As you know from reading The Pulse, the Dobbs versus Jackson Women’s Health Organization abortion case was decided by the Supreme Court of the United States (SCOTUS) this past June. On account of this, the United States is now a patchwork of very different laws when it comes to reproduction and abortion in particular, so we have been taking a virtual tour from state to state, exploring each particular legal situation surrounding abortion. In some cases, states’ reactions to the Dobbs decision affect not only abortion care, but other, related issues, such as fertility treatment and contraception. In many cases, pregnancy care itself is not optimal, because laws that criminalize elective abortion could be applied against those who perform or receive medically necessary abortions, or even in cases of procedures to treat ectopic pregnancy or that remove dead products of conception following missed abortions (a type of miscarriage). There have even been a growing number of cases of antiabortion pharmacists denying women, men, and children medications that they must take for chronic diseases, such as systemic lupus erythematosus or rheumatoid arthritis, due to the fact that certain medications could be used as abortifacients, agents that provoke abortion. So things have gotten ridiculous over a period of just a few months.
In the wake of Dobbs US states states, such as Tennessee, Georgia, Alabama, Arizona, and Missouri are extremely hostile to the right to choose, while various pro-choice states. Various other states, such as New York, Connecticut, Illinois, Oregon, and Washington are very supportive of the right to choose. The state that we’re highlighting today, New Jersey, happily is in the latter group. In fact, the Garden State is one of the most pro-choice states in the US. This also means that healthcare to save your life in cases when pregnancy goes terribly wrong is top notch. If you suffer an ectopic pregnancy, or if you suffer a spontaneous abortion, doctors and nurses in the Garden State have no concern that somebody might prosecute them for saving your life by getting an inviable fetus or dead products of conception out of you. There will be no concern about the meaning of some crazy law that implies that an ectopic pregnancy must transferred to a location where it can thrive, a procedure that is not part of clinical practice
While numerous pro-choice states have wording in their laws that make fetal viability (24-26 weeks gestation) a kind of milestone, New Jersey dose not even have this. In practice, the overwhelming majority of elective abortions occur during the embryonic period, meaning prior to 10 weeks. But legally, in New Jersey, you could decide to have an abortion late in pregnancy, if that’s your wish, although this is not a common scenario. Generally, women who choose late term abortions do so because prenatal testing revealed some very severe problem with the fetus, indicating that the child will be very sick and will suffer and have a very short life. Additionally, if you are a minor and pregnant, New Jersey does not require you to obtain consent from a parent, nor even to notify a parent. The decision is completely up to you.
If you’re in New Jersey and want to terminate your pregnancy, you can have a procedural abortion at any point, you also can have a medication abortion up to 77 days (11 weeks) gestation. One type of procedure that can be used for an abortion is called a D&C, which stands for dilatation and curettage. Curettage is a kind of scraping of the inner lining of the uterus. Extracting a pregnancy, either viable or not, is only one of several reasons for performing a D&C. D&Cs can be performed for diagnostic reasons, such as when there’s a suspicion of abnormal cell growth in the endometrium. Therapeutic D&Cs can be performed for removing products of conception, but also for removing overgrowth of the uterine lining.
D&C by itself is adequate only early in pregnancy, so after a certain point the next option is dilatation and suction. This means that, after the cervix is dilated, the doctor suctions out the products of conception. Sometimes this can be done with a syringe, but often it requires power suction. A tube called a cannula is inserted through the opened cervix. Cannulae come in a range of sizes that are chosen based on how far along the pregnancy is, or was before it became inviable. In some cases, following suction, the doctor may then perform some curettage to extract any remaining products of conception.
At some point during pregnancy, generally around the midpoint, suction is not enough to extract either a viable or inviable fetus. In such cases, the OB/GYN must use instruments to grab onto the fetus, or parts of the fetus. Such a procedure is known as a D&E, which stands for dilatation and extraction. The extraction includes not only the fetus, but also the placenta, as well as the membranes. All the products of conception must be removed and accounted for, because products that remain inside the uterus can become infected. In discussing these techniques, notice how we have switched back and forth between mentioning elective and non-elective procedures. That’s because performing any of these procedures requires the same set of skills regardless of whether it’s a medical necessity, such as removal of retained products after a missed abortion, or it’s an unwanted pregnancy.