Changes

In the immediate post-''Roe'' era, abortions past the midpoint in pregnancy were typically performed by instillation, in which drugs or chemicals, alone or in combination, were used to cause fetal demise and induce labor. These abortions carried with them numerous drawbacks. They were risky for the mother, since the chemicals used to kill the fetus could severely injure or even kill the mother if they entered her bloodstream.<ref name="Wagatsuma1">Wagatsuma, T.: "Intraamniotic Injection of Saline for Therapeutic Abortion," ''American Journal of Obstetrics and Gynecology'', November 1, 1965</ref> They were also logistically challenging, requiring a typical multi-day hospital stay. Furthermore, they required a delay until about 16 weeks into the pregnancy, prior to which point there was not sufficient amniotic fluid for the practitioner to extract and replace.<ref name="Cates1">Cates, W. Jr., Schulz, K.F., Grimes D.A., et al: "The Effects of Delay and Method of Choice on the Risk of Abortion Morbidity," ''Family Planning Perspectives'', 9:266, 1977.</ref>

In the immediate post-''Roe'' era, abortions past the midpoint in pregnancy were typically performed by instillation, in which drugs or chemicals, alone or in combination, were used to cause fetal demise and induce labor. These abortions carried with them numerous drawbacks. They were risky for the mother, since the chemicals used to kill the fetus could severely injure or even kill the mother if they entered her bloodstream.<ref name="Wagatsuma1">Wagatsuma, T.: "Intraamniotic Injection of Saline for Therapeutic Abortion," ''American Journal of Obstetrics and Gynecology'', November 1, 1965</ref> They were also logistically challenging, requiring a typical multi-day hospital stay. Furthermore, they required a delay until about 16 weeks into the pregnancy, prior to which point there was not sufficient amniotic fluid for the practitioner to extract and replace.<ref name="Cates1">Cates, W. Jr., Schulz, K.F., Grimes D.A., et al: "The Effects of Delay and Method of Choice on the Risk of Abortion Morbidity," ''Family Planning Perspectives'', 9:266, 1977.</ref>

The dilation and evacuation (D&E) abortion technique had already been developing, "in part because surgeons needed a `right now' solution to complete suction abortions inadvertently started in the second trimester and in part to provide a means of early second trimester abortion to avoid necessary delays for instillation methods."<ref name="Haskell">Haskell, M.: "Dilation and Extraction for Late Second Trimester Abortion," Presented at the National Abortion Federation Risk Management Seminar, September 13, 1992</ref>

The dilation and evacuation (D&E) abortion technique had already been developing, "in part because surgeons needed a `right now' solution to complete suction abortions inadvertently started in the second trimester and in part to provide a means of early second trimester abortion to avoid necessary delays for instillation methods." As practitioners became more skilled and more confident, they performed D&E later and later in pregnancy, and this method began to eclipse the use of instillation methods.<ref name="Haskell">Haskell, M.: "Dilation and Extraction for Late Second Trimester Abortion," Presented at the National Abortion Federation Risk Management Seminar, September 13, 1992</ref>

As one practitioner noted, "Classic D&E is accomplished by dismembering the fetus inside the uterus with instruments and removing the pieces through an adequately dilated cervix."<ref name="Haskell"/> He also noted that at and beyond 20 weeks of gestation, most abortionists found the fetal tissues too tough to easily tear apart. Thus, methods were developed to kill the fetus in-utero a day or more prior to dismemberment, so as to allow autolysis or softening of the fetal tissues. This method, however, also carried a risk of infection.<ref name="Haskell"/>

As one practitioner noted, "Classic D&E is accomplished by dismembering the fetus inside the uterus with instruments and removing the pieces through an adequately dilated cervix."<ref name="Haskell"/> He also noted that at and beyond 20 weeks of gestation, most abortionists found the fetal tissues too tough to easily tear apart. Thus, methods were developed to kill the fetus in-utero a day or more prior to dismemberment, so as to allow autolysis or softening of the fetal tissues. This method, however, also carried a risk of infection.<ref name="Haskell"/>