METHODS OF ABORTION

The Government is planning to introduce abortion on wide-ranging grounds – up to 12 weeks for any reason, up to six months (viability) on unspecified mental health grounds, and up to birth if the baby has a life limiting condition.

Methods of Abortion

There are two types of abortion: medical and surgical. The choice of method is made according to the gestational age of the pregnancy.

Medical abortions

Medical abortions can be carried out at any gestational age. The two drugs used are mifepristone and misoprostol[1]. Mifepristone (RU486) blocks the action of the mother’s pregnancy sustaining hormone progesterone, which causes the lining of the uterus to break down. The second drug, misoprostol, induces strong uterine contractions leading to the expulsion of the baby from the uterus. The abortion begins within 2-5 hours of taking the first medication, and is usually complete in 1-2 days[2].

In some situations, a further surgical evacuation is necessary to remove a retained placenta[3]. More serious complications, potentially resulting in the death of pregnant woman can occur in cases of undiagnosed ectopic pregnancies.

To prevent the ’risk’ of a live birth, feticide is performed before medical abortion at 22 weeks and above[4]. Digoxin or potassium chloride is injected into the foetal circulation, sometimes the heart or thorax, bringing about the death of the baby[5].

Surgical Abortions

Surgical abortions are also performed at all ages of unborn life. There are generally two types of surgical abortion: vacuum aspiration (also called suction), and dilatation and evacuation (D&E).

Vacuum aspiration, or suction abortions, are done up to 15 weeks gestation, and dilatation and evacuation (D&E) where the fetus is 15 weeks and more. The unborn baby is suctioned out of the uterus, and the remains are assembled to ensure the fetus is completely removed and the uterus is free of all debris. Suction abortions are carried out under local anaesthetic, sedation or general anaesthetic.

The D&E procedure, carried out under general anaesthetic between 15 and 24 weeks gestation[6], involves the removal of the unborn baby piece by piece using a surgical forceps, with or without feticide beforehand. Later term or third trimester abortions involve feticide by injecting digoxin or potassium chloride into the unborn baby’s heart, thorax, or head bringing about cardiac arrest.

Another surgical form of abortion performed in some jurisdictions is the Intact Dilatation and Extraction or D&X procedure (sometimes referred to as Partial birth abortions[7]). The unborn baby is manipulated into a feet first delivery position by means of forceps, and then delivered up to the naval. Using a surgical scissors the skull of the unborn baby is pierced and a suction catheter is inserted to remove the fetal brain tissue. With the skull collapsed, it passes more easily through the birth canal.

[1] BPAS https://www.bpas.org/abortion-care/abortion-treatments/the-abortion-pill/

[2] Marie Stopes UK https://www.mariestopes.org.uk/abortion-services/medical-abortion/

[3] 3-5% require surgical evacuation of “retained products of conception”. BPAS, https://www.bpas.org/abortion-care/abortion-treatments/the-abortion-pill/abortion-pill-up-to-10-weeks/

[4] Dr Thompson at Oireachtas Committee https://beta.oireachtas.ie/en/debates/debate/joint_committee_on_the_eighth_amendment_of_the_constitution/2017-11-29/3/

RCOG, The Care of Women Requesting Induced Abortion: Evidenced-based Clinical Guideline No. 7, Pg. 57

https://www.rcog.org.uk/globalassets/documents/guidelines/abortion-guideline_web_1.pdf

[5] Ibid, Pg. 57 & 58

[6] BPAS

[7] The US Supreme Court 2003 & 2007 ban on Partial Birth Abortion prohibits the delivery of the baby up to the head in the breech position, or the delivery of the baby’s head in the head presentation, followed by the removal of the cranial tissue. The foot first delivery of the baby up to the navel is permissible however. http://news.findlaw.com/hdocs/docs/abortion/2003s3.html