March 7, 2011 • 25 mins
Abortions are tremendously controversial -- but how do they actually work? In this episode, Cristen and Molly cut past the politics to give you the facts on abortion. Tune in to learn more.
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Speaker 1 (00:00):
Brought to you by the reinvented two thousand twelve Camray.
It's ready. Are you welcome to step Mom? Never told you?
From House topbords dot com. Colly, and welcome to the podcast.
This is Molly and I'm Kristin Kristen. Today are our
(00:21):
topic is abortion and you and I are determined to
make this politics free as possible if you know, may
not be possible, but that's what we're gonna do. We're
gonna ignore current events for a moment and just talk
about what happens when you're in a doctor's office to
get an abortion. And to start things off, I will
I will tell a little lighthearted anecdote. Um, I'm going
(00:44):
to admit to googling myself. I think we all do
it every now and I do what you gotta check
up and see see what's gonna make your no one's
talking smack about you? Right? So, Um, I googled myself
recently and at the bottom when it's related searches to
the search term Molly Edmund abortion, Molly Edmonds comes up
and I was like what, But then I remembered I
(01:07):
wrote how abortion works for our site how stuff Works
dot com. Right, So, apparently, people who I don't know
if they're just looking for this article and I know
I wrote it, and so it goes abortion Molly Edmonds.
But it's a common search term apparently. And UM, I'm
happy to be associated with this article because I'm proud
of it. A lot of research went into it to
take out the politics. As we just mentioned, I wanted
(01:29):
it to be as straightforward as possible, and so that's
what we're going to present, a straightforward look at abortion,
right because I would argue that the public is probably
more familiar with the political debate around abortion than they
are about the actual procedure. I think it's the most
common procedure that's not actually talked about. And in fact,
(01:50):
before we came in here, I was trying to find
more information about therapeutic abortion, which is when there's a
health reason for terminating a pregnancy, and it's very hard
to find any accounts it. Um, you know, it's just
not talked about. And UM, we're gonna get behind the
arguments about pro life, pro choice however you want to
put it, and just talk about what happens when you
(02:12):
get abortions, who's having them, why they're having them, how
they have them right because we talked about planned parenthood
way back when, but on most people associates in parenthood
with birth control and abortion. So today we are going
to talk about really what happens. And here's the thing.
It happens a lot. Just to toss out some statistics
(02:34):
since we love statistics. UM. In the US alone, UM
half of the six million pregnancies that occur each year
are unplanned, and about one point three million of those
unplanned pregnancies and an abortion. And according to the Gootmaker Institute,
about one third of women in the US will have
(02:56):
an abortion by the age of forty one in three.
One in three pretty staggering, and worldwide, not just the US,
about two percent of all reproductive aged women have an
abortion each year. So what kind of woman is having
an abortion? According to the Gootmaker Institute in the US,
that woman is young. The women who have an abortion
(03:17):
the U S are under the age of UH, more
likely to be unmarried than married. Lower class. The abortion
rate for poor women is four times higher than that
of women living above the poverty line. UH. The woman
who is likely have abortion probably has at least one
child already. Six of abortions are performed on women who
are already mothers, and she reports not using contraceptives properly,
(03:41):
if at all. And it's pretty spread across UH racial
demographics are attributed to black women percent, to white women,
to Hispanic women. And here's the thing that um, I
think it's important to keep in mind, especially when we do.
You know, I'll side of the podcast get talking about
the politics involved in all of this. Abortion is one
(04:05):
of the most common surgical procedures for women, and yet
we are so uncomfortable talking about what actually happens. And
that's one of the main reasons that Molly and I
wanted to talk about it today, because you don't think
about that. We know that abortion happens, but consider that
one of the most common surgical procedures for women, right
and so if you're let's say, you take a pregnancy test,
(04:28):
you get it back, you're pregnant, you don't want to be,
and you decide to pursue an abortion, where you start
looking a local plan Parenthood, as we mentioned, is a
great place to start. A family planning clinic if there's
not one in your area, can contact just your O,
B G Y in and ask for a referral or
maybe she'll do it. Midwives, nurse practitioners. They are licensed
(04:48):
to do abortion, so there's a wide variety of medical
professionals that can do it. The Gootmacher Institute estimates that
the average amount paid for an abortion in the United
States is fo dollars and just note that first trimester
abortions are less expensive than second trimester abortions. There are
two methods for performing an abortion. You can have a
(05:09):
medical abortion or a surgical abortion. And in a medical
abortion UH, you take pills to expel the fetus from
your body. You take an abortive facient, which is an
abortion inducing substance, and the f d A approved UM.
It's basically a two part procedure where you go in
(05:30):
first to a clinic and you take UM six in
r milligrams of something called mythopristone, which is followed by
four hundred micrograms of ms A prostal, which you can
usually take in your home if you elect to. And
you might have heard of methophristone, as are you for
eight six and it blocks the hormone progesterone, which allows
(05:52):
the uterine lining to build up to support the embryo
in the womb. So basically when you take are you
four it six, it causes that that uter in lining
to break down and bleeding similar to a minstrel period
will start to happen. And typically you will take that
first dosage at a doctor's office, and then a few
(06:13):
days later at your home or in a doctor's office,
you take that second half, which is actually what expels
the fetus in a process very similar to a miscarriage.
It feels very similar in terms of the cramping, nausea,
and the bleeding obviously is very similar so UM and
also something I learned after with this articles, they usually
(06:33):
have you take a suppository of a sedative to deal
with that that cramping and pain UM and then the
leading can occur for up to two weeks. But this
type of abortion is effective nine percent a time when
it's done in the first nine weeks of pregnancy, so
(06:54):
there is a window after which a medical abortion will
not work right, and it's used around the ninth week
in and it's at that time that you will probably
opt for a surgical abortion. And one of the most
common types of surgical abortions would be a vacuum extraction abortion,
and this is Actually, the most common method is a
(07:15):
vacuum extraction, and it can be performed for twelve weeks
after a woman's last period, and it can happen either
with the fetus being extracted, either manually or with a
handheld suction device or with an actual machine vacuum and UM.
The manual vacuum extraction is UM one of was one
of the earliest surgical options available to women. And basically
(07:39):
you go and it's it's not that much unlike a
gynecological exam where um, you sit in the chair, you're
in the stirrups um, you will be a speculum will
be inserted into a woman's vagina um. The cervix might
have to be slightly numbed, and then the doctor will
insert a tube through the cervix and into the unuse
and then apply um section with a special handheld device
(08:02):
to extract the contents of the uterus. And it only
takes a few minutes, right, And you know, we found
a few blogs on the Internet of women who have
had abortion, so we're sharing their experiences and these are
very rare, usually because the politics will enter into it.
But I did want to read a description from an
abortion blog of what this process feels like Emmanuel vacuum extraction,
(08:23):
and this is from my abortion blog dot tumbler dot
com and I'm just gonna read verbatim what she wrote,
and before Molly starts, I do want to provide a
trigger warning for listeners out there, since this is a
pretty graphic account of what happens. The doctrines are the
speculum and then wiped my service clean with an antibiotic.
(08:45):
She then topically numbed it a bit and followed that
up with an anesthestic injection. This felt like a tiny
little poke and was mostly just uncomfortable, no less odd
feeling than a regular pap smear. The weird part was
that I got a little woozy and dizzy seconds after
the shot because the anesthetic entered my bloodst She talked
me through this, but I actually liked the feeling. Next,
she dilated my servix, but I didn't really feel much
(09:05):
more than a bit of pressure. She then inserted a
hose about the diameter of a pen, and again I
felt a bit of pressure. I could feel once the
procedure started, because I started getting some cramps about the
same as I would during a period. They continued. As
she continued the aspiration, there was also a slight tugging
feeling from the inside that was kind of odd. I
kept my hand on my belly the entire time. I
could feel my uterus tugging from the inside, like my
(09:27):
belly was actually rising and falling. The cramping continued, but
it was no worse than when I got from my period.
At the very end, the cramping got really bad, but
which she said was normal because it meant the uterus
was contracting back to its normal size. I think the
worst part was probably the five or so minutes after afterwards,
from the cramping got intense and the naja struck. I
started sweating a bit, and my boyfriend held my hand
(09:48):
tightly and kept a bucket in his hand in case
I needed to throw up. The cramps were uncomfortable, like
a combination of period and bathroom cramps at the same time,
and for a second I felt they would never go
away and I'd be curled up in that room forever.
But actually less than quickly and soon all but disappeared.
So that's one person's first person account of having an abortion.
So that was an example of a manual vacuum extraction,
(10:12):
but women can also have a machine vacuum extraction extraction
and the process is slightly more intensive since the woman's
cervix will need to be dilated and that's going to
happen either through absorbent dilators inserted a day beforehand or
by inserting rods that gradually increase in size on the
day of the procedure. And the rest of the abortion
(10:34):
procedure is very similar to manual extraction, except a machine
is going to apply the suction that pulls out the
uterine contents through the tube. And then sometimes after completing
the vacuum extraction, UH, the doctor will need to use
a curette to scrape the remaining feel tissue from the uterus, right,
And a cura is a long, thin instrument with a
(10:57):
kind of a serrated spirit the end. That's the part
that actually does the scraping, and when the cuat is
brought in, the procedure might be called a d n
C and UH this is you might also have a
d NC just at a gynecological exam if you've got
uh some sort of vaginal bleeding, if there's something going
on up there. Um and these extractions can usually reformed
(11:17):
up to sixteen weeks after women's last period, when they
bring the curet in to help scrape. Now we're at
sixteen weeks after a period extraction and then a curet.
Now once we um hit the sixteen week part, abortions
that take place after that are really the most controversial.
These are performed with a method known as dilation and evacuation.
(11:39):
And uh, this method, again, like to to provide a
little bit of a trigger warning, is a little more
um intensive than the vacuum extraction methods. And I think
it's natural that it has to be a little more
intensive because we're past sixteen weeks, were in the second trimester. U,
the fetus is a little bit more developed, but still
not viable outside womb. It can't live outside the woom
(12:01):
on its own according to medical definition. So I'm gonna
go ahead and read the definition of the dilation and evacuation.
What they have to do is they have to administer
a shot to the fetus through abdominal tissue to ensure
that the fetus is dead. Uh, they give medication to
the woman and as with the other methods that Kristen described,
they have to stretch the cervis through rods or through
(12:22):
um dilators. The fetal tissue is then extracted to the
degree possible with the vacuum that we mentioned in those
first trimester abortions. But then because the fetis has developed
it's a little bit larger, they might have to insert
forceps into the vagina and crush the fetus's head to
bring it out, or to break down the fetus so
that it can be removed. And uh, you know, the
(12:45):
doctors who pioneered this concept said they were looking for
a way to perform second trimester abortions that could be
done in a one day in and out outpatient procedure.
So it's a way to abort a fetis in a
way that that still allows women to kind of leave
of her own volition at the end of the day.
And these are I think we should mention that these
(13:07):
make up a very very small um proportion of all
the abortion procedures that happen every year. That what was
at one point three million abortions happen every year in
the United States, and a lot of times h dilation
and evacuation abortions happen. In the case of therapeutic abortions,
where the mother's life might be at risk carrying the
(13:28):
pregnancy to term. Now, one last type of abortion procedure
that we need to talk about is certainly the most controversial.
It's called dilation and extraction method and you've probably heard
of it as partial birth abortion. Right. This is when
the fetus is partially delivered vaginally, uh, in a breach position.
And when they have the fetus, you know, a little
(13:49):
bit out of the way, they'll make up out of
the way of the woman. They'll make a hole in
the base of the fetal skull, insert tubing, and you
suction to pull out the brain of the fetus. Uh.
This is so that the feet the skull will collapse
in the fetus can be fully expelled. And as Kristen said,
this this method is pretty controversial. It's been banned in
the United States except in the case of protecting a
(14:10):
woman's health. Um. Perhaps you might have an uneffected uterus
or hard condition that makes it impossible to continue the pregnancy. Now,
as Kristen sindys, you're extremely rare. The Gootmaker Institute estimates
that this makes up point to percent of all abortions
in the United States. UM. So that's that's sort of
the range that they can go. We've gone from taking
(14:32):
a pill and having a process very similar to a miscarriage,
all the way up to dilation and extraction, where we're
pulling out the fetus. Again, it's not medically viable at
this point, can't live outside of the womb. But you know,
then that's where the politics gets into it, that we're
gonna skip and that you know, is this a person
yet is it not. That's not our argument today. We'll
(14:53):
let you guys battle that out. But those that's the
range of abortion procedures that can take place. And and
even though the procedures that we've described sound very unpleasant,
I'm sure to our listeners, one thing to keep in
mind is that while possibly unpleasant, they are generally very
very safe. Um. In fact, a woman has eleven times
(15:15):
the chance of dying in childbirth as she does of
dying from an abortion performed in the first twenty weeks
of pregnancy. Now, after an abortion, regardless of the type
of abortion performed, women are kept in a recovery room
for a few hours, and then they usually go home,
where they'll continue to bleed um. They may have really
large blood clots. But a sign of a complication is
(15:36):
when the blood clots get larger than a lemon um.
But you know, you might have some fairly sizeable blood
clots for a few days. You can some women go
back to work the same day or the day after.
Some women go back to class very shortly after. But
the two things you can't do though our strenuous exercise
and putting anything in your vagina which ranges from a
(15:56):
tampon to sexual intercourse that would involve vaginal penetration. So um,
the vagina has to heal from this. Nothing nothing can
go up there. But speaking of intercourse and vaginal healing,
abortion does not affect future fertility. And I think that's
one one common misconception that we need to um that
we need to clear up that if you if a
(16:16):
woman has an abortion, it typically does not harm her
chances of having a child later. And another thing that
has been linked with abortion is a higher rate of
breast cancer. But some researchers are concerned that the studies
that link higher rate of breast cancer to abortion maybe
because the women who have breast cancer are so desperate
(16:36):
to find out why they have it that they'll admit
to an abortion, whereas women who don't have breast cancer
may not admit to an abortion. Uh to a researcher
that they don't know, so they haven't really drawn a
conclusive link. In fact, another study and from two thousand seven,
it followed a control group of women who didn't have
abortions against a group of woman that did, knowing out
from the front how everyone had had scored on the
(16:58):
abortion card, and the sentence of breast cancer was about
the same. So uh, that's right, doesn't affect future utility,
probably doesn't affect breast cancer. One aspect of abortion recovery
that often comes up in these politicized debates that we
do need to address is the mental health of the
woman involved. Because a lot of times you might hear
(17:20):
about post abortion syndrome, essentially that after a woman has
an abortion, she is going to suffer from massive anxiety
and depression and guilt over terminating a fetus, terminating a
pregnancy UM. But we need to remember that it is
not recognized by any medical or psychological association. And in fact,
(17:40):
UM a study that just came out in January UM
from a group of Danish researchers comparing UM mental health
effects post abortion and then post childbirth. Actually finds that
just like with childbirth, you know, you can't um can't
predict the mental health effects of either caring a child
(18:01):
to term or terminating a pregnancy right. In fact, proportion wise,
the women who saw treatment for psychiatric counseling after abortion
it was about the same as the rate of a
woman who had sought treatment before before and after was
pretty much the same, And some doctors say that's because
women who get abortions may be more likely to have
other factors in their life that they need counseling about.
(18:22):
They couldn't draw any sort of uh line between the
abortion and the counseling, whereas the proportion of women who
needed counseling after having the child was much higher compared
to the rate of women in that group who would
need a counseling before. And obviously there are all sorts
of things that can go on. You're sleepless, there's postprimed depression,
it's a lot of stress to have a newborn in
(18:42):
your life. So they're saying that, you know, in terms
of actual mental stress, it's possible that the actual child
might do more for you than than uh than getting here,
than terminating the pregnancy. And we're certainly not sitting here
saying that abortion is better for your mental health been
carrying a pregnancy to term um. But we're just trying
(19:05):
to make the point that you have to consider each
on a case by case basis. You cannot make any
kind of blanket judgment on the mental health of all
women who become pregnant and based on what they choose
to do. Right now, Molly, we have gone through this
entire abortion podcast without mentioning the tune names probably best
(19:27):
that's closely associated with it, and that would be Raw
and that would be Wade, because we're trying to keep
this conversation a political and those names are so charged politically. Yeah,
if there's one. If if you had to walk down
the street and ask anyone uh to name one Supreme
Court case in the US, it would Row v. Way
(19:47):
would probably come up more than any other. I don't
know of a of a more controversial court case that
it happened in nineteen seventy three and established that any
legal restriction to an abortion violated the of privacy guaranteed
by the Fourteenth Amendment. So that established that the decision
to perform an abortion was up to a woman and
her doctor and there should be no government interference. But
(20:10):
the reason we bring Roe v. Wade up, which deserves
a podcast all its own, is um just to talk
a little bit about the history of abortion and its
legality through time. And you know, you'll always find people
who say that, you know, even from the ancient days,
people were finding herbs and mixtures that they could use
to uh induced an abortion. They might beat themselves violently
(20:32):
in the abdominal region. And in fact, some of the
first laws that criminalized abortion were meant to protect women
from doing this rather than to protect a fetus from termination,
because too may were dying from taking poisons to bring
on an abortion. And one thing that we should bring up,
and in terms of statistics, in the United States before
Roe v. Wade, an estimated one point two million abortions
(20:56):
were taking place in back alleys and in you know,
hidden clinics and things like that, and today or even
in some real clinics because you know, money, money can
open a lot of doors. So you know, there were
some doctors who are performing abortions legal just because someone
could pay. And speaking of money, I think that one
one of the most interesting findings that you reveal in
(21:18):
your article on abortion, Molly is that doctors did have
economic motivations for advocating against abortion because they lost a
significant amount of income to midwives and private people who
would perform abortions, and as a result, the American Medical
Association served as one of the main legal lobbies against
abortions legalizing abortion. That was really interesting finding I found
(21:41):
in a book, and of course, as always, will put
all our sources up on our blog. UM, but right now,
abortion is a legal procedure and you know, its status
of remaining so is up to the political debate that
we're not going to touch right now. But we hope
that in sort of just talking about the procedure behind
the politics, that you understand this procedure a little bit
more more. Um. You know, like we said, one in
(22:02):
three women have had an abortion or we'll have an abortion.
So we know there are listeners out there who probably
have UM. As always, you can share our stories or
you cannot share your stories. This is obviously a touchy subjects.
Some people don't want to talk about it. Some people
are eager to shout up from the rooftops, like with
these blogs. Um, and sometimes that can be helpful because,
as we said, when you google it, there's not a
lot that comes up because it is so to have taboo,
(22:25):
so political, and I think that both sides of the
political argument would benefit from a clear, more honest understanding
of an abortion procedure. We all need to be educated
about it because, once again, Molly, it is one of
the most common surgical procedures that women undergo in the
United States exactly. So, UM, we welcome your comments. The
(22:47):
email addresses mom Stuff at how stuff works dot com.
It will be interesting to see if the comments turn
more political than we allowed the podcast to be. Maybe
you guys will pick up on places where we failed
in our ability to be a political Let us know
about that, and in the meantime, let us read some emails. Well,
(23:07):
I have an email here from Megan and this is
in response to our podcast on why women tend to
be colder than men, and she writes, I just transferred
to a cubicle workspace, and for whatever reason, I can't
always anticipate my temperature. My tips number one layers, especially cardigans,
because they're so easy to adjust on button up and
(23:28):
down sleeves, take on an off, et cetera. Two scarves.
These deserve their own mention, mostly because they make a
huge difference if you haven't layered enough. Number three fingerless gloves, Megan,
you must be in a cold office if you are
advocating fingerless gloves. Um. She says that they are a lifesaver.
And then for of course warm liquids, coffee, tea, cocoa,
(23:49):
even water. Megan. I'm just imagining you, you know, like
huddled huddled over your laptop with fingerless gloves and just
a couple of hot water. Megan, I have been there too.
Don't let christ and Kristen put this down. Just that
must be really cold office. But she says, on the
plus side, it's almost March, which means springs come and
well except for office like ours, who turned the air
(24:11):
a c way up in the summer, which is cold.
But then we just the sunny spots would just go outside, Molly,
we try. I have another email from the same podcast
about women running colder than men, and this is from Kristen.
She writes, I noticed that when I've been lifting weights
a lot i eat gain muscle, that I am far
less cold in office environments. And if i'd work out
in the morning. My metabolism is up, which seems to
(24:31):
keep me warmer. Along those lines, don't go hours and
hours without eating, otherwise your metabolism drops and you may
feel cold. Finally, you said that for people who with
seriously cold hands, their hands got from white to blue.
Is this something that affects white people more than other
racists or are you just speaking from your own experience?
And this was a really good call out because ray
knows does affect people of all races equally according to
(24:54):
the research has been done so far, which is kind
of limited, but yes, it can affect people of all racists.
So when I said white to blue, that was just
what I had seen, but it maybe other colors. And
if you have an email you'd like to send our
way again, our address is mom Stuff at how stuff
works dot com. You can follow us on Twitter at
mom Stuff Podcasts. You can hit this s up on
(25:14):
the lace book, which we'd love for you to like. Lastly,
you can check out our blog It's stuff Mom Never
Told You at how stuff works dot com for more
on this and thousands of other topics. Is it how
stuff works dot com so learn more about the podcast
clock on the podcast icon in the upper right corner
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(25:37):
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you
Brought to you by the reinvented two thousand twelve Camray.
It's ready. Are you welcome to step Mom? Never told you?
From House topbords dot com. Colly, and welcome to the podcast.
This is Molly and I'm Kristin Kristen. Today are our
(00:21):
topic is abortion and you and I are determined to
make this politics free as possible if you know, may
not be possible, but that's what we're gonna do. We're
gonna ignore current events for a moment and just talk
about what happens when you're in a doctor's office to
get an abortion. And to start things off, I will
I will tell a little lighthearted anecdote. Um, I'm going
(00:44):
to admit to googling myself. I think we all do
it every now and I do what you gotta check
up and see see what's gonna make your no one's
talking smack about you? Right? So, Um, I googled myself
recently and at the bottom when it's related searches to
the search term Molly Edmund abortion, Molly Edmonds comes up
and I was like what, But then I remembered I
(01:07):
wrote how abortion works for our site how stuff Works
dot com. Right, So, apparently, people who I don't know
if they're just looking for this article and I know
I wrote it, and so it goes abortion Molly Edmonds.
But it's a common search term apparently. And UM, I'm
happy to be associated with this article because I'm proud
of it. A lot of research went into it to
take out the politics. As we just mentioned, I wanted
(01:29):
it to be as straightforward as possible, and so that's
what we're going to present, a straightforward look at abortion,
right because I would argue that the public is probably
more familiar with the political debate around abortion than they
are about the actual procedure. I think it's the most
common procedure that's not actually talked about. And in fact,
(01:50):
before we came in here, I was trying to find
more information about therapeutic abortion, which is when there's a
health reason for terminating a pregnancy, and it's very hard
to find any accounts it. Um, you know, it's just
not talked about. And UM, we're gonna get behind the
arguments about pro life, pro choice however you want to
put it, and just talk about what happens when you
(02:12):
get abortions, who's having them, why they're having them, how
they have them right because we talked about planned parenthood
way back when, but on most people associates in parenthood
with birth control and abortion. So today we are going
to talk about really what happens. And here's the thing.
It happens a lot. Just to toss out some statistics
(02:34):
since we love statistics. UM. In the US alone, UM
half of the six million pregnancies that occur each year
are unplanned, and about one point three million of those
unplanned pregnancies and an abortion. And according to the Gootmaker Institute,
about one third of women in the US will have
(02:56):
an abortion by the age of forty one in three.
One in three pretty staggering, and worldwide, not just the US,
about two percent of all reproductive aged women have an
abortion each year. So what kind of woman is having
an abortion? According to the Gootmaker Institute in the US,
that woman is young. The women who have an abortion
(03:17):
the U S are under the age of UH, more
likely to be unmarried than married. Lower class. The abortion
rate for poor women is four times higher than that
of women living above the poverty line. UH. The woman
who is likely have abortion probably has at least one
child already. Six of abortions are performed on women who
are already mothers, and she reports not using contraceptives properly,
(03:41):
if at all. And it's pretty spread across UH racial
demographics are attributed to black women percent, to white women,
to Hispanic women. And here's the thing that um, I
think it's important to keep in mind, especially when we do.
You know, I'll side of the podcast get talking about
the politics involved in all of this. Abortion is one
(04:05):
of the most common surgical procedures for women, and yet
we are so uncomfortable talking about what actually happens. And
that's one of the main reasons that Molly and I
wanted to talk about it today, because you don't think
about that. We know that abortion happens, but consider that
one of the most common surgical procedures for women, right
and so if you're let's say, you take a pregnancy test,
(04:28):
you get it back, you're pregnant, you don't want to be,
and you decide to pursue an abortion, where you start
looking a local plan Parenthood, as we mentioned, is a
great place to start. A family planning clinic if there's
not one in your area, can contact just your O,
B G Y in and ask for a referral or
maybe she'll do it. Midwives, nurse practitioners. They are licensed
(04:48):
to do abortion, so there's a wide variety of medical
professionals that can do it. The Gootmacher Institute estimates that
the average amount paid for an abortion in the United
States is fo dollars and just note that first trimester
abortions are less expensive than second trimester abortions. There are
two methods for performing an abortion. You can have a
(05:09):
medical abortion or a surgical abortion. And in a medical
abortion UH, you take pills to expel the fetus from
your body. You take an abortive facient, which is an
abortion inducing substance, and the f d A approved UM.
It's basically a two part procedure where you go in
(05:30):
first to a clinic and you take UM six in
r milligrams of something called mythopristone, which is followed by
four hundred micrograms of ms A prostal, which you can
usually take in your home if you elect to. And
you might have heard of methophristone, as are you for
eight six and it blocks the hormone progesterone, which allows
(05:52):
the uterine lining to build up to support the embryo
in the womb. So basically when you take are you
four it six, it causes that that uter in lining
to break down and bleeding similar to a minstrel period
will start to happen. And typically you will take that
first dosage at a doctor's office, and then a few
(06:13):
days later at your home or in a doctor's office,
you take that second half, which is actually what expels
the fetus in a process very similar to a miscarriage.
It feels very similar in terms of the cramping, nausea,
and the bleeding obviously is very similar so UM and
also something I learned after with this articles, they usually
(06:33):
have you take a suppository of a sedative to deal
with that that cramping and pain UM and then the
leading can occur for up to two weeks. But this
type of abortion is effective nine percent a time when
it's done in the first nine weeks of pregnancy, so
(06:54):
there is a window after which a medical abortion will
not work right, and it's used around the ninth week
in and it's at that time that you will probably
opt for a surgical abortion. And one of the most
common types of surgical abortions would be a vacuum extraction abortion,
and this is Actually, the most common method is a
(07:15):
vacuum extraction, and it can be performed for twelve weeks
after a woman's last period, and it can happen either
with the fetus being extracted, either manually or with a
handheld suction device or with an actual machine vacuum and UM.
The manual vacuum extraction is UM one of was one
of the earliest surgical options available to women. And basically
(07:39):
you go and it's it's not that much unlike a
gynecological exam where um, you sit in the chair, you're
in the stirrups um, you will be a speculum will
be inserted into a woman's vagina um. The cervix might
have to be slightly numbed, and then the doctor will
insert a tube through the cervix and into the unuse
and then apply um section with a special handheld device
(08:02):
to extract the contents of the uterus. And it only
takes a few minutes, right, And you know, we found
a few blogs on the Internet of women who have
had abortion, so we're sharing their experiences and these are
very rare, usually because the politics will enter into it.
But I did want to read a description from an
abortion blog of what this process feels like Emmanuel vacuum extraction,
(08:23):
and this is from my abortion blog dot tumbler dot
com and I'm just gonna read verbatim what she wrote,
and before Molly starts, I do want to provide a
trigger warning for listeners out there, since this is a
pretty graphic account of what happens. The doctrines are the
speculum and then wiped my service clean with an antibiotic.
(08:45):
She then topically numbed it a bit and followed that
up with an anesthestic injection. This felt like a tiny
little poke and was mostly just uncomfortable, no less odd
feeling than a regular pap smear. The weird part was
that I got a little woozy and dizzy seconds after
the shot because the anesthetic entered my bloodst She talked
me through this, but I actually liked the feeling. Next,
she dilated my servix, but I didn't really feel much
(09:05):
more than a bit of pressure. She then inserted a
hose about the diameter of a pen, and again I
felt a bit of pressure. I could feel once the
procedure started, because I started getting some cramps about the
same as I would during a period. They continued. As
she continued the aspiration, there was also a slight tugging
feeling from the inside that was kind of odd. I
kept my hand on my belly the entire time. I
could feel my uterus tugging from the inside, like my
(09:27):
belly was actually rising and falling. The cramping continued, but
it was no worse than when I got from my period.
At the very end, the cramping got really bad, but
which she said was normal because it meant the uterus
was contracting back to its normal size. I think the
worst part was probably the five or so minutes after afterwards,
from the cramping got intense and the naja struck. I
started sweating a bit, and my boyfriend held my hand
(09:48):
tightly and kept a bucket in his hand in case
I needed to throw up. The cramps were uncomfortable, like
a combination of period and bathroom cramps at the same time,
and for a second I felt they would never go
away and I'd be curled up in that room forever.
But actually less than quickly and soon all but disappeared.
So that's one person's first person account of having an abortion.
So that was an example of a manual vacuum extraction,
(10:12):
but women can also have a machine vacuum extraction extraction
and the process is slightly more intensive since the woman's
cervix will need to be dilated and that's going to
happen either through absorbent dilators inserted a day beforehand or
by inserting rods that gradually increase in size on the
day of the procedure. And the rest of the abortion
(10:34):
procedure is very similar to manual extraction, except a machine
is going to apply the suction that pulls out the
uterine contents through the tube. And then sometimes after completing
the vacuum extraction, UH, the doctor will need to use
a curette to scrape the remaining feel tissue from the uterus, right,
And a cura is a long, thin instrument with a
(10:57):
kind of a serrated spirit the end. That's the part
that actually does the scraping, and when the cuat is
brought in, the procedure might be called a d n
C and UH this is you might also have a
d NC just at a gynecological exam if you've got
uh some sort of vaginal bleeding, if there's something going
on up there. Um and these extractions can usually reformed
(11:17):
up to sixteen weeks after women's last period, when they
bring the curet in to help scrape. Now we're at
sixteen weeks after a period extraction and then a curet.
Now once we um hit the sixteen week part, abortions
that take place after that are really the most controversial.
These are performed with a method known as dilation and evacuation.
(11:39):
And uh, this method, again, like to to provide a
little bit of a trigger warning, is a little more
um intensive than the vacuum extraction methods. And I think
it's natural that it has to be a little more
intensive because we're past sixteen weeks, were in the second trimester. U,
the fetus is a little bit more developed, but still
not viable outside womb. It can't live outside the woom
(12:01):
on its own according to medical definition. So I'm gonna
go ahead and read the definition of the dilation and evacuation.
What they have to do is they have to administer
a shot to the fetus through abdominal tissue to ensure
that the fetus is dead. Uh, they give medication to
the woman and as with the other methods that Kristen described,
they have to stretch the cervis through rods or through
(12:22):
um dilators. The fetal tissue is then extracted to the
degree possible with the vacuum that we mentioned in those
first trimester abortions. But then because the fetis has developed
it's a little bit larger, they might have to insert
forceps into the vagina and crush the fetus's head to
bring it out, or to break down the fetus so
that it can be removed. And uh, you know, the
(12:45):
doctors who pioneered this concept said they were looking for
a way to perform second trimester abortions that could be
done in a one day in and out outpatient procedure.
So it's a way to abort a fetis in a
way that that still allows women to kind of leave
of her own volition at the end of the day.
And these are I think we should mention that these
(13:07):
make up a very very small um proportion of all
the abortion procedures that happen every year. That what was
at one point three million abortions happen every year in
the United States, and a lot of times h dilation
and evacuation abortions happen. In the case of therapeutic abortions,
where the mother's life might be at risk carrying the
(13:28):
pregnancy to term. Now, one last type of abortion procedure
that we need to talk about is certainly the most controversial.
It's called dilation and extraction method and you've probably heard
of it as partial birth abortion. Right. This is when
the fetus is partially delivered vaginally, uh, in a breach position.
And when they have the fetus, you know, a little
(13:49):
bit out of the way, they'll make up out of
the way of the woman. They'll make a hole in
the base of the fetal skull, insert tubing, and you
suction to pull out the brain of the fetus. Uh.
This is so that the feet the skull will collapse
in the fetus can be fully expelled. And as Kristen said,
this this method is pretty controversial. It's been banned in
the United States except in the case of protecting a
(14:10):
woman's health. Um. Perhaps you might have an uneffected uterus
or hard condition that makes it impossible to continue the pregnancy. Now,
as Kristen sindys, you're extremely rare. The Gootmaker Institute estimates
that this makes up point to percent of all abortions
in the United States. UM. So that's that's sort of
the range that they can go. We've gone from taking
(14:32):
a pill and having a process very similar to a miscarriage,
all the way up to dilation and extraction, where we're
pulling out the fetus. Again, it's not medically viable at
this point, can't live outside of the womb. But you know,
then that's where the politics gets into it, that we're
gonna skip and that you know, is this a person
yet is it not. That's not our argument today. We'll
(14:53):
let you guys battle that out. But those that's the
range of abortion procedures that can take place. And and
even though the procedures that we've described sound very unpleasant,
I'm sure to our listeners, one thing to keep in
mind is that while possibly unpleasant, they are generally very
very safe. Um. In fact, a woman has eleven times
(15:15):
the chance of dying in childbirth as she does of
dying from an abortion performed in the first twenty weeks
of pregnancy. Now, after an abortion, regardless of the type
of abortion performed, women are kept in a recovery room
for a few hours, and then they usually go home,
where they'll continue to bleed um. They may have really
large blood clots. But a sign of a complication is
(15:36):
when the blood clots get larger than a lemon um.
But you know, you might have some fairly sizeable blood
clots for a few days. You can some women go
back to work the same day or the day after.
Some women go back to class very shortly after. But
the two things you can't do though our strenuous exercise
and putting anything in your vagina which ranges from a
(15:56):
tampon to sexual intercourse that would involve vaginal penetration. So um,
the vagina has to heal from this. Nothing nothing can
go up there. But speaking of intercourse and vaginal healing,
abortion does not affect future fertility. And I think that's
one one common misconception that we need to um that
we need to clear up that if you if a
(16:16):
woman has an abortion, it typically does not harm her
chances of having a child later. And another thing that
has been linked with abortion is a higher rate of
breast cancer. But some researchers are concerned that the studies
that link higher rate of breast cancer to abortion maybe
because the women who have breast cancer are so desperate
(16:36):
to find out why they have it that they'll admit
to an abortion, whereas women who don't have breast cancer
may not admit to an abortion. Uh to a researcher
that they don't know, so they haven't really drawn a
conclusive link. In fact, another study and from two thousand seven,
it followed a control group of women who didn't have
abortions against a group of woman that did, knowing out
from the front how everyone had had scored on the
(16:58):
abortion card, and the sentence of breast cancer was about
the same. So uh, that's right, doesn't affect future utility,
probably doesn't affect breast cancer. One aspect of abortion recovery
that often comes up in these politicized debates that we
do need to address is the mental health of the
woman involved. Because a lot of times you might hear
(17:20):
about post abortion syndrome, essentially that after a woman has
an abortion, she is going to suffer from massive anxiety
and depression and guilt over terminating a fetus, terminating a
pregnancy UM. But we need to remember that it is
not recognized by any medical or psychological association. And in fact,
(17:40):
UM a study that just came out in January UM
from a group of Danish researchers comparing UM mental health
effects post abortion and then post childbirth. Actually finds that
just like with childbirth, you know, you can't um can't
predict the mental health effects of either caring a child
(18:01):
to term or terminating a pregnancy right. In fact, proportion wise,
the women who saw treatment for psychiatric counseling after abortion
it was about the same as the rate of a
woman who had sought treatment before before and after was
pretty much the same, And some doctors say that's because
women who get abortions may be more likely to have
other factors in their life that they need counseling about.
(18:22):
They couldn't draw any sort of uh line between the
abortion and the counseling, whereas the proportion of women who
needed counseling after having the child was much higher compared
to the rate of women in that group who would
need a counseling before. And obviously there are all sorts
of things that can go on. You're sleepless, there's postprimed depression,
it's a lot of stress to have a newborn in
(18:42):
your life. So they're saying that, you know, in terms
of actual mental stress, it's possible that the actual child
might do more for you than than uh than getting here,
than terminating the pregnancy. And we're certainly not sitting here
saying that abortion is better for your mental health been
carrying a pregnancy to term um. But we're just trying
(19:05):
to make the point that you have to consider each
on a case by case basis. You cannot make any
kind of blanket judgment on the mental health of all
women who become pregnant and based on what they choose
to do. Right now, Molly, we have gone through this
entire abortion podcast without mentioning the tune names probably best
(19:27):
that's closely associated with it, and that would be Raw
and that would be Wade, because we're trying to keep
this conversation a political and those names are so charged politically. Yeah,
if there's one. If if you had to walk down
the street and ask anyone uh to name one Supreme
Court case in the US, it would Row v. Way
(19:47):
would probably come up more than any other. I don't
know of a of a more controversial court case that
it happened in nineteen seventy three and established that any
legal restriction to an abortion violated the of privacy guaranteed
by the Fourteenth Amendment. So that established that the decision
to perform an abortion was up to a woman and
her doctor and there should be no government interference. But
(20:10):
the reason we bring Roe v. Wade up, which deserves
a podcast all its own, is um just to talk
a little bit about the history of abortion and its
legality through time. And you know, you'll always find people
who say that, you know, even from the ancient days,
people were finding herbs and mixtures that they could use
to uh induced an abortion. They might beat themselves violently
(20:32):
in the abdominal region. And in fact, some of the
first laws that criminalized abortion were meant to protect women
from doing this rather than to protect a fetus from termination,
because too may were dying from taking poisons to bring
on an abortion. And one thing that we should bring up,
and in terms of statistics, in the United States before
Roe v. Wade, an estimated one point two million abortions
(20:56):
were taking place in back alleys and in you know,
hidden clinics and things like that, and today or even
in some real clinics because you know, money, money can
open a lot of doors. So you know, there were
some doctors who are performing abortions legal just because someone
could pay. And speaking of money, I think that one
one of the most interesting findings that you reveal in
(21:18):
your article on abortion, Molly is that doctors did have
economic motivations for advocating against abortion because they lost a
significant amount of income to midwives and private people who
would perform abortions, and as a result, the American Medical
Association served as one of the main legal lobbies against
abortions legalizing abortion. That was really interesting finding I found
(21:41):
in a book, and of course, as always, will put
all our sources up on our blog. UM, but right now,
abortion is a legal procedure and you know, its status
of remaining so is up to the political debate that
we're not going to touch right now. But we hope
that in sort of just talking about the procedure behind
the politics, that you understand this procedure a little bit
more more. Um. You know, like we said, one in
(22:02):
three women have had an abortion or we'll have an abortion.
So we know there are listeners out there who probably
have UM. As always, you can share our stories or
you cannot share your stories. This is obviously a touchy subjects.
Some people don't want to talk about it. Some people
are eager to shout up from the rooftops, like with
these blogs. Um, and sometimes that can be helpful because,
as we said, when you google it, there's not a
lot that comes up because it is so to have taboo,
(22:25):
so political, and I think that both sides of the
political argument would benefit from a clear, more honest understanding
of an abortion procedure. We all need to be educated
about it because, once again, Molly, it is one of
the most common surgical procedures that women undergo in the
United States exactly. So, UM, we welcome your comments. The
(22:47):
email addresses mom Stuff at how stuff works dot com.
It will be interesting to see if the comments turn
more political than we allowed the podcast to be. Maybe
you guys will pick up on places where we failed
in our ability to be a political Let us know
about that, and in the meantime, let us read some emails. Well,
(23:07):
I have an email here from Megan and this is
in response to our podcast on why women tend to
be colder than men, and she writes, I just transferred
to a cubicle workspace, and for whatever reason, I can't
always anticipate my temperature. My tips number one layers, especially cardigans,
because they're so easy to adjust on button up and
(23:28):
down sleeves, take on an off, et cetera. Two scarves.
These deserve their own mention, mostly because they make a
huge difference if you haven't layered enough. Number three fingerless gloves, Megan,
you must be in a cold office if you are
advocating fingerless gloves. Um. She says that they are a lifesaver.
And then for of course warm liquids, coffee, tea, cocoa,
(23:49):
even water. Megan. I'm just imagining you, you know, like
huddled huddled over your laptop with fingerless gloves and just
a couple of hot water. Megan, I have been there too.
Don't let christ and Kristen put this down. Just that
must be really cold office. But she says, on the
plus side, it's almost March, which means springs come and
well except for office like ours, who turned the air
(24:11):
a c way up in the summer, which is cold.
But then we just the sunny spots would just go outside, Molly,
we try. I have another email from the same podcast
about women running colder than men, and this is from Kristen.
She writes, I noticed that when I've been lifting weights
a lot i eat gain muscle, that I am far
less cold in office environments. And if i'd work out
in the morning. My metabolism is up, which seems to
(24:31):
keep me warmer. Along those lines, don't go hours and
hours without eating, otherwise your metabolism drops and you may
feel cold. Finally, you said that for people who with
seriously cold hands, their hands got from white to blue.
Is this something that affects white people more than other
racists or are you just speaking from your own experience?
And this was a really good call out because ray
knows does affect people of all races equally according to
(24:54):
the research has been done so far, which is kind
of limited, but yes, it can affect people of all racists.
So when I said white to blue, that was just
what I had seen, but it maybe other colors. And
if you have an email you'd like to send our
way again, our address is mom Stuff at how stuff
works dot com. You can follow us on Twitter at
mom Stuff Podcasts. You can hit this s up on
(25:14):
the lace book, which we'd love for you to like. Lastly,
you can check out our blog It's stuff Mom Never
Told You at how stuff works dot com for more
on this and thousands of other topics. Is it how
stuff works dot com so learn more about the podcast
clock on the podcast icon in the upper right corner
of our homepage. The How Stuff Works iPhone app has
(25:37):
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