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The first step to making an informed decision concerning
the outcome of your pregnancy is to make sure you are pregnant.
See a health care provider for a pregnancy test, a physical examination,
and possibly an ultrasound procedure to accurately determine how
far along you are. The stage of pregnancy will affect pregnancy
decisions. If you decide on abortion, the stage of pregnancy will
affect the method your doctor uses to terminate your pregnancy.
A careful assessment of your health history may also reveal information
important to your decision-making about abortion. For example,
are you in good health now? What is your blood type? Do you have
an illness or condition, such as diabetes or high blood pressure,
which would complicate a pregnancy? Is there a genetic family
trait that could affect your fetus? Has the fetus been exposed
to toxic substances like alcohol or "street drugs" that
can cause damage? Is this pregnancy the result of rape or incest?
And, it is vitally important to know what your options are for
this pregnancy: adoption, abortion, or continuing the pregnancy
and parenting a child.
Abortion
risks
Prior to any abortion procedure, it is important
to make sure that the pregnancy
is in the uterus. Generally speaking, the earlier in pregnancy
an abortion is performed the safer it is for the woman. The risk
for complications increases with advancing fetal age. According
to year 2000 data from the Centers for Disease Control and Prevention
(CDC), the overall risk of dying as a direct result of a legal
abortion in the U.S. is less than 1 per 100,000 procedures. In
the 10 year period between 1990 and 1999, no women died as a result
of an induced abortion in Alaska.
Some of the risks and possible complications of different abortion
procedures are listed below. More descriptive comments can be
found at the end of this section.
METHODS USED PRIOR TO TWELVE WEEKS
(FOURTEEN WEEKS FROM THE LAST MENSTRUAL PERIOD)
Early Medical Abortion
Medical abortion is achieved by the action of drugs
that interfere with the growth and continued development of the
fetus.
Over 22% (22.6%) of abortions done in Alaska in
2004 were done by medical (non-surgical) means.
| The first drugs given will: |
| • cause the placenta to separate from
the uterine wall |
| • stop the fetal cells from growing and dividing |
A second drug is given within a few days to cause the uterus to
contract and expel the uterine contents of pregnancy.
This method takes longer than surgical abortion
procedures. The entire procedure generally takes place over the
space of a week or less but could take longer. A follow up visit
is needed to be certain the uterus is completely empty.
Vacuum Aspiration
Seventy-six percent (76.1%) of all abortion procedures
done in Alaska in 2004 were done by the vacuum aspiration method.
A visit to the doctor's office will be required
before the procedure for a preliminary examination, ultrasound,
laboratory testing, and to obtain informed consent.
This procedure can sometimes be accomplished during
one long office visit or may require a second visit to complete
the procedure. The actual vacuum aspiration procedure generally
takes 10-30 minutes plus one to two hours for recovery.
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There are several steps involved:
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| • A local anesthetic is used to block
pain at the cervix (opening to the uterus). |
| • The cervix is gently opened to about the diameter
of a fountain pen. This may be accompanied by menstrual-like
cramps |
| • A cannula (a small, hollow tube) is inserted into
the uterus |
| • A vacuum is applied and the uterine contents are
extracted by this suction. This may cause some cramping.
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| • A follow-up appointment should be made for two
to three weeks later |
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Possible complications:
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| • incomplete abortion
(more likely in the very early weeks of gestation) requiring
a D&C |
| • infection |
| • retained blood
clots in the uterus |
| • heavy bleeding |
| • uterine perforation
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| • cervical injury
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Dilation and Curettage (D&C)
Although D&C was traditionally used for abortions,
most surgical abortions are now done by vacuum aspiration. This
procedure can be accomplished within 24 hours, including recovery
time at the clinic.
No D&C abortion procedures were reported done
in Alaska in 2004.
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These are the steps involved:
|
| • A local anesthetic is used to block
pain at the cervix (opening to the uterus) |
| • The cervix is gently opened to about the diameter
of a fountain pen. This may be accompanied by menstrual-like
cramps. |
| • A curette, a tiny metal loop, is used to gently
scrape the walls of the uterus to remove the uterine contents
of pregnancy. This may cause some cramping. |
| A follow-up appointment should be made for about two to
three weeks later. |
| |
|
Possible complications:
|
| • incomplete abortion
(more likely in the very early weeks of gestation) |
| • infection |
| • retained blood
clots in the uterus |
| • heavy bleeding |
| • uterine perforation
|
| • cervical injury
|
METHODS USED AFTER TWELVE WEEKS
(FOURTEEN WEEKS FROM THE LAST MENSTRUAL PERIOD)
Dilation and Evacuation (D&E)
This procedure can usually be done within 24 to
48 hours.
D&E procedures accounted for only 1% of all
the abortion procedures done in Alaska in 2004.
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The steps involved are:
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| • The cervix must be opened up (dilated)
a bit wider for procedures in the second trimester. This
takes a little longer. Often an absorbent material is placed
in the cervix. As the material absorbs moisture, it slowly
dilates the cervix. This may take several hours; sometimes
overnight. This may cause some cramping. |
| • After the cervix is dilated, anesthesia is given.
This is often a combination of local anesthesia at the cervix
as well as intravenous medication to reduce cramping and
promote relaxation. This procedure can also be done under
general anesthesia, that is the woman will be "sleeping". |
| • The uterine contents of pregnancy are then removed
by vacuum aspiration.
|
| • After 14 weeks gestation, medical instruments
such as forceps, curette (a scraping tool), or suction are
often used to grasp and remove the uterine contents of pregnancy.
It is not always possible to remove an intact fetus using
this procedure. |
| |
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Possible complications:
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| • incomplete abortion
|
| • infection |
| • anesthesia-related complications, like allergic
reaction |
| • retained blood
clots in the uterus |
| • heavy bleeding |
| • uterine perforation |
| • cervical injury
|
Dilation and extraction (D&X)
There were no D&X procedures done in Alaska
in 2004.
These procedures are performed later in the second
trimester and into the third trimester. They are rare, and done
to preserve the life or health of the woman. They also might be
done when the fetus has already died in the uterus or has a fatal
defect.
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The steps are:
|
| • The cervix must be opened up (dilated)
and will take up to 24 to 48 hours. An absorbent material
is placed in the cervix. As the material absorbs moisture,
it slowly dilates the cervix. It may take more than one
application of the material. |
| • After the cervix is dilated, anesthesia is given.
This is often a combination of local anesthesia at the cervix
as well as intravenous medication to help with pain control
and relaxation. This procedure may also be done under general
anesthesia. |
| • The uterine contents of pregnancy are
then removed by the use of medical instruments such as forceps,
curette, and suction. It is not always possible to remove
an intact fetus using this procedure. |
| |
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Possible complications:
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| • infection |
| • heavy bleeding |
| • rare events related to surgery such as blood clots,
stroke, or problems with
anesthesia |
Labor Induction
Abortion by labor induction is a procedure generally
used after 16 weeks' gestation. It also might be done when the
fetus has already died in the uterus or has a fatal defect. Labor
is started early and a fetus is delivered in much the same way
as a full term pregnancy and delivery occur. The process generally
takes 1-2 days. Hospitalization is almost always required.
These procedures are rare. No such procedures were
reported done in Alaska in 2004.
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The steps involved in starting early labor are:
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| • The cervix is prepared by "softening"
so it will open easily as labor progresses. To do this,
a medicated suppository, a gel, absorbent material, or a
combination of these, is placed in the vagina or cervix.
|
| • Labor (uterine contractions) is then
started by giving additional medications. This can be done
in several ways: |
| |
• Vaginal suppository (most often used
method) |
| |
• By intravenous administration, that is, through
an "IV" into an arm vein (often used method) |
| |
• By intramuscular injection, that is, a "shot"
(sometimes used method) |
| |
• By administration directly into the
uterus (almost never used method; a last resort) |
| • The duration of labor depends on the
size of the fetus and the strength of uterine contractions.
|
| • The fetus will be pushed out of the
uterus and delivered vaginally as a result of the contractions.
|
| |
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Possible complications:
|
| • incomplete
abortion requiring D&C for extraction of the placenta
or retained fetal tissue |
| • infection |
| • heavy
bleeding |
| • reactions to medication, such as nausea,
vomiting, diarrhea, or allergic
reaction |
| • retained
blood clots in the uterus |
| • uterine rupture (rare) |
POSSIBLE MEDICAL RISKS OR COMPLICATIONS
OF ABORTION
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Infection
|
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Bacterial infection is an uncommon complication of abortion.
Rates are low: less than 1% in vacuum aspiration abortion,
but may be slightly higher for later abortion procedures.
Bacteria from the vagina can enter the dilated cervix
and from there, go upward into the uterus and fallopian
tubes. Antibiotics are often given at the time of abortion
to "head off" potential infections. Antibiotics
will be used to treat any infection that develops. Rarely,
repeat suction or surgery may be needed. Prompt reporting
by the woman of any infection symptoms is important to
reduce the seriousness of an infection and potential complications.
Symptoms of infection may include fever and chills, increasing
pain, odorous vaginal discharge and increased bleeding.
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Incomplete abortion
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Fetal tissue or other products of pregnancy may not be
completely emptied from the uterus. When this occurs,
heavy or irregular bleeding and infection may result.
Incomplete abortion often requires a repeat procedure
such as a D&C. The reported rate of this complication
is low: less than 1%.
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Cervical injury
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Injury to the cervix (the opening to the uterus) can
occur during abortion procedures. This may be either a
surface cut or a deeper tear in the tissue. The risk of
damage to the cervix is made smaller by gradual dilation
techniques. Multiple abortion procedures may result in
future pregnancy complications such as incompetent cervix
(weak cervix), that could lead to a pre-term birth. Injury
to the cervix occurs in less than 1% of all abortions
and is rarely permanent.
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Uterine perforation
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A medical instrument used in the abortion procedure can
go through the wall of the uterus. Depending on the location
of the injury and the depth of the perforation, there
may be bleeding or injury to surrounding organs. Perforation
can also provide an entry point for an infection. An assessment
for possible injury must be done. Occasionally surgery
is needed but often, observation of the woman is all that
is needed. The risk of perforation is related to the stage
of the pregnancy and the experience of the abortion provider.
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Heavy bleeding (hemorrhage)
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Some bleeding will be noted following all abortion procedures.
Heavy bleeding, however, is not common. Following an abortion,
the woman is observed in the doctor's office for any immediate
signs of problems and she will be instructed about what
to watch for after she leaves the doctor's office. Heavy
bleeding may be treated by repeat suction or medication.
Surgery or blood transfusion is very rarely needed.
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Retained blood clots
in the uterus
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Bleeding within the uterus can clot before it is expelled.
This results in severe uterine cramping. It occurs in
less than 1% of all abortions. The clots are usually removed
by a repeat vacuum aspiration procedure or medication.
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Allergic reactions and
Anesthesia-related complications
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Any surgical procedure that requires anesthesia or medications
carries with it a small risk due to the human response
to the drugs. Adverse drug reactions can be allergic reactions
and cause rashes, shortness of breath, nausea, vomiting,
or swelling. These reactions may occur with medications
or local and general anesthesia. If a woman is allergic
to "Novocain" it is important to alert the abortion
provider because lidocaine is the most commonly used anesthetic
drug. Locally applied anesthetics are much safer than
general anesthetics (the kind that make a person sleep).
General anesthetics are almost never used for first trimester
abortion procedures. They are frequently used in the second
trimester.
Other considerations:
- Rh immune globulin therapy: Protein material found
on the surface of red blood cells is known as the Rh
factor. If a woman and her fetus have different Rh factors,
the woman must receive medication to prevent the development
of antibodies that would endanger future pregnancies.
- Infertility: Most causes of infertility have nothing
to do with abortion. Occasionally, getting pregnant
may be difficult after an abortion, especially if there
were complications.
- Breast cancer: The American College of Obstetricians
and Gynecologists (ACOG) has explored the suggested
relationship between breast cancer and termination of
pregnancy. Their findings indicate that early studies
of the relationship between prior abortion and breast
cancer risk have been inconsistent and are difficult
to interpret because of technical considerations. They
find that recent studies argue against a causal relationship
between abortion and a subsequent increase in breast
cancer risk. There are other opinions more supportive
of the suggested relationship between breast cancer
and abortion. The American Association of Pro-Life Obstetricians
and Gynecologists (AAPLOG) supports that point of view.
The subject can be explored in more detail by referring
to the reference lists in this website.
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THE EMOTIONAL SIDE OF ABORTION
Each woman having an abortion will experience the
procedure differently from an emotional perspective based on the
facts of her decision and circumstances such as her age, stage
of pregnancy, and her religious beliefs. Women often report having
both positive and negative feelings after having an abortion.
Women who say they feel comfortable with their decision before
the procedure are less likely to report regret later. Some women
say they have had conflicting feelings lasting a longer time.
These feelings may include anger, grief, emptiness and guilt,
or sadness, as well as relief. Women may be more likely to experience
negative feelings or have difficulty after the procedure if they
were forced into a decision they didn't want or they had previous
depression or other mental health issues.
Counseling or support before and after an abortion is very important.
If family or friends are not supportive of the woman's decision,
the feelings that appear after an abortion may be harder to handle.
This is also true if the procedure was undertaken in secrecy or
isolation. Talking with a counselor before having an abortion
can help a woman understand the factors that are part of her decision
and the feelings she may have afterward.
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