`POOR WOMAN, POOR POTENTIAL HUMAN'

Amanda Craig watches some abortions

and listens to the commentaries of the doctors involved

SEVEN abortions are to be performed at the NHS Samaritan Hospital in Marylebone Road this Wednesday be- tween 2 p.m. and 5 p.m. The women are probably between eight and eighteen weeks pregnant. The duration of their pregnancy has been assessed by asking the woman the date of her last period; by ultrasound, accurate plus or minus seven days according to foetus size, and by the surgeon — in this case Mr David Paintin, senior consultant obstetrician at St Mary's, Paddington — feeling the woman's uterus and abdomen.

The only check that the operation is carried out within the legal timescale of 24 weeks and in accordance with the four categories outlined in the 1967 Abortion Act is this surgeon's professional conscien- tiousness. There are no institutional in- spections. Information is sent to the Chief Medical Officer, and thereafter only stat- isticians will have access to it. It is not accessible to police officers or MPs. Abor- tion is the most secret of operations. Mr Paintin, and his patients, have made an exception in order for me to witness what now takes place.

Three of the women have slight but distinct bulges where their pregnancy shows, but the rest look normal. They have had two to seven days to think over their decision; prior to this, they have discussed with a GP, an obstetrician and a 'neutral' woman counsellor what an abortion means. A printed sheet informs them they have a one in 200 chance of infertility, after. All but one are around 16. More than half have had abortions before. Four are black, none married. All have the tired, tawdry look of poverty, with cal- loused feet and smudgily varnished toenails. One, a heroin addict, screams when injected with general anaesthetic because she has very few clear veins left.

'In Britain, one in five pregnancies is terminated,' Mr Paintin tells two medical students. 'The most recent figures, up to March 1988, show there are 157,100 annually for women resident in England and Wales. Since 1975, the proportion of single women having abortions has actually

been drifting downwards from 40 per cent to 35 per cent. Our proportions are half those of America and Eastern Europe. But the total number of abortions is rising because there are more single women. We expect it to go on rising to the end of the century.'

The Samaritan Hospital, founded in 1840 and attached to St Mary's, is one of the oldest gynaecological units in the world. Spotless and shabby, its floors are tiled with sea-green lino and its corridors smell of curry. Doctors and nurses dress in papery pale blue uniforms, and white clogs. The two surgeons, anaesthetist and the scrub nurse also wear green overalls and transparent rubber gloves. Mr Paintin, in addition, wears a green plastic apron and a pair of white wellington boots.

Gynaecologists usually look like Mr Cecil Parkinson, but Mr Paintin is stocky, with tufted grey eyebrows and a kindly, intelligent face. His nurses radiate benign pragmatism. Most are only a few years older than the women who, every 20 minutes or so, get wheeled into the white- walled room. Already injected with a general anaesthetic, each patient is admin- istered gas as soon as she is transferred by stretcher on to the operating couch. A blood pressure machine by her head moni- tors her heartbeat as submarine blips and glowing blue waves.

The couch is narrow, with three black cushions. The middle cushion has a semi- circle taken out. When the unconscious woman is on the couch, her ankles are suspended above the level of her head in a pair of medical stirrups, and the third section removed. The semi-circle funnels paper leading to a stainless steel bowl below. The angle of her legs is precisely that of making love. Before this bare V stand the surgeon, assistant surgeon, swab nurse, two medical students and myself. Above the end of the couch is a great circular lamp, made up of seven smaller lamps arranged in the shape of a stylised flower.

The woman's genitalia are swabbed, inside and out, with a soapy disinfectant. A speculum with a round weight on the end is inserted to keep the vagina open. A pulpy crimson is all that can be seen, although the surgeon can feel with two fingers all the way to the uterus.

A series of steel rods, each progressing to the thickness of a finger, are inserted. These dilate the uterus. A suction tube is then pushed in. This tube works on exactly the same principle as a hoover. When switched on, a loud noise is made, like a giant sucking on a melting ice cube.

One of the two medical students is a Christian. 'Whenever I hear that horrible noise of suction, I always think, poor woman, and poor potential human. I feel abortion is right in a few cases, where pregnancy is injurious to a woman's health,' he says. 'But even incestuous conception is a problem I haven't really sorted out yet.'

The other says, 'I judge a case on its individual merit. I don't really have a problem philosophically about it. I'm just observing a clinical process.

`But it's good to be informed. It's a pity that birth and death are hidden away in hospitals now,' says the Christian.

Both had seen babies being born, and had taken part in heated ethics discussions. Abortion and euthanasia are the two sub- jects which worry medical students most.

'Between 20 and 25 per cent of all doctors feel it's wrong under any circum- stances,' says Mr Paintin. 'Then there is a middle ground of those who fear it's a distasteful chore. You have to go a long way to find those who, like myself, see abortion as the lesser of two evils, an ethical equation in which the needs of a potential human being are weighed against those of a fully formed one: the mother.'

Blood streams along the transparent tube into one of the two glass jars on top of the suction machine. After eight weeks of pregnancy, an abortion takes 30 to 40 seconds to perform. A foetus is 1cm long at this stage, with a heart but no face. 'Unless you looked in the suction bottle, you wouldn't know it was there,' says Mr Paintin.

By the end of the 13th week, the foetus is properly formed, but even at 24 weeks it would be quite impossible for it to scream. That, at least, is one horror story that is not true.

As the catheter is drawn out from the 17-week pregnancies, bright red flows down the speculum, and into the round steel bowl beneath. Some spurts onto the green floor, and the surgeon's apron. A damp, salt smell is in the air. The placenta, a mauvish oblong, comes with a rush. A portion is scooped into a jar: with the women's consent, it will be used for research to prevent miscarriages.

Next comes the foetus. 'This is the bit people have fantasies about,' says Mr Paintin, squeezing and tugging with his long steel forceps.

A dismembered arm half the size of a finger takes two or three attempts to pull out. No head is identifiable as such, but a miniature spinal cord gushes down, and floats briefly on the bowl of blood. In the 18-week foetus, a complete 7cm torso with the left arm and hand still attached comes out. It has the rubbery, marine sheen of those monsters of the deep envisaged by Albany in King Lear. The semi- transparent hand, the size of the smallest child's fingernail, itself has fingernails.

'It takes skill to use this technique,' says Mr Paintin, panting slightly. 'You only acquire the expertise if you have a big caseload. The Parkside South Health Au- thority does about 1,100 a year, of which I perform about 250, although I'm semi- retired and every surgeon's caseload is different. Between 30 and 40 of those are pregnancies past 18 weeks. Some surgeons insist on prostaglandins [the hormones which induce labour, or in the case of an abortion, premature labour] because they think bringing the foetus out in one piece is more reverent. That's irrelevant, in my opinion. Inducing labour is a painful ex- perience all round, both to the patient and the hospital staff. Nurses are not always positively orientated to abortion, and find it difficult to be sympathetic towards a mother whose premature labour has been induced.'

An NHS abortion (41 per cent of the national total) costs the taxpayer a mere £160. All staff are paid, irrespective of the number of abortions performed. There is no financial incentive in the NHS to increase the number of terminations; it is difficult enough to find funding for this, as opposed to all the many other operations required. Abortions performed by charit- able organisations such as the British Preg- nancy Advisory Service cost the patient £210. Being non-profit-making, they also have no incentive to encourage termina- tions. Private abortions cost around £650, their price kept down by the competing success of the charities. A top private abortionist earns little more than a top NHS consultant: £35,000. However, he or she will earn this at a younger age and without the social connections needed to rise in other branches of medicine.

Both the surgeons are relaxed and smil- ing as they work, discussing Mr Paintin's difficulties in buying a new house. In order to perform competently no distressing emotions can be allowed to sway the surgeon's hand.

'People say, how can you bear to do this work?' And then, in answer to the ques- tion, Mr Paintin remarks, 'But I find considerable satisfaction in providing the entire service skilfully. I would much pre- fer women not to need abortions, but seeing that they do, I have fought my own

way through this ethical equation.

'You are always dealing with a balance of harm, rather than good. The first time you see any surgical operation, you think, how horrid; but this is helping a woman to reproduce at a time she wants to. These women are set up by our society because they are poorly educated and lack the articulacy to discuss sex with their partner. They even see contraception as threaten- ing. Their lives are in chaos,' Mr Paintin says, in his calm voice.

'Yes,' his assistant surgeon agrees. 'I've always thought it a most satisfying opera- tion. Unlike many others, which are so variable in their effect, there is a very definite end-point to it.'

After the forceps, the suction tube makes sure the womb is quite empty. Again and again, it is. Whatever was in there is bundled up and put into yellow bags, to be incinerated. The third cushion is brought out again, the machines discon- nected, the woman's legs lowered. Wrap- ped in the long white fishtail of a blanket, she will wake in an hour — to relief, to guilt, to childlessness.