About abortion 26

Witnessing Abortion Procedures -by journalist Mary Kenny

Mary Kenny is a well-known journalist in Britain, who in the 1970s had an abortion. The issue continued to fascinate her and in 1986, she wrote a book entitled: "Abortion: The Whole Story".

As the title suggests, she interviewed many women about their experience of abortion, why women choose abortion and extensively covered its medical and social history in Britain.

For her chapter, "What Happens at an Abortion," she arranged to be an observer at abortions being performed during the various stages of pregnancy. Hers is a unique glimpse and we are grateful for Mary Kenny's permission to quote directly from her book.

Witnessing a first-trimester abortion (up to and including 12 weeks)

A Marie Stopes clinic in London. At 2pm, the surgeon, a beautiful young Indian woman wearing a filmy, canary-coloured sari and bangles around her ankles, arrived. There is a rota of doctors, most of whom work in other fields of gynaecology and family planning as well, since it is considered repetitious and medically unrewarding to do abortions all the time.

While the operating theatre was being set up, the women waited in semi-detached wards ? some have private rooms. They can elect to have a local anaesthetic, or a general anaesthetic. Most prefer a full anaesthetic.

The operating theatre was similar, in the eyes of a lay-person, to any other. In the theatre was the surgeon, now in white coat and cap, the anaesthetist, the theatre sister and the nurses.

The women were wheeled out within minutes and very soon brought back to consciousness. Some were quiet and slept for a while. Some were in pain. Some wept. The intellectual, whose boyfriend was reading Proust, cried like a child. Her notes said she was thirty seven, an age when women often feel their last chance of motherhood is passing.

The punk-haired young Scottish girl was soon sitting up having a cup of tea and a cigarette. A cheerful London woman joined her and they talked philosophically. "Well, I mean nowadays, you've got to consider having a baby haven't you?" said the Londoner. "I'm not proud to be here mind, but with my other two so young and what with having a job, we felt we couldn't manage another."

In a sunny garden room I talked to Joyce, aged twenty two, and Carol, thirty two, both of whom said they became pregnant while taking the Pill. The most common reaction after an abortion is relief at the removal of the problem; the relief can quite often be euphoric. Both said with smiles that they were very happy.

Dr Paintin is a neat bespectacled man who has been associated with the Abortion Law Reform Association since the 1960s. He is committed to legal abortion as a proper medical procedure, and indeed believes it can be good medicine. He is liked by nurses, considered gentle and kind by the hospital counsellors, and is a truthful man who is ready to share his experience and knowledge. He comes from a Methodist background and indeed, in appearance could be a clergyman ? bringing to the subject of abortion and earnest sense of moral righteousness. That is, in doing abortions properly, Dr Paintin clearly believes he is doing the right thing.

On the afternoon that I visited the Samaritan Hospital, Dr Paintin was to operate on eight women, ranging from a thirty-three year-old woman with a repeat pregnancy (the first had been recently aborted), to a twenty-three year-old girl, twenty-two weeks pregnant, whose boyfriend had changed his mind about wanting the baby. All were social abortions.

The atmosphere in the operating theatre was clean, busy and professional. Several young male doctors gowned for the theatre, were standing around when I entered, talking cheerfully about the cricket score. There was no hint here, of life-and-death drama. It was just another day, another hospital theatre session.

The sister in charge, a friendly Chinese nurse, greeted me and asked if I wanted coffee. Although she was busy, she attended to me with efficiency. She took me to a small office and provided me with a sterile gown, shoes, cap and surgical mask.

Operations commenced at two o' clock. A student nurse prepared the instruments in an obstetric theatre like any other, with an operating table in the centre and a large set of lights overhanging it. The place gleamed with technical apparatus, everything labelled, sterilized and properly wrapped.

It was over quite quickly and what remained in the bottle at the base of the suction pipe was a small amount of blood and the remains of the foetus, which cannot be seen with the naked eye. The IUD was inserted and the patient was wheeled out. The foetal material was washed down the sluice and all the instruments disappeared to be sterilized. A fresh pack was opened for each patient to minimize infection risks.

The second patient was wheeled in. She was a young woman of twenty-two, the mother of one child. She was fourteen weeks pregnant. Dr Paintin inserted the dilators as before, using slightly thicker ones. The size of the dilators ? sometimes called cannulas ? accords with the number of weeks of pregnancy. Thus 8mm for an eight-week pregnancy, 10 mm for a ten-week pregnancy and so on.

When he drew out the material with the forceps, he found very little in the way of foetal remains. He concluded that in this case the foetus had been abnormal and had perished naturally. The woman would have miscarried. Medically this is called a "missed abortion". Dr Paintin remarked that this knowledge will probably be of some consolation to her ? a genuine abortion did not take place since the foetus had already died.

The third patient was aged sixteen, and again was fourteen-weeks pregnant. This time it was a normal foetus. When the uterus was evacuated into the small bowl under the operating table, the contents were again examined. Here the remains of a very small body, about the size of a newborn kitten could be seen. It is tiny indeed, but its form is umistakable.

The fourth and fifth cases were also young girls, aged sixteen and fifteen respectively. They had been admitted overnight and had a catheter ? a small tube inserted through the cervix ? the night before. The catheter contains sterile water and the presence of a small balloon near the tip of the catheter, softens the cervix, preparing it to open.

The forceps went into the uterus, quite roughly this time. Fluid and blood continued to fall into the bowl underneath the table. After some vigorous action he started to extract the foetus. First came an arm, perfectly formed, a tiny baby's hand, fingers curled. A limb was extracted. Then two limbs lay in the bowl.

Dr Paintin worked away and pieces of the trunk emerged. The intestines, brain tissue, liver, lungs came away. Last of all - the most difficult part - was the cranium. The skin was torn and there was not much more than a skull. After all the parts had come away, the suction was inserted and the uterus cleanly evacuated.

With later abortions like this one, the remains are not taken to the sluice, but incinerated. Sometimes foetal parts are taken to a laboratory to be used for tissue culture. The woman's perineum was cleaned. Her stomach was flat again. She was then wheeled to a nearby recovery room to sleep for some time.

With great swiftness, everything was cleared away. We went into the surgeon's changing room and Sister Lee served us tea. Here, the men did the significant work, the women assisted and served.

But many doctors in Britain are wary of saline because of its poisonous properties and consequent risk to the woman. Prostaglandin abortion is generally contra-indicated for women with asthmatic or bronchial disorders, or those prone to kidney or liver disease, or to epilepsy.

Prostaglandin could constrict the bronchial tubes, affect sodium and water regulation and trigger seizures.

Prostaglandin abortion is also a more distressful experience for the woman. The procedure takes between twelve and thirty-six hours to complete. The woman endures the pains and contractions of labour, and delivers at the end of it, what she may perceive (if she actually sees it, which she may do) as a dead baby.

Obviously, the operation must be performed by an experienced doctor, who is careful that the urea or prostaglandin is not erroneously injected into the maternal vascular system, or abdominal cavity. And a curettage (D&C) is required afterwards, to clear out any retained products.

Prostaglandin is still the method used for most late abortions. It is probably safer, still, than a surgical method. The main advantage is that the patient dilates her own cervix, gradually, over a period of many hours ? rather than having it dilated forcibly over a period of a few minutes. Prostaglandin simulates normal labour, and is thus sometimes seen as being more "natural".

And some women, apparently prefer to experience abortion ? dimly, because consciousness is lowered with drugs - than to sleep through it.

His experience makes him assured; abortion may be in most cases, a technically simple operation, but you can run into unusual cases. There was the case of the woman who had a double vagina; and the woman who had two wombs and had conceived a baby in each, thus requiring a double abortion. A less experienced doctor might have missed twins, too, aborting one foetus and mistakenly leaving the other untouched.

Dr Rogers took me up to the fourth floor of the clinic, where nine women were waiting in small rooms off a central ward, to have their abortions induced by prostaglandin. All were more than eighteen weeks pregnant; one young student was just on twenty-four weeks. All were healthy and normal and Dr Rogers did not expect any complications.

The atmosphere on the fourth floor was subdued. It was just after 5.30pm on a warm bright afternoon. Dr Roger's first patient was aged twenty-two, and eighteen weeks pregnant. As he entered her little room, she was weeping silently. He spoke consolingly to her, stroking her arm comfortingly. "I think this young women didn't realise how far the pregnancy had gone," he said.

"He, must be suffering too," she said, referring to the baby. "Will the nurses arrange it so that I don't see the baby?" Yes, they will I told her. "I feel I have failed at everything. I think badly of myself.." She asked me to mop her brow and was touchingly grateful when I did.

Soon after 1am, the nurse told me that it was time I left. They were soon going to be very busy, and it was not convenient to have me under their feet. "Will you come by and see me tomorrow?" Marie-Claire asked. I said that I would.

The women delivered through the dawn, with the last abortion taking place at 10.15am on the Tuesday. During the course of the morning, each woman was taken to the operating theatre for a final curettage called an ERPC (evacuation of retained products of conception). They generally check out of hospital the following day, on Wednesday morning.

I called in on the Tuesday evening to visit Marie-Claire as promised. Her boyfriend was there and her small son. She was still pale, but seemed recovered. Most of the women on the ward seemed back to normal, though some wore a curiously chastened expression. The feeling was of the calm after the storm. Marie Claire chatted to me, her small son played around, and her boyfriend Philippe made friendly conversation about how agreeable, how helpful everyone in England had been.

She had delivered quite soon after I had left ? around 2am. But she had been alone at the end because the nurses were so busy. She saw the foetus and was left with it for several minutes. It had been a boy. "The moment I saw it, I regretted everything," she said. Now she was going to put the experience behind her.

We had a strange conversation about the population in France coming to a halt. "The French are ceasing to have children," said Philippe. "In France only immigrants have children now. When we are old, there will be no young people to look after us. It's a disaster."

Such reflections on one's personal past and philosophy are not unusual at such a time.