Saturday, March 10, 2007

Search: Saline abortions

In 1939, a Rumanian abortionist named Abruel first got the idea of taking out amniotic fluid and replacing it with something to kill the fetus and/or induce premature labor. Although different substances were tried, with varying success and varying complications, hypertonic saline (a strong salt soloution) became the most popular. Abortions that involve taking out amniotic fluid and replacing it with something else are called "instillation abortions" or "amniotic fluid replacement abortions," or are named after the substance injected. I use the terms "saline abortion" and "saline instillation" interchangably.

The saline causes abortion by two mechanisms:
  • Killing the fetus
  • Irritating the uterus

    Saline abortion is hardly a pleasant experience. The abortionist would remove as much amniotic fluid as he cound using a needle and syringe. He would then replace the amniotic fluid with a concentrated saline (salt) solution that would poison and kill the fetus. The woman would then go into labor and expel the fetus.

    Instillation abortions spread into nations where abortion was legal, and saline quickly became the favored abortifacient, although other substances, including glucose, were tried. Glucose was quickly abandoned because it fed infection rather than killing the fetus.

    Saline abortions became very popular in Japan following WWII. Within the Japanese medical community, however, word quickly spread: this method was unsatisfactory. Too many women were being injured and killed. Over 70 papers were published in the Japanese medical community reporting hazards of saline abortions, including at least 60 maternal deaths. The Japanese Obstetrical and Gynecological Society condemned the technique, and it was quickly abandoned. But the Japanese abortionists kept news of the trouble among themselves -- until Western nations discovered instillation abortions and embraced them with great enthusiasm. (Mark Crutcher, Lime 5, p. 126; Manabe, "Artificial Abortion at Midpregnancy by Mechanical Stimulation of the Uterus," Am. Journ. Ob Gyn 9/1/68)

    Two Japanese doctors, Takashi Wagatsuma and Yukio Manabe, broke the silence. Wagatsuma wrote, "It is, I think, worthwhile to report its rather disastrous consequences which we experienced in Japan." Manabe wrote, "It is now known that any solution placed within the uterus can be absorbed rather rapidly into the general circulation through the vascular system of the uterus and placenta. Thus any solution used in the uterus for abortion must be absolutely safe even if given by direct intravenous injection. ... A solution deadly to the fetus may be equally toxic and dangerous to the mother. ... In spite of the accumulating undesirable reports, the use of hypertonic saline for abortion is still advocated and used ... in the United States and Great Britain. I would like to call attention to the danger of the method and would predict the further occurrence of deaths until this method is entirely forgotten in these countries." (Wagatsuma, "Intraamniotic Injection of Saline for Therapeutic Abortion," Am. Journ. Ob Gyn 11/1/65; Manabe, "Danger of Hypertonic Saline Induced Abortion," JAMA 12/15/69)

    As western abortionists gained experience with saline abortions, other grim reports arose. A British study published in 1966 found that the saline would enter the mother's bloodstream and cause brain damage. Swedish researchers noticed an unacceptably high rate of complications and deaths. Sweden and the Soviet Union abandoned saline abortion as too dangerous for women in the late 1960s. (Mark Crutcher, Lime 5, p. 127; Cameron, "Association of Brain Damage with Therapeutic Abortion Induced by Amniotic Fluid Replacement: Report of Two Cases," British Medical Journal, 4/23/66 )

    For whatever reasons, American abortionists were deaf to these warnings. When New York had completely repealed its abortion law, doctors had tremendous leeway in abortion practice. In New York City in particular, it became popular to inject the woman with the saline in the office, then send her home with instructions to report to a hospital when she went into labor. This was, to say the least, a highly irresponsible way to use an abortion technique that was risky even when performed in a hospital under close medical supervision. Women started dying from these saline abortions. (See: New York Saline Abortion Deaths, 1970-1972)

    Women were also already dying in California as well, even though the law there still required abortions to be done in hospitals: California Saline Abortion Deaths, 1972)

    After Roe v Wade was handed down, saline and other instillation abortions spread to other areas of the country, despite the dismal goings-on in New York and California, and of course more women died: Instillation Abortion Deaths After Roe

    US abortionists showed no alarm over these deaths. Even as late as the 1990's, the American College of Obstetricians and Gynecologists, and abortionists such as Don Sloan and Warren Hern, were describing saline and other instillation abortions in such terms as "a low-risk procedure."

    Stastics show, however, that abortionists did gradually move away from saline instillation abortions, albeit more slowly in New York City than in the rest of the country.

    Since the problem of maternal deaths from instillation abortions had been long documented, this factor probably only had a minor impact on the move away from saline and other instillation abortions. One important factor was financial: although suction and D&C were adequate procedures for first-trimester abortions, they were inadequate for killing and removing the larger second-trimester fetuses. But the uterus was not large enough to perform instillation abortions until 16 weeks. This left a 4-week "grey period" during which women could change their minds about aborting.

  • There was also the problem of starting a suction or D&C abortion only to discover that the pregnancy was already in the second trimester. Necessity is the mother of invention, and abortionists who found themselves dealing with second-trimester fetuses that had already been damaged had to come up with ways to remove these fetuses quickly and without alarming the patient. Thus evolved the Dilation and Evacuation (D&E) procedure that remained popular for mid-trimester abortions for over a decade.

    D&E was cheaper than instillation abortions, which required at least an overnight hospital stay. It also had the advantage of producing fewer live births, the "dreaded complication" no abortionist wanted to face.

    While instillation abortions were still the most common method of mid-trimester abortion, roughly 500 live births were reported to the Centers for Disease Control every year by abortionists. The CDC's Willard Cates thought that this number probably came nowhere near the true number of live births, because there is no penalty for failing to report these births to the CDC. "It's like turning yourself in to the IRS for an audit," Cates said.

    So, addressing the multiple problems of live births, lost sales during the "grey zone," and miscalculating gestational age, the abortion industry gradually phased out saline and other instillation abortions, replacing them with D&E dismemberment abortion.

    The few persisting saline abortions raise interesting questions. Why are these physicians, who are conscientious enough to report the abortions they do, still using an outdated and highly risky technique? Are there still a large number of saline abortions being performed by fringe abortionists who aren't reporting to the CDC? And will the "greying" of the abortionist pool eliminate saline abortions entirely over the next decade?

    For the sake of the women, one would certainly hope so.


    Anonymous said...

    As a nurse, I find it hard to believe that a hypertonic solution, in the amount injected into the uterus, can harm the woman or the fetus. We use hypertonic solutions in the hospital in IVs for electrolyte imbalances. The only precaution a woman undergoing a saline abortion should take would be to drink a lot of water prior to and following the procedure. As for the fetus, the death occurs due to the separation of the placenta from the uterus, which is caused by both the saline and the contractions.

    Anonymous said...

    I would also like to note that, I am not defending second trimester abortions, and find them appauling, however, I also find skewing the facts to further a point repulsive.

    Anonymous said...

    As a nurse, then you most certainly know the difference between normal saline (0.9%) infused for hydration and metabolic balancee purposes and hypertonic saline used in second trimester abortions, which has a concentration which can be as high as 20%, as mentioned here. In fact, it's use is mentioned in several medical journals:

    Clinical Indications for Sodium Therapy

    Obsteritics and Gynaecology Department,S.C.B.Medical College & Hospital,Cuttack,Orissa-753 007.
    Comparative evaluation of intra amniotic hypertonic saline and ethacridine lactate instillation for midtrimester abortion.

    Sodium Chloride 20% Injection: AHFS Drug Information

    Mid-trimester induced abortion: a review
    S. Lalitkumar, M. Bygdeman and K. Gemzell-Danielsson1
    Human Reproduction Update Advance Access originally published online on October 17, 2006
    Human Reproduction Update 2007 13(1):37-52; doi:10.1093/humupd/dml049

    Christina Dunigan said...

    Thanx, Rachael!

    Anonymous said...

    No Problem! *Smiles*

    Unknown said...

    I am a person who had a saline injection abortion in 1970. It was not without severe complications while in the hospital. I ran a fever of 112 degrees, when the fever broke, my temperature plummeted to 94 degrees. Needless to say, I was put on the critical list. Later I was told I had sepsis and hepatitis (which are known side effects of the procedure, although I did not learn that until many years later). Did I recover? Hardly. My electrolyte balance became and remains very tenuous, particularly sodium. My blood does not coagulate as it should. I am subject to collapse, seizures, and stroke-like symptoms. I have been disabled since that procedure--imagine becoming totally disabled at 26 years old! I have since learned I had Myalgic Encephalomyelitis as a result of the procedure, which did severe nerve damage. All of these are known side effects of saline injection abortion and/or high fevers. Moreover, the statistics speak for themselves. So, please do not fall into the category so many health care providers of my experience have in dismissing what you truly don't have a clue about. That ignorance on their/your parts has been a horror in itself. Fortunately for myself, I am a researcher and was eventually able to find specialists who have recognized and addressed the nerve damage done at that time and the other issues from that procedure. Although I'll never regain my health, or be able to work again, I at least now have some semblance of a life. It's tragic it took over 35 years to find any help. Please do your own research, rather than having your patients do it for you, or, worse, patients, or you, being the victim of your hubris.

    Christina Dunigan said...

    Kaos, I'm very sorry that you had such a horrible experience, but glad that you nevertheless survived.

    Who exactly are you scolding, though?

    Unknown said...

    Oh, "anonymous", the nurse, of course.

    I am not opposed to abortion. I think it is, more frequently than not, a "gnawing off of the leg", when one is in a trap, type situation, as you said elsewhere. But I do believe that women should have more options than they do, particularly those who either feel as though they are trapped, or are being coerced by others into having an abortion. I do believe also, though, contrary to the current policies, that women should be able to make INFORMED choices, that they need to know the pros and cons, what, if any, options there are, and all the facts.

    I do not regret having had an abortion. It was a necessary decision at the time. I regret getting pregnant. I regret that once I knew I was pregnant, I didn't opt for an abortion earlier. I regret I had no other options. I regret that I was not informed of the risk and the possible side effects. I am bitter about what happened to me and all the years nobody took me seriously, and what those years cost my children--the same children I already had at the time of that abortion, when I was alone and just couldn't manage two more (I was carrying twins). I regret that we live in a society where women and their concerns are not taken more seriously.

    In further response to "anonymous", I would like to say that while second trimester abortions are certainly less than ideal (as though an abortion at any stage is an ideal time), sometimes it just comes down to that. Something changes, or one has hoped against hope that something *will* change and time has run out.

    But, perhaps that is a reasonable compromise--to have first trimester abortions as legal, but not allow any thereafter, if not for the child's sake, then for the risk it holds for the mother.

    Personally, I have never met a woman who has had an abortion and was callous about it. I doubt that there are any. There seems to be some sort of notion that a woman who has had one is supposed to show her emotional pain and explain herself to everyone. Those women who speak the most defiantly about it, and seem callous, are likely to be the ones with the most pain, determined not to show it and/or to defend herself. It is her tragedy, and she is under no obligation to share it or to do penance.