The Guardian Newspaper's Guide to Abortion

I found this on The Guardian website. It gives 'information' on abortion. What I found striking was that the language of the 'guide' is so flippant about the health risks of abortion, which it suggests is a course of action taken as a health-related matter. My comments in orange, bold obviously...It is long, but I think, worth a fisk.

This information tells you about an abortion to end a pregnancy. It explains the different types of abortion, how they work, what the risks are and what to expect afterwards. [Introductory para: There are risks to having an abortion. That's not a great start...].

The statistics we've included here are based on research studies. But some things, such as the chances of having complications, can vary from hospital to hospital. You may want to talk about this with the doctors and nurses treating you. [2nd paragraph: "There could be complications. But don't worry, it is pot luck on which hospital you go to. Hey, life's a lottery so just roll with it! It's nothing to do with the medical studies!"].

This information is about abortions for women who are less than 13 weeks [over 3 months] pregnant. More than 9 in 10 women have their abortion in the first 13 weeks of pregnancy.[1] However, in the UK, you can legally have an abortion at any time up to your 24th week [6 months] of pregnancy.

What is an abortion?

An abortion is a way of ending your pregnancy [There are other ways of ending your pregnancy. Abortion is one way. The other way is by giving birth to the child]. Abortions can be done with drugs or surgery .

* Drugs cause your womb to cramp. The contents of your womb [the unborn baby] pass[es] out of your vagina like a heavy period [a very heavy period]

* Surgery involves gently stretching the entrance to your womb (cervix) until it is wide enough for the fetus to be removed with a suction tube [the unborn baby is hoovered out of your body and is then binned]

You can have either type of abortion at any stage of pregnancy, but it's safest to use drugs in very early pregnancy [there are risks very early and later]. Surgery isn't usually done before you are seven weeks pregnant. Before this, the fetus may be too small for the doctor to find ["So wait until the baby has grown more so the doctor can find it, because at the moment, the baby is too small. It is alive and growing, so wait a while"] [2]

You may not want to be pregnant because of circumstances at home or problems with your relationship [even though according to studies described later in this article, 1 in 4 women report relationship problems after an abortion]. Your health may be at risk, or there may be a chance that the baby will have a medical problem [even though this guide explicitly admits that abortion carries health risks to you and to your unborn child, should the abortion 'not work' and the baby survives, or it is botched and stays in your body]. This information can't help you make the decision to have an abortion [It can help you decide against it if you read the orange bold input!]. What it does is to tell you what will happen if you decide to go ahead [No it does not. It basically says that abortion is like lucky dip. Read on].

The decision to have an abortion is a very personal one. Whatever your reasons, no-one has to know about your abortion unless you want them to. Your usual doctor, partner or parents don't have to be informed, even if you are under 16 ["You don't have to tell mummy or daddy, or even the father or your trusted family GP..." Anyone would have thought abortion carries a certain stigma or taboo] [3] If you are under 16, most doctors will suggest you talk to your parents ['But you just said no-one has to know? How confusing!'].

Can I have an abortion?

The law says you can have an abortion if:

* You are less than 24 weeks [6 months] pregnant
* Two doctors agree that it would cause less damage to your physical or mental health than going on with the pregnancy [How is this decided?] This is a legal requirement, but in many cases it is just a formality. [Which is it? A legal requirement or just a formality!?] [3] You should be able to have an abortion if you choose to [regardless of the second signature or lack thereof?]. If your usual doctor is unwilling to refer you for an abortion, you are entitled to go to another doctor who will [I see, the second signature bit is easy to get around] Charities which offer abortion advice, such as the British Pregnancy Advisory Service [There is even a 'charity' set up to get you the elusive second signature] (http://www.bpas.org), can help with getting authorisation from two doctors. ["Leave the paperwork to us..."]

You can only have an abortion after 24 weeks if there are exceptional circumstances, such as a risk to your health [You can have an abortion after 24 weeks if you get two signatures from doctors. However, if you read on, you will discover that abortion is indeed a risk to your health. i.e it is far from 100% safe either mentally or physically. So how on earth is the judgment made?].

The doctor works out how many weeks pregnant you are by counting from the first day of your last period. The earlier in your pregnancy you have an abortion, the more likely it is to work and the safer it is.[2] [4] [5] [6]

Guidelines for doctors say that:[2]

* You shouldn't have to wait more than three weeks between asking for an abortion and your appointment
* You should be cared for separately from women who may be going ahead with a pregnancy
* You should be given the choice between an abortion using drugs or surgery. However, some hospitals don't offer both, so it's important to check this with your doctor.[1] [So...read on, you may be out of luck and have to have the doctor remove the baby by an even more barbaric method than you had thought]

More than 190,000 women have an abortion in England and Wales each year.[7] At least a third of British women will have had an abortion by the time they are 45.[1] There are more restrictions on abortion in Northern Ireland than there are in England, Wales and Scotland.

What happens during an abortion?

Preparing for an abortion:

Before the abortion, your doctors will give you a check-up and ask about your health.[2] You will have a blood test to make sure you have enough iron in your blood. You may have an ultrasound scan. This isn't essential, but it can tell you more precisely how many weeks pregnant you are.

If there's a risk that you have a sexually transmitted infection (STI), such as chlamydia, you may have tests to check. Having an STI can increase your risk of getting an infection after the abortion, so it's best to get it treated [but even if you do, you may still contract an infection and leave the clinic in a less healthy state than that in which you entered].

An abortion using drugs

An abortion using drugs is called a medical abortion. You might hear it called the abortion pill, but it doesn't just involve taking a pill. You need to take two different tablets, usually two days apart. You'll need to visit the clinic or hospital twice and have a check-up about a week later.

* On the first visit you take tablets called mifepristone. These block the hormone that makes the lining of your womb hold onto the fetus. You should wait at the clinic for half an hour or so to make sure the tablets are working properly.
* You can carry on as normal in the two days between appointments. You may get some bleeding or period-like pains.
* On the second visit, about two days later, you'll be given one of two drugs. These are called misoprostol and gemeprost. They contain a hormone called prostaglandin, which makes your womb push out the fetus. They are usually given as a tablet that you put into your vagina. You can also get misoprostol tablets that you swallow, but it works better and has fewer side effects when used in your vagina.[8]
* You may be given a choice between going home and staying in the clinic or hospital after taking the second drug. You don't have to lie in bed. You may feel more comfortable walking around or watching television.
* The drugs can sometimes make you feel sick, vomit or have diarrhoea. [The drugs have nasty side effects] The cramps in your womb will be painful, [this procedure will be painful] but the nurse can give you a strong painkiller to help [but hey we've got painkillers!]. The pain usually settles after the abortion.

The abortion usually happens after the second visit [Second visit? You mean it isn't over?]. It will be like a very heavy period with clots of blood. It should be over within four hours to six hours. You will keep bleeding after this, but it will be much lighter. You'll need to wear sanitary towels to soak up the blood as you may get an infection with tampons.

Occasionally, the abortion takes longer than four hours to start [Sometimes the drugs don't work]. If this happens, you may be given another dose of the second drug you took [The does is increased]. Abortions can take longer to start in women who are more than nine weeks pregnant. You can be given up to four doses of the second drug, with a three-hour gap between doses, until the abortion happens [You could be in the clinic for up to 12 hours, while they dose you full of drugs to get rid of the fetus]. [2]

It's important that you take the second drug, even though it means a second visit to the clinic. There is lots of research to show that taking two drugs works far better than taking one.[8] [9] [Is it me or is this guide to medical abortion not filling you with confidence in the procedure? Some research says this, some research says that!]

Drugs used for abortion

The second drug you take will be either misoprostol or gemeprost. Misoprostol was originally used for treating stomach ulcers. Many doctors use misoprostol for abortions, and studies show that it works and is safe.[2] [8] But it hasn't been licensed for abortions by the government organisation that decides on the safety of drugs [Say what?! Let's run that one by, one more time. The drug used by many doctors for abortions has not been licensed by the government for use as an abortive drug?! Holy crap! This procedure is illegal!] It's common for drugs to be used outside their original license, so there's no need to worry about this [Oh really?! You mean like heroin, cocaine and morphine?].

Having a surgical abortion

The operation doctors usually use for an abortion is called suction aspiration or vacuum aspiration. This is because the contents of your womb [err...guys, that is the baby] are [is] gently sucked out with a tube and pump.

The operation takes about 10 minutes. You should expect to stay at the clinic for a few hours. You can usually go home the same day. You don't have to get fully undressed. You'll be asked to take off your pants shortly beforehand.

The entrance to your womb may be softened with a hormone called prostaglandin. This is done to make it easier for your doctor to open your cervix without damaging it. You or your doctor may put a prostaglandin tablet into your vagina three hours before surgery. Or you may be given tablets to take at home a day or two before your operation.

You can have a general anaesthetic, which makes you sleep, or a local anaesthetic, which numbs the area around the entrance to your womb. With a local anaesthetic you are awake and aware of what's happening, but you won't feel any pain. Your doctor or nurse will talk to you during surgery to make sure you're OK.

During a surgical abortion, the fetus is gently sucked out of your womb. The suction can be done with an electric pump or a syringe operated by hand. It doesn't involve any cutting. If you have an abortion using an electric pump, you will usually have a general anaesthetic.

Here's what happens.

* First, the doctor inserts a small instrument called a speculum into your vagina so he or she can see your cervix. Your cervix is cleaned with a swab.
* Your cervix is gently stretched and opened. A series of metal instruments called dilators are put into your cervix, starting with one that is 2 millimetres (1/12 of an inch) wide. Bigger ones are added until your cervix is open. How far open your cervix needs to be depends on how many weeks pregnant you are. If you are nine weeks pregnant, 9 millimetres (a third of an inch) should be enough.
* A thin plastic tube is put into your womb through the cervix. The contents of your womb are gently sucked into the tube using a pump.
* If you're awake during surgery, you'll probably feel strong, period-type pains.

If you're having an abortion with a hand-held syringe, your cervix will not need to be opened beforehand, as the tube used is very thin and bendy. You will have a local anaesthetic and the abortion will probably happen in a small treatment room rather than an operating theatre. It takes longer than suction using an electric pump.

After a rest and a check-up, most women can leave the clinic within three hours. Driving isn't recommended for 48 hours after a general anaesthetic. You may be given antibiotics to prevent infection.

How well do abortions work?

Abortions usually work [usually work?] and most women are no longer pregnant afterwards [most women?!] [8] [10] [11] But there is a small chance that you will still be pregnant after your abortion [So, there is a chance you will experience a botched abortion?].[3]

* Just over 2 in 1,000 women who have a surgical abortion are still pregnant afterwards.[2] [10] [Still pregnant?]
* Some studies show that as few as 2 in 1,000 women are still pregnant after a medical abortion. Other studies show that between 1 in 100 and 2 in 100 are still pregnant. [Which one's the right one? Do the clinics not keep records?] The results of studies vary because they looked at different drugs.[3] [11]

Before the seventh week of pregnancy, a medical abortion works better than a surgical abortion.[3] [8] [11]

Some women prefer surgery because they don't want the heavy blood loss you get after a medical abortion. Surgery is also quicker and happens in one go. Other women prefer to take drugs because they feel more in control, see it as more natural, or because they don't want the risks of surgery or an anaesthetic.

What if my abortion doesn't work? [There is a chance your abortion won't work]
An incomplete abortion means that part of the contents of your womb [the baby] is left behind. This is more common with a medical abortion than a surgical one. You'll usually need surgery to remove the contents of your womb. About 2 in 100 women who have a medical abortion need surgery afterwards.There's a very small chance that an abortion won't work [There is a 2% chance that the clinic will botch your abortion and you will still have parts of the baby in your womb].

If your abortion hasn't worked at all, [the clinic cannot 100% guarantee they will not botch your abortion] you may decide to have another [another?] or go ahead with the pregnancy. It's important to know that if you had a medical abortion and it didn't work, it's possible that one of the drugs could have harmed the fetus. [You may have to have the child if the abortion failed and the abortion may have harmed the child for life as a result of the procedure] [12]

What are the risks of an abortion? [There are risks to having an abortion]

All medical procedures have risks. About 2 in 1,000 women who have an abortion get complications.[13] But the earlier in pregnancy you have an abortion, the safer it is.

You are more likely to get problems in the two weeks after the abortion than at the time.[2] Getting an infection is the biggest risk. [You could get an infection]

Problems at the time of the abortion

There is a risk of heavy bleeding (a haemorrhage) after an abortion [There is risk of haemorrhage after an abortion?]. This happens to less than 2 in 1,000 women.[13] About half of these women will need a blood transfusion.[3] You are more likely to have heavy bleeding after a medical abortion.

Other risks of a medical abortion are:[14]

* Pain, from cramps in your womb[15] [Pain]
* Stomach problems, such as sickness and diarrhoea. These are caused by the drug prostaglandin. [Rather horrible side effects of the drug]
* Fever and chills. These can be a side effect of prostaglandin.[12] But they don't usually last very long. [Rather horrible side effects of the drug]

If you have a surgical abortion, there's a higher risk of:

* Damage to your cervix. Some studies show this happens in up to 1 in 100 women who have a surgical abortion.[16] Other studies show the risk is less than 1 in 1,000.[17] The risk is lower for early abortions and if your surgeon is experienced[2] [There is a risk the abortion will damage your cervix. It depends on which study you read and whether you've got an experienced doctor or an inexperienced doctor. It's pot luck].
* Damage to your womb. It's possible for surgery to tear your womb. This happens in around 1 in 1,000 to 4 in 1,000 abortions.[2] [17] Again, the risk is lower for early abortions and if your surgeon is experienced.

Problems within two weeks of the abortion

* Up to 1 in 10 women will get an infection after an abortion.[2] An infection can lead to a more serious problem, called pelvic inflammatory disease. This needs to be treated quickly as it could stop you having a baby in the future [There is a risk you will not be able to have a baby in the future if you are one of the 10% of women who contract pelvic inflammatory disease through an abortion]. Taking antibiotics after your abortion reduces the risk of infection [but cannot eliminate it totally].
* Your abortion might not get rid of all the contents of your womb [Some of the baby may be still in your womb] This can cause pain, bleeding or an infection. You may need surgery and a further course of antibiotics [You could have a botched abortion and you'll have to come back to do it all over again].

Longer-term problems [There could be longer term problems]

There's no evidence that having an abortion will harm your health or affect your chances of getting pregnant again.[2] Most women who choose to can go on to have a healthy pregnancy [Hang on...most? There is a risk of becoming infertile forever?]

You are no more likely to have problems with future pregnancies than a woman who hasn't had an abortion. Problems with pregnancy include the fetus growing outside your womb (an ectopic pregnancy) or the placenta covering the entrance to your womb (placenta praevia). There's no good evidence that having an abortion increases your risk of either of these problems.[18] [2] [If there is no evidence why have they mentioned two problems with pregnancy described above?]

Some research suggests that women who have an abortion and become pregnant again are more likely to have a miscarriage or a baby that's born too early.[19] [20] [21] [22] However, other studies show no link between abortions and miscarriages or premature births.[23] [So, which study is the right one?]

Having an abortion doesn't increase your risk of breast cancer. Some studies have suggested that there might be a link between abortions and breast cancer. [Hang on, I thought you just said it doesn't?] [23] [24] But there's good-quality research to show this isn't true, and most experts say that having an abortion doesn't increase your risk.[25] [2] [26] [27] [But some studies still suggest this is true, right?] A recent study compared women who'd had an abortion with women who'd had a miscarriage. There was no increase in risk for women who'd had an abortion.[28]

What other options are there?

Another type of surgery, called dilation and evacuation, is available, but it's usually only used for women who are more than 15 weeks pregnant. It uses a combination of electric suction and cutting with forceps. You usually need a general anaesthetic. Only 5 in 100 abortions in England and Wales use this method.[13]

If you decide to go ahead with your pregnancy rather than having an abortion, there are still some choices available to you. You may decide to keep the baby. Or you may choose to have the baby looked after by foster parents or adopted.

For many women this is a very difficult decision. If you aren't sure about what to do, it may help to talk to someone. You may wish to contact the Family Planning Association on 0845 122 8690 or at http://www.fpa.org.uk.

What can I expect after the abortion?

After you leave the hospital or clinic, usually the same day, you will probably want to go home and rest. You can bath or shower normally. You can drive after a medical abortion, but you should get someone to give you a lift if you've had an anaesthetic.

Most women feel fit enough to return to work within a day or so, but you may prefer to wait a little longer.

You'll need to go for a check-up a week after a medical abortion, or two weeks after a surgical abortion.[2]

Bleeding

You will continue to bleed for a while after the abortion. Bleeding often lasts longer after a medical abortion than a surgical abortion.[29] You may see clots in the blood.

Bleeding after a medical abortion usually lasts between 14 days and 17 days, then trails off.[12] But it can go on for several weeks. After surgery you probably won't bleed very much, but some women bleed for up to 14 days [You will experience a 2-week sustained period of bleeding. This could continue for several weeks].

The bleeding is usually no worse than a heavy period. You should see a doctor if the bleeding is worse than this. Your usual painkillers will help with any cramps. You may have spotting right up to your next period. Your next period should happen in about four to six weeks, although it may not start for eight weeks.

Infections [Say what?]

If you get heavy, continuous bleeding, pain that doesn't go away or a temperature, you should see a doctor straight away [You may experience heavy, continuous bleeding after an abortion]. You could have an infection. [You could have an infection because of your abortion]. An infection is usually easy to get rid of with antibiotics, but could affect your ability to get pregnant again if it's not treated [Because of your abortion and the possible infected area as a result, you may never be able to have children again, say, if it is treated too late, but we've said it so casually you'd hardly notice without the bold orange input].

Using sanitary towels instead of tampons until you stop bleeding can help prevent an infection.[30] If you can, wait until your check-up after the abortion before you have sex again. If you have sex before this time, it's best to use condoms.

Signs of pregnancy

If you have signs of pregnancy, such as morning sickness, these will gradually go away as your hormone levels return to normal. Breast tenderness is often the last sign of pregnancy to disappear.

But if you still have signs of pregnancy two weeks or three weeks after the abortion, you need to see your doctor. A pregnancy test can't tell you if you are still pregnant, because the hormone it measures can take up to a month to return to normal after an abortion [We cannot categorically rule out that they may have botched the abortion].

Contraception

You need to use contraception immediately after your abortion if you want to avoid becoming pregnant. This is because you are likely to produce another egg (ovulate) before your next period. So, you could become pregnant again before your next period is due [Theoretically speaking, you could be back at the abortion clinic the following month, if you are 'careless'].

It's safe to have a coil (also called an intrauterine device or IUD) fitted straight away.[31]

How will I feel afterwards?

Your feelings afterwards may depend on your reasons for having an abortion and how comfortable you are with your decision. You may feel sad and tearful after your abortion [You may feel you have lost your baby]. Some women say they feel relieved it's over [What is over?]. Other women feel guilty or have a sense of loss [You may feel you have lost your baby]. You may feel a mixture of different feelings after your abortion [But mostly you will feel that you have lost your baby].

Any anxiety or distress you feel will usually go away after the abortion. But up to 3 in 10 women may still have emotional problems a month later.[32] [Up to a month later 30% of women who have an abortion are still suffering emotional problems]

Some studies suggest that women who've had an abortion may be more likely to get depressed or harm themselves [Having an abortion has been reported by some studies to lead some women to depression and self-harm] [2] [23]. But there's no evidence that these problems are actually caused by the abortion [But it is plausible that they are]. [33] [34] Psychological problems may actually be more likely after childbirth than an abortion.[34]

You may not feel like having sex for a while. This is normal. Up to a third of women feel this way after an abortion. [1 in 3 women don't want to have sex after an abortion, 'for a while'. Read, having an abortion will probably ruin your sex life for a sustained period] [35] And a quarter of women may have problems in their relationships. [Having an abortion could destroy your relationship. 1 in 4 women verify this].

Having someone to talk to can help. If you have problems coping, ask your nurse or doctor about counselling [After an abortion you may have problems coping with what you have done].

In conclusion, there are on average 190,000 abortions a year:

Every year, on average, according to the Guardian guide and my calculations, of these abortions:

• Between 380 and 3800 women in the UK who have a surgical abortion are still pregnant afterwards.
• 380 women haemorrhage after an abortion.
• 160 of these women need blood transfusions.
• Between 190 and 1900 women experience damage to their cervix in abortion.
• Between 190 and 760 women experience tearing of the womb in abortion.
• 3800 required surgery after a botched abortion, whereby the baby or parts of the baby were left in the womb.
• 57,000 women suffer depression for a month or longer after an abortion.
• 47,500 women's relationships suffer as a result of abortion
• 19,000 women contract an infection from an abortion, which if not caught early could result in indefinite infertility.
• 9500 babies are aborted by the method of 'cutting with forceps'.
• 190,000 babies are killed by abortions in the England and Wales alone, every year.

There is so much going on in this 'guide'. I have fisked a lot of it, but there is so much more I could say. The Guardian are so flippant about the risks and show such little respect to the countless women who have had an abortion and then realised that something went seriously, seriously wrong, or that they now have long term health problems, or suffer depression or are suicidal or self-harm, or have seen their relationship destroyed by it, or regret it, or who have damaged their womb or cervix, or who have haemorrhaged, or who bled profusely for several weeks afterwards. By all means fisk through it yourself some. It's an horrendously misleading and dangerous guide. The Guardian should be ashamed because they have dressed up very serious health risks related to abortion and glossed over them at every stage.