Abortion methods: European issues
C. Fiala
Department of Obstetrics & Gynecology, Hospital Korneuburg, Vienna,
Austria
Currently 3 methods are available for first trimester termination of
pregnancy: surgical under general anaesthesia, surgical under local anaesthesia
and medical. Interestingly, the frequency of these 3 methods varies tremendously
by country and also by region within a given country.
The medical method for example is used in 0.8% of all first trimester
abortions in the Netherlands, whereas the figure is around 50% in Scotland and
Sweden. The other countries are in between these two extremes. And the very slow
integration of medical abortion in most countries may reflect the reluctance of
adopting new developments in female reproductive health. This reluctance is in
sharp contrast to other examples in medicine, i.e. Viagra® was rapidly
integrated in the medical system. Another example is general anaesthesia, which
in most countries is the predominant method of analgesia for surgical abortion.
Not so in the Netherlands, where 60% of surgical abortions are performed under
local anaesthesia.
It is unlikely that these huge regional variations in the frequency of
different methods are the result of patient preference. Furthermore, most women
are given only a limited choice concerning the method. It is therefore safe to
assume these differences reflect regional traditions, provider preference and
administrative or legal incentives. They may also be seen as the remains of the
prevailing double standard concerning women with an unwanted pregnancy.
The predominant use of general anaesthesia for surgical abortion has
important implications in another aspect: it reinforces the woman’s
pre-existing fantasies and imaginations about an abortion. At the same time, it
prevents her from correcting these mostly wrong and overdramatic fantasies. The
majority of women have never experienced an abortion before. Their fantasies
about this procedure are therefore entirely based on second-hand information.
But most of the information available to the public is coming from religious
sources. These institutions have no professional experience in performing
abortions and dramatise this intervention by giving wrong information in an
emotional language.
It is no surprise that women coming for an abortion frequently report this
same misinformation. If the health professionals performing the intervention are
offering general anaesthesia in this situation, they do in fact confirm these
erroneous fantasies. Although they claim general anaesthesia would be in the
best interest of the women, this might not necessarily be the case. Instead, the
different methods should be explained in the pre-abortion counselling. Women
should be offered the option to correct their fantasies after professional
counselling and with empathic care during the intervention. Studies evaluating
the psychological status of women after an abortion showed most women were
satisfied with the method they had used provided they had a truly free choice.
