Dilation and Extraction

Dilation and Evacuation (D&E) is the gold standard abortion procedure conducted during the second and third trimester of pregnancy (16 weeks and beyond). The D&E procedure, when used as a mean of terminating an unwanted pregnancy, is safer at any point in a pregnancy than the only alternative available to the pregnant woman: childbirth. That is to say that research suggests that the risk of injury or death from childbirth and complications is much greater than an abortion procedure.

In a California based study conducted about a decade ago, researchers found that approximately 20% of births in the state were reported in conjunction with at least one obstetric complication to the woman during labor and delivery. The numbers increase to about 25% for women of color. Whereas the Alan Guttmacher Institute (AGI) reports less than 1% of women report complications during an abortion. AGI also reports that the risk of death associated with childbirth is 10 times greater than the risk of death from an abortion. AGI supports the findings that abortion is safer than childbirth. Perhaps, there in lies the argument that anti-aborts should be chasing. But we'll get to that in later posts.

Below are basic descriptions of D&E and intact D&E. These are meant to provide us with some background for our discussion about Stanek's webpage. Please do not take these for medical advice or guidance. You should consult a licensed medical physician for information and advice on abortion services. The reasons for, the adverse side effects, and the procedures themselves are basic and are not all inclusive.

The Procedure

The medical prep work for a D&E begins 24 hours prior to the actual procedure. One day prior, a medical professional inserts laminaria or a synthetic dilator into the cervix. The following day, the provider will begin the procedure by attaching a tenaculum to the cervix to keep the uterus intact, while cone-shaped rods of increasing size further the dilation process. A cannula is then inserted to clear and remove tissue from the lining. With a curette, the lining of the uterus is scraped to remove remaining residuals. If needed, forceps may be used to remove larger parts, which is often the case in late abortions. The final step is suctioning to make ensure fetal contents are completely removed. The removed tissue is examined to confirm a complete abortion has been performed.

The procedure normally spans about 30 to 60 minutes. It is preferred that the procedure be conducted in a hospital setting because of the potential for side effects, however a D&E can be conducted in a stand-alone abortion clinic. The woman is able to return home shortly after the procedure is complete, if no complications are noted.

If there is a concern with the fetus or it is too large, an intact D&E is performed. Intact D&E procedure is:

Much like the other method of D&E, preliminary procedures occur first over a period of two to three days, to gradually dilate the cervix. The drug pitocin is sometimes administered to progress the process. Much of the goal of this exercise is to prepare the woman for removing the fetus and during an intact D&E, largest portion of the fetus, which is the head, is reduced in diameter to allow vaginal passage.

Once the physician is satisfied the woman is dilated enough for the procedure, the fetus is positioned for a footling breech. Through the use of ultrasound and forceps, the physician grasps the fetus' leg. The fetus is then turned to a breech position, if required, and the physician pulls both legs out of the uterus. The physician subsequently extracts the rest of the fetus, usually without the aid of forceps, leaving the head and sometimes the shoulders intact inside the birth canal. At the base of the skull, a tiny incision is made and a blunt dissector (i.e. Kelly Clamp) is then inserted. The clamp is inserted directly into the incision and opened to widen the opening, and then a suction catheter is inserted into the opening. Lastly, the brain and matter inside the skull are evacuated. This causes the skull to collapse and allows the fetus to pass more easily through the birth canal, which is the primary goal of intact D&E. The placenta follows shortly thereafter and the uterine wall is vacuum aspirated using a cannula to remove any remaining debris.

The procedure itself takes spans about 12 hours from start to recovery of the woman. The crux of the debate for Stanek and like is that some fetuses can remain alive for up to six hours after the procedures, but will cease to function on their own. We'll get into this debate shortly. However, this is the fallacy of the so called "partial ban abortion" debate.

There are three main reasons why either form of D&E is conducted:

1. The procedure may recommended when the fetus that has severe medical problems or abnormalities.
2. A woman who is pregnant as a result of rape or incest may not confirm the pregnancy until the second or third trimester because of her emotional response to the traumatic cause of the pregnancy.
3. A woman who lacks access to an affordable abortion specialist in her community or whose access is slowed by legal restrictions may take several weeks to have a planned abortion.

According to WebMD, the risks of dilation and evacuation (D&E) include:

• Injury to the uterine lining or cervix.
• A hole in the wall of the uterus (uterine perforation, rare), which most commonly happens during cervical dilation. Bleeding is usually minimal, and no repair is necessary. If bleeding is a concern, a laparoscopy (a procedure that uses a lighted viewing instrument) can be used to see whether it has stopped.
• Infection. Bacteria can enter the uterus during the procedure and cause an infection. This is more likely if an untreated disease, such as a sexually transmitted disease (STD), is present before the procedure. Antibiotics given during and after the D&E procedure will reduce this risk.
• Moderate to severe bleeding (hemorrhage), which is sometimes caused by:

• Injury to the uterine lining or cervix.
• Uterine perforation.
• Uterine rupture. In rare cases, a uterine incision scar tears open when a medicine is used to induce contractions.
• Tissue remains in the uterus (retained products of conception). This can cause recurring cramping, abdominal pain, and bleeding within a week of the procedure. Sometimes, prolonged bleeding is not evident until several weeks after with the reasons for this are unknown.

Medical risks are higher for surgical abortions done in the second trimester of pregnancy than for those done in the first trimester, particularly if they are done after 16 weeks of pregnancy.

Other rare complications may include:

• Tissue remaining in the uterus (retained products of conception). Cramping abdominal pain and bleeding recur within a week of the procedure. Sometimes prolonged bleeding does not occur until several weeks later.
• Blood clots. If the uterus doesn't contract to pass all the tissue, the cervical opening can become blocked, preventing blood from leaving the uterus. The uterus becomes enlarged and tender, often with abdominal pain, cramping, and nausea.
A repeat vacuum aspiration and medicine to stop bleeding are used to treat retained products of conception or blood clots.

Abortion is one of the most common operations in the United States. An indicator of its prevalency suggests that is it more common than tonsillectomy or removal of wisdom teeth. (The most common procedure in most pediatric hospitals today.) Wenberg and colleagues state that legal abortion is safer than a tonsillectomy, an appendectomy, and a shot of penicillin. Thus, abortion serves as a healthy means by which to terminate an unwanted pregnancy, more so than a live birth. more...