Reply to Comments on "Women's Health In Women's Hands: Menstrual Extraction"

By Carol Downer

Reply to comments on "Women's Health In Women's Hands: Menstrual Extraction"

TO WOMEN WHO

• UNDERSTAND THE REVOLUTIONARY SIGNIFICANCE OF LEARNING TO DO MENSTRUAL EXTRACTION;
• WHO ARE COMMITTED TO DEVELOPING A MENSTRUAL EXTRACTION GROUP; AND
• WHO ARE  WILLING TO SEARCH OUT ANSWERS FOR THEMSELVES:

I want to encourage your interest in safely reducing or eliminating the discomfort of your menstrual periods-or the periods themselves if you wish through the use of the Del’em (or similar device) that Lorraine Rothman developed in 1972.   

MENSTRUAL EXTRACTION IS NOT ABORTION
Many times, people have confused this procedure with abortion, or think that the feminists who pioneered it were simply using a semantic trick to disguise their true purpose of doing abortion. It’s true that menstrual extraction was discovered in the process of learning how to do vacuum aspiration abortion, and it’s also true that in the very early stages of pregnancy, using the menstrual extraction technique will vacuum out the fertilized egg or embryo.  

And it is further true that unless the woman wants to carry any pregnancy to term, the group doing the menstrual extraction are concerned with determining whether the procedure is an abortion only to the extent that, if it is an abortion, they will switch gears from doing a menstrual extraction to doing an early abortion, and they will make any appropriate changes in the procedure.  

DIFFERENCES BETWEEN MENSTRUAL EXTRACTION AND ABORTION   
Menstrual Extraction consists of inserting a narrow, flexible plastic cannula attached to a plastic tubing into the uterus 2 to 3 inches through the os of the cervix and then using suction to extract the period.  Very early abortion can be done using the same equipment in much the same way.  The procedures are very different, however, in terms of:

• the setting, 
• equipment used, 
• amount of preparation needed, 
• amount of skill needed, 
• amount of time it will take, and
• follow-up needed.

In our patriarchal society, some of the differences between the two procedures arise from the problematic legal status of women directly exercising reproductive control using equipment to extract their periods or doing an abortion.  The legal status of a group of women doing menstrual extraction among themselves has never been established, nor has any group of women doing abortion among themselves been arrested or tried for any crime.  

If the group is concerned about legal repercussions, they will take precautions against possible discovery by the authorities.  This mainly means establishing a network of committed feminists who are trained in the method and committed to providing support to defend menstrual extraction.

Being prepared also means having back-up arrangements with sympathetic medical personnel for consultation if something unusual comes up, so that if necessary, the woman undergoing the procedure can be admitted to a medical clinic facility for any follow-up needed.  (This has rarely happened and has always occurred when the group misjudged the length of gestation, and the Del’em was not adequate for the procedure.  What was needed was a more experienced operator and other equipment.  The procedure then was successfully completed.)  

Setting:  

Menstrual extraction is generally performed within a circle of friends who have learned the technology by using it with one another when their periods came or were expected soon. 

Abortion using this equipment is usually performed within a circle of friends, even though the woman getting the procedure may be a relative or friend of one of the women.  It is usually performed by the more experienced persons in the group   

Equipment: 

Menstrual extraction can be done using the Del’em which consists of a 4 mm cannula attached to a long tubing (3 feet or more) which goes into a Mason jar through a hole in a rubber stopper.  The stopper has another hole.  Another tubing (2-3 feet long) protrudes from the other hole and goes to a one-way valve that is attached to a 50 cc. syringe.  

Abortion can be done using the Del’em may consist of a 4mm cannula, or sometimes a 6 mm or even an 8 mm. cannula.  The reason the larger cannula may be used is because a woman’s cervix softens and becomes more pliable by the second or third week of pregnancy and a larger cannula can be used without undue discomfort.  If it is an abortion, the larger cannula makes the procedure go faster because small clumps of tissue can pass through easily. 

Additional equipment:

Some menstrual extraction groups utilize surgical tools, such as an O-ring forceps to hold the cannula, or serrated forceps to stabilize the cervix.  These metal tools can be modified or stretched open so that they do not close completely, thus preventing the possibility of pinching the lip of the cervix. 

NOTE: Problems with the Del’em: 
Unfortunately, the company manufacturing the one-way valves has discontinued production, and only those groups that already had equipment are able to use the features of the Del’em.  However, over the forty years since its invention, ingenious women have found other equipment that can be modified to ensure that the flow of air can never be reversed so that air would be introduced into the uterus.

Amount of Preparation:

In Menstrual Extraction, since the women in the group know each other well and have been examining each others cervixes monthly or even weekly, they know whether the woman is having penis-vagina sex and whether she has any health problems.  Even if she is pregnant without any signs of pregnancy, they know they would only be dealing with a very early pregnancy, therefore the usual bimanual uterine size check would be sufficient, and they don’t have to have any medical back-up arrangements made, etc.

In Abortion: if the woman getting the procedure is not an ongoing member of the group, it is vital that the group establish that the woman is not further along in her pregnancy than she states or that she herself is aware of.  This requires much more careful examination and checking of the reliability of the information.  The group considers the social, legal and political environment to decide whether to continue or to refer the woman to an abortion facility.

Amount of skill needed:
The use of the Del’em required a lower level of skill than a vacuum aspiration done by an individual operator in a medical setting.  The long tubing between the cannula and one-way valve and the collection bottle allows one woman in the group to sit comfortably at the foot of the table and insert the cannula into the vaginal cavity (the vaginal walls are kept apart by a speculum).  Similarly, the long tubing between the collection jar and the syringe allows another woman to stand at the woman’s side and pump the syringe to create the vacuum.  This separation of functions dramatically reduces the skill level.  Many times another member of the group will stand at the woman’s other side and keep her posted as to the progress of the procedure, maybe even helping her to hold a mirror so that she can visualize the material coming down the tube.  Or, this woman may massage her uterus to ease any discomfort and to stimulate the uterus to contract. 

Menstrual extraction is not usually as easy to do as an abortion, because the os has not softened and opened up as much.  The woman may feel some pain on insertion of the cannula.  She may need extra time to adjust, or to be massaged, etc.  Or, she may decide not to continue the procedure.  The necessary skill of inserting the cannula is higher, but the amount of skill in manipulating the cannula within the uterus is less.  

Abortion: Any pain in the insertion of the cannula is usually quite tolerable; in fact there may be none.  The necessary level of skill of manipulating the cannula is somewhat higher, because it’s important not to perforate the uterus.  Risk of perforation is very low because in early pregnancy, the uterine wall is thick and tough and the unsedated woman is able to say, “That’s it; I feel it on the back wall; don’t go any further”.  

Amount of time Needed:
Menstrual Extractions can take a long time.  The menstrual material is viscous and moves very slowly through the tubing. Of course, since this is an elective procedure, we usually take our time and manipulate the cannula very gently.  Sometimes people in the group just run out of time and decide to stop the procedure, because they have to get home to a baby-sitter or something.  The material, when it comes out into a bowlful of water in the sink, forms tubing-width coils, looking something like spaghetti.  The tip of the cannula can be felt sliding against the slick inside of the uterus. 

Abortion:  After the cannula is inserted and the procedure begins, the material often then comes down the tubing at a fast pace.  It’s watery & clumpy and not sticky, like a ME.  If the group was uncertain if the procedure was an abortion, they usually know at this point that it is an abortion.

Follow-up
Menstrual Extraction usually requires very little follow-up.  The menstrual material is discarded and the woman either continues to have some menstrual flow or she has no further flow.  All symptoms of menstrual go away.

Abortion: The material that is extracted is placed in a basin of water and additional water is poured into the bowl until it overflows and the solid pieces of material are gradually rinsed off and then examined.  If it is a very early abortion, the bits of material will look pale pink and fern-y.  Rarely can any particle be seen that looks like a part of a embryo.  If there is any doubt that there is still products of conception in the uterus, the group may do another aspiration either then or the next day, using another sterile cannula.  The person doing the abortion can feel the cannula rubbing against the ridged inside of the uterus, almost hearing a “scraping” sound.  The uterus will have contracted and it may be hard to extract the cannula because the os will have tightened around the tubing, grabbing it.

In the next week after the procedure, the group will keep close track of the woman who got the procedure.  If she starts having any pain, or any discharge from the uterus, they will want to get together and re-aspirate the uterus and extract any leftover tissue. If they do a thorough job, that’s usually the end of it.  Any further problem and they will want to consult will their medical back-up.  Needless to say, any excessive bleeding would be an immediate red flag.     

Legality:  If abortion is completely illegal, all of the above guidelines will be affected.  For example, even if a woman has an extra-tender cervix, she may tolerate a high degree of pain or discomfort in the insertion of the cannula.  Also, the group will bring in extra consultation, sometimes just with a more experienced member, to be absolutely sure they’re not dealing with an advanced pregnancy that might result in needing to go to a hospital to finish the procedure.

Social Network: Both Menstrual Extraction and Abortion in a Menstrual Extraction Group require close-knit groups with high level of trust.  Individuals must have a willingness to become well-trained and to be resourceful.  This is not a procedure to be performed by a loner or person who’s doing it for superficial motives, such as avoiding heavy periods or “helping out a friend”. 

STARTING A MENSTRUAL EXTRACTION GROUP 

In the past, menstrual extraction groups have typically formed in communities where women are geographically and philosophically close.  Communes, women’s health activists, small rural communities, college groups; these are possible places to start a menstrual extraction group.  

SUMMARY: Any group of motivated and conscientious women can learn and perform menstrual extraction (and early abortion) using the Del’em with a high degree of safety.  The real challenge facing such groups is to recruit and train a stable, disciplined group and build community support in the broader community, including sympathetic medical and legal personnel.    

Woman-Centered Pregnancy and Birth - Chapter 2

Excerpt from Chapter 2 of Woman-Centered Pregnancy and Birth by Ginny Cassidy-Brinn, R.N., Francie Hornstein, and Carol Downer
Federation of Feminist Women's Health Centers
Illustrations by Suzann Gage

Full Book AVAILABLE online for FREE

PDF of Chapter 2: Available ONLINE for FREE

Chapter 2: First, You Have To Get Pregnant

 

SIGNS OF PREGNANCY

Subjective Signs

Many women experience

• Breast tenderness
• Nausea
• Fatigue or sleepiness

Some women experience

• Breast enlargement
• More frequent urination
• Weight gain
• Sensitivity to certain tastes or odors
• Cravings for or ability to eat only certain foods
• Changes in the appetite

Uterine Signs

• Missed menstrual period (for most women)
• Softer uterus
• Enlargement of the uterus

7 weeks of pregnancy - the size of a lemon

9 weeks of pregnancy - the size of an orange

12 weeks of pregnancy - the size of a grapefruit

Cervical Signs

• Change of color to a deeper red or bluish-purplish
• Softer cervix
• The os is more open than usual

 

Cervical Examination

    Looking at the cervix provides valuable information in pregnancy detection and is usually included as part of an examination by a physician or health worker.  It is even more useful for a woman to look at her own cervix if she has done self-examination before and is familiar with the appearance of her cervix when she is not pregnant.  Many women notice changes in their cervices by comparing what they see to the way it usually looks.  A darkening in color to a deeper red or bluish-purplish color is characteristic of pregnancy.  This is caused by the increased blood supply to the cervix and uterus.  This color change can occur within days after conception or, in some women, it doesn't become apparent until she is several months pregnant.  When a woman is several weeks pregnant, the cervix is softer and the os is more open than usual. 

Uterine Size Check

    Feeling an increase in the size of the uterus can be another indicator of pregnancy.  Since it is very difficult for a woman to feel her own uterus, this examination is usually done by a friend in a Self-Help group, a health worker or a physician.  A uterine size check or pelvic examination provides more specific information about the length of a pregnancy than looking at the cervix or a chemical pregnancy test does.  And experienced examiner will be able to tell with reasonable accuracy (within one to two weeks), how many weeks pregnant a woman is by the size of her uterus.  For example, the uterus is about the size of a large, unshelled walnut or a plum if a woman is not pregnant.  The uterus of a woman who is about seven weeks pregnant is about the size of a lemon; nine weeks, the size of an orange; and 12 weeks about the size of a grapefruit. Making the comparison of uterine size to fruit sizes is helpful for training women in Self-Help Clinics, health workers and physicians.  It is also valuable for graphically explaining to women about the increase in uterine size in early pregnancy. 

    If a woman has participated in a Self-Help group together to feel the size of her uterus and report if it feels softer or larger than it previously did.

    The length of time since the union of sperm and egg is usually measured from the first day of a woman's last menstrual period.  This is done for uniformity since many women do not know exactly when they became pregnant.  In fact, even when women know the exact date that they became pregnant, physicians still measure Gestation from the first day of the last normal menstrual period (LNPM).  The actual size of a woman's uterus is used less often by physicians.

    Any one subjective sign or observable characteristic of a woman's cervix and uterus is usually not enough for her to conclude that she is pregnant.  More often, it is a combination of these factors together with the knowledge that she was exposed to sperm at a time in her cycle when it was likely that she had ovulated.  However, some women have such regular menstrual periods that a matter of a few days of delay of their periods signals a sure sign of pregnancy to them.

    There are situations in which women find it difficult to determine whether or not they are pregnant.  Women who have irregular periods, who are under great stress, women who are nearing menopause, women who have recently stopped taking the Pill, or women who have signs of pregnancy often have difficulty in determining pregnancy without the help of a chemical test.  Occasionally, a woman has some bleeding around the time of her expected period when she is actually in the early part of her pregnancy.  Many a woman mistakes this for her regular period, especially if she has no other indication that she is pregnant.  Usually, this bleeding is different from a normal period; sometimes there is a lighter flow or the flow does not last as long as a regular period.  Also, having these episodes of bleeding can cause women or their physicians to think they have not been pregnant as long as they have been.  In these instances, having a uterine size check is particularly important. 

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