Post Abortion Trauma Healing Service - Complications of Abortion

Post Abortion Trauma Healing Service
PO Box 1557, Christchurch 8040
P. 03 379 7710 F. 03 980 4589

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Possible Complications of Abortion

Possible Physical Complications

Possible Psychological Complications

Post Abortion Stress or Syndrome

Grief After Abortion

Possible Spiritual Complications

POSSIBLE PHYSICAL COMPLICATIONS

Physical complications may arise immediately after the operation or occur later. Immediate physical complications, which can be serious though rarely fatal, include:

Uterine Perforation
Haemorrhage
Septicaemia

Where an abortion is incomplete with retained foetal or placental products another operation (dilation and curettage) is usually required to evacuate the uterus. ⁽¹⁾

Chronic or Long Term problems may include

Gastro-intestinal Disturbances
Infection including
Pelvic Inflammatory Disease - Infertility
Endometritis
Problems with future pregnancies such as
Placenta praevia
Ectopic pregnancy
Cervical lacerations & cervical incompetence predisposing to
Premature delivery
Labour complications ⁽²⁾
Links between abortion and breast cancer are being made

These physical sequelae can be painful and upsetting for women. The ramifications spread wider and invariably impact deeply upon the lives and relationships of those affected. Statistics are limited, and do not give an accurate picture of the often chronic problems, nor do they reflect the real lived experiences of the women involved.

The following complications were reported by the Abortion Supervisory Committee for the 1999 year.

Complication	Number
Cervical Laceration Tear	1
Perforation of the Uterus	15
Haemorrhage 500 mls or more	19
Retained Placenta Tissue	25
Failed Termination Requiring 2nd Procedure	1
Siezure	1
Pain Post-op	1
Total	63

(Note: These statistics fail to give an accurate picture of the extent of problems in the New Zealand population. Many of the physical problems associated with an abortion occur after the post-operative period and some become long-term problems. Women confront general practitioners with physical and emotional problems but many doctors fail to recognise the possible connection to a recent or past abortion.)

REFERENCES:
1. Complications of termination of pregnancy: a retrospective study of admissions to Christchurch Women’s Hospital , 1989 and 1990, NZ Medical Journal, March 1993
2. The Aftereffects of Abortion , http://www.afterabortion.org/complic.html

POSSIBLE PSYCHOLOGICAL COMPLICATIONS

There is a general perception that women are liberated by abortion. However, the attempt to “get rid of” a problem, often produces problems of its own. There is no such thing as a simple uncomplicated abortion, because abortion is always the disruption of the psycho-biological process of pregnancy and always involves the loss of a child, albeit unborn. The trauma involved in being both attached to, and responsible for the death of one’s foetal child can be emotionally overwhelming. ⁽¹⁾

Dr Julius Fogel, a psychiatrist and obstetrician who has performed hundreds of abortions himself said: One is dealing with the life force. It is totally beside the point whether or not you think a life is there. You cannot deny that something is being created and that this creation is physically happening… Often the trauma may sink into the unconscious and never surface in the woman’s lifetime. But it is not as harmless and casual an event as many insist… A psychological price is paid. It may be alienation; it may be a pushing away from human warmth, perhaps a hardening of the maternal instinct. Something happens on the deeper levels of a woman’s consciousness when she destroys a pregnancy. ⁽²⁾

Regardless then of how a woman views the developing baby growing inside her or experiences her pregnancy, there is a sense there exists a primitive bond between mother and child, which although not able to be glimpsed from the outside is a profound attachment that may seem shadowy and submerged even to her. If this was not the case, having an abortion would not be more difficult than having a tonsillectomy or appendicectomy. ⁽³⁾

There are physiological changes associated with the disruption of an otherwise normal pregnancy, and sudden hormonal changes can create mood swings and bodily upsets in the early stages after an abortion, as with any pregnancy loss.

Significant distress may be experienced, particularly for women who suffer post-operative complications necessitating further treatment and/or hospital admission, those who experienced a high degree of ambivalence about the pregnancy, moral conflict over the abortion decision, or pressure to abort the baby.

In the absence of initial complications, the short term effect of an abortion is often relief - the operation is over and there is no longer a need to face the unwanted or difficult pregnancy with all the accompanying distress and subsequent responsibilities. This may be “followed by a period psychiatrists identify as emotional “paralysis”, or post-abortion “numbness.” ⁽⁴⁾ Psychological defences, such as denial and repression of feelings, tend to come into action fairly quickly, to cope with the stress and changes incurred in the decision making process, living through the actual procedure, the recovery and adjustment period afterwards, relationship issues and other aspects.

Some women may experience acute and severe reactions. Others appear to adjust well to the loss incurred in the abortion and it would not appear to impact greatly. Some have no identifiable symptoms and show few negative reactions initially, but are at risk of developing symptoms of at some future stress point (often a new pregnancy, inability to conceive or complete a pregnancy, or some other major loss or crisis). Many women are suffering emotionally from a procedure which was supposed to be emotionally benign. ⁽⁵⁾

REFERENCES:

1.	Complicated Mourning: Dynamics of Impacted Post Abortion Grief , Anne Speckhard, PhD, and Dr Vincent Rue, PhD, Pre- and Perinatal Psychology Journal, 1992
2.	Aborted Women: Silent No More By Dr David C Reardon, Loyola University Press, 1987, p141
3.	Complicated Mourning: Dynamics of Impacted Post Abortion Grief , Anne Speckhard, PhD, and Vincent Rue, PhD, Pre- and Perinatal Psychology Journal, 1992, p2
4.	Kent, et.al., Bereavement in Post-Abortive Women: A Clinical Report , presented at the annual meeting of the Canadian Psychiatric Association, Saskatoon, Sept. 1977
5.	Giving Sorrow Words , Melinda Tankard Reist, Duffy & Snellgrove, Sydney, 2000

POST ABORTION STRESS OR SYNDROME

Researchers suggest that women can report abortion-related distress similar to classic Post Traumatic Stress Disorder (PTSD) symptoms and that these symptoms may be present many years after the abortion. Most trauma victims encounter feelings of horror or terror at the time of the traumatic episode, but many women are in complete denial that they have experienced an abortion and indeed that it was traumatic. This denial can be seen as a major contributing factor to the development of post traumatic stress. ⁽¹⁾

In 1987, the American Psychiatric Association stated in its then newly revised manual of diagnostic criteria, the Diagnostic and Statistical Manual of Mental Disorders III-R (DSM-III-R), that abortion is a type of ‘psychosocial stressor’ (an event outside the range of usual human experience) of the type capable of causing ‘post-traumatic stress disorder’. It doesn't matter what the pattern of symptoms is labelled or if you choose to consider post-abortion stress as a PTSD or not, the important thing to be aware of and acknowledge when dealing with post-aborted women is that the symptoms and experiences are real. Following is the pattern of symptoms generally recognised as Post Abortion Stress/Syndrome (PAS):

Re-experiencing the trauma

nightmares, flashbacks, recurrent dreams (of the abortion, the baby or death)
anniversary reactions (on date of abortion or expected date of delivery)
distress at exposure to events that resemble some aspects of the abortion (pelvic examination, sexual intercourse, childbirth, sound of vacuum cleaner)

Avoidance or denial type behaviours

avoiding thoughts or feelings about the abortion
avoiding situations or activities that cause thoughts of the abortion (medical examinations/procedures, exposure to babies or pregnant women, conversations about pregnancy or abortion....)
memory blocks or inability to recall aspects of the abortion
emotional numbing, withdrawal from others

Increased arousal

sleep disturbances e.g. insomnia
irritability or outbursts of anger
difficulty concentrating
hypervigilance e.g. being watchful, on the alert, suspicious
exaggerated startle response - on edge, jumpy, overreactive

Associated symptoms

depression, frequent crying, anxiety
grief (sometimes intense), sadness, sense of loss
guilt, inability to forgive oneself
self-destructive behaviours, including drug/alcohol abuse, promiscuity, eating disorders, suicidal impulses ⁽²⁾

Anxiety over fertility and child-bearing issues

Subsequent children

⁽³⁾

Subsequent relationship problems

Depression

Depression is worth a special mention as it is recognised as one of the most frequent recognisable abortion sequelae, particularly where it originated around the time of, or following, the event. Shame, secrecy and thought suppression regarding an abortion are all associated with greater post-abortion depression, anxiety, and hostility. ⁽⁴⁾

Depression may be associated with impacted or pathological grief (loss of the baby, loss or a role, loss of a dream). Depression may be the result of unexpressed anger, changes in primary relationships or personal circumstances or deeper unresolved issues. Interestingly, the frequency and degree of severe depression associated with abortion is far higher than with miscarriage, even though the loss in each case is comparable. ⁽⁵⁾ Whether this is due to the fact miscarriage is generally regarded as an unfortunate accident and abortion the result of “choice” attached to it is not fully understood.

Some studies also show that the incidence of suicide is higher for abortion than miscarriage, and data suggests that abortion is more likely than pregnancy and childbirth to drive an unstable woman to suicide. ⁽⁶⁾

REFERENCES:

1.	Post-traumatic stress disorders in women following abortion: Some considerations and implications for marital/couple therapy , D. Bagarozzi, Internat. Journal of Family and Marriage 1:51-68, 1993 The Long TermPsychosocial Effects of Abortion , C. Barnard, Institute of Pregnancy Loss, Stratham, New Hampshire, 1990. Also refer Hanley et al. 1992.
2.	The Mourning After by Terry Selby, Baker Book House, Grand Rapids, 1990
3.	The Wounded Generation , Victoria M. Thorn, Post Abortion Review, Vol 5, No.1, Winter 1997
4.	Clinical Depression After Unintended Pregnancy Linked to Abortion , www.afterabortion.org/
5.	Aborted Women. Silent No More , David Reardon, Loyola University Press, Chicago, 1987,
6.	The Abortion Suicide Connection , Post Abortion Review, Vol 1, No.2, 1993 Suicides after pregnancy in Finland , M. Gissler, E Menninkin, and J Lönnqvist, British Medical Journal 313:1-11, 1996

GRIEF AFTER ABORTION

Every mother or father of an aborted child knows the truth - their children are gone forever and cannot be brought back or replaced. There will always be a void in their lives - a void made more painful by memories and regrets, and dreams of what their child might have been. ⁽¹⁾

Grief is a normal, natural, healthy process, of acknowledging and experiencing our real feelings about and adjusting to living with any significant loss. Expressing painful and hurtful feelings helps to release you from them and relieve the pain they induce. Gradually as you move through the feelings, you become less overwhelmed by them and they lose some of their power over us. Some of the feelings may never go away entirely, but the power they have over you and your life will diminish.

After an abortion, it is not unusual after an initial sense of relief, you might plunge into an unpleasant, painful place of distressing feelings and confusing thoughts. Life takes a dip. With awareness of the loss you may sink down and feel overwhelmed. The dip can take you down into a mix of feelings e.g. sadness, hurt, anger, guilt, fear... which may be experienced very intensely, over and over, and mixed together over time. This ebb and flow of feeling can be distressing, and many people try to avoid going through it. However, the only way through is through, if you are to find new features to give your life meaning and direction.

Even though an abortion decision has seemingly been your ‘choice’ and a voluntary decision, the reality of the loss of the baby through the termination of the pregnancy, often evokes feelings of sadness and grief, which may be expressed immediately following the abortion as distress, or may be suppressed. If you hang on to the feelings they may begin to consume you - you may internalise the feelings and they become more and more who you are, or they may manifest as physical symptoms. Unexpressed feelings, such as anger, may manifest as depression, affecting sleep patterns, appetite, energy levels, libido, ability to concentrate, motivation.... or anger may be expressed outwardly, and sometimes inappropriately, at others.

The perception of loss of a pregnancy is individual, and the experienced impact of the loss of a baby through abortion varies from person to person. The significance of that loss may not be uncovered until the healing process has begun and grief is expressed. Understanding the process of grief then, is about understanding the significance of the loss for the self, and what it means. If you experience the abortion as particularly traumatic, or feel that your personal boundaries have been violated, or feel abandoned... and if your grief becomes impacted, the process of recovery may be prolonged and complicated.

Abortion grief may only surface when another significant change or trauma occurs in your life. Conversely, other unresolved grief issues may surface, and need to be dealt with in conjunction with the abortion grief.

Grief is a process and can take time. Sometimes the grief process may begin, but is not completed as you become stuck at a particular point. It can feel particularly difficult to get past the feelings of guilt and anger if these dominate your heart. Before grieving can be fully entered into you need to confront your guilt and deal with anger. You need people who can be there for you, listen to your confusion, tolerate your feelings, and who will give you ongoing support. Sometimes it is helpful to talk to someone uninvolved who has special skills of listening and caring.

I lament the death of my baby
I feel empty inside
Overwhelmed by a sort of haunting sadness....

Why didn’t anyone ever tell me
that grief felt so like fear,
and that I would cry
more than I would laugh..

I never dreamed it could be so painful -
It all feels so unreal, and it’s like
Going through the motions quite disembodied.
Now my baby is gone, my partner is gone,
and I am alone......

WESTBERG'S JOURNEY THROUGH GRIEF ⁽²⁾

1. Shock & denial - These mechanisms help you to absorb your sense of loss without being totally overwhelmed. There may be a feelling of numbness and sense of moving like a robot or disembodied feeling. You may not remember much of events surrounding the abortion or immediately following.

2. Immediate expression of feelings - Pain & sadness (tears), anger, fear... are not uncommon.

3. Disturbances in physical functions - Bottling things up and holding the pain in can increase the stress in our bodies e.g. gastro-intestinal disturbances, problems sleeping, headaches, abdominal pain....

4. Depression & panic - All is dark and gloomy, life feels like a nightmare, it may be hard to cope, you may question "Is life worth it?"

5. Guilt - Tormenting yourself about failings, regrets and feelings of remorse may happen and keep happening until you begin to address what really happened in the abortion and what is meant for you.

6. Anger, resentment, rage - These feelings and emotions need to be expressed and may relate to feelings of being let down, betrayed, abandoned.... You may feel you need to come to forgive before being able to turn the corner.

7. Idealisation - Holding the past as best and convinced life cannot be good again. When your energy is locked into what was, could have been or should have been, there is less energy available to develop the future positively.

8. Realisation begins to dawn - When you are able to see the weakness of the past situation and accept the bad with the good you can begin to hope again.

9. New patterns begin to emerge - Here there is some new thinking and new routines, finding new reasons to get up and go on with everyday life.

10. Living with the loss - There has been significant adjustment to the loss and the loss becomes part of the fabric of life and integrated into the self. At times feelings of sadness or fear may cause disruption but life begins to hold new meaning and you are functioning well.

REFERENCES:
1. Men and Abortion, Grief and Healing , Brauning, Dr Wayne, Post Abortion Review, Vol 4, No.4, Fall 1996
2. Adapted from Good Grief, a Constructive Approach to the Problem of Loss, Granger E. Westberg

POSSIBLE SPIRITUAL COMPLICATIONS

A woman’s spirituality, faith or religious beliefs can impact on issues and feelings relating to her abortion.

Often a woman instinctively reacts to an unwanted pregnancy resolving her crisis by having an abortion, and she may not have time or the opportunity to fully explore the possible impact of her decision. Often the seemingly sound practical reasons for proceeding with an abortion, outweigh spiritual or religious concerns when under pressure to make a decision.

Many factors contribute to a woman’s spiritual experience and response to her abortion: her sense of (or lack of a sense of) God and her relationship with God, whatever she conceives God to be; her experiences of traditional religion and religious teachings, which may have shaped her beliefs and contributed to forming her spirituality, its nature and depth, and her sense of morality.

Feelings are complicated if a woman believes she has contradicted the will of God by aborting her baby, and deep hurt may open within her heart and psyche. “Have I made a mistake?” “Will I be punished for this decision?” are key questions a woman may ask herself as she deals with the spiritual implications of what she has done. She can easily become trapped in long-term fear, guilt and shame. Devoutly religious women from denominations that ban abortion often fear they may struggle with misgivings about their past abortions, whilst women who feel a less rigid religious identification are sometimes amazed by their spiritual or conscious discomfort afterwards.

A woman who terminates a pregnancy is usually aware of the ways in which her religion regards abortion; she is also aware of how her family, friends, and the members of her religious community (where applicable) would view her decision in light of their own spiritual or religious convictions. This however can seem of less concern than dealing with the immediate problem of an unplanned or unwanted pregnancy and is overridden by a need to get rid of the problem.

A woman’s sense of her relationship to her body and her ability to create life is significant. For a woman to simultaneously view herself as ‘creator’ and a ‘destroyer’ can generate confusion, a vital questioning by her of her character, conflict in her moral convictions and her identity as a spiritual person. ⁽¹⁾

Abortion is a life-death experience, and affects a woman at every level of her being - physical, mental, emotional and spiritual. Dealing with the loss of her baby, at the core of her being can be extremely painful, and moving through grief can be difficult, especially if grief is denied.

If a woman perceives her abortion experience as traumatic, it may overwhelm her normal coping mechanisms, leaving her feeling not only psychologically but also spiritually wounded. Violence, or perceived violence, traumatises the body, mind and soul. When someone has been traumatised, they may “lose their breath”. Recovery from trauma then is also about recovery of the wounded spirit. ⁽²⁾

Some symptoms of spiritual dis-ease include feelings of fear, despair, impatience, jealousy, disillusionment, emptiness, sadness, anxiety, loneliness, bitterness, hopelessness, boredom, insecurity, irritation, anger... Signs of spiritual dis-ease might include:

indifference towards others or self-pity
lessening of wonder and enthusiasm
lessening of gentleness and courtesy, rudeness, teasing, sarcasm, nagging
bad humour, quarrels, quick temper
chronic feelings of being used or misunderstood
routine or mechanical communication
taking advantage of others or taking others for granted
pre-occupation with or neglect of self
continuous escapes: do-gooding, overindulgence/misuse of food, alcohol, sex

Women often express this ‘disquiet’ deep inside, often afraid and unsure about what is happening, feeling disconnected, alone... and it can seem like nothing quite makes sense anymore. There is a sense that ‘something is not right’ at the deepest level, indicating a sense of separation from God or spiritual alienation. Guilt and shame can become magnified and the desire to run or hide is a natural response.

Some women describe the feeling of being trapped in a dark place, filled with pain and unspoken fear. A woman’s sense of self-worth decreases and she can sometimes think she cannot possibly be forgiven for her part in the death of her baby. This is usually an unconscious process, and manifests in the physical and emotional symptoms and signs. Self-judgement is often huge and self-forgiveness can be the biggest obstacle.

Some of the spiritual work in dealing with the aftermath of an abortion experience:

breaking through denial and grieving
discovering ‘how the trauma has affected me’ and ‘who I am now’
overcoming guilt and shame
understanding and resolving the spiritual and moral conflicts that arise
offering and receiving forgiveness and unconditional love
finding self-acceptance within present spiritual beliefs or redefining beliefs to include the reality of the abortion

The journey into darkness and isolation can, with appropriate spiritual help lead into the intimacy of being known and the joy of being healed.

“I know the plans I have for you” declares the Lord, “plans to prosper you and not to harm you, plans to give you hope and a future.” (Jeremiah 29:11)

REFERENCES:
1. The Healing Choice , Candace de Puy & Dana Dovitch, Hodder & Stroughton, 1997
2. A Spirituality of Trauma , Joe Wardhaugh, FMSA., Human Development Vol 21, No. 3, Fall 2000


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