Abortion

If you are considering abortion, you owe it to yourself to get accurate, evidence-based medical information. Like any medical procedure, abortion has risks and side effects. The caring team of trained Advocates and Medical Professionals at Elevier are here to support, equip, and empower you in your decision making by providing evidence-based medical information and answering your questions.

Choosing Abortion

Before having an abortion, you need to verify the viability of your pregnancy and the gestational age. A viable pregnancy is determined by a positive pregnancy test and a limited obstetrical ultrasound. You will also need to learn the approximate date of conception which determines the type of abortion you can have. A viable pregnancy is located in the uterus.

For your health and safety and to equip and empower yourself, learn about the particular medical risks associated with the abortion procedure you choose, the probable gestational age of the pregnancy at the time the abortion is to be performed, the medical risks associated with carrying a child to term, and the medical assistance benefits that may be available for prenatal care, childbirth, and information about neonatal care.

At Elevier, we provide you with this information because we believe that an informed decision is an empowered decision.

Option consultations

Believe it or not, you do have options for your unplanned pregnancy. Although abortion may seem like a quick way “to get rid of the problem,” there are lingering after effects. If you have questions about abortion procedures or are curious about the options available to you, contact us. It costs nothing to chat. You and your future are important. We’re here for you.

The following abortion information is taken directly from the Minnesota Department of Health’s booklet If You Are Pregnant: Information on Fetal Development, Abortion and Alternatives. For more information, visit the Minnesota Department of Health website.

Two Main Types of Abortion

There are two types of abortion, early non-surgical abortion and surgical. How far along you are in your pregnancy determines what kind of abortion you may have.

Early Non-Surgical Abortion

Non-surgical (medical) abortion is an abortion method approved by the FDA for pregnancies up to 70 days after the last menstrual period. This method is also referred to as RU-486.

• A drug is given that stops the hormones needed for the fetus to grow. The drug also causes the placenta to separate from the uterus, ending the pregnancy.
• A second drug is given by mouth or placed in the vagina causing the uterus to contract and push out the fetus and placenta, ending the pregnancy. An appropriate location should be selected for taking these drugs, because they may cause bleeding, cramps, nausea, diarrhea and other symptoms that usually begin within 2 to 24 hours.
• 7 to 14 days after taking the drugs, a woman must return to the doctor to make sure that the drugs succeeded in ending the pregnancy and that the fetus and placenta are completely gone from the uterus.
• If the pregnancy is not ended by the drug combination, a surgical abortion may be required

Who should not have a non-surgical abortion?

According to the FDA, women should not use the drugs in a medical (non-surgical) abortion who:

• Are using an IUD (intrauterine device or system); it must be taken out before a medical abortion
• Have a pregnancy outside the uterus (ectopic pregnancy)
• Have problems with their adrenal glands (chronic adrenal failure)
• Take medication to thin their blood
• Have a bleeding problem
• Have porphyria
• Take certain steroid medicines
• Have allergies to either of the drugs used in the abortion method
• Ask your healthcare provider if you are not sure about all your medical conditions before taking these drugs.

Possible Complications or Adverse Events

Cramping and vaginal bleeding are expected with this abortion. The complication rate for first-trimester non-surgical abortion is 5% (four times the complication rate of aspiration abortion).

Rarely, serious and potentially life-threatening complications occur:

• Heavy bleeding (hemorrhage)
• Infections
• Incomplete abortion

The most common side effects are:

• Nausea and/or vomiting
• Weakness
• Diarrhea
• Fever/chills
• Dizziness
• Headache

Surgical Abortion

Vacuum Aspiration Abortion

Vacuum aspiration is the most common used method of induced abortion in the United States.

• A local anesthetic is applied or injected into or near the cervix to reduce discomfort or pain.
• The opening of the cervix is gradually stretched with a series of dilators. The thickest dilator used is about ½ inch wide.
• A cannula (a thin, hollow tube with a sharp pointed end) is inserted into the uterus.
• The cannula is attached to a suction system that removes the fetus, placenta, and membranes from the woman’s uterus.
• A follow-up appointment should be made with the doctor.

Possible Complications or Adverse Events

Cramping and vaginal bleeding are an expected part of this abortion. Complications include:

• Incomplete abortion
• Infection
• Heavy bleeding (hemorrhage)
• Torn cervix
• Perforated uterus
• Premature birth associated with subsequent pregnancies
• Rarely, serious and life-threatening complications occur

Methods Used After Fourteen Weeks

Dilation and Evacuation (D&E)

• The cervix is dilated using one of the following methods. One method uses sponge-like tapered pieces of absorbent material laced into the cervix to dilate the cervix over a period of several hours or overnight. Another method is to insert dilating rods of increasing sizes in the cervix until the cervix has been dilated to an opening wide enough to accept the medical instruments.
• Following dilation of the cervix, intravenous medications may be given to ease discomfort or pain and prevent infection.
• After local or general anesthesia has been administered, the fetus and placenta are removed from the uterus with medical instruments such as forceps and suction. Occasionally for removal, it may be necessary to dismember the fetus.

Possible Complications or Adverse Events

Cramping and vaginal bleeding are an expected part of this abortion.

• Blood clots in the uterus
• Heavy bleeding
• Cut or torn cervix
• Perforation of the wall of the uterus
• Pelvic infection
• Incomplete abortion
• Anesthesia-related complications
• Rarely, death

Labor Induction (Including Intra-Uterine Instillation)

• Labor induction may require a hospital stay.
• Medicine is placed in the cervix to soften and dilate it.
• There are three ways to start labor early:
• Medication is given directly into the bloodstream (vein) of the pregnant woman to start uterine contractions.
• Medication inserted into the vagina to start uterine contractions.
• Medication is injected directly into the amniotic sac by inserting a needle through the woman’s abdomen and into the amniotic sac (bag of waters). This medication kills the fetus and starts uterine contractions.
• Labor and delivery of the fetus during this period are similar to the experiences of childbirth.
• The duration of labor depends on the size of the fetus and the contractility of the uterus.
• There is a small chance that a fetus could live for a short period of time depending on the fetus’s gestational age and health at the time of delivery.

Possible Complications

• This method is more physically and emotionally stressful to the woman than the D&E method.
• If the placenta is not completely removed during labor induction, the doctor must open the cervix and use suction aspiration to remove the remaining placenta and tissue.
• Labor induction abortion carries the highest risk for problems, such as infection and heavy bleeding.
• When medicines are used to start labor, there is a risk of rupture of the uterus.
• As with childbirth, possible complications of labor induction include infection, heavy bleeding, stroke, and high blood pressure.
• Other medical risks may include blood clots in the uterus, heavy bleeding, cut or torn cervix, perforation of the wall of the uterus, pelvic infection, incomplete abortion, and anesthesia-related complications.

Medical Risks of Abortion

The risk of complications for the woman increases with advancing gestational age (see above for a description of the abortion procedure that your doctor will be using and the specific risks listed in those pages). Medical abortions have four times as many complications as surgical abortions.

Pelvic Infection (Sepsis):

Bacteria (germs) from the vagina may enter the cervix and uterus and cause an infection, blood can become infected (septicemia), surgical incisions can become infected and infections from unknown sources can develop. Infections can be mild or severe. Antibiotics are used to treat an infection. In rare cases, a repeat suction, hospitalization, or surgery may be needed. Infection rates are about .2% for first-trimester medical and surgical abortions and under 1% for dilation and evacuation (D & E), and 5% for labor induction.

Incomplete Abortion:

Fetal parts or other products of pregnancy may not be completely emptied from the uterus, requiring further medical procedures. Incomplete abortion may result in infection and bleeding. In the first-trimester, the reported rate of such complications is between 5% and 10% for medical abortions and less than 1% after a dilation and curettage (D & C). In later abortions, the rate is less than 1% in dilation and evacuation (D & E) following a labor induction procedure, the rate may be as high as 36%.

Blood Clots in the Uterus:

Blood clots that cause severe cramping occur in about 1% of all abortions. The clots usually are removed by a repeat dilation and suction curettage.

Heavy Bleeding (Hemorrhage):

Some amount of bleeding is common following an abortion. Heavy bleeding (hemorrhaging) is not common and may be treated by repeat suction, medication, or, rarely, surgery. Ask the doctor to explain heavy bleeding and what to do if it occurs.

Cut or Torn Cervix:

The opening of the uterus (cervix) may be torn while it is being stretched open to allow medical instruments to pass through and into the uterus. This happens in less than 1% of first-trimester abortions.

Perforation of the Uterus Wall:

A medical instrument may go through the wall of the uterus. The reported rate is 1 out of every 1,000 with early abortions and 3 out of every 1,000 with dilation and evacuation (D & E). Depending on the severity, perforation can lead to infection, heavy bleeding, or both. Surgery may be required to repair the uterine tissue, and in the most severe cases hysterectomy may be required.

Anesthesia-Related Complications:

As with other surgical procedures, anesthesia increases the risk of complications associated with abortion. The reported risk of anesthesia-related complications is around 1 per 5,000 abortions. Most are allergic reactions producing fever, rash, and discomfort.

Long-Term Medical Risks

Future childbearing:

Early abortions that are not complicated by infection do not cause infertility. Complications associated with an abortion may make it difficult to become pregnant in the future or carry a pregnancy to term.

Premature Birth:

Increased risk of premature birth has been shown to be associated with abortion. Premature babies (“preemies”) have a higher risk of death in their first year of life and raised risk of autism, cerebral palsy, deafness, blindness, and cognitive impairments (developmental disability).

Cancer of the Breast:

The National Cancer Institute (NCI) and the American Cancer Society (ACS) report that scientific research studies have shown no increased risk of developing breast cancer if a woman has had an abortion.

Medical Emergencies

When a medical emergency requires the performance of an abortion, the physician shall tell the woman, before the abortion if possible, of the medical indications supporting the physician’s judgment that an abortion is necessary to avert her death or that a 24-hour delay will create a serious risk of substantial and permanent impairment of a major bodily function.

Fetal Pain

There is no evidence to suggest that a fetus experiences pain. According to the American College of Obstetricians and Gynecologists, scientific studies have found that a human fetus does not have the capacity to experience pain until at least 24 weeks gestation.

The Emotional Side of Abortion

Feelings and Emotions

Stress and anxiety are expected when making a decision about a pregnancy—whether deciding to continue the pregnancy, have an abortion, or place the child for adoption. These feelings are normal. Some women may experience loss of appetite, difficulty sleeping, and loss of interest in enjoyable activities. Reaching out to family and friends can provide essential support during this time. If these feelings continue or get worse, you should contact your health care provider.

Talk It Over

Talking with a counselor or physician not associated with an abortion provider may help a woman to consider her decision fully before taking any action. Many organizations listed in the Minnesota Department of Health Resource Guide offer counseling services at no cost. The directory is online: If You Are Pregnant: A Directory of Services Available in Minnesota. Women’s Right to Know Directory (www.health.state.mn.us/docs/people/wrtk/directoryenglish.pdf)

The Medical Risks of Childbirth

Labor is the process in which a woman’s uterus contracts and pushes, or delivers, the fetus from her body. The fetus may be delivered through the woman’s vagina, or by caesarean section. A caesarean section is a surgical procedure that delivers the fetus after making a (incision) through the woman’s belly and uterus.

A woman who carries the pregnancy to full term (40 menstrual weeks, 38 weeks after fertilization) can usually expect to experience a safe and healthy process. For a woman’s best health, she should visit her physician before becoming pregnant, early in her pregnancy, and at regular intervals throughout her pregnancy.

Possible Complications

• Uterine infection – 10% may develop during or after delivery, and on rare occasions cause death
• Blood pressure problems – 1 in 20 pregnant women have during or after pregnancy, especially first pregnancies
• Blood loss – 1 in 20 women experience during delivery
• Rare events such as blood clot, stroke, or anesthesia-related death
• Women with severe chronic diseases are at greater risk of developing complications during pregnancy, labor, and delivery
• Risk of dying as the result of a pregnancy complication is 12 per 100,000 women