Does it hurt and if so, do you need anesthesia?
Since we use very narrow cannulas, there is no need to dilate the cervix, because it's already open enough. Since the insertion of a large cannula or other instruments is the main cause of pain in an abortion, the need for any anesthetic is eliminated.
Most women are able to tolerate insertion of the 4 mm. cannula into the cervix to extract the menstrual period. If a woman has heavy cramping and her uterus is tender, she may find it more painful; on the other hand, she may decide to endure some minor pain to see if extracting the menstrual material, especially clots, gives her relief from the cramping.
A lot depends on the circumstances. If a woman's period is late and she suspects that she is pregnant, then she decides to do menstrual extraction even if there is some discomfort in inserting the cannula. We have done menstrual extractions in situations where abortion was illegal. Once, in those circumstances, the woman's cervix was quite sensitive, but she was willing to endure pain in order to proceed.
What about infection?
We always use a sterile cannula. Before abortion was legalized, we used cannulas more than once and kept them in a solution that reduced bacteria. Now that abortion is legal throughout the country, it is easy to purchase disposable sterile cannulas that are individually packaged .
It is important to be very careful not to touch the vaginal walls to keep the cannula sterile so that we don't introduce bacteria into the uterus. Do remember that the uterus is open to the outside; it is not a sterile cavity. You just don't want to bring in a lot of new germs all at once. Usually, before inserting the cannula, we swab the cervix with some antibacterial solution to wipe off any mucus or other secretions that are there.
How do you know you've gotten everything out?
When you're extracting a menstrual period, you will see that the material coming down the tube is solid red, and it comes very slowly. The material comes down at a slow but even rate for 10 to 20 minutes, even more sometimes. Sometimes the cannula gets stopped up with a clot; the cannula is taken out, rinsed out and then reinserted. Usually, the woman is the one to decide when she's "done". Apparently, all the menstrual blood has been formed by the time it starts to come out, because sometimes the woman doesn't get another drop. On the other hand, and this has been my experience, there's more there and I continued to need a tampon or a napkin for the next day or two, but it's just the remnants apparently.
When you're dealing with a pregnancy, the experience is quite different. The material coming down the tube will not be solid red; it will be an inch or so of clear fluid, then some whitish clumps for an inch or so and then maybe some red material. Also, it comes out much faster than menstrual blood and is not sticky like menstrual blood. When you start the procedure, you can move the cannula back and forth within the uterus easily and the uterine wall may feel slick. Then, as the uterus is emptied, it starts contracting and it gets difficult to push the cannula back and forth. The uterus starts clamping down on the cannula. It begins to get rough, you may feel the inside walls of the uterus. Then, the cervical canal closes around the cannula and it becomes difficult to pull back on the cannula. This usually means that the uterus is empty.
What do you do if there is an infection?
When you're in a menstrual extraction group with friends and neighbors, it's natural to follow up on the procedure. You call up your friend and ask, "How are you doing?" If she says, "Well, I'm not feeling too well. I think I might have a fever," you say, "Come right over!" You get a few of the group together the same day and you do another suction and take out any matter that been left in there which may have developed into an infection. That's what they do at the abortion clinic. Reaspiration is the recommended treatment when a woman has tenderness or fever which could indicate an incomplete abortion.
In a menstrual extraction group which is not made up of a friendship group or fellow sorority sisters, you set up a more formal follow-up plan. Everyone has each other's contact information and you make sure that you keep in close touch for the next week or two.
One reason that it was so important to "get everything out" in the old days of illegal abortion is that the woman might have travelled very far, perhaps to another city, another state, or even another country, or she might be unable to get out at her house without arousing suspicion, so you wanted to make very, very sure that you extracted every little bit, even using a metal curette to do a final scraping of the uterine walls. Today, in the legal abortion setting, less traumatic methods are used and the small number of incomplete abortions are easily and quickly dealt with in the follow-up visit.
Dr. David Grimes, of Center for Disease Control, figured out that it is not good to routinely give anti-biotics because it camouflaged an infection. It's not an infection like an infection of your bodily tissues. It's an infection of material inside your uterus, so suctioning it out is the best way to reduce the infection.
I understand that nowadays some clinics do give out antibiotics, perhaps because some of their clients would have a hard time coming back to the clinic.
How do you know how far into the uterus that the cannula should go?
In menstrual extraction, no anesthesia, local or general, is used, so the woman stays awake, no general anesthesia, so as the cannula goes in, she feels it. She's not just an inert body that's having something done to her. She can feel the cannula as it touches the inner walls of her uterus. When she feels it touching the back wall, she will usually say, "It's in." Also, most cannulas have a mark at the 3 or 4 inch level to show the person inserting the cannula how far in the cannula is.
How far along can you do menstrual extraction?
We recommend that the cut-off point for doing menstrual extraction be 6 weeks after the last menstrual period, We are taking into consideration the possibility that the estimate might be a couple of weeks off or that the woman may have had a false period. We know of menstrual extractions that have been successfully performed 8 or 9 weeks after the last menstrual period.
Why is it so important to know how far along the pregnancy is when determining whether to do the menstrual extraction?
Besides knowing that the woman getting the procedure is in ordinary good health, we have to make sure that the woman is not further in pregnancy than our experience and equipment are adequate for.
This is an incredibly safe procedure, when it's done by women who have worked together, and who have done uterine size checks on one another on a regular basis who are reasonably sure that someone is not too much further along than her uterus feels like.
It has happened, not in our group, but in groups that didn't follow our protocol, that they have found they were dealing with a pregnancy that was further than they realized. In the instances where we were aware that this had happened, usually the group the woman needed to go to a hospital to get the procedure finished using instruments and skills that they didn't have. Medically, it turned out fine, but on a couple of occasions, the person who did the menstrual extraction was investigated for practicing medicine without a license and one was charged. No one that we're aware of has been actually prosecuted.
Why is it so important that menstrual extraction be performed by a group, and why is it only be performed on a member of the group?
The primary reason that we do menstrual extractions on ourselves is for training or demonstration purposes. Over the years, most menstrual extraction groups have been composed of women who either used effective birth control or who did not have regular penis-vagina sex or who were lesbians or celibate. However, no birth control method is 100% effective.
This is not to say that menstrual extraction groups only (underline "only") perform menstrual extraction on members of their own group. A group often does this for women outside their group because they have done enough uterine size checks to know the size, shape and texture of a woman's uterus and to come within a week or two of how far along the pregnancy is, and they've learned the procedure well enough that they want the experience of performing menstrual extraction on someone that may be pregnant. Then they will do it on a friend, or a friend of a friend who they can keep in touch with.
Especially, in the early days of menstrual extraction, before Roe v. Wade(underline "Roe v. Wade"), our group learned how to do uterine size checks by doing them on women who we referred to the hospital for a legal abortion. We accompanied the women through the procedure at the hospital and we saw the products of conception. This gave us immediate feedback. We realized that women could learn to estimate the length of pregnancy accurately with minimal training.
How does a menstrual extraction group get started?
We suggest the following guidelines.
First, we do not suggest that a menstrual extraction group be formed by advertising or by placing a notice on Facebook. Although menstrual extraction has never been ruled illegal and there's no law against it, as far as we know, it is controversial and the new group might be infiltrated by law enforcement officer or anti-abortion zealots. Groups have arisen out of women's health courses, college women's groups, N.O.W. chapters, and midwife and doula groups. It is very helpful to the group to have someone to come speak in the community about abortion and menstrual extraction. The speaker, if she is experienced in menstrual extraction, can be an invaluable resource to the group.
Successful ME group should start with at least 4 or 5 people (an ideal of 10). In order to learn how to do uterine size checks, the group has to meet over a period of at least 2 months. It is not vital to have every single person at every single meeting, but it would be great and expected for women to recruit more women, friends or family, etc. to be a part of a meeting. These participants do not have to be committed to the ME project but should be willing to contribute their uterus for viewing through self-exam. It takes two months to examine a few women throughout a complete menstrual cycle.
In the first meeting we will need to exam each other's cervixes, in addition to learning about each other's cycles and menstrual and birth history. Women in the group do not have to become close friends, although many do. They need to develop trust of one another and learn enough about each other's personal circumstances to work together collectively.
CAUTION: The group needs to know if any of the women attending might be pregnant. Examining each other's cervixes and sharing our health history will assure them that they will not be inadvertently dealing with an advanced pregnancy. Of course, if someone is pregnant, they need to decide if they wish to keep the pregnancy. If so, they are not candidates for menstrual extraction, however the group may benefit from doing uterine size checks as the pregnancy advances.
The group may want to discuss why they want to learn menstrual extraction and why learning about our menstrual cycles and how to control them is important. We have various reading materials that we can suggest. See Resources (hyperlink).
Some menstrual extraction groups have been meeting for years; they don't need to meet that often; maybe they only get together when someone has a concern or when a friend or a friend of a friend needs a menstrual extraction.
Does it change your menstrual periods?
As far as we know, and we've been doing this a long time, our periods stay the same. I did menstrual extraction just about every month for several years. When I wasn't doing it every month, my same old period came back. I didn't keep very good track of my periods, so I was surprised to find that I had spotted my dress, then I took notice and found that my periods came every three weeks or so, and then started and stopped over a week's time. To me it seems like I was always on my period. That pattern did not change. Other women in our group and in other groups told us the same, and we never heard of anyone who experienced any change. No one has ever really studied this, of course.
What about perforation?
There's two things I want to say in answer to this question.
One) It would be very difficult to perforate with a flexible, 4mm cannula. If you held this cannula in one hand and attempted to punch it through your other palm, you would see that it bends back. Our uterine walls are made of thick muscles which would also bend back a narrow, flexible plastic cannula. We have no information or reason to think that a woman's uterus has been perforated while doing menstrual extraction. We are very slow and careful, and the woman is awake and would alert us if she felt any pricking or cutting.
Second) Sometimes perforation of the uterus can be a very serious complication of abortion. Nearly always a metal instrument has been used to "sound" the uterus, meaning to measure the depth of the uterus, or the uterine wall is thinner because the pregnancy is more advanced and the abortionist has vigorously inserted a thick and stiff cannula into the uterus.
But, even when perforation does occur, it probably will not be a problem unless the instrument has seriously perforated a blood vessel or intestine. Usually, as the uterus is emptied, it contracts and perforations are closed.
Dr. Michael Burnhill, a well-respected and experienced abortionist found out coincidentally many years ago about the frequency of perforations in abortions when he was performing tubal ligations. Ast is customar, he routinely suctioned out the contents of a woman's uterus prior to tying her egg tubes to make sure that she wasn't pregnant. Then, once in awhile, when he visualized the uterine wall using the laparascope, he saw signs of a closed-up perforation. He realized that simple perforations occurred more often than previously thought and he concluded that a simple perforation was not problematic. Dr. Burnhill published his findings.
Is menstrual extraction available as a service?
No. Menstrual extraction groups are closed groups. In order to offer the extraction of the menses as a service or to do an early abortion using the Del-Em in the privacy and comfort of the home, the service would have to be offered by well-trained personnel using tests or equipment to determine if the woman coming in for the service was pregnant, and anesthesia and equipment would have to be available in order to complete all procedures if the woman had a pregnancy which was over 6 or 8 weeks past the last period. Menstrual extraction would no longer be a woman-controlled procedure.
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