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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.
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)
