How Menstrual Extraction became the Aspiration Abortion Procedure

Wednesday, October 14th, 2009 by Dr Joan F.

imagesI am a pioneer, educator, and advocate of the Aspiration Abortion Procedure (Manual Vacuum Aspiration) for ending early pregnancy and for treating miscarriage. I have been providing the Aspiration Procedure for over a decade to thousands of appreciative patients. I continue to be astounded at how few people know about this simple procedure that can be completed in a regular doctor’s office in a few minutes. The procedure has an interesting history, and I thought it would be valuable to summarize this for those who have learned about this amazing device.

The Aspiration Procedure (Manual Vacuum Aspiration) is the most safe, simple, and natural procedure to end early pregnancy. The clinician inserts a thin cannula (straw) through the natural opening of the cervix. She then attaches a small handheld device that applies gentle pressure. This pressure or suction then releases the menstrual lining and early pregnancy tissue into the device. Within minutes, the pregnancy is over, and the patient can return to her normal activities. The Aspiration procedure is best used under 10 weeks of pregnancy, but can be used later depending on the clinician’s judgment.

The Aspiration Procedure is considered a non surgical abortion procedure, because there is no scraping, so there is no entry into the uterine wall. The device simply causes a natural release of the thickened menstrual lining, which would have shed with the menstrual period. Compared to surgical abortion, there are no major complications, because there is no scraping and no strong electric suction.  There is minimal discomfort so that the procedure can be completed with a safe local anesthetic.

Manual Vacuum Aspiration is a modernized form of an interesting procedure called Menstrual Extraction. It has its history in the feminist “take back your health” movement. It is worth learning about the history of this remarkable procedure:
American feminists Carol Downer and Lorraine Rothman developed menstrual extraction in 1971 as a method American feminist activist Carol Downer and Lorraine Rothman developed menstrual extraction in 1971 as a method of removing a woman’s menses to avoid an inconvenient period or, more importantly, to end a pregnancy at an early stage. They introduced their work to fellow activists in Los Angeles in the same year the Roe v. Wade case was in court, before the legality of abortion had been established. The two activists wanted to create a safe, simple, affordable means of ending a pregnancy at a time when U.S. law and culture severely limited women’s legal and medical options concerning reproductive health.

Rothman fabricated a device called the Del-Em, constructed of easily obtainable laboratory supplies: a jar, rubber stopper, plastic tubing, a cannula, a one-way valve, and a syringe. Downer and Rothman organized self-help clinics for women and demonstrated the uses of the Del-Em. These self-help groups were formed not simply as an introduction to menstrual extraction, but as a broader forum within which women could educate themselves and each other about their bodies and reproductive health in an informal, nonmedical setting. Self-examination with a speculum was one technique employed at the meetings to demystify the female reproductive anatomy. It was within this context of underground, politically oriented sexual health education that Rothman and Downer developed and disseminated the technique of menstrual extraction.

To demonstrate menstrual extraction at self-help meetings, a woman about to begin her period (or who suspected she was pregnant) would volunteer to undergo the procedure, while the other women would watch. The procedure involves the insertion of a flexible 4mm cannula into the os, or cervical opening. The cannula is attached to a long piece of plastic tubing connected to one of two small openings in a rubber stopper covering a jar. A second piece of plastic tubing is connected to the other hole in the stopper; a one-way valve is attached to this piece to control the flow of the contents and attached to a syringe. Once the kit has been assembled and the cannula inserted into the cervix, the woman undergoing the extraction pumps the syringe to gently suction the contents of her uterus, which are caught in the jar. Because she is holding the syringe, she can control the speed and pressure of the extraction, moving at a pace she finds comfortable. The extraction process could be finished in about five minutes.
Copied from: everything2.com/title/menstraul%2520extraction.

In the early 90’s, Manual Vacuum Aspiration entered the mainstream medical world in the United States. Jerry Edwards published a seminal paper describing a device manufactured by IPAS  (ipas.org) which had significant advantages over surgical abortion for early termination of pregnancy (Edwards, Jerry and Mitchell D. Creinin. 1997. Surgical abortion for gestations of less than 6 weeks. Current Problems in Obstetrics and Gynecology and Fertility, January/February: 11-19.) Edwards presented his findings at a National Abortion Federation conference.

I was at this conference, and remember my astonishment when I learned about this simple procedure. I had finished my residency training and was training in surgical abortions (D&C’s) at a Planned Parenthood clinic in NYC. I couldn’t believe how simple the procedure was, and how much potential it had to transform the provision of early abortion services. Years later, when I was finally able to access training in the procedure, I was able to perform my first Manual Vacuum Aspiration. I was surprised that the patient barely felt anything, sat up immediately after the procedure, and gave me a big hug! Since then I have been at the forefront of trying to make this procedure available to all women by developing the Early Options® model for early abortion services.

For more information, there is a reprint of an excellent paper by Carol Joffe on the history of abortion at: http://www.prochoice.org/education/resources/surg_history_overview.html

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