Reproductive Health – Page 5 – Population Matters-USA

Before Roe v. Wade, and before pregnancy tests were easily available, there were ways a woman could get her period started if it was late. This is called “Menstrual Extraction” (ME) or “menstrual regulation”. Without knowledge if she were pregnant or her period was just late, ME was not considered an abortion.

ME can be done with herbs, medicines or instruments. In Indonesia a doctor told me about “EM Kapsuls”, which are advertised on TV. Kapsuls are used to ease menstrual cramps, plus they are advertised to start a late period.

“Emmenagog” is the word for herbs or medicines that are used to start a woman’s period. Herbal emmenagogs are used in many cultures and have a long history. One of the most used emmenagogic plants, pennyroyal, is mentioned in Aristophanes’ play, Peace, written in 421 BCE! Although pennyroyal is apparently effective both in starting menses or causing an abortion, it is also toxic; it can cause severe liver damage and death. Tansy and rue are two other plants with similar effects—and toxicity.

Dr. Karmen, a psychologist, developed a MR technique using instruments: a flexible cannula and a syringe for suction. It is fast, simple and safe in the hands of an experienced person. That technology is still used for early abortions and incomplete miscarriages. I used Karmen cannulas until the office nurse pointed out that patients seemed to have more problems with that type of cannula than with the conventional, rigid cannula.

In general, Islam is against abortion—although there are exceptions. For instance, abortion is illegal in Bangladesh, a Muslim country, but ME is acceptable. It was introduced to decrease maternal mortality associated with unsafe abortion. A doctor can legally perform MR up to 12 weeks from the onset of a woman’s last menstrual period.

In addition to using herbs or suction to remove the tissue in the uterus, ME can be done with the same tablets, mifepristone and/or misoprostol, that a woman can take for a medication abortion. These medicines are even available in some countries without a prescription. They are also available in some states of the USA for ME through the Period Pills Project.

What are the dangers of ME? There is a risk that pregnancy, if indeed the woman is pregnant, may continue. Rarely the pregnancy isn’t in the uterus, but in a tube. A tubal pregnancy may have the same symptoms as a normal pregnancy, but it can tear the tube as it grows and cause internal hemorrhaging.

Performing an ultrasound before an abortion is wise for 2 reasons—to determine the pregnancy’s location and its gestational age. However, MR may skip the ultrasound if it’s done outside of the medical system. This means an ectopic pregnancy could escape detection, or that a pregnancy might be too far advanced for safe MR. Fortunately, the possibility of a continuing pregnancy can be excluded if the woman has a negative pregnancy test a week or two after she has had the ME.

Is MR going to make a comeback in US states where abortion is severely limited or entirely illegal? That is difficult to predict. However, there are studies suggest that women are interested in the idea.

An old video, No Going Back, shows how ME is done with the Karmen cannula. Unfortuately, it neglects to mention sterile technique and other precautions, so I don’t recommend it. Nevertheless, do-it-yourself ME might be safer than a back-alley abortion.

I searched and could only find information about the efficiency of ME using a combination of mifepristone and misoprostol, which are very effective. There doesn’t seem to be any study of the success rate of either a single medication or of herbal products. A study is being done in California to test misoprostol; it will be interesting to find its results.

The recent Dobbs decision by the Supreme Court has limited access to safe abortion care. However, ingenious women can find ways to get around the law. I just hope they can do so without compromising their safety.

SHAPESHIFTER

I have to make you sick to make you well,

The oncologist says, five months

we’ll scour each cell of your abdomen clean.

INTRAPERITONEAL CHEMO

It always burns, multiples thousands of bone splinters

stinging cells, murdering nerves, dulling

my mind, my spine alive, a drawn bow

aimed at heaven, sprouting agony’s three stingy feathers.

Both from Refugee; poems by Pamela Uschuk

When I first learned that our friend Pamela Uschuk had ovarian cancer, I despaired for her life. Ovarian cancer is one of the worst killers. By the grace of God, and the Mayo Clinic, she is still alive and well 10 years later.

Unfortunately, there is no screening test, like the Pap smear, for this terrible disease. Ovarian cancer has usually spread widely by the time that it is detected, so heroic treatment is required. Despite medical advances, most women who get ovarian cancer are killed by it.

Mysteriously, the risk of getting ovarian cancer is reduced by using birth control pills, by tubal ligation or by hysterectomy. Even more puzzlingly, about a decade ago it was discovered that most ovarian cancers actually start in the Fallopian tubes.

Ovarian cancer is not that rare—about 1 in 80 women will develop it. Some women are at higher risk because they carry a genetic mutation such as BRCA, but they only account for about one tenth of the people who develop this disease. Pamela was at normal risk; she is BRCA negative.

Now, rather than just blocking a woman’s tubes to prevent pregnancy, it is recommended to consider removing the tubes entirely (salpingectomy). The final word isn’t in because the recommendation is too new, but bilateral salpingectomy has the possibility of preventing hundreds of cases of ovarian cancer, saving many lives annually!

If a woman has a planned Cesarean with what she intends to be her last child, why not have a salpingectomy at the same time? After all, her tubes are exposed and this procedure only adds 5 minutes to the surgery.

Regrettably, that may not be possible in some hospitals under Catholic control. They must abide by the “Ethical and Religious Directives for Catholic Health Care Services” of the United States Conference of Catholic Bishops. This document states:

“Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution. Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present or serious pathology and a simpler treatment is not available.”

This statement has unintended consequences. Many women have hysterectomies in Catholic hospitals because the simpler, safer and less expensive tubal ligation is prohibited. Worse, this policy leads to unplanned pregnancies and abortions. Remember, the most effective way of preventing abortions is with effective contraception!

Of course, there is the option for the new mother to go to another hospital at a later time for her tubal surgery, but that means a second anesthesia, additional cost, plus more pain and recovery time. What mother wants to leave her newborn child and not be able to breastfeed?

All healthcare institutions should endeavor to prevent illness and death. A study examined the number of women having tubal ligations at the time of cesarean birth and calculated that over 900 cases of ovarian cancer and 550 deaths every year in the USA could be prevented by doing salpingectomies for women who want sterilization at the time of cesarean.

Let’s look at this issue from a different viewpoint. What if it had been shown that vasectomy decreased the risk of testicular cancer (it doesn’t, unfortunately). Do you think that the Catholic patriarchy would deprive their priests and other men of this potentially life-saving surgery?

Preventing sterilization, especially salpingectomy, at the time of cesarean is a case of religious doctrine standing in the way of good medical care.