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why terminate a pregnancy in the later stages and how it is done in Krasnoyarsk

“Like a bolt from the blue”

“We counted the fingers and toes, saw how the heart was beating. Then there was a short pause, and the doctor asked us to go for a walk so that the baby would roll over and he could finish the study. When we returned, there were already two doctors in the doctor's office. Now they were staring at the monitor together and trying to see something. I understood that there were some problems.

And suddenly, like a bolt from the blue, the phrase sounded: “I can’t see the baby’s bladder. There is some kind of education, but what it is is too hard to understand ", - there are hundreds of stories with a similar beginning.

For many women, becoming a mother is a cherished dream. In most cases, pregnancy ends safely - the birth of a healthy baby. But sometimes families get a disappointing prognosis even at the stage of the first ultrasound and tests. Finding out that a child has serious illnesses is always difficult, especially if the health of the father and mother is all right and there are no prerequisites for terrible diagnoses.

Where to go, what to do, what decisions to make? These are only the first questions that arise in pregnant women who have received a poor prognosis.

It is not customary in society to discuss this topic. In our time, when the question of whether abortion is considered murder is still unresolved, the topic of late pregnancy termination, when the unborn child is not just an embryo, but already looks like a full-fledged baby, is painful even for the medical community.

"No error"

Memories of mothers who have experienced the loss of a child (from the forum of the charity fund "Light in Hands"): "After 12 weeks, no one will terminate a pregnancy without a special consultation of doctors and a clearly established diagnosis. Needless to say, none of the doctors spoke to us normally, no one explained a clear sequence of actions, terms, risks, what does “abortion of pregnancy”, etc. mean in general?

Genetic abnormalities are detected at the stage of pregnancy screenings, there are three in total. Screening is a set of studies that allows you to get the most complete information about the health of the fetus. If the ultrasound doctor has doubts during the examination, the patient is sent to the Medical Genetic Center.

“Of course, most of all we are tuned in to early diagnosis, namely, to identify some abnormalities up to 12 weeks, less often up to 21-22 weeks. But sometimes there are cases when deviations can be detected only in the second half of the term: usually this happens either when a woman registers late and has never been examined before, or when the pathology manifests itself late. Then a decision is already made on a more detailed examination and on the possible termination of such a pregnancy, ”said Tatyana Elizaryeva, head physician of the medical genetic center.

The Medical Genetic Center of Krasnoyarsk sees patients from all over the Krasnoyarsk Territory. In the event that the doctor has doubts about the health of the child during the screening, the pregnant woman is sent for a more detailed examination

If the woman has passed all the examinations and the diagnosis is confirmed, she is invited to the medical commission of the genetic center. You can come to it either alone or with your husband or family members, usually the patient is asked how it is convenient for her. The commission includes several specialists: an ultrasound diagnostician, a neonatologist, an obstetrician-gynecologist, a doctor specializing in a particular pathology (cardiac surgeon, neurosurgeon, pediatric surgeon, etc.). There, the woman is told in detail about what is happening, what kind of pathology the child has, whether it can be treated and what kind of treatment it is.

“It is important to let a woman understand what she is facing and offer all possible options. If these are chromosomal disorders and an intellectual deficiency in the fetus, for example, Down's syndrome, we explain that a child can be born and, in the absence of any physical disabilities, even be able to develop - sit, perhaps write and draw, communicate a little. But we also make it clear that such a child will never be able to live independently, especially after the departure of parents or other guardians, such a child requires rather large financial costs, which not every family is ready for, such a child will always require more attention and strength, and for his parents will have to fight every step in his development. All this is necessary so that families understand what they are getting into in both cases. In any situation, we, as doctors, are obliged to respect their choice,” emphasizes Tatiana Elizarieva.

After a medical consultation, any couple has time to think and make an informed decision. Doctors note that today the equipment and technology of the medical genetic center excludes even the very possibility of making an incorrect diagnosis. In addition, in each case, the results of the tests are processed by several doctors, each giving an opinion and recommendations on pregnancy.

“This is a forced measure”

Up to 22 weeks, pregnancy can be terminated, including by medication. The procedure is carried out in the Krasnoyarsk maternity hospital No. 4.

“Medical indications for termination of pregnancy from 12 to 22 weeks are fetal developmental anomalies that are incompatible with life and cannot be surgically corrected,” said Lyudmila Popova, chief physician of maternity hospital No. 4.

This is a chromosome analysis. In a healthy person, all chromosomes are paired, in the picture at number 21 there are three chromosomes instead of two. This is what Down syndrome looks like

According to doctors, a woman can choose to terminate her pregnancy or report it. But often mothers do not fully realize what they doom themselves and their families to when they give birth to children with serious pathologies or non-viable ones.

Memoirs of mothers who experienced the loss of a child from the forum of the charity foundation "Light in Hands"): "The diagnosis was terrible, the doctors said that children with such pathologies are born dead or die in infancy. Realizing that losing a baby, a long-awaited daughter, after her birth would be simply fatal for me, I agreed to an abortion for medical reasons. To be honest, I still don’t understand if I did the right thing, and I blame myself that I went along with my relatives and doctors by agreeing to this abortion.”

“It is very hard to survive. Walk for 9 months and know that a child can die on the first or second day. What is more difficult: walking and knowing that it will be so, or terminating a pregnancy in the middle? Usually women agree with the opinion of doctors, but sometimes they still decide to leave the child, ”says Lyudmila Popova.

In general, most often, before the 22nd week, women agree and go for an abortion.

“This is not just an abortion at the request of a woman, this is a forced measure. Because then supporting the lives of these children is a colossal burden. It happens that mothers then refuse them, because they cannot cope, they give them to the Homes for the Disabled, and then the state takes care of these children, ”concluded Lyudmila Popova.

“After 22 weeks, this is already a full-fledged birth”

Until 2019, in the Krasnoyarsk Territory, pregnancy was not terminated at later stages (after 22 weeks of pregnancy) due to indications from the fetus (congenital malformations incompatible with life, which for some reason have not been previously identified). Women had only one way out - to give birth to a child with a pathology. And only at the end of 2018, the clinical protocol of the Ministry of Health of the Russian Federation "Artificial termination of pregnancy at a later date for medical reasons in the presence of fetal developmental anomalies" was approved, on the basis of which this medical technology was introduced in the Krasnoyarsk Regional Clinical Center for Maternal and Child Health.

The procedure for terminating a pregnancy at a later date is the same throughout Russia: an anesthetic is administered to the fetus in utero, after which the elimination (cardiac arrest) of the fetus is carried out, and labor is induced. The procedure is performed by an ultrasound doctor, an anesthesiologist, an anesthetist nurse and a laboratory assistant.

“Like any manipulation, the interruption procedure has certain risks associated with both the use of medications and the operation. Bleeding may develop, there may be negative consequences from drugs - side effects, allergies. Any intervention in a woman's body, even at the present stage of the development of medicine, is always a health risk that can lead to complete deprivation of reproductive function. Many couples decide to prolong the pregnancy, hoping for a miracle, for a diagnostic error, ”says Pavel Baurov, head of the advisory clinic at the Regional Clinical Center for Maternal and Childhood Welfare.

Head of the advisory polyclinic of the Regional Clinical Center for Maternal and Childhood Pavel Baurov

Women who refuse to terminate a pregnancy in case of medical indications, most often name their personal beliefs as the reasons, as well as their families. In the case when a decision is made to leave a non-viable child, the patient continues to be observed in the consultation.

How to survive the impossible

Late pregnancy termination is a severe psychological trauma. After the procedure itself, each woman is waiting for the rehabilitation process, a psychologist always works with her. Now there are such specialists at every antenatal clinic. A psychologist from the Center for Maternal and Childhood Welfare talks with a patient before and after the procedure.

“A woman in such a situation has a lot of difficult experiences. And one of the most difficult that appears at such moments is the feeling of guilt. Thoughts often arise in the mother’s head: “How could I allow this to be done?”, even if the situation is completely hopeless. The moment of choice also leaves an imprint - the woman still decides whether to terminate her pregnancy or keep it. Guilt, as a rule, is irrational, not corresponding to the real situation, ”the psychologist notes.

Memories of mothers who have experienced the loss of a child (from the forum of the charitable foundation "Light in Hands"): “Two years have passed. And yes, we still gave birth to a child, a beautiful daughter. But there was not a day that I did not remember my first daughter. I wake up in the middle of the night and remember those days. I keep these memories as the only thing left of my child.”

Medical termination is exactly the same antenatal loss ( situation where the baby dies at during pregnancy — ed. ). A woman loses a baby for a long time, despite the fact that from the end of the first trimester she already perceives him as a person, interacts with him, communicates internally.

A psychologist has no influence on a woman's choice - such is the professional position. It helps to realize some things, provides psychological support. Sometimes the situation itself can be completely hopeless when a diagnosis of a pathology that is incompatible with life is made, but even this does not always affect the final choice of a couple. A psychologist helps to dispel any doubts, relieve tension and at least slightly alleviate the moment of suffering.

After the interruption, the woman goes through the process of mourning, as after any other loss. If adaptation is disrupted for too long and a person cannot live a full life, then psychologists talk about pathological mourning, which requires more serious treatment. It is very important that the environment of the woman also helps to survive the crisis.

“Unfortunately, no one taught us sympathy, our society, and usually people feel discomfort next to those who have suffered a loss. As a rule, a woman's relatives think that the most important thing is that she stopped worrying about . This is where all these tips start: “stop crying”, “live on”, “get together”, and so on. But a woman doesn’t need this, she needs to live her grief, cry out her tears, she needs to speak out, ”says psychologist Svetlana Chursina.

Rehabilitation usually takes months, but even when a woman returned to normal life, this difficult moment will remain in her memory forever, it is impossible to erase it. From time to time, with tears, she will still remember her unborn baby.

Clinical psychologist of the Center for Maternal and Child Health Svetlana Chursina

Patients often ask the question: “What should I do with the child? What will happen to him after I give birth to him?

“The doctor cannot insist, but still it is better if you look at the baby and say goodbye to him. It is better to keep some of his things related to pregnancy, ultrasound scans and so on. Firstly, the brain is arranged in such a way that until it sees it, it will not believe that this is final, therefore subconsciously it will not give you rest, there will always be doubts: “What if he were alive, but if he were healthy? “. Secondly, after some time, women who could not look at the child and say goodbye may regret it. Still, over time, this is perceived as the loss and death of a loved one, so you should not completely depersonalize the baby. But in any case, the choice is up to the woman herself. You can offer, but in no case insist,” advises Svetlana Chursina.

At the Maternity and Child Care Center, a woman receives 1-2 consultations, after which the doctors recommend (if necessary) that she contact a psychologist at the antenatal clinic, or visit free support groups. In Russia, the charitable foundation "Light in Hands" works with mothers who have suffered perinatal loss. You can get advice and find out all the working conditions on the fund’s hotline.

Psychologists advise relatives, friends and colleagues to start from the desires of a woman - do not impose help, insist on talking if she does not want it. “Time heals” is one of the main principles of recovery, so the main thing is to give a woman this time.

As the doctors say, there are no right or wrong decisions when it comes to terminating a pregnancy, there are only those with which the family can live on. The task of doctors is to support the life and health of both the mother and her child at any cost. Life and quality of life depend only on the family where they faced the problem. It is impossible to predict possible risks by 100%, and you need to remember that no family is immune from this. Today in the Krasnoyarsk Territory there is all the necessary medical support for pregnant women with pathologies of the unborn baby and for those who decide to terminate the pregnancy. We hope that as few families as possible will need such assistance.

Valya Kotlyar especially for Newslab online newspaper.
Photographs by Alina Kovrigina.

Abortion and its consequences

Abortion and its consequences.

The issue of termination of pregnancy at the request of a woman remains relevant for modern Russia. In the Komi Republic, only 60% of pregnancies end in childbirth, while the birth rate in the republic is declining.

Unwanted pregnancy is always a high risk of unsafe abortion and maternal death. Unfortunately, pregnancy does not always occur at the moment when it is realized and desired.

In some cases, the measure of abortion is forced. For example, if the health of the mother does not allow a healthy fetus to be born; there are fetal malformations that are incompatible with life; had a spontaneous abortion ("miscarriage").

According to the Federal Law of the Russian Federation No. 323 - FZ "On the Fundamentals of Protecting the Health of Citizens in the Russian Federation", a woman is given a waiting time for making a decision to terminate a pregnancy:

weeks, but no later than the end of the twelfth week of pregnancy;

2) not earlier than 7 days from the date of application for a period of 8-10 weeks of pregnancy.

There are currently three types of artificial termination of pregnancy.

1. Medical abortion.

Medical abortion is the safest abortion technology available today. It does not imply surgical intervention, which women are so afraid of. With medical abortion, patients take drugs orally according to a certain scheme.

Terms of termination of pregnancy in medical abortion up to 9 weeks of pregnancy.

2. Vacuum abortion.

This type of abortion is often referred to as a "mini-abortion". It is believed that after a vacuum abortion, the female body recovers faster than after a surgical one. With a “mini-abortion”, medical intervention is carried out in the uterine cavity using special equipment (vacuum aspirator).

Terms - up to 20 days of delayed menstruation (5-6 weeks).

3. Surgical abortion.

Is the so-called "classic" abortion, which is also popularly called "curettage". It is considered the most dangerous of all, as it can lead to catastrophic consequences. This type of abortion is especially dangerous for primigravida, young girls - there is a risk that after such an abortion they will not be able to have children in the future.

Possible complications during abortion:

• Heavy bleeding requiring surgery.
• Massive haemorrhage requiring a blood transfusion.
• Injury to the cervix.
• Uterine perforation.

If these complications occur, surgical treatment may be suggested.

Possible complications after abortion:

• Infection. Taking antibiotics can reduce the risk of this complication. If left untreated, women at risk may develop a severe infection (acute pelvic inflammatory disease).
• Having a chlamydial infection before an abortion increases the risk of salpingitis (“inflammation of the uterus”).
• Secondary infertility.
• Incomplete abortion requiring additional emptying of the uterine cavity by vacuum aspiration.
• Increased future risk of preterm birth.

Any abortion leads to a change in the hormonal background in the female body. This leads to the development of gynecological diseases, weight gain, metabolic disorders.

Finally, one cannot ignore the psychological consequences of abortion. This is especially true for young girls, for whom an abortion can be a real shock. In this case, psychologists talk about the "post-abortion syndrome", which is characterized by severe depression and stress.

Timing of initiation of contraception after an abortion.

Ovulation can occur as early as 8-10 days after induced abortion. It is noted that more than 50% of women resume sexual activity within two weeks after an abortion, and 6% of them have a new pregnancy in the next cycle. Therefore, it is necessary to start using contraception immediately after an abortion. Modern contraception is effective and safe enough to completely protect a woman from unwanted pregnancy.

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