Crisis Pregnancy Center

First Trimester (1 - 12 weeks)
Menstrual Extraction (menstrual regulation, Karman method)-- This method is performed in very early pregnancy, up to 50 days LMP (50 days after the first day of the last menstrual period.) A Karman cannula, a thin, flexible plastic tube with a blunt tip featuring two side openings, is inserted into the cervix and connected to a manually operated vacuum source. The suction created by the vacuum pump empties the uterus of the developing child and supporting tissues. The abortionist completes the procedure by scraping down the walls of the uterus with the cannula, the tip of which acts as a curette. Because this method is used so early in pregnancy, little or no dilation of the cervix is needed.

Major disadvantages of this method to women include the facts that the continued pregnancy rate with this procedure is higher than for other procedures performed later in pregnancy, and the "retained tissue rate" is also higher. In addition, according to abortionist Warren Hern, "It is much more painful than a later abortion."

Suction Curettage -This is the most common method for first trimester abortions. In a suction abortion, the abortionist dilates the cervix with mechanical dilators or laminaria, a porous substance that is inserted hours or a day before the abortion and that gradually dilates the cervix by soaking up fluid. Next, the abortionist attaches a cannula to a vacuum source, and inserts the cannula into the uterus. (The cannula is necessarily wider in diameter, because of the larger body parts, than the straw like cannula used in very early abortions.) The suction created by the vacuum tears the fetus' (unborn baby's) body apart and detaches the placenta from the wall of the uterus, sucking the fetal parts and placenta into a collecting bottle. If the fetus' body parts are too large and stop up the suction tubing, the abortionist must remove the remaining parts with instruments.

The abortionist dilates (opens) the cervix with mechanical dilators or laminaria (a porous substance that is typically inserted a day before the abortion). Overnight the laminaria gradually dilates the cervix by soaking up fluid. The day of the abortion the abortionist attaches tubing to a suction machine, and inserts the tubing into the uterus, The suction created by the vacuum pulls the unborn baby’s body apart and detaches the placenta from the wall of the uterus, sucking the fetal parts and placenta into a collection bottle. (1)

Dilation and Curettage (D&C, or sharp curettage)--This method is not as common anymore for abortions, because it requires more dilation and more time, and is considered less safe than suction curettage. (2) The cervix is dilated, and a curette, or loop-shaped knife, is inserted into the uterus to cut apart the unborn baby and scrape the uterine lining to detach the placenta. All body parts and membranes are then scraped out of the mothers body.

Second Trimester (13-26 weeks)
Dilation and Evacuation (D&E)--At this point in pregnancy, the unborn baby’s body is too large to be broken up by suction, and it will not pass through the tubing. (3) The cervix needs to be dilated more than in a first-trimester abortion, and this is usually accomplished by inserting laminaria a day or two before the abortion. The abortionist then dismembers the body parts. The skull is crushed and the spine is broken to facilitate removals. (4)

Saline, Prostaglandin, and Urea Instillation--These methods, more common during the 1970s and 1980s, are rarely used now, according to the Centers for Disease Control (CDC), which reported that they accounted for only 0.7 % or approximately 11,200 of all reported abortions in 1991.

In a saline abortion, the abortionist injects a concentrated salt solution through the mother's abdomen into the amniotic sac surrounding the baby. The fetus absorbs the solution, which causes burning, hemorrhage, edema, shock, and eventually death. The saline also causes the uterus to contract and expel the baby.

Prostaglandin abortions are performed by injecting a prostaglandin hormone into the amniotic sac. The hormone stimulates uterine contractions to expel the fetus, who has usually died, although a 1978 study showed that up to 7% of babies aborted with prostaglandins showed signs of life. (5)
Urea abortions are similar to saline abortions but are not as effective. They are thought to have fewer complications for the mother. Urea infusion is more commonly combined with later-term D&E abortions to soften fetal tissues for easier, safer, and less painful removal.
(6)

Second and Third Trimester
Dilation and Extraction (D&X)--Congressional action in 1996 brought to light yet another procedure for aborting late-term unborn babies. This technique, called D&X abortion, does not dismember the fetus; rather, the fetus is delivered intact, without infusions.

As described and performed by abortion doctor Martin Haskell, D&X abortions take three days to complete. In the first two days, the woman's cervix is dilated with laminaria in two or more sessions, with medication given for cramping. On the day of the procedure, the laminaria are removed, and the patient is injected with Pitocin to induce contractions.

The abortion doctor next determines the fetus orientation in the uterus through ultrasound, and locates the legs. Grasping a leg with large forceps, he then pulls the leg into the vagina, and delivers the baby (live) up to the baby’s head with his hands.

Next, the abortionist slides his hand up the baby’s back and hooks his fingers over the shoulders of the baby. Then a pair of scissors are inserted into the base of the skull to create an opening. Removing the scissors, he inserts a suction catheter into the opening, and suctions out the skull contents. (7) Minus its brains, the skull decompresses, and is easy to remove. Finally, the abortionist removes the placenta with forceps and scrapes the uterine walls with a suction curette. (8)

	Cervical tearing and laceration from instruments used to dilate the cervix and enter the uterus. The risk of cervical damage is heightened when the abortionist has failed to dilate the cervix properly, which could be caused by unwillingness to use laminaria (a much slower process tat takes hours or a day to dilate the cervix) instead of mechanical dilators, a misjudgment of the length of gestation, or hasty and careless procedure. Most first-trimester abortions are performed in freestanding clinics in one visit, not two visits as would be required when the cervix is dilated overnight with laminaria.
	Perforation of the uterus by instruments; serous bowel damage can occur if suction is applied after perforation and the intestines are sucked through the perforation
	Scarring of the uterine lining by suction cannulas, curettes, and other instruments
	Infection, local and systemic (sepsis)
	Hemorrhage and shock, especially if the uterine artery is lacerated. If the abortionist doesn’t realize quickly enough that the artery is cut, death can soon follow.
	Anesthesia toxicity from both general and local anesthesia, resulting in possible convulsions, cardio respiratory arrest, and in extreme cases, death. General anesthesia in abortion has a two to four times greater risk of death than local anesthesia.
	“Retained tissue,” or incomplete abortion, indicated by cramping, heavy bleeding, and infection. A high fever within a few days of the abortion is the most obvious evidence of retained tissue.
	Postabortal syndrome, also known as uterine atony, referring to an enlarged, tender, and boggy uterus retaining blood clots. This condition manifests itself within several hours after an abortion, and if not treated promptly with reaspiration (resuctioning) and medication, can lead to more serious complications, such as sepsis, excessive blood loss, and the need for major surgery, including possible hysterectomy. Many abortionist do not keep a first-trimester abortion patient in the recovery room long enough to observe, diagnose, and treat this condition before she leaves.
	Failure to recognize an ectopic pregnancy. This could lead to the disastrous complications of hemorrhage and resulting infertility or death, if treatment is not provided in time.

Second Trimester
Infusion Methods (used in only about 1 percent of 1990 abortions reported to the Centers for Disease Control)

	Toxicity to the mother of the pharmacologic agents used in the abortion. Toxicity may be caused by the agent itself or by the method of infusing it, such as intravascularly instead of intraamniotically.
	“Failed abortion,” also known as “live birth.” A 1978 study showed that up to 7 percent of fetuses aborted with prostaglandins showed signs of life.
	Retained tissue, including the placenta.
	Uterine rupture, with resulting severe pain and blood loss. Major surgery, including hysterectomy, will need to be performed.
	Cervical laceration, perforation, heavy bleeding or hemorrhage, and infection.

	Trapped fetal parts, leading to possible damage to the uterus and adjacent organs, such as the bowel and bladder. Uterine atony (see above) can be a contributing factor to this situation.
	Laceration and perforation of the uterus and/or cervix by fetal parts, particularly the skull, pelvis, and long bones, as they are removed. The larger instruments used in these mid-term abortions can also cause such damage.
	Greater risk of hemorrhage.

Emotional Aspects of Abortion
Praise be to the God and Father of our Lord Jesus Christ, the Father of compassion and the God of all comfort, who comforts us in all our troubles, so that we can comfort those in any trouble with the comfort we ourselves have received from God.

Scholarly literature is replete with studies finding some degree of post abortion trauma or negative affects. Some studies have shown these effects extend even to men involved in abortions and siblings of the aborted fetus. The research has pinpointed factors that predict negative psychological sequelae: prior children, prior abortion(s), low self-esteem, second-trimester abortions, more maternal orientation, religious affiliation and religious conservatism, forced or coerced abortion, lack of relationship support and/or immature interpersonal relationships, preabortion ambivalence, genetic rather than elective abortion, prior emotional problems, prior unresolved traumatization, lack of support from one’s family of origin, adolescent rather than adult status, and biased preabortion counseling.

Characteristics of post abortion stress include uncontrolled negative reexperiencing of the abortion; unsuccessful attempts to put away negative recollections and pain of the abortion, which reduces the sufferer’s responsiveness to others; and experiencing symptoms not present before the abortion. Such symptoms may include the following:

	Guilt
	Anxiety
	Psychological “numbing”
	Depression experienced as unexplained feelings of sadness; sudden and uncontrollable crying episodes; deterioration of self-concept; sleep, appetite, and sexual disturbances; reduced motivation; disruption in interpersonal relationships; and thoughts of suicide
	Anniversary syndrome (on the anniversary date of the abortion or due date of the aborted child)
	Flashbacks of the abortion experience
	Preoccupation with becoming pregnant again
	Anxiety over fertility and childbearing issues
	Interruption of the bonding process with one’s children
	Survival guilt
	Eating disorders
	Alcohol and drug abuse
	Other self-punishing or self-degrading behaviors
	Brief reactive psychosis

1. Warren Hern, Abortion Practices (Philadelphia: J.B. Lippincott Company, 1990, pp. 108-117.
2. Stephen L. Corson, M.D., Richard J. Derman, M.D., M.P.H., and Louise B. Tyler, M.D., eds., Fertility Control (Boston: Little, Brown and Company, 1985, pg. 64.
3. Hern, op. cit., pg. 123.
4. Ibid., pg. 128.
5. W.K. Lee and M.S. Baggish, “ Live Birth as a Complication of Trimester Abortion Induced with Intra-amniotic Prostaglandin F2a,” Adv. Planned Parenthood (vol. 13, No.7, 1978). Quoted in Hern, Abortion Practice, pg. 183.
6. Hern, op. cit., pp. 124-125.
7. Martin Haskell, M.D., “ Second Trimester Abortion: From Every Angle,” paper presented at the Fall Risk Management Seminar at the National Abortion Federation, September 13-14, Dallas, Texas.
8. Ibid.
The remainder of this information was taken from the Christian Action Council Education and Ministries Fund, Inc. ©1995 p. 84-90.