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Hermit
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Abortion Manual
« on: 2006-03-14 14:32:25 » |
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For the women of South Dakota: an abortion manual
[Hermit notes: Interesting person, interesting topics and interesting comments on her blog. I have added a few caveats and notes to this article, as well as "a possible complications section" which should be studied and a copy given to the potential patient before the procedure is considered, all subject to the same - and indeed stronger disclaimers than the original. An issue to consider is that of liability. I'm not sure how this could be handled. While any waiver is probably better than none, there is some likelihood that any consent could be invalidated as contra bono mores. I'd suggest that this is why, despite the fact that it is "relatively" safe, a "backstreet" abortion be the very last step taken after exploring all other avenues. Consider that helping someone financially to enable them to travel to a jurisdiction where abortion is safe and legal, and to pay for the abortion itself if needed, is likely to cost far less than even the legal fees, never mind possible fines or damages, attempting to defend oneself from some of the charges which might be laid against a "backstreet abortionist" no matter how well intentioned.]
Source: mollysavestheday
Authors:"Molly" (former journalist turned phone sex operator)
Dated: 2006-02-17
I understand that you're probably really angry right now. Maybe you're reading a blog expressing that anger -- the anger that your state thinks it knows better than you what to do with your body. Maybe you're anxiously wondering where the nearest abortion clinic is, now that you will have to leave the state to get to one. If you have a serious medical condition, you might be doubling up on birth control methods, leading to a lot of worry and possibly negative side effects.
But what you need right now isn't the righteous anger the rest of the blogosphere will give you. You need more.
In the 1960s and early 1970s, when abortions were illegal in many places and expensive to get, an organization called Jane stepped up to the plate in the Chicago area. Jane initially hired an abortion doctor, but later they did the abortions themselves. They lost only one patient in 13,000 -- a lower death rate than that of giving live birth. The biggest obstacle they had, though, was the fact that until years into the operation, they thought of abortion as something only a doctor could do, something only the most trained specialist could perform without endangering the life of the woman.
They were deceived -- much like you have probably been deceived. An abortion, especially for an early pregnancy, is a relatively easy procedure to perform. And while I know, women of South Dakota, that you never asked for this, now is the time to learn how it is done. There is no reason you should be beholden to doctors -- especially in a state where doctors have been refusing to perform them, forcing the state's only abortion clinic to fly doctors in from elsewhere.
No textbooks or guides existed at that time to help them, and the equipment was hard to find. This is no longer true. For under $2000, any person with the inclination to learn could create a fully functioning abortion setup allowing for both vacuum aspiration and dilation/curettage abortions. If you are careful and diligent, and have a good grasp of a woman's anatomy you will not put anyone's health or life in danger, even if you have not seen one of these procedures performed.
Today, I will discuss dilation and curettage -- what used to be the most common abortion procedure before vacuum aspiration took its place. Vacuum aspiration is an easier method, but sometimes remaining fetal/placental material necessitates doing a "cleanup" D&C anyway, so you should know how to do this procedure first.
DISCLAIMER: I am posting this as information only. Whether anyone chooses to act upon this information is their own concern. I believe in the free exchange of information and ideas. I believe this information has been kept from women for too long, and there is no reason they should not know about a procedure being performed on their own body, and no reason women should be kept in the dark about how to perform it -- especially if someone they know is having their health jeopardized by this law.
[Hermit notes: If at all possible and you have time, get the subject to stop smoking before and after the procedure. Smokers heal more slowly after surgery and are more likely to have problems during surgery. For this reason, if you have the time (you really want to perform an abortion as early as possible, before 11 weeks is preferable and before 13 weeks unless you know what you are doing), you should ask the smoker to quit at least 2 weeks before the procedure (the longer before hand the better)).]
Instruments needed and their uses. You will need:One set of uterine dilators (any equipment may be purchased from numerous websites. If you need assistance in finding this equipment, do not hesitate to email me at molly.blythe@gmail.com)
Vaginal speculum
Pregnancy test
One set of uterine curettes
One pair of uterine forceps
One pair of regular forceps
Sterile bags for medical instruments and medical waste
A course of antibiotics
Sedative medication
Pressure cooker
Container of bleach solution: one part chlorine bleach to 10 parts water
Strong soap
Sterile latex gloves
Water-based lubricant
Maxi pads
Clean plastic sheeting and towels
Exam table
Wet wipes First, let's talk instruments, before we talk implementation:
Cervical dilators come in many forms. Some hydroscopic dilators work by absorbing moisture from the vagina into the dilator, gradually increasing its diameter until it is workable. However, the "old-fashioned" way is with a set of dilators -- metal instruments of varying sizes. It would probably be best for an illegal practitioner to use these, as they are essentially infinitely reusable as long as they are sterilized between uses. Essentially, the practitioner begins with the smallest instrument and inserts it into the cervix. Then, he or she moves on to the next smallest, and so forth, until the cervix is sufficiently dilated to allow the uterine forceps to be used. This is the easiest part of the abortion, and one that requires very little knowledge other than the placement of the cervix.
Uterine forceps look like a hybrid of a scissor handle and a bird of prey's talon. Their use, once the cervix is dilated enough to allow access to the uterus, is simple: they remove the fetal material from the uterus -- as much as can be removed in this manner.
Curettes are perhaps the most foreign-looking of the implements used. Essentially, they look like small spoons with sharp edges. These are used after the uterine forceps, to make sure the rest of the fetal material and placenta is scraped from the sides of the uterus.
A course of antibiotics is CRUCIAL. The most common cause of death post-illegal abortion is due to infection. When your uterus has been opened up, it is more prone to infection. Do not fool around with this: antibiotics are absolutely necessary post-abortion. Antibiotics can be purchased from Mexican pharmaceutical supply houses for less than $2 per course.
Now that we've discussed the more uncommon instruments, let's move on to discussing the procedure itself.
Procedure
[Hermit notes: Rather than following the advice on a pregnancy test below, get the patient to visit a doctor to confirm a normal (uterine) pregnancy (ultrasound is safest) before considering these procedures. An ectopic pregnancy will still show up on a pregnancy test but needs to be dealt with surgically. The chances of this happening are small but you don't want or need to have to deal with this issue. As important, don't attempt an abortion before 6 weeks (8 weeks since the last period) as the risk of missing some tissue (incomplete abortion) with almost certain complications is very much higher in the very early weeks of gestation.]
Sterilizing instruments is absolutely critical. The most professional way to sterilize instruments would be with an autoclave -- but this is something to get only if you have an extra few hundred dollars to spend in the name of efficiency. Sterilization is no joke, and nothing to be skimped on, but you can sterilize instruments very well with a household pressure cooker. Ordinary boiling water does not kill all pathogens; while boiling water was the best people could do 100 years ago, it is not the best we can do now. Check your pressure cooker's manual carefully and figure out how much water needs to be placed in it to stay at 250-260 degrees for 30 minutes. Be sure to refer carefully to the manual, or injury and damage to the cooker could result. Place the water and instruments into the pressure cooker and allow it to "cook" them for 30 minutes at the 250-260 temperature. This will steam-sterilize your instruments. If you have an autoclave, lucky you! Follow its operating instructions.
Assuming you have no autoclave, follow the instructions for opening your pressure cooker, then remove the instruments with an already-sterilized pair of ordinary forceps. set them in the sterile bags. Now your instruments are prepared. From now on, be sure to only touch the instruments on the handle side, rather than on the side coming into contact with the cervix and uterus. Wipe down your table with bleach solution, allow it to dry, and then place clean plastic sheeting over it.
Your patient should be naked from the waist down and should have her pubic area shaved. Request that the patient does so the night before. Administer a sedative to the patient long enough before the procedure begins that it will be fully effective during the D&C procedure. Prior to the procedure, conduct an ordinary pregnancy test on the woman. This may seem like a silly step, but pregnancy tests are never 100% accurate, and women have been known to come to abortion clinics and test negative. Ask your patient how long it has been since her last period. If it has been eight weeks or less, the procedure itself will take less than 15 minutes after dilation begins. The length grows, however, until at about 13-14 weeks (the limit for a D&C procedure because of the limited dilation ability of dilators) it will last up to 45 minutes. Honesty is IMPERATIVE, because dishonesty could endanger the woman's health.
Once the patient has "assumed the position" in the stirrups, wipe the vulva and anal areas with separate wet wipes, including the labia majora and minora. Once the patient is clean, lubricate the vagina with water-based lubricant and use the vaginal speculum to open the vagina and examine the cervix (information on how to use a speculum properly is widely available online and in print and does not need to be reprinted here, but please be sure you understand how to use the speculum prior to conducting this procedure).
The cervix is a small, round, smooth-looking muscle at the top of the vaginal canal. Please be sure to familiarize yourself with the female reproductive system prior to performing any procedure such as this. The cervix is the entrance to the uterus. A non-pregnant uterus is only as big as a small pear, but it grows bigger even in the earliest months of pregnancy -- at 8 weeks, it is the size of a peach, and at 14 weeks, the size of a grapefruit. I didn't make up all these fruit-sizing terms, other people did, and I apologize for making anyone uncomfortable whilst eating fruit salad from now on.
[Hermit notes: See the footnote on "Allergic reactions and Anesthesia-related complications" before considering this section, but most potential mothers have probably been to the dentist and know whether or not they are sensitive or allergic to lidocaine. The infusion of a local anesthetic containing adrenaline (e.g. 5mL 4% lidocaine) directly into each side of the cervix just before beginning the procedure, and into the walls of the uterus after dilation helps in two ways. It reduces pain (by establishing paracervical and uterine blocks) and it reduce s bleeding (by constricting blood vessels in the area). Use of a topical anesthetic (e.g. Gebauer's Ethyl Chloride a few minutes before the injection will greatly reduce the pain of the injection itself. After numbing, wipe the cervix with iodine solution, then grasp the cervix with the normal forceps covered with an iodine coated swab, and push it, first to one side, then to the other while infusing the anesthetic into the tissue on each side with a number of injections. In addition, before beginning curettage, a 4% intrauterine lidocaine infusion will reduce discomfort during that phase of the procedure. The usual Mexican or Russian suppliers can provide the drugs, the syringe and the finebore needle. If you have not given injections before, practice first on an orange and then on yourself to get the feel for it. To maintain control of the process and not drive your patient insane, you need to press the needle in firmly, then depress the plunger with a firm yet steady motion expecting a high first resistance and then easier movement until you stop. You should warn your patient about the (absolutely normal) symptoms of lydocaine, oral numbness and tingling, and of adreneline, increased pulse rate to avoid her from being disturbed by them.]
It is important to know the approximate size of the uterus because that's where you're headed. Get out your smallest dilator and insert it slowly and gently into the cervix. This hurts -- it's part of why your patient is sedated. Novocaine is sometimes injected to numb the cervix, but when you are just starting, it is probably preferable to stay away from needles entirely [Hermit: I disagree. This part of the procedure is going to hurt - a lot. See note above.] Insert each dilator in turn. Even the largest dilator, as you will notice, doesn't give you very much room -- less than an inch of opening. There's no way you can see into the uterus. From here on out -- this is the scary part -- you will have to operate on feel alone. Don't feel too afraid. Each element in the uterus feels different from the others, and as long as you are careful and understand exactly what the procedure involves at each step, it will not be too difficult.
[Hermit notes: The article did not mention sounding, which is a part of the normal D&C procedure that I suggest be carried out immediately after dilation and before putting anything else into the uterus. Sounding is simply the use of a thin flexible rounded tip piece of metal (called a sound and available from the same surgical supplier as the other instruments) into the cervix to determine the depth of it, which establishes the maximum safe depth to which a curette can be inserted.]
The first step is to break the membrane holding the fetus inside. You can feel around with the forceps for it. To get an idea of what each part looks like -- and to see the texture so that you understand better how it will feel -- I recommend looking at books with photographs of first trimester fetuses (personal recommendation for its astonishing photographs: A Child is Born), The membrane should be easily broken with the forceps. Depending on how far along the pregnancy is, varying quantities of clear or pinkish fluid may come from the vagina. As you grasp the sac with your forceps, twist it away so that it detaches. You will now need to remove small pieces of fetal material and membrane from the uterus with the forceps. Some of these pieces will be distinctly identifiable as fetal material. Save the material until the end of the procedure on a piece of plastic, so that you can be sure the entire fetus has been removed. If doing this sounds too ethically challenging, remember that fetuses do not have the capacity to feel actual pain until the third trimester. You are not "hurting" it, and it has no awareness, nor the capacity for awareness, that you are extracting it.
This portion of the abortion procedure should not be particularly painful for the patient.
[Hermit notes: If a cervical block, and preferably IMO, an intrauterine local anesthetic infusion was established, the patient will only feel "pulling" sensations during this part of the procedure. If a cervical block was not established there will be some discomfort but not nearly as much as during dilation.]
While you are removing fetal material, you will also be removing pieces of placenta. However, because the placenta is attached to the uterine wall -- and because it is the blood source for the baby -- bleeding may begin at this time. It is imperative that if bleeding begins at this point in the procedure, you do NOT stop. Stopping the procedure and attempting to stanch the bleeding will not work. The bleeding will stop on its own once the placenta is totally removed from the uterus. It may be scary, but keep going.
Once you have removed most of the material that is removable, you must move on to curettage. By now you will have felt the walls of the uterus with the forceps, and you must move on to using the spoon-shaped curettes. Find the spot on the uterine wall where placenta still clings -- the curette will make a sound much like metal on metal on a clean uterine wall, but will not make the same scraping sound on a place that still needs material removed. Scrape from the uterine walls, scraping material toward the cervix. Use the same general form of stroke you would use to scoop ice cream, and don't be afraid to scrape fairly hard. Scraping softly could leave tissue behind, and if there's anything you don't want, it's that. The other cue that will inform you the uterus is clean is that the patient will generally report feeling a cramp when the clean uterus is scraped, whereas a scrape of placenta will not feel as painful. Listen to your patient and listen to your curettes.
Once the material is removed from the uterine wall, any excess bleeding will generally slow or stop and it's uterine forceps time again. Take the remaining material out with the forceps. Most pieces of fetal material will come out with a simple tug on the forceps (again, don't be too afraid to use force and put a bit of muscle into it). However, at 13-14 weeks the fetal head may be slightly big to bring out. Pinch it with the forceps and take it out in pieces, as well. Make absolutely sure all bone fragments are removed from the uterus, as well as all other material. If necessary, use the curette again to remove remaining material and repeat the procedure with forceps.
By this point, bleeding should be no more than in a normal period, and likely quite a bit less. If the patient is still bleeding heavily at this point, get her to a hospital -- it means you likely did not curette completely, and the hospital will generally complete the procedure as her life is assuredly in danger.
When you feel the curettage and removal is complete, make sure you examine the fetal material you have already extracted. If you're missing anything obvious -- for instance, a head -- make sure to find and remove it.
Allow your patient to rest comfortably on the table if she wishes, or to get dressed. She will likely have some residual bleeding, so make sure you have maxi pads on hand (I would not risk infection from tampons so soon after the procedure). Give her the course of antibiotics and stress to her how imperative it is that she use them as directed. Make sure that she understands any bleeding or problems means she needs to call 911 immediately. When she is ready, allow her to leave -- if sedated, do not allow her to drive home herself. Follow up in a few days and make sure she is not experiencing much bleeding or pain.
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I will be following up this article with directions for performing vacuum aspiration for first-trimester pregnancies and inducing miscarriages for later ones. I hope this can prove educational for the next generation of women, who may have to start a second Jane program. I am sorry we live in times where it is necessary to publish this material, but if women work together, an abortion ban doesn't mean that women and girls are left with no choices.
POSSIBLE MEDICAL RISKS OR COMPLICATIONS OF ABORTION
Source: http://www.hss.state.ak.us/DPH/wcfh/informedconsent/abortion.htm
Infection
Bacterial infection is an uncommon complication of abortion. Rates are low: less than 1% in vacuum aspiration abortion, but may be slightly higher for later abortion procedures. Bacteria from the vagina can enter the dilated cervix and from there, go upward into the uterus and fallopian tubes. Antibiotics are often given at the time of abortion to "head off" potential infections. Antibiotics will be used to treat any infection that develops. Rarely, repeat suction or surgery may be needed. Prompt reporting by the woman of any infection symptoms is important to reduce the seriousness of an infection and potential complications. Symptoms of infection may include fever and chills, increasing pain, odorous vaginal discharge and increased bleeding.
Incomplete abortion
Fetal tissue or other products of pregnancy may not be completely emptied from the uterus. When this occurs, heavy or irregular bleeding and infection may result. Incomplete abortion often requires a repeat procedure such as a D&C. The reported rate of this complication is low: less than 1%.
Cervical injury
Injury to the cervix (the opening to the uterus) can occur during abortion procedures. This may be either a surface cut or a deeper tear in the tissue. The risk of damage to the cervix is made smaller by gradual dilation techniques. Multiple abortion procedures may result in future pregnancy complications such as incompetent cervix (weak cervix), that could lead to a pre-term birth. Injury to the cervix occurs in less than 1% of all abortions and is rarely permanent.
Uterine perforation
A medical instrument used in the abortion procedure can go through the wall of the uterus. Depending on the location of the injury and the depth of the perforation, there may be bleeding or injury to surrounding organs. Perforation can also provide an entry point for an infection. An assessment for possible injury must be done. Occasionally surgery is needed but often, observation of the woman is all that is needed. The risk of perforation is related to the stage of the pregnancy and the experience of the abortion provider.
Heavy bleeding (hemorrhage)
Some bleeding will be noted following all abortion procedures. Heavy bleeding, however, is not common. Following an abortion, the woman is observed in the doctor's office for any immediate signs of problems and she will be instructed about what to watch for after she leaves the doctor's office. Heavy bleeding may be treated by repeat suction or medication. Surgery or blood transfusion is very rarely needed.
Retained blood clots in the uterus
Bleeding within the uterus can clot before it is expelled. This results in severe uterine cramping. It occurs in less than 1% of all abortions. The clots are usually removed by a repeat vacuum aspiration procedure or medication.
Allergic reactions and Anesthesia-related complications
Any surgical procedure that requires anesthesia or medications carries with it a small risk due to the human response to the drugs. Adverse drug reactions can be allergic reactions and cause rashes, shortness of breath, nausea, vomiting, or swelling. These reactions may occur with medications or local and general anesthesia. If a woman is allergic to "Novocain" it is important to alert the abortion provider because lidocaine is the most commonly used anesthetic drug. Locally applied anesthetics are much safer than general anesthetics (the kind that make a person sleep). General anesthetics are almost never used for first trimester abortion procedures. They are frequently used in the second trimester.
Other considerations:- Rh immune globulin therapy: Protein material found on the surface of red blood cells is known as the Rh factor. If a woman and her fetus have different Rh factors, the woman must receive medication to prevent the development of antibodies that would endanger future pregnancies.
- Infertility: Most causes of infertility have nothing to do with abortion. Occasionally, getting pregnant may be difficult after an abortion, especially if there were complications.
- Breast cancer: The American College of Obstetricians and Gynecologists (ACOG) has explored the suggested relationship between breast cancer and termination of pregnancy. Their findings indicate that early studies of the relationship between prior abortion and breast cancer risk have been inconsistent and are difficult to interpret because of technical considerations. They find that recent studies argue against a causal relationship between abortion and a subsequent increase in breast cancer risk. There are other opinions more supportive of the suggested relationship between breast cancer and abortion. The American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG) supports that point of view. The subject can be explored in more detail by referring to the reference lists in this website.
THE EMOTIONAL SIDE OF ABORTION
Each woman having an abortion will experience the procedure differently from an emotional perspective based on the facts of her decision and circumstances such as her age, stage of pregnancy, and her religious beliefs. Women often report having both positive and negative feelings after having an abortion. Women who say they feel comfortable with their decision before the procedure are less likely to report regret later. Some women say they have had conflicting feelings lasting a longer time. These feelings may include anger, grief, emptiness and guilt, or sadness, as well as relief [Hermit notes: Just as occurs after birth, a major emotional swing is likely due to hormonal changes. During pregnancy the body pumps out "feel good" and "brain suppression" drugs. When these are withdrawn, depression is possible or even likely. Support over the next few weeks is important or critical to a non-traumatic outcome.]. Women may be more likely to experience negative feelings or have difficulty after the procedure if they were forced into a decision they didn't want or they had previous depression or other mental health issues.
Counseling or support before and after an abortion is very important. If family or friends are not supportive of the woman's decision, the feelings that appear after an abortion may be harder to handle. This is also true if the procedure was undertaken in secrecy or isolation. Talking with a counselor before having an abortion can help a woman understand the factors that are part of her decision and the feelings she may have afterward.
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With or without religion, you would have good people doing good things and evil people doing evil things. But for good people to do evil things, that takes religion. - Steven Weinberg, 1999
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Hermit
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Re:Abortion Manual
« Reply #1 on: 2006-04-28 23:10:33 » |
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Agreed but. And the "buts" are important.
One "but" is that with antibiotics, and in the absence of nasty septic conditions (nosocomial infections with Staphylococcus aureus and other resistant gram neg bacteria spring to mind) the procedure is relatively safe and certainly abortions, even those procured in "backstreet" clinics, are safer than giving birth and much safer than the currently fashionable, non-indicated caesarean procedure.
The other "but" is that hopefully posting articles like this (the more detailed and "how-to" oriented the better), might help to make it abundantly clear that one way or another, legal or not, abortions are going to continue. Making the procedure illegal just makes it more dangerous and more discriminatory (the wealthy can travel elsewhere for abortions, the poor are forced to give birth). This is an avenue which I suspect we will see argued if, as I suspect, this issue heads to the now even more massively right wing dominated Supreme Court*.
Hermit
*Well done Republifuckwits.
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With or without religion, you would have good people doing good things and evil people doing evil things. But for good people to do evil things, that takes religion. - Steven Weinberg, 1999
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