Abortion and pre abortion visits

When the topic of liberalising abortion comes up, as it has recently, invariably there is talk about “increasing access” and reducing the number of visits required before a woman can have an abortion.

New Zealand law stipulates that the woman seeking an abortion must see two certifying consultants. Sometimes this can happen in one visit. Beyond this the law doesn’t specify anything about visits and appointments, but there is the need for a few more visits and procedures. The Abortion Supervisory Committee does have medical recommendations, but the extra visits and procedures are there more for medical reasons than legal.

Abortion providers generally want some basic tests done, and some information about when the woman became pregnant. This is important because different abortion procedures can only be used in some stages of pregnancy.

They want to know if there is an active sexually transmitted infection, as this can cause complications including chronic pelvic pain, infertility and increase risk of future ectopic pregnancy. One study of women presenting for an abortion found chlamydia at a rate of nearly 19% in one population group. Clearly it’s important to test and wait for the results before risking invasive surgery and all the risks of infection that can result.

One requirement that is very controversial overseas is ultrasound. There are some good reasons why it’s appropriate to do an ultrasound before an abortion. The first reason is to confirm that it’s a normal pregnancy, and not an ectopic or molar pregnancy. The recent case of “Dr N” highlights the risks or forgoing the ultrasound. She facilitated several of her patients to have medical abortions by providing the medication outside New Zealand’s current legal framework. One of these women had an ectopic pregnancy, which was not ended by the medical abortion. Later this patient was admitted to hospital for treatment due to a ruptured fallopian tube. Her outcome could have been much worse.

Ultrasound can confirm if the unborn child is healthy likely to survive to birth. There is an appreciable miscarriage rate in early pregnancy, and sometimes an ultrasound can predict a miscarriage before it happens. Clearly in these cases there is no need for the woman to be exposed to the additional trauma of an abortion. I’ve also heard that many women who have made up their mind to have an abortion, and then cry when they hear the news that their child has died, or will soon die.

An increasingly important feature of ultrasound is the ability to accurately estimate the age of the preborn baby. Many women are using forms of contraception that disrupt the normal menstrual cycle, which can make dating an unexpected pregnancy more difficult. The gestational age of the child is important information for abortion providers, as different methods of abortion are used as the gestational age of the child increases.

Blood tests are normally required. These indicate the health of the mother, and her rhesus blood group. If the mother is rhesus negative, and the baby is rhesus positive, after the abortion the mother may produce antibodies which could cause rhesus disease in her future babies. This can easily be prevented by an injection of ‘anti-D’ at the time of the abortion.

And then there is counselling. The Abortion Supervisory Committee strongly recommends counselling for all women wanting an abortion, both before and after abortion. This is universally optional, despite the growing evidence that abortion is harmful to a woman’s mental health.

It’s clear that the extra visits for a woman wanting an abortion in New Zealand are not because of some pro-life conspiracy, but are all justified on medical and evidence based grounds. They are certainly not hoops to be gotten through. They are there to protect the health of the woman and her future children.

But how much more could we protect women and children if we recognised the harm abortion does to them, and supported them in pregnancy and beyond? Then no unexpected pregnancy would be a crisis pregnancy, and every child could be born into a society which loves and affirms them.

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