Abortion

Abortion is a tough topic to talk about. People have strong feelings about whether is it right or wrong to end a pregnancy. Some people feel it is completely up to the woman to decide because it is her body and her life. Other people feel there is more to it – the baby and the baby’s life is also involved.

Australia has a very high abortion rate. About half of all teenage pregnancies end in abortion. Often girls and women having abortions are pressured into the decision by partners, parents or other circumstances and some may find it hard to cope afterwards with how they feel.

An abortion may solve a problem in the short term but there’s no doubt that it’s a life altering decision which does cause intense grief and sadness for some people. Often girls and women struggling with how they feel after abortion don’t tell anyone. This only makes it harder for them and also adds to society’s view that most women cope ok.

People facing crisis pregnancy need correct information about all their options and support while they make their decision. People who have abortions and find it hard to cope need to know they are not alone and there is help available.

Decisions about sex
Whether or not to get into sex is something to really think about – not just because of the risk of unplanned pregnancy and abortion but because of sexually transmitted diseases and emotional hurts. There’s no such thing as casual sex. People’s emotions and physical well being are always on the line.

Most teen magazines, movies and TV soaps give the impression that pretty much all teens are having sex. Not true! By age 19 only half the teen population has had sexual intercourse. If you are a virgin you are not alone – and you’re keeping safe. Saying No to sex as a teenager is a smart move.

In everyday terms an abortion means bringing about an end to a pregnancy by surgery or the use of drugs.

In abortion literature, abortion is sometimes described as removing the lining of the uterus, or the contents of the womb. Other words often used for abortion are termination of pregnancy or termination.

The correct title for an unborn child in the first eight weeks of development is embryo; from then until birth s/he is referred to as a foetus. (Foetus is a Latin word, meaning ‘little one’.)

Sometimes in abortion literature the embryo is referred to as products of conception, foetal tissue, protoplasm or a blob of cells.

The way a thing is described can affect the way you think and feel about it.

Abortion is most commonly performed between the 8th–12th week of pregnancy, counted from the first day of the woman’s last period (6–10 weeks after conception). If abortion is attempted earlier than 8 weeks, the embryo may be missed due to its small size, requiring the woman to undergo the procedure a second time.

What is the embryo like at 8 weeks?

At eight weeks (6 weeks since conception), the embryo no longer has the appearance of a mass of cells, but is almost fully formed. The embryo is 2.5cm long and weighs 1 gram. It has all the internal organs of an adult in various stages of development. The heart has been beating since 4 weeks after conception and the nervous system is functioning. The head, arms and legs are moving.
(Click here if you would like to see a picture of an 8 week old embryo.)

What is the foetus like at 12 weeks?

At twelve weeks (10 weeks since conception) the unborn child is now known as a foetus. It is 6-8cm long and weighs about 18 grams. Closed eyelids can be seen as the face becomes properly formed. Muscles are growing and the foetus makes more obvious movements of legs and arms. The foetus is now able to squint, swallow and make a fist, and responds to touch. The fingers and toes are fully formed and have nails. Internal and external reproductive organs have become definitely male or female.
(Click here if you would like to see a picture of a 12 week old foetus.)

The method of abortion used depends on both the gestation (age) of the foetus and therefore its size and the risk of complications to the mother.

Suction Aspiration is by far the most common method of abortion in Australia. It is used in 98% of abortions up to 12 weeks (counted since last period). The procedure is performed either with:

  1. a local anaesthetic, where the woman is awake but is given an injection into the cervix to deaden the pain,
  2. a ‘twilight’ anaesthesia, where sedation is given to make the woman very drowsy but she is awake or
  3. a general anaesthetic where the woman is unconscious during the procedure.
  • The entrance to the uterus (the cervix) is stretched open by inserting metal rods of increasing size
  • A plastic tube about 9mm wide with a sharp tip is inserted into the uterus through the cervix
  • Using a vacuum pump attached to the tubing, powerful suction is used to remove the embryo/foetus along with the placenta and the lining of the uterus
  • The walls of the uterus are then scraped with a curette – a small sharp instrument with a spoon shaped end – to check the uterus is empty.

Abortion After 12 Weeks (Late term abortion)

Abortion is less commonly performed after 12 weeks (10 weeks from conception) because of increased risk to the woman. The foetus by this stage is too large for suction aspiration and other methods may be used to bring on early labour. In late term abortions the foetus may be born dead or death may be induced just before the foetus emerges.

Abortion using drugs

RU486 is a drug that causes abortion. Only a few services in Australia are licensed to use it. It is used up until about 9 weeks of pregnancy. The drug is administered by a doctor and is followed some hours later by a second drug to start contraction of the uterus. The woman then returns home. Bleeding and cramping begins and after several days she may pass the embryo or foetus into the toilet. Sometimes the drug is not effective and the woman must have a surgical abortion to complete the procedure.

All studies show that having an abortion (like any other surgical procedure) involves some risk although in numbers this is not large.

In 2000 the overall proportion of women who reported complications was about 0.6% according to the DHS. This is a small percentage but probably does not give the whole picture.

Under-reporting of complications is part of the reason for this low figure. The clinic or hospital is required to send a Report form to the DHS within 14 days after the abortion. Any complications occurring after this time won’t be counted.

If the woman goes to a different doctor than the one who performed her abortion, the complication goes unreported. It is common for women experiencing problems after abortion to avoid the clinic or hospital where it was performed. This leads to a high level of under reporting of abortion complications.

There are physical risks and emotional risks to having an abortion. These complications can and do happen, but how frequently is not certain. Some studies show a higher incidence of complications while others show a lower incidence.

Early Physical Risks

Pre-medication Usually before a local or general anaesthetic, the patient is given a sedating medication. If a woman changes her mind at the last minute about having the abortion she may feel powerless in her sedated state to object. It is important for women to know that they are entitled to change their mind at any stage. It is important for women not to sign abortion consent forms when under the influence of medication.

General Anaesthetic A general anaesthetic always carries some risk of complication, no matter what the operation. Recovery from a general anaesthetic varies. Some people recover quickly while others are very drowsy or feel sick for some time.

Haemorrhage Bleeding after an abortion should be no heavier than a normal period. Excessive bleeding following an abortion is most commonly caused by an Adherent Placenta (where the placenta has not been completely removed). To stop the bleeding, the abortion procedure would need to be repeated to remove any missed tissue and, if the woman has lost a lot of blood, she may require a blood transfusion.

Infection It is not uncommon following any operation to have a slight rise in body temperature. A prolonged high temperature following abortion however, may be a sign of an infection of the uterus and fallopian tubes. Symptoms are not always obvious. Infection following abortion may be caused by tissue being left behind in the uterus, which becomes infected. If the woman has a sexually transmitted disease such as Chlamydia at the time of the abortion, there is a much higher risk of infection spreading. If not correctly treated with antibiotics, this infection can lead to blockage of the fallopian tubes, which is a major cause of infertility (inability to have children). Damage to the fallopian tubes also puts the woman at risk of ectopic (tubal) pregnancy .

Later Physical Complications

Future Fertility Infertility (being unable to have children) is a known risk of the abortion procedure. The risk is greater in abortions after 12 weeks and in repeat (2nd or more) abortions, but it is still a small risk in early abortions using the suction method.
The main causes of infertility following an abortion are:

  • Blocked fallopian tubes caused by infection
  • Scar tissue caused by damage to the uterus during the abortion
  • Cervical damage caused by over-stretching or tearing

Cervical Incompetence The cervix, which is normally firm and tight, may be damaged and weakened during an abortion by the metal rods, suction tubing and other instruments passed through its narrow opening. This damage can make the cervix “incompetent” (unable to hold the weight of a developing pregnancy), leading to miscarriage or premature birth in later pregnancies. Young women who have not previously given birth are at a greater risk of cervical damage.

Tubal (Ectopic) Pregnancy Inflammation or scarring of the fallopian tubes following abortion may lead to a later ectopic pregnancy (where a developing embryo implants in the fallopian tube, being unable to pass through the narrowed tube). The pregnancy cannot continue and the woman would need surgery to remove the embryo and possibly part of the fallopian tube. If not detected early enough, the pregnancy may rupture the fallopian tube causing internal bleeding. This is a life threatening condition and would require emergency surgery and blood transfusions.

Early Emotional Effects

Each individual’s response immediately after abortion is different. Here is a description of what women commonly report –

Relief Initial feelings of relief may follow an abortion as there is often a strong desire to get back to ‘normal’… as if the pregnancy had never happened.

Numbness Many women also experience feelings of numbness and emptiness, which are a common early reaction to any loss. However these feelings are a part of the early stages of the normal grief response which may later give way to stronger, more intense feelings. Because of the tendency not to talk about the abortion, these effects may be pushed aside rather than acknowledged and dealt with.

Later Emotional Effects

When we experience the loss of someone or something close, we move through a normal grieving process. In time we reach a sense of resolution and adjustment to our loss. The sympathy of friends, flowers and funerals all help us move through grief.

Abortion loss is different because it tends to be a secret event that is rarely spoken about afterwards. Often the girl may not want anyone to know she was pregnant. She may try to put it all behind her and get on with her life. Any sense of loss she may feel is often not acknowledged by her or others around her and this makes it difficult to come to terms with. Many women do not expect to feel a sense of loss. They try to return to life before the abortion but struggle with depression, tearfulness, anxiety, guilt, anger and sadness.

A girl may find these feelings occur around the date of the abortion or the date her baby would have been born. She may find it difficult to face others who are pregnant or have babies. She may also experience envy and hostility towards others with babies, which, in turn, causes her to feel guilty.

Her reactions may be to turn these feelings inwards, push them down and suffer in silence. Unresolved grief can negatively impact on the woman’s relationships with her partner/husband, children, other family members, extended family and the community. It can be years later before a resolution of her grief occurs, and sometimes the issue is never resolved. Many women talk about a deep underlying ache that is always with them.

Recent findings published in the British Medical Journal (Jan 2002) indicate that women who abort a first pregnancy are at greater risk of later long-term clinical depression. The study, begun in 1979, showed at an average of eight years after their abortions, married women were 138% more likely to be at a high risk of clinical depression compared to similar women who continued on with an unplanned pregnancy to term.

These findings are consistent with other research that has shown a 4 – 6 fold increase risk of suicide and substance abuse (alcohol, drugs) associated with a previous abortion (Reardon & Ney, 2000).

‘Replacement’ Pregnancy – turning back the clock

Some women get pregnant again often within 3 – 6 months after the abortion. This may be a conscious or unconscious attempt to ‘undo’ the abortion and turn back the clock. Many women do then proceed with the second pregnancy.

However, the number of repeat abortions is of concern as women may be drawn into a cycle they cannot break. For those who have repeat abortions the potential for difficulties (both physical and emotional) obviously increases.

How do teenagers fare in all of this?

Teenagers are particularly vulnerable to the effects of abortion. Estimates vary, but it is believed that around one in four sexually active teenage young women become pregnant by mistake (Healey, 2005). Contraceptive failure is a common factor in teenage pregnancy. About half of all teen pregnancies end in abortion.

What about the father? Where does he stand?

Men are also affected by abortion and often suffer in isolation, often feeling frightened, alone and overburdened with responsibility. Legally, the father has no say in whether or not the pregnancy continues. Yet, if the mother wants to keep the child the father is bound by law to financially provide for the child until it is an adult, whether or not he wants the pregnancy to continue.

What support is there for women to continue a pregnancy?

Open Doors offers counselling and support during and after pregnancy. Working with a counsellor can provide a woman or girl with the security of someone who is willing to be there in any difficulty and offer on-going support and practical assistance.

What support is there for anyone troubled by an abortion?

Open Doors has a specialist counselling service for anyone needing support following an abortion. Coping with an abortion can be a very lonely experience. Many young women feel very isolated with few people they can talk to. Skilled and caring listeners can help ease the pain and confusion of hidden or unresolved grief.

Most teenagers are not sexually active. There are good reasons for this choice.
Having sex can complicate single relationships. You are free to choose to have more control of your sexual and emotional health.
Remember

  • It’s OK to delay sexual activity. You don’t have to justify yourself.  Not everyone is ‘doing it’
  • Sex is worth waiting for, and so are you
  • Enjoy many friendships
  • You can have affectionate and fun times without having sex
  • Support each other and your friends in the decisions you have made
  • If someone puts the pressure on you they don’t care about you
  • Alcohol, drugs, and even your emotional state can affect your decision making
  • Have a support network of trusted adults you can talk to.

Sometimes we make mistakes about sex, especially if we are feeling down about something, or lonely and sad. Sex can seem like a promise of love and affection but afterwards we can feel really let down and used and somehow lonelier than ever. This emotional state can get in the way of making clear decisions and leave us open to risk.

REFERENCES

Thirty-first Annual Report – For the Year 2000.  Committee appointed to examine and report on abortions notified in South Australia.  Department of Human Services.
Depression and unintended pregnancy in the national Longitudinal Survey of Youth: A cohort study. David C. Reardon and Jesse R. Cougle.  British Medical Journal 324:151-151, January 2002.
Abortion and subsequent substance abuse.Reardon, D.C. and Ney, P.G.  American Journal Drug Alcohol Abuse, 2000; 26(1): 61-75.
The Abortion Issue (2005) Edited by Justin Healey, The Spinney Press.