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Wednesday, October 27, 2010

Menstrual Extraction

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Originally Published in Women's Health Movement Paper, May 1981

Procedures
By Lorraine Rothman

Menstrual Extraction is a procedure developed by the Los Angeles Self Help Clinic women in 1971 which gently removes the contents of the uterus by suction on or about the first day of menstruation. It is not a medical procedure performed by a physician as a service to women who request an abortion, and it is not a do-it-yourself abortion technique. Menstrual extraction is a home health care procedure developed by Self Help Clinic women who saw its potential for regaining control over our reproductive lives.

Early History

The development of menstrual extraction resulted from our participation as feminists in the national abortion reform movement. We found that we were supporting actions that did not help women as much as they helped particular individuals. We promoted an illegal abortion clinic in Los Angeles opened by Dr. John Gwynn in 1970. After the clinic was raided in 1970, we picketed the courthouse for the two men and three women who had been arrested. The publicity about the clinic focussed on the charisma and the heroism of the men, rather than on the issue of a women's right to abortion.
Early in 1971 our group decided to learn to do abortions and to open an underground, woman-controlled abortion clinic. We had observed less traumatic methods such as suction using a small diameter plastic cannula, and we saw that this method was not only more gentle and safe, but it could be learned by laypersons.
We also recognized that it was important to be more informed about each procedure that is performed on a woman's body so that we could have a better basis for referring women to safe, competent health care facilities.

We abandoned the plan for an underground abortion clinic, however, because in the fall of 1971, hospitals in Los Angeles were expanding their abortion programs, liberally interpreting the 1967 Therapeutic Abortion Act.

Menstrual Extraction Concept

We saw the possibilities of using the non-traumatic method for reasons other than early abortion. We had practiced on one another during our menstrual periods and we learned that introducing a four millimeter cannula into the os of the cervix caused very little pain so that it was unnecessary to use any anesthetic. We learned that simple sterile techniques were sufficient, since there was no breaking of the skin or scrapping of tissue. We also learned that it was possible to extract the major portion, or all, of the typical menstrual period. This usually brought immediate cessation of the cramps and other uncomfortable menstrual symptoms. We decided to name the procedure menstrual extraction.

Materials and Methods

It was evident that women did not have equipment to do menstrual extraction, nor any way to get and safely use what was available. Vacuum aspirators are expensive, large and cumbersome, and produce much more vacuum than is necessary. We had practiced with a portable device used by Harvey Karman, and were impressed with its simplicity (the plastic cannula attached directly to a plastic syringe). We found it difficult to manipulate, however, and it had the potential to accidently reverse the suction, thus allowing menstrual fluid and possibly air into the uterus. We were concerned about the potential complications that might result from reversing the suction. As a member of the Los Angeles Self Help Clinic, I saw that we needed a simple and inexpensively-made device, which had built-in safety features. I invented the Del-Em to suit the group's needs. Vacuum is created in a small bottle which is attached to a small cannula that is inserted into the cervical os. An automatic valve attachment controls the direction of the air flow and locks in the pressure, eliminating any possibility of pushing menstrual fluid or air back into the uterus.

The Del-Em's safety features are particularly important because of the constraints under which we operate. Opportunities to learn the procedure are dependent on a member of the group having her menstrual period. In spreading the technology to other communities, we are limited by the short time in which we can visit others or in which other women can visit us.
Menstrual extraction occurs either at the woman's home or at the group's meeting place. A woman will usually choose to have an extraction on or about the first day her period is expected. However, some women have extractions as much as two weeks beyond the expected date of menstruation.

Three women are the key people involved with extractions: the woman who is to have the extraction (she sometimes controls the vacuum pressure), a woman who observes the equipment for proper functioning, and a woman who inserts and moves the cannula. At times, other group members participate in order to learn the procedure.

After the woman who is to have the extraction places herself comfortably on a table or bed, other women in the group perform a pelvic examination to determine the size, location, and characteristics of the woman's pelvic organs. Certain signs are watched for, such as advanced pregnancy, infection, or other problems. Because the group has frequent opportunities at regular meetings to become familiar with one another, a basis for comparison has been established so that any contra-indications are more easily recognized.

The woman inserts her own speculum, examines her own cervix and talks with the group; has others in the group look at her cervix; and then decides whether or not she wants to have the extraction. She talks about her past experiences and purposes for extracting her period, such as relief of menstrual pain. If she suspects she is pregnant, she will discuss her subjective signs and these signs will be evaluated in light of her previous experiences with pregnancies, amount and frequency of exposure to sperm, and her fertility at the time of exposure.

The Del-Em consists of a plastic 50-cubic-centimeter syringe that has a valve on the end. The valve prevents air from being injected into the uterus. The syringe is pumped until it becomes difficult to pull the plunger. Air is removed from the bottle in this way creating a vacuum. The cannula is carefully inserted through the undilated cervical os. Often, the inner cervical muscle can be felt against the cannula. If the slender flexible cannula bends, forceps can be attached to the middle of the cannula giving it more stability. Sometimes a stabilizer is attached to the cervix so that the uterus does not move with the movement of the cannula.

The woman who is having the extraction will tell the other women when she feels the cannula touching the back wall of her uterus. She will continue to relate what she is experiencing as the cannula is moved back and forth making sure, however, that it remains fully inserted. The menstrual material appears within the cannula after a short time.

The cannula is moved within the uterus until either no more menstrual material comes out or the woman having the extraction says she wants to stop. The tubing attached to the cannula is clamped off to avoid any unnecessary discomfort of suction as the cannula is removed through the cervical canal.

Results

Most women who do menstrual extraction do not experience excessive discomfort. Women experience different degrees of cramping during the extraction. Sometimes, women can feel strong cramping when the cannula is inserted through the cervical canal. Most women feel strong cramping at the end of the extraction as the uterus contracts. Menstrual extraction discomfort or pain from abortions that are done by electrically powered suction machines.
Daily phone contact is the common follow-up method until the group meets again. Infections, which in our experience have been rare, are recognized by a rise in temperature to 100.5 F. or more for 8 or more hours. Pain or cramping in the lower abdomen may be felt as well. It is important that if an infection occurs, the woman receives antibiotic treatment.

Sometimes a woman may have strong cramping in the couple of days following the extraction and pass clots or retained tissue. We have found that passing of the clots or tissue can be aided by gently messaging or pressing the lower abdomen and uterus.

If the woman believes she may have been pregnant, the group will pour the uterine contents into a shallow pan looking for chorionic villi*. They are yellowish with branch-like structures and are quite different from menstrual fluid. If there were no signs of a pregnancy, the extracted material will be studied in order to better understand the composition of menstrual fluid.
We are often asked about complications, such as uterine perforations, hemorrhage, infection, retained tissue, cervical incompetence, uterine prolapse and air embolism. These questions arise out of confusion of menstrual extraction with abortion techniques performed by physicians. People incorrectly assume that we use dilators, large rigid cannulas and curettes.

Most women who have access to legal, reasonably priced abortions have chosen to do menstrual extraction only if they were part of an on-going group and had done menstrual extraction previously, have missed their periods by a few days, and, because of their familiarity and knowledge, were reasonably sure that no contradictions existed.

Lorraine Rothman, an activist in the women's health movement, is currently a member of a book-writing team at the Feminist Women's Health Center in Los Angeles which is writing a self-help book. As a member of the first self-help clinic organized by Carol Downer in 1971, she invented and patented the Del-Em menstrual extraction kit.

*Webster's defines these as "highly vascular embryonic" membranes that are associated with "the formation of the placenta." (Webster's Third World International Dictionary, G. and C. Merriam Co., Springfield, Massachusetts, 1966)

12 comments:

  1. Why cant i learn how to do this? Everywhere i have went or tried, i've been rejected. They've all redundantly repeated the SAME points. "No. we cannot just simply teach you how to use this technique because you aren't interested in our group." Ladies, i understand that you are protective of this, and you think that it should only be bestowed to the elite few. Seriously though, you're contradicting the whole basis of this procedure. To take control of OUR bodies. Please,please tell me what i need to do for you to help me. . Its bad enough that my parents are rejecting me and now the people who are supposed to support womens right to chose are even pushing me away. .My time is running away quickly. The window is closing and i've been on the internet for DAYS. Please just send me in a direction, send me a kit. Instructions. I just need help. .

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    Replies
    1. Menstrual Extraction was not invented to be offered as a service to the public. It is a procedure that a group of women learn by practicing self-examination with one another over a period of time, and they use if for themselves and friends when needed.

      If you need an abortion, it is wise to act quickly, because the procedure gets a little more complicated as time passes. I don't know where you live, but abortion providers, either clinics or doctor's offices, can be found in all major cities. Early abortion is a safe, simple procedure, so compare prices, what type of anesthesia is used, if any (local anesthesia is usually all that is actually needed) and convenience of location.

      If you're interested in starting a menstrual extraction group, I would encourage you. I know women who have started groups to do menstrual extraction and other self-help projects in many different communities over the last 40 years. They hold community meetings to introduce the concepts of self-help in their community. Women who want to pursue it further meet together for weeks or months, learning self-examination and becoming knowledgeable about their own bodies. The equipment for menstrual extraction is available and also there are several good books about it. If you're interested in being part of a group please let us know because there are groups that are exploring the technology.

      Women's Health in Women's Hands
      whwh@womenshealthinwomenshands.org

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    2. Yeah, Carol? Where is the equipment available? It's more about that than anything, bc if I can get the syringe and cannula, I can figure it out.

      TELL SPECIFICALLY WHERE TO BUY FROM.

      I cannot believe that Anon up there who needs help is being treated like the new girl at school here. This is shameful. I had a feeling that most of the ME sites online would be shills willing to hurt women to keep what they see as their private purview to themselves.

      History will remember such people as jokes. Sorry.

      - Quesadilla

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    3. MENSTRUAL EXTRACTION - NOT Personal Solution
      By Carol Downer

      Dear Anonymous:
      I welcome the chance to respond to your question. First of all, some of the parts we used in the original Del’ems are no longer being manufactured, therefore no one is being coy or self-protective when they give you a vague answer about how to construct a Del’em. Some ME groups have found alternatives that are working for them.

      Secondly, beyond this problem, those of us who developed this technology have never intended it to be used by an individual woman to solve her own unwanted menstrual period or pregnancy on her own, for both practical and political reasons.

      Practically speaking, if you are unwilling or unable to figure out how to overcome the equipment problem or to put in the time and effort to get a group together, you will not be able to acquire the knowhow to do the procedure. When a group of women who have worked together over a period of time (at least a couple of months, usually, learning about their anatomy, becoming familiar with the device by extracting each others’ periods, etc., they find that it is very safe and simple. However, in the hands of someone who has not educated herself through this group training, it could result in less than perfect results. We know of no medically serious outcomes from those who have tried a short cut, but naive persons who have not done the work of educating themselves along with other women and building up a network could get themselves in a pickle.

      Politically speaking, I don’t blame anyone for refusing to help you to exploit this technology just for your own personal benefit. This would be especially true if abortion were illegal, because this irresponsible attitude could endanger ME groups who were helping women to avoid unwanted pregnancy on a large scale. Fortunately, today, abortion is legal in the United States and doctors do assist women with difficult periods, etc. Therefore, for you to get upset that politically active people who are keeping this technology alive on a small scale are not willing to take the time, effort or possible risk to enable you to work on your own personal solution just shows that you don’t understand the first thing about menstrual extraction and its significance for women.

      I’m always willing to discuss this more. Your request has given me the opportunity to clarify the difference between the use of ME for a personal solution, which is impractical and possibly dangerous and the use of ME for a political solution, which is a revolutionary tool for achieving reproductive freedom from unwanted pregnancy.

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  2. Carol, I happened upon this page while doing research on natural healing regarding excessive periods. I am self-taught on my herbal remedies and was searching for herbs to help my daughter with a seemingly endless period. This whole process was done for me at my gyno a few years back and I was quite unsure exactly what he had done and now I know. This procedure will fit well into the select few women with whom I practice the art of village healers. The demand for natural healing is blossoming in our town. We have practiced what we have learned on ourselves and our families (sometimes not so willingly as many taste horrific) but our knowledge and believers are increasing steadily. I have just started formal training with an herbologist and plan to learn as long as I possible can. I am the oldest in the group, my children are grown and supplying me with grandchildren who believe I really am a doctor. They do have a pediatrician, but in small problems, Marmar (me) is the go-to person. They even willingly take some of the ucky tinctures, as they know they will feel better soon. Ok, back to my original reason for this post, I believe this is something that myself and other healers would appreciate learning how to do. I have read all I can find on the subject tonight and I intend to purchase the book that I have marked somewhere in my 4 hour perusal of the subject. I would like to be able to talk to you about your insights into this. I am not sure how the comment drop-down box works (Did I mention I was the oldest of the group? And technology disadvantaged?) so I will bookmark this site and check to see your response.
    In faith of healing,
    Teri

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    Replies
    1. Hello, I am writing on behalf of Carol Downer. She very much appreciates and is interested in your comments. At the moment, she is planning a trip to attend "The Persecution of Midwives as a Human Rights Issue" Summit in Eugene, OR. But, she wants to assist in connecting you with others who are also interested in the same topic - as this is how she envisions utilizing her website "Women's Health in Women's Hands".

      As soon as she can - she'll reply with a much fuller response. Currently, she is not aware of any work done on this particular issue; but, your knowledge would of come in-handy because she had similar experiences - she did have her period most of the time...And, while it was not fatal it was a nuisance.

      It might be best - to correspond via email: whwh@womenshealthinwomenshands.org
      Otherwise, Carol will correspond (on this blog post) as soon as possible.

      Thank you,
      Women's Health in Women's Hands
      www.womenshealthinwomenshands.org

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  3. Why would you pay information about ME on the internet if you aren't willing to give help to those women who aren't looking for abortions. I'm interested in this as an alternative to my regular cycle and from what I've read I would love to join a group. Your information is great. But your personality and people skills are greatly lacking. I agree with the first anonymous post about you treating women like they are the new girl in school. You seem like the mean girls who need an attitude change.

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  4. Why would you post so much information on ME on the internet and then refuse to help women who are simply tired of having 3-4 days of painful messy flow? It's like you simply can't understand this technique being used for anything other then abortion. I'm very interested in find a group or learning how to do this myself. However you seem extremely stuck up and arrogant. "I have the knowledge to help you but because I never intended to help women other then my friends I'm going to post it on the internet like meat in from of a hungry dog and then say NO". You attitude is no appreciated, however you information up to the point were you stop helping was very good.

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  5. Hello ~

    I would suggest that the best way to find a self-help group to join is to start one with a few friends. After all, there were no self-help groups until a few women got together and decided to start one. Then those women moved around and started new groups where ever they went. That's how the concept and the shared knowledge has grown over the years. It's an ideal ~ an ideal of women getting to know ourselves and each other, of sharing information and experiences, and of helping and supporting each other through the good times and the bad. It's a support network for our privacy and protection.

    The best way to start a self-help group is with the speculum. Women get together in a group of 2 or more and share the experience of learning how to use a speculum for the best view of our inner sanctum. The more women present in a group, the more variations on a theme will be present, and the quicker the learning process will be. In one meeting you might see the cervix of a menstruating woman, an ovulating woman, a pregnant woman, a woman with an IUD or a woman with an infection. Each view is an enormous learning experience with discussions and considerations to occur, so the more views the quicker the learning process will be. Plus there is safety in numbers, but even a group of 2 is a shared experience for heightened awareness.

    If the group wants to pursue learning menstrual extraction and putting together a kit or kits, they will then take the necessary actions to research the issues, locate, purchase and assemble the parts and learn how to safely use the kits for educational purposes. It's not a secret and the material has been published, plus there are women who would be happy to provide workshops to share the information, if invited. There have been groups that were able to produce their own kits to support the women in their group and other groups that were forming. What stopped that momentum however, was the fact that one of the parts was discontinued and no longer available, so it became difficult to complete the kit as originally designed and as far as I know, no alternative has yet been developed.

    So it's not for someone seeking instant gratification at this level. This site is a public forum for sharing information with the public ~ whereas a private self-help group is for sharing in the private, and not a public forum. Both worlds can co-exist but must be differentiated. A self-help group is more of a commitment to learning and sharing and networking to create real change in the knowledge base and our ability to control our own bodies, and thus our lives. And when women's lives are better, men and children's lives will be better too. In fact, it may just be about whether of not our species survives at all. As women, we have a role in protecting our egg supply and our children and grandchildren forever. With the planned genocide program of vaccines and GMO's, chemtrails and HAARP, endless war and economic collapse ~ I'd say, what better time is there than right now to take back control of our bodies and our lives? For this, we each need to do what we can in our own private life, but with the help of a supportive network, our job becomes much more enjoyable.

    I, and others, would be more than happy to provide self-help workshops on these topics, sharing ways that women can take control of our own bodies, including safe alternatives in birth control. In regard to heavy menstrual bleeding, we can learn how to control the flow with a raw food diet, described in a small booklet called Is Menstruation Necessary? by Nadin Forrest and Wendy Harris, Life Science Publishers, Austin, Texas.

    Keep posting on this site and we will try to help you learn what you need to know within the context of this public forum, or make arrangements for a workshop provider. Thank you and have a wonderful day.

    peace sisters ~ be well and stay well ~
    Cervix Cervices!

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  6. I think your answers to anonymous were incredibly obtuse and unhelpful. Perhaps this is all ideology to you now or have you ever been in a situation where you need an abortion yourself? We as women have got to teach other women and provide them with what they need to do this procedure for themselves or others in their community. Because, as I write this in 2014, the option to have a safe legal abortion is not an option if you live in many states. The right has dismantled Roe V Wade and women are desperate, and women are dying from more egregious methods of illicit abortions.

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  7. Although I am EXTREMELY interested in this technique to relieve excruciating pain and monstrous flow issues with my cycle, I can understand hesitation due to risk of liability in today's litigious society.

    Perhaps someone gives you exactly what you request...items for the kit and a manual on the procedure...you attempt it at home, something goes wrong...who do you blame? Yourself for being hasty or the person who put you in contact with the means?

    It would be more helpful if there were a registry of groups available to assist women like me who want to learn the technique safely and let us reach out to them for guidance. I have no interest in starting my own group, only seeking information on how to find a reputable, established group in my area without Googling every ME thing in my area.

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    Replies
    1. @Anonymous, thank you for your comment. At this point there are no such groups. And, we don't perceive there to be some in the future. Only way groups form are for women to all take much more responsibilities for their lives.

      Women's Health in Women's Hands
      www.womenshealthinwomenshands.org

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