How are early abortions done?

Most common first trimester abortion procedures are:

Suction aspiration: or "vacuum curettage," is the abortion technique used in most first trimester abortions. A powerful suction tube with a sharp cutting edge is inserted into the womb through the dilated cervix. The suction dismembers the body of the developing baby and tears the placenta from the wall of the uterus, sucking blood, amniotic fluid, placental tissue, and fetal parts into a collection bottle.

Great care must be taken to prevent the uterus from being punctured during this procedure, which may cause hemorrhage and necessitate further surgery. Also, infection can easily develop if any fetal or placental tissue is left behind in the uterus. This is the most frequent post-abortion complication. [9-13]

Dilatation (Dilation) and Curettage (D&C): In this technique, the cervix is dilated or stretched to permit the insertion of a loop shaped steel knife. The body of the baby is cut into pieces and removed and the placenta is scraped off the uterine wall. Blood loss from D & C, or "mechanical" curettage is greater than for suction aspiration, as is the likelihood of uterine perforation and infection.

This method should not be confused with routine D&C’s done for reasons other than undesired pregnancy (to treat abnormal uterine bleeding, dysmenorrhea, etc.). [14-16]

RU 486: While many people focus solely on RU 486, the so-called " French abortion pill," the RU 486 technique actually uses two powerful synthetic hormones with the generic names of mifepristone and misoprostol to chemically induce abortions in women five-to-nine weeks pregnant.

The RU 486 procedure requires at least three trips to the abortion facility. In the first visit, the woman is given a physical exam, and if she has no obvious contra-indications ("red flags" such as smoking, asthma, high blood pressure, obesity, etc., that could make the drug deadly to her), she swallows the RU 486 pills. RU 486 blocks the action of progesterone, the natural hormone vital to maintaining the rich nutrient lining of the uterus. The developing baby starves as the nutrient lining disintegrates.

At a second visit 36 to 48 hours later, the woman is given a dose of artificial prostaglandins, usually misoprostol, which initiates uterine contractions and usually causes the embryonic baby to be expelled from the uterus. Most women abort during the 4-hour waiting period at the clinic, but about 30% abort later at home, work, etc., as many as 5 days later. A third visit about 2 weeks later determines whether the abortion has occurred or a surgical abortion is necessary to complete the procedure (5 to 10% of all cases).

There are several serious well documented side effects associated with RU 486/prostaglandin abortions, including prolonged (up to 44 days) and severe bleeding, nausea, vomiting, pain and even death. FDA reported in March of 2006 that it had 2 additional documented deaths in the United States in addition to the 4 deaths reported from September, 2003 to June, 2005.

Long term effects of the drug have not yet been sufficiently studied, but there are reasons to believe that RU 486 could affect not only a woman’s current pregnancy, but her future pregnancies as well, potentially inducing miscarriages or causing severe malformations in later children. [17-33]

References:

9. Phillip G. Stubblefield, "First and Second Trimester Abortion," in Gynecologic and Obstetric Surgery, ed. David H. Nichols (Baltimore: Mosby, 1993) p. 1016. Also, the U.S. Centers for Disease Control (CDC), "Abortion Surveillance: Preliminary Data -- United States, 1991, " Morbidity and Mortality Weekly Report, Vol. 43, No. 3, 1994, p. 43, puts the percentage of suction curettage abortions relative to other techniques at 98%, though the CDC admits that their numbers include a number of D & E abortions which should be classified otherwise (personal communication with Lisa Koonin,Division of Reproductive Health, CDC, March 6, 1996).

10. U.S. Senate Report of the Committee on the Judiciary, Human Life Federalism Amendment, Senate Joint Resolution 3, 98th Congress, 1st Session, legislative day June 6, 1983, p. 36. (Hereafter referred to as Human Life Federalism Amendment).

11. A. Jefferson Penfield, M.D., Gynecologic Surgery Under Local Anesthesia, (Baltimore: Urban & Schwarzenburg, 1986), p. 79.

12. Jane E. Hodgson, M.D.,"Abortion by vacuum aspiration," Abortion and Sterilization: Medical and social aspects, Jane E. Hodgson, ed. (New York: Academic Press, Grune and Strathon, 1981), pp. 256-258.

13. Ibid, pp. 256, 260-261.

14. Human Life Federalism Amendment, cited in note 10, p. 36.

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

16. Penfield,cited in note 11, pp. 50-51.

17. According to Andrea Sachs, because of these generic names, the RU 486 technique is sometimes referred to as the "M & M " method. "Abortion Pills on Trial," TIME, December 5, 1994, p. 45.

18. Étienne-Émile Baulieu, M.D., Ph. D., "1993: RU 486 -- A Decade on Today and Tomorrow," in Clinical Applications of Mifepristone (RU 486) and Other Antiprogestins, Institute of Medicine, eds. Molla .S. Donaldson et al (Washington, D.C.: National Academy Press, 1993), p. 92-96. Though Baulieu, creator of the abortion pill, recommends its use up to nine weeks, American trials have found the method considerably less effective after the seventh week, according to Carol Jouzaiis, "Abortion Pill Clinic Tests Drawing to a Close in U.S.," Chicago Tribune, Wednesday, August 30, 1995, p. 1.

19. 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. The regimen in France, where the drug was first developed and approved, involves a total of four visits, adding an additional week for reflection prior to the ingestion of the pills (Diane Gianelli, "RU 486 effective, not problem-free," American Medical News, April 12, 1993, p. 25.

20. See 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; and 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.

21. Raymond, Klein, and Dumble, Misconceptions, cited in note 20, pp. 57-62.

22. André Ulmann, et al, "Medical Termination of Early Pregnancy With Mifepristone (RU 486) Followed By A Prostaglandin Analogue," Acta Obst. Gyn. Scand., Vol. 71 (1992), pp. 280-281.

23. Population Council, Release, cited in note 19, p. 3

24. Gianelli, "RU 486 effective..." cited in note 19, p. 25.

25. Élisabeth Aubeny and É.É.Baulieu, "Contragestion with Ru 486 and an orally active prostaglandin," C.R. Acad. Sci. Paris (III), Vol. 312 (1991), pp. 539-545, obtained a 95% completion rate with women 49 days amenorrhea or less. 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, obtained a completion rate of 89.1% for women 50-63 days amenorrhea.

26. Mary W. Rodger and David T. Baird, "Blood loss following a prostaglandin analogue (Gemeprost)" Contraception, Vol. 40 (1989), pp. 439-447.

27. UK Multicentre Trial, "The efficacy and tolerance of mifepristone and prostaglandin in first trimester termination of pregnancy, B.J. Obst. & Gyn., Vol. 97 (1990), pp. 480-486.

28. Population Council, Release, cited in note 19, p. 3.

29. McKinley, et al, "The effect of dose of mifepristone...," cited in note 25, p. 1504.

30. Alan Riding, "Frenchwoman’s Death is Linked To Abortion Pill and a Hormone," New York Times, April 10, 1991, p. A-10

31. Mark Louviere, M.D., "Group lied when it said ‘abortion pill’ test resulted in no complications,’ Waterloo Courier, September 24, 1995, p. F3. See alsoTom Carney, "‘Abortion pill’ test goes awry for one patient," Des Moines Register, September 21, 1995, pp. 1M, 5M.

32. Raymond, Klein, and Dumble, Misconceptions, cited in note 20 , pp. 71-79.

33. FDA Public Health Advisory "Sepsis and Medical Abortion Update"; March 17, 2006. www.fda.gov/cder/drug/advisory/mifeprex200603.htm