Abortion; the logic behind legalization.

Introduction

Abortion is the expulsion of a fetus from the uterus before it has reached the stage of viability (in human beings, usually about the 20th week of gestation). An abortion may occur spontaneously, in which case it is also called a miscarriage, or it may be brought on purposefully, in which case it is often called an induced abortion.₁

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The legal argument about abortion concerns induced abortion, but there are some nuances about spontaneous abortion that should be discussed.

Spontaneous abortions, or miscarriages, occur for many reasons, including disease, trauma, genetic defect, or biochemical incompatibility of mother and fetus.₁

Types of Miscarriage

The different types of miscarriages have peculiar features which distinguishes them from the other and also influences their outcome and prognosis.

Threatened Miscarriage
A threatened miscarriage refers to vaginal bleeding that occurs during the first 20 weeks of pregnancy. It does not necessarily mean your pregnancy will end in a miscarriage — around half of threatened miscarriages result in a live birth.

Signs and Symptoms: Other symptoms of threatened miscarriage include lower back pain and abdominal cramps. If you have experienced unexplained bleeding during pregnancy, your doctor will want to perform an examination.

Cervix Dilation: In a threatened miscarriage, the cervix will remain closed. However, if an examination reveals the cervix has opened, a miscarriage is much more likely.

Inevitable Miscarriage
Inevitable miscarriage refers to unexplained vaginal bleeding and abdominal pain during early pregnancy.

Signs and Symptoms: Bleeding is heavier than with a threatened miscarriage and abdominal cramps more severe.

Cervix Dilation: Unlike threatened miscarriage, an inevitable miscarriage is also accompanied by dilation of the cervical canal. The open cervix is a sign that the body is in the process of miscarrying the pregnancy.

Incomplete Abortion
An incomplete abortion, which is also called an incomplete miscarriage, happens when some—but not all—of the pregnancy tissue is passed.

Signs and Symptoms: It is often accompanied by heavy vaginal bleeding and intense abdominal pain.

Cervix Dilation: The cervix will be open, and some remaining pregnancy tissue will be found in the uterus during an examination.

Complete Miscarriage
A complete miscarriage, also called a complete abortion, refers to a miscarriage in which all of the pregnancy tissue is expelled from the uterus.

Signs & Symptoms: A complete miscarriage is characterized by heavy vaginal bleeding, severe abdominal pain, and passage of pregnancy tissue. With a complete miscarriage, the bleeding and pain should subside quickly. Complete miscarriages can be confirmed through an ultrasound.₂

Cervix Dilation: The cervix will be open, then closed.

Missed miscarriage
In a missed miscarriage, the placental and embryonic tissues remain in the uterus, but the embryo has died or was never formed.₃

Signs and Symptoms: If you have a missed miscarriage, you may have a brownish discharge. Some of the symptoms of pregnancy, such as nausea and tiredness, may have faded. You might have noticed nothing unusual.₄

Cervix Dilation: The cervix will be closed.

The Unwanted Necessity
A spontaneous miscarriage is usually a very sad experience for the mother and family. However, induced miscarriage, though deliberate, may also be an unwanted necessity and a sad event.

According to Dr. Duke, a medical emergency is determined by a physician or health care professional, not by the state, and there are multiple medical conditions that could result in a medically necessary abortion.

One common reason is the effect of pregnancy on the heart, specifically the tremendous strain it can place on it by disrupting blood flow and increasing the risk of blood clots from elevated hormones. "Some people are medically in conditions where that would be too much for their system and so it's either terminating a pregnancy or basically signing a personal death warrant," said Dr. Duke.

Ectopic pregnancies—during which a fertilized egg implants itself outside of the uterus (mainly in one of the fallopian tubes)—are another example of medical emergencies. Ectopic pregnancies only occur in 1%-2% of pregnancies, but make up about 2.7% of all pregnancy-related deaths. A fetus cannot survive an ectopic pregnancy, which, left untreated for too long, can be harmful or fatal for the pregnant person.

According to the Kaiser Family Foundation, other life-threatening conditions for the pregnant person include: severe preeclampsia, newly diagnosed cancer that needs treatment right away, and an intrauterine infection known as chorioamnionitis following a premature rupture of the amniotic sac. A placental abruption, in which the placenta separates from the uterine lining, may also be considered a medical emergency in some cases of extensive bleeding.

Still too, lethal fetal abnormalities may lead to a nonviable pregnancy during which abortion may be preferred. According to Dr. Duke, when health care providers discover abnormalities that would make the fetus incompatible with life, parents may choose to compassionately terminate the pregnancy to prevent the fetus from being born only to pass shortly after. These fetal abnormalities—which may only be detected on a 20-week fetal anatomy scan—include anencephaly (an underdeveloped brain and incomplete skull), renal agenesis (absence of one or both kidneys), and hydrops fetalis (extensive fluid build-up and swelling).₅

Methods of Abortion
Abortions methods fall into two major categories; medical abortions and surgical abortions. Which type of abortion is used to terminate a pregnancy will depend on which one the woman is most comfortable with, the recommendation of the doctor, and the length of time since the woman’s last menstrual cycle. Some abortion methods can only be performed within the first trimester, while others can be done safely in the second or (in extreme cases) the third trimester.₉

These methods include;

• Non-surgical (Medical Abortion)
• Vacuum Aspiration
• Dilation & Curettage (D&C)
• Dilation and Evacuation (D&E)
• Labor Induction (also called induction abortion)
• Hysterotomy (similar to a C-Section)

Abortion Pill and Mifepristone
Approximately 4 to 7 weeks after the start of the LMP (Last Menstrual Period)
This drug is only approved for women up to the 49th day after the start of their last menstrual period.

The procedure usually requires three office visits. On the first visit, the woman is given pills that cause the death of the embryo. Two days later, if the abortion has not occurred, she is given a second drug which induces something similar to contractions, causing the body to expel the embryo.

The last visit is to determine if the procedure has been completed. The abortion pill will not work in the case of an ectopic pregnancy.₁₀

Vacuum Aspiration
Vacuum Aspiration is normally performed under local anesthetic. During the procedure, the doctor will insert a speculum (a simple instrument used to make a part accessible to observation) into the vagina and cervix.

A thin tube connected with a handheld syringe will then be inserted into the uterus through the cervix. The doctor will operate the syringe to suction the tissue from the uterus. This is called a Manual Vacuum Aspiration. Sometimes a mechanical suctioning device is used and this is called simply Vacuum Aspiration.

During a vacuum aspiration the uterus will contract producing a cramping sensation in most women. When the tube is withdrawn, these cramps subside. At times, during the procedure, the woman may sweat, get nauseous, or feel faint.

This abortion procedure used from 3 weeks to 12 weeks since the last period. As it is with other different types of abortion, the sooner in the pregnancy this is performed, the better.₉

Dilatation and Curettage
Approximately 7 to 12 weeks after LMP
This surgical abortion is done early in the pregnancy, up until 12 weeks after the woman’s last menstrual period. The cervix is dilated, the curettage tool is inserted and the developing fetus is “scraped” out from the uterus.₁₀

Dilation and Evacuation (D&E)
Approximately 13 to 24 weeks after LMP
This surgical abortion is done during the second trimester of pregnancy. At this point in the pregnancy, the fetus is too large to be broken up by suction alone and will not pass through the suction tubing.

In this procedure, the cervix must be opened wider than in a first trimester abortion. This is done by inserting numerous thin rods made of seaweed (called laminaria) a day or two before the abortion. Once the cervix is stretched open the doctor pulls out the fetal parts with forceps.

The fetus’ skull is crushed to ease removal. A sharp tool (called a curette) is also used to scrape out the contents of the uterus, removing any remaining tissue.₁₀

Labor Induction
After a certain point in pregnancy (usually around 24 weeks), a dilation and evacuation (D&E) procedure can no longer be performed and an induction abortion or a hysterotomy are the only options.

A small number of abortions are done by inducing labor with drugs, a procedure called induction abortion or a labor induction abortion. The procedure usually takes place in a specialized facility or hospital.

As the name implies, induction abortion involves medications that cause (induce) the uterus to contract and expel the pregnancy.
Once the contraction have been induced mild cramping normally occurs, getting stronger and then easing off. The strength and intensity of this cramping varies. Each person is different.

When the amniotic sac breaks there will be a rush of warm liquid expelled through the vagina. More pressure will follow as the fetus is expelled. If the placenta does not come out on its own within a few hours, the doctor will remove it.

Painful contractions can last for several hours or even a day or so. This type of abortion is completely effective.₉

Hysterotomy
Hysterotomy, the surgical removal of the uterine contents, may be used during the second trimester or later.₁₁

It is done usually from the 24th week and beyond. The procedure is similar to a caesarean section, but with no expectancy of a live birth. This surgery is performed under general anesthetic or a local anesthetic which numbs the entire lower part of the body.

Pain medications will be given as needed following the operation. This method is completely effective, however, due to the extensiveness of the surgery, it is considered an abortion method of last resort.₉

The Danger
Induced abortion for the reason of an unwanted pregnancy is frowned upon on several bases and that's the issue I would like to address. Statistically, it's been shown that the danger is not with abortion in itself, but in the deleterious practice of unsafe abortion.

A study has shown that legal induced abortion is even safer that childbirth itself.

Legal induced abortion is markedly safer than childbirth. The risk of death associated with childbirth is approximately 14 times higher than that with abortion. Similarly, the overall morbidity associated with childbirth exceeds that with abortion.₆

In contrary to the mortality rate of legal induced abortion, unsafe abortion has a very high mortality rate, which in many experts opinion, is one of the lead causes of unnecessary maternal mortality.

According to the World Health Organization (WHO), every 8 minutes a woman in a developing nation will die of complications arising from an unsafe abortion. An unsafe abortion is defined as “a procedure for terminating an unintended pregnancy carried out either by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both.₇

It is also believed that the magnitude of the problem isn't well appreciated as most of these procedures are done quietly and undocumented.

Obtaining accurate data for abortions is challenging, and especially so for unsafe abortion. Two-thirds of nations do not have the capacity to collect data, and data collection varies from country to country in both quantity and quality. Because unsafe abortion is often done clandestinely by untrained individuals or by the pregnant women themselves, much of it goes undocumented; figures are therefore estimates. Data suggest that even as the overall abortion rate has declined, the proportion of unsafe abortion is on the rise, especially in developing nations. From 1995 to 2003, the overall number of abortions declined, but the unsafe abortion rate was steady (from 15 to 14 abortions per 1000 women, respectively), constituting an increase from 44% to 48%.₇

The numbers are quite clear, unsafe abortion is the real problem and not abortion.

Unsafe abortion is one of the five major causes of maternal mortality and accounts for 13% of maternal deaths globally but up to 50% in sub-Saharan Africa.₈

What's the difference between the safe legal induced abortion and the killer unsafe abortion? legislation.
Abortion has been legalized is several places and this legislation has been shown to reduce abortion-related maternal mortality to the bare minimum.

Some governments, still believe abortion is wrong for one reason or the other and have subjected their citizens to take the unsafe route which has resulted in millions of unnecessary deaths.

Conclusion
Over the years, it has been proven that these unsafe procedures are not discouraged by their illegal status, only an unnecessary index of maternal mortality. it is my opinion that the people's lives should trump any moral high ground and their health and safety be prioritized.

References

1. https://www.britannica.com/science/abortion-pregnancy
2. https://progyny.com/education/female-infertility/types-miscarriage/
3. https://www.mayoclinic.org/diseases-conditions/pregnancy-loss-miscarriage/diagnosis-treatment/drc-20354304#:~:text=In%20a%20missed%20miscarriage%2C%20the,miscarriages%20occurring%20before%2012%20weeks.
4. https://www.pregnancybirthbaby.org.au/miscarriage
5. https://www.health.com/news/abortion-medically-necessary
6. https://pubmed.ncbi.nlm.nih.gov/22270271/#:~:text=The%20mortality%20rate%20related%20to,with%20childbirth%20than%20with%20abortion
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2709326/
8. https://www.data4impactproject.org/prh/womens-health/postabortion-care/percent-of-deaths-related-to-unsafe-abortion/
9. https://eastsidegynecology.com/blog/different-types-of-abortion/
10. https://pregnancylansing.com/abortion/methods/
11. https://www.britannica.com/science/hysterotomy