aspiration, suction uses an electronic pump to effectively suck out everything inside the uterus.

Dilation and curettage (D and C) involves using curettes which are instruments with sharp edges to remove the pregnancy tissue while the cervix is dilated. The procedure often involves the use of suction to make sure that there is no remaining pregnancy tissue in the uterus. D and C is easier to carry out early in the pregnancy so the cervix may be less dilated.

Dilation and evacuation (D and E) is similar to D and C’s procedure. The main difference being in D and E, larger instruments are used since this procedure is usually done to terminate a pregnancy of 14 to 21 weeks. D and E is usually for women who was unable to decide earlier whether or not to terminate the pregnancy, has a medical problem, or if the fetus has a severe abnormality. This procedure takes longer than the others with some lasting up to 2 days.

Abdominal hysterotomy is the rarest of all 5 to be done. This procedure is usually done if proceeding with D and E is riskier or impossible. This is a major caesarian-like operation to remove the fetus. Another option is induction abortion where the mother is given a medicine to induce labor in order for the uterus to contract. This is followed by suction or a spoon-like instrument to thoroughly clean the uterus.

Risks of Abortion

A woman has to attend follow-up check-ups to ensure her health and that all the pregnancy tissue has passed. Usually, a woman is able to resume most of her regular daily activities after a short recuperation especially if the procedure done does not involve surgery. Sexual activity must be avoided for up to six weeks to prevent infection. Pain medication may also be given to those experiencing severe cramps.

Abortion does carry risks, but not as great as the elders think. Medical abortion risks are infection, bleeding, and incomplete abortion. While surgical abortion risks include infection, continued bleeding, incomplete removal of the pregnancy tissue, and perforated uterus. All of these can be treated and should not be feared as the chances of having complications during safe abortion procedures are quite low.

It is not true that abortion will hinder a woman from bearing a child in the future, that is if the abortion procedure is uncomplicated. However, the risk of infertility is higher in surgical abortion complications because it may lead to endometritis, perforation of the uterus, or an incomplete removal of the pregnancy tissue.

It is not advised and also illegal for a woman to induce abortion on her own. This includes buying pills or any type of medication online or in black markets. Unsafe abortions risk the life of many mothers and why some women suggest that abortion clinics should remain open and accessible.

Abortion is safe as long as it is carried out within the standards and practices that the World Health Organization requires. A woman may face slight risks in terminating a pregnancy but there is a reason as to why she is getting an abortion and it must be considered. There are many abortion procedures that can be carried out safely, with the promise of not harming the mother or of causing infertility.

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References

Center for Reproductive Rights. (n.d.) The World’s Abortion Laws. Center for Reproductive Rights. https://reproductiverights.org/worldabortionlaws

Ernst, H. (2018, December 6). What are the different types of abortion? Healthline. https://www.healthline.com/health/types-of-abortion

Harvard Medical School. (2019, January). Abortion (Termination of pregnancy). Harvard Health Publishing. https://www.health.harvard.edu/medical-tests-and-procedures/abortion-termination-of-pregnancy-a-to-z

Sullivan, D. (2019, June 27). What are the different types of abortion? Medical News Today. https://www.medicalnewstoday.com/articles/325582