I have a question about abortion

[Redstones]

I can't be the only one confused on this. I'm not pregnant first of all, I was only interested on how an abortion occurred.
Where I'm confused is the doctor puts the tube through the cervix into the uterus but isn't the uterus at a 90° angle? How does the tube go up into the uterus? How does the doctor know when everything has been removed?
My other question is why does the cervix need to be widened? Doesn't it already open on its own? It mentions dilators but why would these need to be used? And how many dilators?
I hope it's okay to ask all this. I was looking around for answers but I wasn't getting anywhere.

[Heather]

Hey there, Redstones. I'm happy to answer your questions for you. It's absolutely always okay to ask questions about abortion here, and there really aren't wrong questions.

So, you're asking about surgical abortion, just so we're clear.

The tubing used in surgical abortion is clear, flexible tubing. The cervix has two openings: the small one facing the vaginal opening, the os, and then a wider opening that opens into the uterus. When the flexible tubing is inserted into the cervix, there's nowhere else for it to go but a few inches through to the opening of the uterus. Make sense?

When performing surgical abortion, the abortion provider will usually be looking at the contents of the uterus during the procedure using an ultrasound. That's how they can assure that the contents of the uterus have been fully evaculated.

The os, the cervical opening, does not open on its own unless we are talking about a pregnancy which has been brought to full term and then delivered. In that case, the cervix (usually) dilates/opens on its own. In abortion procedures, the cervix needs to be softened or widened. In terms of how many dilators (laminaria or mechanical dilators) are used, that generally depends mostly on how far along someone is in their pregnancy. The further along someone is, the more dilators are used (and in most cases, when over about 13 weeks, then they will generally need to be put in one day, kept in to expand overnight, and then the procedure will be the next day).

Does that answer those questions for you?

[Redstones]

When you look at a photo of the reproductive system the vaginal canal is going up towards the uterus but the uterus is at a different angle. I can't picture how the tube goes in there. I realize that it does go in there somehow.

I pictured an abortion like a doctor would put something through the cervix and then everything would fall out, I didn't think all this other stuff would be needed and I never thought an ultrasound would be used. This is all more complicated than I imagined.

How does the coat hanger thing work? They say that's how abortions were done back in the day, doesn't that mean the coat hanger went through the cervix to let everything fall out?

They keep the dilators in overnight at 13 weeks but doesnt that risk the chance of the contents falling out overnight?

I looked up the Planned Parenthood near me, they do abortions up to 19 weeks 6 days. The question that I have to that is how big does the cervix have to be to get that out?

I was curious about all of this because I think my mom recently had an abortion. I overheard my parents mention abortion a few weeks ago, and my mom wasn't really herself these last few days. I don't know if she did it or not but my brain wanted me to understand how abortion worked.

Thanks for the answers, knowing how all this works makes me feel a bit better.

[Heather]

Before I say anything else, I do want to say that you can ask your mother about abortion, and potentially her abortion, if you like. Maybe not right now, because like you say, if it seems she's not been herself she might be tired, and neither you or I currently know how she might have felt about that choice, if it was a choice at all (sometimes abortion is necessary when there are fetal abnormalities or a pregnant person's health is at risk).

But I think it might help for you to know that while you seem very focused on what happens physically, in terms of supporting your Mom, the emotional aspects might be a better focus for you. Perhaps until or unless it does feel right to ask her about this, you can just assume she might be dealing with a range of feelings and see what you can do to just be sweet and kind, like asking if she wants company to watch a movie together, offering to make her a drink or meal she likes, maybe helping her around the house?

* * *

I think it's important to be sure to always recognize that illustrated diagrams of internal systems are only so accurate: I think you are perhaps thinking about them too literally. They look the way they do to do the best they can to accurately convey how this all works in a visual representation people will understand.

The cervix juts into the back of the vaginal canal, and the tube for a surgical abortion goes into the cervical opening, and then just a couple inches past, is inside the uterus. I think one issue you might be having is thinking all of this is a much larger scale than it is. But, in reality, the cervix and uterus could fit in the palm of your hand.

The contents of the uterus can't and don't "fall out." Even with a full-term delivery that isn't what happens: for an infant to be born, there have to be uterine contractions. Gravity alone, in any siutation, isn't at play here, because at every stage of a pregnancy, there is an attachment to the walls of the uterus. During surgical abortion, aspiration -- a suction device, usually attached to the tubing we talked about -- is the way the products of conception (that's what everything inside the uterus during a pregnancy is called) are removed.

Also, when dilators are in, they have effectively filled the opening of the cervix, so there's no way for anything else to get in or out. And I think you also are perhaps misunderstanding that there's no need for the cervical opening to be dilated all that much, because the contents being removed at most stages of pregnancy are more liquid than solid. In later term procedures when that's not so much the case, the opening needs to be dilated more, but nothing near the kind of dilation needed for a full-term vaginal birth: that's about 10 centimeters, if it helps to have that comparison.

I do need you to recognize that talking about some kinds of violent back-alley abortion procedures, or ways that scared, desperate and uneducated people tried to self-terminate, as if they were both normal (and no, that was not the norm, thank goodness) and something without the great suffering and harm of people attached isn't really okay. I'm not comfortable talking about this in the way you're presenting it much in the same way that I wouldn't be comfortable talking about ways people sexually assault other people, or try to kill themselves, in this kind of detached way. What some people did back in the day to pregnant people who didn't know other means or didn't care to learn, or what some folks did to themselves in desperation -- for example, in that era, there were still plenty of doctors doing abortion like it is done today under the radar, as well as midwives, collective care circles and individuals using methods like manual suction aspiration -- was a tragic horror. Most people who had the sad misfortune of attempts to terminate with coat hangers or other unsafe or dangerous objects didn't survive it, or did, but often were left with lifelong illness or injury. It's not really a situation any of us can talk about and separate the massive cost of life and well-being, if you follow me.

[Redstones]

You are a lifesaver when it comes to answers. So much easier than looking online.

I get what you're saying on your last paragraph, I'm sorry for asking. The back alley idea was what made me think that an abortion wasn't all that complicated, but I understand now.

I'll start taking care of my mom as well. It's been really rough with her the last few days, I wasn't thinking of the emotional part. She's different. Over hearing that conversation from a few weeks ago came back to my mind and I thought maybe she did it. My parents have me and my two younger sisters who are 11 and 9, I get how their hands are full. I don't think my mom would have done it though, I think I'm overreacting.

[Heather]

I appreciate you taking in what I said, it's all good. <3 The internet -- including our site! -- can be great, but with this kind of information, it can be tricky to understand it in broad strokes or generally. I've written most of our abortion info though, and I have also worked in clinics, so please feel free to ask or reference the info we have on site here.

Over 50% of people who can get pregnant have abortions in their lifetime, and more than not already have kids, so it is possible and also very normal. It's also okay for you to be curious.

Do you feel like you can even just ask her, "Hey Mom, are you okay? I overheard this conversation and you seem different, like you're going through something. I love you and want to support you in anything you're going through where you want my support. I also want to respect your privacy." Something like that? I can't think of the mothers I know who wouldn't feel very loved to hear something like that, whatever they're going through.

[Redstones]

Heather, I took your advice and my mom and I had a good night together watching a movie and having popcorn plus ice cream. It was a good night.
And I read the article that you wrote about abortion on here. It says that one in three will have an abortion, and six out of 10 are mothers. I never knew the number was that high, and I never thought mothers would have an abortion. I thought it was only teenagers and single women who had to do it.
I think my mom did have an abortion, I didn't ask her about it, I wanted to but I didn't. I overheard them talk about it, I know that. I want to know why she did it, I want to ask that.
I wish she asked my opinion, and that's a dumb wish. I can't tell her what to do I know that.

[Heather]

That's so lovely that you had that night and gave your mother that love and affection. I bet that meant a lot to her.

I think it might be helpful to realize that when someone is making a decision about their own pregnancy, it's actually usually not a situation where it is often helpful to be asking other people for their feelings and opinions. Those people, after all, aren't people who are going to physically carry a pregnancy or who will be responsible for any children that results from one in the way the person who gives birth is. Too, it is a very personal decision often based on a lot of factors and specifics only we, the person making the pregnancy decision, either know or fully understand. Last of all, having someone else tell us they don't approve of our choice or wish we'd make a different one is not only not helpful, it can get in the way of our own clarity about our choices that's so necessary for us to truly make the best decision for ourselves.

If and when you ever find yourself pregnant or considering pregnancy, that's the place for your own opinions.

That said, you still get to have your own feelings about people's pregnancy choices that have something to do with your own life, and it's not dumb to have them: it's human.

It might also help to maybe stop thinking about abortion as something people only choose when they "have" to. Abortion, like choosing to remain pregnant, is often a choice people make because they want to make that choice, because it is the choice that is best for them and their lives (and in some cases, for any other children they may have), because it is the choice they very much want to make. Sure, sometimes it can be a have-to, like when there is a health issue or when someone would want to bring a pregnancy to term, but the financial or other resources to support them in that pregnancy and to support that child simply are not available. But the idea that everyone who chooses abortion does sadly or reluctantly isn't reflective of the reality of abortion.

It sounds like she isn't wanting to talk to you about this now, so I'd suggest not asking things like why she made the choice she did. However, it may be something you are able to ask or talk about later on in your life with her: it's not uncommon for adult mothers and daughters to have conversations about their abortion histories. <3