SEX AND HEALTH > Abortion

Each year, approximately 1.33 million pregnancies are terminated by abortion in the United States. Forty-nine percent of pregnancies among American women are unplanned. Of those women, 1/2 choose to have an abortion
-Alan Guttmacher Institute

There are two kinds of abortion - surgical and medical. The method used depends on how long you have been pregnant - the number of days since the first day of your last period.

Surgical Abortion

First Trimester (7-13 weeks)
Dilation & Aspiration (D&A)

1. A series of dilators are used to open the cervix.
   
2. The doctor inserts a long plastic tube, which is attached to a strong vacuum. At the end of the tube is a scraping device called a cannula. The doctor uses this to scrape and suction the inside of the uterus making sure he gets all the fetal parts, placenta, and uterine lining.
3. The procedure takes about 10 minutes.
4. It is important to have a follow-up exam two weeks after the abortion.

Second Trimester (13-26 weeks)
Dilation & Evacuation (D&E)

Abortion performed in the middle months of pregnancy is a significantly different procedure from the first trimester. The procedure entails a somewhat greater risk.

1. Laminaria, a seaweed type product that absorbs fluid, is used to dilate the cervix. It is usually inserted and left overnight (this will cause cramping). The next morning, the cervix will have dilated and softened.
2. Because the fetus and placenta are well developed, suctioning and scraping are more involved. The risk of bleeding and infection are increased.
3. The fetus and placenta are removed in parts with forceps. Suction is then used to scrape the uterus to ensure that no fetal parts remain. This type of abortion is generally performed under sedation.

   * Abortions are not performed in the state of Texas after 24 weeks.

   Possible Complications Following Surgical Abortions:

   • Infection
   • Incomplete abortion
   • Heavy bleeding
   • Damage to the uterus or nearby internal structures
   • Cervical tears
   • Continued pregnancy

   Possible Emotional Complications

   • Anxiety attacks
   • Intense grief or depression
   • Flashbacks about the abortion
   • Nightmares about the abortion
   • Withdrawal from relationships

   How can you know if you might have some of these emotional complications? You might have them if you:

   • Make the decision too quickly, without time to explore all the options.
   • Focus only on practical reasons (financial problems, single parenthood.)
   • Waver back and forth and have trouble making a decision because of conflicting feelings.
   • Allow others (your boyfriend, parents, a friend, a doctor) to make the decision for you.

Medical Abortions (for use up to 7 weeks, or 49 days)
RU486

1. It must be used in the first 49 days or less, counting from the beginning of the last menstrual period.
   
   
2. Three pills of RU486 are given at the clinic and the patient is sent home. The drug acts by blocking the progesterone hormone, which is needed to maintain a pregnancy. Without the hormone, the lining of the uterus softens and begins to break down and bleeding begins. Two days later the patient returns to the clinic and is given two pills of the prostaglandin misoprostol. As the drug takes effect, the patient experiences powerful, painful contractions which begin to work to expel the fetus. This can happen during the 3-4 hours she is at the clinic or after she returns home. Fourteen days later she returns to the clinic to determine whether the abortion has occurred.
   
   
3. Side effects include: heavy bleeding, clotting, cramps, nausea, diarrhea and vomiting. Most women will bleed or spot for 9-16 days. Blood clots are often larger than the fetus.
   
   
4. Certain conditions or habits can put you at increased risk for complications. Examples include high blood pressure, diabetes, allergies, or heavy smoking. It is important that you communicate this to your doctor.