Abortion history dates back to over 5000 years ago. According to Chinese folklore; the legendary Emperor Shennong prescribed the use of mercury to induce abortions. The first recorded evidence of a termination of pregnancy is from the Egyptian Ebers Papyrus in 1550 BC. Chinese records document the number of royal concubines who had abortions in China between the years 500 and 515 BC.
Pregnancies were ended through a number of methods that included deep abdominal massage, sharpened instruments, herbal medicines, various liquids flushed into the intrauterine cavity, as well as other techniques.
Throughout the centuries abortion laws have changed. Prior to the mid 1500’s the Catholic Church and other governmental laws focused on “quickening” (where the mother feels fetal movement) to determine whether or not an abortion was allowable. Prior to quickening, abortion was lawful. Not until the 18th and 19th centuries did physicians, clergymen, and politicians enact an outright ban on abortion. They were successful in prohibiting abortion by the beginning of the 1900’s in the United States. Abortion continues to be legal in this country, but legislators, prosecutors, and others in the justice system are either striving to make abortion illegal, or making the steps to obtain an abortion so difficult for women, that it is becoming more arduous for what should be a private decision between a woman and her Physician to occur.
Several of the methods used to perform abortions many years ago were predominantly non-surgical. Physically exhausting techniques such as weightlifting, diving, paddling, strenuous labor, climbing, fasting, pouring hot water onto the abdomen, lying on a heated coconut shell, and irritant leaves were some of the techniques used for abortion. Surgical instruments used for abortion that date back thousands of years have been found through Archaeological discovery. Most of the instruments were never mentioned in old medical texts.
Midwives and knowledgeable laypeople were the main groups primarily responsible for performing termination procedures in early history. Abortion became well documented in the 2nd century by a Greek physician named Soranus. He suggested that some women should have an abortion due to their emotional immaturity. He described enemas, fasting, bloodletting, energetic walking, riding animals, and jumping so that the woman’s heels touched her buttocks with each jump (Lacedoemonian Leap) as abortion methods.
Abortion surgical instruments are described in many religious texts. Tertullian, a 2nd and 3rd century Christian theologian described surgical instruments and techniques very similar to those used for dilatation and evacuation today. These instruments were used when a pregnant woman’s life was in danger, or the fetus had died in the uterus.
Some women practiced sitting over a pot of steam. Candles, glass rods, penholders, curling irons, spoons, sticks, knives, catheters, coat hangers, knitting needles, douching with dangerous lye solutions, swallowing strong drugs and chemicals, were all used in an effort to self-induce abortion. Millions of women had self-induced abortions and thousands of those women died. There were more abortions performed per capita in the late 19th century than currently performed today.
Abortion techniques improved in the 19th century. In 1870, abortions were performed by flushing the inside of the uterus with injected water. Around this time, the social perception of abortion began to change. Married women wanted to limit the number of children they were having and routinely sought abortion. White Anglo-Saxon men were alarmed in the late 1800’s when the U.S. government warned against the danger of “race suicide” and urged white native born women to reproduce when there was a dramatic decline in the white birth rate. Making abortion illegal was meant to accomplish two things. 1) Vastly increasing industrial capitalism relied on women to be household workers and reproduce, thus keeping women in their traditional child-bearing role. 2) Male doctors wanted complete control of the medical profession. They saw midwives who attended births and performed abortions as a threat to their economic and social power. Therefore the American Medical Association which was started in the 1860’s actively took up the anti-abortion movement to eliminate midwives.
The Comstock law, passed in 1873 in the U.S. made it a crime to sell, distribute, or own abortion-related products and services, or to publish information on how to obtain them. Between 1820 and the 1900, abortion became illegal in all States. Laywomen and Physicians began performing illegal abortions at this time. Women who could afford safe abortions would pay up to one to two thousand dollars to have them performed illegally. There were abortion facilities overseas where well-to-do patients could have their abortions performed, but the majority of women with unwanted pregnancies either had to attempt to self-induce abortion, or rely on people who performed them under un-sterile and unsafe techniques. The rate of maternal morbidity and mortality rose sharply.
Women who were victims of botched abortions filled hospital emergency wards. Septic abortion wards were set up in the majority of city hospitals in the 1940’s to 1970’s. Women died of abdominal infections, sepsis and bleeding. There were many women who recovered from these infections but found themselves with chronic pelvic and abdominal pain, left painfully ill or sterile. The emotional stress from having the procedure performed and going through the crisis left permanent scars for the remainder of their lives. Poor women and women of color ran the greatest risks with illegal abortions.
Making abortion illegal at any time throughout history has not eliminated the need for abortion nor prevented its practice. Women who do not want to carry a pregnancy have always found a way to abort, even if it meant at the risk of dying.
The beginning of modern day suction technology used for abortion was first described in the 1800’s and was practiced in China, Japan, and the Soviet Union before being introduced to Britain and the United States in the 1960’s. The invention of the Karman cannula, which is a flexible plastic tube, replaced earlier metal models used in the 1970’s which reduced the occurrence of complications. It also allowed suction-aspiration methods to be possible under local anesthesia.
When the State of NY allowed abortions to be performed on demand in 1970, the maternal morbidity and mortality rate decreased by 50%. There was no change in the total number of abortions performed and this allowed abortions to be performed safely.
Menstrual Extraction procedures had been performed for almost 50 years in other countries before being performed in the US in 1971. Lorraine Rothman and Carol Downer, the founding members of the feminist self-help movement, invented a suction device called the Del-EM that women used to perform abortions on each other safely. This early abortion technique was called a menstrual extraction. There has been a resurgence of this technique in the mid-90’s in the U.S. as a method of surgical abortion. This resurgence is due to much earlier pregnancy detection methods and the growing demand for safe and effective early surgical abortion.
In 1973, The U.S. Supreme Court in Roe v. Wade declared all individual state bans on abortion during the first trimester to be unconstitutional. The “right of privacy” founded in the Fourteenth Amendment concept of personal liberty encompasses a woman’s decision to terminate her pregnancy. Through the end of the first trimester of pregnancy, only a pregnant woman and her doctor have the legal right to make the decision about an abortion. The court allowed states to regulate but not ban abortion in the second trimester of pregnancy. States are able to restrict second trimester abortions in the interest of a woman’s safety. States are able to prevent abortion during the third trimester unless abortion is in the best interest of the woman’s health. This is due to the protection of a ‘viable fetus” (able to survive outside the womb) and is allowed only during the third trimester.
In 1973, The U.S. Supreme Court in Doe v. Bolton declared that health includes physical as well as mental health. Mental health must take into account the moral, ethical, family, age, and psychological factors of the patient. Following this evaluation, the Physician can then best determine whether the abortion procedure can be performed.
In the 1980’s, researchers at Roussel Uclaf in France developed mifepristone, a chemical compound which works as an abortifacient by blocking hormone action. It was first marketed in France under the trade name Mifegyne in 1988. It is used to abort early pregnancies between three and nine weeks gestation. By giving the medication 24 to 48 hours prior to induction of labor in second and late term abortion, the delivery rate can be reduced from 16 to 18 hours to as little as 6 to 8 hours. Mifeprex is also effective for reducing fibroids in the breast, for treating endometriosis, and used as a morning after pill (emergency contraceptive).
Intact dilatation and extraction (D&X) was developed by Dr. James McMahon in 1983. It is very similar to a procedure used in the 19th century to save a woman’s life in the case of obstructed labor in which the fetal skull was first punctured with a perforator, then crushed and extracted with a forceps-like instrument, called a cranioclast. In this particular case, Dr. McMahon recognized that the D&X procedure would be more effective at saving the woman’s life than the Dilation and Evacuation (D&E) procedure which consists of placing Laminaria into the mother’s cervix which opens the cervix overnight. This makes it easier for the surgeon to remove the pregnancy tissue from the uterus by oval forceps. The pregnancy tissue that is removed has been known to cause tears of the cervix and perforation (making a hole) in the uterus which can lead to heavy bleeding and bladder or bowel damage to the patient. These complications can lead to hysterectomy, bowel and bladder surgical repair, and in a small percentage of cases even maternal death.
By modifying the 19th century procedure, Dr. McMahon’s intent was to reduce the morbidity and mortality of the mother when performing complicated late term abortion procedures by removing a fetus that was intact verses in multiple pieces out of not only patient safety as described above, but for the majority of Dr. McMahon’s patients who had fetal abnormalities that were incompatible with life, it was giving the opportunity for his patients to view their loved one and to say goodbye in a loving, respectful and appropriate manner. To be able to hold and see the fetal abnormalities brings comfort and closure to the patient and her family.
Despite the good intentions of Dr. McMahon, who presented his findings and maternal safety records at the 1992 National Abortion Federation conference, the D&X procedure became known as the Partial Birth Abortion by the lay public, which declared the procedure inhumane and the murdering of innocent children and babies even though Dr. McMahon performed the D&X on patients whose fetus had abnormalities that were incompatible with life.
The Partial Birth Abortion description is described as after two to three days of dilating the cervix with Laminaria, the amniotic fluid sac (bag of water) is ruptured and the patient is placed in active labor using uterotonic medications (causes the uterus to contract). In the United States, the medications most often used are oxytocin (Pitocin) or a form of prostaglandin (Misoprostol). With the use of oval forceps the fetus is pulled down into the vagina feet first and delivered to where the fetal head is still inside the maternal cervix (in essence the fetal head is still inside the uterus). The posterior skull of the fetus is punctured which decompresses the skull and the in-tact fetus is immediately delivered.
In Gonzalez vs. Carhart in 2007, the D&X or Partial Birth Abortion procedure was banned by the United States Supreme Court. This was the first medical procedure ever to be banned. There is not much argument that the D&X procedure is safer for the mother than a D&E procedure. It was banned because it was found to be inhumane to the fetus.
We at the Women’s Center actually agree with the Gonzalez vs. Carhart decision. We have never performed a Partial Birth Abortion procedure in our facilities.
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