What happens to the fetus during the abortion

Termination of pregnancy after a suspicious PND finding

The news that their child is likely to be born with an illness or disability can make difficult decisions for pregnant women and couples. If you are considering an abortion, it is important to know the legal requirements.

Find a way

In the course of pregnancy it can become apparent that a child will be born sick or disabled. Sometimes the developmental disorder is so severe that the child will die during pregnancy, at birth, or soon after. Or many medical interventions can be expected after the birth, from life-saving measures to serious operations.

If there is an abnormal finding, a world of hope collapses for many expectant women and couples. You get into a deep crisis and experience moments of despair and fear of the future. Not infrequently they have to find a way in a situation where no decision feels really good or right. There are also no sure answers to many questions: What would my or our life with the sick or disabled child look like? How could I do this mentally and physically? And what will happen to me, what will happen to us if I cannot imagine that?

Many couples find it helpful to talk to friends and family in this situation. A conversation in a counseling center can also be of great help. The counselors have a lot of experience and can support the women and couples in their decision-making and in all further steps.

Even if you would like to end the uncertainty as quickly as possible in such a situation: You can usually better respond to decisions that are made carefully and with care later. Whatever decision you make: it always remains a part of your own life.

The medical indication

If it is foreseeable that the continuation of the pregnancy will seriously endanger the physical or mental health of the pregnant woman, this can be a medical indication for a legally permissible termination of pregnancy, even after the twelfth week of pregnancy. However, the law makes the medical indication subject to certain requirements:

  • Only a doctor can make the medical indication.
     
  • Taking into account the current and future living conditions of the pregnant woman, there must be a danger to life or the danger of serious impairment of the physical or mental state of health of the pregnant woman, which cannot be averted in any other reasonable way.
     
  • There must be three full days between the notification of the diagnosis and the written indication, unless there is an immediate health risk to the life of the pregnant woman.
     
  • Before the medical indication is issued, the doctor must advise the pregnant woman on the medical and psychological aspects of an abortion and inform them about the possibility of further psychosocial advice. If the pregnant woman so wishes, the doctor is obliged to put people in touch with counseling centers.
     
  • If the pregnant woman is given a written certificate of indication, she must confirm to the doctor in writing that she has received medical advice and has been advised of the possibility of advice from other offices.

Affected women have a legal right to talk to a pregnancy counseling center in order to clarify their feelings and thoughts and to make a decision with the help of the counselor. The counseling can help to say goodbye to the ideal of a healthy child and to give space to grief. It can help the woman and the couple to cope with the crisis and the helplessness and excessive demands associated with it. Feelings like guilt, self-doubt, anger, and sadness are quite normal in such a situation. Finding ways to deal with it is also the aim of counseling.

However, the pregnant woman decides for herself whether or not she wants to contact pregnancy counseling centers, self-help groups, associations for the disabled or other offers of help. There is no compulsory consultation. If the pregnant woman waives the consultation, she must confirm this in writing.

The termination of pregnancy

In most cases, pregnant women and expectant parents find out late that their unborn child is sick or will be disabled. It is then often so large that it is no longer possible to terminate the pregnancy using the suction method or scraping the uterus. In the case of abortions after the twelfth week of pregnancy after conception (i.e. after the 14th week after the first day of the last period), a birth is initiated with medication.

The medication is necessary because at this point the pregnant woman's body is geared towards maintaining the pregnancy and not yet ready for the birth. They are supposed to soften the cervix and trigger labor and thus initiate a birth. It generally takes a few hours before the intended miscarriage occurs, but it can also be a few days. Pain relievers may be taken or epidural anesthesia may be used to treat pain.

The induced birth takes place in a delivery room or in a labor room. She is looked after by a doctor and a midwife. Once the child is born, the parents can watch it if they want and be alone with him for a while.

It may be necessary to scrape the uterus under a brief general anesthetic after the birth, for example if placenta remains in the uterus. If there are no complications after the termination and if her general condition is good, the woman can leave the clinic after a few hours.

Even after such a miscarriage, the body begins to produce milk. The formation of milk can either be stopped with medication or by cooling the breasts with cold compresses and tying them up with an elastic bra. A midwife can give advice and support here. The breasts react to the lack of signals within a few days and stop producing milk.

Before or after the termination of the pregnancy, the parents are likely to be asked for consent to a tissue removal or autopsy of the child so that the exact clinical picture can be determined. This can be useful for a new pregnancy.

What to consider

From about the 20th week after conception, the probability increases that the child will survive the initiated birth and also be viable. In this case, doctors are ethically and legally obliged to keep the child alive. With the consent of the pregnant woman, a so-called fetocide can therefore be carried out before the birth. This means that a potassium chloride solution is injected into the child's heart or umbilical vein, which leads to an immediate cardiac arrest and thus to the death of the child.

Doctors are not obliged to carry out such a termination. Midwives can also refuse to participate. In many clinics, an ethics council consisting of medical staff, midwives, pastors and psychologists jointly decides on the implementation of a late abortion.

After the termination of pregnancy

As a rule, the body and soul need their own time to cope with the termination of the pregnancy and the farewell to the child and to complete the regression and healing processes. You may be entitled to the maternity protection period after the birth. If not, it can make sense to take at least a short break from work.

In addition to the physical consequences, a late termination and, in particular, a fetocide mean enormous emotional stress for many women and couples. In addition to the grief for the child, quite a few also feel guilty or doubt their decision. Perhaps feelings of inadequacy and powerlessness towards fate also arise. In this exceptional situation, many affected parents are helped by psychosocial counseling and support, as well as discussions and close contact with the obstetric team. Support groups run by parents who have had similar experiences can be another important source of support. They can help mourn the loss, come to terms with fate, and develop new confidence.