The method of abortion to be used is dependent on the gestational age (how far along the pregnancy is) and the woman’s physical condition. More than 90% of all abortions are performed in the first trimester of pregnancy (the first 14 weeks after a woman’s last menstrual period).
Early Non-surgical Abortion
Medical abortion, chemical abortion, instrument free abortion (RU486, mifiprex, mifipristone, abortion pill, early option pill, french pill, methotrexate, tamoxifen, cytotec, misoprostol)
(Up to 9 weeks LMP, 7 weeks conception)
Approximately 2 to 5% of abortions performed by this method fail and a vacuum aspiration must then be done to remove the embryo. Patients may resume sexual activity, including intercourse as soon as they wish.
Early Surgical Abortion
(3 to 6 weeks LMP, 1 to 4 weeks conception)
Patients may undergo a surgical abortion procedure prior to missing a period. Minimal pain and discomfort. IV Sedation is not necessary. May return to normal activities the same day. May have sex 24 hours after the surgery.
First Trimester Abortion by Vacuum Aspiration
(Up to 14 weeks LMP, 12 weeks conception)
Local anesthetic (numbing medicine) is injected into or near the cervix. Intravenous medication may be administered to ease discomfort. The opening of the cervix is gradually dilated, and a tube attached to a suction machine is inserted into the uterus. The uterus is emptied by suction. After the suction tube is removed, a curette (a spoon-like instrument) is used to gently scrape the walls of the uterus to be certain it has been completely emptied of the fetus and other products of conception. The procedure takes approximately 2 to 3 minutes.
Second Trimester Abortions by Dilatation and Evacuation
(17 to 24 weeks LMP, 15.5 to 22 weeks conception)
Laminaria/Dilapan (small, tapered segments of absorbent material which expand as they become moist and slowly open the cervix) may be placed into the cervix for several hours or overnight. Intravenous medication may be given to ease discomfort. A local anesthetic is injected into or near the cervix. If expansion is incomplete, the cervix is carefully opened with a succession of dilators. The fetus and other products of conception are removed from the uterus with instruments and suction curettage. The procedure takes about 10-30 minutes.
Second and Third Trimester Abortion by Induction
(17 weeks and beyond LMP, 15 weeks and beyond conception)
The cervix is softened and becomes dilated over a period of hours with the use of Misoprostol and Laminaria. Fetal demise is accomplished with an injection of medication into the fetal heart. Drugs are administered which help the uterus to contract and expel the fetus. The time from the beginning of the procedure to delivery varies greatly. At Orlando Women’s Center most women complete the procedure on average of 20 hours (range: 4 to 36 hours). Following delivery and removal of the placenta, the patient is observed in the recovery room to make certain the uterus is well contracted and bleeding has been controlled. In rare cases where the induction method fails or cannot be used, an extraction procedure (similar to an abortion by D&E or a hysterotomy is performed to remove the fetus. A hysterotomy is similar to a caesarean section delivery and carries the same risks.
Complications of Abortion
Psychological Impacts Associated with Abortion
Studies conducted on the impacts of abortion do not provide conclusions which allow doctors and others to make statements or predictions about psychological problems associated with abortion. While many women are relieved after their abortion, others may experience anger, regret, guilt, or sadness. In a review of 250 such studies, former Surgeon General C. Everett Koop reports that factors which may make the decision about abortion more difficult for some women than others include: Strongly held personal values, feelings about abortion, pressure from other people, ending an originally desired pregnancy, a decision made late in the pregnancy, or the lack of support by a partner or family member.
Effects of Abortion on Fertility or Future Pregnancy
Most studies show no impact of first trimester abortion on fertility or subsequent pregnancies. The effects of multiple second trimester abortions are undetermined.
Methods and Medical Risks
There are three ways a pregnancy can end: a woman can give birth, have a miscarriage, or she can choose to have an abortion. If you make an informed decision to have an abortion, you and your doctor will need to consider the age of your pregnancy before deciding which method to use. Based on data from the Centers for Disease Control and Prevention (CDC), the risk of dying as a direct result of a legally induced abortion is less than one per 100,000. The risk of dying from a full term vaginal delivery is 8 to 11 per 100,000 and from a C-Section it is 28 per 100,000.
From 4-14 Weeks (after the first day of the last normal menstrual period)
Abortion Methods: Early non-surgical abortion or Vacuum Aspiration
Early Non-surgical Abortion
Medication is given to stop the development of the pregnancy. A second medication is given by mouth or placed in the vagina, causing the uterus to contract and expel the fetus and placenta.
Local anesthetic is applied or injected into or near the cervix to prevent discomfort. The cervix is gradually opened through the insertion of a series of dilators, each one slightly larger than the previous. The largest dilator used is approximately the same circumference as a fountain pen. After the cervix has been dilated, a clear plastic tube is inserted into the uterus, and attached to a vacuum aspiration system which removes the pregnancy.
After the tube has been removed, a spoon-like instrument, called a curette may be used to gently scrape the walls of the uterus to make certain it has been completely emptied of the pregnancy.
Immediate medical risks include the following: Blood clots in the uterus, heavy bleeding, lacerated or torn cervix, perforation of the wall of the uterus, pelvic infection, incomplete abortion, and anesthesia-related complications.
15-24 Weeks (after the first day of the last normal menstrual period)
Abortion Methods: Dilatation and Evacuation (D&E) or Labor Induction
Dilatation and Evacuation (D&E)
Laminaria (sterile seaweed) is placed into the cervix which becomes moist and slowly opens the cervix. They will remain in place for several hours or overnight. A second or third application may be necessary. Intravenous medications may be given to ease discomfort. After local or general anesthetic is given, the fetus and placenta are removed from the uterus with medical instruments (such as forceps) and the use of suction aspiration.
Immediate medical risks may include the following: Blood clots in the uterus, heavy bleeding, lacerated or torn cervix, a perforation of the wall of the uterus, pelvic infection, incomplete abortion, anesthesia-related complications. Possible long-term medical risks.
Labor induction is started by administering medications in one of three ways: medication is placed in the cervix, directly into the patient’s vein or by inserting a needle through the abdomen and into the amniotic sac (bag of waters).
Labor will usually begin within 2 to 4 hours.
If the afterbirth (placenta) is not completely removed during labor induction, the cervix must be dilated and suction evacuation performed.
Labor induction abortion carries the highest risk for complications such as infection and excessive bleeding. When medications are used to initiate labor, there is a risk of rupture of the uterus. Other immediate medical risks may include the following: Blood clots in the uterus, heavy bleeding, lacerated or torn cervix, a perforation of the wall of the uterus, pelvic infection, incomplete abortion, or anesthesia-related complications.
Possible Long-term Medical Risks
If the labor induction method is used, there is a small chance that the baby could live for a short period of time. (See “What if the fetus is determined to be viable”)
From 24 to 40 Weeks (after the first day of the last normal menstrual period)
No person will perform or induce an abortion when the fetus is viable unless such person is a physician and has a documented referral from another physician who has determined that continuing the pregnancy is a threat to the mother’s life or poses a risk to her health.
Abortion Methods: Labor Induction or Hysterotomy
Labor induction is started by administering medication in one of three ways: medication is placed in the cervix, directly into the patient’s vein or by inserting a needle through the abdomen and into the amniotic sac (bag of waters).
Labor will usually begin in 2 to 4 hours.
If the afterbirth (placenta) is not completely removed during labor induction, the cervix must be dilated and suction evacuation performed.
Labor and delivery of the fetus during this period are similar to childbirth.
The duration of labor depends on the size of the baby and condition of the uterus.
Medical Risks with Labor Induction
As with childbirth, possible complications of labor induction include infection and excessive bleeding.
When medications are used to initiate labor, there is a risk of rupture to the uterus.
Other immediate medical risks may include the following: Blood clots in the uterus, heavy bleeding, lacerated or torn cervix, a perforation of the wall of the uterus, pelvic infection, incomplete abortion, or anesthesia-related complications.
Hysterotomy (Similar to a Caesarean Section)
This method requires that the woman be admitted into the hospital.
A hysterotomy may be performed if labor cannot be started by induction, or if the woman or the fetus are too ill to undergo labor.
A hysterotomy is the removal of the fetus by surgically incising the abdomen and uterus. Medication given intravenously or into the patient’s spine, or by breathing the anesthesia, is administered to prevent pain during the surgery.
Medical Risks Associated with Hysterotomy
Complications are similar to those seen with other abdominal surgeries and the administration of anesthesia, such as severe infection (sepsis); blood clots to the heart and brain (emboli); stomach contents breathed into the lungs (aspiration pneumonia); severe bleeding, pelvic infection, retention of the placenta, and anesthesia-related complications.
WHAT IF THE FETUS IS DETERMINED TO BE VIABLE?
The chance of the fetus living outside the uterus (viability) improves as the gestational age increases. The physician must inform the patient of the probable gestational age of the fetus at the time the abortion would be performed.
If an abortion is to be performed after the physician has determined the fetus to be viable, the following steps must be taken:
A physician referral that has determined continuing the pregnancy is a threat to the mother’s life or poses risk to her health.
If the child is born alive, the attending physicians have the legal obligation to take all reasonable steps necessary to maintain the life and health of the child.
When a medical emergency requires an abortion be performed, the physician will inform the woman before the procedure if possible, of the medical indications supporting the physician’s judgment that an abortion is necessary to prevent substantial and permanent damage to any of the woman’s major bodily functions.
In the case of a medical emergency, a physician is not required to comply with any condition listed above if in the physician’s best medical judgment, he or she is prevented from satisfying the requirement because of the medical emergency.
Medical Risks of Abortion
The risk of complications for the woman increase with advancing gestational age.
The following is a description of the risks:
Pelvic Infection (sepsis): Bacteria (germs) from the vagina or cervix may enter the uterus and cause infection. Antibiotics may be necessary. In rare cases, resuctioning, hospitalization or surgery may be needed. Infection rates are less than 1% for suction curettage, 1.5% for D&E, and 5% for labor induction.
Incomplete Abortion: Fetal parts or other products of pregnancy may not be completely emptied from the uterus and require further medical procedures. Incomplete abortion may result in infection and bleeding. The reported rate of such complications is less than 1% after a D&E; following a labor induction procedure, the rate may be as high as 36%.
Blood clots in the uterus: Blood clots which may cause severe cramping occur in approximately 1% of all abortion procedures. The clots are usually removed by a repeat suction aspiration.
Excessive 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. Patients are informed about heavy bleeding and instructed what to do if it occurs.
Lacerated or torn cervix: The opening to the uterus (cervix) may be torn while it is being dilated to allow medical instruments to pass through to the uterus. This happens in less than 1% of first trimester abortions.
Perforation of the uterine wall: A medical instrument may puncture the wall of the uterus. The reported rate is 1 out of every 500 abortions. 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 risks of anesthesia-related complications are approximately one per 5,000 abortions.
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, she must receive medication to prevent the development of antibodies that would endanger future pregnancies.
LONG TERM MEDICAL RISKS
Future childbearing: Early abortions that are not complicated by infection do not cause infertility or make it more difficult to carry a later pregnancy to term. Complications associated with an abortion may make it difficult to become pregnant in the future or carry a pregnancy to term.
Cancer of the breast: Several studies have found no overall increase in the risk of developing breast cancer after an induced abortion; however, there are other studies which do indicate increased risk. The consensus is that this issue needs further study. Women who have a strong family history of breast cancer or who have clinical findings of breast disease should seek medical advice from their physician irrespective of their decision to become pregnant or have an abortion.
Because every person is different, one woman’s emotional reaction to an abortion may be different from another’s. After an abortion, a woman may have both positive and negative feelings, even at the same time. One woman may feel relief, both that the procedure is over and that she is no longer pregnant.
A woman may feel sad that she was in a position where all of her choices were hard ones. She may feel sad about ending the pregnancy. For a period of time after the abortion, she also may feel a sense of emptiness or guilt, wondering whether or not her decision was right.
Some women who describe these feelings find they go away with time. Others find them more difficult to overcome.
Certain factors can increase the chance that a woman may have a difficult adjustment to an abortion. One of these is not having any counseling before consenting to an abortion. When help and support from family and friends are not available, a woman’s adjustment to the decisions may be more difficult.
Other reasons why a woman’s long-term response to an abortion might be perplexing may be related to past events in her life. For example, negative feelings could last longer if she has not had experience with making major life decisions, or already has serious emotional problems.
Talking with a counselor or physician may help a woman to consider her decision fully before she takes any action.
We offer our sincerest condolences. We realize this is an extremely difficult decision and that it may take time and a tremendous amount of soul searching to arrive at a choice that is right for you and your family. Once the decision is made to have a premature delivery, we will make your stay at Orlando Women’s Center as supportive and as comforting as possible. We believe that you will find the atmosphere of our center to be filled with warmth and compassion. The members of our staff are highly dedicated individuals who are fully devoted to providing you with kindness, respect, and the utmost quality of care.
Medical Risks of Childbirth
Women who are more likely to experience problems during and after a pregnancy are those who did not obtain prenatal care early in the pregnancy and/or did not continue with that care, and those with generally poor health and life styles, e.g., smoking, alcohol and drug use. Continuing a pregnancy and delivering a baby is usually a safe, healthy process. Based on data from the CDC, the risk of the woman dying as a direct result of pregnancy and childbirth is less than 10 in 100,000 live births. Continuing a pregnancy also includes a risk of experiencing complications that are not always life-threatening.
Caesarean section (C/S) delivery: Occurs in 20 out of every 100 births
Infection: Approximately 4 out of every 100 women experience an infection after childbirth and are treated with antibiotics. Lack of treatment may lead to infertility or more serious infections.
Bleeding: Heavy bleeding may occur as a result of clotting problems, tears in the placenta prior to delivery, or if pieces of the placenta remain in the uterus after delivery.
Need for Rh Immune Globulin: As part of prenatal care, the woman will have a blood test to find out her blood type. If the pregnant woman is Rh negative and the father is Rh positive, she can make antibodies (sensitization) that can attack the red blood cells of the fetus if the fetus is Rh positive. This sensitization can occur any time fetal blood mixes with the mother’s blood; during pregnancy or after an abortion, miscarriage, ectopic pregnancy, or amniocentesis.
To prevent the development of the antibodies the woman can receive injections (immunizations) of Rh immune globulin. One at 28 weeks of pregnancy and the other following a miscarriage or delivery of a baby. The only known side effect of the immunizations for the woman is soreness from the shot or a slight fever. There is no risk of infection with human immunodeficiency virus (HIV) with the globulin.
If the woman who is Rh negative does not receive the Rh immune globulin, the fetus’ red blood cells may be damaged, leading to anemia, serious illness or death of the fetus or newborn.
CAUSES OF COMPLICATIONS WITH PREGNANCY
- Severe bleeding
- Blood clots in the lungs
- High blood pressure
- Seizures or strokes
- Severe infection
- Abnormal functioning of the heart
- Anesthesia-related complications and death
Together, these complications account for 80% of all deaths relating to pregnancy. Unknown or uncommon causes account for the remaining 20%. Women who have chronic severe diseases are at greater risk of death than are healthy women.
PREGNANCY, CHILDBIRTH, AND NEWBORN CARE
You may or may not qualify for financial help for prenatal (pregnancy), childbirth and neonatal (newborn) care, depending on your income. If you qualify, programs such as the state’s medical assistance program, called Medicaid, will pay or help pay the cost of doctor, clinic, hospital and other related medical expenses to help you with prenatal care, childbirth delivery services, and care for your newborn baby.
A listing of agencies that are available to provide or assist you to access financial assistance or medical care is available.
What About Adoption?
Women or couples facing an untimely pregnancy who choose not to take on the full responsibilities of parenthood have the option of adoption.
Making a plan for adoption is rarely an easy decision. Counseling and support services are a key part of adoption and are available from a variety of adoption agencies and parent support groups across the state. A list of adoption agencies is available.
There are several ways to make a plan for adoption, including through a child placement agency or through a private attorney. Although fully anonymous adoptions are available, some degree of openness in adoption is more common, such as permitting the birth mother to choose the adoptive parents.
The Father’s Responsibility
The father of a child has a legal responsibility to provide for the support, educational, medical and other needs of that child. In Florida, this responsibility includes child support payments to the child’s mother or legal guardian. A child has rights of inheritance from their father and may be eligible for benefits such as life insurance, Social Security, pension, veteran’s or disability benefits of the father. Further, the child benefits from knowing the father’s medical history and any potential health problems that can be passed genetically.
Paternity can be established in Florida by two methods:
- The father and mother, at the time of birth, can sign forms provided by the hospital acknowledging paternity and the father’s name is added to the birth certificate.
- A legal action can be brought to a court of law to determine paternity and establish a child support order.
Issues of paternity affect your legal rights and the rights of the child. More information concerning paternity establishment and child support may be obtained from any regional office of the Florida Division of Child Support Enforcement.
The decision to have an abortion, to have a baby or for adoption must be carefully considered. There are lists of state, county and local health and social service agencies and organizations available to assist you. You are encouraged to contact these groups if you need more information for making an informed decision.
Thousands of patients throughout the world have received quality reproductive health care services at our clinic. Facilitated support groups are offered to patients and their significant others. Professional individual counseling is available.
Fees include all costs associated with the procedure with the exception of prescriptions. Payment includes sonogram(s), laboratory tests, anesthesia, surgery, follow-up examinations(s) and one month’s birth control (as appropriate to the patient’s personal medical history). Our telephone counselors will take a brief medical history and quote fees according to the duration of the pregnancy and medical considerations. Fees may be paid with cash, Master Card, Visa, American Express, Discover, money orders, traveler’s checks, or cashier’s checks. We regret that personal checks cannot be accepted.
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