HEALTH EDUCATION

Abortion

What is abortion?
Abortion is a way to end pregnancy. Sometimes, an embryo or fetus stops developing and the body expels it. This is called spontaneous abortion or "miscarriage."

You can also choose to end a pregnancy. This is called induced abortion. There are three ways it can be done — with medicine, vacuum aspiration, or surgery.

How is medication abortion done?
Medication abortion ends a pregnancy with medicine and without surgery.

There are three steps:

• First, your clinician will give you a dose of mifepristone to take in the medical center. Mifepristone is taken orally. Mifepristone blocks the hormone progesterone. Without progesterone, the lining of the uterus breaks down, ends the pregnancy in the uterus, and causes vaginal bleeding.

• Second, you will take another medication called misoprostol at home 1-2 days after your visit in the medical center. Misoprostol is placed in the mouth and absorbed through the lining of the mouth. This causes the uterus to contract and empty.

• Third, you will return to your clinician for follow-up to make sure the abortion is complete.

How is vacuum aspiration done?
Vacuum aspiration is a way to end pregnancy by emptying the uterus with suction. This method is performed in a clinician’s office or in a hospital.

The two most common methods are manual vacuum aspiration, and dilation and suction curettage. The method used depends on how long you have been pregnant.

Manual vacuum aspiration (MVA) — MVA can be done as soon as you know you are pregnant and up to 10 weeks after your last period:

• Your vagina is washed with an antiseptic.

• The clinician may inject a painkiller into or near your cervix and may offer other painkillers.

• The opening of the cervix may be stretched with dilators.

• A tube is inserted through the cervix into the uterus. A hand-held instrument gently empties the uterus.

• You will return to your clinician for follow-up.

Dilation and suction curettage (D&C) (also called vacuum aspiration) — D&C can be performed after the first month of pregnancy and throughout the first trimester:

• Your vagina is washed with an antiseptic.

• The clinician may recommend sedation and may inject a painkiller into or near your cervix and may offer other painkillers.

• The opening of the cervix is stretched with dilators. In addition, you may be given a medication or you may have special dilators inserted
before the procedure to open your cervix slowly and gently.

• A tube is inserted through the cervix into the uterus. This tube is attached to a suction machine.

• The suction machine is turned on. The uterus is emptied by gentle suction.

• A curette (narrow metal loop) may be used to clean the walls of the uterus.

• You will return to your clinician for follow-up.

How effective is it?
Medication abortion — 92–97%
Vacuum aspiration — Nearly 100%

How long does it take?
Medication abortion — Most women have the abortion within 4-24 hours after taking the second medication (misoprostol). The process usually takes 12-24 hours to complete.

Vacuum aspiration — MVA and D&C take about 10 minutes. You may bleed off and on for a couple of weeks after vacuum aspiration. Some women have cramps and pass a few large blood clots for up to 10 days.

How does it feel?
Some kind of painkiller is used in all abortions. Most women feel cramps. You may have cramps during and after a vacuum aspiration. You will feel strong cramps with medication abortion — which is done with medicine instead of instruments.

Medication abortion — Most women say it feels like an early miscarriage. You may:

• Bleed as if having a heavy period

• Feel strong cramps

• Feel temporary abdominal pain

• Feel uncomfortably warm

• Have fever and chills

• Feel nauseous or vomit

• Have diarrhea

Vacuum Aspiration — Most women say they feel pain similar to strong menstrual cramps. For others, it is more uncomfortable. Some clinics use a kind of medicine that allows you to be awake but deeply relaxed.

After a vacuum aspiration you’ll rest in a recovery room for about an hour. You will receive written after-care instructions and a 24-hour emergency phone number. You may also want to relax for the rest of the day. You can usually return to work or other normal activities the next day.

Can an embryo or fetus feel pain?
We know for sure that the embryo or fetus cannot perceive pain in the nearly 99% 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 urgent medical reasons.

How will I feel afterward?
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 women’s right to make their own decisions claim that abortion often causes long-lasting emotional problems, or "post-abortion syndrome." There is no scientific proof for these claims.

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 already has emotional
problems

If you need to talk with someone after an abortion, abortion providers can offer follow-up counseling or refer you to a counselor.

What do I need to have an abortion?
For either method, you will need to:

• Have counseling

• Sign a consent form

• Give a medical history

• Have laboratory tests

• Have a physical exam — usually including an ultrasound

Will I see the embryo or fetus?
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 56 days of pregnancy are somewhat more likely to be able to identify the embryo or fetus.

Vacuum Aspiration — The clinician and other staff people who perform the procedure may see the embryo or fetus, as well as the other products of conception.

What are the possible risks?
First trimester abortion is much safer than giving birth.

Medication Abortion — Possible risks include:

• Incomplete abortion — your clinician will help you decide whether to wait 2-6 weeks and check again, take more misoprostol, or have a vacuum aspiration

• 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 — fewer than one in 200,000 cases

Vacuum Aspiration — Possible risks include

• Allergic reactions to the anesthetics

• Incomplete abortion — in fewer than one out of 100 D&C abortions

• Infection

• Very heavy bleeding

• Cut or torn cervix — in fewer than one out of 100 first trimester abortions

• Organ injury — in about five of 1,000 first trimester abortions. Surgery, or very rarely, hysterectomy, may be needed.

• Undetected ectopic pregnancy, which can be fatal if left untreated

• In extremely rare cases death is possible from very serious complications — approximately one in 200,000 cases

Where can I 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 medication abortion can refer you to someone who does. Or you can call the National Abortion Federation at 1-800-772-9100.

How much does it cost?
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. Costs vary from community to community, based on regional and local expenses. Contact your nearest Planned Parenthood health center 1-800-230-PLAN for information about costs in your area.

Vacuum aspiration — 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. Costs vary from community to community, based on regional and local expenses. Contact your nearest Planned Parenthood health center
1-800-230-PLAN for information about costs in your area.

How do I know if abortion is right for me?
Most women look to their husbands, partners, families, health care providers, clergy, or someone else they trust for support as they make their decision. Specially trained counselors at women’s health clinics can talk to you in private. You may bring someone with you. You will discuss your options — adoption, parenting, and abortion. Your counselor will try to make sure that no one is pressuring you to have an abortion.

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.

Do my parents or partner have to know?
Many women go to the clinic with their partners. However, you don’t have to tell your partner. Either way, the clinic ensures complete privacy. If there are complications during the procedure, however, parents of minors may be notified.

Most teens have a parent involved in their decision to have an abortion. But telling a parent is only required in states with mandatory parental involvement laws. In the state of California, parental notification is not required.

If you have questions about parental notification in your state, call your nearest Planned Parenthood health center at 1-800-230-PLAN. Our staff will be able to provide you with further information and answer any questions you may have.

When are abortions performed?
Most abortions — nearly 90 percent — are provided in the first trimester — the first three months of pregnancy. Fewer than 11 percent take place in the second trimester. Abortion is very rare and only done for serious health reasons after 24 weeks.

The earlier, the better. Try to arrange an abortion as soon as you have made up your mind. Earlier abortions are easier and safer than abortions later in pregnancy. They also cost less.

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