Willing and Unable: Doctors' Constraints in Abortion Care

Appendix A: Abortion Terminology

153 appendix a abortion terminology aspiration: Suctioning out the contents of the uterus with a machine or manual vacuum technique. (Most first-trimester abortions are technically aspiration procedures, not surgical procedures, because surgery implies the cutting of tissue. However, the term “surgical” was more commonly used to refer to such procedures by participants in the study and is more readily understood by readers. Therefore, I chose to refer to aspirations as surgical procedures in many places throughout the book.) d&C (dilation and CUrettage): Emptying the contents of the uterus by dilating the cervix and scraping the side walls of the uterus with a curved instrument to evacuate all tissue. For pregnancies of not more than thirteen weeks. Most of the procedure is currently done with an aspiration/ suction device. Procedure duration: Five to fifteen minutes. d&e (dilation and eVaCUation): Same as a D&C with the addition of surgically removing the larger fetus. Typically done in women who are aborting or miscarrying when between thirteen and twenty-four weeks’ gestation. Procedure duration: Usually fifteen to thirty minutes. d&x (dilation and extraCtion): Also known as a partial-birth abortion (see below). Similar to the D&E in duration time and gestational period, but the fetus is removed intact. The procedure was rarely done before it was banned for political reasons. 154 Willing and Unable eleCtiVe abortion: An abortion that is done for reasons other than genetic or medical reasons, such as reasons related to poverty, career, mental health, separation/divorce, drugs, etc. Technically, genetically indicated terminations are also elected by the pregnant woman, but they are usually perceived as more “legitimate” and therefore are grouped with medical rather than social reasons for termination. Note: One abortion clinic I am aware of separated abortions by maternal indications (includes all elective reasons) and fetal indications (includes all medical and genetic reasons). genetiCally indiCated abortion: (1) Fetal anomaly—the fetus is not developing “normally” and is likely to be born unhealthy or with a disability of some sort; (2) fatal fetal anomaly—something is wrong with the fetus that makes life impossible outside the uterus. indUCtion oF labor: Anabortionthatisdonewithoutsurgicalinstruments, but rather with medications that induce labor so the woman’s uterus expels the pregnancy. Usually takes place in a hospital labor and delivery ward. For women aborting, miscarrying, or experiencing fetal demise in the second or third trimester of pregnancy. Procedure duration: Usually less than twenty-four hours. Other terms: induction, labor induction, KCl injection. mediCally indiCated abortion: An abortion that is done when the pregnancy is hazardous to the pregnant woman’s health or life. mediCation abortion, mediCal abortion: An early abortion (typically fewer than nine weeks’ gestation) induced usually with a combination of the drug mifepristone (the “French abortion pill,” RU-486) or methotrexate (a drug used in the treatment of cancer) with misoprostol (which causes contractionsandcervicalsoftening).Misoprostolaloneislesseffective,but because of its affordability and over-the-counter status in Latin America, it has been studied and used widely. A medication abortion can be done at home, and the physical experience is similar to severe menstrual cramps. A woman may have just a few hours of cramping and bleeding, or days of bleeding and spotting, with intermittent episodes of severe cramping. The unpredictability of the side effects and duration is what causes many women to choose a surgical procedure. appendix a: abortion terminology 155 partial-birth abortion: A term made up solely for political reasons by antiabortion activists in order to ban an abortion during which the fetus is extracted intact (see D&X). The legal language of the final ruling of the Supreme Court (Gonzales v. Carhart 2007) was so vague as to make many practitioners and lawyers fear that it could apply to all second-trimester abortions. seleCtiVe redUCtion: Usually used in conjunction with fertility treatments that result in multiple embryos. The uterus is viewed by ultrasound, and an injection is made directly into the embryonic sac to kill one or more of the embryos, thus reducing the number carried to term. ...