What REALLY happens during an abortion: One surgeon finally tells the truth

The blonde teenager, waiting to go into the operating theatre, is 16 years old and nearly 16 weeks pregnant. She'll be one of up to 60 women having an abortion that day at the Marie Stopes clinic in south London.

She realised she was pregnant about eight weeks earlier, but couldn't pluck up the courage to tell her mother. The weeks ticked by. She agonised over what to do: she had plans to go to college; her boyfriend said he'd stand by her whatever she decided.

She had considered having an abortion in secret, but eventually her mum guessed and made the appointment for her.

Silent scream: 'It's likely that foetuses can feel pain by 20 weeks' says Dr Sunny Anand

The abortion she's about to have would be illegal in many European countries, where the time limit is 12 weeks, unless the foetus is severely disabled or the mother's life is at risk.

But in Britain, abortions performed for those critical health reasons accounted for only 2 per cent of the 200,000 abortions carried out last year.

The overwhelming majority were carried out on the legal grounds that two doctors agreed that continuing the pregnancy would damage the mother's physical or mental well-being.

Small wonder, then, that some say the law is interpreted to allow abortion on demand. Very few doctors will refuse a woman who believes she can't cope with the pregnancy or an unwanted child. And she can make that decision right up to 24 weeks of pregnancy.

These facts are worth restating because 40 years ago this month abortion became legal in Britain. The heat has never gone out of the debate, but the issue has usually simmered on the political back-burner. That's all set to change in the next few weeks.

Dr Vincent Argent: Believes the current law urgently needs changing A committee of MPs is already investigating whether new medical and scientific advances mean the law should be updated. And later in the year, backbenchers will table a series of amendments to try to change the law in both directions.

The pro-life lobby want to restrict the upper time limit on abortions, while the pro-choice side want to make early abortion even easier.

The debate has already boiled over into the headlines. This week the Science and Technology Select Committee published more than 300 pages of written evidence from doctors and campaign groups on each side of the argument.

One of the most controversial submissions - as revealed in yesterday's Daily Mail - comes from senior consultant obstetrician Dr Vincent Argent, who wants to see so-called social abortions (where the foetus is healthy and there is no serious risk to the mother's wellbeing) limited to 16 weeks.

And he's not alone in his unease about the current law. In next Wednesday's Dispatches programme on Channel 4 we reveal the deep concern among many doctors who, like Dr Argent, work within the abortion service and are passionate supporters of a woman's right to choose, yet who still believe the current law urgently needs changing.

They've been having this debate privately for a long time, but they don't talk about it in public - and one of the reasons is the very nature of the abortion procedure, especially in the later stages.

About 20,000 abortions a year are performed after 12 weeks - 10 per cent of the total. And among those statistics is the 16-year-old who is about to undergo the procedure.

Like many in her situation, she has looked on the internet to find out exactly what the operation involves. "It doesn't look very nice, but it's what has to be done," she says, "so I'm not really that bothered about it."

If she'd asked the surgeon, scrubbing up in the operating theatre, he would have given her his standard, brief answer: "The terminology I'd use would be that the foetus is removed and that the foetus dies as a result of that process," says Dr John Spencer, who is the senior clinical director for Marie Stopes and one of only a handful of doctors in the country who perform abortions right up to the legal limit of 24 weeks.

But in the Dispatches programme, Dr Spencer will break a huge medical taboo and spell out exactly what happens. Though we do not show the aborted foetus, what viewers will see and hear may very well shock them, but it is a vital contribution to the whole debate.

In the first 12 weeks or so of pregnancy, doctors can use a simple suction procedure. After that, the surgery becomes more complicated.

Dr Spencer opens a fresh pack of shiny instruments. He's an extremely calm, softly spoken man, which somehow makes his words all the more devastating. "The foetus can't come out in one go. We haven't dilated sufficiently for that. The foetal parts are soft enough to break apart as they are being removed..."

In other words, he has to dismember the foetus inside the uterus and pull it out, bit by bit. He uses an ultrasound scan to guide him. Even then, some body parts are too large to come out intact.

To illustrate what happens, Dr Spencer grips his thumb between the surgical forceps and squeezes gently. "Those parts are the skull and then the spine and pelvis, and in fact they are crushed..."

The operation on the 16-year-old is over in 12 minutes. The bowl with what they call "the products of conception" is quickly wheeled out of the theatre, covered in yellow plastic.

The surgical procedure is done under general anaesthetic. A couple of hours later the slightly groggy teenager is driven home by her mother, on her way to getting on with the rest of her life.

Everyone involved in providing abortions - the doctors, the nurses, those running the clinics - will stress that the women coming for abortions in the later stages of pregnancy are often those in the most difficult circumstances.

Although the teenager was typical - shocked and unsure what to do - the same applies to many older women who've already had children and feel their family is complete. Would they still feel the same way about a late-term abortion if they knew the full details of the procedure?

"When you get to the later stages," says Dr Spencer, "they're making a very difficult but important decision, putting their future first, as they're entitled to do."

Dispatches: Wednesday's prgramme follows a 16-year-old having an abortion at the Marie Stopes clinic in South London

But that hides the fact that many doctors - including those who perform abortions - have deep concerns about the current law. So much so that the Royal College of Obstetricians and Gynaecologists (RCOG) recently warned of a shortage of doctors willing to train to perform abortions.

Already many local NHS trusts don't have any staff who are willing to perform abortions much beyond 12 weeks of pregnancy. Women needing later abortions are often referred to Marie Stopes or the British Pregnancy Advisory Service.

Dr Kate Guthrie is a senior member of the RCOG. She also runs the NHS abortion service in Hull, where she operates on patients who are up to 14 weeks pregnant.

She'd be willing to retrain for the more complicated later procedure, but she wouldn't operate beyond 20 weeks. "I think every individual has their cut-off point. It's not scientific, it's just personal, it's just foetal size."

When I press her to spell out whether she means if the foetus is just "too much of a baby", she says: "I suppose so."

But the debate goes beyond distaste for the procedure or the personal ethics of individual doctors. There are two key scientific issues that could shape the forthcoming parliamentary debate.

One of the most powerful pieces of anti-abortion propaganda ever produced was a 1984 film called The Silent Scream, which purported to show the ultrasound image of a foetus being aborted - it's mouth apparently wide open in agony.

In the mid-Nineties, partly in response to growing public concern about such issues, the RCOG put together a panel of experts who came to the reassuring conclusion that the foetus couldn't feel pain until 26 weeks gestation - safely beyond the abortion time limit.

They said the part of the brain that responds to pain simply isn't developed at 26 weeks. In other words, any physical movements the foetus displays before then are purely reflex actions - the foetus is not aware and can't feel anything.

But we found disturbing research in America that directly contradicts this established view. It came from Dr Sunny Anand, who has a distinguished record in helping to prove that very young babies can feel pain. When he was based at Oxford University in the 1980s his work helped to ensure that newborn babies were routinely given pain relief for surgical procedures.

His latest research is extremely technical and covers two areas. First, he's been comparing how newborn babies and unborn foetuses react to any kind of stress, including pain.

He's found similar changes in their hormones and their blood flow, suggesting that foetuses can indeed respond to pain.

Secondly, he's been researching - using rats - exactly which parts of the developing brain are used to detect pain.

He says that while the adult uses the very top section of the brain, the foetus has the first flickerings of sensation in the area below that. Crucially, this part of the brain develops before 26 weeks.

His conclusions could have enormous consequences for the abortion debate. He told Dispatches: "I believe that foetuses can feel pain very likely by 20 weeks of gestation and possibly even earlier."

The other scientific evidence MPs will be hearing about concerns viability - the age at which premature babies can survive. Forty years ago, when the abortion law was first passed, babies under 28 weeks rarely survived. Things have changed dramatically since then.

Back in July, we filmed a newborn baby named Hope in the neo-natal intensive care unit of Liverpool Women's Hospital. In her incubator, Hope was almost invisible under a pink blanket, surrounded by wires and bleeping monitors.

She had been born at 23 weeks - one week before she could have still been legally aborted. And here she was, three weeks later, still clinging to life with the frailest of grips.

Hope lived for two months, with her parents constantly at her side, before she died. In Britain, modern drugs and high-tech treatment meant she had about a 25 per cent chance of survival - hich would have doubled if she'd been born a week later. The odds were against her from the outset.

But those statistics are changing all the time. In America the chances of her survival would have been better, and what happens over there will inevitably filter through to Britain.

At a specialist unit in Arkansas, we filmed Dr Whit Hall checking on his tiny patients. "The survival is as high as 75 to 80 per cent for 24-weekers and about 50 per cent for 23-weekers," he explained.

How relevant those statistics are to the whole abortion debate in Britain seems to depend on your views. Ann Furedi, who runs the British Pregnancy Advisory Service, strongly believes the two issues shouldn't be confused.

"The women we see at 23 weeks are the ones who have incredibly compelling grounds for abortion," she says.

The pro-life view is expressed by Dr Trevor Stammers, a GP from Wimbledon, south London: "I think it's totally barbaric that a 24-week foetus will be aborted on one floor of a hospital and in the intensive care unit they'll be trying to save the life of another one."

So where does this new scientific evidence take us? One thing is certain: the need for debate has never been more urgent. The last major parliamentary discussion on abortion was back in 1990. There have been huge advances in science and medicine since then.

It will be interesting to watch whether MPs can balance the hard and frequently difficult facts about abortion with the strongly held personal and moral views that have always driven this most emotive of subjects.

• Dispatches: Abortion - What We Need to Know, reported by Deborah Davies, is on Channel 4 on Wednesday at 10.40pm

Add your comment

Here's a sample of the latest comments published. You can click view all to read all comments that readers have sent in.

Please give equal time to the ALREADY BORN women whose lives are wrecked when they have to carry an unwanted foetus to full term, and the anguish of raising a child in poverty.

- Deek, NYC

Before I had my 3 children I was pro choice, now I'm even more pro choice as an unwanted baby should never be born. They need and deserve much love and attention. I do believe, however, that the cut off date should be lowered to 16 weeks.

- Mandy, Sheffield, UK

I had my first scan at 16 and a half weeks, and saw a real baby, I couldn't imagine killing it and dismembering it. I am all for abortions, but it should be performed early on. After that, you have a responsibility and you must face it, either realise you are going to be a mum, or have it adopted. My son was a complete surprise, I didn't want kids not for a long time, but here I am enjoying it and it wasn't the end of my world, just the beginning of a new one.

- Danielle Mccarthy, London

It’s an interesting map, but I gotta say it doesn’t match the other moral tones in those parts of the world. The muslim green areas where women are barely people? The african areas where genocides continue? China’s forced abortion policy if you already have a child is equal to the US because they are both purple? India is morally above the US - a country that still has a rigid caste system that considers the lowest caste not even to be people?

You could make all the red countries essentially purple because these are the same excuses they use in the purple countries - the very above article shows how the UK has used its safeguard laws to essentially give abortion on demand.

It should also be noted that the US has the most people in the world fighting to end abortion.

You'll be shocked (or not) but 46% who have abortions didn't use a contraceptive the month they got pregnant.

Among women who had abortions, 8% have never used any contraceptive.

That's 54% not bothering with contraceptives and effectively selecting abortion as their birth control method.

Among the rest of aborting women, "inconsistent use" of their contraceptive method was reported about 85% of the time for condoms and The Pill.

I guess that means about 1 million (4/5ths of abortions) happen in lieu of a good faith effort at birth control or personal responsibility.

It’s an interesting map, but I gotta say it doesn’t match the other moral tones in those parts of the world.

That's what makes it surprising to so many, including myself. It's hard to hold up our country as a moral exemplar when we do the least to protect the most innocent.

"whatever you did for one of the least of these brothers of mine, you did for me." --Jesus

"Any country that accepts abortion, is not teaching its people to love, but to use any violence to get what it wants." --Mother Theresa

It is a great irony that most of the countries where abortion is not allowed are Muslim.

In the West, as the article states, abortion is supposedly justifiable when a pregnancy represents a hardship to the mother. Yet it is the poorest continents in the world (South American and Africa) that seem to have the most compassion for unborn children.

"Blessed are you who are poor, for yours is the kingdom of God." --Jesus

I’m proud of you for speaking up. The “laser look” lady may be over-reacting because she KNOWS you’re right and hates to admit it to herself.

Whatever, we shouldn’t keep quiet because we OFFEND the liberals and commandment breakers.

I think this is an interesting article, and pushing the line back regarding abortions will save lives. That is a good thing. The sad and disgusting thng about this article is that these physicians still seem perfectly ok with doing abortions. They just prefer to do them when the child is smaller and less developed. The bigger the child gets, the more it looks like a baby to them. It becomes emotionally and morally harder in their eyes. The thing is, it doesn’t matter if a child is killed at 20 weeks, 8 weeks, or 1 week. The child is the same person whether at conception or 20 weeks. He/she is just smaller and less developed.

I have a tough time figuring out the proaborts. They claim that the child is not a person. You then prove to them scientifically the child is a person. They then say it doesn’t matter if the child is a person because a person cannnot live attached to another’s body against their will. However, if they believe that, they would have to believe abortion should be legal for 9 months. Only the very hardcore want abortion legal for 9 months, and others claim the child is too far developed to be killed. Of course this counters their claim that a person can’t live attached to another’s body against their will. It’s an inconsistent position that makes your head spin. Besides, Judge Blackmun said if the personhood of the unborn child is established, abortion would then be illegal under the 5th and 14th amendments.

Are lives of women truly “wrecked” when they “carry an unwanted foetus to full term?” It seems more of an inconvenience, a challenge to personal selfishness, in today’s society.

It’s only a matter of nine months; after which the baby (something called a foetus is easier to kill) may be adopted into a loving home.

Pregnancy out of wedlock does not cause women in the Western world to be shunned in this day and age; women cannot use that an excuse. It boils down to the inconvenient interruption and unwanted physical changes.

The teenager in the article justified killing her baby - with the grandmother’s complicity - because she wished to attend college. Does an innocent baby deserve to die because a teenager wishes to continue (in all likelihood) unprotected sex with even more partners at college?

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