So You Want to Be the Next “Jane”
That has been the call of many abortion supporters since hearing Trump would get to add another justice bent on ending legal abortion to the Supreme Court. Luckily, abortion techniques have vastly progressed since the Janes were providing illegal abortions in the late 1960s and early ’70s. That means people seeking to end their pregnancies outside a clinic setting are far more likely to turn to medications than medical devices.
Yet there will probably always be some people looking for ways to terminate a pregnancy without the use of medications. This chapter provides information on menstrual extractions and early vacuum aspirations for those who are truly insistent on “bringing back Jane” and offering non-medication abortion outside a legal clinical setting.
Who Was “Jane”?
The Jane Collective was a group of mostly white women from the Chicago area who first offered counseling and referrals and later trained to provide first- and second-trimester abortions prior to legalization in 1973. The Janes—all in their late teens and twenties—started out by using doctors or other medical professionals and simply acting as the go-between for pregnant people and the providers, but they eventually realized that they could easily do D&Cs (dilation and curettage, where the cervix is opened with dilators then the uterus is gently scraped with an instrument to remove the embryo or fetus as well as additional products of conception like placenta and uterine lining) themselves. This offered them not just a chance to eliminate how many people were involved that could be susceptible to a police investigation, but also to do lower-cost and even free abortions since there was no doctor to pay.
The Janes were forced to work under multiple layers of secrecy to protect themselves and their patients from the law. They shared a phone number through posters, fliers, and word of mouth, telling people who were pregnant and didn’t want to be to call and leave a callback number, as well as the date of their last period. The Janes would return calls afterward with instructions on where to meet. The meeting area was just the first step—the patient would then wait for transportation to another secret location, and it was there that the abortion would be performed.
Most of the Janes had no professional medical background. Instead, they learned first from their original doctors and then later from each other. According to NPR, which profiled the Jane Collective in an article in early 2018, the group believes they performed about eleven thousand first- and second-trimester abortions in the four years they operated before the Roe decision came down and abortion was legalized in the country.41
For more information about the Janes, read Laura Kaplan’s book The Story of Jane: The Legendary Underground Feminist Abortion Service. Kaplan, a former Jane, provides a fascinating look into the history and legacy of the radical group—one that is even more compelling as the country returns to a pre-Roe era.
How Were Abortions Done Pre-Roe?
The coat hanger became and for some reason remains the ubiquitous symbol of the illegal abortion, and it’s true that some women may have used that, but it was just one of many ways that pregnant people attempted to end their pregnancies pre-Roe.
Kate Manning, author of My Notorious Life, highlighted many of the most popular pre-Roe home abortion remedies in a New York Times column in 2013. “WHY would a woman put a leech inside her body, in the most private of female places? Why would she put cayenne pepper there? Why might a woman swallow lye? Gunpowder? Why would a woman hit herself about the abdomen with a meat pulverizer? A brickbat? Throw herself down the stairs? Why would she syringe herself, internally, with turpentine? Gin? Drink laundry bluing? Why might she probe herself with a piece of whalebone? A turkey feather? A knitting needle? Why would she consume medicine made of pulverized Spanish fly? How about powdered ergot, a poisonous fungus? Or strychnine, a poison? Why would she take a bath in scalding water? Or spend the night in the snow?” Manning asked. “Because she wanted to end a pregnancy. Historically, women have chosen all those methods to induce abortion.”42
While dangerous DIY home abortion approaches using tools, corrosives, and toxins were commonplace before Roe (and unfortunately are still attempted in times of complete desperation today, as we learned from the 2015 arrest of a woman who tried to do her own abortion at home using a coat hanger43) so were actual medical procedures done by trained professionals and even enthusiastic activists.
D&C abortion was how the women of Jane performed their abortions, but other activists also worked outside the medical profession complex and offered abortions via menstrual extractions—a type of early manual vacuum aspiration.
Unlike a D&C, menstrual extractions didn’t require that the cervix be dilated, making it far simpler for someone without extensive medical training to perform them. Because there is no curettage, there is less likelihood of a hemorrhage or puncture, too.
In California, a group of women began meeting to conduct “self-help clinics” to do menstrual extractions, teaching each other to insert speculums and look at their own cervixes. Soon after, they adapted a manual aspirator that would allow them to essentially suction out menstrual lining and blood all at once at the beginning of a period, or, if a period was delayed because of possible early pregnancy, simply remove the lining and fertilized egg all at once.
The tool and technique was developed by Carol Downer and Lorraine Rothman, who took a standard plastic cannula and syringe, then modified it in order to ensure there would be enough container for a full menses to fit in and that there would be no issue with air accidentally being pumped back into the uterus, where it could cause a potential embolism. With their new kits they believed they could do extraction and very early abortion in a safer, less uncomfortable manner, eliminating the sharp tools and the lack of anesthetic that came from traditional illegal D&Cs, where abortion providers refused to give patients medications so they could leave more quickly if there were police or other problems.
What to Know About Menstrual Extractions
The process is done with a device called a Del Em, which nonmedical professionals have been able to build at home. According to Carol Downer, one of the originators of the American practice, menstrual extraction should always be done with others, and never on yourself. “The tabloids and the electronic media have labeled menstrual extraction ‘self-abortion’ or ‘do-it-yourself abortion’ but these terms are misleading,” Downer explains in her 1992 book A Woman’s Book of Choices: Abortion, Menstrual Extraction, RU-486, coauthored with Rebecca Chalker. “First of all, due to the location of the uterus, it is virtually impossible for a woman to do ME on herself. To do the procedure safely and correctly, a woman needs the help of one or more women who are trained and experienced in ME.”
The most significant physical risk of menstrual extraction is the possibility of infection from unsterile equipment or otherwise introducing bacteria into the uterus. Downer suggests in her book that a person doing menstrual extractions do them multiple times on nonpregnant people in order to gain experience before ever attempting it on a person who may be pregnant.
How Can a Person Build a Del Em?
Below is an image of items needed for crafting the Del Em, provided by Carol Downer via her website Women’s Health Specialists (https://www.womenshealthspecialists.org/self-help/menstrual-extraction/).
What Are the Instructions for Doing a Menstrual
Extraction?
A person can easily find instructions for doing a menstrual extraction online. Full information, including illustrations, is available at http://womenshealthinwomenshands.com/PDFs/MenstrualExtraction.pdf, which is a reprint of the detailed guide published in A New View of Women’s Bodies, a now out-of-print book published by the Federation of Women’s Health Centers in 1981.
The following information was found at http://www.skepticfiles.org/atheist2/selfabor.htm and was allegedly first published in a pamphlet called Womenpower—Do It Yourself Abortion—Time’s Up!
How to Perform a Menstrual Extraction (ME)
1) Supplies first: Betadine, speculum, “Del Em” ME equipment, latex gloves, alcohol, Valerian or Motrin, copy of When Birth Control Fails, small four millimeter and five millimeter cannulas, flashlight, mirror, pillows.
2) Before proceeding, with the help of your group, check to see if you’re pregnant or not. ME can be done on nonpregnant women. Look at your cervix and see if it has changed in color or texture. Have a member of your self-help group perform a pelvic exam as well. Make sure it is someone who has felt your cervix before. See if your cervix feels enlarged or softer to her. Have you had any morning sickness? For how long? Study your most recent menstrual cycle. You do this by counting the number of weeks that have passed since your last normal period. If you are late, this might be a sign that you are pregnant. If you think you might be more than eight weeks pregnant, do not proceed with this method.
3) Lie back on a low bed or futon and, with your legs spread, get comfortable. You may want someone to hold your legs for you. Definitely have someone by your side to assist you with whatever you might want (water, abdominal massage, Motrin, an extra pillow) during the extraction.
4) Although the vagina is not a sterile area, bacteria should never enter the os, cervix, or uterus or else you run the risk of infection. With the speculum in place, so that your cervix can be easily seen by the person who will be holding the cannula, and using tongs that have been boiled until sterile to hold a Betadine soaked cotton swab, cleanse the cervix and the vaginal canal.
5) Touching only the two or so inches furthest from the end of the cannula that will enter the cervix, carefully put the cannula inside the vagina (do not let it touch the vaginal walls either; remember the vagina is not a sterile field) and slowly insert it into the exterior os. After you have put the cannula into the os about three-quarters of an inch, you will begin to feel resistance, as if the cannula will not go any further. You have reached the inner os or the entrance to the uterus. You may feel cramping at this point because both the os and the uterus are muscles. The uterus may also recede into the body making it hard to continue. This is normal as well. Continue to push, with a gentle insistence, until you feel something give and the level of resistance reduce; the cannula has entered the uterus.
6) It is time to attach the rest of the Del Em apparatus to the cannula. Before doing so, remove all the air from a Del Em jar using your one-way valve syringe. This will provide the right amount of suction needed to detach early-first-trimester menses and fetal tissue from the uterine wall. Attach the tubing to the cannula and begin to move it in a semi-slow, back-and-forth rotating fashion in the uterus. Remain in one area until you feel the texture of the uterus go from soft and mushy to hard and ribbed or ridge-like. Then repeat the same motions in another part of the uterus. You will see blood and, if you are pregnant, a white, pudding-like substance (fetal tissue) in the tubing. Continue to do this until you no longer feel (through your “eleventh finger,” the cannula) any softness in the uterus nor see any blood or fetal tissue in the tubing. Remove the cannula. Mission accomplished.
Where Can I Find the Tools for Making a Del Em?
Many of the tools can be found through medical supply stores. One woman, meanwhile, provides her own experience online on her blog of building one at home and for minimal cost primarily by obtaining items from local stores and a pet supply company. Writing at the Reproductive Right Blog (the-reproductive-right.blogspot.com) the woman explains that after purchasing a speculum off eBay, she then found the rest of the supplies much closer to home, including a mason jar, a rubber sink stopper, tubing, and a one-way value in a pet store’s fish department, and a spray bottle tube for a cannula. She then bought a meat injector and removed the needle to serve as her syringe. Cut down the stopper if it is too large for the jar, she writes, then create two small holes for the tubing. After inserting the tubing and creating an airtight seal around the holes, add the valve to one end and then the syringe. Add the cannula to the other and test your device on a glass of water to be certain it works, she advises.44
What’s a Manual Vacuum Aspiration?
A manual vacuum aspiration (MVA) is similar to a menstrual extraction but can be done until later gestation (usually up to fourteen weeks). Unlike a menstrual extraction, a series of dilators is used to slowly and incrementally open the cervix, allowing a larger cannula to be inserted, which by extension means a more developed pregnancy can be terminated in this manner.
The following instructions are meant only for trained medical professionals and were found in Médecins Sans Frontières (MSF), which “has been producing medical guides for over twenty-five years to help practitioners in the field. The contents of these guides are based on scientific data collected from MSF’s experience, the World Health Organization (WHO), other renowned international medical institutions and medical and scientific journals.” The instructions can be found at https://medicalguidelines.msf.org/viewport/EONC/english/9-5-manual-vacuum-aspiration-mva-20316948. html, under the section “9.5 Manual Vacuum Aspiration.” Instructions pick up after placing the speculum in the patient.
Dilation
Dilate the cervix if the cervical canal cannot accommodate the cannula appropriate for gestational age (or the size of the uterus). Dilation should be smooth and gradual:
—With one hand, pull the forceps attached to the cervix and keep traction in order to bring the cervix and the uterine body into the best possible alignment.
—With the other hand, insert the smallest diameter dilator; then switch to the next larger dilator. Continue in this way, using the next size dilator each time, until obtaining dilation appropriate to the cannula to be inserted, without ever relaxing the traction on the cervix.
—Insert the dilator through the internal os. A resistance may be felt: this indicates that there is no need to advance the dilator any further. This resistance is not necessarily felt. In such case, it can be assumed that the internal os has been penetrated when the dilator has been inserted five centimeters beyond the external os.
—Do not force the cervix with the dilators (risk of rupture or perforation, especially when the uterus is very retro- or anteverted).
Aspiration
—Attach the prepared (i.e., under vacuum) sterile syringe to the chosen cannula.
—Maintain traction on the cervix with one hand.
—With the other hand, gently insert the cannula into the uterine cavity. Rotating the cannula while applying gentle pressure facilitates insertion. Slowly and cautiously push the cannula into the uterine cavity until it touches the fundus.
—Release the valves on the syringe to perform the aspiration. The contents of the uterus should be visible through the syringe (blood and the whitish products of conception).
—Hold the syringe by the tube (not the plunger) once a vacuum has been established in the syringe and the cannula has been inserted into the uterus; otherwise, the plunger can go back in, pushing the aspirated tissue or air back into the uterus.
—Carefully (risk of perforation) suction all areas of the uterus, gently rotating the cannula back and forth 180°. Take care not to break the vacuum by pulling the cannula out of the uterine cavity.
—If the syringe is full, close the valves, disconnect the syringe from the cannula, empty the contents, re-establish the vacuum, and reconnect the syringe to the cannula and continue the procedure.
—Stop when the uterus is empty, as indicated by a foamy, reddish-pink aspirate, with no tissue in the syringe. It is also possible to assess the emptiness of the uterus by passing the cannula over the surface of the uterus: if the surface feels rough, or it feels as if the uterus is contracting around the cannula, assume that the evacuation is complete.
—Close the valve, detach the syringe and then remove the cannula and the forceps. Check for bleeding before removing the speculum.
In a surgical setting, aspiration can be done using a cannula connected to the electric suction machine, with a maximum pressure of eight hundred millibars.
Examining the aspirated contents
To confirm that the uterus has been emptied, check the presence and quantity of debris, estimating whether it corresponds to the gestational age.
The debris consists of villi, fetal membranes, and, beyond nine weeks, fetal fragments. To inspect the tissues visually, place them in a compress or strainer, and rinse them with water.
Where Would I Find Equipment if I Wanted
to Perform MVA?
Because MVA should only be conducted by trained professionals, most equipment can only be found through medical retailers. There are rare occasions that abortion tools can be discovered in places like rummage shops or other unique stores (for example, I found dilators and a speculum at an art fair in a “Strange Items” boutique display).
MVA kits can also be purchased through some websites, which can be found by googling keywords like “Menstrual extraction kits” or “MVA kits” or “MVA tools.” One such complete kit was found on the online retail site https://www.alibaba.com, which offers disposable MVA kits for anywhere between ten and fifty dollars apiece, depending on the number purchased. Note: this retailer has not been verified; this is only an explanation of how a person would find kits online.
What Are the Risks of Doing Non-Medication
Abortion Outside Clinics?
According to the Janes, they never had a patient die, but they did have to occasionally send them to the emergency room for follow-up care—dealing with complications that included excessive bleeding or incomplete abortion. Of course that was fifty years ago, and using a curettage, which is not in any of the practices above.
Still, unlike medication-induced abortion, these other procedures introduce obvious medical risks. Not having properly and completely sterilized equipment means a possibility of bacterial infection even if the abortion itself is a complete success, and few people have antibiotics just lying around for treatment. While a medication abortion can be done solely by the pregnant person if they choose, these non-medication techniques require at least one other person to be involved in the procedure, opening up more legal risks, too. And while medication abortion doesn’t require any experience, MVA and even menstrual extraction requires extensive practice to complete safely, something that would be difficult to obtain outside a medical setting.
Are MVA and ME safer than introducing a long, sharp object into the womb through the cervix in order to start a miscarriage? Or ingesting toxic poisons or inserting them into the uterus? No doubt. But with medications in existence that can safely be used to end a pregnancy, “safer than douching with lye” really shouldn’t be our standard anymore.
If a person were to decide to try to undertake abortion outside a legal clinic setting after the first trimester, the simplest and least dangerous way to undertake that process would simply be to attempt a miscarriage with the same medications used for medication abortion. The major difference between the protocol earlier in the pregnancy and later in the pregnancy would be the amount of time and medication necessary, and the amount of support a person would require to go through the abortion.
One abortion provider with over twenty years of experience suggested that in their opinion mifepristone and misoprostol alone in multiple doses would work. In such a situation, a person would want to take one dose of mifepristone, then wait thirty-six hours, then take four hundred micrograms of misoprostol every three hours until completion. This method would likely be able to end a pregnancy at any gestation. Also, according to them, this would be the “the safest route to go” if the options are using medication or attempting an invasive procedure outside a clinic setting. They suggested having an experienced doula involved as a support person in this case to assist with the process.
Can I Get Arrested for Providing an Abortion if
I’m Not a Doctor?
Yes. Absolutely. Even with abortion legal, abortion opponents are fiercely charging those who help a person end a pregnancy outside an approved clinical setting. Jennifer Whalen’s 2014 arrest for helping her daughter obtain medicine to end her pregnancy put her in jail with a felony for “offering medical consultation about abortion without a medical license” as well as misdemeanors for endangering the welfare of a child, dispensing drugs without being a pharmacist, and assault.
According to the New York Times in 2014, “In thirty-nine states, it’s against the law to perform an abortion if you’re not a doctor. In some of the remaining states, you are still required to be a medical professional (a midwife, nurse, or physician assistant). In New York, you can do your own abortion in the first two trimesters, but only if you’re following a doctor’s advice. About a quarter of states also still have old laws that make it a crime to help someone else with a self-induction. In a law passed in 1845, for example, Massachusetts calls for a sentence of up to seven years for assisting.”45
Massachusetts revoked their law in the summer of 2018 and New York is currently looking to remove theirs as well. But be certain that when Roe falls, wherever abortion is made illegal, the biggest focus will be on arresting those who provide clandestine abortions. That means increased legal danger for anyone helping a person obtain medicines, assisting in non-medication procedures, or helping minors bypass laws around parental consent.
With this risk in mind, the next chapter will discuss tactics for keeping your actions secure and private.