“Congratulations, you’ve just affirmed her right to choose”

Strong words from an Irish senator. He describes what abortion is in some detail. Warning: It’s gory. This is what abortion at 20 weeks is. (You decide whether you support it.)

Your patient will have been feeling her baby kick for the last two months of more. But now she’s asleep on an operating room table, and you are there to help her with her problem pregnancy. The first task is to remove the laminaria that had earlier been placed in the cervix to dilate sufficiently to allow the procedure you are about to perform.

The first instrument you reach for is a French suction catheter. Picture yourself introducing this catheter through the cervix and instructing the circulating nurse to turn on the suction machine. What you will see is a pale yellow fluid that looks like urine coming through the catheter into a glass bottle on the suction machine. This is amniotic fluid that surrounded the baby to protect her.

With suction complete, look for your sopher clamp. This instrument is for grasping and crushing tissue. When it gets hold of something, it does not let go. A second-trimester D&E abortion is a blind procedure. The baby cannot be seen in any orientation inside the uterus. Picture yourself reaching in with the sopher clamp and grasping anything you can.

Once you’ve grasped something inside, squeeze on the clamp to set the jaws and pull hard. Really hard. You feel something let go, and out pops a fully formed leg about six inches long. Reach in again, set the jaw and pull really hard once again, and out pops an arm about the same length. Reach in again, and again with that clamp and tear out the spine, intestines, heart, and lungs.

The toughest part of a D&E operation is extracting the baby’s head. You can be pretty sure that you’ve got hold of it if the sopher clamp is spread about as far as your fingers will allow. You will know you have it right when you crush down on the clamp and see white gelatinous material coming through the cervix. That was the baby’s brains. You can then extract the skull’s pieces. Many times a little face will come out and stare back at you.

Congratulations, you’ve just affirmed her right to choose.

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