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Some other medical insurance plans pay all or part of the costs. A number of organizations also help out. While regular hospitals usually want to be paid in advance, especially if the woman is a transient, some nonprofit clinics attempt to set terms according to need. In Seattle, the Y.W.C.A. university chapter provides living quarters and counseling for women undergoing abortions, and students at the University of Maine have set up an abortion-loan fund that subsidizes coeds' trips to New York.
Once the arrangements have been made, abortion can be relatively easy. Three methods widely used are both practical and safe:
· Saline induction, which is used between the 16th and 24th weeks of pregnancy, is one of the more drastic means. A doctor inserts a needle through the patient's abdomen into the uterus, draws off most of the amniotic fluid in which the fetus floats and replaces it with a salt solution. The saline substance kills the fetus, and then a miniature labor begins—with real pain—and continues until the fetus is expelled some 24 to 72 hours later.
· Dilatation and curettage, usually done under general anesthesia, has long been used within the first twelve weeks. The cervix, or opening of the uterus, is dilated with a series of progressively larger sounds—thin, blunt-ended metal rods. Then the uterus itself is scraped with a dull-edged curette, a small spoon-shaped instrument, until all embryonic matter has been removed. The entire procedure can take as little as 15 minutes. When it is done under local anesthesia, it sometimes produces painful cramping, but many women can return to their homes or jobs only hours after it has been performed.
· Vacuum aspiration, used on most outpatients, is a new variation on the D. and C. method that makes abortion even easier. Performed only through the twelfth week of pregnancy, the operation consists of dilating the cervix, inserting a metal tube attached to a small vacuum pump and drawing off the fetal matter into a bottle. Discomfort during the five-minute operation, which often includes a quick curettage, is minimal. Pain is all but eliminated in a refinement of vacuum aspiration developed by Harvey Karman, a Los Angeles psychologist: for pregnancies of less than ten weeks' duration, doctors use a thin plastic tube that is smaller in diameter than the more commonly used cannula. This avoids the dilatation process entirely.
One great fear about abortion, among doctors and nurses as well as patients, is that a fetus will be born alive. Claims by anti-abortion groups that doctors routinely throw "screaming, wriggling bundles of humanity" into garbage cans are unfounded. But despite laws banning abortions after the 24th week, well before a fetus can survive outside the womb, "live births" do occur. The reason, often, is that the date of conception has been miscalculated or misstated by the woman. At least 40 fetuses have reportedly been born "alive" in New York. All died within hours, despite doctors' efforts to maintain life.