As one of the requirements of this clerkship, I spent the morning in our hospital's abortion clinic, amusingly dubbed the "Reproduction Clinic", which is ironic considering it's more along the lines of an "anti-reproduction" clinic. We were given a quick tour of the "facilities" (a big clinic room with 3 chair/beds, separated by curtains) by one of the family planning fellows and then participated in several cases.
The process begins with a patient coming in desiring to terminate their pregancy; most of the pregnancies are in their first trimester. The patient is then counseled to ensure that she is certain of her decision, and once she is, she sets up an appointment in the near future.
One of the most interesting things was learning that patients don't need to provide a reason why they want to end their pregnancy. Initially this seemed odd, but after considering that certain reasons offered by patients might lead to ethically difficult situations, I realized this was the best approach.
On the morning of the big day, the patient arrives, is put on the table, examined, and given a mild sedative (usually a benzodiazepine). An ultrasound is then performed to establish the status of the pregnancy. One of our patients was unknowingly carrying twins, one of whom was already demised.
The termination itself is performed with a procedure known as a D&C, aka "dilation and curettage". Dilation refers to the enlarging of the cervix (the opening into the uterus); curettage is the scraping of the insides of the uterus with either a large syringe or vaccuum pump.
What occurred next was both the most fascinating and eerie part of the procedure. The products of conception (POC), meaning the pregnancy itself, was run through a strainer and then dumped onto a lighted surface. Then, like anthropologists trying to reconstruct an old fossil, all the tissue were examined in search of identifiable parts. In what initially looked like a soggy, watery mess of shredded red tissue paper, with some probing, little fetal parts were soon surfacing and being identified.
Watching this part of the procedure, while interesting because I felt like a crime scene investigator, was also slightly disturbing because the parts being separating out in front of us were the same ones that, just minutes earlier, were seen moving around inside the patient's uterus. It's saddening if you think about it too much. This wasn't a high school biology dissection, it was a tiny human being.
This might seem as if I'm siding with the pro-lifers, but I am most definitely not. I'm merely conceding that the procedure is one that undoubtedly carries much impact on the patient, and having participated in this clinic's activities made it even clearer why this is such a controversial topic across the country. With that said, I still hold that it's better to terminate a pregnancy than to carry it to term and provide the child with a sub-standard quality of life.