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Abortion
This Vulvapedia entry focuses on abortion. (Go here to read more about VP's stance on abortion and why we offer resources and information about it.)
What is abortion?
Abortion occurs when a pregnancy ends before birth. When it occurs spontaneously, it is usually referred to as miscarriage. The term "abortion" is more commonly associated with induced abortion, which occurs when a woman chooses to terminate a pregnancy.
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Where can I get an abortion?
Surgical abortions are performed by qualified medical professionals in an appropriate healthcare setting. Women who choose a medication abortion may take the second dose of medication in the privacy of their homes, but they will see a medical professional before taking the first dose.
A good way to find an abortion provider in your area is to visit Abortion Clinics OnLine (ACOL). ACOL is a directory of both public and private clinics and has both U.S. and international listings.
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How much does abortion cost?
The best way to find out how much an abortion will cost in your area and for you specifically is to call a local clinic. Check out Abortion Clinics OnLine's directory of clinics to find one near you.
Additionally, you may wish to check with your insurance provider, if you have insurance, as some insurance plans do cover elective abortion.
The cost of an early abortion, surgical or medical, is usually between $300 and $550USD. (There may also be a difference in price between medication and surgical abortion, depending on the clinic.) Terminations done after the first trimester can be significantly more expensive, so if you have decided to have an abortion, time is of the essence.
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Can I get an abortion if I'm under 18?
You can get an abortion if you are a minor, though depending on where you live it may be more difficult than it is for a woman over 18. In the United States, some states have laws that require women under the age of 18 to notify and/or get permission from their parent(s) or guardian(s) if they choose to have an abortion. In most of these states, a minor who chooses to have an abortion but does not wish to notify her parents/guardians can get what is called a judicial bypass by appealing to a judge.
A good way to find out what the laws in your area require is to check with your local Planned Parenthood, or with a local clinic. (See the section above for help finding a local clinic.)
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Is abortion the right choice for me?
Only you can answer this question. If you are dealing with an unplanned pregnancy and are not sure what the best option for you is, PregnancyOptions.infohas some information that can help you come to a decision.
Backline also offers unbiased advice about pregnancy options. You can reach them toll-free (in the United States) at 888-493-0092.
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How can I get an abortion?
The first step is to call a local clinic. They will help you schedule an appointment, discuss the cost, and tell you what you should do before the appointment. Depending on the laws in your state, you may have to make a visit to the clinic or speak over the phone with a doctor prior to the day of your appointment; the staff at your clinic will tell you if this is the case.
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What happens beforehand?
Before having an abortion, you will provide a medical history and sign a consent form. Most states require that you read some information about abortion prior to the procedure.
You will also have some laboratory tests done, and have a physical exam (usually including an ultrasound). If you have questions or concerns at any time during this process, the staff at your clinic can answer them for you.
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What happens during an abortion?
How an abortion is performed and what happens during it depends on which type of abortion you choose and how far along the pregnancy is. Earlier abortions are easier and safer than those that take place later in pregnancy, and they are usually less expensive.
First Trimester Options
Surgical Abortion
The term "surgical abortion" is a bit of a misnomer, as this procedure is not technically considered surgery.
Vacuum Aspiration
The most common type of surgical abortion is vacuum aspiration. It is performed either with a hand-held suction device or with machine-operated suction. The former is sometimes also called manual vacuum aspiration or MVA; the latter is sometimes called dilation and suction curettage or D&C.
- Manual Vacuum Aspiration (MVA)
- MVA can be done up to about 10 weeks from the last menstrual period (LMP). The cervix is dilated and a handheld syringe is used to empty the uterus. This procedure takes place in a clinic and last about ten minutes.
- Vacuum Aspiration with Curettage (D&C)
- This method is sometimes also called dilation and suction curettage. It can be done up to 14 weeks after the LMP.
- Usually the cervix is first injected with a numbing agent. Some clinics offer sedation and/or general anesthesia; ask before scheduling your appointment, though, as not all clinics offer these options. It is also possible to have a D&C without either sedation or general anesthesia.
- A set of small rods of increasing thickness called dilators are used to open the cervix. During some procedures (usually later-term abortions), absorbent dilators made of a material called laminaria are inserted the day before the procedure is to take place -- these work by absorbing fluid and stretching the cervix as they expand.
- Sometimes medication such as misoprostol (also used in medication abortion) is used to soften and dilate the cervix.
- Once the cervix has been opened (usually to only the width of a fountain pen), a tube attached to a suction machine is inserted through it. The physician then turns on the machine and uses suction to gently remove the contents of the uterus.
- Sometimes a narrow metal loop called a curette is used as well to make sure that the uterus has been completely emptied.
- A D&C is performed by a qualified health professional and usually takes about ten minutes.
What does surgical abortion feel like?
This varies from woman to woman. Some women say that the pain they feel is similar to strong menstrual cramps, while others feel that it is more painful. If you opt to have a sedative or general anesthesia, that may help to lessen the pain.
You may also feel some cramping, pain or nausea after the procedure.
Who shouldn't have a surgical abortion?
Surgical abortion is safe for most women.
However, special considerations may be necessary if you:
- are extremely overweight
- are running a fever
- have an infection in your uterus
- have certain kinds of sexually transmitted infections
- have certain serious health problems
- have problems with anesthesia
- have seizures more than once a week
From Planned Parenthood
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Medication Abortion
Medication abortion is a non-invasive way of terminating a pregnancy using a combination of medications.
There are three steps involved in a medication abortion:
- First, a dose of either mifepristone (RU-486) or methotrexate is administered (this most often occurs at a health care provider's office, or a clinic)
- Then, between three and five days later, depending on whether mifepristone or methotrexate is used, a dose of misoprostol is taken. Misoprostol is often taken at home, but may also be taken at a clinic. It causes the uterus to contract and empty. These contractions are accompanied by cramping and bleeding as the contents of the uterus are expelled.
- The third step is a return visit to health care provider around two weeks after taking the misoprostol. This is very important, as your health care provider needs to make sure that the abortion is complete and that you are healthy.
What are the side effects of medication abortion?
The side effects of a medication abortion are very much like those of an early miscarriage. Most women experience bleeding and cramping.
Other possible side effects are:
- dizziness
- strong cramps or abdominal pain
- nausea and vomiting
- diarrhea
Over-the-counter painkillers such as Tylenol (acetominophen), Advil or Motrin (ibuprofen), or Aleve (naproxen) can help relieve these symptoms. You should not take aspirin after a medication abortion.
What is the difference between mifepristone (RU-486) and methotrexate?
Mifepristone, or RU-486, was first developed and used in France. It works by blocking the hormone progesterone, which causes the uterine lining to break down. It is used in conjunction with misoprostol, and can be taken up to 56 days after the last menstrual period. It is effective in 96 to 97 percent of women.
Methotrexate is also used in conjunction with misoprostol, but it works in a slightly different way. It acts by preventing further cell division in the embryo. (Another use of methotrexate is to stop the growth of ectopic pregnancies -- pregnancies which develop outside the uterus, generally in the fallopian tubes.) Methotrexate can be used up to 49 days after the last menstrual period and is effective in 92 to 96 percent of patients.
What happens when medication abortion doesn't work?
When medication abortion fails to work, or fails to work completely (which is fairly uncommon), another abortion procedure (such as vacuum aspiration) must be used to end the pregnancy.
According to Religious Tolerance, "[b]ecause of the nature of the medication used, it [the fetus] will be almost certainly seriously deformed. Before proceeding with a medical abortion, the woman should be willing to follow up with a surgical abortion if the chemical technique fails. One study expresses concern that a small percentage of women may change their mind and not follow through with a surgical abortion in the event that a medical abortion fails. Very serious limb damage in the newborn will result."
Who shouldn't have a medication abortion?
You shouldn't have a medication abortion if you:
- are too far along in pregnancy
- are unsure about having the procedure
- are unwilling to have a vacuum aspiration if needed
- cannot return for follow-up visits
- do not have access to a telephone, transportation, and back-up medical care
- have a known or suspected molar pregnancy — one in which the placenta develops abnormally
- have severe adrenal gland, heart, kidney, or liver problems
- take any medicine that should not be combined with the medications used in medication abortion — methotrexate, mifepristone, or misoprostol
- take anti-clotting medication or have blood-clotting disorders
- are unwilling to have your IUD — if you have one — removed before taking the medicine
Special considerations may be necessary if you
- are breastfeeding
- have chronic heart, liver, respiratory, or kidney disease
- have an infection or are sick
- have severe anemia
- have uncontrolled high blood pressure
- have any other serious health problem
From Planned Parenthood
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Which is better, surgical or medication abortion?
Many women have a hard time deciding between these two options. Ultimately, there is no "better" option -- what's best for you may not be best for someone else. PregnancyOptions.info has a helpful article here that discusses the pros and cons of each method.
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Later-Term Options
Beyond fourteen weeks after the last menstrual period, the options available change.
Dilation and Evacuation (D&E)
D&E is performed in two steps.
- The first step involves softening and dilation of the cervix. Absorbent dilators are placed in the cervix and remain there for several hours or overnight. Misoprostol may also be used to dilate and soften the cervix. At this point, a preventative course of antibiotics may be given to guard against infection.
- Once the cervix has been dilated, painkillers, sedatives or general anesthesia may be used, and a numbing agent is injected into the cervix. The dilators are taken out, and the products of conception and other contents of the uterus are removed with medical instruments and suction curettage, in a process that takes between 10 and 20 minutes.
Induction
Induction is extremely rare. To perform an induction, a doctor can administer prostaglandin (either vaginally or intravenously), which causes the uterus to contract and expel the fetus. A solution of urea or salt can also be injected directly into the uterus to cause contractions.
Unlike other forms of abortion, induction is usually done in a hospital and usually requires an overnight (or longer) stay.
What about alternative methods of abortion?
While we recognize the fact that there are methods of terminating a pregnancy other than surgical or medical abortion, VP's official stance is that the safest way of ending a pregnancy is to do so under the care and supervision of a qualified medical professional.
We support all women's choices when it comes to pregnancy, but because of the risks inherent in "at-home" and herbal abortion methods we cannot in good conscience recommend using these methods.
Acknowledging a woman's right to choose both whether and how to terminate a pregnancy, we hope to provide the necessary information for her to make the choice that is best and safest for her.
The alternative method most commonly discussed in VP on LJ is herbal abortion, which involves ingesting a combination of herbs which are known to have abortifacient effects.
Risks of Herbal Abortion
- Hemorrhage
- Incomplete abortion
- Infection
- Ectopic pregnancy complications
- Fetal abnormalities, if the pregnancy is not successfully terminated
- Self-poisoning, including liver and/or kidney damage
- Death
The risk of death is not one to be taken lightly, as many herbal abortifacients are highly toxic. The "successful" dose needed to induce abortion and a fatal dose are often not far off in quantity, and there have been documented cases of women dying after use of herbal abortifacients, both in infusion/tea form and also from ingesting essential oils of some herbs used to induce abortion.
- Note: Essential oils should NEVER be ingested, even in the course of attempting an herbal abortion. Herbal abortion methods use herbal teas/infusions or capsules, not essential oils, as essential oils are often highly toxic when ingested -- some, such as pennyroyal, are potentially fatal in quantities as small as 10mL.
Because herbal abortion is sometimes recommended as an alternative for women in situations (financial or geographical) that don't allow ready access to standard abortion methods, the possibility of herbal methods failing to terminate a pregnancy is a very serious concern. Even if a woman is readily able to get a surgical abortion in a medical setting, the time it takes to research, obtain, and use herbal methods can cause a delay, and mean that she will have to have a more complicated and expensive surgical abortion later on.
Herbal/non-standard abortion methods generally have a much lower success rate than medical/surgical abortions performed by qualified medical professionals, so it is VERY important that a woman choosing one of the former methods is prepared (both financially and mentally) to seek a surgical abortion if the method she chooses does not succeed because of the risk of fetal abnormalities or incomplete abortion.
Sources:
- Herbal Abortion and Risks of using Herbs - SisterZeus.com
- Herbal Abortives and Birth Control - Henriette’s Herbal Homepage
- Pennyroyal toxicity: measurement of toxic metabolite levels in two cases and review of the literature (via PubMed)
- Herbal infusions used for induced abortion (via PubMed)
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What happens afterwards?
Your health care provider will give you a list of aftercare instructions that you should follow carefully; you may also be given some antibiotics to take as a preventative measure against infection. Be sure to take them, and to watch for any signs of infection (such as a high fever) after an abortion.
Generally speaking, after an abortion:
- be sure to take any medications given to you by your clinic (including hormonal birth control, if you choose to start using it immediately after the abortion) as directed
- watch for any symptoms of infection (taking your temperature daily may be helpful -- call your clinic if your temperature goes above 100.4 degrees)
- do not use tampons until your next period
- do not insert anything in the vagina for two weeks (or as long as directed by your clinic) -- this includes:
- fingers
- sex toys
- penises
- tampons (as mentioned above)
- The one exception to this rule is NuvaRing -- if you have chosen to begin using NuvaRing after your abortion, you may insert it during this time.
- do not douche
- do not take baths (showers are fine) or use hot tubs or swimming pools
- avoid heavy lifting (anything over 15 pounds)
- avoid strenuous exercise such as aerobics or running
- avoid drugs, alcohol, and aspirin -- they may cause heavier bleeding
Source: Feminist Women's Health Center
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What are the risks associated with abortion?
Vacuum Aspiration and D&E
According to Planned Parenthood, "[t]he risks associated with vacuum aspiration and D&E increase the longer you are pregnant and if sedation or general anesthesia is used."
Some possible risks are:
- incomplete abortion — the embryo or fetus and other products of conception are not entirely removed from the uterus
- allergic reaction
- infection
- very heavy bleeding
- undetected ectopic pregnancy, which can be fatal if left untreated
- blood clots in the uterus
- injury to the cervix
- organ injury
- in extremely rare cases death is possible from very serious complications. In general, the risk of death from abortion increases the longer a woman has been pregnant. Overall, the risk of death from childbirth is 11 times greater than the risk of death from abortion up to 20 weeks of pregnancy. After 20 weeks, the risk of death from abortion is about the same as the risk of death from childbirth.
From Planned Parenthood
Medication Abortion
- incomplete abortion — the embryo and other products of conception are not entirely expelled from the uterus
- 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 — the risk of death from medication abortion — about one out of 100,000 — is
- about the same as it is from miscarriage — about one out of 100,000
- higher than it is from early vacuum aspiration abortion — about one out of one million
- lower than it is from carrying a pregnancy to term — about 10 out of 100,000
From Planned Parenthood
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Is abortion safe?
Yes. The risk of complications such as those described in the section above is minimal when the procedure is performed in a health care setting by a qualified medical professional.
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Will I still be able to have children later on if I have an abortion now?
Studies have shown that safe abortions without complications should not affect your fertility. Many, many women who have abortions later go on to have healthy wanted pregnancies and healthy children.
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How will I feel after having an abortion?
The answer to this question varies greatly from woman to woman. There is no way that you should or should not feel -- whatever feelings you have are completely valid.
If you are experiencing any feelings that you would like to talk about (whether they are positive, negative, in between, or both), you may want to try using one of the following resources.
- Exhale - Call Exhale to talk freely about your experience with abortion. Toll-free at 866-439-4253.
- Backline - Talk with someone about pregnancy options, pre or post-abortion questions toll-free at 888-493-0092 .
- Peace After Abortion
- I'mNotSorry.net - a website where women share their positive experiences with abortion.
From Feminist Women's Health Center
Some resources for LiveJournal users:
- The abortioninfo community on LiveJournal
- abortionstories -- a closed community -- join to read others' stories about their experiences with abortion
- imnotsorry -- similar to I'mNotSorry.net, but on LiveJournal
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Additional Resources
On LiveJournal
- The abortioninfo community on LiveJournal
- abortioninfo_uk abortioninfo's sister community for UK residents
- VP's collection of tagged entries about abortion and abortion support/resources
Elsewhere
- Europe's abortion rules -- a country-by-country guide put together by the BBC
- Abortion in Australia -- a government site about abortion in Australia
- Abortion in Australia on wikipedia -- a wikipedia article with some information on the legal issues related to abortion in Australia
- Childbirth By Choice Trust -- a Canadian site with information about pregnancy options
- The Morgentaler Clinic -- a group of Canadian clinics located in Alberta, New Brunswick, Newfoundland, Ontario, and Quebec that offer abortion services
- Marie Stopes UK -- a network of clinics in the UK that offer abortion services
- Planned Parenthood on abortion
NOTES AND DISCLAIMERS: This FAQ (and VP) is no substitute for medical care. Much of the information above has been adapted from the indicated sources. Click on the links to see their original text or to get more information. Any non-quoted items come from the VP Team's personal experience, which, again, is no substitute for medical care. As always, there is a limit to the information internet resources can provide; if you require additional assistance, it's best to contact an appropriate professional.
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