Abortion Techniques: First Trimester
Suction aspiration, or "vacuum curettage," is the abortion technique used in most first trimester abortions. A powerful suction tube with a sharp cutting edge is inserted into the womb through the dilated cervix. The suction
dismembers the body of the developing baby and tears the placenta from the wall of the uterus, sucking blood, amniotic fluid, placental tissue, and fetal parts into a collection bottle.
Great care must be taken to prevent the uterus from being punctured during this procedure, which may cause hemorrhage and necessitate further surgery. Also, infection can easily develop if any fetal or placental tissue is left behind
in the uterus. This is the most frequent post-abortion complication. 
Dilatation (Dilation) and Curettage (D&C)
In this technique, the cervix is dilated or stretched to permit the insertion of a loop shaped steel knife. The body of the baby is cut into pieces and removed and the placenta is scraped off the uterine wall.  Blood loss from D & C,
or "mechanical" curettage is greater than for suction aspiration, as is the likelihood of uterine perforation and infection. 
This method should not be confused with routine D&Cís done for reasons other than undesired pregnancy (to treat abnormal uterine bleeding, dysmenorrhea, etc.). 
While many people focus solely on RU 486, the so-called " French abortion pill," the RU 486 technique actually uses two powerful synthetic hormones with the generic names of mifepristone and misoprostol  to chemically induce
abortions in women five-to-nine weeks pregnant.
The RU 486 procedure requires at least three trips to the abortion facility. In the first visit, the woman is given a physical exam, and if she has no obvious contra-indications ("red flags" such as smoking, asthma, high blood
pressure, obesity, etc., that could make the drug deadly to her ), she swallows the RU 486 pills. RU 486 blocks the action of progesterone, the natural hormone vital to maintaining the rich nutrient lining of the uterus. The developing
baby starves as the nutrient lining disintegrates.
At a second visit 36 to 48 hours later, the woman is given a dose of artificial prostaglandins, usually misoprostol, which initiates uterine contractions and usually causes the embryonic baby to be expelled from the uterus.  Most
women abort during the 4-hour waiting period at the clinic, but about 30% abort later at home, work, etc.,  as many as 5 days later. A third visit about 2 weeks later determines whether the abortion has occurred or a surgical
abortion is necessary to complete the procedure (5 to 10% of all cases).
There are several serious well documented side effects associated with RU 486/prostaglandin abortions, including prolonged (up to 44 days)  and severe bleeding, nausea, vomiting,  pain,  and even death. At least one woman
in France died while others there suffered life-threatening heart attacks from the technique.  In U.S. trials conducted in 1995, one woman is known to have nearly died after losing half her blood and requiring emergency surgery. 
Long term effects of the drug have not yet been sufficiently studied, but there are reasons to believe that RU 486 could affect not only a womanís current pregnancy, but her future pregnancies as well, potentially inducing miscarriages
or causing severe malformations in later children. 
The procedure with methotrexate is similar to the one using RU 486, though administered by an intramuscular injection instead of a pill. 
Originally designed to attack fast growing cells such as cancers by neutralizing the B vitamin folic acid necessary for cell division, methotrexate apparently attacks the fast growing cells of the trophoblast as well, the tissue
surronding the embryo that eventually gives rise to the placenta. The trophoblast not only functions as the "life support system" for the developing child,  drawing oxygen and nutrients from the motherís blood supply and disposing of
carbon dioxide and waste products,  but also produces the hCG (human chorionic gonadotropin) hormone which signals the corpus luteum to continue the production of progesterone necessary to prevent breakdown of the uterine lining and
loss of the pregnancy.  Methotrexate initiaties the disintengration of that sustaining, protective, and nourishing environment. Deprived of the food, oxygen, and fluids he or she needs to survive, the baby dies.
Three to seven days later (depending on the protocol used), a suppository of misoprostol (the same prostaglandin used with RU 486) is inserted into a womanís vagina to trigger expulsion of the tiny body of the child from the womanís
uterus. Sometimes this occurs within the next few hours, but often a second dose of the prostaglandin is required, making the time lapse between the initial administration of methotrexate and the actual completion of the abortion as long as
several weeks.  A woman may bleed for weeks (42 days in one study ), even heavily,  and may abort anywhere -- at home, on the bus, at work, etc.  Those found to be still pregnant in later visits (at least 1 in 25) are given
surgical abortions. 
Even doctors who support abortion are reluctant to prescribe methotrexate for abortion because of its high toxicity and unpredictable side effects.  Those side effects commonly include nausea, pain, diarrhea,  as well as less
visible but more serious effects such as bone marrow depression, severe anemia, liver damage and methotrexate-induced lung disease. 
The manufacturer warns in the package insert that while methotrexate has shown itself useful in treating certain types of cancer and severe cases of arthritis and psoriasis, "deaths have been reported with the use of methotrexate," and
recommends that its use be limited to "physicians whose knowledge and experience includes the use of antimetabolite therapy."  Though researchers performing methotrexate abortions have dismissed such concerns because of the low dosage
used,  other doctors in the abortion trade have disagreed,  and the package insert clearly warns that "toxic effects may be related in frequency and severity to dose or frequency of administration but have been seen at all doses"
(emphasis added).