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.
Three Types of Abortion
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.
Chemically Induced Abortion
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.
One Million Abortions a Year
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.