There are many methods of surgical abortion. The procedure used depends largely upon the stage of pregnancy and the size of the unborn child.
In Abortion: Questions and Answers, Dr. J.C. Willke divided the methods of abortion into three main categories: those that use instruments inserted via the cervix to end the life of and remove the unborn child; those that use drugs to induce fatally premature delivery; and those performed through abdominal surgery.
In the first method, dilation of the cervix is required. The usual method is to insert a series of instruments, metallic curved instruments known as dilators, of increasing size into the cervix. This is necessary before inserting the instruments of abortion past the cervical opening into the uterus.
Unlike a normal birth, where dilation occurs slowly over many hours, the forced stretching by the abortionist to open the cervix takes a matter of seconds. This unnatural stretching can result in permanent physical injury to a woman.
A dehydrated material known as laminaria, usually a type of seaweed, is sometimes used to reduce damage to the cervix. Laminaria is inserted into the cervix the day before the scheduled abortion. Over several hours it will swell as it absorbs water, gradually pushing open the cervix in the process.
By the time most facilities begin offering surgical abortion for a given pregnancy, the unborn baby’s heart has been beating for a week or more. (1) Two miniature lungs have also begun to form.
At eight to nine weeks the eyelids have begun forming and hair appears.
By the ninth and tenth weeks the embryo can turn somersaults, jump, squint against light, frown, and swallow.
Around weeks 11 and 12, the embryo’s anatomy is becoming clearly male or female. The face has a definite form and unique characteristics, and taste buds have emerged.
This is the most common method of abortion during the first 12 weeks of pregnancy. General or local anaesthesia is given to the mother and her cervix is quickly dilated. A suction curette (a hollow tube with a knife-edged tip) is inserted into the womb. This instrument is then connected to a vacuum machine by a transparent tube.
The vacuum suction, 29 times more intense than a household vacuum cleaner, tears the embryo and placenta into small pieces that are sucked through the tube into a bottle and discarded.
At earlier stages of development, suction abortions are performed using a smaller tube with little cervical dilation. This is called "menstrual extraction." If all the fetal remains are not removed, full dilation of the cervix and a scraping out of the womb is necessary to prevent infection.
Dilation and Curettage (D&C)
This method is similar to the suction method with the added insertion of a hook shaped knife, or curette, which cuts the embryo into pieces. The pieces are scraped out through the cervix and discarded. (Note: This abortion method should not be confused with a therapeutic D&C done for other reasons.)
13-14 weeks: By the end of the third month all arteries are present, including the coronary vessels of the heart. Blood is circulating through these vessels to all body parts.
The heartbeat ranges during this fetal period from 110 to 160 beats per minute.
Vocal cords are complete, and the child can and does sometimes cry silently. The brain is fully formed, and the nerves can feel pain.
At 14 weeks, muscles lengthen and become organized. The mother will soon start feeling the first flutters of the baby kicking and moving inside.
15-18 weeks: The fetus has an adult's taste buds and may be able to savor the mother's meals. Around 16 weeks, eyebrows, eyelashes and fine hair appear. The child can grasp with his hands, kick, and somersault. At 18 weeks, the child blinks, grasps, and moves her mouth.
20-22 weeks: The child can hear and recognize mother's voice. Fingernails and fingerprints appear, and sex organs are visible. Though still small and fragile, babies at 22 weeks have been known to survive outside the womb.
Dilation and Evacuation (D&E)
This method is used up to 18 weeks' gestation. Instead of the loop-shaped knife used in D&C abortions, a pair of forceps is inserted into the womb to grasp part of the fetus. The forceps are used to break and twist off the bones of the unborn child. This process is repeated until the fetus is totally dismembered and removed. Usually the spine must be snapped and the skull crushed in order to remove them.
Salt Poisoning (Saline Injection)
This method is used after 16 weeks (four months) when enough amniotic fluid has accumulated. A long needle injects a strong salt solution through the mother's abdomen into the baby's sac. The baby swallows this fluid and is poisoned by it. It also acts as a corrosive, burning off the outer layer of skin. It normally takes a little over an hour for the baby to die from this. Within 24 hours, labor will usually set in and the mother will give birth to a dead or dying baby. (There have been many cases of these babies being born alive, which are then usually left unattended to die. However, a few have survived and later been adopted.)
The unborn child at six months is covered with a fine, downy hair called lanugo. Its tender skin is protected by a waxy substance called vernix. Some of this substance may still be on the child's skin at birth at which time it will be quickly absorbed. The child practices breathing by inhaling amniotic fluid into developing lungs.
Prostaglandin Chemical Abortion
This form of abortion uses chemicals in the second trimester that cause the uterus to contract intensely, pushing out the developing baby. The contractions are more violent than normal, natural contractions, so the unborn baby is frequently killed by them -- some have even been decapitated. Many, however, have also been born alive.
Hysterotomy or Caesarean Section
Used mainly in the last three months of pregnancy, the womb is entered by surgery through the wall of the abdomen. The technique is similar to a Caesarean delivery, except that the umbilical cord is usually cut while the baby is still in the womb, cutting off oxygen supply and suffocating the child. Sometimes the baby is simply removed alive and left to die.
For several months, the umbilical cord has been the baby's lifeline to the mother. Nourishment is transferred from the mother's blood, through the placenta, and into the umbilical cord to the fetus. If the mother ingests any toxic substances, such as drugs or alcohol, the baby receives these as well. At 32 weeks, the fetus sleeps 90-95% of the day, and sometimes experiences REM sleep, a possible indication of dreaming.
A partial birth abortion is composed of several steps.
- Guided by ultrasound, the abortionist takes hold of the baby's legs with forceps.
- The baby's leg is pulled out into the birth canal.
- The abortionist delivers the baby's entire body, except for the head.
- The abortionist jams scissors into the baby's skull. The scissors are then opened to enlarge the skull.
- The scissors are removed and a suction catheter is inserted. The child's brains are sucked out, causing the skull to collapse. The dead baby is then removed.
The baby, approximately seven and a half pounds at 40 weeks, is ready for life outside its mother's womb. At birth the placenta will detach from the side of the uterus and the umbilical cord will cease working as the child takes his first breaths of air.
The child's breathing will trigger changes in the structure of the heart and bypass arteries which will force all blood to begin flowing through the lungs.
1. Less than half (46%) of abortion facilities in the U.S. offer surgical abortions at four weeks gestation or earlier in 2012. (source)