Surgical abortion methods explained from the beginning of pregnancy up to 40 weeks.
There are many methods of surgical abortion. The procedure used depends largely upon the stage of pregnancy and the size of the unborn child.
In Abortion: Questions and Answers, Dr. J.C. Willke divided the methods of abortion into three main categories: those that use instruments inserted via the cervix to end the life of and remove the unborn child; those that use drugs to induce fatally premature delivery; and those performed through abdominal surgery.
In the first method, dilation of the cervix is required. The usual method is to insert a series of instruments, metallic curved instruments known as dilators, of increasing size into the cervix. This is necessary before inserting the instruments of abortion past the cervical opening into the uterus.
Unlike a normal birth, where dilation occurs slowly over many hours, the forced stretching by the abortionist to open the cervix takes a matter of seconds. This unnatural stretching can result in permanent physical injury to a woman.
A dehydrated material known as laminaria, usually a type of seaweed, is sometimes used to reduce damage to the cervix. Laminaria is inserted into the cervix the day before the scheduled abortion. Over several hours it will swell as it absorbs water, gradually pushing open the cervix in the process.
By the time most facilities begin offering surgical abortion for a given pregnancy, the unborn baby’s heart has been beating for a week or more. (1) Two miniature lungs have also begun to form.
At eight to nine weeks the eyelids have begun forming and hair appears.
By the ninth and tenth weeks the embryo can turn somersaults, jump, squint against light, frown, and swallow.
Around weeks 11 and 12, the embryo’s anatomy is becoming clearly male or female. The face has a definite form and unique characteristics, and taste buds have emerged.
This is the most common method of abortion during the first 12 weeks of pregnancy. General or local anaesthesia is given to the mother and her cervix is quickly dilated. A suction curette (a hollow tube with a knife-edged tip) is inserted into the womb. This instrument is then connected to a vacuum machine by a transparent tube.
The vacuum suction, 29 times more intense than a household vacuum cleaner, tears the embryo and placenta into small pieces that are sucked through the tube into a bottle and discarded.
At earlier stages of development, suction abortions are performed using a smaller tube with little cervical dilation. This is called “menstrual extraction.” If all the fetal remains are not removed, full dilation of the cervix and a scraping out of the womb is necessary to prevent infection.
Dilation and Curettage (D&C)
This method is similar to the suction method with the added insertion of a hook shaped knife, or curette, which cuts the embryo into pieces. The pieces are scraped out through the cervix and discarded. (Note: This abortion method should not be confused with a therapeutic D&C done for other reasons.)
13-14 weeks: By the end of the third month all arteries are present, including the coronary vessels of the heart. Blood is circulating through these vessels to all body parts.
The heartbeat ranges during this fetal period from 110 to 160 beats per minute.
Vocal cords are complete, and the child can and does sometimes cry silently. The brain is fully formed, and the nerves can feel pain.
At 14 weeks, muscles lengthen and become organized. The mother will soon start feeling the first flutters of the baby kicking and moving inside.
15-18 weeks: The fetus has an adult’s taste buds and may be able to savor the mother’s meals. Around 16 weeks, eyebrows, eyelashes and fine hair appear. The child can grasp with his hands, kick, and somersault. At 18 weeks, the child blinks, grasps, and moves her mouth.
20-22 weeks: The child can hear and recognize mother’s voice. Fingernails and fingerprints appear, and sex organs are visible. Though still small and fragile, babies at 22 weeks have been known to survive outside the womb.
Dilation and Evacuation (D&E)
This method is used up to 18 weeks’ gestation. Instead of the loop-shaped knife used in D&C abortions, a pair of forceps is inserted into the womb to grasp part of the fetus. The forceps are used to break and twist off the bones of the unborn child. This process is repeated until the fetus is totally dismembered and removed. Usually the spine must be snapped and the skull crushed in order to remove them.
Salt Poisoning (Saline Injection)
This method is used after 16 weeks (four months) when enough amniotic fluid has accumulated. A long needle injects a strong salt solution through the mother’s abdomen into the baby’s sac. The baby swallows this fluid and is poisoned by it. It also acts as a corrosive, burning off the outer layer of skin. It normally takes a little over an hour for the baby to die from this. Within 24 hours, labor will usually set in and the mother will give birth to a dead or dying baby. (There have been many cases of these babies being born alive, which are then usually left unattended to die. However, a few have survived and later been adopted.)
The unborn child at six months is covered with a fine, downy hair called lanugo. Its tender skin is protected by a waxy substance called vernix. Some of this substance may still be on the child’s skin at birth at which time it will be quickly absorbed. The child practices breathing by inhaling amniotic fluid into developing lungs.
Prostaglandin Chemical Abortion
This form of abortion uses chemicals in the second trimester that cause the uterus to contract intensely, pushing out the developing baby. The contractions are more violent than normal, natural contractions, so the unborn baby is frequently killed by them — some have even been decapitated. Many, however, have also been born alive.
Hysterotomy or Caesarean Section
Used mainly in the last three months of pregnancy, the womb is entered by surgery through the wall of the abdomen. The technique is similar to a Caesarean delivery, except that the umbilical cord is usually cut while the baby is still in the womb, cutting off oxygen supply and suffocating the child. Sometimes the baby is simply removed alive and left to die.
For several months, the umbilical cord has been the baby’s lifeline to the mother. Nourishment is transferred from the mother’s blood, through the placenta, and into the umbilical cord to the fetus. If the mother ingests any toxic substances, such as drugs or alcohol, the baby receives these as well. At 32 weeks, the fetus sleeps 90-95% of the day, and sometimes experiences REM sleep, a possible indication of dreaming.
A partial birth abortion is composed of several steps.
- Guided by ultrasound, the abortionist takes hold of the baby’s legs with forceps.
- The baby’s leg is pulled out into the birth canal.
- The abortionist delivers the baby’s entire body, except for the head.
- The abortionist jams scissors into the baby’s skull. The scissors are then opened to enlarge the skull.
- The scissors are removed and a suction catheter is inserted. The child’s brains are sucked out, causing the skull to collapse. The dead baby is then removed.
The baby, approximately seven and a half pounds at 40 weeks, is ready for life outside its mother’s womb. At birth the placenta will detach from the side of the uterus and the umbilical cord will cease working as the child takes his first breaths of air.
The child’s breathing will trigger changes in the structure of the heart and bypass arteries which will force all blood to begin flowing through the lungs.
At times, an aborted child survives the attempt on his or her life. There have been instances of these children being left to die or directly killed which turns abortion into infanticide. Click here to learn more about the ongoing issues surrounding late term abortions and infanticide.
- Less than half (46%) of abortion facilities in the U.S. offer surgical abortions at four weeks gestation or earlier in 2012. (source)
Pharmaceutical abortion, also known as chemical or medical abortion, is a method to chemically induce abortion early in pregnancy.
It is typically done using two drugs. The first is mifepristone, also known as RU-486, and the second is misoprostol. The drugs are taken orally over three days, although the abortion itself may take much longer to complete.
In 2000 the U.S. Food and Drug Administration authorized the use of mifepristone for abortions up to 49 days of pregnancy. By 2011, chemical abortions accounted for 28.5% of all U.S. abortions at or before eight weeks.
A chemical abortion causes a serious reaction in a woman’s body in order to cause it to interrupt and expel the pregnancy. It normally causes several hours of bleeding and cramps ranging from mild to severe, and side effects may include nausea, vomiting, diarrhea and shivering. Infection and hemorrhage requiring emergency care are known risks.
The abortion may end in about 4 to 5 hours, but in some cases takes as long as two weeks to complete. According to Marie Stopes, bleeding and cramps following chemical abortion can last several weeks.
There have been fourteen women known to have died in the U.S. between 2000 and 2011 due to complications following this method.
How Mifepristone Works
Mifepristone is an antiprogestin: it works by blocking the pregnancy hormone progesterone. Progesterone is “pro-gestation,” as the name suggests, and makes the nutrients in the uterine lining available to the newly-conceived fetus as it arrives from the fallopian tube.
When progesterone is blocked by mifepristone, the lining of the uterus softens and breaks down. Taken in pill form, mifepristone alone will cause abortion in 70% of early pregnancies. (1)
Misoprostol is then taken to help ensure expulsion, two days later in the U.S. FDA-approved regimen or as early as 6 hours later in the UK. Misoprostol is a hormone-like compound (prostaglandin) that produces uterine contractions to expel the dead baby and placenta.
Danco Laboratories, the U.S. manufacturer of the mifepristone brand Mifeprex, states that the two-pill regimen is 92 to 95 percent effective in completing an abortion.
If the drugs fail to end a pregnancy, surgical abortion may be performed.
FDA Guidelines for Chemical Abortions
The FDA-approved pharmaceutical abortion protocol is for pregnancies up to 49 days gestation and follows this regimen:
- Day 1: three 200 mg mifepristone tablets orally in one dose.
- Day 3: two 200 mcg misoprostol tablets orally in one dose at a provider’s office.
- Day 14: The patient must return to confirm that a complete termination has occurred. If not, surgical termination is recommended.
Bleeding and cramping can begin after either the first or second set of pills.
Unlike surgical abortions, in which abortion staff immediately remove products of conception, medical abortions usually take place at home and in solitude. Women and experts have said the gestational sac and embryo is sometimes intact and can be seen after it is expelled during these abortions, especially if the pregnancy is relatively late. (2) For some, this could be distressing.
The medication guide for Mifeprex includes an agreement to be signed by patient and provider, in which the patient assents that “I believe I am no more than 49 days (7 weeks) pregnant,” and “I will take [this guide] with me when I visit an emergency room or a provider who did not give me Mifeprex.”
The mifepristone label indicates that bleeding or spotting will likely continue for an average of 9-16 days, and possibly last up to 30 days.
The FDA lists 2,207 adverse events in women who used mifepristone between 2000 and 2011. Beyond 14 deaths and 612 hospitalizations, the most frequently occurring complications were hemorrhage requiring transfusion (339) and infection (256).
Second Trimester Chemical Abortions
Mifepristone and misoprostol are sometimes also used to end pregnancy in the second trimester. This off-label alternative induces labor by the use of both drugs or of misoprostol alone.
When mifepristone is followed by misoprostol 48 hours later, one study found that the time to fetal expulsion was about 7 1/2 hours. (3)
Retained placenta is the most common complication for second trimester pharmaceutical abortion, and may happen for as many as 50% of women. Hemorrhage requiring transfusion and infection are the next most frequent complications.
Women who change their minds and want to keep the baby after starting a medical abortion in the first trimester may be able to do so up to 72 hours after taking the first pill, mifepristone. This is done by progesterone treatments with a claimed survival rate for the pregnancy of 60%.
“By giving extra progesterone, we hope to outnumber and outcompete the mifepristone in order to reverse the effects of mifepristone,” say the founders of AbortionPillReversal.com, which refers women to doctors providing the progesterone treatment.
Although the Mifeprex guide suggests birth defects could affect a child born after failed chemical abortion, the American College of Obstetricians and Gynecologists reports that “No evidence exists to date of a teratogenic [birth defect] effect of mifepristone.”
In fact, babies born after the progesterone treatment have not shown birth defects due to mifepristone. AbortionPillReversal.com reports that 89 babies have been born after progesterone treatment. Aside from one minor and unrelated birthmark, all were without birth defects.
(adapted from abortionis.com)
- Sam Rowlands, ed., Abortion Care (Cambridge University Press, 2014), 63.
- (2011-08-24). Management of Unintended and Abnormal Pregnancy: Comprehensive Abortion Care (Kindle Location 6159). Wiley. Kindle Edition.
- (2011-08-24). Management of Unintended and Abnormal Pregnancy: Comprehensive Abortion Care (Kindle Locations 8873-8874). Wiley. Kindle Edition.