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MoonDragon's ObGyn Womens Health Information
ABORTION
POST-ABORTION SYNDROME (PAS)
POST-ABORTION STRESS SYNDROME (PASS)


For "Informational Use Only".
For more detailed information, contact your health care provider
about options that may be available for your specific situation.




INTRODUCTION


COMMENTS FROM MOONDRAGON.ORG

On a quick personal level as a midwife and mother, I have handled several clients over the years that have had abortions at some point in their lives. Abortion and pregnancy are very stressful times for women under normal conditions. Fortunately, these women clients, for the most part, have not had problems with their decisions, stating that for that time in their lives and for that pregnancy, abortion was the best choice for them. They did not regret or have lingering problems with their decision. I have met very few emotionally secure, informed women that regret their decision, one way or the other, regardless of their religious backgrounds.

I admit I am a Pro-Choice individual (and not just regarding abortion), but about everything you must make choices for in your life regarding your body and your life! I believe that every woman (or man) should have the right to make the decision about her (his) own body. No one should force you into anything you do not want to have done to you. This goes with abortion, pregnancy-birth options (including home birth or hospital birth choices) or whether or not to be sterilized if pregnancy is not wanted, medication or health treatment options (some prefer drugs, others alternative therapies) both for men and women. For men, I believe that they should have the right to choose whether or not to have a circumcision on themselves (when they are adults and not babies AND if there is a medical reason for it and not simply a cosmetic purpose) and not leave it up to parents and/or health care providers at the time of their birth. Even the right to choose end-of-life options such as the right not to have life prolonged by procedures or drugs or by being hooked up to life support, euthanasia or do-not-resuscitate (DNR) choices, organ donations, and burial/cremation options. Your body is a very personal thing and I believe we all have the right to decide what happens to our bodies, no matter what the situation or the decision.

I have my personal beliefs (for myself and my body) regarding whether or not abortion would be the right choice if it was to be an option. There were times in my life where I would have chosen to have an abortion, where other times I would have said "no, that it is not right for me." My decision would have been based on a particular situation at that time and the knowledge I had available to me to make my decision. I believe that any woman considering abortion should be as well informed as possible about her decision with all the pros and cons and risks that are involved with it. She should have a good support system around her and appropriate counseling before her decision is made, no matter what her decision may be in the end. She should take full responsibility, either way, regarding her final decision. When a woman takes control of her decision making process through education and knowledge, doing research about choices she may have available to her and follows her own moral-ethical values, she becomes empowered and has fewer regrets, guilt, and emotional-psychological issues than a woman who is not informed and pushed into a decision she does not want by individuals around her, life circumstances outside her control, or by stressful economical/financial situations or health issues.

I believe that the abortion should be used only as a last resort (like any surgical procedure) and not as a means of birth control (repeated over and over again). There are plenty of contraceptive methods available today that will help prevent unwanted pregnancy, if used correctly and faithfully.

I believe that every baby born should be wanted, loved, and cared for by parents or a parent that is emotionally stable and financially capable. I want to see the end of child abuse and neglect. Too many children are permanently scarred, hurt, and killed by people that should never have been a parent.

I also believe that many of these PAS symptoms listed below could be the result of hormonal fluctuations and shifts that happen after birth, miscarriage or abortion. Some women deal fine with these physical changes and others do not, just as some women have problems with Pre menstrual Syndrome (PMS) and some do not. Many women who have problems with PMS symptoms, will very often suffer from a varying degree of Post Partum Depression (PPD)-like symptoms after a miscarriage or birth. Of course, other factors always come into play when generalizing outcomes (which goes back to a good support system around her and whether or not she made an informed decision). It is only when certain symptoms arise, or increase in intensity, or continue to last well beyond post-abortion/post-partum hormonal stabilization and what would be considered "normal" that it may be "pathological" and need further treatment.

Many of these symptoms are also similar to Post Traumatic Stress symptoms. I also have this problem as a survivor of 38 years of domestic violence & sexual abuse beginning as a small child and through my adult relationships. Post Traumatic Stress is often seen in abuse cases, survivors of traumatic life experiences, and in soldiers that have gone to war.

I have had experiences with PMS throughout my life, PPD with the birth of two of my children and after the midterm miscarriage of one of my pregnancies. With my three other births and the 9 miscarriages I had in my childbearing life I was fine and did not have any PPD problems. If I had opted for a clinical abortion, I may or may not have had problems with PAS/PASS. Knowing me now, I would say no, but 20-30 years ago, perhaps. Mostly because of my situation years ago was not healthy (with abuse issues and stressful environmental influences) and today I am a more informed, empowered, and balanced individual that I was back then.

So it comes down to this... I believe that there is a likelihood that there such a thing as PAS/PASS that some women go through regarding abortion (and miscarriage)... just like some women experience postpartum depression symptoms after the birth of their baby. Many of these symptoms can also apply to women who have lost a baby at birth or a child later on (a recognized grieving process is well known to grief counselors).

Some women may find abortion a traumatic experience and suffer traumatic after-effects. Just because the medical community has not officially defined it yet, does not mean it does not exist (the conventional medical community is notoriously slow at accepting new ideas beyond what they learned in medical school). After all, it took them along time to decide that PMS was real and that women with PMS and menopausal women (another stressful time for women and hormones) were not really losing their minds and that there were real chemical-hormonal reasons for these symptoms.





DESCRIPTION OF PAS/PASS

There is a lot of controversy about Post Abortion Stress Syndrome. Pro-life activists claim PAS/PASS is real, and affects every woman who has an abortion. Pro-choice activists claim it does not exist, and is a myth made up by pro-lifers to help in their "fight to make abortion illegal." Pro-choice activists claim that PAS is a "scare tactic" to try and pressure women into not choosing an abortion, and to pressure congress into making abortion illegal. To date, there have been conflicting "official" studies on whether PAS/PASS exists or not.

Post Abortion Syndrome (PAS) is defined as a woman's inability to process the fear, anger, sadness, and guilt that surrounds her abortion. She is often unable to grieve for or unable to come to terms with the loss of her baby or come to peace with herself, her religion or belief in a higher power (God, Goddess) and others involved in the abortion decision.

As in so many other aspects of elective abortion, the pro-life and pro-choice sides differ greatly over the after-effects of the procedure. Many pro-life groups conclude that a large percentage of women who have undergone an abortion experience serious depression, and massive feelings of guilt. This has been called "Post-traumatic abortion syndrome," "Post abortion syndrome," "Post-abortion stress syndrome," "PAS," and "PASS." Many pro-choice advocates from secular groups agree that PAS/PASS exists, but believe that it is rare. A major longitudinal study by the American Psychological Associated was unable to detect any evidence of PAS/PASS. A representative of the APA has testified before a committee of the U.S. House of Representatives that PAS/PASS does exist, but is less common than post-partum depression after a birth. A commentary in the Journal of the American Medical Association (JAMA) points to PAS/PASS as a rare post-abortion phenomenon.

PAS/PASS seems to happen primarily to women who, at the time that they had an abortion:
  • Believed that the fetus was not a human being, and changed their beliefs later.

  • Believed that the fetus was a human being, but proceeded with the abortion anyway.

  • Felt heavily pressured, either by family, friends, or circumstances, into having an abortion that she did not want.

  • Did not received adequate counseling and information before the abortion.






SYMPTOMS OF PAS/PASS

Post Abortion Syndrome (PAS), also known as Post Abortion Stress Syndrome (PASS) is the name for a condition that can affect women after an abortion. Not every woman who has an abortion is affected by it. Some women who have abortions feel peaceful about their decision beforehand, relieved afterwards, and then live the rest of their lives with no regrets. Other women may have a different experience, and may have a more difficult time recovering after an abortion. When a woman has an abortion, it's possible that the woman will have some normal feelings of grief, guilt and loss. If the feelings become severe, or persist for a long period of time, she may be suffering from Post Abortion Stress Syndrome (PASS). "PASS" is different from "normal feelings" of loss and depression immediately following an abortion.

Some pro-life PAS/PASS counselors list up to about 2 dozen indicators of PAS/PASS. Some of the symptoms listed are:
  • Appearance since the abortion of at least three symptoms related to "persistent avoidance of the stimuli associated with the abortion trauma or numbing of general responsiveness" out of a list of 8 possibilities.


  • Appearance since the abortion of at least two symptoms from a list of 10 specific behaviors.

Please Note: Many people have serious reservations about the usefulness of checklists used in therapy and counseling. Some volunteers in various groups have compared their life experience over the past decade with the indicators in this checklist, and concluded that all of the volunteers are suffering from PAS/PASS. It is very likely that the checklist gave false positives since some of the volunteers were males, and some of the females have never had an abortion.

These symptoms will not necessarily appear at the same time, nor is any woman likely to experience all of them. Some symptoms may appear immediately after an abortion (within the first 3 months), or some may appear years later.
  • GUILT: Guilt and a feeling of shame about their abortion is what the woman feels because she has violated her moral code. For the woman who has come to believe, at some point after the abortion, that she has consented to the killing of her pre-born child, the burden of guilt is relentless. The woman may go to great lengths to prevent anyone from finding out about it, including lying to doctors, family and friends about having one.


  • SURVIVAL GUILT: Some women who have had abortions feel guilty for being the "survivor" of the abortion decision. It was either her life or the baby's life, and she chose to not interrupt her life. These women may enter a heightened and unrealistic compensation mode, attempting to atone for her selfish choice.


  • ANXIETY: Anxiety is defined as an unpleasant emotional and physical state of apprehension. Problems with anxiety, worry and nervousness, with no visible cause. Anxiety can be treated with medication. Post-abortion women may experience any of the following associated with anxiety:
    • Tension (inability to relax, irritability, and so forth).


    • Physical responses (dizziness, pounding heart, upset stomach, headaches) and worrying about the future.


    • Difficulty concentrating.


    • Disturbed sleep. Sleep problems may include having difficulty falling asleep, having difficulty staying asleep, sleep problems in general.


    • Dreams & Nightmares, which may include dreaming about a baby in danger that you can't help, or yourself in danger. Common "threateners" are people with knives, or medical people. Picturing yourself having a baby, or being with a baby or small child - various problems happen in these dreams, people try to take the baby away from you, or the baby or child is upset and will not look at you, or other people are telling you what you have to "do" with the baby, commonly like it needs surgery that you do not want it to have, etc. These occur frequently, nightly for some women, weekly for others, monthly or only on "anniversaries" for others. These dreams can be quite upsetting, and can contribute to the sleep problems.

  • PROBLEMS WITH PHOBIAS: An increase in severity of existing phobias or new phobias developing such as fear & avoidance of health care provider's & dentist's offices. Any type of medical building or situation may cause irrational fear. Fear of health care provider's offices in general and any invasive medical procedure can cause extreme anxiety, nausea, sweating, panic attacks, and other problems. Things that trigger this are: obgyn exams, having blood drawn, dental or oral procedures, and tests involving hands or tubes or needles or anything put into her body. Feeling very "protective" of her body, and not wanting anyone to touch her or come into her personal space for any reason. If a woman had certain phobias before, such as fear of heights, fear of thunderstorms, or fear of bugs, those fears and phobias can become more severe, with the woman being much more sensitive to these phobias than she was before.


  • REPRESSION & DENIAL: When a person experiences anxiety because of an intense inner conflict, and there is no end in sight, the mind will take whatever course of action necessary to regain emotional equilibrium. One such defense mechanism is repression, a sort of "motivated forgetting" which simply pushes the unbearable emotions away from the conscious level of thinking. Denial is a more thorough mechanism in which one not only pushes down unacceptable emotions surrounding a painful event, but also part or all of the event itself.


  • RE-EXPERIENCING THE ABORTION: The most common experience that a post-abortal woman reports is that she suddenly begins to have distressing, recurring "flashbacks" or intrusion (means involuntary re-experience) of the abortion or events surrounding it, with no apparent explanation for what is causing them. This may include flashbacks to the clinic, to protestors, to the actual abortion procedure, and the hours afterwards.


  • PSYCHOLOGICAL "NUMBING" or EMOTIONAL CONSTRICTION: It is the need to avoid feelings, thoughts, and situations reminiscent of the trauma. A person who has experienced a highly painful loss will develop an instinct to guard against future situations which might bring that much pain again. Some post-abortal women may work hard to keep their emotions on a flat level, a loss of normal emotional responses or both, experiencing neither highs or lows. This greatly hampers their ability to form and maintain close interpersonal relationships. Their feelings can seem "unreal" to them, and the ordinary day to day business of life no longer matters. They feel cut off from the concerns of others, and are unable to trust them. It seems like the future holds nothing, and there is really no purpose for living. They numb themselves out, to protect themselves from possible future trauma. Alcohol, food and drugs can also be used as part of the "numbing" process.


  • OBSESSION WITH PICTURES OF FETUSES: This is called the "drive-by" obsession. It is like slowing down to look at a car wreck - she knows it is going to horrify her, but she "has" to see. At this stage, women become obsessed with what their fetus looked like, and search out pictures of a fetus that matches the age that theirs was, and stare at it, and imagine what it felt like when it was alive, and try to imagine if it heard or felt anything. Woman have reported that they feel compelled to look, to know, yet feel even worse afterwards! There are a few links below that have pictures like this online, so they can AVOID the pro-life sites that show unnecessarily graphic pictures, as well as misrepresentations of what fetuses look like at different ages.


  • CO-DEPENDENCE & INABILITY TO MAKE DECISIONS EASILY: Women have reported difficulty making decisions, being unwilling to make any decisions, being very upset by any changes such as moving, changing jobs. There is a panic that a "wrong" decision might be made, and this can be a big problem. It can affect all kinds of daily small decisions, like what to have for dinner, what movie to get from the video store. A sense of panic sets in, and the woman feels frozen and paralyzed. An example may be a woman breaking down with her partner and crying in a video store, because she couldn't handle even choosing a movie for the weekend.


  • SELF-PUNISHING or SELF-DEGRADING BEHAVIORS: Self mutilation by cutting, burning, or other dangerous activity. Anger directed inward at self, as a means of self-punishment.


  • DEPRESSION: Clinical depression can be common for women with PAS/PASS. The trauma of the whole experience, and the problem of not having readily available public support for her feelings and issues after an abortion can lead to clinical depression. Clinical depression should be treated with anti-depressant medication! While few post-abortal women reach the point of an overt clinical depression, many will experience some of the following:
    • Sad mood. Unexplained feelings of sadness.


    • Sudden and uncontrollable crying episodes.


    • Deterioration of self-concept.


    • Sleep, appetite, and sexual disturbances.


    • Reduced motivation.
      • Inability to perform normal self-care activities.

      • Inability to function normally in her job or in school.
      • Lack of desire to do those things you would normally enjoy doing.

    • Disruption in interpersonal relationships. Inability to take care of or relate to her existing children or function normally in her other relationships (i.e. with a spouse, partner, other family member or friends).


    • Thoughts of suicide. Self-harm, strong suicidal thoughts or suicide attempts. Many women have problems for weeks, even months or years of struggling with suicidal feelings, feeling like they "don't deserve" to be alive, and some report the urge to want to go "find" the baby in "where-ever" and apologize to it, hold it, and so forth. And just general suicidal feelings with the thoughts of being unable to cope with what has occurred.

  • ISOLATING THEMSELVES: They may be experiencing shame at their own helplessness to "get over this," and then become demoralized and isolated, and withdraw themselves from activities they used to enjoy, and isolate themselves from friendships, and social situations. Isolating is very common, and also seems to come with depression.


  • EASILY STARTLED & UPSET: Loud noises that resemble the suction machine, such as vacuum cleaners, and blenders. one woman reported that the first time she went to a coffee shop after her abortion, to get her favorite blended coffee drink, that the sound of their blender made her sick to her stomach, and shaky and sweaty, and she ran out without even her coffee.


  • OVER ACHIEVEMENT ANXIETY: Unhealthy obsession with excelling at work or school, to justify the abortion.


  • RELATIONSHIP PROBLEMS: Having problems with relationships with her partner, lots of anger or other emotions interfering in her daily life and relationship, being unable to discuss and resolve these problems, and relationship problems with anyone else who was around or influenced her decision to have an abortion. Unwanted relationships or marriage may occur as an "atonement marriage," where the woman marries the partner from the abortion, to help justify the abortion.


  • PREOCCUPATION WITH BECOMING PREGNANT AGAIN: A significant percentage of all women who have abortions become pregnant again within one year of their abortion. This may represent an unconscious hope for a new pregnancy to become a replacement for the one that was aborted. A desire to immediately get pregnant and "replace" the baby that was aborted, even when all the circumstances that led her to "choose abortion" the first time are still in place. This may involve a strong urge to go out and get pregnant again, preferably with the same man, but in this urge, any man will do, and "keep" it this time. Many of the women have done that, and then were surprised to find that they actually felt "worse" about the abortion because of it! And that is because "replacing" a baby is impossible - you still miss the one you "lost" regardless of how many additional babies you have. But when that desperate urge hits, you cannot realize that - it seems like if you just "get pregnant again" and keep it, everything will be fine. The "replacement baby" feeling can be very strong. Women can even go as far as to sneak behind their partner's back, and stop using birth control, or even get artificially inseminated, if the partner has had a vasectomy. Even if a woman does go and get immediately pregnant with a replacement baby, once the new baby is born, they have reported a return of the replacement baby urge right after birth.


  • SEXUAL BEHAVIOR CHANGES: Increase in dangerous casual or indifferent sexual encounters. Sex with anyone at anytime. Unprotected sexual behavior that would expose the woman to STD's (sexually transmitted diseases) and not caring about birth control or caring if another pregnancy occurs. This can go the other way too - fear of sex, and a terror of getting pregnant again, no desire for sex, and no ability to enjoy it.


  • REPEATED UNPLANNED PREGNANCIES: With additional abortions and/or carried to term.


  • ANXIETY OVER FERTILITY & CHILDBEARING ISSUES: For the Christian woman, this is a particularly poignant issue, as they will verbalize these fears in terms of God punishing them. Distress and problems with infertility, getting pregnant again and/or maintaining a later pregnancy. Added emotional issues and problems when dealing with future infertility. Anxiety about physical complications resulting from the abortion.


  • INTERRUPTION OF BONDING WITH CHILDREN: After having an abortion, a woman might not allow herself to properly bond with future children because of a fear of loss. Or she may begin another pregnancy intending to be the "world's most perfect mother." Inability to care for a new baby. Likewise, a woman who already had children at the time of her abortion may discover that she is beginning to look at her existing children in a different light. She may have unconsciously quot;devalued" them, or unable to relate and bond with them. Feeling like a "bad mother" and feeling like the children would be better off without her interaction and influence.


  • OVER PROTECTIVENESS OF CURRENT CHILDREN: An almost hysterical worry about current children, constant fears that something will happen to them, as "punishment" for having the abortion. This can lead to parents not being willing to leave the child with any baby sitters, being over protective about their physical health, and the activities they do.


  • FEARS & OVER PROTECTIVENESS WHEN PREGNANT AGAIN: When a woman becomes pregnant after an abortion with a planned pregnancy, there can be a reoccurrence of nightmares, as well as constant fear and worry that something will "go wrong" with this pregnancy, as punishment for the abortion. Fear of the baby dying, or having something wrong with it are common.


  • COMPARISON OF PREGNANCIES and/or CHILDREN: Looking at pregnant women, babies or children (depending on "when" you had your abortion), and comparing yourself to where you would be in the pregnancy, had you kept it, or also comparing the baby or child to where "your child" would be, if you had kept it. Looking at other children and thinking they look like what your child would have looked like.


  • VIEWING MISCARRIAGE OR INFERTILITY AS PUNISHMENT: Feeling that future problems with infertility or miscarriages are "punishment" for having had an abortion.


  • PREGNANT WOMAN DISTRESS: Distress at the sight of Pregnant Women, other people's babies and children. Inability to deal with or socialize with other pregnant women, other people's babies and children.


  • BEING DISTRESSED AT THE SIGHT OF BLOOD: Having a period can be a reminder of the abortion with lots of blood and cramps again, and no baby. Women with PAS/PASS seem to be very upset the first few times they have their period after an abortion. One woman who had no problems before was terrified by the sight of blood, and had to keep getting in the shower 5 or 6 times a day to wash herself clean - she could not stand seeing or smelling and blood on herself.


  • DEVELOPMENT OF EATING DISORDERS: Anorexia and compulsive overeating both have been noted to start after an abortion, where there was no history before. Making herself unattractive serves as a form of self-punishment and helps the post-abortal woman perpetuate the belief that she is unworthy of anyone's attentions. A substantial weight gain or severe weight loss is associated with unattractiveness, which helps the woman avoid relationships and reduces the odds of becoming pregnant again. It is a form of protection to the woman. Anorexia and bulimia may become a form of control for the woman who feels her life is totally out of control. Also, an underweight condition can lead to the stopping of a woman's periods, which would also effectively prevent any future pregnancies. Anorexia and bulimia can be life threatening if not treated.


  • TRIGGERS OF SMELLS & FOOD: Women have reported being unable to eat or having a panic/nausea/anxiety attack at the smell of food they ate on the morning of the abortion, or from what they gave them in the recovery room afterwards. One woman said she wants to vomit at the smell and site of graham crackers now, because that was what her clinic gave afterwards.


  • ALCOHOL &/Or SUBSTANCE (DRUG) ABUSE: Alcoholism and substance abuse often begin as a form of self-medication as a way of coping with the mental pain of abortion memories.


  • ANGER: Problems with severe and disproportionate anger and fits of rage. Depending on the stage, the anger may be weak and hidden, or it may be extremely intense and full blown. The anger may be towards themselves, or the people they perceive as responsible for their abortion, or both.


  • BRIEF REACTIVE PSYCHOSIS: Rarely, a post-abortal woman will experience a brief psychotic episode for two weeks or less after her abortion. The break with reality and recovery are both extremely rapid, and in most cases the person is completely back to normal when it is over. It is quite possible for a person to have a brief psychotic reaction to a stressful event without being labeled a psychotic individual.


  • ANNIVERSARY DATE SYNDROME: There tends to be an increase in many of the symptoms listed above around the time of the anniversary of the abortion and/or the due date of the aborted child. It may include the date the woman got pregnant. Anniversary Date problems can be: an unexplained lapse back into severe depression in the days before and after an Anniversary Date, illness on or around Anniversary Dates, Accidents and Injuries around Anniversary Dates, reoccurrence of any other regular PAS/PASS symptoms. Sometimes this can be unconscious - the woman does not think "consciously" about an upcoming date being an "Anniversary," it is all subconscious, and just finds herself getting any of the above mentioned problems around an Anniversary Date year after year, with no other explanation for them. Even when women recover, Anniversary Dates can still be problematic.





DEFINITION OF A SYNDROME

Officially, here's the "Webster's Dictionary" definition of a "syndrome":

1 : A group of signs and symptoms that occur together and characterize a particular abnormality.

2 : A set of concurrent things (as emotions or actions) that usually form an identifiable pattern.

That is the definition of a "Syndrome," and PAS/PASS fits that definition. Much of the mainstream world still does not acknowledge its existence. However, let us remember that abortion has only been legal and widely practiced for twenty-some years. There is no long history of how women react to legal abortion, for people to really know.

As recently as fifty years ago, intelligent, educated and experienced professional mental health clinicians were teaching that schizophrenia was caused by poor parenting. Usually they blamed mothers! Today, we know that schizophrenia is caused by a brain chemical disorder, and we have also discovered that some of the other mental health problems that have been blamed on "bad parenting" are also caused by aberrant brain chemical reactions or other physiological problems. At one time, people with clinical depression were only said to have "poor coping skills"! Now today depression as well as other mental illnesses are treated successfully with medication. This is not saying that PAS/PASS may be caused by a brain chemical disorder but it may have some hormonal influences associated with it and the interruption of a pregnancy. It is not known yet. Hopefully, in the near future, researchers will be able to find the causes of it and if it is a physical condition or a psychological condition or a mixture of both. Too many researchers make judgments on what they can see, measure, and whether or not results can be scientifically proved. What cannot be proved or done today may be proved or done tomorrow (such as space travel, cloning, bacteria and viruses, and the fact that the earth is not the center of the universe). Science is nothing more than people making assumptions based on the information they have at the time. When that information changes, then so does the opinion of the scientific community.

THE HORMONAL TRIGGER THEORY

There are many of us that have the theory that PAS/PASS within the first few months following an abortion may have a hormonal trigger as part of the reason for the woman's suffering.

It is common knowledge that some women experience Pre-menstrual Syndrome (PMS) in such a severe way that they are driven to extreme reactions, and can even be given medication for treatment of PMS. Other women do not have a single symptom of PMS at all. Pre-menstrual Dysphoric Disorder (PMDD) is the new medical term given to PMS.

Some women have postpartum depression (PPD) after the birth of their baby. PPD can become so severe she must be hospitalized, and/or treated with medication. Other women remain blissfully full of joy from delivery date onward, and do not have one minute of depression after her baby's birth.

Some women become extremely sick and nauseated in the first few months of pregnancy, occasionally so severely ill that they must be hospitalized and re hydrated with IV fluids after developing hyperemesis gravidarum. Other women "glow" in the early months of pregnancy and never even feel queasy.

Some women have a severe reaction to hormonal methods of birth control, such as the Pill, Depo-Provera and Norplant. These reactions can be so severe that the women are unable to use hormonal methods of birth control. Other women use hormonal methods with no side effects.

Some women experiencing menopause also have severe problems with mood swings, rage, crying, weight gain, menstrual flooding, irregular menstrual cycles, hot flashes, night sweating and all the other symptoms related with peri menopause. Other women whisk right through their "change of life" with nary a problem.

All of these examples are triggered by hormones, sensitivities to hormones and fluctuation in hormone levels. For those of us that theorize the hormonal trigger factor, these women who are sensitive to hormonal fluctuations or hormonal level changes are also very susceptible to PAS/PASS. Hormones regulate all the major parts of our body systems including brain function. Some women feel suicidal, or severely depressed, or unable to function or cope after an abortion might be hormonal. There is also the emotional aspect, if the woman felt coerced, pressured, or like she had "no other choice" - these are also definitely contributing factors. I think the hormonal factor is also very important, and may have been overlooked by researchers so far. Studies need to be done that address the possibility of a hormonal connection with PAS/PASS.





PAS/PASS STAGES - ANOTHER COUNSELOR'S VIEWPOINT

Here are the stages that have identified for Post Abortion Stress Syndrome by some counselors. They are listed in the order that are considered "normal." However, women can start with different stages, can skip stages, can start with one stage, progress, and then go back to another stage! There is no set "time" that a woman spends in these stages. Some stages may last a few days, or weeks, and some may last years! There is also varying levels of "intensity" that women will experience with these stages. While stage 3 might be mildly upsetting for one woman, another woman may become seriously suicidal in that part. As more studies are done, we will be able to refine this better. It is recommended that any woman experiencing PAS/PASS, in ANY stage, should seek professional help to help her deal with this. For help on finding a counselor or depression therapy, see the links below or consult with your health care provider.

STAGE 1 - DENIAL, NUMBNESS, APATHY

This stage can start before the abortion has even taken place! Many women, after coming to the extremely difficult choice to terminate a pregnancy, may enter Stage 1. Women have reported feeling a sense of "disassociation" with the abortion plans, things like "calling the clinic," or making other arrangements seem to have been done "in a fog," like it was "someone else" doing it. A woman may tell herself over and over again that she is NOT having an abortion, that she was just having a "procedure" done. Afterwards she may continue to stick with this thought as a way of coping with her decision. She may lie about it to her health care providers and/or to other people around her. Sometimes a women may experience emotional trauma to the point of a nervous breakdown because she has stuffed her true feelings down inside of herself for a long time. Denial and numbness can go on for weeks or even years. Women can be having problems in their lives, and having problems with their health, but discount their abortion as the cause. Women can experience a wide range of emotional and physical problems after abortion such as: sexual dysfunction, eating disorders, alcohol abuse, drug (prescription and street) abuse, depression, relationship problems, low self esteem.

STAGE 2 - BEGINNING AWARENESS

At this stage she may feel a bit sad or uncomfortable when thinking about the abortion experience. This stage is characterized by avoidance of babies, women who are pregnant, baby related sections in stores, and avoidance of discussions of pro life/choice issues. The reason is not fully there in the woman's mind yet, but she knows that these things are bothering her, triggering her somehow, and she just stays away from them at every chance. Women can be edgy, irritable, easily startled, easily upset by triggering things and sounds (vacuum cleaners, or smells or other things that remind her of the abortion).

STAGE 3 - FULL AWARENESS

A woman may be very upset about the abortion, but possibly still not "consciously" acknowledging the abortion as the cause of the problems. This stage begins with awareness of the reality of the abortion, followed by extreme sadness, depression and grief - also includes a desire to "punish" oneself by viewing pictures of aborted fetuses, thinking of pain the fetus may have felt, obsessing over what happened, thinking of herself as a "murderer," punishing herself with abuse of drugs or alcohol, not eating or eating too much. This is a very intense, very frightening stage. Women can be haunted or obsessed night and day, and can have recurring frightening nightmares. Women can sleep poorly, wakening often during the night, have trouble falling asleep, and can also be easily startled. This can also be where the "replacement baby" symptom shows, and the woman will start attempting to become pregnant again, almost desperately so, in order to replace the "lost" baby - thinking if she gets pregnant again, that all her pain from the abortion will go away. Clinical depression is a common part of this stage, as well as major difficulty dealing with existing children, and any relationships. "Intrusion" is also a part of this stage, which means the woman can involuntarily re-experience the abortion or events surrounding it - flashbacks to the clinic, to protestors, to the actual abortion procedure, and the hours afterwards. When they are not suffering these "reminders," PAS/PASS sufferers are subject to another set of symptoms, described as "emotional constriction" or "numbing" - a need to avoid feelings, thoughts and situations reminiscent of the trauma, a loss of normal emotional responses or both. Their feelings can seem "unreal" to them, and the ordinary day to day business of life no longer matters. They feel cut off from the concerns of others, and are unable to trust them. It seems like the future holds nothing, and there's really no purpose for living. At the same time they may feel hidden anger towards those responsible for their abortion, and may be experiencing shame at their own helplessness to "get over this," and feel guilty about having the abortion. They become demoralized and isolated, and withdraw themselves from activities they used to enjoy, and isolate themselves from friendships, and social situations. They may have feelings that they would like to go back and "not have" the abortion, but the abortion cannot be "undone" and there is anger and depression associated with that thought.

STAGE 4 - BEGINNING ANGER

Beginning anger may be directed towards the man or the people involved with the pregnancy and resulting abortion. In this stage, women are still suffering from the symptoms and behaviors in Stage 3, but are now becoming more aware of anger. If certain people forced or coerced her abortion, or if she perceives certain people to be responsible for her abortion, anger at these people can begin to break through her numbness, and can cause her to have problems with her temper, explosiveness at little situations, yelling frequently, even throwing things - a sensitivity that is easily triggered, especially when in conflict with the people she perceives as "responsible" for her abortion decision. This can make her life difficult, because her episodes of anger can now isolate the people who can recognize her actions, and who can help her seek treatment. The woman herself is not always capable of realizing why she is having this problem, and so does not always seek out treatment at this stage. Anger at "herself" can also emerge at this stage, and she can begin or worsen self-destructive behaviors. Anger can emerge at seeing pregnant women, or hearing about pregnant women. Clinical depression can emerge in this stage as well. The feeling can surface that they would like to go back and "not have" the abortion, but the abortion cannot be "undone" and there is anger and depression associated with that thought.

STAGE 5 - ANGER OR SEVERE DEPRESSION

Anger - Lots of self destructive behaviors can emerge in the anger stage. Drinking, illegal drugs, casual relationships, carelessness in activities of all sorts, disassociation emotionally from existing children and family, overeating, anorexia, bulimia and other self-harming practices like "cutting." The woman can seem completely out of control temper-wise, emotions-wise, actions-wise. Again the feeling can surface that they would like to go back and "not have" the abortion, but the abortion cannot be "undone" and there is anger and depression associated with that thought. People may look at her actions, and label her as uncaring, or selfish, or just plain "sick," without ever realizing what is driving her to act this way. At this point, the woman is usually becoming "tired" of whatever is pushing her underneath, but is unable to help herself stop - she still may not realize it is the abortion that is causing her to have these problems, and even if she does, she most likely does not know where to get help. Intrusion may also be present in this stage. Clinical depression can also emerge here. This can also be the stage where women who are "online" will go to "Abortion Debate" message boards, and will express extreme anger towards other people, depending on their view. For example if the woman now feels pro-life, she will express inappropriate anger and hatred towards any woman or man who is pro choice. Likewise if she is pro-choice, she may express inappropriate anger and hatred towards women or men who are pro-life.

Depression Aspect - Some women have a "depression" Stage 5, where instead of feeling anger, and having self-destructive behaviors, they fall into complete and very deep depression, have difficulty getting out of bed, have difficulty performing normal daily self care, feel completely hopeless, express a wish to "die" and "join the baby," do not eat, or eat too much. They can see no point in the future, no hope in the future, and no reason to go on. They cannot see a light at the end of the tunnel, they cannot even see the tunnel! They cannot function in their normal lives, and can even quit or get fired from their job, or school, and do not really care. The black cloud of despair comes down on women so strongly, that nothing matters anymore. It is important that women with these symptoms seek professional help immediately, to help avoid suicidal thoughts or actions.

STAGE 6 - BEGINNING RESOLUTION STAGE

The beginning resolution stage deals with dealing with what happened and dealing with choices made. At this stage, the woman has realized that she needs help resolving her feelings about the abortion, and has realized that her abortion has been causing problems for her. She now seeks out either a professional counselor, a psychiatrist or a woman's post-abortion support program. Sadness, fear, panic, and many of her PAS/PASS symptoms will still be with her, but hope may be dawning that she can finally find a way to deal with all this.

STAGE 7 - FORGIVENESS STAGE

The forgiveness stage is finding out how to forgive yourself, how to forgive the people you are angry at, naming and asking your baby for forgiveness. As the woman begins therapy, or begins a post-abortion support group, she begins to deal with all her feelings and issues about the abortion. She examines what happened to her, how it affected her life, and works on finding forgiveness for herself and the others involved. Anxiety may return at this stage. PAS/PASS symptoms may still be occurring. The longer she has waited from procedure date to officially seeking help, the harder recovery can be. There can be a period of wanting to "withdraw" from all of it, and just try to go back to the way things were, and try to forget everything about the abortion. Healing, and all the things we must do and examine can be overwhelming, and retreat seems the better choice. Sometimes women do take "escape breaks" from healing. But usually Intrusion and PAS/PASS symptoms start again, and then they will return to the emotionally difficult task of healing.

STAGE 8 - BEGINNING PEACE

The beginning peace stage is starting to feel resolved with your personal feelings and losses, getting through the majority of the grief stage. As woman continue with their healing efforts, a light begins to break through the clouds. She starts to actually feel better, some of the grief, guilt and depression starts to lift. She begins to feel better about herself, and her role in the abortion. She begins to feel peace with the situation. The loss of the potential baby is still painful, and upsetting, but it is not as devastating as it was before. Seeing pregnant women does not evoke the same anger and jealousy that it did before. Her anger towards others starts to lessen. She can begin to see a future, and reasons for living, and she can see a definite lessening of her PAS/PASS symptoms and triggers.

STAGE 9 - FULL PEACE

At this stage, women have totally forgiven themselves, the man involved and anyone else who they felt contributed to their abortion. They feel at peace with the loss of their potential child. They are able to listen to and discuss abortion issues without emotion taking over. Their PAS/PASS symptoms are gone, or are very mild. Their response to triggers is mild. They feel at peace with themselves, at peace about the abortion in general, and are functioning normally in their lives again. In any of the 9 stages, women can have a strengthening of their views about abortion, and can become strongly pro-choice, or strongly pro-life. Some women switch their view about abortion, after they have one themselves. Counselors have talked with women who were pro-life before their abortion, and became pro-choice after, and vice versa. During the more difficult stages, women can become very vocal about their particular preference in this area. Once a woman gets to Stage 9, however, if she has strong views about abortion, she discusses them in more gentle and subtle ways.





FREQUENCY OF PAS/PASS

In 1995, Dr. Paul Sachdef, professor of social work at Memorial University in Newfoundland, Canada, conducted 70 in-depth interviews of women who had elective abortions during the previous 6 to 12 months. They are typical of women who have sought abortions: aged 18 to 25, single, white females. All had terminated their first pregnancy during the first trimester giving mental health as their reason for seeking an abortion. He concluded: Two-thirds of the woman had used contraceptives rarely or not at all.
  • Three-fourths of the woman thought they would not become pregnant.

  • Almost 80 percent "felt relief and satisfaction" soon after the abortion.

  • Long term guilt or depression were rare.

  • Elective abortion is less traumatic than giving a child up for adoption.

  • Women do not lightly decide to have an elective abortion.

June Scandiffino (Toronto ON Right to Life) disagreed with his findings. She wonders about the 10 percent of women who declined to be interviewed. She maintains that the "Post-traumatic abortion syndrome" may not emerge until perhaps 7 years after the elective abortion.

Former Surgeon General C. Everett Koop, a famous opponent of abortion, was asked by President Reagan to study the health effects of induced abortions. He responded in a 1989-JAN-8 letter that he could not form a conclusion from the available data. A year later, Dr. Koop told representatives of some pro-life groups that the risk of significant emotional problems after an abortion was "miniscule."

In 1989, a panel of the American Psychological Association unanimously concluded that legal abortion "does not create psychological hazards for most women undergoing the procedure." They found that about 21 percent of US adult women had an abortion. If severe emotional reactions were common, then they would have expected to notice an epidemic of women seeking treatment. No evidence of such a flood was observed.

The American Psychological Association conducted an 8 year study involving almost 5,295 women, starting in 1979. The women were interviewed each year until 1987. The researchers found that the best predictor of the women's well-being during the study was their well-being at the start of the study. Whether they had an abortion or not during the interval covered by the study did not seem to affect their mental health. Neither did their income level, job status, educational attainment, marital status, etc. In other words, they were unable to detect the existence of PAS/PASS.

The American Psychological Association further analyzed the data from the 1979-1987 study and issued a press release on 1997-JAN-31. They concluded: "Data from [a] long-term study demonstrate that even highly religious women are not at significantly greater risk of psychological distress because they had an abortion." This time they included an analysis of the woman's religious beliefs and practices - specifically: whether they were affiliated with a religious group, or were not religious. If religious, whether they attended church often or rarely.

They found that:
  • "...Having had an abortion (or more than one) had no relation with self-esteem."

  • "...The type of religion to which women who had an abortion belonged also did not make a difference in their post-abortion well-being..."


Thus, even religious women did not appear to suffer from PAS/PASS at a detectable level. They further analyzed the data for the Roman Catholic women in the study. They found that "highly religious Catholic women were slightly more likely to exhibit post-abortion psychological distress than other women..." But this is probably explained by the presence of a lower level of well-being at the start of the study by the devout Catholics, rather than any after-effect of the abortion.

A review of an article in the Journal of Social Issues states that PAS "results in partial to total cognitive restructuring and behavioral reorganization. Secondary symptoms of PAS include depression, substance abuse, sleep disorders and suicidal thoughts." The authors of the article concluded that: "at present, it is impossible to estimate with any degree of accuracy the incidence of Post Abortion Syndrome." They urge that more research be done.

We have personally noticed TV ads in various parts of North America by pro-life groups and crisis pregnancy centers which offer "Post-traumatic Abortion Syndrome Counseling" or "Post-Abortion Counseling." It is not clear whether they are offering a genuine, needed service, or are attempting to create a false belief among the public that such a syndrome is common.

Planned Parenthood has an information sheet on PAS. They quote a representative of the American Psychological Association who testified before a committee of the U.S. House of Representatives. He stated that PAS is rare and is less common than emotional upset after a birth.





SUSCEPTIBILITY TO PAS/PASS

The authors of the Planned Parenthood information sheet on PAS examined 50 studies from around the world that measured negative emotional reactions to abortion. They found that the women most at risk are those who:
  • Are emotionally unstable, with unstable living conditions.

  • Felt pressure to have an abortion from their partners or parents.

  • Chose an abortion because of a genetic problem with the fetus.

  • Had an abortion after the first trimester.

  • Had strong religious beliefs against abortion.


Ohio Right to Life describes a survey taken among women who have had abortions, and later were sufficiently distressed by the experience to join a support group: "Women Exploited by Abortion" (WEBA). The survey was conducted by David Reardon. It involved 252 women contacted via WEBA chapters throughout the United States. The survey organizers made no attempt obtain a random sampling of women. Rather, they collected data from women who felt "exploited by abortion." Some of the factors reported by the women in the survey were:
  • 90 percent were not given information on the biological nature of the fetus.

  • 84 percent felt that the clinic/health care provider/counselor very unhelpful in exploring options.

  • 74 percent felt that her decision was not well thought out.

  • 73 percent felt strongly that information was lacking or misinformation given.

  • 69 percent felt very rushed.

  • 65 percent felt that she was very much out of control of her life at the time.

  • 58 percent had an annual income less than $10,000.

  • 54 percent felt "very much" forced by outside circumstances to have the abortion.

  • 51 percent took 4 or fewer days to decide whether to have an abortion.

  • 47 percent reported physical complications (vs. 0.06 percent reported for Michigan in 1995).

  • 26 percent felt at the time of the abortion that the fetus was not a person.

  • 97 percent currently feel that the fetus was human when the abortion was performed.

  • 19 percent were 13 or more weeks into their pregnancy (twice today's average).

  • 18 percent reported permanent physical damage.

These indicators may point to the need for a woman to:
  • Confirm pregnancy earlier.

  • Study of all of her options.

  • Arrive at a careful decision, based on full and accurate information.

However, of these precautions may be inadequate to prevent guilt and depression if the woman changes her beliefs, and later concludes that the life that was terminated was that of a human person.





LINKS ABOUT PAS/PASS ISSUES & ABORTION DECISIONS

Note: Some of these links may be very Christian-oriented and preachy regarding abortion and abortion related issues. This is especially true of the pro-life links, which may or may not contain explicit graphics that can be disturbing to most individuals and may inflate the incidence of PAS/PASS as a means of "scaring" women considering abortion as an alternative to unwanted pregnancy. Many of the Pro-choice links often will down-play the surgical risks and emotional issues that may influence a woman's choice in deciding to obtain an clinical abortion. You have to use your own common sense and your discretion at visiting these links from both extremes of a highly charged issue. I have included these links as a means of gaining knowledge, both pro and con, to make an informed decision as well as providing links to help in recovery from any emotional and/or psychological issues you may experience after having an elective abortion.

You should see a licensed counselor or health professional in your area, before you make any decisions about your pregnancy. If you decide to give your baby up for adoption, you should do the process through a lawyer, AND see a counselor. NEVER agree to an abortion or an adoption without seeing a professional counselor.

After Abortion: Support for women experiencing PAS
    PAS/PASS Awareness that provides a neutral, non-political, non-religion based, non-judgmental place for women to communicate with each other after an abortion.

Suicide Hotlines: A Listing of Help Lines By State
    There are hundreds of help lines in North America. Most are anonymous, confidential and staffed by trained volunteers who care. They go by a variety of names: distress lines, crisis centers, suicide prevention bureaus, etc. Even though the words "crisis" and "suicide" often appear in their names, most of their calls are from people in distress and who simply want someone with whom they can talk. In the U.S. There is a national hotline at 1-800-784-2433. In Canada, look for a number on the first or second page of your telephone book, or in the "distress center" topic in your yellow pages.

About.com: List of PAS/PASS Web Sites
    About.com maintains of list of related web sites that offer information and/or support.

Post-Abortion Syndrome A Growing Health Problem
    Anne Speckhard & Vincent Rue: Journal of Social Issues, Fall 1992. Christian oriented.

Planned Parenthood: The Emotional Effects of Induced Abortion
    Informative article about the positive emotional effects of induced abortion and the existence and existence or non-existence of PAS/PASS. Definitely Pro-choice.

Ohio Right To Life: A Survey of Aborted Women
    Mr Reardon found his subjects for this study through Women Exploited by Abortion (WEBA), a support group for women who have had abortions. Clearly, this is not a random sample of aborted women: A woman who is completely satisfied with her decision to abort, who has no regrets or feelings of guilt, is unlikely to join a support group. (For example: 94 percent of the women in this study said they experienced "negative psychological effects." It would not be fair to say that this means that 94 percent of ALL aborted women experience negative psychological effects.) But the value of Mr Reardon's study is that his sampling technique is very different from that of other studies. By putting his study together with others we may hope to arrive at a more complete understanding of the truth.

PregnantPause.org: Recognizing Post Abortion Syndrome
    Informative article about the emotional effects of induced abortion and the existence and study of PAS/PASS.

LifeLinks: Post Abortion Help
    Pro-Life support group.

Ava Torre-Bueno: Peace After Abortion
    Ava Torre-Bueno, "Peace after Abortion," Pimpernel Press, San Diego CA. This web site contains a form for ordering her book. It also describes some women's stories about handling depression after an abortion. It lists centers in the United States and in Alberta, Canada which specialize in post-abortion counseling.

Yahoo.com: I Might Be Pregnant Email List
    The "I Might Be Pregnant" Email List - This list is for women who think they might be pregnant, and don't know what they are going to do. If your period is late, or you think you are pregnant, or want to talk about signs of possible pregnancy, or if you are pregnant and not sure what you want to do, here is an email list you can join to discuss your options.

Yahoo.com: Support For Abortion Decisions
    Discussion group for pre-abortion situations - contains members that are pro-life and pro-choice, so you will receive opinions from both views

National Abortion Federation (NAF): ProChoice.org
    Resource listing to find an abortion provider.

BirthMother.com: Adoption Support
    Adoption - If you are pregnant, and are considering giving your baby up for adoption, this is an adoption support group. If you've had a previous abortion, and are pregnant again and are going to continue the pregnancy and give the baby up for adoption, you need special support. They can provide support for the pregnancy in general on their "pregnancy support" board, however they ask that you please do not discuss adoption "issues" there, or discuss your feelings about the adoption or the issues of adoption vs abortion, and which one is better/more difficult, etc. These types of discussions may bring out deep feelings in the other women there, and will lead to non-supportive debates over adoption vs abortion. Keep to adoption related discussions at a website specifically designed to provide pre-adoption support.

PregnancyCenters.org: Unplanned Pregnancy & Abortion Information
    This is a pro-life organization, so the resources they have are for continuing your pregnancy. They will help you with counseling, pregnancy tests, medical care, baby supplies, maternity supplies, adoption information, information on WIC, welfare and other services for women who need help with food, medical care or money to continue a pregnancy. They can also help you find other resources in your area.

A Child To Love: Adoption Link
    This site has been designed to offer the opportunity for connection between couples/families and birth parents seeking to place their child for adoption.

A Choice To Live With: Pregnancy, Parenting, Abortion & Adoption Information
    The site is seems to be neither pro-life nor pro-choice, but it only seeks to help women decide, find accurate information, and find support as they go through this difficult time.

Pre-Abortion Support: Support for Abortion Decisions
    This is an email list for those who are considering an abortion. You can join this group. It contains members that are both pro life and pro choice, so you will get both views when you ask for advice here.

VoyForums: Unplanned Pregnancy Discussion
    Diane Cheryl's Unplanned Pregnancy Discussions Message Board. This is a pro-life message board run by Diane Cheryl, who has a website encouraging alternatives to an abortion (called "Abortion Alternatives"). The pro-life women there can help you find resources if you are interested in keeping your baby, or putting it up for adoption.

Abortion Facts: Post Abortion Syndrome
    Discussion and information about Post Abortion Syndrome.

AfterAbortion.com: After Abortion Resources
    Pro-choice and Pro-life resources.

A Heartbreaking Choice: Support Group
    A support group mailing list for parents who terminated due to poor prenatal diagnosis.

NARAL Pro-Choice California
    California Abortion and Reproductive Rights Action League (CARAL) has news, information and links to pro- and anti-choice web sites.

International Planned Parenthood Federation
    Voluntary organization concerned with family planning and sexual and reproductive health around the world.

NARAL: National Abortion & Reproductive Rights Action League
    Leading political force dedicated to securing the freedom to choose.

Planned Parenthood
    Information about teen issues, pregnancy options, and parenting issues.

GynPages.com: Abortion Clinics OnLine
    Information, links and a directory of providers of abortion services and other reproductive health care.

The Abortion Law Homepage
    Background and links to related legal material.

Guttmacher Institute: Abortion & Reproduction Information
    The Guttmacher Institute web site includes numerous research articles which could help activists.

Prochice.org: National Abortion Federation (NAF)
    This web site is "The Voice of Abortion Providers" which includes fact sheets about abortion, and an activist's kit to supporting abortion providers in your community.

NOW.org: NOW and Abortion Rights/Reproductive Issues
    National Organization for Women (NOW) has information about current actions and the historical fight for reproductive rights.

Center for Reproductive Rights
    The Center for Reproductive Law and Policy.

National Office of Post-Abortion Reconciliation & Healing
    This web site is Pro-Life providing support services.

Carol's Legal Abortion's Risks
    This web site is Pro-Life and may contain some upsetting pictures.

MS Magazine: Is PAS a real syndrome?





EMBRYO-FETAL DEVELOPMENT INFORMATION

Sometimes women want to know what a baby looks like at different weeks and stages in the development. It starts out as a single cell, and proceeds from there. To see accurate pictures of what an embryo looks like at different stages. Here are some links to some medical/biological web sites:

The National Institutes of Child Health & Human Development

Zygote: The Virtual Library of Developmental Biology

UNSW Embryology: Learning Concepts in Embryological Development





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