Surgical abortion refers to abortion done using surgical instruments. Procedures vary due to the stage of the pregnancy and size of the fetus at the time of the abortion.
- Suction Aspiration (surgical aspiration, vacuum abortion, suction dilation and curettage (D&C))
- Menstrual Aspiration (menstrual extraction, manual aspiration)
- Dilation and Evacuation
- Dilation and Extraction (D&X) (intact D&E, partial birth abortion)
- Surgical Dilation and Curettage (D&C)
- Hysterotomy and Hysterectomy Suction Aspiration (surgical aspiration, vacuum abortion, suction dilation and curettage (D&C))
- Partial Birth Abortion (D&X)
The Suction Aspiration method is the most common method of abortion used in Canadian abortion clinics and hospitals. Used generally between six and 14 weeks of pregnancy, the cervical muscle is stretched open. A hollow plastic tube with a knife like edge is inserted into the uterus. The suction machine then tears the baby’s body into pieces. These pieces are sucked through the tube and collected into a bottle. Often a sharp loop-shaped knife called a curette is then inserted into the uterus to loosen any remaining tissue so that it can be suctioned out. When the suctioning is finished, the abortionist must examine the fetal parts and tissue to see if the abortion is complete. 2,3,4
Menstrual Aspiration – Also known as menstrual extraction or manual aspiration
In 2004, less than 1% of abortions reported in Canada used this method. 5 Before abortion was legalized, the term ‘menstrual extraction’ was used to disguise the performance of an early suction abortion up to seven weeks’ gestation, sometimes even before a pregnancy was confirmed. The term is misleading, since either the embryo (if the woman is pregnant), or the uterine lining (if she is not pregnant) is suctioned out. Currently, menstrual aspiration refers to an early abortion from three to 10 weeks’ gestation, using a syringe for suction. A thin hollow tube is inserted into the slightly dilated cervix. The tube is attached to a large syringe and the embryo is suctioned out. 6,7
Dilation and Evacuation (D&E)
Statistics are not clear on how many D&E abortions occur in Canada each year. In 2004, at least 11% of abortions in Canada occurred after 13 weeks’ gestation. 8 In the US, the majority of abortions that occur after 13 weeks are performed using a variation of this method.9
The D&E method refers to an abortion done using forceps to dismember and extract the fetus instead of, or together with, suction. In reality, a combination of methods is generally used in abortion after 13 weeks. As the fetus grows larger and its bones become harder, the fetus becomes more difficult to extract. The cervix must be opened wider, and the head of the fetus is large and must be crushed before it can be removed. Bone fragments are sharp and must be carefully removed to avoid damage to the uterus and cervix. The fetal parts removed must be identified to make sure the abortion is complete and no parts are left in the uterus. Suction is used for a final clean out of any bits of fetal or placental tissue that may remain. 10,11 Sometimes medications such as digoxin or potassium chloride are injected into the fetus through the woman’s abdomen, to kill it before the D&E procedure. 12
After 19 to 20 weeks, a solution of urea or saline is sometimes injected into the amniotic sac before the abortion. This kills the fetus and stimulates contractions. Urea also begins the breakdown of fetal bones and other tissue to make removal of the parts easier for the abortionist and less painful for the mother.13 Oxytocin may be used to stimulate contractions and bring about delivery of the fetus.14
Prostaglandin is a hormone that induces labor. The baby usually dies from the trauma of delivery.
This method is done after the 16th week of pregnancy. A large needle is inserted into the abdominal wall of the mother and into the baby’s amniotic sac. A concentrated salt solution is injected into the the amniotic fluid. The baby breathes and swallows it, is poisoned, struggles, and sometimes convulses. It takes over an hour to kill the baby. When successful, the mother goes into labour and about a day later delivers a dead baby.
Dilation and Evacuation – Also known as dilation and Evacuation (D&X) (intact D&E, partial birth abortion)
There are no laws in Canada restricting abortion. Since abortion reporting and recording is inconsistent and incomplete across Canada, it is not known if, or how many, abortions occur by this method in Canada each year. D&X abortion is a variation of the D&E method, and is used after the first 20 weeks of pregnancy. The Canadian Medical Association considers a child viable after 20 weeks gestation. Laminaria treatment over several days causes wide cervical dilation. The abortionist, guided by ultrasound, uses forceps to grasp the fetus and position it face down and feet first. The fetus, intact and often still alive at this point, is delivered up to the head. The head is too big to pass through the cervix. After puncturing the base of the skull, the brain is suctioned out, the skull collapses, and the dead fetus is delivered. Digoxin, potassium chloride, saline or urea are sometimes used to kill the fetus before delivery.15
Surgical Dilatation and Curettage (D&C)
Approximately 6% of abortions reported in Canada in 2004 used this method.16 Local or general anesthetic is given to the mother before her cervix is dilated. The cervix is dilated with laminaria or rigid dilators; sometimes, the prostaglandin Misoprostol is also given to soften and dilate the cervix. A loop-shaped knife called a curette is inserted through the cervix. The curette cuts the fetus and its placenta from the uterine wall and breaks it up. Then the fetal parts and the placenta are scraped out of the uterus through the cervix and discarded.17 Hysterotomy and Hysterectomy Hysterotomy refers to a caesarean delivery as an abortion method. The woman’s abdomen and uterus are opened surgically. The fetus is lifted out, the placenta is delivered and the umbilical cord is clamped. If no chemical has been injected to kill the fetus prior to this point, the fetus is often still alive. Hysterotomy is sometimes used in situations where there is a uterine abnormality, which would make the more common abortion methods difficult or impossible. Hysterectomy is the removal of the uterus. When used as abortion methods, these procedures have a higher risk of major complications and death than any other method.References 1.Health Care Statistics Section, Health Statistics Division. “Therapeutic Abortion Survey, June 2007: 2004-A.” 2.Hern WM. “Abortion Practice.” J.B. Lippincott Company, 1984: 108-120. 3.Stubblefield PG, Carr-Ellis S, Borgatta L. “Methods for induced abortion.” Obstetrics and Gynecology 2004;104: 174-177. 4.Grimes DA and Creinin MD. “Induced abortion: an overview for internists.” Annals of Internal Medicine 2004;140: 621-622. 5.Health Care Statistics. “Therapeutic Abortion Survey,” 2007. 6.Hern. p. 120-122. 7.Stubblefield. et al. p. 175. 8.Health Care Statistics. “Therapeutic Abortion Survey,” 2007. 9.Stubblefield. et al. p. 178. 10.Hern. p. 137-156. 11.Stubblefield. et al. p. 177-179. 12.Stubblefield. et al. p. 178-180. 13.Hern. p. 144-146. 14.Stubblefield. et al. p. 178. 15.Stubblefield. et al. p. 178. 16.Health Care Statistics. “Therapeutic Abortion Survey,” 2007. 17.Hern. p. 116-117.