Whats is abortion:
Abortion ends a pregnancy before birth. It occurs naturally in 15–40 percent of all established pregnancies — when an embryo or fetus stops developing and the body expels it. This is called spontaneous abortion, miscarriage, or early pregnancy loss. Women choose abortion in less than 25 percent of the 6,000,000 pregnancies that are diagnosed in the U.S. every year — 50 percent of which are unintended. This is called induced abortion.
Risks & Side Effects :
What Abortion Feels Like
Medication Abortion
For most women, medication abortion is like an early miscarriage. It is expected you will have bleeding and cramping. You might also
* feel dizzy
* feel strong cramps
* feel nauseous or vomit
* feel temporary abdominal pain
* have diarrhea
* have temporary mild fever or pains
Acetaminophen — such as Tylenol® — can reduce most of these symptoms. Painkillers such as ibuprofen — for example, Motrin® or Advil® — can also reduce symptoms. Do not take aspirin.
Vacuum Aspiration and D&E
Most women say they feel pain similar to strong menstrual cramps. For others, it is more uncomfortable. Local numbing medications are usually used. Some clinics use additional medicines that allow you to be awake but deeply relaxed. Others offer general anesthesia so you can sleep through the procedure. This, however, increases the medical risks and the time you must stay at the clinic.
Embryonic and Fetal Pain
We know for sure that the embryo or fetus cannot perceive pain in the nearly 99 percent of all abortions that occur before the 20th week of pregnancy. It is even possible that a fetus is unable to perceive pain at any time during pregnancy. If, however, the ability to feel pain does develop before birth and consciousness, it is likely to happen only after the 28th week of pregnancy, when abortion is performed only for rare, unusual medical situations.
Feelings After an Abortion
Most women feel relief. Some women feel anger, regret, guilt, or sadness for a little while. Sudden hormonal changes may intensify these feelings.
Some people who oppose a woman's right to make her own reproductive decisions claim that abortion often causes long-lasting emotional problems, or "post-abortion syndrome." There is no scientific proof for these claims.
Emotional Problems After Abortion
Serious, long-term emotional problems after abortion are extremely rare and less common than they are after childbirth. Such problems are more likely if
* the pregnancy was wanted but the health of the fetus or the woman was in danger
* having an abortion is related to serious problems in a relationship or other disturbing life events
* a woman is depressed or has other emotional problems that predate her pregnancy
If you need to talk with someone after an abortion, abortion providers can talk with you or refer you to a counselor.
Health Risks of Abortion
First-trimester abortion is much safer for women than giving birth. But there are risks associated with any medical procedure. Your overall health may affect you risks of complications.
Medication Abortion
Possible risks include
* incomplete abortion — the embryo and other products of conception are not entirely expelled from the uterus
* allergic reaction
* infection
* very heavy bleeding
* undetected ectopic pregnancy, which can be fatal if left untreated
* in extremely rare cases death is possible from very serious complications — the risk of death from medication abortion — about one out of 100,000 — is
o about the same as it is from miscarriage — about one out of 100,000
o higher than it is from early vacuum aspiration abortion — about one out of one million
o lower than it is from carrying a pregnancy to term — about 10 out of 100,000
Vacuum Aspiration and D&E
The risks associated with vacuum aspiration and D&E increase the longer you are pregnant and if sedation or general anesthesia is used. Possible risks include
* incomplete abortion — the embryo or fetus and other products of conception are not entirely removed from the uterus
* allergic reaction
* infection
* very heavy bleeding
* undetected ectopic pregnancy, which can be fatal if left untreated
* blood clots in the uterus
* injury to the cervix
* organ injury
* in extremely rare cases death is possible from very serious complications. In general, the risk of death from abortion increases the longer a woman has been pregnant. Overall, the risk of death from childbirth is 11 times greater than the risk of death from abortion up to 20 weeks of pregnancy. After 20 weeks, the risk of death from abortion is about the same as the risk of death from childbirth.
Future Pregnancies
Safe, uncomplicated abortion should not affect your ability to have a child in the future. In future pregnancies, it does not
* cause birth defects
* cause premature birth or low infant birth weight
* make ectopic (not in the uterus) pregnancy more likely
* make miscarriage more likely
* make the risk of infant death more likely
Having more than one abortion also should not affect future pregnancies.
Seeing the Embryo or Fetus
Some women fear seeing the embryo or fetus during abortion.
Medication Abortion
Women who have medication abortion in the first 49 days of pregnancy are unlikely to see the embryo. Women who have medication abortion from 49 to 63 days of pregnancy are somewhat more likely to be able to identify the embryo or fetus.
Vacuum Aspiration and D&E
The clinician and other staff people who perform the procedure may see the embryo or fetus, as well as the other products of conception.
Breast Cancer
Abortion does not cause breast cancer or increase the risk of breast cancer.
Procedures:
When Abortions Are Performed
Most abortions in the United States — nearly 90 percent — are provided in the first trimester. Fewer than 10 percent take place in the second trimester. But after 24 weeks of pregnancy, abortions are performed only for serious health reasons. Fewer than one-tenth of one percent of abortions happen during this time.
The Earlier, the Better — Try to arrange an abortion procedure as soon as you have made up your mind to have one. Earlier abortions are easier and safer than abortions later in pregnancy. They may also cost less.
Preparing for an Abortion
You will need to
* discuss your options
* sign a consent form
* give a medical history
* have laboratory tests
* have a physical exam — often including an ultrasound
How Medication Abortion Works
There are three steps for medication abortion:
STEP ONE
Your clinician will give you a dose of either mifepristone or methotrexate at the clinic.
Mifepristone — blocks the hormone progesterone. Without progesterone, the lining of the uterus breaks down, ending the pregnancy.
Methotrexate — stops the growth of the pregnancy in the uterus. It can also stop the growth of pregnancies that develop in a fallopian tube — ectopic pregnancies.
STEP TWO
You will take a second medication — misoprostol. Misoprostol softens the cervix and causes the uterus to contract and empty.
You and your clinician will plan the timing and place for the second step — you may take the second medicine at home. Or you may need to return to the clinic. Your clinician will give you instructions on how to take it.
You will take the misoprostol
* up to three days after taking mifepristone
* about five days after taking methotrexate
After you take the misoprostol you will most likely start to bleed heavily within hours or days. This is the abortion. You may see large blood clots or tissue at the time of the abortion.
STEP THREE
You will return to your clinician for a follow-up visit within two weeks.
* Follow-up visit. Your clinician needs to make sure the abortion is complete and that you are well. You will need an ultrasound or blood test.
How Vacuum Aspiration and D&E Work
Vacuum aspiration empties the uterus with gentle suction of a hand-held suction device or with machine-operated suction. When it is performed with a manual suction device, it is sometimes called manual vacuum aspiration or MVA. When it is performed with machine-operated suction, it is sometimes called dilation and suction curettage or D&C.
During a vacuum aspiration abortion
* Your uterus will be examined.
* A speculum will be inserted into your vagina.
* You may be offered sedation.
* The clinician may inject a numbing medication into or near your cervix.
* The opening of the cervix may be stretched with dilators — a series of increasingly thick rods. Or you may have special absorbent dilators inserted that will absorb fluid and slowly stretch open your cervix — sometimes absorbent dilators are inserted the night before and work as you sleep. Medication may also be used instead of — or along with — dilators to help open the cervix. You may also be given antibiotics to prevent infection.
* A tube is inserted through the cervix into the uterus.
* Either a hand-held suction device (MVA) or a suction machine (D&C) gently empties the uterus.
* A separate curette may be used to help remove the tissue that lines the uterus.
During a D&E abortion
* Your uterus will be examined.
* A speculum will be inserted into your vagina.
* You may have special absorbent dilators inserted as early as the night before that will absorb fluid and slowly stretch open your cervix as you sleep. Medication may also be used instead of — or along with — dilators to help open the cervix. You may also be given antibiotics to prevent infection.
* You may be offered sedation or IV medication to make you more comfortable.
* A local numbing medication is injected into or near the cervix.
* The dilators are removed.
* The uterus is emptied with medical instruments and suction.
Make a follow-up appointment in two to four weeks after your vacuum aspiration or D&E abortion.
How Long an Abortion Takes
Medication Abortion
Medication abortion is a process that begins immediately after taking mifepristone or methotrexate. Some women may begin bleeding before taking misoprostol. For most, the bleeding and cramping begin after taking the misoprostol.
More than 50 percent of women who use mifepristone abort within four or five hours after taking misoprostol. Bleeding may continue for about 13 days. Spotting can last for a few weeks. About 92 percent of mifepristone abortions are completed within a week. About 75 percent of methotrexate abortions are completed within a week. But in 15-20 percent of women it can take up to four weeks.
Vacuum Aspiration and D&E
A vacuum aspiration procedure takes about 10 minutes. A D&E procedure usually takes between 10 and 20 minutes. Additional time is needed for client education, a physical exam, reading and signing forms, and a recovery period of about one hour.
What to Expect After an Abortion
Medication Abortion
You will be given written after-care instructions and a 24-hour emergency phone number to take home with you.
You should feel better each day after the abortion. You may have some bleeding for up to four weeks after. You may use pads or tampons, but using pads makes it easier to keep track of your bleeding.
You may want to stay home and relax on the day that you take the misoprostol, or whenever your bleeding starts. You can usually return to work or other normal activities in the next day or two.
Until your follow-up visit, do not take aspirin. If you had methotrexate abortion, do not take vitamins with folic acid.
A low dose of misoprostol will be present in breast milk around the time of its use. It may cause an infant to have diarrhea. Talk with your clinician if you are breastfeeding.
Vacuum Aspiration and D&E
You will be given written after-care instructions and a 24-hour emergency phone number to take home with you.
You may have cramps. You may want to relax for the rest of the day. You may shower as soon as you wish. Do not take baths, douche, or use vaginal medications. Do not drive after the procedure if you've had sedation. You can usually return to work or other normal activities the next day. Recovery after D&E may take longer.
Some vaginal bleeding is normal after an abortion. It is normal to pass a few clots the size of a quarter. It is also normal to have no bleeding, spotting that lasts up to six weeks, heavy bleeding for a few days, or bleeding that stops and starts again. You may use pads or tampons, but using pads makes it easier to keep track of your bleeding.
Warning Signs After an Abortion
Call your clinician right away if at any time you have
* heavy bleeding — pass clots larger than a lemon or soak through more than two maxi pads an hour, for two hours or more in a row
* pain or discomfort not helped by medication, rest, a hot water bottle, or a heating pad
* a fever
* vomiting for more than four to six hours and are not able to keep anything down
* an unpleasant smelling vaginal discharge
* signs of a continuing pregnancy
During a medication abortion, feeling sick — including abdominal pain or discomfort, diarrhea, nausea, vomiting, or weakness — more than 24 hours after taking misoprostol could be a sign of serious infection. Contact your clinician right away if you have any of these symptoms. Do not wait for your follow-up appointment.
You may need another visit with your provider. Rarely, women need vacuum aspiration or hospitalization after medication abortion. Take your medication guide with you if you need to visit an emergency room, hospital, or clinician who did not give you the medicine.
Getting Your Period After an Abortion
Abortion begins a new menstrual cycle. You should have a regular period in four to eight weeks.
Having Sex After an Abortion
You can get pregnant very soon after an abortion. Discuss birth control options with your clinician.
Many clinicians recommend that you not have vaginal intercourse or insert anything except a tampon into your vagina for one week after the abortion.
Cost
Costs vary from community to community, based on regional and local expenses.
Medication Abortion
Nationwide, cost ranges from $350 to $650. Costs may be more or less, depending on whatever additional tests, visits, or exams are needed.
Vacuum Aspiration and D&E
Costs vary depending on how long you've been pregnant and where you go. Nationwide, the cost ranges from about $350 to $700 for abortion in the first trimester. Hospitals generally cost more.
Where to Get an Abortion
Contact Planned Parenthood at 1-800-230-PLAN, other women's health care centers, or your private clinician. Planned Parenthood centers that do not provide abortion can refer you to someone who does. Or you can call the National Abortion Federation at 1-800-772-9100.
Choosing Abortion:
These documents are for informational purposes only and are not intended to constitute medical advice, diagnosis, or treatment.
Choosing Abortion
The chances are high that a woman will have more than one unplanned pregnancy in the course of her lifetime. More than one-third of all U.S. women will have an abortion by the time they are 45 years old. About six million women in the U.S. become pregnant every year. Half of those pregnancies are unintended. Nearly 1.3 million women choose abortion to end their pregnancy each year.
The most common reasons a woman chooses abortion are
* She is not ready to become a parent.
* She cannot afford a baby.
* She doesn't want to be a single parent.
* She doesn't want anyone to know she has had sex or is pregnant.
* She is too young or too immature to have a child.
* She has all the children she wants.
* Her husband, partner, or parent wants her to have an abortion.
* She or the fetus has a health problem.
* She was a survivor of rape or incest.
Deciding If Abortion Is Right For You
Most women look to their husbands, partners, families, health care providers, clergy, or someone else they trust for support as they make their decision about an unintended pregnancy. And many women go to the clinic with their partner. But you don't have to tell anybody. Specially trained educators at women's health clinics can talk with you in private. You may bring someone with you. You will discuss your options — adoption, parenting, and abortion. You may be asked if someone is pressuring you to have an abortion.
Teens are encouraged to involve parents in their decision to have an abortion, and most do have a parent involved. But telling a parent is only required in states with mandatory parental involvement laws. Such laws force a woman under 18 to tell a parent or get parental permission before having an abortion. In most of these states, if she can't talk with her parents — or chooses not to — she can appear before a judge. The judge will consider whether she's mature enough to decide on her own. If not, the judge will decide whether an abortion is in the teen's best interests. In any case, if there are complications during the procedure, parents of minors may be notified.
Here are some things to consider if you are thinking about abortion.
True False
1. No one is pressuring me to choose abortion. [ ] [ ]
2. I have strong religious beliefs against abortion. [ ] [ ]
3. I look down on women who have abortions. [ ] [ ]
4. I'd rather have a child at another time. [ ] [ ]
5. I can afford to have another child. [ ] [ ]
6. I can afford to have an abortion. [ ] [ ]
7. I care about what other people will think. [ ] [ ]
8. I can handle the abortion experience. [ ] [ ]
9. I'll go before a judge if necessary. [ ] [ ]
10. I would do anything to end this pregnancy. [ ] [ ]
Think about whether or not your answers suggest that abortion might be right for you.
You can get abortion information and assistance at Planned Parenthood and other family planning centers, women's health centers, youth centers, and departments of health or social services. Or you can call the National Abortion Federation hotline: 1-800-772-9100.
To make an appointment with the Planned Parenthood center nearest you for information about abortion and your other pregnancy options, call toll-free 1-800-230-PLAN.
Abortion Options
Early in pregnancy, you have two options for ending a pregnancy — medication abortion or abortion by vacuum aspiration. (The information about procedures is presented alphabetically.) Medication abortion is the use of medicine to end a pregnancy. Vacuum aspiration is the use of gentle suction to end pregnancy.
Pregnancy is usually dated from the first day of the last menstrual cycle. You may choose medication abortion if you are early enough in pregnancy — this may be defined as up to 49, 56, or 63 days, depending on how the medicine is taken. After 63 days, vacuum aspiration is your only abortion option during the first trimester, which is calculated as the first 14 weeks after the first day of a woman's last menstrual period.
After the first trimester, dilation and evacuation (D&E) is the most common abortion procedure. In a D&E, the cervix is slowly stretched open. The procedure is completed by emptying the uterus using a combination of suction and medical instruments. Another option, induction — in which premature labor is induced with various medicines — is not widely available.
Abortion Contraindications
Medication Abortion
You should not have medication abortion if you
* are too far along in pregnancy
* are unsure about having the procedure
* are unwilling to have a vacuum aspiration if needed
* cannot return for follow-up visits
* do not have access to a telephone, transportation, and back-up medical care
* have a known or suspected molar pregnancy — one in which the placenta develops abnormally
* have severe adrenal gland, heart, kidney, or liver problems
* take any medicine that should not be combined with the medications used in medication abortion — methotrexate, mifepristone, or misoprostol
* take anti-clotting medication or have blood-clotting disorders
* are unwilling to have your IUD — if you have one — removed before taking the medicine
Special considerations may be necessary if you
* are breastfeeding
* have chronic heart, liver, respiratory, or kidney disease
* have an infection or are sick
* have severe anemia
* have uncontrolled high blood pressure
* have any other serious health problem
Vacuum Aspiration and D&E
You should not have vacuum aspiration or D&E if you
* are unsure about having the procedure
Special considerations may be necessary if you
* are extremely overweight
* are running a fever
* have an infection in your uterus
* have certain kinds of sexually transmitted infections
* have certain serious health problems
* have problems with anesthesia
* have seizures more than once a week
Effectiveness
Medication Abortion
There are two types of medication abortion offered in the U.S. — mifepristone medication abortion and methotrexate medication abortion. Mifepristone and methotrexate affect the body differently. Mifepristone is used more often than methotrexate because it is more effective and more predictable. Mifepristone is 96-97 percent effective. Methotrexate is about 92-96 percent effective.
Some of the medicines used in medication abortion may cause serious birth defects if pregnancy continues. So, if they don't work, vacuum aspiration should be done.
Vacuum Aspiration and D&E
Vacuum aspiration and D&E abortion are more than 99 percent effective. Failure to end a pregnancy can happen due to unusual conditions: there can be more than one chamber in the uterus, or the pregnancy may not be in the uterus. Repeated aspiration or other treatment may be needed if the initial procedure does not end the pregnancy.
Comparing Risks
If you choose abortion, you will also want to compare the benefits, risks, and side effects of each of your options. For example, both medication abortion and early vacuum aspiration are extremely safe. But current data suggest that medication abortion may carry a higher risk of death than early vacuum aspiration abortion. Even so, both procedures are much safer than abortion later in pregnancy or carrying a pregnancy to term.
Some women prefer medication abortion because they feel its benefits outweigh its risks. Other women prefer vacuum aspiration abortion because they feel its benefits outweigh its risks. Your clinician can help you decide, but the choice is up to you.