Abortion has been a political hot topic throughout the last several decades. Medically, however, it is standard procedure and is available throughout the country generally and in Maryland specifically. The Centers for Disease Control (CDC) reports that there were more than 660,000 legally induced abortions in 2013. The actual number of abortions annually in the U.S. is thought to be between 900,000 and a million, and the CDC confirms that 660,000 is not accurate because not all states provide (nor are they required to) abortion data to the CDC. Generally speaking, the CDC data breaks down to a rate of 12.5 abortions per 1,000 pregnancies in the United States (age range of 15 - 44) and a ratio of 200 abortions for every 1,000 live births.
Maryland is one of the states that does not report its abortion numbers to the CDC. Guttmacher Institute, a private research institute that provides data on abortion throughout the U.S., reports more than 28,000 abortions in Maryland for the year 2014, making Maryland home to roughly 4% of abortions in the U.S. Regardless of the exact numbers, abortions are performed throughout the U.S. in high numbers. It is one of the safest, routine operations conducted on women, but like all medical and surgical treatments and operations, there are certain risks and precautions that accompany abortions.
Methods of Abortion Available in Maryland
If you are pregnant and want or need to terminate the pregnancy, there are a number of methods, medically and surgically, available in Maryland. Usually, the method used depends on the gestational age of the fetus.
Medical Abortions. Medical abortions are abortions by use of drugs that are either in the form of a pill, tablet and/or injection. Medical abortions are an option only in the early weeks of the first trimester. There are two medical abortions currently and widely available in Maryland: (1) Methotrexate & Misoprostol (MTX); and (2) Mifepristone and Misoprostol (RU-486, otherwise known as the "abortion pill").
- MTX. MTX is available up to the 7th week (49 days) of pregnancy. Methotrexate is used first, either given orally or by injection during the first office visit. Three to 7 days later, Misoprostol is used to expel the embryo either during an in-office visit or at home. Misoprostol is taken by tablet form either orally or inserted vaginally. Generally a week later, the physician will conduct a physical exam to ensure the procedure was successful and that there are no complications. Sometimes, only Misoprostol is used, in which case repeated doses are required. The use of Misoprostol only also carries with it a higher failure rate than the combination of Methotrexate and Misoprostol or RU-486.
- RU-486. RU-486 became available in 2000, and since that time is the preferred method of medical abortions. It is approved for use between 4 - 7 weeks gestation (30 - 49 days of last menstrual period), though some facilities use it up to the 9th week of gestation. Mifepristone is used first, given orally during the first office visit. About 36 to 72 hours later, Misoprostol is taken by tablet form either orally or inserted vaginally to expel the embryo. About a week later, the physician will conduct a physical exam to ensure the procedure was successful and that there are no complications. If the procedure was not successful, a surgical abortion will have to be performed.
In both instances, a physical exam is conducted first to ensure that you are able to have the medical abortion (e.g., if you have certain disorders, diseases, etc, you cannot proceed with a medical abortion). After all medical abortions, antibiotics are provided to prevent infection.
Surgical Abortions. Surgical abortions are abortion procedures that require some kind of mechanical device, surgical instrument(s), and/or long needles to remove the fetus. Surgical abortions are performed in all three trimesters, and the exact method is determined largely on the gestational age of the baby. In most surgeries, medication is provided to enlarge and numb the cervix, and after most procedures, antibiotics are given to prevent infection. Below are some of the more common types of surgical abortions.
- Aspiration. Aspiration is a surgical abortion procedure performed sometime between 13 - 12 weeks gestation. It is also known as suction aspiration, suction curettage, or vacuum aspiration. The procedure usually lasts 10-15 minutes and requires medication for pain, sometimes sedation, and local anesthetic to the cervix. A medical device with a clamp (tenaculum) is used to hold the cervix in place while a suction device is inserted into the uterus to suction out the fetus and placenta. Recovery can last a few hours within the clinic.
- Dilation & Evacuation (D&E). D&E is a surgical abortion procedure performed as early as 14 weeks but usually after 16 weeks gestation. The procedure takes 15-30 minutes. Twenty-four hours prior to the procedure, the physician will insert laminaria (or another synthetic dilator) inside the cervix. During the procedure, a tenaculum is used to keep the cervix and uterus in place, and medicine is given to numb the cervix. Tissue is scraped out and a suction is used to ensure all contents are completely removed.
- Dilation & Extraction (D&X). D&X is a surgical abortion procedure usually performed after 21 weeks of gestation and is not available in all states, but is permitted in Maryland. It is also known as Intact D&X, Intrauterine Cranial Decompression, and, most commonly known as, Partial Birth abortion. Two days prior to the surgery, laminaria is vaginally inserted. On the third day, the water breaks, and when that happens, the patient is instructed to go to her physician. Forceps are used to pull the body through the birth canal. An incision is made to the base of the skull so the brain can be suctioned out. When the skull collapses, the fetus can then pass completely through the cervix.
- Heart Attack. The heart attack method is a surgical abortion procedure performed between 20 - 40 weeks. A lethal injection is inserted into the fetus' heart to produce a fatal heart attack. Afterwards, a D&E is performed. This method poses the greatest risk to the health and well-being of the mother.
Places Where Abortions are Performed in Maryland
In 2014, there were 1,671 facilities in the U.S. that provided abortion, which was a 3% decrease from facilities (1,720) available in 2011. Facilities come and go with the waves of political aspirations and new or rejected regulations in each state. Facilities providing abortions fall under four categories:
- Abortion clinics, where more than half of all patient visits were for abortions and where most abortions are performed;
- Nonspecialized clinics, where the second highest number of abortions are performed;
- Hospitals, where very minimal abortions are performed; and
- Private physician offices, where abortions are performed very rarely.
If you are pregnant and want or need to abort the pregnancy, you have options in Maryland. Maryland differs from the national average. According to Guttmacher, from 2011 to 2014, Maryland experienced a 21% increase in facilities that offered abortions. In 2014, there were 41 facilities that provided abortions (as opposed to 34 abortion providers in 2011), and 25 of those 41 facilities were specifically abortion clinics.
Since 2014, there has been a small drop in the number of abortion clinics in Maryland. As of 2017, according to abortion.com, a website that lists all available abortion clinics in each state, only 22 abortion clinics are currently available in Maryland, which results in a 12% decrease in abortion clinics from 2014 to 2017.
Again, as can be ascertained, the number of facilities providing abortions fluctuates by year. The availability matters to someone who requires an abortion but does not have a facility nearby. Hospitals and physician private practices will not perform abortions generally just because someone wants it, but will only do so in most cases because it is medically necessary. Even though Maryland offers more facilities than the national average, 67% of its counties are without abortion clinics, according to Guttmacher. All abortion clinics in Maryland are located in the larger cities, and a number are in nearby states. As of 2017, abortion clinics are available in:
- Camp Springs;
- College Park;
- Owings Mill;
- Silver Spring;
- Cherry Hill;
- Manhattan; and
Surgical abortions are one of the safest surgical procedures conducted on women, and the CDC reports that fewer than 0.05% of women experience physical complications. But complications do happen, and physicians, prior to any abortion procedure, must advise women of the potential risk of side-effects and complications. Common side effects include bleeding and cramping. Other less frequent complications include heavy bleeding, blood clots, damage to the cervix, nausea, sweating, tingling, blurry vision, headaches, and/or infection. More devastating but very rare complications include:
- Spontaneous rupture of membranes;
- Onset of labor and fetal expulsion before surgery;
- Dilators migrate into uterine cavity;
- Allergic reaction;
- Toxic Shock Syndrome;
- Uterine hemorrhage;
- Perforation of the uterus;
- Tissue remaining in the uterus (incomplete abortion);
- Injury to the bowel or bladder;
- Scar tissue in uterus or cervix;
- Placenta Previa in future pregnancies;
- Infertility due to the consequences of infection or damage to cervix;
- Pulmonary Embolism;
- Amniotic Fluid Embolism; and/or, but in rarest circumstances,
If you experience a complication, you should see your physician immediately. If, however, you believe your complication is due to an error made by your physician, then you should consult with another physician immediately for an examination and determination of what the complication is and how it was developed.
Abortion Errors & Complications
Risk of surgical errors and medical negligence are not acceptable causes of complications. In fact, errors are one of the main causes of complications and is another way to say that the physician was negligent. Errors can happen at any time, either before the procedure, during or afterward.
Preoperative Evaluation & Diagnosis. There are two things that a physician must do prior to an abortion: (1) screen the patient; and (2) inform the patient. If either of these responsibilities is neglected, then the physician may be guilty of malpractice.
- Screening. Physicians must thoroughly screen women prior to any abortion procedure. Women with certain disorders or conditions cannot have medical and/or surgical abortions. Each procedure carries with it a list of disorders or conditions that will likely deem an abortion candidate as unacceptable if the disorder is present. For instance, women with uterine abnormalities, multiple gestations, anemia, bleeding disorders, liver or kidney disease, seizure disorder, among many others, are generally disqualified from both medical procedures. The screening also includes determining gestational length. An error estimating gestational length can lead to the wrong abortion method used. If the physician fails to screen the abortion candidate thoroughly, including identifying certain disorders or gestational length, and as a result of that failure, complications arise, then the physician could be held liable.
- Informed Consent. Physicians must inform the patient of all potential complications. If a complication does arise, and the patient was informed of its possibility, then the physician has done what he was required to do. A physician cannot delegate to a staff person the duty to inform patients of all potential risks, and if he does, then he may be liable if any complications occur that the patient was unaware could happen.
During the Abortion Procedure. Errors do not generally happen during medical abortion procedures but do happen during surgical procedures. Surgical abortions are invasive procedures and any number of errors can be committed that can lead to malpractice claims. Serious errors that could happen during the procedure include:
- Failure to exercise sufficient caution to avoid trauma;
- Non-sterile or contaminated equipment;
- Inadequate cervical dilation;
- Improper use of anesthesia (either general or local); and
- Not thoroughly removing devitalized tissue or emptying the uterus completely.
Postoperative Evaluation & Diagnosis. The physician is required to follow-up with the patient to ensure no complications arise. If the physician neglects the follow-up exam, and a complication arises or the abortion was not completed successfully, then malpractice may be present.
When errors happen, and to address the complications made by those errors, many women are rendered sterile or must undergo another surgery to remove their reproductive organs to prevent the spread of infection. Consequences, as such, can move beyond complications of physical injury to the inability to reproduce. If any serious complication transpires, and you suffer because of it, you should seek medical help immediately and then inquire into your legal rights.
Abortion Medical Malpractice
If you or someone you know has had an abortion and you suspect medical malpractice, then you should consult an experienced medical malpractice attorney. In the meantime, you should know that to establish medical malpractice, four elements must be present for a successful medical malpractice lawsuit. These elements are:
- A doctor-patient relationship must have existed.
- The medical care provided fell below the accepted medical standard of care. In other words, the duty of care was breached and resulted in medical negligence. Medical care includes any decisions made, treatment provided, or the failure to treat.
- A causal link exists between the physician's medical negligence and the patient's harm.
- Harm ("damages") to the patient must exist and be quantifiable.
If negligence was involved or caused the complication, then you have the right to seek legal counsel and to bring a lawsuit against the physician or the facility. An experienced medical malpractice attorney will help you identify if medical negligence is present and who is liable for the harm caused by the negligence.