Induced Abortion, Chapter 14 PDF

CHAPTER 14 Induced Abortion Induced Abortion An induced abortion is one in which an implanted embryo is terminated through artificial means. This is a VERY divisive topic. https://www.cbc.ca/news/canada/manitoba/hundreds-rallyin-anti-abortion-event-manitoba-march-for-life-1.2638574 The availabil...

CHAPTER 14 Induced Abortion Induced Abortion An induced abortion is one in which an implanted embryo is terminated through artificial means. This is a VERY divisive topic. https://www.cbc.ca/news/canada/manitoba/hundreds-rallyin-anti-abortion-event-manitoba-march-for-life-1.2638574 The availability of induced abortion services varies widely around the world. Up to 45% of abortions worldwide are perform under unsafe conditions and/or illegally. https://www.winnipegfreepress.com/breakingnews/2019/10 /07/handmaids-appear-at-anti-abortion-rally History in Canada Information sourced from: https://nafcanada.org/history-abortioncanada/, https://www.jogc.com/article/S1701-2163(19)307376/fulltext , https://www.arcc-cdac.ca/media/position-papers/60History-Abortion-Canada.pdf, https://web2.gov.mb.ca/bills/414/b200e.php The first legal introduction to abortion in Canada came in 1969. Only performed in hospital for safety/health of carrier. At this time many hospitals and medical professionals still refused to provide abortions. 1982, Canada enacts the Charter of Rights and Freedoms. In 1988, Supreme court strikes down the original law. Canada becomes a country without specific laws against abortion. 1989, Sperm donor has no legal right to veto a carrier’s abortion decision. 1995 ruling forces provinces to allow private abortion clinics. 2010s rulings and regulations regarding protestors around abortion clinics comes into play (this is built into Manitoba’s legislation). Late 2010s/early 2020s, several provinces pass Acts for protecting access to reproductive heath care (Bill 200 passed in 2018-2019 in Manitoba). Statistics (in Canada) Information sourced from: https://www.arcccdac.ca/media/2020/07/statistics-abortion-incanada.pdf, https://www.cihi.ca/en/induced-abortionsin-canada Rates of abortions in Canada have been declining for several decades. More surgical abortions are performed than medication abortions. >60% of Abortions are performed within the 1st trimester. Less than 5% are performed after 19 weeks. Over 97% of abortions performed in Canada result in no complications. Most abortions are performed for individuals between the ages of 18-34. Abortions over the age of 34 are more common than under the age of 18. https://www.arcc-cdac.ca/media/2020/07/statistics-abortion-in-canada.pdf Rationale Behind Abortions Individuals seek out an induced abortion for a variety of reasons. The most common include: • Risk of health or life for the carrier (therapeutic abortion) • Determination of substantial fetal abnormalities • Unwanted pregnancy Abortion is often a decision which is made after careful consideration to many different factors. Access to appropriate care, persecution, and cost are factors many people outside of Canada must consider when seeking out an induced abortion First Trimester Induced Abortions An induced abortion performed during the first 12 weeks of development is considered the most safe and easiest to perform with little risk of complication. Two major categories: surgical (physical removal) and medication. The carriers health must be examined prior to an induced abortion to check for potential conflicts with medications, and negative side effects such as inducing Rhesus factor incompatibility. Vacuum Aspiration This is the most commonly performed method of induced abortion within the first trimester. In Manitoba, an aspiration abortion can be performed up to 14 weeks (from fertilization). An anesthetic is used to number the cervical wall and a vacurette is inserted into the uterus. This applies suction to remove the implanted embryo/fetus. A version of this, menstrual regulation, involves manual vacuum aspiration, and is generally performed closer to the time of the missed menstrual period. Performed in many places around the world where abortions are illegal. Human Reproductive Biology, 4th Ed. (2014) pg. 276 Dilation and Curettage A.k.a a D&C procedure. Generally performed later into the 1st trimester/early second trimester. Involves the scrapping away of fetal growth with a curette. Human Reproductive Biology, 4th Ed. (2014) pg. 277 In order to access the uterus, the cervix must be dilated. This use to be performed with a metal device, but now a laminaria tents or inflatable rubber balloons are used. Medication Induced Medication abortions are those which involved no surgical intervention. Earliest methods used prostaglandins (misoprostol) to cause uterine contractions and disrupt attachment. In 2015, mifepristone became available to use in Canada. This drug prevents fetal growth and disrupts implantation. Methotrexate + misoprostol is another medicinal combination used to induce abortion up to 7 weeks Human Reproductive Biology, 4th Ed. (2014) pg. 276 Second Trimester Abortions Second trimester abortions include those performed between weeks 11-22 after fertilization. The longer a pregnancy is sustained, the greater the associated risks with inducing a termination. Carrier death rate from induced abortion increases after 17 weeks of development. <20% of abortions in Canada occur within the second trimester. Dilation and Evacuation A.k.a a D&E procedure This is the most common process used to performed a second trimester abortion. As with a D&C, the cervix is dilated and then the uterine contents are removed with a combination of suction, scrapping, and grabbing extraction. Often anesthetics and analgesics are used. Typically takes around 30 minutes to perform. Often used after a miscarriage to make sure the uterus is cleared of all fetal growth. Intra-Amnionic Saline This is a very uncommon procedure. The cervix is dilated and then a needle is inserted through the abdomen, into the amniotic sac. This needle removes some amniotic fluid. The amniotic fluid is replaced with saline. This kills the growing fetus. Labour is then induced in order to deliver the fetus. Probability of complications, to both the carrier and with the efficacy of the method, are high. Human Reproductive Biology, 4th Ed. (2014) pg. 280 Prostaglandin Injections Prostaglandin injections can be used both in first trimester and second trimester terminations, however use in second trimester is not approved in Canada. Where it is used as a method of second trimester abortion, the carrier will be induced to deliver the fetus 6-8 hrs later. As with the intra-amnionic saline, the need to deliver the non-viable fetus can be psychologically (and physically) difficult. Dilation and Extraction Intact dilation and extraction ( a.k.a a D&X procedure) is only performed after 18 weeks of development (end of second trimester/into third trimester). During this procedure labour is induced and the fetus is partially delivered feet first. The fetal brain is then removed via suction. The entire fetus is then removed. This procedure is generally only performed when the fetus is already deceased, severe hydrocephaly is found, or the carrier’s life is in imminent danger. This is generally not considered an elective procedure. Third Trimester Induced Abortions Third trimester abortions are extremely rare and not generally performed in Canada. These are abortions which take place after 22 weeks of development, when a fetus is at/close to viability with medical intervention. Under the most extreme circumstances, a hysterotomy may be performed. This is similar to a c-section, and at times the removed fetus is alive. This poses very high risk for the carrier in terms of complications and death. Folk Abortifacients For most of history, abortions were performed using all manner of medicinal herbs, physical trauma, and cultural practices. In many places around the world lack of access, affordability, and appropriate education causes individuals to seek alternative methods for inducing an abortion. https://www.cancer.gov/about-cancer/causesprevention/research/aspirin-cancer-risk Some alternative methods include • High doses of medicinal herbs (pennyroyal) • High doses of therapeutic and nontherapeutic drugs • Self inflicted physical trauma to abdomen • Injection of caustic/toxic agents into the body • Prayer and magic Safety and Consequences Induced abortions are a very common procedure. It is estimated that 1/3 people with a uterus in Canada will have an induced abortion at some point in their lives. Greater availability and information about induced abortions has helped to prevent harm/deaths associated with illegal/home abortions. Generally, an induced abortion does not affect a person’s future ability to become pregnant. Most people will ovulated within a few weeks of having an abortion. Lasting negative psychological systems from deciding (or needing) to have an abortion are typically minimal, and affect those with previous depression symptoms at higher rates.