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Saline Abortions: Past, Present, Future

In 1939, a Rumanian abortionist named Abruel first got the idea of taking out amniotic fluid and replacing it with something to kill the fetus and/or induce premature labor. Although different substances were tried, with varying success and varying complications, hypertonic saline (a strong salt soloution) became the most popular. Abortions that involve taking out amniotic fluid and replacing it with something else are called "instillation abortions" or "amniotic fluid replacement abortions," or are named after the substance injected. I use the terms "saline abortion" and "saline instillation" interchangably.

The saline causes abortion by two mechanisms:

Saline abortion is hardly a pleasant experience. The abortionist would remove as much amniotic fluid as he cound using a needle and syringe. He would then replace the amniotic fluid with a concentrated saline (salt) soloution that would poison and kill the fetus. The woman would then go into labor and expel the fetus.

The Saline Abortion Experience
First-person accounts.

Carhart in Review
An overview of the history of late abortion techniques.

Abortion Techniques
Other ways abortions are done.

Abortion History
More on the history of abortion practice.

Instillation abortions spread into nations where abortion was legal, and saline quickly became the favored abortifacient, although other substances, including glucose, were tried. Glucose was quickly abandoned because it fed infection rather than killing the fetus.

Saline abortions became very popular in Japan following WWII. Within the Japanese medical community, however, word quickly spread: this method was unsatisfactory. Too many women were being injured and killed. Over 70 papers were published in the Japanese medical community reporting hazards of saline abortions, including at least 60 maternal deaths. The Japanese Obstetrical and Gynecological Society condemned the technique, and it was quickly abandoned. But the Japanese abortionists kept news of the trouble among themselves -- until Western nations discovered instillation abortions and embraced them with great enthusiasm.
Mark Crutcher, Lime 5, p. 126
Manabe, "Artificial Abortion at Midpregnancy by Mechanical Stimulation of the Uterus," Am. Journ. Ob Gyn 9/1/68

Two Japanese doctors, Takashi Wagatsuma and Yukio Manabe, broke the silence. Wagatsuma wrote, "It is, I think, worthwhile to report its rather distasterous consequences which we experienced in Japan." Manabe wrote, "It is now known that any solution placed within the uterus can be absorbed rather rapidly into the general circulation through the vascular system of the uterus and placenta. Thus any solution used in the uterus for abortion must be absolutely safe even if given by direct intravenous injection. ... A solution deadly to the fetus may be equally toxic and dangerous to the mother. ... In spite of the accumulating undesirable reports, the use of hypertonic saline for abortion is still advocated and used ... in the United States and Great Britain. I would like to call attention to the danger of the method and would perdict the further occurrence of deaths until this method is entirely forgotten in these countries."
Wagatsuma, "Intraamniotic Injection of Saline for Therapeutic Abortion," Am. Journ. Ob Gyn 11/1/65
Manabe, "Danger of Hypertonic Saline Induced Abortion," JAMA 12/15/69

As western abortionists gained experience with saline abortions, other grim reports arose. A British study published in 1966 found that the saline would enter the mother's bloodstream and cause brain damage. Swedish researchers noticed an unacceptably high rate of complications and deaths. Sweden and the Soviet Union abandoned saline abortion as too dangerous for women in the late 1960s.
Mark Crutcher, Lime 5, p. 127
Cameron, "Association of Brain Damage with Therapeutic Abortion Induced by Amniotic Fluid Replacement: Report of Two Cases," British Medical Journal, 4/23/66

For whatever reasons, American abortionists were deaf to these warnings. When New York had completely repealed its abortion law, doctors had tremendous leeway in abortion practice. In New York City in particular, it became popular to inject the woman with the saline in the office, then send her home with instructions to report to a hospital when she went into labor. This was, to say the least, a highly irresponsible way to use an abortion technique that was risky even when performed in a hospital under close medical supervision. Women started dying from these saline abortions.

Women were also already dying in California as well, even though the law there still required abortions to be done in hospitals:

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After Roe v Wade was handed down, saline and other instillation abortions spread to other areas of the country, despite the dismal goings-on in New York and California, and of course more women died:

US abortionists showed no alarm over these deaths. Even as late as the 1990's, the American College of Obstetricians and Gynecologists, and abortionists such as Don Sloan and Warren Hern, were describing saline and other instillation abortions in such terms as "a low-risk procedure."

Stastics show, however, that abortionists did gradually move away from saline instillation abortions, albeit more slowly in New York City than in the rest of the country:

Year Saline Abortions
Reporting States NY City
# % # %
1974 42,669 7.7% 14,221 11.8%
1976 39,093 5.1% 8,339 8.2%
1978 21,805 2.8% 8,440 8.0%
1980 22,682 2.2% 7,579 7.4%
1982 20,732 2.0% 7,358 7.0%
1984 11,860 1.5% 3,681 3.8%
1986 8,938 1.1% 2,470 2.5%
1988 6,318 0.7% 1,345 1.5%
1990 2,825 0.3% 1,058 1.0%
1992 2,513 0.3% 917 0.8%
1994 2,161 0.3% 760 0.7%
1996 1,164 0.2% 617 0.6%

Since the problem of maternal deaths from instillation abortions had been long documented, this factor probably only had a minor impact on the move away from saline and other instillation abortions. One important factor was financial: although suction and D&C were adequate procedures for first-trimester abortions, they were inadequate for killing and removing the larger second-trimester fetuses. But the uterus was not large enough to perform instillation abortions until 16 weeks. This left a 4-week "grey period" during which women could change their minds about aborting.

There was also the problem of starting a suction or D&C abortion only to discover that the pregancy was already in the second trimester. Necessity is the mother of invention, and abortionists who found themselves dealing with second-trimester fetuses that had already been damaged had to come up with ways to remove these fetuses quickly and without alarming the patient. Thus evolved the Dilation and Evacuation (D&E) procedure that remained popular for mid-trimester abortions for over a decade.

D&E was cheaper than instillation abortions, which required at least an overnight hospital stay. It also had the advantage of producing fewer live births, the "dreaded complication" no abortionist wanted to face:

While instillation abortions were still the most common method of mid-trimester abortion, roughly 500 live births were reported to the Centers for Disease Control every year by abortionists. The CDC's Willard Cates thought that this number probably came nowhere near the true number of live births, because there is no penalty for failing to report these births to the CDC. "It's like turning yourself in to the IRS for an audit," Cates said.

So, addressing the multiple problems of live births, lost sales during the "grey zone," and miscalculating gestational age, the abortion industry gradually phased out saline and other instillation abortions, replacing them with D&E dismemberment abortion.

The few persisting saline abortions raise interesting questions. Why are these physicians, who are conscientious enough to report the abortions they do, still using an outdated and highly risky technique? Are there still a large number of saline abortions being performed by fringe abortionists who aren't reporting to the CDC? And will the "greying" of the abortionist pool eliminate saline abortions entirely over the next decade?

For the sake of the women, one would certainly hope so.

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