Tue | Aug 22, 2017

Michael Abrahams | Thinking of having an abortion? Please read this

Published:Monday | May 29, 2017 | 5:05 AM
Abrahams

Although abortion is, for the most part, illegal in Jamaica, you are surrounded by women who have had pregnancies terminated. Lawyers, doctors, domestic helpers, nurses, policewomen, teachers, hairdressers. They work in your office, walk past you in supermarket aisles and sit beside you at church.

But many women who have abortions place themselves at risk without even knowing it. This is because shortcuts are often taken, which can cause significant morbidity or even death. I am not encouraging any woman to have an abortion, but the truth is that whether the procedure is legal or not, if a woman is determined not to carry a pregnancy, she will find ways of having it terminated. I am not in the habit of giving advice to people regarding breaking the law, but in this instance, I have placed concern for human safety above political correctness. So, if you have decided that you must terminate a pregnancy, please read this carefully.

Firstly, you need to see a physician. A proper history and thorough examination are to be carried out. The stage of the pregnancy must be determined, as well as the presence of medical conditions that could complicate the procedure. An ultrasound should be performed for many reasons: to confirm the pregnancy, to see how old it is, to see if it is viable, and to locate it. The confirmation is important because you may not be pregnant and may undergo an unnecessary procedure. The age is important because different procedures are done at different stages.

I recall a case that I encountered when I was a resident. A woman visited a health facility to get an abortion done. The age of the pregnancy was underestimated and serious complications arose from the procedure. The patient was advised to stay in a hospital overnight, but she refused because she did not want her family to know what she was doing. So, she went home, where her condition deteriorated, and she died. The determination of viability is also important. Significant regret can follow an abortion, and if an ultrasound shows that the pregnancy is non-viable, there may be much less guilt associated with the procedure, or it may even be unnecessary.

The location of the pregnancy, however, is probably the most important reason. Not all pregnancies are located in the uterus. Some end up in other locations, such as in one of the Fallopian tubes. If this occurs, the pregnancy is destined to fail because the Fallopian tubes are unable to carry a pregnancy to term. Sometimes the pregnancy is expelled into the pelvis with little consequence. However, in many cases, the tube will rupture, resulting in internal haemorrhage, which can be severe, or even fatal. If an ultrasound is not done, and it is assumed that the pregnancy is in the uterus, a woman can present herself for an abortion, have instruments inserted into her uterus to remove the pregnancy and go home with the gestation still in her tubes. This can result in catastrophic consequences. During the first week at my practice, I encountered two women who experienced the unpleasant sequelae of this type of mismanagement. They both had abortions performed by physicians, but ultrasound examinations were not performed. They presented to me with severe abdominal pain, abdominal distension and dizziness. Ultrasound examinations found their abdomens to be filled with blood from internal haemorrhage resulting from ruptured ectopic pregnancies. They were both rushed to hospital for emergency surgery. Luckily, they both survived.

What is even more disturbing, is the misuse and abuse of pills used to effect abortion. If the decision is made to perform an abortion medically (using drugs only), certain steps should be taken. Unfortunately, it appears that these steps are often ignored, and the results can be nerve-racking and life-threatening. One of the commonest complications with medical abortion is that the pregnant woman will bleed, assume that she has lost the pregnancy, and still be carrying a live child, or decaying tissue in her uterus that can become infected.

Last year I saw two women who were given pills to terminate their pregnancies. They bled and thought that they aborted. But when their periods did not return and their abdomens began to get distended, they consulted me, only to discover that they had live foetuses moving around in their uteri and were about four to five months’ pregnant. For the remainder of their pregnancies, they were burdened with anxiety, not knowing if the drug had affected their babies. Fortunately, their children were okay. Recently, I saw a young woman who was given the pills by a pharmacist. When I saw her, she had been bleeding for a month and her uterus contained decaying tissue. What is alarming is that these pills, although strictly regulated by the Pharmacy Council of Jamaica, are sold on the streets by non-medical personnel.

Even when performed carefully, abortions can result in complications such as infection, haemorrhage, anaesthetic complications, perforation of the uterus, bladder or bowel, infertility, miscarriages, preterm labour, menstrual irregularities, depression and even death. It is far better to avoid unwanted pregnancies. So, if you are sexually active, but do not wish to conceive, please consider using reliable a reliable contraceptive method if you are not already doing so.

- Michael Abrahams is an obstetrician and gynaecologist, comedian and poet. Email feedback to columns@gleanerjm.com and michabe_1999@hotmail.com, or tweet @mikeyabrahams.