Abortion (termination of the pregnancy)

Do I Really Need to Get STD/STI testing if I want to have an abortion?

Yes! Can I say it again? Yes! First, it’s super important that you get tested for STD/STI (Sexually Transmitted Disease/Sexually Transmitted Infection) just for your own knowledge. An undiagnosed STD/STI can cause long-term and sometimes irreversible effects if not treated appropriately. At our center, we test for Chlamydia, Gonorrhea, Syphilis, HIV, Hep C, Herpes Type 1 & 2.

Secondly, when dealing with a possible abortion, an STD/STI could cause potential complication following the procedure, including Pelvis Inflammatory Disease (PID). PID occurs because of untreated bacterial infections, including chlamydia and gonorrhea (source: Center of Disease Control). Research states women who have abortions are more likely to develop PID after their procedure because of the risk of bacterial infection during the procedure. PID can lead to some very serious complication including infertility and ectopic pregnancy (tubal pregnancy). When PID is caused by chlamydia infection, a woman may be more likely to experience only mild symptoms even when extremely serious damage is being done to her reproductive organs. (source: National Center of Biotechnology Information as of the US National Library of Medicine) *More information on STD/STI under STD/STI tab).

Late-Term

Ru-486

Otherwise known as the Abortion Pill, this pill(s) can terminate an embryo up to 10 weeks gestation. Considered a medical abortion (not surgical) must prescribe the Abortion Pill (it’s actually 2 different pills), and it includes a three-step process:

• First, take Mifepristone. This medication actually blocks your body’s ability to recognize progesterone by the uterus. Progesterone is one of the hormones that your uterus needs to maintain the life of the embryo. By blocking progesterone, the lining of the uterus begins to break down. Then, the life of the growing embryo is ended.
• Secondly, take Misoprostol. Misoprostol causes the uterus to contract causing the embryo, lining of the uterus, and the embryonic sac to exit the uterus. This process usually takes 24-48 hours and causes extreme bleeding and strong uterine cramping. Do not use tampons during the process, only use pads.
• Lastly, return to the clinic to confirm that the procedure is complete. Your doctor will ask you a variety of questions from if you were able to see the expulsion of the gestational sac or embryo, to how much bleeding did you experience, and if you think you are still experiencing pregnancy symptoms.
• This is very important because the Abortion Pill is not 100% effective and you may still be pregnant. If that is the case, then a surgical abortion will be the next step.
• Your period should return within the next 2 months after the abortion process.

What you need to know: The abortion pill is not taken in a hospital. It is taken at home. Since heavy bleeding and cramping accompany it, it is important that you have someone with you in case of an emergency. Other symptoms during the process can include:

1. Mild fever and chills
2. Light lactation
3. Diarrhea
4. Nausea and sometimes vomiting

Things to be aware about taking ru-486:

• Do not take it if you are past the 10-week window. The chances for it working decrease.
• You are using an IUD.
• You have a blood clotting condition and/or you are taking blood-clotting medication.
• Determine if you are willing to continue with a surgical abortion if the pill fails.

Please contact your doctor or go the ER if you are experiencing any of these symptoms after taking the abortion pill:

• Foul smelling vaginal discharge
• Blood clots that occur for 2 hours or more.
• Excessive bleeding (fills up more than 2 pads in an hour and happens for 2 hours or more)
• Extreme depression and suicidal thoughts.
• A fever of 100.4F or higher.
• Severe depression and/or suicidal thoughts.

What if I change my mind?

There is a pill called Abortion Pill Reversal (APR). What it does, is that it essentially counteracts the first pill (Mifepristone) of ru-486. It can only be used if only the first pill is taken. If the 2nd pill has been ingested, APR cannot be used.

The idea is that a major dosage of progesterone will make up for the progesterone being blocked by the Mifepristone. It needs to be taken up to 72 hours after taking Mifepristone. The earlier it is taken the better. One particular statistic states that if taken within the first 24 hours, there is a 55% chance that the pregnancy will continue (americanpregnancy.org).

Aspiration Abortion (first trimester):

Aspiration Abortion is commonly referred to as a suction abortion and considered a surgical procedure. This is a one-day procedure available up to the 14th week of pregnancy. It should entail local anesthesia and oral pain relievers. It is common that this procedure could take between 3 – 6 or more hours. It should only be performed in a medical setting.

The Procedure:

• You should receive oral pain medications such as Valium or ibuprofen. If you are more than 12 weeks pregnant, you should also receive misoprostol with causes the cervix to soften and dilation to occur.
• If you are less than 12 weeks pregnant, you will begin your procedure in about an hour to allow the pain relievers to kick in.
• If you are over 12 weeks pregnant, the misoprostol needs a few hours to work.
• After the medications are working, you will go into the procedure room and be asked to undress from the waist down.
• The doctor will use a tool called the “speculum” to view inside your vagina.
• Your vagina will be cleaned with soapy gauze and numbing medication applied to your cervix.
• The use of metal rods will then be used to dilate your cervix.
• A tube will be inserted into your uterus.
• The doctor will then apply suction from a machine to the end of the tube and remove the embryo through the tube.
• The doctor will check to make sure the complete embryo has been suctioned out, and if not, repeat suction.

Side Effects:

• Cramping
• Dizziness
• Bleeding (including blood clots)

What you need to know: Any surgical procedure has risk involved. If you experience any of these symptoms go to the emergency room or call your doctor.

• Fever (this is usually a sign of infection)
• Passing clots that are larger than a fist for more than 2 hours.
• Bleeding that goes through 2 pads in an hour for more than an hour.
• Vaginal discharge that is foul smelling.
• Pain and cramping that gets worse over time
• Continued pregnancy symptoms.

Dilation and Evacuation (D&E):

This surgical type of abortion is the most commonly used in second-trimester abortion. It takes places usually between 15 weeks and 23 weeks gestation. It takes a couple of days for the entire procedure.

The Procedure:

• In many cases, your doctor will insert laminaria (or another synthetic dilator) inside your cervix 24 hours before the procedure.
• When a woman comes back the next day, she should be offered antibiotics to prevent infection and may be administered anesthesia for the procedure.
• The doctor will then begin to open the cervix using metal dilators and a speculum.
• Then, the doctor will insert a large suction catheter into the uterus emptying the amniotic fluid.
• When the amniotic fluid is removed, a Sopher clamp (an instrument that allows the doctor used to grasp the fetus) is then used to pull out the fetus.
• This can take several attempts.
• After the fetus is removed, the doctor will use a curette instrument to scrape the inside of the uterus, remove the placenta, and any other remaining tissue.
• All tissue and fetal matter are examined to determine that everything was removed and the procedure is complete.

What you need to know:

• There may be irregular bleeding and spotting in the first 2 weeks.
• Don’t use tampons only use pads.
• There could be some cramping that resemble menstrual cramps which may last for a few hours to a few days as the uterus shrinks to its average size.
• Antibiotics will be given to prevent infection.
• Over the counter pain medication can be taken to help alleviate pain.

Contact the doctor or visit the emergency room if you have any of these symptoms:

• Bleeding heavily for 12 or more hours in a row.
• Soaking more than 2 pads in an hour, for 2 or more hours in a row.
• Blood clots the size of a ping-pong ball being passed for 2 or more hours.
• Signs of infection that include headache, dizziness, fever of 100.4 F or higher that lasts longer than 4 hours.
• Foul-smelling vaginal discharge
• Rapid heart rate
• Sudden abdominal pain
• Pain, swelling or redness in the genital area.

Risks:

• Injury to the uterus
• Infection
• Moderate to severe bleeding.
• Blood clots can occur if the uterus doesn’t contract to pass all the tissue (medication can be used to stop the bleeding) and the cervical opening can become blocked and prevents blood from leaving the uterus. This created an enlarged uterus with tenderness, cramping, and nausea.
• A repeat vacuum aspiration can be used if there is any fetal/tissue remains and to expel blood clots.

Late-Term Abortion:

Late-term abortion is really directly connected to “fetal viability” or when a fetus can survive outside the womb with our without medical assistance. Some states will say that is 24 weeks of gestation and others will say it’s different. The definition is different from state to state. If you are unaware of your state’s late-term abortion laws, communicate your concerns to the doctor or research your particular states’ abortion laws.

However, in cases where gestation is 21 weeks, Dilation and Extraction (D&X), Intrauterine Cranial Decompression, and Partial Birth Abortion are used.

The Procedure:

• Two days before the procedure the use of laminaria (a product made of seaweed) is inserted vaginally to dilate the cervix.
• On the third day, the amniotic sac should break.
• After returning to the clinic, forceps are to grasp the fetus and pull it out by the legs through the birth canal.
• Before the head comes completely through the birth canal, a tiny incision is placed at the base of the skull and a suction catheter inside.
• The catheter suctions the developing brain material until the skull collapses.
• After that, the fetus is then completely removed.

Contact the doctor or visit the emergency room if you have any of these symptoms:

• Bleeding heavily for 12 or more hours in a row.
• Soaking more than 2 pads in an hour, for 2 or more hours in a row.
• Blood clots the size of a ping-pong ball being passed for 2 or more hours.
• Signs of infection that include headache, dizziness, fever of 100.4 F or higher that lasts longer than 4 hours.
• Foul-smelling vaginal discharge
• Rapid heart rate
• Sudden abdominal pain
• Pain, swelling or redness in the genital area.

Risks:

• Injury to the uterus
• Infection
• Moderate to severe bleeding.
• Blood clots can occur if the uterus doesn’t contract to pass all the tissue (medication can be used to stop the bleeding) and the cervical opening can become blocked and prevents blood from leaving the uterus. This created an enlarged uterus with tenderness, cramping, and nausea.
• A repeat vacuum aspiration can be used if there is any fetal/tissue remains and to expel blood clots.

Emotional Cost:

There is an emotional component that comes with having an abortion procedure. Of course, terminating a pregnancy causes hormonal shifts that effect mood. But, there is more than that. There are many feelings that come with having an abortion that can be complex and, at times, life threatening. It’s important to reach out to someone to share your concerns. Consider contacting a counselor or if you don’t know who to turn to, call us! We are willing and ready to walk alongside you in any part of your journey. Here is a list of possible emotional feelings after having an abortion procedure.

• Guilt
• Shame
• Anger
• Loneliness or isolation
• Low self-confidence
• Problems sleeping
• Problems dealing with relationships
• Suicidal thoughts and feelings
• Possible eating disorders
• Anxiety
• Depression

**if you are having suicidal thoughts or long term depression, seek a medical professional immediately.

Why do some women have negative emotional or psychological effects after an abortion?

Many times, the emotional side effects are highly connected to how we view the growing fetus. Some don’t view the fetus as a baby, when others do. Some feel immediate relief and others struggles with the after effects for years. Here are some reasons why some women have a more difficult time after an abortion.

• Someone who may already have mental health issues.
• If the abortion felt pressured or demanded.
• Someone with a religious background that doesn’t support abortion.
• Someone who has a moral conflict with abortion.
• Someone who had a second or third term abortion.
• Someone who doesn’t have a support system.
• Someone who felt abortion was necessary based off of genetic testing or fetal abnormalities.