Disposal of Aborted Fetal Remains

What are “Aborted Fetal Remains”?

Aborted fetal remains include all the body parts of a fetus who has been killed by abortion. In some cases, the fetus will be all in one piece. In other cases, especially second-term abortions, the fetus is dismembered for ease of delivery.

How are Aborted Fetal Remains disposed of currently?

State by State

There are no federal laws specifically concerning aborted fetal tissue disposal. This issue has historically been legislated by each state. Today, aborted fetal remains laws are a mix of state health codes, statutes, and regulations, according to a report released by the Charlotte Lozier Institute. [1]

Methods of Disposal

Former abortion clinic workers have described fetal body parts, including parts of larger babies aborted in the second trimester, being flushed down toilets. Those body parts end up in the city sewage system. [2] Fetal remains have been stored in freezers, and later incinerated. [3] They have been dumped in landfills. [4] One grotesque news story from Oregon reported aborted fetal remains being burned to provide energy for homes. [5] In another grisly news report, an abortion doctor carried around 15 jars of aborted babies in his trunk.

Renee Chelian

Michigan abortion clinic worker Renee Chelian [6], was a panelist at a 2015 National Abortion Federation Conference. [7] She spoke about storing fetal body parts in abortion clinic freezers for 5 months after her fetal remains and medical waste disposal company “fired us.”

She joked: “We were really tempted to give the fetus back. Um, we thought, we’ll give it to everybody in a gift bag – they can take it home, figure out what to do with it. It’s their pregnancy, and why is this our problem?”

Unborn Infants Dignity Act (UIDA)

The Unborn Infants Dignity Act (UIDA) is legislation drafted by Americans United for Life, and has been proposed in 28 states since 2016. [8] Americans United for Life is a pro-life public interest law firm founded in 1971. They “provide state lawmakers, state attorneys general, public policy groups, lobbyists, the media, and others involved in the cause for life with proven legal strategies and tools that will, step by step and state by state, lead to a more pro-life America.” [9]

The goal of UIDA laws is the humane disposal of human fetal remains.
Abortion rights supporters have claimed that this law would require burial of any fetus, regardless of gestational age or size. Others have stated that the law would require women who miscarry or abort at home to bring in their baby’s remains in a jar. In reality, UIDA legislation mandates that the bodily remains of aborted babies “who have reached a stage of development so that there are cartilaginous structures and/or fetal or skeletal parts and who are ‘expelled or extracted’ at an institution must be either cremated or buried.” [10]

Some states’ UIDA laws only apply to aborted babies. Others include stillborn or miscarried or both stillborn and miscarried babies. An example of Indiana’s UIDA law is here.

Why Should We Care?

In 2016, Indiana enacted a version of UIDA. Christopher Cooke, superintendent of cemeteries in Fort Wayne, stated in an article for The Atlantic: “Everyone deserves to go through the grief and loss process with dignity, from the individual we’re putting in the ground … to the family and friends who are paying their respects. This is a chance to give those individuals who don’t have anyone to fight for them the dignity and respect to go through a burial.” [11]

Objections

Some opponents of UIDA laws argue that because fetuses are not considered humans by the law while alive, they should not be after death. As detailed here, both federal and state laws recognize that a fetus is a human being. Examples of federal laws include the 2002 Born-Alive Infant Protection Act, 2003 Partial-Birth Abortion Act, and the 2004 Unborn Victims of Violence Act. Certainly, it’s contradictory to have laws that ban the murder of human beings, laws that acknowledge that fetuses are human beings, and laws that allow the killing of fetuses. However, the claim that current state and federal laws do not recognize the humanity of a preborn baby is false.

A complete listing of objections and AUL responses is here.

Recent Rulings on UIDA Legislation

Texas

In Texas in September, 2018, a federal judge struck down a version of the UIDA with a permanent injunction. This means that the law will not be enforced. In his ruling, Judge David Ezra stated that the law imposed “significant burdens on women seeking an abortion.” [12]

It’s unclear what burdens he was referring to because women seeking abortions would not incur any additional financial cost due to the law. Instead, each abortion clinic would be financially responsible for any costs of cremation and burial or interment of ashes. In the Texas case, the plaintiff agreed that cost was not even a factor in whether the law should be upheld or not. Furthermore, the Texas Conference of Catholic Bishops offered to provide free fetal burial services to any hospital or abortion center in the state.

Though UIDA laws do not financially burden women seeking abortions, abortion supporters consider this type of law ‘burdensome’ because it: “increases the grief, stigma, shame, and distress of women experiencing an abortion.” [13] One wonders: if abortion is not the taking of a human life, what is there to be distressed about?

In response to Judge Ezra’s ruling, Joe Pojman of Texas Alliance for Life stated: “The unfortunate reality is that abortion will remain readily available in Texas and will occur tens of thousands of times every year. This law merely requires that the dignity of the unborn child is recognized after abortion and that their remains are not treated as medical waste.” [14]

Indiana

Separately in Indiana, the 2016 UIDA law mentioned above was challenged by Planned Parenthood. Americans United for Life (AUL) filed a “friend of the court” brief requesting that the Supreme Court hear this case because it has implications nationally. The Indiana UIDA law’s constitutionality affects similar laws on the books or being proposed across the country. [15] [16]

AUL’s brief noted that the humanity of the preborn human fetus has been acknowledged in such various areas of United States law as: tort law, guardianship law, healthcare law, property law, and family law.

Additionally, nearly all states have wrongful death statutes covering the death of a preborn human fetus or a fetus who is born but later dies from in utero injuries.

Finally, United States law has protections for survivors of failed abortions, also known as the 2002 Born-Alive Infant Protection Act, as well as a ban on intact D&X or dilation and extraction or partial-birth abortions.

What’s Really at Stake?

UIDA laws really get at the heart of the question:when does life begin? That is why abortion rights proponents are so offended by UIDA laws. If fetuses were not human beings, then their disposal would be the same as any other biohazardous waste from a doctor’s office or hospital, etc.

Since abortion clinics absorb the cost, not the pregnant woman, abortion proponents cannot object to the law for financial reasons (see Indiana case above). They object to the requirement that each pregnant patient and abortion clinic staff counselor have to address the humanity of the unborn child by deciding how to dispose of its dead body.

Tanya Marsh, a law professor at Wake Forest University, summed up the importance of UIDA laws this way for the 2016 The Atlantic article: “The most important impact of this law is taking another step toward recognizing fetuses as humans. That’s a philosophical goal of the law. It doesn’t have to do anything else except sit on the books and start to impact the way people think about it.” [17]

Abortion Clinic Violence

The way many abortion advocates tell it, pro-life individuals are modern-day domestic terrorists. They report near-constant “harrassment“and even violence toward abortion clinic doctors and staff, as well as the women coming for abortions themselves. Are their claims true? Or are they exaggerated or even fabricated stories trumped up for political motives? Is being anti-abortion the same thing as being pro-life?

Before we continue, we must make one thing clear: we are against violence of any kind including against those in the abortion industry. If we want respect for life in the womb, we must also respect all lives involved in abortion.

What is “Abortion Violence”?

“Abortion violence” includes a broad range of activities and actions, according to several abortion rights organizations like the National Abortion Federation (NAF) and the Feminist Majority Foundation. For instance, they consider posting a pro-life comment on a pro-choice social media page “harassment,” reportable as “abortion violence” in national surveys.

Survey Says

The NAF tracks “abortion clinic violence and disruption”. They send out a questionnaire annually to all known abortion clinics and then release a report of their findings. Their annual report has three categories: violence, disruption, and clinic blockades, tracked over four time periods: 1977-1989, 1990-1999. 2000-2009, and 2010-2017. Their latest report does not state how many clinics responded.

NAF report: Violence

The Violence category includes: murder, attempted murder, bombing, arson, attempted bombing/arson, invasion, vandalism, trespassing, butyric acid attacks, anthrax/bioterrorism threats, assault and battery, death threats or threats of harm, kidnapping, burglary, and stalking. Of note, several of these categories have had between zero and three events reported since 2000. Also of note, trespassing includes any person entering an abortion facility with the intent to dissuade patients from going through with the procedure, regardless of whether they are doing so peacefully.

NAF Report: Disruption

The Disruption category includes: Hate Mail or Harrassing Calls, Hate Email or Internet Harrassment, Hoax Devices/Suspicious Packages, Bomb Threats, Picketing, and Obstruction. For clarification purposes, Hate Mail or Harrassing Calls along with Hate Email or Internet Harrassment includes any mail or phone call or e-mail or internet posting to a pro-abortion organization or clinic which does not support abortion and/or encourages abortion clinic workers to consider quitting.

Picketing includes any person standing outside or nearby a facility where abortions are performed, regardless of whether they are praying out loud or shouting or standing silently or attempting to speak to clinic staff or patients. In short, anyone present outside of an abortion facility who does not support abortion is considered a picketer. According to Reports of picketing are far and away the most reported form of disruption.

Obstruction includes various methods of attempting to delay business operations at an abortion facility. This could include linking arms to block the doorway of a clinic, blocking the driveway of a clinic, or otherwise physically blocking entry.

NAF Report: Clinic Blockades

The third category, Clinic Blockades, includes Clinic Incidents and Clinic Arrests. Clinic Incidents is not defined in the report, but perhaps refers to times that an abortion facility called law enforcement? Clinic Arrests refers to a total number of arrests, and the report notes that “Many blockaders are arrested multiple times.”

The full report is here.

National Clinic Violence Survey

The Feminist Majority Foundation conducts a yearly survey of abortion clinics encouraging them to self-report “anti-abortion violence, intimidation, and harassment of abortion providers.” Their 2018 survey contacted 729 abortion clinics and 219 responded, for a response rate of 30%.

According to their report, 24% of the 219 clinics reported at least one incident of severe violence OR threat of severe violence as defined below. They classified as severe violence: “blocking clinic access (also known as blockades), invasions, bombings, arson, chemical attacks, stalking, physical violence, gunfire, bomb threats, death threats, arson threats, as well as other incidences of severe violence.” The most common form of severe violence was “blocking clinic access.” 9.1% of respondents reported it. Stalking was second most common, reported by 7.3% of respondents, followed by “invasions,” (called “trespassing” in the NAF report above) reported by 6.8%.

Categorizing “blockades” and “invasions” as “severe violence” seems disingenuous, given that these types of activities did not cause physical harm to anyone anywhere during 2018. See more on invasions below.

Abortion Restrictions and Rates of Violence or Disruption

Do states with more abortion restrictions have higher rates of abortion clinic violence and disruption? A 2012 article in the medical journal Contraception examined this question. They analyzed self-reported responses from the Feminist Majority Foundation’s 2010 National Clinic Violence Survey.

They found that states with more restrictive abortion laws had more acts of “harrassment” and/or minor vandalism than states with less restrictive abortion laws. Harassment was defined as “videotaping or photographing patients, approaching or blocking cars, recording patients’ license plates, making threatening phone calls, filing frivolous lawsuits, creating noise disturbances, forming clinic blockades, and posting patient or staff information on the Internet.”

Fact vs. Fiction

Unfortunately, it is all too true that 11 abortion providers or clinic workers have been murdered in the last 30 years. 7 murders occurred in the 1990s, 1 in 2009, and 3 during one incident in 2015. [3] Their deaths are horrific, unconscionable, unjustifiable. Violence of any kind is in direct opposition to the reverence for every human life that the pro-life movement represents. There can be no exceptions to respect and care for the dignity of each person’s life.

Murders at Abortion Clinics

2015 Garrett Swasey, Ke’Arre Stewart, and Jennifer Markovsky

2009 Dr George Tiller

1998 Barnett Slepian

1998 Robert Sanderson

1994 Leanne Nichols and Shannon Lowney

1994 Dr John Bayard Britton and his bodyguard James Barrett

1993 Dr Dravid Gunn

Documented Incidents of Violence

The NAF and Feminist Majority Foundation conclude that all acts of violence or harrassment that occur at abortion clinics or towards abortion clinic staff are by pro-life individuals. They further imply that the individuals who pray on the sidewalk in front of their hometown abortion clinics are the same individuals who go and vandalize clinics or (attempt to) harm workers. A sampling of recent documented incidents of violence or vandalism at abortion clinics is not consistent with this stereotype.

In 2018, a man drove a truck into a New Jersey abortion clinic. Three people were injured. The motive was unknown. The man had no ties to pro-life organizations.

In 2017, bricks were thrown through a window of a Cleveland abortion clinic facility on three separate days. The motive was unknown.

Also in 2017, three members of the White Rabbits militia group bombed a Minnesota mosque and attempted to bomb an Illinois abortion clinic. No one was injured. Their motive in bombing the abortion clinic was unclear. [

In 2015, a man shot and killed three people at a Colorado Planned Parenthood. Nine others were injured. The man was recorded saying that he specifically targeted the clinic because it performed abortions. He had no previous connection to pro-life work or organizations.

In 2015, an individual destroyed several security cameras and a power generator at an abortion clinic in Mississippi. The vandalism occurred after hours with no reported injuries.

In 2009, abortion provider Dr George Tiller was shot in the head inside his church in Kansas by a man who targeted him because he performed abortions. His killer, Scott Roeder, had a Post-It note on the dashboard of his vehicle with the phone number for pro-life organization Operation Rescue. Operation Rescue’s statement is here.

But what about….?

Operation Rescue

Operation Rescue is a well-known national pro-life organization. It was founded in 1986. It was most famous in the late 1980s and 1990s, particularly the Summer of Mercy of 1991, for leading “the largest movement involving peaceful civil disobedience in American history. During those early years, thousands of men and women willingly sat in front of abortion mill doors to prevent the killing of innocent children and paid the penalty in arrest and prosecution on trespassing charges,” according to the organization’s website.

Over the years, their leadership has changed, and their focus has shifted to ending abortion through documentation. They track 911 calls by abortion clinics, unsafe abortion providers, women injured or killed by abortion, and abortion clinic closings. Their partner website AbortionDocs.org is a comprehensive listing of abortion clinics in the nation along with hundreds of documents obtained through Freedom of Information Act (FOIA) requests. These documents tell of failed health inspections, abortion providers who sexually abused their patients, malpractice lawsuits and more.

Abortion rights organizations routinely accuse Operation Rescue of fomenting hate and violence, and their response is here. Abortion rights organizations also cite vice president Cheryl Sullenger’s past criminal conviction, and their response is here.

Operation Save America

Operation Save America formed in 1991 as a split off of Operation Rescue. Their message is broader than Operation Rescue’s, and includes supporting traditional marriage and exposing the dangers of Islam. They strongly favor the “rescue” approach to ending abortion. A “rescue” is when activists enter an abortion clinic and sit in the waiting room, encouraging women scheduled to have abortions to keep their babies instead. Typically, the activists do not leave when asked. They are then arrested by police for trespassing and/or blocking the clinic doors. They are more controversial than Operation Rescue, in part because they have stated that some women who have abortions should be criminally prosecuted. They also have ties with several individuals who signed a 1993 statement that homicide of abortion providers was morally acceptable.

Controversial Tactics

Red Rose Rescues

As mentioned above, abortion clinic “blockades” and “invasions” are some of the most common forms of abortion clinic disruption. These modern-day protess have their roots in the pro life movement of the 1980s and 90s. Especially during the 1991 Summer of Mercy, thousands of pro-lifers were arrested for physically blocking abortion clinic entrances or parking lots. Their goal was to save lives by peaceful civil disobedience. In recent years, “rescues” have resurfaced.

Particularly in 2017, Red Rose Rescue activists entered women’s clinics across the country, presenting the women inside with roses and a plea not to have an abortion. One of the RRR founders, Dr. Monica Migliorino Miller, shared the rationale in a 2018 article for Celebrate Life magazine:

“Certainly not all of the women respond to our plea, yet we have firsthand experience of women actually leaving the abortion facility. We know that their babies were saved at least that day. Every sidewalk counselor knows that’s a victory! The women who left had a chance to reconsider their decision to abort. That would not have happened unless we had been inside the clinic to urge them to give life to their babies!”

Sidewalk Advocates for Life Respond

Also in 2017, Sidewalk Advocates for Life released a 20 minute Youtube documentary called “Desperate Measures: Saving the Movement that is Saving Lives”. In it, several former abortion clinic workers offer perspective on what sit-ins and trespassing or invasions look like from the inside. They state that any time a person “breaks the law” by trespassing, they reinforce a stereotype about pro-lifers. These protestors, nonviolent and peaceful though they may intend to be, become aggressors in the eyes and hearts of clinic staff. Clinic staff figure that if pro-lifers are capable of trespassing, they could be capable of causing actual physical harm.

Furthermore, pregnant women who come for abortions are routinely moved behind closed doors per protocol. And behind those closed doors, the abortions continue.

The Sidewalk Advocates’ video argued that sit-ins or other clinic invasions may achieve a short-term gain of delaying or stopping abortions for a day. In the long-term, though, other methods are more effective in ending abortion.

Other Methods More Effective

This approach is consistent with Operation Rescue’s own statements. From their book “Abortion Free: Your Manual for Building a Pro-Life America One Community at a Time,” Operation Rescue leaders Troy Newman and Cheryl Sullenger note:

“Changes in culture and the advent of the Freedom of Access to Clinic Entrances Act of 1994….forced Operation Rescue to develop new tactics to close abortion clinics. The peaceful sit-ins, known as Rescues, would close an abortion clinic for a few hours or maybe a full day, but they would result in lengthy court hearings, fines, and often jail time. Today, Operation Rescue employs new tactics that are closing abortion clinics permanently.” (from the book’s preface)

What Does the Law Say?

The Freedom of Access to Clinic Entrances (FACE) Law, enacted in 1994, prohibits use of force, threat of force, or physical obstruction of entrances to abortion clinics. [2]

FACE specifically prohibits “the use of force or threat of force or physical obstruction” to intentionally injure, intimidate, or interfere with someone seeking to enter a facility that provides abortions. FACE also prohibits the same actions at places of religious worship.

The penalty for a first violation of FACE is 6-12 months in prison, and a fine of $10,000 to $100,000. Subsequent convictions carry a punishment of 18-36 months in prison and a fine of $25,000 to $250,000. These penalties are far more severe than the penalties already imposed by state law for the acts prohibited by FACE. [3]

A Better Way

Two organizations utilizing best practices in ending abortion include 40 Days for Life and And Then There Were None.

The 40 Days for Life Approach

40 Days for Life began in 2004, and is now an international organization. Their methods are simple: end abortion through 40-day campaigns of prayer and fasting at local abortion clinics or hospitals that perform abortions. The results in these last 15 years have been remarkable. They report 15, 256 babies saved, 186 abortion clinic workers leaving their jobs, and 99 locations of prayer campaigns closed.[

And Then There Were None

In 2009, Planned Parenthood Clinic Director Abby Johnson quit her job. In 2011, she founded And Then There Were None. Their mission is to: “love an abortion clinic worker out of the industry” and to “end abortion from the inside out.” They provide financial assistance to abortion clinic workers who leave their jobs, as well as help with resumes’ and finding new jobs. They also offer healing retreats for former clinic workers. As of January 2019, nearly 500 abortion clinic workers have quit their jobs.

Safety and the Abortion Industry

Pro choice advocates used to say that abortion should be “safe, legal, and rare.” The Guttmacher Institute, Planned Parenthood’s former research arm, now a stand-alone reproductive rights organization, states: “Abortion providers in the United States are subject to strict evidence-based regulations (such as state licensing requirements, federal workplace safety requirements, association requirements and medical ethics) created specifically to ensure patient safety. ” [1] But just how safe is abortion for a woman in modern-day America? Below, we’ll review the stories of women who were severely injured or even died because of an abortion. We’ll learn about some of America’s most notorious abortion providers. Next, we’ll look at the results of abortion clinic safety inspections across the country. Then, we’ll find out how to check what abortion safety regulations each state has in place. Finally, we’ll learn how to check the safety of a clinic in your local area.

Is Safety the Top Priority in Abortion Clinics?

Whole Women’s Health v Hellerstedt

Evidence suggests that abortion access, rather than safety, is the highest priority within the abortion industry. The most recent example was the landmark 2016 ruling in Whole Women’s Health v. Hellerstedt. The Supreme Court ruled that two measures on the books in Texas would unnecessarily restrict women’s ability  (i.e. create undue burden) to access abortion, because nearly half of the state’s abortion clinics either closed or stopped providing abortion services after it became law. [2] A helpful graphic to understand the law and its impact is here.

What the Law Said

These two measures were: 1) The abortion provider must have admitting privileges at area hospitals within 30 miles of the clinic 2) Abortion clinic hallways (or other locations where abortions are performed, such as doctor’s offices) are wide enough to fit an ambulance stretcher through, in case of medical emergency. Let’s look a little further into what these two measures mean.

Admitting Privileges

First, “admitting privileges” means that if an abortion doctor’s patient is admitted to a hospital, he or she can continue to be their primary care provider in the hospital. The abortion provider would effectively be a staff member of the hospital. He or she could place orders and direct the woman’s care. It is true that other outpatient specialists, such as dermatologists or orthodontists, do not have to have admitting privileges at local hospitals. Furthermore, a woman who experiences an abortion complication can go to any hospital that she chooses to receive care. Logically, as with other outpatient specialties, the doctor that performed the abortion would be consulted to get more information about the procedure and the woman’s medical history.

Circuit Riders

Unfortunately, the phenomenon of  “circuit rider” abortion providers muddies the waters. “Circuit rider” abortion doctors may perform abortions in one state one day and fly out that same night to another city where they live or perform abortions. As in several patient deaths mentioned below, patients and their families or medical staff may have trouble contacting these abortion providers when complications do happen.

Admitting Privileges for Late-Term Abortions Make Sense

Requiring admitting privileges for providers of first trimester abortions may seem like overkill. In the case of late-term multi-day abortion procedures, though, having admitting privileges to a local hospital is common sense. Second trimester and third trimester abortions have a much-higher complication rate than first trimester abortions. If a woman starts having problems on day two of a three day procedure, for example, it makes sense to admit her to a hospital for closer monitoring during the rest of the procedure. “Continuity of care” is medical best practice, and in this situation it means that the doctor who started the abortion should be the doctor who finishes it.

Ambulatory Surgical Center Standards

In contrast, requiring that abortion clinic hallways be wide enough to meet ambulatory surgical center standards is clearly common sense. Ambulatory surgery centers require hallways and corridors be wide enough to get a gurney through in case of medical emergency. The case of Karnamaya Mongar, detailed below, makes the necessity of this basic safety measure startlingly clear.

Creating a Legal Precedent

Whole Women’s Health vs Hellerstedt was considered a landmark Supreme Court case because it created a legal precedent. That precedent judged the validity of abortion restrictions in large part based on how they impacted women’s ability to access abortions. Unfortunately, as we’ll see below, when “access” is prized above all else, women lose. They not only lose; sometimes, they die.

Women Injured or Killed After Abortion

Known Victims (since 2003) including gestational age of baby and cause of death, include:

     Sherika Mayo

Sherika Mayo died in 2008 in Georgia after an abortion at 25 weeks. Her cervix and intestine were lacerated and her uterus was perforated during the abortion.  In the recovery room after the abortion, her heart stopped beating due to massive internal bleeding. She was resuscitated and taken to a local hospital, but her heart stopped again and she could not be brought back to life. [3]

     Keisha Marie Atkins

Keisha Marie Atkins died in New Mexico in 2017. She was around six months pregnant, and had a four-day abortion procedure. She developed symptoms of disseminated intravascular coagulopathy, a life threatening blood clotting problem likely brought on by septic shock- a whole body response to infection. The infection was likely because of the abortion, according to her autopsy report. [4]

      Diamond Williams

Diamond Williams died in 2016 in North Carolina just five days after a first trimester abortion. Her autopsy suggests that she died of a severe pneumonia and disseminated intravascular coagulopathy (see above). [5]

     Jamie Lee Morales

Jamie Lee Morales bled to death in New York in 2016 after an abortion at 25 weeks pregnant. Her uterine aorta was severed, her cervix was ripped, and her uterus was perforated. [6]

     Cree Erwin-Sheppard

Cree Erwin-Sheppard died in Michigan in 2016. She reported severe abdominal pain after her abortion, and an ultrasound at a local emergency department showed an incomplete abortion- pieces of her baby and/or other pregnancy tissue was left inside of her. After discharge from that emergency department, she went home to lay down and never woke up. The autopsy report also documented a blood clot in her lung that traveled there from one of her uterine veins, and uterine perforation that bled out internally. She was in her first trimester. [7]

     Lakisha Wilson

Lakisha Wilson died in 2014 in Ohio. She was around 23 weeks pregnant. At some point during or immediately after her abortion, she stopped breathing. She was resuscitated but was declared brain dead and died in a local hospital a week later. [8] [9] [10]

     Jennifer Morbelli

Jennifer Morbelli died in 2013 (see story below)

     Maria Santiago

Maria Santiago also died in 2013, in Maryland. Her vital signs were not monitored after her abortion, so no one noticed when she developed hypoxia (low oxygen levels). Eventually she stopped breathing and her heart stopped beating. She was 12 weeks along. [11]

     Tonya Reaves

Tonya Reaves died in 2012 in Illinois. Her uterus was perforated during her abortion and she bled to death. She was in her second trimester. [12] [13]

     Alexandra Nunez

Alexandra Nunez died in 2010 in New York. She was 16-17 weeks pregnant. She had previous history of Cesarean sections and placenta increta, where the placenta is deeply attached in the uterine wall. This medical history put her at risk for uncontrollable bleeding after an abortion, which she had. CPR was not performed, and 911 was not called for 48 minutes after she stopped breathing and her heart stopped beating. [14][15]

     Antonesha Ross

Antonesha Ross died in 2009 in Illinois. She had a severe form of pneumonia that should have prevented her from having her first trimester abortion. Within hours of the abortion, her heart stopped beating and she stopped breathing. She could not be resuscitated. The abortion clinic that did her abortion closed down for three weeks, and then the abortion provider started a new clinic with the same phone numbers and website. [16]

     Ying Chen

Ying Chen died in 2009 in California. She was given the wrong dosage of anesthesia, and her heart stopped beating. Abortion clinic staff did not respond appropriately, and she was unable to be resuscitated by emergency personnel. She was 16 weeks pregnant. [17]

     Karnamya Mongar

Karnamaya Mongar died in 2009 (see story below)

     Edrica Goode

Edrica Goode died in 2007 in Massachusetts. She developed toxic shock syndrome after cervical dilators called laminaria were placed in preparation for a second trimester abortion procedure.  The laminaria should never have been placed because she had an active vaginal infection. The infection eventually spread throughout her body, and she died 2 weeks later. [18]

     Laura Hope Smith

Laura Hope Smith died in 2007 in Massachusetts. She was not monitored properly after her abortion and never woke up from anesthesia. Clinic staff did not call 911 in a timely manner. She was 13 weeks pregnant at the time of her abortion. [19] [20] [21]

     Christin Gilbert

Christin Gilbert died in 2005 (see story below)

     Tamiia Russell

Tamiia Russell died in 2004 in Michigan. She was at least 6 months pregnant. After her abortion, she hemorrhaged and eventually bled to death. [22]

     Regina Johnson

Regina Johnson died in 2003 in Michigan at 5 weeks pregnant. The same doctor that performed Tamiia Russell’s abortion (above) performed hers. Her vital signs were not appropriately monitored after her abortion, and she stopped breathing. CPR was performed but 911 was not called for over 20 minutes after staff noticed that she was not breathing. [23]

     Holly Paterson

Holly Paterson died in California in 2003 after a medication abortion at 7 weeks pregnant. She developed toxic shock syndrome from clostridium sordelli bacteria (linked in multiple other cases to use of the abortion pill) that spread to the rest of her body and caused her organs to shut down. She died one week after taking the abortion pill. [24] [25] A listing of  known women who died from legal abortions in the United States is here.

Women permanently injured by abortion include:

In 2012, Ayanna Byer experienced sepsis (multi organ system response to infection in the body) requiring hospitalization after a first trimester abortion. [26] [27] In 2010, B.M. experienced was hospitalized for bleeding due to perforation of her uterus during her abortion at approximately 15 weeks. [28] Also in 2010, D.B., 21 weeks pregnant, was hospitalized for a perforated uterus and bowel damage from her abortion. [29] Also in 2010, Roberta Clark, 8 weeks pregnant, was not told by Planned Parenthood that she had an ectopic pregnancy. Her “abortion” did not work because the pregnancy was not in her uterus. Three weeks later, still pregnant, her Fallopian tube ruptured and she was hospitalized for emergency surgery. [30] [31] These are just a few cases where the details of what went wrong during the abortion are fully known. Every week, websites like LifeNews.com and OperationRescue.org feature new stories of 911 calls like this one from abortion clinics around the clinic.

Doctors Who Harm

Kermit Gosnell

     House of Horrors

Kermit Gosnell is likely the most notorious abortion provider since abortion was legalized in the United States in 1973. His Pennsylvania “House of Horrors”, discovered in 2010 during a prescription drug bust by the FBI, was the stuff horror stories are made of. His abortion clinic smelled of cat urine due to cats roaming around in the halls. Employee food and the bodies of aborted fetuses shared the same refrigerator. Severed baby feet were found in rows of jars. Fetal body parts were frozen in milk cartons. Medical equipment was dirty, and office furniture was bloodstained.

     Illegal Abortions

Abortions were performed past the state limit of 24 weeks, with testimony from former workers reporting abortions on fetuses nearly 8 months along. Gosnell reportedly joked that one baby was “big enough to walk to the bus.”  Gosnell was convicted of delivering babies alive and killing them by inserting scissors in the back of their necks, snipping their spinal cords.

     Karnamaya Mongar

Unlicensed and unqualified personnel administered sedation medications, leading to the 2009 death of a woman named Karnamaya Mongar. Mongar’s heart stopped beating because she was oversedated, and precious time in resuscitation efforts was lost when paramedics could not get a gurney through the clinic’s hallways.

     Everyone Knew, but Nobody Cared

There is even evidence that numerous regulatory oversight bodies knew what was going on and did nothing.  Pennsylvania Department of Health documents from as long ago as 1989 report failure to pass basic health inspections. [7] [8] Other sources show that organizations as small as local hospitals and as large as the National Abortion Federation (a professional association for abortion providers, similar to the American College of Obstetricians/Gynecologists, known as ACOG) itself knew about Gosnell’s clinic- about the spread of sexually transmitted infections due to reuse of disposable instruments, the women injured by abortion who were admitted to local emergency departments, unlicensed personnel as young as 15 years old administering anesthesia….and did nothing. In 2011, Gosnell was finally convicted of murder and sentenced to life in prison. The full grand jury report is here. An excellent summary of the case is here.

Dr. Steven Chase Brigham

     Not An Actual OB/GYN

Steven Brigham Chase received his MD from Columbia University, but never trained as a gynecologist during his schooling. He was never board-certified for obstetrics/gynecology. Nevertheless, in the late 1980s, he began performing first trimester abortions. He opened his first abortion clinic in 1992 in New Jersey.

     Medical Mayhem

Accounts of his professional misconduct began in 1994,  when he botched two late-term abortions in New York. A review committee for the New York Department of Health disciplined his medical license, saying that he “used inexcusably bad judgment and that his negligence was life threatening.” Over the years, he was implicated in everything from employing unlicensed staff to assist with abortions, injuring women, financial irregularities, inadequate patient record keeping, to using and reusing unclean equipment. Eventually, even the National Abortion Federation banned him from its meetings. Over the years, as he lost his medical license in New York, Pennsylvania, and Florida, he moved from primarily performing abortions himself to owning a chain of abortion clinics, in New Jersey, Maryland, Virginia, and Florida.

     The Final Straw

Between 2009 and 2010, he led a two-state abortion scheme. He initiated nearly 250 late second or early third-trimester abortions in New Jersey, and his partner Dr Nicola Riley finished them a day or two later in the neighboring state of Maryland in an unmarked office building. Late-term abortions were illegal in New Jersey, and Brigham was not licensed to practice medicine in Maryland. Various life-threatening medical emergencies resulted for these abortion patients. Finally, in 2014, New Jersey revoked his last active medical license. An appeal to have his license reinstated was rejected in September of 2018. Remarkably, to date, Steven Chase Brigham continues to own and run multiple abortion clinics. [32] An excellent summary of Brigham’s career and misdoings is here.

Dr. Leroy Carhart [33]

     Late Term Abortion Provider

Dr. Carhart is one of four late-term abortion providers in the country who provide abortions after 26 weeks, with clinics in both Nebraska and Maryland. [34] He was the plaintiff in two late-term abortion cases that made it to the Supreme Court, Stenberg v. Carhart in 2000, and Gonzalez v. Carhart in 2007. To abortion advocates, Dr. Carhart is a hero, providing much-needed terminations for women whose babies are unlikely to live long after birth or will have a physical disability of some kind. He continues to work even after the murder of his good friend and fellow late-term abortion provider Dr. George Tiller in Kansas in 2009. Dr. Tiller’s murder was reprehensible, unjustifiable, and totally at odds with the “respect for all life” that pro-life advocates hold dear.

     There is Another Way

To pro-life advocates, deliberately taking the life of a preborn person mere weeks before delivery, especially anytime after the point of viability at 24 weeks, is unimaginably horrific. Perinatal hospice programs exist for cases as fetal anomalies that are incompatible with life, facilitating the grieving process and letting nature take its course rather than exposing the mother to serious and potentially life-threatening second or third-trimester abortion complications. Deliberately ending the fetus’ life in the womb and then inducing labor and delivery of a dead baby , or tearing it apart and removing it piece by piece, is an act against the woman’s motherhood. It speeds up the process, to be sure, but also makes her, rather than a medical condition, directly responsible for the baby’s death.

     Late Term Abortions have Serious Risks

Furthermore, serious complications after second and third-trimester abortions are significantly higher than after first-trimester abortions. [35][36] Risk of death from second trimester abortion is over 20 times higher than from first trimester abortion. [37] Risk of death from abortion increases by 38% each week starting in the second trimester. [38] Two women who Dr. Carhart has cared for have died, and countless other patients have been transported to hospitals from his abortion clinics.

     Christin Gilbert

Christin Gilbert died in 2005 due to bleeding and infection from her abortion at 28 weeks pregnant. Dr. Carhart was her abortion doctor. Late second and third-trimester abortions are a several days process- first the fetus is killed, then the cervix is dilated, and then labor is induced. Christin, like other women undergoing this type of abortion, stayed at a local hotel in between her multiple visits to the abortion clinic. No monitoring occurs outside of the abortion clinic, even though the woman has received medications that can cause powerful uterine contractions and significant bleeding. Like Christin, women sometimes deliver their dead babies outside of the clinic, and sometimes they bleed too much (hemorrhage). The official complaint filed against Dr. Carhart after her death chronicles the whole timeline. Her family tried to contact the abortion clinic, but Dr. Carhart was unavailable. By the time Christin was taken to the hospital after her abortion, it was too late. [39] [40] [42]

     Jennifer Morbelli

Jennifer Morbelli, another Dr. Carhart patient, died in 2013. She was 33 weeks pregnant and died of massive irreversible internal bleeding due to disseminated intravascular coagulation caused by an amniotic fluid embolism. [43] Disseminated intravascular coagulation is when the blood simultaneously clots in some areas and bleeds out in others. [44] An amniotic fluid embolus happens when the baby’s amniotic fluid enters the mother’s bloodstream. [45] Jennifer’s family tried multiple times to contact Dr. Carhart when she began experiencing symptoms, but were unable to reach him. Her heart stopped 6 times at the hospital before the final attempt to resuscitate her failed. [46]

     Recurrent 911 Calls

In addition to Christin and Jennifer’s deaths, a listing of recent and increasingly frequent 911 calls for Dr. Carhart’s Nebraska and Maryland clinics can be found here and here. Details of a medical malpractice suit filed against him in late 2016 are here.

Dr. George Rutland

Dr. George Rutland of California lost his medical license in 2011 for the second time, after Ying Chen’s abortion death in 2009 was ruled a homicide. Dr. Rutland also lost his license in 2002 for severing a baby’s spinal cord during a delivery and then lying about it to the parents. [47] According to a local news article, “he also was accused of scaring patients into unnecessary hysterectomies, botching operations, lying to patients, falsifying medical records, over-prescribing painkillers and having sex with a patient in his office. He admitted negligence only in the case of the death of a newborn girl who died during a forceps delivery.” [48]

(Dis)honorable Mention:

Other abortion doctors worth (dis)honorable mention include: Douglas Karpen [49], James Pendergraft [50],  Nicola Riley [6], Robert Hosty [52], Robert Rho [53] [54] [55],  Antonio Hodari [56], and Pansour Manah [57].

Survey Says….

Americans United for Life (AUL) is an organization that exists to “protect and defend human life from conception to natural death through vigorous legislative, judicial, and educational leadership.” [58] Their report “Unsafe: How the Public Health Crisis in America’s Abortion Clinics Endangers Women”, released in 2016, documents cases from 227 facilities in 32 states that were cited for over 1,400 health and safety deficiencies between 2008 and 2016. In many cases, the same clinic was cited for the same violations repeatedly, often multiple years apart. In other words, problems were found, no corrections were made, and business was allowed to continue as usual without penalties against the clinic. [59]

Safety violations categories:

  1. failure to ensure a safe and sanitary environment
  2. patient record documentation failures and privacy violations
  3. failure to provide staff adequate training and ongoing education
  4. unlicensed and unqualified staff providing medical care, staff performing duties unsupervised
  5. expired medicines and medical supplies
  6. failure to follow safety protocols
  7. missing or outdated equipment for responding to medical emergencies
  8. medication safety violations
  9. failure to maintain safe building and environmental conditions
  10. failure to monitor patient vital signs
Other violations include failure to report sexual abuse of minors, failure to follow abortion reporting requirements.

What safety regulations does my state have in place for abortion clinics?

In  Planned Parenthood v. Danforth in 1976, the Supreme Court found that: “record keeping and reporting provisions that are reasonably directed to the preservation of maternal health and that properly respect a patient’s confidentiality and privacy are permissible.” [60]

New in 2018

The Guttmacher Institute summarizes new abortion restrictions enacted in 2018 here.

TRAP Laws

The Guttmacher Institute lists all TRAP (Targeted Regulation of Abortion Providers) laws currently in effect, temporarily enjoined (not being enforced) or permanently enjoined (will not be enforced) on their website. These types of laws include: 1) physical building standards comparable to surgical centers for outpatient abortion clinics, doctors offices where abortions are provided, and/or clinics where medication pills are dispensed 2) specifications about procedure room size for one or more of the above types of locations 3) specifications for corridor width in one or more of the above types of locations 4) specified maximum distance to the hospital for one or more of the above types of locations 5) transfer agreement with a nearby hospital for one or more of the above types of locations in case of medical emergency caused by or during the  abortion 6) requirement that doctor performing abortion have admitting privileges or alternative agreement with local hospital in case of medical emergency caused by or during the abortion [61]

Guttmacher Institute Responds

In response to these types of laws, the Guttmacher Institute cites statistics that 0.3% or 0.5% (both statistics are cited in their article) of women who undergo an abortion are hospitalized for a complication. (See problems with abortion complication reporting here) The Guttmacher Institute also take issue with reporting anesthesia complications as abortion complications. Grouping anesthesia complications under the medical procedure they were given for is standard medical practice. For example, anesthesia complications are routinely listed as potential surgical complications when patients sign surgical consent forms.

The Life List

Americans United for Life (AUL)’s “Life List” ranks the most and least pro-life states in America based on restrictions and regulations such as mandatory waiting periods before an abortion, mandatory reporting of abortion complications, parental notification or parental consent laws, and more. [62] They report: “Only nine states offer strong legal protections for women; 16 states provide moderate protection, 12 states offer minimal protection and sadly, 13 states are ranked as dangerous for their failure to regulate the abortion industry by holding them accountable for the conditions they create that can endanger women.” [63]

How do I check the safety of my local clinic?

One resource is http://abortiondocs.org. This website lists every surgical and medication abortion clinic operating in the United States. A clickable map and a search function allow users to search for the clinic they are looking at visiting. Any available photos, videos, news stories, and any relevant court documents are included in each listing. [64] Another resource is https://checkmyclinic.org/. Clicking on any state in the map of the United States brings up a list of common abortion restrictions and whether the state allows or prohibits them. Examples include availability of telemedicine (webcam) abortions, mandatory waiting periods, and parental consent laws. Limited information on specific clinics is also listed. [65] http://abortionsafety.com/ is another website that lists malpractice suits against specific abortion clinics, accessible through a clickable map of the country.

Citations:

36.  Cassing Hammond MD, and Stephen Chasen MD, “Dilation and Evacuation,” Management of Unintended and Abnormal Pregnancy. Ed. Paul, Lichtenberg, Borgatta, Grimes, Stubblefield and Creinin. (Wiley-Blackwell, 2009), 179.

Abortion Methods: Vacuum Aspiration or Suction Abortion

What is a Vacuum Aspiration or Suction Abortion?

Vacuum aspiration, also known as suction abortion, is the most common type of abortion during the first trimester. They are typically done up until 12-14 weeks after the woman’s last menstrual period (LMP). [1] This type of abortion does not work up to 5% of the time, or in up to 1 in 20 women. [2] It is more effective than medication abortion, which does not work up to 7% of the time. [3]

History of Vacuum Aspiration Abortion [4]

Early Vacuum Aspiration

The tools that would later be used for vacuum aspiration abortions were first developed in England in the late 1800s to sample tissue from the lining of the uterus or womb. These tools were not used for vacuum aspiration abortions until the 1920s in Russia. Their use later spread to China and the United States.[5]

After World War II ended, medical professionals from countries all over the world agreed on what is called the Nuremberg Code. [6] The Nuremberg Code states that new medications or procedures should be tested on animals, instead of experimenting on human beings. Unfortunately, this did not happen with vacuum aspiration abortions, and American women suffered.

Harvey Karman

In the early 1950s,  while abortion was still illegal, an American psychologist named Harvey Karman performed an abortion on a woman in a hotel room. He did not have any formal medical training, and the woman died of complications. He went to jail for several years, but when he was released he continued to work to make abortion more accessible for women.

In the early 1970s, when abortion was still illegal, he created a flexible, disposable, plastic device called the Karman cannula that used suction to remove everything that would normally be shed during a menstrual period. This procedure was called menstrual extraction, and it was performed so that women did not have to undergo a menstrual period, and also in cases of first trimester miscarriage. The Karman cannula was also used for abortions because it was safer for the woman than the traditional dilation & curettage (D&C) method, which uses a sharp scraping tool to remove baby parts from the uterus. The Karman cannula is still in use today. [7] Unfortunately, Harvey Karman was again connected to the abortion-related deaths of over a dozen other women in the 1970s but did not go back to jail.

What Percentage of Abortions are Suction Abortions?

The Centers for Disease Control (CDC) collect abortion data each year, and the results of their data collection are available online through the year 2014. [8] Abortion data since 2014 have not yet been published. States and several large cities like Washington D.C. and New York City have the option to report their data to the CDC each year or not. For 2014, California, Maryland, and New Hampshire abortion numbers were not reported. In the CDC report, abortion methods are classified as surgical or medical (medication). Exact numbers on how many of these surgical abortions were suction abortions are not available because most of the states that report their data to the CDC did not provide this information.

What happens during a Suction Abortion?

Prep for Abortion

The prep work includes a pregnancy test, blood tests, physical exam, testing for sexually transmitted infections, and usually an ultrasound to confirm that the woman is pregnant and that she does not have an ectopic pregnancy. An ectopic pregnancy is when the fertilized egg implants outside of the uterus, also known as the womb. An ectopic pregnancy can be dangerous because often the fertilized egg implants inside a fallopian tube, and as it grows the fallopian tube can burst. This can cause life-threatening bleeding for the mother.[9]

Dilation

If the woman is far enough along in her pregnancy, she may need to have her cervix, or the opening to her womb or uterus, opened wide enough to have the fetal parts suctioned out. This is most often done with long, thin rods of sterilized seaweed called laminaria that soak up amniotic fluid in the womb and make the cervix widen. The laminaria are left in place for a period of time and then removed before the abortion.

Procedure

Just before the actual procedure, she will be given Ibuprofen or a stronger pain pill. She may receive anti-anxiety medicine also. She will lay on the exam table with her feet up in stirrups like she would for a pelvic exam. A gripping tool called a speculum will be inserted in her vagina to spread the walls apart. A tool called a tenaculum may be used to keep it open for the abortion. A numbing shot will be given into the cervix. [10]

Then, a syringe is inserted through her vagina, past the cervix, and into the uterus. The fetal tissue is aspirated or suctioned out either with a syringe (manual aspiration) or a plastic or metal catheter hooked to suction on the wall (electric aspiration). Wall suction is about 10-20 times stronger than a vacuum’s force. [11]

Monitoring after Abortion

The whole abortion takes about 5-10 minutes from start to finish. The woman is typically monitored for an hour afterwards. Her heart rate, temperature, oxygen level, and blood pressure will be checked occasionally during this time.  She cannot drive herself home if she has taken anti-anxiety medication or certain types of pain pill.

At what point does the Fetus die?

Typically, the fetus dies from being detached from the placenta by the suction catheter or syringe.

What are the Side Effects of Vacuum Aspiration Abortions?

Expected side effects include:

  • Cramping
  • Nausea
  • Fainting
  • Sweating[12]

Vacuum aspiration abortions are considered safer than dilation & curettage (D&C) abortions because the risk of serious side effects is less. [13] The World Health Organization specifically states that vacuum aspiration abortions and not D&C abortions should be performed in developing countries because of the difference in safety for the mother. Women most at risk for suction abortion complications include teenagers, women who have had a cervical surgery before, and women who have an abnormal cervix. [14] Still, serious complications from vacuum aspiration abortion include:

  • Hemorrhage
  • Blood clots
  • Infection
  • Uterine perforation, or tearing of a hole in the wall of the uterus

Vacuum Aspiration + D&C

In some cases, after the uterus is suctioned out, the abortionist scrapes the uterus to be sure that no baby body parts or other uterine contents are left behind. If this happens, the woman is at risk for complications of a more dangerous D&C abortion. These include:

  • Injury to the cervix or uterus leading to preterm labor or miscarriage in future pregnancies[15]
  • Injury to the bladder or bowel or other organs caused by the curette breaking through the wall of the uterus
  • Asherman syndrome[16]– [17] bands of scar tissue form inside the uterus. This can stop a woman from having cycles when scar tissue blocks the exit of blood from the uterus. It can also lead to infertility, or to complications during future pregnancies like miscarriage or placenta previa

How often do Complications occur?

Less than 1% of women who have a basic vacuum aspiration abortions experience one of the serious complications listed above. [18] Virtually all women who have a vacuum aspiration abortion will have one or more of the less serious side effects listed above. The rate of serious complications from a D&C abortion is significantly higher. (See D&C article)

[2] Niinimaki M et al. Immediate complications after medical compared with surgical termination of pregnancy. Obstetrics and Gynecology, 2009, 114:795–804.

[5] Meckstroth, K and Paul, M. (2009) First Trimester Aspiration Abortion. In. Paul, M., Lichtenberg, S., Borgatta, L., Grimes, D., Stubblefield, P., and Creinin, M. Management of Unintended and Abnormal Pregnancy: Comprehensive Abortion Care. Pp. 135-152. Blackwell Publishing Ltd: United Kingdom. Accessed May 24, 2017. https://www.prochoice.org/pubs_research/publications/downloads/professional_education/TextbookCh10.pdf

[14] Grimes DA, Schulz KF, Cates WJ. Prevention of uterine perforation during currettage abortion. Journal of the American Medical Association, 1984, 251:2108–2112.

Abortion Methods: Dilation & Curettage (D&C Abortion)

What is a D&C?

A D&C is a dilation & curettage. The cervix is dilated and a long, sharp, spoon-shaped instrument called a curette is used to scrape the inside of the uterus. Sometimes a D&C is done after a baby dies in a miscarriage but the woman does not go into labor on her own. Other times, a D&C is done to take a sample of uterine tissue to diagnose problems like polyps or fibroids. A D&C abortion may be done up to 13 weeks after the woman’s last known menstrual period. [1]

What Percentage of Abortions are D&Cs?

The Centers for Disease Control (CDC) collect abortion data each year. The results of their data collection are available online through 2014.[2] Abortion data since 2014 have not yet been published. All 50 states plus several large cities (like Washington D.C. and New York City) have the option to report their data to the CDC each year or not. For 2014, California, Maryland, and New Hampshire abortion numbers were not reported. In the CDC report, abortion methods are classified as surgical or medical (medication). Exactly how many surgical abortions were D&Cs was not reported.

What happens during a D&C?

Dilation

A D&C usually takes place in the abortion clinic, and rarely at a hospital. Before the abortion, the cervix must be dilated so that the abortion doctor can get the curette inside, and so that the fetal body parts can be taken out. Dilating the cervix happens in one of two ways. The first way is to use laminaria. Laminaria are long, slender rods of sterilized seaweed that swell by soaking up amniotic fluid. This causes the cervix to open or dilate.

The second way to dilate the cervix is with medications, most commonly one called Misoprostol or Cytotec. Cytotec is taken either orally as a pill or vaginally. This process of dilation may take a few hours or a few days.

Day Of Preparation

The woman will have to stop eating and drinking a certain amount of time before the abortion. The prep work also includes a pregnancy test, blood tests, physical exam, testing for sexually transmitted infections, and usually an ultrasound. The ultrasound confirms that the woman is pregnant and that she does not have an ectopic pregnancy. An ectopic pregnancy is when the fertilized egg implants outside of the uterus, also known as the womb. An ectopic pregnancy can be dangerous because often the fertilized egg implants inside a fallopian tube. As it grows, the fallopian tube can burst. This can cause life-threatening bleeding for the mother.

Procedure

After the ultrasound, the woman lies down on the exam table with her feet up in stirrups as for a pelvic exam. The abortion doctor uses tools to separate the walls of her vagina, to numb her cervix, and to hold the cervix in position for the abortion to happen. The woman will be given some type of anesthesia to keep her relaxed, or even asleep, throughout the abortion. The cervix will be cleaned with a solution to decrease the likelihood of infection. [3]

Sometimes, the abortion doctor suctions the fetal body parts out of the uterus before using the curette. Then, the doctor will scrape all the surfaces inside the uterus with the curette, a long, sharp, spoon-shaped tool. The fetal body parts and other contents of the uterus will be put in a tray or other container to be counted. If the abortion doctor leaves any body parts behind, they can cause life-threatening infection or bleeding for the mother.

Monitoring After the Abortion

The woman is monitored at the abortion clinic for up to several hours after the abortion, until the anesthesia wears off. Her heart rate, temperature, oxygen level, and blood pressure will be checked occasionally during this time. She usually has to take a few days off of work or regular activities due to fatigue, cramping, bleeding, and pain. She may be given a prescription for pain pills, or she may take over-the-counter medications like Ibuprofen. [4]

At what Point does the Fetus Die during the Abortion?

The fetus may die when the curette scrapes it, or when it is in the suction catheter. Or, it may die after it has been suctioned out and is in a jar or other medical waste container. Sometimes the abortion doctor needs to use forceps or some other medical instrument if a body part like a leg or arm gets stuck in the suction catheter.

What are the Side Effects or Complications of a D&C?

  • Injury to the cervix or uterus leading to preterm labor or miscarriage in future pregnancies[5]
  • Injury to the bladder or bowel or other organs caused by the curette breaking through the wall of the uterus[6]
  • Asherman syndrome[7]– bands of scar tissue form inside the uterus. This can stop a woman from having cycles if scar tissue blocks the exit of blood from the uterus. It can also lead to infertility, or to complications during future pregnancies like miscarriage or placenta previa

The World Health Organization notes that compared to suction abortion D&Cs are more painful to women, and have 2-3 times higher complication rates. [8]

How often do Complications occur?

Overall, the rate of serious complications from a D&C is directly related to how experienced the abortionist is. Risk of perforation, or poking a hole in the uterus, leading to heavy bleeding that requires a blood transfusion and hospitalization is higher for an abortion D&C than for a diagnostic D&C. This is because current or recent pregnancy makes the uterine tissue more likely to tear.

In a recent study, women who had had a D&C were 29% more likely to have a baby born pre-term, meaning before 37 weeks. Women who had had a D&C were 69% more likely to have a baby born very pre-term. Very pre-term means born before 32 weeks, when a baby is much more likely to have serious, lifelong brain, heart, lung, or other problems.

Researchers say that this is because in future pregnancies the cervix “remembers” being forced open for the abortion and starts to open earlier on its own. Another reason for pre-term birth could be that the cervix’s natural antibacterial properties are damaged, which makes the woman more likely to have an internal infection. Internal infections of the reproductive system are a pre-term birth risk factor.[9] [10] [11] Risk of preterm birth after D&C increases if a woman has more than one D&C. [12]

Abortion Methods: Dilation & Evacuation (D&E Abortion)

What is a Dilation and Evacuation Abortion?

Dilation and Evacuation is the most common type of surgical abortion during the second trimester in the United States. [1] A dilation and evacuation abortion implies two parts. The cervix must first be “prepared”, meaning dilated wide enough for the fetal parts to fit through. The second part is to dismember and remove or “evacuate” the fetus piece by piece.

History of D&E Abortion

Dilation and evacuation abortions were first performed in the United States in the 1970s. Dr. David Grimes, a late-term (including the second half of the second trimester and into the third trimester) abortion doctor published a research study on D&Es in 1977. [2] The biggest challenge in performing D&Es has always been getting the cervix to dilate, since its natural tendency at that point in the pregnancy is to remain closed. Japanese and European abortion doctors first developed a way to dilate the cervix gradually over several days with sterilized seaweed, called laminaria. Later on, synthetic dilators such as Dilapan and Lamicel allowed for even more dilation. Once greater dilation could be achieved, larger instruments could be used to reach through the cervix into the uterus to remove fetal body parts. Dr Warren Hern, another currently-practicing abortion doctor, developed instruments to rotate fetal body parts before removing them from the uterus. [3]

What percentage of Abortions are D&E Abortions?

The Centers for Disease Control (CDC) collect abortion data each year, and the results of their data collection are available online through the year 2014. [4] Abortion data since 2014 have not yet been published. States and several large cities like Washington D.C. and New York City have the option to report their data to the CDC each year or not. For 2014, California, Maryland, and New Hampshire abortion numbers were not reported. In the CDC report, abortion methods are classified as surgical or medical (medication). They report 652,639 abortions total, and almost 47,000 abortions in the second trimester.[5]

The second trimester typically refers to between 12 and 26 weeks after the last menstrual period. Some estimates say that up to 96% of abortions between 14 and 20 weeks along are D&Es. This statistic may not be accurate, though, because it comes from Centers for Disease Control and Prevention (CDC) data that also include other abortion methods. [6]

What happens during a D&E Abortion?

Cervical Preparation

“Cervical preparation” is recommended for all pregnancies over 12-14 weeks to reduce the risk of complications. [7] Dilating the cervix adequately is especially important for four groups of women. These include: teenagers, women with abnormal cervical anatomy, women who have had medical procedures done to their cervix before such as a colposcopy or cervical biopsy or LEEP (loop electrosurgical excision procedure), and women past 20 weeks gestation. [8] All of these groups have a higher likelihood of injury to the cervix and perforation or puncture of the uterus.

Different combinations of medicines and sometimes sterilized seaweed called laminaria or long, thin, synthetic rods called Dilapan-S or medicated sponges called Lamicel may be used to dilate or open the cervix so that the abortion tools and fetal body parts can fit through. [9]  The sponges and laminaria swell to absorb the amniotic fluid, forcing the cervix open. The medications chemically cause contractions and cervical softening and opening. One combination of medicines includes the same two medications, Misoprostol and Mifepristone, which are used for medical abortion in the first trimester.

Dilation of the cervix varies from one abortion doctor to another. Some of them start the process two days before the abortion, some the day before the abortion, and some just four hours before the abortion is performed. [10] Often, antibiotics will be given when the laminaria or other synthetic materials are placed to prevent infection. [11] More laminaria or Dilapan-S or Lamicel may be added to the cervix every few hours, or what’s currently in place may be removed and new materials may be placed.

Procedure Day

The day of the abortion, a brief history and physical are performed, blood samples are taken to check for sexually transmitted infections, an antibiotic pill will be given, and an ultrasound will be done. After the cervix has been dilated, the dismemberment and removal process only takes about 30 minutes. [12] The woman may be given pain medication such as Ibuprofen, anti-anxiety medication such as Valium, and some type of local anesthesia shot or shots to numb the cervix. Sometimes intravenous (IV) sedation medicine or general anesthesia are given since D&E is associated with significant pain, but general anesthesia also has higher complication rates than local anesthesia.

Dilation & Extraction

Once the pain and anxiety medications are given, the abortion doctor inserts a speculum, the same cold, metal gripping tool used during Pap smears in OB/GYN offices. The speculum may be weighted if the woman is past 16 weeks along. The speculum widens the vagina and makes the cervix more visible so that the abortion doctor can see what he or she is doing. A tenaculum is a gripping instrument with long handles and a clamp at the end that moves the cervix closer to the vaginal opening. Tenaculum may have sharp metal teeth to help hold the cervix in place. Ultrasound is often used to guide the abortion doctor. Dilators such as Dilapan-S or Lamicel or laminaria are removed. [13]

If the woman is less than 16 weeks along, the abortion doctor may be able to suction out the fetal parts like in a vacuum abortion. Once the fetus is older than 16 weeks, though, forceps are required. Forceps are grasping instruments used to grasp, crush, twist, and pull fetal body parts such as arms and legs or pieces of arms and leg out. The fetal head and spinal column often have to be crushed before they can be removed, especially the farther along the woman is. After the body parts are removed, the placenta is suctioned or scraped out, usually with the abortion doctor placing his hand on the woman’s stomach to help feel for it in the uterus.

After this, the abortion doctor or other staff have to reassemble all of the body parts to make sure that no fetal bone or other tissue remains.

At what point does the fetus die during the Abortion?

The World Health Organization suggests inducing fetal demise, making sure that the fetus is dead before the abortion, for women 20 weeks or more pregnant. This is because the fetus is easier to dismember if it is not moving. The two medications used together for first trimester medication abortion do not technically cause fetal death. In those abortions, the fetus typically dies during the violent contractions they cause. Similarly, and because the fetus is bigger, when one or both of those medicines are used to dilate the cervix before a second trimester abortion like a D&E, they are not expected to cause fetal death.

Fetal death is typically achieved through injection of a medication such as Potassium Chloride or Digoxin into the amniotic sac that holds the fetus. Potassium Chloride is very effective but requires a highly skilled doctor because accidentally injecting it into the mother’s bloodstream could kill her instead of the fetus. Potassium Chloride kills the fetus almost immediately, and the abortion doctor uses ultrasound to watch for the heart to stop beating. Digoxin, on the other hand, takes more time to stop the fetal heartbeat, but is safer for the woman, especially in cases of accidental injection into her bloodstream. It is less effective than Potassium Chloride in killing the fetus, and because it takes longer to act is often given one day before the abortion. This means an additional office visit for the woman seeking an abortion.

When fetal death is not induced before the D&E, the fetus dies when the abortion doctor crushes its skull with large forceps.

What are the Side Effects or Complications of a D&E Abortion?

Expected side effects include:

  • Pain, may be severe, especially if general anesthesia is not used[14]
  • Cramping
  • Bleeding

Serious complications include:

  • Cervical injury
  • Uterine perforation
  • Infection
  • Life-threatening hemorrhage (bleeding)
  • Uterine rupture
  • Incomplete abortion due to body parts or placenta or other tissue left inside the uterus
  • Disseminated intravascular coagulopathy (life-threatening blood clotting and bleeding)
  • Anesthesia-complications such as respiratory depression[15]

Both cervical injury and uterine perforation can lead to life-threatening hemorrhage or bleeding. [16] A weakened or damaged cervix may lead to preterm labor or preterm premature rupture of membranes (bag of waters breaking) in future pregnancies. Either one of these conditions can end in miscarriage or in the baby being born before 37 weeks and having brain, lung, heart, and other problems. [17]

How often do Complications occur?

While only about 10–15% of all abortions are done in the second trimester, they are responsible for roughly two-thirds or 66% of all major complications. [18][19] Risk of death from second trimester abortion is over 20 times higher than from first trimester abortion. [20] Risk of death from abortion increases by 38% each week starting in the second trimester. [21] Generally, serious complications occur in about 1 in every 100 women who undergoes D&E abortion. [22] [23] [24]

Citations:

[3] Cassing Hammond MD, and Stephen Chasen MD, “Dilation and Evacuation,” Management of Unintended and Abnormal Pregnancy. Ed. Paul, Lichtenberg, Borgatta, Grimes, Stubblefield and Creinin. (Wiley-Blackwell, 2009), 158.

[6] Jatlaoui, T. C., A. Ewing, M. G. Mandel, K. B. Simmons, D. B. Suchdev, D. J. Jamieson, and K. Pazol. 2016. Abortion surveillance—United States, 2013. MMWR Surveillance Summaries 65(12):1–44.

[11] Cassing Hammond MD, and Stephen Chasen MD, “Dilation and Evacuation,” Management of Unintended and Abnormal Pregnancy. Ed. Paul, Lichtenberg, Borgatta, Grimes, Stubblefield and Creinin. (Wiley-Blackwell, 2009), 171.

[13] Cassing Hammond MD, and Stephen Chasen MD, “Dilation and Evacuation,” Management of Unintended and Abnormal Pregnancy. Ed. Paul, Lichtenberg, Borgatta, Grimes, Stubblefield and Creinin. (Wiley-Blackwell, 2009), 172.

[19] Cassing Hammond MD, and Stephen Chasen MD, “Dilation and Evacuation,” Management of Unintended and Abnormal Pregnancy. Ed. Paul, Lichtenberg, Borgatta, Grimes, Stubblefield and Creinin. (Wiley-Blackwell, 2009), 179

[22]  Grimes DA et al: Mifepristone and misoprostol versus dilation and evacuation for midtrimester abortion: a pilot randomised controlled trial. BJOG 2004 Feb;111(2):148-53;

[23] Kelly T et al: Comparing medical versus surgical termination of pregnancy at 13-20 weeks of gestation: a randomized controlled trial. BJOG 2010 Nov;117(12):1512-20

[24] Turok DK et al: Second trimester termination of pregnancy: a review by site and procedure type. Contraception 2008 Mar;77(3):155-61

Abortion Methods: D&X Abortion (Partial-Birth Abortion)

Dilation & Extraction (D&X), also known as Partial-Birth Abortion or Intact D&E or Intact D&X

What is a Dilation & Extraction Abortion?

From the law banning dilation & extraction abortions in 2003,  the legal definition of a D&X abortion is: “the person performing the abortion deliberately and intentionally vaginally delivers a living fetus until, in the case of a head-first presentation, the entire fetal head is outside the body of the mother, or, in the case of breech presentation, any part of the fetal trunk past the navel is outside the body of the mother or, in the case of breech presentation, any part of the fetal trunk past the navel is outside the [mother’s] body . . . , for the purpose of performing an overt act that the person knows will kill the partially delivered living fetus; and performs the overt act, other than completion of delivery, that kills the fetus.” [1]

History of D&X Abortion

Independently of each other, Dr Martin Haskell, an abortion doctor from Ohio, and another abortion doctor in California started performing intact D&Xs on some women more than 16 weeks pregnant in the early 1990s. In 1992, Dr Martin Haskell presented a paper on intact D&Xs at a medical conference of the National Abortion Federation. Intact D&X abortions theoretically would have decreased complication rates because an intact delivery of the dead fetus would mean less likelihood of retained fetal body parts and tissue. Also, delivering the dead fetus aborted because of a medical anomaly (something wrong with the fetus potentially preventing it from living long or at all outside the womb) whole as opposed to in parts could potentially make for a better autopsy. Finally, delivering the dead baby whole could give his or her parents the opportunity to hold him/her rather than the body being in pieces. [2]

Court Cases

In 1997, Nebraska banned intact D&X abortions, which Supreme Court Justice Anthony Kennedy later called “a procedure many decent and civilized people find so abhorrent as to be among the most serious of crimes against human life.”[3]

In 2000, Stenberg vs Carhart, the Supreme Court struck down Nebraska’s ban on intact D&X abortions. Stenberg vs Carhart said that the ban was invalid because, among other reasons, it did not include an exception to allow for the life of the mother.  Partial birth abortion was later made illegal throughout the entire United States by a Supreme Court decision in 2003. In that ruling, the Supreme Court determined that an intact D&X abortion “is a gruesome and inhumane procedure that is never medically necessary and should be prohibited.” [4]

Two court cases, Carhart vs Ashcroft in 2003 and Planned Parenthood Federation of America vs Ashcroft in 2004, challenged this court ruling. In 2007, Gonzalez vs Carhart, the Supreme Court upheld the 2003 ban on intact D&X. [5] 

What percentage of Abortions are D&X Abortions?

Less than 0.5& of all abortions were estimated by Alan Guttmacher Institute (in 2006) to be D&X abortions. Now that this type of abortion is illegal, numbers are no longer tracked. However, video footage obtained during an undercover investigation by the Center for Medical Progress suggests that at least some Planned Parenthood affiliates may still be doing D&X abortions. The purpose of doing these D&X abortions would be to get intact fetal specimens for body part harvesting and sale. In the video, Dr Suzie Prabhakaran, an abortion doctor and Planned Parenthood medical director, described “checking a box” on abortion documentation to say that the doctor intended to use dismemberment, also known as the D&E (dilation & evacuation) method. If the fetus were actually aborted by D&X, the law would not technically be broken because the documented intent was to abort by dismemberment. [6]

Previously, another abortion doctor and Planned Parenthood executive named Dr Deborah Nucatola was recorded speaking about D&X abortions happening in Planned Parenthood clinics. She stated: “The Federal [Partial-Birth] Abortion Ban is a law, and laws are up to interpretation. So there are some people who interpret it as it’s intent. So if I say on Day 1 I do not intend to do this, what ultimately happens doesn’t matter.” [7]

What happens during a D&X Abortion?

Dilation

The “d” in D&X stands for “dilation,” and this starts one or more days before the abortion. The cervix typically has to be dilated more than with suction or D&C abortions because the baby is bigger. Oftentimes osmotic cervical dilators called laminaria start the process. Laminaria are long, thin rods of sterilized seaweed, and they soak up the amniotic fluid. This stretches and opens the cervix. Sometimes synthetic osmotic cervical dilators like Dilapan-S may be used instead. On the day of the abortion, Misoprostol, the early abortion pill, is often given to increase the dilation. If needed, surgical instruments may be used to manually stretch and open the cervix.

Extraction

After the cervix is adequately dilated, the abortion doctor pulls the baby feet first (this is called a breech presentation) until only its head remained inside. Then, the doctor punctures the head or back of the neck with sharp surgical scissors or a trochar, a hard, pointed metal tool. Then, they suction the fetus’ brain tissue out into a catheter which collapses the skull. The fetus is then delivered the rest of the way. [8]

Testimony

From testimony by a nurse for abortion provider Dr Martin Haskell, given during 2007 court case:

“Dr. Haskell went in with forceps and grabbed the baby’s legs and pulled them down into the birth canal. Then he delivered the baby’s body and the arms, everything but the head. The doctor kept the head right inside the uterus. . . . The baby’s little fingers were clasping and unclasping, and his little feet were kicking. Then the doctor stuck the scissors in the back of his head, and the baby’s arms jerked out, like a startle reaction, like a flinch, like a baby does when he thinks he is going to fall. The doctor opened up the scissors, stuck a high powered suction tube into the opening, and sucked the baby’s brains out. Now the baby went completely limp. . . . He cut the umbilical cord and delivered the placenta. He threw the baby in a pan, along with the placenta and the instruments he had just used. [9]

Variations on this procedure include: crushing the fetal skull with forceps, squeezing the fetal skull until the brain tissue oozes out and the skull collapses, or twisting the fetal head until it comes off of the rest of the body (decapitating it). [10]

At what point does the fetus die during the Abortion?

Typically, the fetus dies when the skull is pierced and the brain tissue is suctioned out.

What are the side effects of a D&X Abortion?

D&X abortion has the same general risks as any other surgical method of second trimester abortion. These include:

  • Non-white women undergoing surgical abortion are more than twice as likely as white women to die from the procedure
  • Obese women undergoing surgical abortions are more likely to have greater blood loss and increased procedure time
  • Retained fetal tissue, placenta, or amniotic sac can lead to life-threatening infection
  • Hematometra (abnormal collection of blood in the uterine cavity)
  • Bleeding severe enough to require a blood transfusion
  • Uterine atony (failure of the uterus to contract after abortion, causing uncontrolled bleeding)
  • Disseminated intravascular coagulopathy (life-threatening blood clotting and bleeding disorder)
  • Infection (may require hospitalization)
  • Cervical injury
  • Uterine perforation (hole punctured in the uterine wall)
  • Asherman syndrome (scarring of the uterine lining or in the cervical canal potentially causing infertility, miscarriage, or preterm delivery in future pregnancies)
  • Deep vein thrombosis (potentially life-threatening blood clot, usually in legs)
  • Pulmonary embolism (life-threatening blood clot in one or both lungs)
  • Amniotic fluid embolism (amniotic fluid from fetal amniotic sac enters the mother’s blood stream)[11]

How often do Complications occur?

Between 1 and 2 of every 100 women who have a second trimester intact D&X abortion could expect to experience one or more of the serious complications listed above. [12]

Citations:

[2]Cassing Hammond MD, and Stephen Chasen MD, “Dilation and Evacuation,” Management of Unintended and Abnormal Pregnancy. Ed. Paul, Lichtenberg, Borgatta, Grimes, Stubblefield and Creinin. (Wiley-Blackwell, 2009) 193.

[11] Cassing Hammond MD, and Stephen Chasen MD, “Dilation and Evacuation,” Management of Unintended and Abnormal Pregnancy. Ed. Paul, Lichtenberg, Borgatta, Grimes, Stubblefield and Creinin. (Wiley-Blackwell, 2009), 244-264.

[12] Ibid.

Abortion Methods: Saline Abortion

What is a Saline or Instillation Abortion?

An instillation abortion refers to any abortion where medication is injected or “instilled” into the uterus (womb), either inside or outside the amniotic sac that holds the fetus. Saline abortion is a specific type of instillation abortion, and the technical name is hypertonic saline abortion. Hypertonic saline is a highly concentrated salt solution. Other types of medications that can be instilled are urea, prostaglandins, and prostaglandin analogues. [1]

History of Instillation Abortion

Hypertonic Saline

Hypertonic saline was the first type of instillation abortion. Starting in the 1960s, saline abortions were typically done during the 2nd trimester because the uterus was easier to puncture at that gestational age. [2] Hyperosmolar urea, a highly concentrated kidney waste product, was also used for instillation abortions around the same time. [3]

Both these types of instillation abortion fell out of favor in the 1970s and 80s because of serious complications.  Several otherwise healthy women died after having them, and many abortions failed and ended up as live births. One study found that saline abortions were effective only 74% of the time. In other words, there were 26 failed abortions in every 100 women. [4]

Prostaglandins

As hypertonic saline and urea phased out, abortion doctors switched to instillation of prostaglandins. Prostaglandins are chemical messengers produced naturally by the body for different purposes. These purposes include: muscle contraction, blood clotting, inflammation, pain perception, the gastrointestinal or GI system, and other things. Prostaglandins also had many side effects, including strong GI symptoms like nausea, vomiting, and diarrhea. The latest version of instillation abortion, starting around the 1990s, is prostaglandin analogues. Prostaglandin analogues are slightly chemically modified versions of prostaglandins with fewer side effects.

Overall, prostaglandin analogues are routinely used nowadays, but they are not usually given by instillation. They are more likely to be given as pills, such as Misoprostol (see Medication Abortion article) because they have fewer side effects that way.

What Percentage of Abortions are Instillation Abortions?

Most Recent Data

A CDC report from 2007 reported that 0.5% of abortions that year were instillation abortions, which includes instillation of different substances: hypertonic saline, urea, prostaglandins, and prostaglandin analogues. The CDC website also reported that their abortion estimates were off by 35% from the Guttmacher Institute numbers. Guttmacher Institute numbers are considered the most accurate source for abortions statistics in the United States.[6] Theoretically, then, the actual number of abortions for the year would have been around 1.2 million, and about 12,000 of those would have been instillation abortions.

The most recent abortion numbers available are from 2014, but CDC numbers for that year do not break down types of abortion the way that the 2007 report did. They report 652,639 abortions total, and almost 47,000 abortions in the second trimester. If roughly 1% of those were instillation abortions, that would be around 6,000. [7] If the numbers are adjusted for Guttmacher estimates, there were just under 1 million abortions and around 10,000 of those were instillation abortions.

Instillation Abortions mostly done in the Second Trimester

The National Abortion Federation textbook, published in 2009, reports that in 1974 57% of abortions done after 13 weeks gestation were instillation abortions. By 2005, they estimated that number to be 0.4%. [5]

What happens during an Instillation Abortion?

Instillation as part of Induction Abortion

Instillation of medications is often done as part of an induction abortion. Usually, being “induced” means that a woman is given medications to make her go into labor and deliver the fetus at a specific time, often before the due date. This is done for a variety of reasons, such as if the mother’s blood pressure is getting too high, or the fetus is not growing properly in the womb anymore.

In an induction abortion, the plan is to go into labor but to deliver a dead baby. Instillation of medications causes fetal death and speeds up the labor process by softening the cervix and causing contractions. Instillation-before-induction abortions are done in hospitals.

Before the Abortion

Before the abortion, the woman has bloodwork and sexually transmitted infection screenings done. Vital signs like blood pressure and heart rate and temperature are recorded. An ultrasound will be done to confirm how far along she is. She may be given an antibiotic pill to prevent infection of the cervix, vagina, and uterus.

Often, her cervix will be dilated using laminaria, sticks of sterilized seaweed. This may be done up to 24 hours before the instillation.

Procedure

An injection is given into her abdomen (stomach area) to numb the skin around the needle. Next, the abortion doctor uses ultrasound to guide a long needle through the abdomen and into the uterus. Approximately one cup of amniotic fluid is removed to be sure that the needle is in the right place, and it is replaced with hypertonic saline or another medication. Inside the uterus, the medication is either injected into the amniotic sac that contains the fetus or into the space outside of the sac. [9] Afterwards,  labor inducing medications may be given through an IV. Typically, the woman will go into labor and deliver the dead fetus within about 24 hours.

At what point does the fetus die during the Abortion?

Instilled medications work in different ways. All ways are meant to kill the fetus before it is delivered. Hypertonic saline and urea cause severe dehydration, burning of the fetal skin and internal organs, and then death. The prostaglandins and prostaglandin analogues similarly break down the fetal tissue. This causes death, softens the cervix, and stimulates uterine contractions.

What are the Side Effects of an Instillation Abortion?

Hypertonic saline and urea instillation abortions can cause side effects:

  • Infection
  • Babies born alive, sometimes with deformities or other health problems

Melissa Ohden and Gianna Jessen are two well-known survivors of saline abortions during the 1970s. [10]  [11]

  • A life-threatening blood clotting disorder called disseminated intravascular coagulopathy (DIC)[12]
  • Life-threatening hemorrhage (bleeding) [13]
  • Seizures
  • Death

For example, 3 otherwise healthy women died in 1966 due to seizures after saline abortions. Hypertonic saline is a highly concentrated sodium (salt) solution. If it leaks out of the uterus and into the bloodstream, it causes major problems for the woman. Besides leaking out through a hole (or perforation) punctured in the uterus, the medication can also be accidentally instilled into the bloodstream instead of the uterus. In the bloodstream, the salt solution travels throughout the body. Too much sodium in the brain causes severe swelling and bleeding. Severe swelling and bleeding can cause seizures and ultimately death. [14] Hypertonic saline accidentally given into the bloodstream can also cause a life-threatening blood clotting disorder called disseminated intravascular coagulopathy (DIC).

Prostaglandins and prostaglandin analogues can cause:

  • Severe abdominal pain
  • Nausea
  • Vomiting
  • Diarrhea
  • Fever
  • Shivering [15]
  • Vaginal bleeding, sometimes requiring blood transfusion [16]
  • Cervical fistulae (abnormal opening between the cervix and the vagina or bladder causing leakage of urine) [17]
  • Uterine rupture (can be life-threatening), typically in women who had previously had a Cesarean section (C-section) [18]

Induction abortions are specifically associated with retained placenta, which puts the woman at risk for life-threatening infection.

How often do Complications occur?

Life threatening blood clotting and bleeding after prostaglandin analogue abortion occurs in approximately 1 in every 100 women. [19]  Research has shown that induction abortions can be complicated by retained placenta up to 30% of the time. [20]

While only about 10–15% of all abortions are done in the second trimester, they are responsible for roughly two-thirds or 66% of all major complications. [21][22] Risk of death from second trimester abortion is over 20 times higher than from first trimester abortion. [23] Risk of death from abortion increases by 38% each week starting in the second trimester. [24]

Citations:

[1] Many research studies and resources cited in this document are from the 1970s and 1980s because more recent research on instillation abortions has not been done.

[3] While most sources are from the 1970s and 1980s, one case report from the United Kingdom of a urea instillation abortion was published in 2009.

[5]  Cassing Hammond MD, and Stephen Chasen MD, “Dilation and Evacuation,” Management of Unintended and Abnormal Pregnancy. Ed. Paul, Lichtenberg, Borgatta, Grimes, Stubblefield and Creinin. (Wiley-Blackwell, 2009), 158.

[17] Berger, G., Bygdeman, M., and Keith, L.G. Prostaglandins and their Inhibitors in Clinical Obstetrics and Gynaecology. (Springer Netherlands, 1986), 297.

[20] Autry AM, Hayes EC, Jacobson GF, Kirby RS. A comparison of medical induction and dilation and evacuation for second-trimester abortion. Am J Obstet Gynecol 2002; 187: 393– 397.

[22] Cassing Hammond MD, and Stephen Chasen MD, “Dilation and Evacuation,” Management of Unintended and Abnormal Pregnancy. Ed. Paul, Lichtenberg, Borgatta, Grimes, Stubblefield and Creinin. (Wiley-Blackwell, 2009), 179.

Citations:

Abortion Methods: Medication Abortion, Abortion Pill, RU-486

We will review the different methods of abortion currently used in the United States. Here we will give you a detailed overview of medical abortions.

What is a Medication Abortion?

They often go by various names:

    • Medication Abortion
    • Medical Abortion
    • Abortion Pill
    • RU-486

History of Medication Abortion

In 2000, the United States Food and Drug Administration (FDA) approved two abortion pills. The two medicines are mifepristone and misoprostol. [1]

In 2016, the FDA approved a new label for the medicines. This change allowed for lower dosages, increased gestational age limit, and fewer follow up visits.

How Common is Abortion by Medication?

Medication abortion is increasingly popular. It accounted for 6% of nonhospital abortions in 2001, and 31% by 2014 (the most recent year for which data are available according to the Guttmacher Institute, the former research arm of Planned Parenthood). [2]

This is for several reasons.

Medication abortion is cheaper for abortion providers. A patient is typically charged the same amount for either a medication abortion or a surgical abortion. The medication abortion, though, takes less manpower, clinic time, and does not involve anesthesia. The woman is responsible for giving herself Ibuprofen and relieving her own pain outside the clinic.

Also, abortion advocates want nurse practitioners and physician assistants to offer medication abortion. They say that simply performing a physical exam and giving a pill does not require a doctor. Pro-life advocates point out that abortion is not routine healthcare, and that it’s potentially very serious consequences deserve the oversight of an actual physician.

Prescribed medicines usually come from a pharmacy, and the patient can ask the pharmacist if they have questions. The abortion pill is only available at an abortion clinic. The abortion doctor signs very detailed paperwork about the abortion medicines and returns it to the manufacturer.

What happens during a Medication Abortion?

First, an ultrasound is done to confirm that the pregnancy is intrauterine (inside the uterus) and not ectopic (growing outside the uterus). A nurse or other staff member takes the woman’s vital signs like heart rate and blood pressure. The abortion doctor also listens to the woman’s heart and lungs with a stethoscope and does a pelvic exam, except in webcam abortions (see below). Sometimes, the woman receives antibiotics to prevent infection.

Mifepristone or Mifeprex or RU-486, is the first medicine. It is given to the woman at the abortion clinic. Misoprostol is the second medicine. The woman takes Misoprostol at home. 

The abortion usually takes  24-48 hours after the second medicine, Misoprostol, is taken. The woman signs a Patient Agreement Form that she will come back for a follow up appointment in 14 days. This is to be sure that the abortion worked. In 2-7% of cases, this type of abortion does not work. If that happens and the woman is still pregnant, she is then encouraged to have a surgical abortion such as a dilation and curettage (D&C). If she chooses to carry the baby to term after a failed medication abortion, the baby might have birth defects.  

About the Drugs used in Medical Abortion

Mifepristone works by blocking progesterone. Progesterone is the hormone that sustains pregnancy. Without progesterone, the lining of the uterus breaks down and sheds like in a menstrual period. This cuts off nutrients and support to the fetus. [3]

Misoprostol was first developed to prevent stomach ulcers in people who take nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or advil. [4]  Another way it works is by releasing prostaglandins in the body. This effect is the reason Misoprostol is part of medication abortions. Prostaglandins cause the uterus to have contractions and expel the dead fetus. This happens while at home and the fetus is usually expelled into the toilet. These strong uterine contractions are said to feel like the pain from very strong period cramps. According to Planned Parenthood’s own website, fetal tissue may be visible along with “lots of bleeding.” 

In very rare cases, when a woman is allergic to Mifepristone, a different medication called Methotrexate may be used by itself without the Misoprostol. Methotrexate is typically a chemotherapy medication or a rheumatoid arthritis treatment. In medication abortion, it kills the embryo by stopping the reproduction of fast-growing fetal cells.

At what point does the Fetus die?

Typically, the fetus dies when its nutrients are cut off because of the first abortion medicine, Mifepristone.

What Percentage of Abortions are Medication Abortions?

Medication abortion is increasingly popular. It accounted for 6% of nonhospital abortions in 2001, and 31% by 2014 (the most recent year for which data are available according to the Guttmacher Institute, the former research arm of Planned Parenthood). [5]

This is for several reasons.

Medication abortion is cheaper for abortion providers. A patient is typically charged the same amount for either a medication abortion or a surgical abortion,  but the medication kind takes less manpower, clinic time, and does not involve anesthesia. The woman is responsible for giving herself ibuprofen and relieving her own pain outside the clinic.

Also, abortion advocates want nurse practitioners and physician assistants to offer medication abortion. They say that simply performing a physical exam and giving a pill does not require a doctor. Pro-life advocates point out that abortion is not routine healthcare, and that it’s potentially very serious consequences deserve the oversight of an actual physician. Prescribed medicines usually come from a pharmacy, and the patient can ask the pharmacist if they have questions. The abortion pill is only available at an abortion clinic. The abortion doctor signs very detailed paperwork about the abortion medicines and returns it to the manufacturer.

Side Effects of the Abortion Pills [6]

Abortion is never safe for the developing embryo or fetus. A medication abortion is also not safe for women themselves who meet any of the following criteria:

    • Pregnancy greater than 10 weeks along
    • An ectopic pregnancy, also known as pregnancy outside the uterus
    • Have an intrauterine device (IUD) currently in place
    • History of adrenal gland problems
    • Take blood thinners
    • Have a blood clotting disorder or other bleeding problem
    • Have porphyria
    • Take steroids
  • Have an allergy to misoprostol, mifepristone, or other prostaglandins

Common side effects up to 24 hours after taking the medicines can include:

    • Nausea/vomiting
    • Weakness
    • Fever/chills
    • Headache
    • Diarrhea
  • Dizziness

Rare but serious side effects include:

    • Life-threatening bleeding requiring hospitalization and possibly a blood transfusion
  • Life-threatening infection

Bleeding is not listed as a side effect because it is expected. This does not mean that the amount of bleeding will necessarily be safe. Serious or life-threatening bleeding is more likely with medication abortion because of the way the medicines work. Since every woman’s body reacts differently to medications, some women’s bodies may not automatically stop bleeding and contracting just because the fetus has already been expelled. This can progress to life-threatening bleeding depending on how much the woman bleeds and how long she bleeds for.

Additionally, there is a risk of infection. This risk is highest for women who experience “incomplete abortion.” This is when the fetus is dead and expelled but the body retains some of the membranes or placenta that were supporting it. [7]

How often do Complications occur?

In a 2014 research study in California, there were four times as many complications from medication abortions as surgical abortions in the first trimester. About 5.2% of women had to go to the emergency room for a medication abortion complication. [8] In another research study in Finland, there were four times as many complications from medication abortions at or before 7 weeks gestational age compared to surgical abortions. 20% of women, or 1 in every 5 women, who had medication abortions in the study experienced a complication. [9]

Deaths from the Abortion Pill

After the original FDA protocol was released in 2000, eight young women who took Misoprostol vaginally died of a bloodstream infection caused by clostridium sordelli bacteria. The FDA protocol did not mention vaginal use, but this “off-label” use was common at the time.  The FDA said those deaths were “infection-related” rather than “abortion-related. ” Nowadays, Misoprostol is no longer used vaginally. It is placed inside the cheek until it dissolves.

In total, 22 women who took RU-486 have died since 2000. 2 of those women died from ruptured ectopic pregnancies, even though the FDA insert says that no woman with an ectopic pregnancy should take RU-486. [10]

In 2016, the FDA accepted off-label dosages that were being widely used by abortion doctors, instead of the dosages from the 2000 protocol. When this protocol change was made, no safety research studies were cited.

What are Webcam or Telemedicine Abortions?

Telemedicine or “webcam” abortions are becoming more popular. After an ultrasound and a review of the woman’s medical history, she takes the first medicine in clinic. A physician watches remotely on a webcam. Abortion advocates say that webcam abortions give rural woman more access. Pro-life advocates point out that women miss out on an actual physical examination. Also, living in rural areas could mean less access to a hospital when complications occur. Iowa was the first state to pilot webcam abortions, and Sue Thayer managed a Planned Parenthood clinic there. She was fired for refusing to participate.

As this article was being written, California’s legislature is considering HB320, which would mandate that health centers at state-run colleges and universities dispense abortion medicines.

What if I Change my Mind?

For women who have only taken Mifepristone and change their minds, stopping the abortion may be possible. A large dose of oral progesterone may be able to reverse Mifepristone’s effects. In a research study, the abortion was effectively stopped in 68% of patients who took the progesterone. More information is available here: https://abortionpillreversal.com/

What does Baby Look Like at 10 weeks?

At 10 weeks, the brain, heart, lungs, liver, and kidneys are all formed. Baby’s heart has been beating since about 3 weeks. Baby’s fingernails and hair are starting to grow.

Abortion Methods: Intracardiac Abortion

We will review the different methods of abortion currently used in the United States. Here we will give you a detailed overview of  intracardiac abortions.

History of Intracardiac Abortion

The first successful intracardiac abortion was in 1978.[5] A woman pregnant with twins chose to abort a fetus with a lethal disease with the hope of saving its twin. Since then, abortionists have used injectable medications particularly before second or third trimester dilation & evacuation (D&E) abortions, to make sure that the fetus is dead before it is delivered.

Reasons for Intracardiac Abortion

Reasons for these late term abortions include aborting fetuses who have a disability that won’t allow them to live outside of the womb, or who may have health issues for the rest of their life after birth like Down Syndrome. Injected medication abortions are also sometimes done after in vitro fertilization.

Selective Reduction

Abortion of one or more fetuses after in vitro fertilization is called “selective reduction.” Abortion after in vitro fertilization might not seem to make sense, since the couple was obviously trying to get pregnant.  However, as part of in vitro fertilization, typically multiple embryos are implanted in the woman’s uterus. That way, there’s a higher likelihood of having at least one live birth.

But, sometimes multiple embryos survive the transfer process from the lab to the womb. The risk of health problems if these embryos live until birth is high. There are higher rates of preterm (early) delivery, low birth weight, brain problems, development problems, and many other issues if multiple babies are born at once rather than if just one baby is born at a time.

“Selective reduction”, then, is the process of aborting one or more of these fetuses so that the one (or two) fetus(es) that makes it to birth has (have) a higher chance of being relatively healthy. [6]

End Goal

Whatever the reason that the woman may be aborting, these medications are injected to ensure that the fetus is not alive when it is born. Some women who are aborting fetuses with health problems believe that abortion is the “merciful” thing to do. They want to be sure that the fetus isn’t alive when it is born because then they would feel conflicted about trying to resuscitate it or watching it die.

Connection to Partial Birth Abortion 

Also, the Partial Birth Abortion Act of 2003 in the United States states that killing a living fetus when it has been partially delivered from the woman’s body is illegal. [7] Some abortion doctors make sure that the fetus is dead before delivery so that they don’t get in trouble for breaking this law.

What are Intracardiac Abortions?

An intracardiac abortion happens when a medication being injected through the pregnant woman’s abdomen (stomach area) into the fetal heart. The medicine stops the fetus’ heart from beating.

Potassium Chloride

This is often done with a medicine called Potassium Chloride. Outside of its use in abortions, Potassium Chloride is also one of several medicines given for execution of prisoners by the death penalty.

Digoxin

Medications to stop the fetus’ heartbeat are also sometimes injected into the amniotic fluid around the fetus, or into a random fetal body part. The most common of these medicines is called Digoxin.[1]

Outside of its use in abortions, Digoxin was originally developed for adults  to make the heart beat stronger and with a regular rhythm, or to treat an irregular heart rhythm called atrial fibrillation. Digoxin injected into the fetus is given in a lethal dose that slows the heart beat gradually until it stops.

Research

In research studies, injected Digoxin failed to stop the fetal heartbeat in 6.6% to 13% of abortions. [2][3] In research studies, Potassium Chloride failed less than 1% of the time. [4]

What Percentage of Abortions are Intracardiac Abortions?

The Centers for Disease Control and Prevention (CDC) collect abortion data each year, and the results of their data collection are available online through the year 2014.[8] Abortion data since 2014 have not yet been published. States and several large cities like Washington D.C. and New York City have the option to report their data to the CDC each year or not. For 2014, California, Maryland, and New Hampshire abortion numbers were not reported.

In the CDC report, abortion methods are classified as surgical or medical (medication). Exact numbers on how many of these surgical abortions were intracardiac abortions are not available because most of the states that report their data to the CDC did not provide this information.

The studies used in this article included from fewer than 10 up to nearly 5,000 women. Studies of digoxin included 8 women, 126 women, and 4,906 women. [9] [10] [11] Studies of Potassium Chloride included 192 women and 239 women. [12] In one study from Britain in 2004, where abortions by type are tracked better than in the United States, about 1% of abortions were intracardiac or injectable. [13]

What Happens During an Intracardiac Abortion?

On the day of the procedure, the woman first has a blood sample drawn to check her blood type, and vital signs like heart rate and blood pressure taken. She is positioned on the clinic or hospital bed as if she were having a regular pregnancy ultrasound. A numbing shot is given through a small needle into her belly. Then a long, large needle with the medicine in it is put in her belly. An ultrasound is used to determine where the fetal heart is, and when the needle is in the fetal heart.

The medicine is then injected, and the abortion doctor watches on the ultrasound screen until the heart stops. An ultrasound is often done again 30 minutes after the fetal heartbeat has stopped, to make sure that it is still stopped.

After the fetal death, the woman may be induced or may wait up to several weeks to go into labor on her own. [14] Sometimes, she goes into labor and delivers the stillborn baby before she can get back to the hospital. If she does deliver at the hospital, sometimes it is on a bed as with a planned live birth, and other times it is into a toilet.

A visual overview is here.

At What Point Does the Baby Die During the Abortion?

Typically, the baby dies within several minutes after a Potassium Chloride injection because the medication stops its heartbeat immediately. The abortionist watches the ultrasound until it shows that the heart has stopped. With Digoxin, fetal death can take hours.

An ultrasound may be done periodically to check when the heart stops beating. Around 30 minutes after electrical activity stops, another ultrasound is done to confirm that the heart has not started beating again. If the heart has restarted, a repeat dose of medication may be given. [15]

What are the Side Effects of an Intracardiac Abortion?

Side effects after a Potassium Chloride injection abortion are different from a Digoxin injection abortion. Digoxin injections are not recommended as standard practice before a dilation and evacuation abortion because they don’t decrease how long the abortion takes. Side effects include vomiting, women going into labor on their own at home or other places before the scheduled dilation and evacuation, and infections inside the uterus. Digoxin cannot be given to any woman with a history of Wolff-Parkinson-White syndrome. [16]

In one Potassium Chloride study, a woman suffered cardiac arrest (her heart stopped) and was successfully brought back to life. In another research study, a woman developed a life-threatening infection after the medicine was accidentally injected into her bloodstream instead of into the fetus’ heart. [17]

How Often Do Complications Occur?

Complications other than vomiting occurred less than 1% of the time in women who received Digoxin injections. Vomiting occurred in around 15% of women. Complications occurred less than 1% of the time in women who received Potassium Chloride injections, but when they did occur they were very severe (see above).

Sometimes intracardiac injections are given before a woman is induced to go into labor. Research shows that induction abortions can be complicated by retained placenta up to 30% of the time. Retained placenta puts the woman at significant risk for life-threatening infection. [18]

Citations:

[16] [16] Cassing Hammond MD, and Stephen Chasen MD, Management of Unintended and Abnormal Pregnancy. Ed. Paul, Lichtenberg, Borgatta, Grimes, Stubblefield and Creinin. (Wiley-Blackwell, 2009).

[18] Autry AM, Hayes EC, Jacobson GF, Kirby RS. A comparison of medical induction and dilation and evacuation for second-trimester abortion. Am J Obstet Gynecol 2002; 187: 393– 397.